Journal of Clinical Ultrasound最新文献

Aims: We aimed to evaluate the myocardial dyssynchrony in patients with gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) by two-dimensional (2D) speckle tracking echocardiography (STE) and myocardial work (MW).

Methods: This cross-sectional study included 40 patients with GEP-NENs (45.00% men; mean age, 51.48 ± 15.22 years) and 24 age- and gender-matched healthy subjects (58.33% men; mean age, 46.17 ± 11.12 years) who underwent standard echocardiography. Left ventricular (LV) and right ventricular (RV) strain measurements were assessed by 2D-STE. Post-systolic index (PSI) was calculated as [(post-systolic peak longitudinal strain-end-systolic strain)/end-systolic strain] × 100%. LV mechanical dispersion (MD) was measured as the standard deviation of time to peak negative strain (TTP). MW indices were measured based on pressure-strain loop (PSL) analysis. The cases were grouped based on treatment therapy.

Results: Compared with healthy controls, patients with GEP-NENs had impaired global longitudinal strain (GLS), global work index (GWI), global constructive work (GCW), global work efficiency (GWE), RV global strain (RV-GS) and RV free wall strain (RV-FWS) (p < 0.05). Increased PSI_max, MD, and global wasted work (GWW) were also observed in patients with GEP-NENs (p < 0.05). GLS was independently associated with male gender (β = 0.443, p = 0.003) and hypertension (β = -0.418, p = 0.005). MD was positively correlated with the treatment of surgery (β = 0.333, p = 0.036). PSI_max was positively correlated with the duration of disease (β = 0.517, p = 0.001). GWI was positively correlated with the treatment of targeted therapy (β = -0.355, p = 0.025).

Conclusion: Assessment of 2D-STE and PSL analysis provides novel information to early detect LV and RV subclinical mechanical dyssynchrony in patients with GEP-NENs.

Respiratory complications are a significant cause of newborn morbidity. The objective of this study was to determine if ultrasonographic fetal lung echotexture analysis can predict respiratory distress syndrome (RDS) and transient tachypnea of the newborn (TTN). This prospective cohort study included 370 singleton gestations that delivered from 34 and 0 to 38 and 6 weeks of gestation. Combined RDS or TTN occurred in 16.8% of neonates. Fetal lung echotexture was modestly predictive of RDS and combined RDS or TTN in late preterm gestations and may be a useful adjunctive tool in neonatal respiratory morbidity prediction.

Background: In recent years, tumor management strategies have focused on less invasive methods, aiming to yield optimal efficacy while minimizing further complications and enhancing the overall outcome of patients. High-intensity focused ultrasound (HIFU), a known thermal ablative technique, has shown promising results in breast cancer treatment. Therefore, we performed this systematic review and meta-analysis to assess the clinical, histopathologic, immunologic, and radiologic outcomes of HIFU ablative therapy and its complications in patients with primary breast cancer.

Methods: We searched PubMed and Scopus databases to identify the eligible articles. Data extraction was conducted by two independent authors. A random effects model was employed to pool the proportion of remaining tumor after HIFU therapy in breast cancer. A subgroup analysis was performed according to imaging guidance modality and study design. Moreover, the heterogeneity and bias were assessed using funnel plot, Egger's regression plot, and Baujat plot. Pooled CD4/CD8 ratio mean difference between HIFU and radical mastectomy was measured using a fixed-effect model.

Results: We included 26 studies and 677 participants in the systematic review. Tumor necrosis rates varied, with 4 studies reporting less than 50% complete necrosis and 5 more than 50%. Two studies observed HIFU-induced disturbances in the microvasculature of the targeted tissue. Six noted no contrast enhancement in successfully treated areas, two observed a thin rim indicating necrosis or fibrosis, and four reported a persistent enhancement in MRI images associated with a residual viable tumor. The weighted proportion of patients with residual tumor was 0.59 (95% CI; 0.44-0.73). The subgroup analysis demonstrated that although the pooled proportion of ultrasound-guided studies was notably higher than magnetic resonance imaging-guided studies (0.71 vs. 0.57), the between-group difference was not statistically significant (p = 0.1693). The diagnostic tools showed that the results are driven by certain studies, and there is also a potential small-study effect. Furthermore, the CD4/CD8 ratio was higher in the HIFU group, with a weighted mean difference of 0.6 (95% CI: 0.41-0.78). The most prevalent side effects were pain (47.14%) and skin burn (2.59%).

Conclusions: HIFU is a relatively safe procedure for the treatment of breast cancer as an independent or conjugated therapy and its effectiveness is promising regarding histopathological response, immunological reactivity, and vascular damage in the targeted area.

Appendiceal signet ring cell carcinoma (ASRC) is an exceptionally rare and aggressive malignancy, representing < 0.1% of gastrointestinal neoplasms. Its nonspecific imaging manifestations frequently mimic inflammatory conditions such as appendicitis, leading to delayed diagnosis. We report a diagnostically challenging case of a 75-year-old woman with recurrent right lower abdominal pain over 6 months. Initial ultrasonography revealed appendiceal wall thickening (19.5 mm diameter) without layered structure loss, suggestive of chronic appendicitis. Follow-up computed tomography (CT) demonstrated cystic distal appendiceal dilatation (5.6 × 2.5 cm) with mural nodular enhancement. Despite three ultrasound examinations and CT scans, no definitive malignant features were identified preoperatively. Intraoperative findings revealed an 8.0 cm enlarged appendix with serosal infiltration, and histopathology confirmed the diagnosis of high-grade appendiceal mucinous neoplasm (HAMN) with associated signet ring cell carcinoma. This case highlights the limitations of conventional imaging in detecting ASRC, particularly when mucinous components obscure tumor invasion. The key to distinguishing ASRC from appendicitis lies in recognizing its progressive nature on serial imaging. Discriminatory features include: rapid and asymmetric wall thickening (often > 10 mm), the evolution from a preserved to a lost "target ring sign" on ultrasonography, and the presence of mural nodular enhancement on CT.

Objectives: Intravenous leiomyomatosis (IVL) is a rare uterine leiomyoma subtype. In this study, we aimed to explore IVL ultrasound features to improve its recognition and diagnostic accuracy.

Methods: We retrospectively analyzed the clinical, ultrasound, and pathological data of four patients diagnosed with IVL via surgery at our hospital between April 2023 and February 2025, assessing lesion morphology, mobility, extension, clinical staging, and enhancement patterns via conventional and contrast-enhanced ultrasound (CEUS).

Results: We included four female patients (age and mean age: 28-50 and 45.25 ± 7.46 years, respectively) in this study. Three patients had a history of uterine leiomyoma. Three and one cases were stage III and IV, respectively. Conventional ultrasound revealed that IVL within the veins appeared as continuous "cord-like" sign or "sieve hole" sign masses with high mobility and no adhesion to the vessel walls. In the cardiac chamber, IVL manifested as "snake head" or "sieve hole" sign masses extending from the inferior vena cava into the right cardiac chambers, moving dynamically with the cardiac cycle. CEUS revealed heterogeneous IVL enhancement, delayed enhancement, and slightly lower enhancement intensity compared to adjacent vascular or cardiac chambers.

Conclusions: IVL ultrasound features displayed continuous "cord-like" or "sieve hole" sign masses with high mobility and no adhesion to the vessel walls. When extending to the heart, IVL manifested as a "snake head" or "sieve hole" sign in the cardiac chamber. Taken together, CEUS examination is helpful for IVL diagnosis.

Congenital absence of the pericardium (CAP) represents an exceedingly rare cardiac anomaly that poses significant diagnostic challenges. We report a case in which paradoxical interventricular septal motion was observed. Dynamic echocardiography showed visually hyperdynamic cardiac motion and abnormal swinging movements. The bulging segment not enclosed by the pericardium on the anterior area in the apical four-chamber view of the heart exhibits synchronous motion with the adjacent lung tissue. A chest CT imaging finally verified a congenital partial absence of the left pericardium. CAP should be included in the consideration of diagnostic possibilities when dynamic echocardiography showed visually hyperdynamic cardiac motion and abnormal swinging movements.

Purpose: To explore the diagnostic value of miR-454-3p combined with Color Doppler ultrasonography (CDUS) in BC, hoping to provide new insights for breast cancer (BC) diagnosis.

Methods: A total of 205 female BC patients, 80 patients with benign breast diseases, and 50 healthy females were recruited. Serum miR-454-3p levels were measured by RT-qPCR, and all subjects underwent ultrasonic examination.

Results: BC patients had significantly higher rates of irregular morphology, unclear boundaries, spiculations, shadowing, microcalcifications, aspect ratio ≥ 1, and blood flow grades II-III. Blood flow characteristics (RI, PI, and V_max) were also notably elevated in BC compared to benign cases. miR-454-3p is significantly upregulated in both benign and BC groups. In BC patients, the expression levels of miR-454-3p were significantly elevated in those with larger tumors, higher histological grades, higher TNM stages, tumor lymph node metastasis, positive ER, and positive HER-2. The expression of miR-454-3p in BC patients was significantly correlated with ultrasound boundary, spiculated margins, echogenicity, aspect ratio, blood flow grading, and blood flow characteristics (RI, PI, and V_max). miR-454-3p can improve the accuracy of CDUS in diagnosing BC.

Conclusion: miR-454-3p has diagnostic value in BC, and its expression is significantly correlated with tumor deterioration. Combining miR-454-3p and CDUS can improve diagnostic accuracy, providing a reference for early clinical diagnosis of BC.

Adenomyomatosis of the gallbladder (ADM) is generally considered benign. The presented cases were initially diagnosed with ADM via ultrasound during an annual health check-up and monitored for several years without further investigations due to the absence of significant changes or symptoms. Subsequently, one case was diagnosed with pancreaticobiliary maljunction (PBM) with a non-dilated extrahepatic bile duct (EBD) after symptom onset, and underwent prophylactic laparoscopic cholecystectomy to avoid the risk of carcinogenesis. Although the other case remained asymptomatic, ultrasound later revealed far-advanced gallbladder carcinoma with direct invasion into the liver and hepatic metastases, and endoscopic retrograde cholangiopancreatography identified PBM with a non-dilated EBD. At laparotomy, she was found to have unresectable disease and died 4 months later. ADM associated with PBM has been recently reported. Consequently, evaluating the presence or absence of PBM is essential for determining an appropriate treatment strategy when diagnosing ADM.

Cerebral arteriovenous malformations (AVMs) are congenital vascular anomalies characterized by direct connections between arteries and veins, bypassing the capillary network. They can lead to serious complications such as intracranial hemorrhage, seizures, and elevated intracranial pressure. While imaging modalities such as computed tomography, magnetic resonance imaging, and digital subtraction angiography remain essential for diagnosis and treatment planning, brain point-of-care ultrasound (POCUS) offers a valuable complementary tool, particularly in emergency and critical care settings. This pictorial review highlights the role of different ultrasound modalities in the evaluation of AVMs. B-mode ultrasound is useful for identifying structural abnormalities and secondary effects such as hemorrhage and hydrocephalus. Color and power Doppler imaging allow visualization of abnormal vascular flow patterns within the nidus, while spectral Doppler provides hemodynamic information. Although limited by bone windows and operator dependency, brain POCUS offers a rapid, noninvasive bedside assessment that can aid in the early recognition and monitoring of AVMs and their complications.