Journal of Clinical Ultrasound最新文献

Objective: We aimed to investigate how combining myocardial contrast echocardiography (MCE) with dobutamine stress echocardiography (DSE) could help evaluate myocardial perfusion in coronary heart disease patients and understand changes in microcirculation across different levels of coronary artery blockage.

Methods: We conducted MCE and DSE tests on 53 coronary heart disease patients, categorizing ischemic myocardium into four groups: A (<50%), B (50%-69%), C (70%-89%), and D (≥90%). Dynamic myocardial perfusion images were captured during rest and peak dobutamine stress from various angles, analyzing parameters like plateau value A, slope β, and the product A × β, reflecting different aspects of myocardial blood flow.

Results: Parametric values of myocardial perfusion (PVMPs) were significantly lower in group D at rest compared with other groups (p < 0.001). PVMPs increased notably at peak dobutamine stress in groups A, B, and C (p < 0.001). Groups A and B had higher PVMPs than groups C and D, with group D significantly lower (p < 0.001). β reserve values decreased gradually from group A to D, with significantly lower values of A and A × β in groups C and D compared with A and B (p < 0.001). Sensitivity and specificity for predicting >70% coronary artery blockage was 80%, 66%, and 74%, 80%, respectively, using specific thresholds.

Conclusion: Combining MCE with DSE is highly sensitive and accurate in diagnosing obstructive coronary artery blockages. It also helps assess myocardial microcirculation perfusion and left ventricular reserve function, which decline with increasing severity of coronary artery blockage.

Purpose: To evaluate superb microvascular imaging for measuring puerperal myometrial microvascular blood flows at incisional sites following cesarean delivery.

Methods: Twenty postpartum women (singleton births) were studied: 10 with cesarean and 10 with transvaginal deliveries. All cesarean cases were first operational delivery with lower uterine incision, repaired with double-layer suture. At 1 and 4 weeks postpartum, the uterus was delineated using transvaginal ultrasonography with superb microvascular imaging. Separate regions of interest were created for anterior myometrium of the isthmus and the body. The microvascular flow profile in three circular sampling points placed in a region of interest was quantified and expressed as vascular density. The vascular density ratio of the uterine isthmus to the body was compared between one and four weeks for both groups. Wilcoxon's signed-rank test was used to assess statistical significance (set at p < 0.05).

Results: In cesarean deliveries, the vascular density ratio of the uterine isthmus to the body increased from 1 (median: 0.51, range: 0.30-0.68) to 4 weeks (0.99, 0.85-1.60), whereas no changes were noted in transvaginal deliveries.

Conclusion: Superb microvascular imaging can effectively measure myometrial microvascular blood flow recovery at cesarean incision sites, indicating its potential as a tool for monitoring postpartum wound healing.

Objectives: Pubertal gynecomastia (PG) is defined as benign proliferation of male breast tissue. Ultrasonography is frequently used for follow-up of symptomatic gynecomastia. Shear wave elastography (SWE) is an auxiliary tool for the diagnosis of breast disorders. Our aim is to evaluate SWE properties of breast tissue in PG.

Methods: Fifty consecutive adolescents, aged 10-18 with a diagnosis of gynecomastia were prospectively included in the study. Following clinical and laboratory evaluation, participants underwent B-mode ultrasound and classified as nodular, dendritic, and diffuse pattern. SWE and hormonal values of all groups were recorded. Then, statistical analysis was performed.

Results: Briefly, 92 breasts (43 left and 49 right; 42 bilateral and 8 unilateral) were included in the analyses. There were no significant differences in clinical parameters including age, BMI-SDS, estradiol (E2), testosterone (T), and E₂/T levels within groups (p > 0.05). Breast volume and SWE levels were significantly different in all groups (p < 0.05). SWE values were significantly lower for those of dendritic pattern than in nodular pattern (p < 0.05). ROC analysis revealed that for the best the cut-off value of 13.7 kPa, area under the curve value was 0.922 with 84% sensitivity and 87% specificity.

Conclusions: SWE values were significantly lower in patients with dendritic gynecomastia than those with nodular gynecomastia. Knowledge of the SWE values for the initial diagnosis and follow-up values could help avoid unnecessary interventions.

Objective: This study was aimed to assess the predictive validity of internal os distance (IOD) in mid-trimester scan for the prediction of third-trimester low-positioned placenta, and to define a cut-off of IOD at which third-trimester low-positioned placenta could be identified, see the association of placental site (anterior/posterior), previous history of cesarean section with abnormal location of placenta in third trimester and see the maternal and neonatal outcomes.

Methods: It was a prospective cohort study of women with low-positioned placenta (IOD < 20 mm) at mid-trimester anomaly scan followed up in third trimester till birth. Relative risks for a low-positioned placenta in the third-trimester were calculated for women with posterior versus anterior, low-lying placenta versus placenta previa and positive versus negative history of cesarean section. Multilevel likelihood ratios and corresponding ROC curves for different ranges of IOD were calculated.

Results: Women with posterior placenta had a high risk of low positioned placenta compared to anterior placenta (9.28% vs. 0.74%); RR 1.45, similarly women with placenta previa had high risk compared to low lying placenta (68.57% vs. 1.69%); RR 6.51, so did the women with previous cesarean section (9.41% vs. 5.87%); RR 1.47.

Conclusions: 93.42% placenta which were low positioned in mid trimester were normally situated in third trimester. The cut-off for IOD in anterior placenta was -40 mm and in posterior placenta was 14.3 mm. IOD measurement and interpretation seems promising.

Immersive virtual reality (IVR) and augmented reality (AR) are emerging technologies with significant potential in ultrasound education. IVR, utilizing head-mounted devices (HMDs), and AR, enhancing real-world views with digital overlays, have demonstrated their value in various educational and training scenarios. This narrative review examines the use of IVR and AR in ultrasound education, evaluating their effectiveness compared to traditional methods. Studies show that IVR and AR can match or surpass conventional training, offering benefits like standardized assessments and reduced costs. Despite some limitations, such as small sample sizes and potential conflicts of interest, the current data supports the viability of IVR and AR as tools for ultrasound education. Further research is needed to confirm these findings and explore broader applications.

This study aimed to develop and validate the tendinopathy hemophilia detection with ultrasonography (THD-US) protocol for assessing hemophilia-related tendinopathy. Twenty male patients with hemophilic arthropathy underwent ultrasound evaluations of 200 tendons. The THD-US scoring method assessed structural changes, hyperemia, and calcifications, revealing various tendon abnormalities. This protocol provides a standardized, efficient method for assessing tendinopathy in hemophilia patients, potentially improving patient management and outcomes.

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited disease characterized by progressive fibrofatty tissue replacement of the myocardium. Asymptomatic individuals can often present for the first time with acute cardiac symptoms, such as syncope and ventricular arrhythmias or sudden cardiac death (SCD), which can occur in young and athletic populations. In the field of inherited cardiomyopathies, ARVC is one of the most challenging to diagnose due to its variable expressivity, incomplete penetrance, and lack of specific, unique diagnostic criteria. Without additional clinical findings or context, current imaging modalities are unable to definitively distinguish ARVC from other disease entities. Right ventricular (RV) structural changes can lead to prominent ARVC features. An important component of the 2010 revised task force criteria (TFC) is the assessment of RV wall motion contraction by echocardiography; however, this can be difficult to assess. This case report explores the diagnostic criteria used for ARVC and the role of RV wall motion contraction in the diagnosis.

This study explored echocardiography's role in diagnosing and managing pediatric pulmonary artery sling (PAS). Data from 145 patients (January 2017 to December 2023) were analyzed, including echocardiography, CT angiography, bronchoscopy, and surgical records. Results indicated echocardiography accurately diagnosed PAS in 98.62% cases, with 1.38% misdiagnosed. Tracheal compression was common (95.86%), along with intracardiac anomalies (73.79%). Combined vascular ring types were found, notably PAS with left aortic arch and aberrant right subclavian artery (LAA-ARSA) and PAS with double aortic arch (DAA). Echocardiography's effectiveness underscores its crucial role in clinical management and surgical planning for these complex conditions.

Background: Methotrexate (MTX) and leflunomide (LEF) play fundamental roles in rheumatoid arthritis (RA) treatment and require proper monitoring of side effects. Concerns about MTX/LEF-related liver fibrosis (LF) in patients with RA remain unclear. This study investigated liver stiffness using two-dimensional shear wave elastography (2D-SWE) in RA patients undergoing disease-modifying antirheumatic drug (DMARD) therapy. Moreover, 2D-SWE was employed to evaluate the correlations between liver stiffness, cumulative MTX and LEF doses and risk factors for substantial LF.

Methods: We recruited 222 participants from the Department of Rheumatology. The participants were divided into healthy controls (n = 78) and patients with RA (n = 144). Pearson's correlation analysis was performed to assess the correlations between liver stiffness and the cumulative dose of MTX/LEF and other clinical and laboratory variables.

Results: The mean elasticity modulus was 4.79 ± 0.92 kPa, excluding the presence of significant fibrosis. Mean 2D-SWE values were significantly lower in healthy controls than in RA treated with MTX and LEF. The cut-off ≥3.8 kPa 2D-SWE values with the sensitivity of 86.1%, specifity of 83.3%. 2D-SWE values were not significantly different across the strata of the cumulative MTX subgroups.

Conclusions: MTX and LEF increase liver stiffness but may be considered low risk for the development of LF.

Sirenomelia is a rare congenital caudal abnormality. We applied two-dimensional, three-dimensional, and color Doppler ultrasound to diagnose a fetus with sirenomelia at 12 + 6 weeks. The fetus exhibited on ultrasound fused lower limbs, two tibiae in lower legs, no fibulae, knees in retroflexion, pelvic hypoplasia, hypoplasia of the lower lumbar vertebrae and coccyx, bilateral renal agenesis, no bladder, and a single umbilical artery. The postnatal X-ray revealed a fetus with two femurs, two tibiae, and no fibula. The results of chorionic villus aspiration indicated that the fetus was male with a normal karyotype (46, XY), and the microarray results were normal.