Journal of Clinical Ultrasound最新文献

Purpose: Accurate grading of prostate cancer is critical for treatment strategies and risk stratification. This study aims to develop a machine learning (ML) model integrating Dynamic Contrast-Enhanced Magnetic Resonance Imaging (DCE-MRI) pharmacokinetic parameters with Prostate-Specific Antigen (PSA) values to predict ISUP grade metastatic risk groups.

Methods: This retrospective study included 102 patients with histologically confirmed prostate cancer. DCE-MRI pharmacokinetic parameters (Ktrans, Kep, Ve, CER, MaxSlope, IAUGC) were standardized. The dataset was balanced using the Synthetic Minority Oversampling Technique and split into training, validation, and test sets. ML models, including Random Forest, were evaluated using Area Under the Curve (AUC) values.

Results: The Random Forest classifier achieved the highest performance, with an AUC of 0.92. Precision-recall analysis identified an optimal threshold of 0.3, balancing sensitivity and specificity for high-risk group detection. SHAP analysis highlighted PSA, MaxSlope, and Kep as key predictors contributing to model accuracy.

Conclusion: Integrating DCE-MRI parameters with PSA values using ML algorithms enhances the prediction of ISUP grade metastatic risk groups. This method provides a robust tool for metastasis screening and personalized treatment in prostate cancer.

Objective: This study aims to evaluate the clinical utility of the Middle Cerebral Artery Diastolic Deceleration Area (MCA DDA) as a novel Doppler parameter for predicting hypoxia and adverse perinatal outcomes in pregnancies complicated by Fetal Growth Restriction (FGR).

Methods: A prospective observational study was conducted at the Perinatology Clinic of Ankara Bilkent City Hospital between November 2023 and November 2024. A total of 102 singleton pregnancies were enrolled, including 51 FGR cases and 51 gestational age-matched controls. All participants underwent comprehensive ultrasonographic and Doppler assessments at 34 weeks of gestation. Doppler parameters, including Umbilical Artery Pulsatility Index (UA PI), Middle Cerebral Artery Pulsatility Index (MCA PI), Cerebroplacental Ratio (CPR), Cerebroplacental-Uterine Ratio (CPUR), and the novel MCA DDA, were recorded. Receiver Operating Characteristic (ROC) analysis was performed to evaluate the predictive performance of these parameters for composite adverse perinatal outcomes (CAPO), which included NICU admission, 5-min Apgar score < 7, umbilical artery pH < 7.20, and perinatal mortality.

Results: MCA DDA was significantly higher in the FGR group (9.26 ± 2.31) compared to controls (7.49 ± 2.98, p < 0.001). ROC analysis revealed that MCA DDA had an area under the curve (AUC) of 0.63 (95% CI: 0.52-0.75, p = 0.023) with an optimal cut-off value of 8.43 (sensitivity 63.6%, specificity 61.0%). In comparison, CPR demonstrated superior predictive performance with an AUC of 0.71 (95% CI: 0.59-0.82, p = 0.001), while CPUR showed an AUC of 0.66 (95% CI: 0.55-0.78, p = 0.006). The FGR group had significantly higher rates of CAPO (80%) and NICU admissions (42.2%) compared to the control group (p < 0.001).

Conclusion: While MCA DDA is significantly elevated in FGR cases and provides valuable insights into cerebral diastolic blood flow, its predictive ability for adverse perinatal outcomes is moderate compared to traditional Doppler indices like CPR and CPUR. Integrating MCA DDA with established parameters may enhance fetal surveillance and improve perinatal outcome prediction in pregnancies complicated by FGR.

Objective: To evaluate the usefulness of Doppler of the ophthalmic artery performed between 19 and 25 weeks of gestation to predict the occurrence of preeclampsia.

Materials and methods: This was a prospective longitudinal study conducted among pregnant women between the 19th and 25th weeks of gestation. The study was carried out from October 1, 2023, to May 31, 2024, in the Departments of Radiology and Medical Imaging and Obstetrics and Gynecology of the Sylvanus Olympio University Hospital in Lomé (Togo). The Doppler parameters were compared between pregnant women who developed preeclampsia and those who did not during follow-up.

Results: A total of 313 pregnant women were enrolled, including 80 cases of preeclampsia. Only the first systolic peak, the second systolic peak, the pulsatility index, and the ratio of systolic peaks were significantly associated with the occurrence of preeclampsia. The first peak of systolic velocity had a sensitivity of 78.75% and a specificity of 63.51% for a cut-off value of 40 cm/s, with an area under the curve of 0.769 (95% CI: 0.709-0.830). The second peak of systolic velocity had a sensitivity of 76.28% and a specificity of 84.97% for a cut-off value of 23.28 cm/s, with an area under the curve of 0.853 (95% CI: 0.801-0.905). The PSV ratio had a sensitivity of 72.50% and a specificity of 63.94% for a cut-off value of 0.80, with an area under the curve of 0.718 (95% CI: 0.587-0.718).

Conclusion: Ophthalmic artery Doppler may play a crucial role in early screening of preeclampsia, allowing timely intervention and treatment.

We report a case of a pseudovascular breast lesion caused by microcalcifications mimicking internal vascularity on Doppler ultrasonography. A middle-aged woman underwent routine screening, and mammography revealed benign-appearing punctate microcalcifications. Ultrasound showed a cystic lesion with apparent septal vascularity, initially raising suspicion for a complex lesion. However, further evaluation confirmed twinkle artifact due to intralesional microcalcifications. Recognition of this artifact prevented unnecessary biopsy. This case highlights the importance of integrating multimodal imaging and understanding Doppler artifacts in the accurate assessment of breast cystic lesions.

Purpose: Ebstein anomaly (EA) is a congenital heart disease that can cause intrauterine fetal death. Pulmonary valve stenosis or atresia (PS/PA) and retrograde ductus arteriosus flow (RDAF) are important factors leading to a poor prognosis, but the causes of its formation are still unclear. This study aimed to assess the correlation between left and right ventricular function and PS/PA and RDAF in fetuses with EA using MAPSE and TAPSE Z-score values measured by free angle M-mode (FAM) echocardiography.

Methods: This retrospective cohort study of 34 EA and 68 normal fetuses was enrolled. Differences in Z-score values were compared between the control, EA with and without PS/PA groups, and between EA-PS/PA with and without RDAF group. Correlation analysis was performed between Z-score values with the ratio of inner diameter of the pulmonary to the aortic valve annulus (PA/AO) and RDAF.

Results: The differences in Z-score values were significant (p < 0.001) between three groups. Z-score values were lower in EA-PS/PA with RDAF compared to the without RDAF group (p < 0.05). Z-scores were all positively correlated with PA/AO in the EA group (p < 0.05), and negatively correlated with RDAF in the EA-PS/PA group (p < 0.05).

Conclusion: Decreased ventricular function of EA fetus is related to the formation of PS/PA. After the formation of PS/PA, the degree of damage to ventricular function is not related to the diameter of the pulmonary artery; it is related to the formation of RDAF.

At our institution, we offer a one-step office endometrial evaluation using the simultaneous endometrial aspiration and sonohysterography (SEAS) method. This involves pelvic ultrasound and sonohysterography, followed by ultrasound-guided endometrial aspiration with the same catheter. The aspirated specimens are sent for histological analysis, and in difficult or inconclusive cases, immunohistochemistry (IHC) is performed to refine the diagnosis. In this manuscript, we present a case demonstrating the utility of ultrasound-guided endometrial aspiration supported by IHC. This method should be considered in the evaluation of focal endometrial lesions and/or persistent endometrial bleeding.

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.

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.

Retroperitoneal extra-adrenal paragangliomas are rare neuroendocrine tumors that frequently arise in a confined anatomical space bordered by the right side of the abdominal aorta, the left side of the inferior vena cava, and the posterior aspect of the horizontal part of the duodenum (hereafter referred to as the duodenum-adjacent aortocaval region). Although ultrasonography (US) is a noninvasive and useful modality for initial diagnosis, detailed imaging characteristics of such tumors have not been sufficiently reported. This report aimed to describe the anatomical location and ultrasonographic features of three cases of retroperitoneal extra-adrenal paraganglioma, with a focus on blood flow evaluation using superb microvascular imaging (SMI) and contrast-enhanced ultrasound (CEUS). We retrospectively analyzed B-mode US, SMI, CEUS, computed tomography (CT), magnetic resonance imaging (MRI), and ¹²³I-MIBG scintigraphy findings in all three cases. In every case, tumors were located in the duodenum-adjacent aortocaval region. US revealed well-defined, hypoechoic, oval-shaped masses with heterogeneous internal structures. SMI showed abundant intratumoral blood flow, while CEUS demonstrated contrast enhancement. SMI under contrast enhancement revealed blood flow that was not visible with conventional SMI. Our findings indicate that retroperitoneal extra-adrenal paragangliomas exhibit characteristic morphology and vascularity on US. The combined use of SMI and CEUS may further enhance diagnostic accuracy and contribute to US as an important noninvasive diagnostic tool. Moreover, when a mass is identified in the duodenum-adjacent aortocaval region, paraganglioma should be considered in the differential diagnosis.

Purpose: This study aimed to develop a preoperative logistic regression model to predict sentinel lymph nodes (SLN) metastasis risk in clinical T1 stage (cT1, diameter ≤ 2 cm) breast cancer patients using ultrasound (US) and contrast-enhanced ultrasound (CEUS) characteristics.

Methods: Consecutive patients with primary cT1 breast cancer from June 2018 to May 2024 who have undergone breast CEUS examination and subsequent breast surgeries with SLN biopsies were retrospectively enrolled. Histopathological results following surgical resection were considered the gold standard. The patients were randomly classified into training and validation sets in a 7:3 ratio for the development and validation of the logistic regression, respectively. Univariable analysis and multivariable logistic regression analysis were performed to identify independent indicators of SLN status. We developed Model_1 (solely based on conventional US characteristics) and Model_2 (integrating conventional US and CEUS characteristics) to predict SLN metastasis (present vs. absent) and further the number of metastatic SLN (≤ 2 vs. > 2). The additive prediction effect of CEUS characteristics was also discussed by comparing the predictive performance of Model_1 and Model_2.

Results: In the final analysis of 383 patients, multivariable analysis identified tumor size, hyperechoic halo, positive axillary nodes, perfusion defect, enhancement order, penetrating vessel, and crab claw-like enhancement as independent indicators of SLN status. In the validation set, for predicting SLN metastasis (present vs. absent), the AUCs of Model_1 and Model_2 were 0.70 and 0.80, respectively. For predicting SLN metastasis (≤ 2 vs. > 2), the AUCs of Model_1 and Model_2 were 0.75 and 0.88, respectively. Both models were well-calibrated, and the addition of CEUS features significantly improved the predictive performance of Model_2 compared to Model_1.

Conclusion: The Model_2, using US and CEUS characteristics from cT1 breast cancer patients, effectively predicts SLN metastasis and the number of metastatic SLNs. This model aids clinicians in assessing SLN metastasis risk and making informed decisions about axillary surgery.