Journal of Ultrasound in Medicine最新文献

Objective: To determine the proportion of cases of lower extremity symptoms attributable to underlying musculoskeletal (MSK) rather than thrombotic etiologies in emergency versus non-emergency settings.

Methods: We retrospectively reviewed all lower extremity Venous Doppler ultrasounds performed on emergency department (ED) and non-ED patients over a 1-year period at a single institution. Using radiology report data mining software, keywords including tear, tendon, hematoma, and muscle were used to identify cases of MSK pathology of the lower leg. All reports were also reviewed for findings of venous thrombosis. Statistical significance between ED and non-ED patients for both incidental MSK pathology and venous thrombosis was assessed using chi-squared tests.

Results: A total of 5714 lower extremity Doppler ultrasounds were performed at a single institution during the 1-year period, 1829 in the ED and 3885 in non-ED settings. Sixty-nine of 1829 (3.8%) ED patients had incidental MSK pathology of the lower extremity compared to 53/3885 (1.4%) in the non-ED setting (p < .001). Two hundred sixty-seven of 1829 (14.5%) ED patients had evidence of venous thrombosis and/or chronic post-thrombotic change. When combined with thrombotic pathology as positive cases, incidental MSK injury accounted for 69/336 (20.5%) of ED cases with positive sonographic findings.

Conclusions: MSK pathology of the lower leg is significantly more likely to contribute to lower extremity symptoms in the ED compared to a non-ED setting. Therefore, a brief sonographic evaluation of the MSK apparatus may be beneficial in a subset of ED patients, particularly those with focal pain but no identifiable thrombotic etiology.

Objectives: Evaluate the value of ultrasound specialist assessment of ovarian masses over 50 mm with sonograms interpreted as possible hemorrhagic ovarian cysts (HOC).

Methods: Retrospective review of consecutive endovaginal pelvic US reports of premenopausal women at one organization identified adnexal masses over 50 mm maximum diameter designated as possibly being HOC (large HOC). Four ultrasound specialists reviewed studies, scoring two assessments as true or false: 1) US features are most consistent with either an ovarian hemorrhagic cyst (HOC) or endometrioma; 2) If assessment 1 was true, the mass meets O-RADS criteria of classic HOC except for size.

Results: A total of 457 of 51,305 women (0.9%) had reports indicating possible large HOC. For 366 patients with established outcomes, 225 (61.5%) had a large HOC (87.1% ≤ 70 mm). Assessment 1 was true for 318 patients; outcomes showed 224 (70.4%) HOC, 89 (28.0%) endometriomas, 4 (1.3%) TOAs, and 1 (0.3%) cystadenoma. Assessment 1 was false for 48 patients; outcomes showed 1 (2.1%) HOC, 1 (2.1%) endometrioma, 6 (12.5%) other non-neoplastic cysts, 33 (68.8%) benign neoplasms, 5 (10.4%) borderline tumors, and 2 (4.2%) high-grade malignancies. The decrease in neoplasms and malignancies with true assessment 1 was significant (p < .001). Assessment 2 was true for 190 patients (180 [94.7%] HOC, 9 [4.7%] endometrioma, 1 [0.5%] cystadenoma), false for 128 patients (44 [34.4%] HOC, 80 [62.5%] endometrioma, and 4 [3.1%] TOA) (p < .001), and not applicable for 48 patients.

Conclusions: Ultrasound specialist review of adnexal masses designated as a possible large HOC adds value since over 10% are neoplasms (nearly 2% malignant). Ultrasound specialist assessment can expedite additional imaging or intervention when necessary and obviate follow-up when HOC features are typical.

Introduction: Sympathectomy in the lower extremities after spinal anesthesia (SA) increases arterial blood flow. This increased blood flow can be detected by pulsed-wave Doppler (PWD) of ultrasonography (USG). The aim of this study was to investigate PWD measurements of the posterior tibial artery (PTA) in patients having SA. The hypothesis was that systolic and diastolic flow velocities in the PTA increase after spinal block.

Materials and methods: Patients aged 18-65 years, American Society of Anesthesiologists physical statuses I-II, undergoing elective surgery were included in the study. Using USG and PDW modality, vessel diameter, peak systolic velocity (PSV), end-diastolic velocity (EDV), mean velocity (Vmn), S/D (PSV/EDV ratio), pulsatility index (PI), and resistive index (RI) parameters were measured before, at 5th and 10th minutes after SA from the PTA.

Results: The study was completed with 30 patients with a mean age of 52 years (22-65 years). After SA, the spectral waveform changed from triphasic to monophasic. Vessel diameter, PSV, EDV, Vmn, VTI, and AT values measured with PWD increased, while PI, RI, and S/D values decreased significantly (p < .001). There was a significant correlation between all these parameters and the degree of sensory and motor block.

Conclusion: SA causes significant changes in spectral waveform morphology, vessel diameter, and Doppler-derived flow velocity parameters of the PTA. This technique may serve as a supplementary tool for assessing block success in patients with communication limitations, particularly when SA is preferred over general anesthesia.

Abscesses are a common esthetic procedure complication that can lead to disfigurement and systemic complications. Accurately identifying the type of abscess is essential for early and appropriate treatment. In this context, the ultrasound (US) has become a pivotal tool for diagnosing and managing abscesses when combined with clinical and laboratory assessment. However, many professionals in the field still have limited knowledge of the subject, especially regarding abscess differentiation. Given this scenario, this article aims to address the US-standard to distinguish between common bacterial, nontuberculous mycobacterial, and sterile abscesses, highlighting the importance of integrating clinical presentation and laboratory findings for accurate differentiation.

Objectives: This study aims to evaluate the diagnostic value of a novel multimodal approach combining transperineal ultrasound (TPUS), transrectal dual-plane ultrasound, and shear wave elastography (SWE) in predicting stress urinary incontinence (SUI).

Methods: A total of 70 women diagnosed with SUI and 110 healthy controls were included. Clinical data such as age, body mass index (BMI), mode of delivery, and relevant medical history were collected. Pelvic floor ultrasound was performed using TPUS and transrectal dual-plane ultrasound. Key parameters, including bladder neck mobility, urethral rotation angle, urethral length, and urethral stiffness measured by SWE, were recorded and analyzed. Statistical analysis was conducted using SPSS version 27.0, and a multifactorial predictive model was developed.

Results: Significant differences were observed between the SUI and control groups in bladder neck mobility (p = .034), urethral rotation angle (p = .059), and urethral stiffness measured by SWE (p < .001). The average Young's modulus of the urethral sphincter was significantly lower in the SUI group (39.22 ± 5.83 kPa) compared to the control group (52.11 ± 9.24 kPa). Age and average urethral sphincter elasticity were identified as independent risk factors for SUI. The multifactorial model demonstrated high clinical applicability with an AUC of 0.891 (sensitivity: 84%, specificity: 80%).

Conclusions: The combination of TPUS, transrectal dual-plane ultrasound, and SWE provides a reliable, non-invasive diagnostic tool for predicting SUI. The study highlights the importance of urethral stiffness and bladder neck mobility in the pathophysiology of SUI. This multi-modal approach shows strong potential for early detection and personalized treatment strategies. This multimodal approach offers a non-invasive, reliable tool for early SUI detection and personalized management.

Objectives: Six-region lung ultrasound (LUS) scores show good predictive value for predicting surfactant need in preterm infants but rely on a fixed threshold, which may lead to misclassification near the cut-off and lack data-driven justification for selecting these 6 regions. This study explored whether evaluating individual regions-and combinations-could improve predictive accuracy and utility.

Methods: Data from preterm infants born at ≤34 weeks and enrolled in the Serial Lung Ultrasound for Surfactant Replacement Therapy (SLURP) cohort study were analyzed to develop predictive models for surfactant administration based on regional LUS scores. Univariate, bivariate, and machine learning analyses were conducted to identify the most informative lung regions. Rule-based, decision tree, and logistic regression models were then developed, compared to the 6-region model, and validated on an external dataset.

Results: The training set consisted of 77 patients from the SLURP cohort study. The rule-based, decision tree, and logistic regression models showed the best performance, primarily using 2 lung regions-left lateral and left upper posterior. A refined model that included the right upper anterior (RUA) region further improved performance. On the external test set (n = 42), the rule-based model with RUA achieved the highest accuracy (0.93) and the lowest false negative rate (0.11), outperforming the 6-region model. Adding more regions did not enhance accuracy.

Conclusions: A simplified, rule-based model that accounts for the differential predictive value of individual lung regions may enhance the accuracy of LUS-based prediction of surfactant need in preterm infants. It is also more accessible, effective, and time-efficient for clinicians.

Objectives: To overcome the limitation of traditional sparse regularization methods in ultrasound imaging, which struggle to preserve speckle textures, and to enhance the resolution, contrast, and texture fidelity of plane wave imaging.

Methods: A joint sparse regularization model is proposed, combining the ℓ₁ (spatial sparsity) and ℓ_2,1 (joint sparsity in the frequency domain) regularization terms. The inverse problem is solved using the Alternating Direction Method of Multipliers (ADMM) optimization algorithm. Based on the PICMUS dataset (including simulated, experimental, and in vivo data), the proposed method is compared with traditional Delay-and-Sum (DAS), single sparse regularization (ℓ₁), and multi-plane wave compounding (75_PW) methods. The axial and lateral resolutions (Full Width at Half Maximum, FWHM), Contrast-to-Noise Ratio (CNR), generalized CNR (gCNR), and Kolmogorov-Smirnov (KS) test results are evaluated.

Results: The joint sparse method achieved an axial FWHM of 0.28 mm and a lateral FWHM of 0.30 mm in simulated resolution (SR), and 0.30 and 0.47 mm in experimental resolution (ER), respectively. These results are superior to those of DAS (ER lateral FWHM of 0.97 mm) and ℓ₁ method (ER lateral FWHM of 1.16 mm). The simulated contrast (SC) CNR reached 12.34, and the experimental contrast (EC) CNR was 9.15, both passing the KS test (preserving speckle distribution). The computational efficiency was significantly improved, with a single-frame reconstruction time of only 5.3 s, much faster than the ℓ₁ method (363.2 s) and 75_PW (45.6 s), but slightly slower than the single-angle DAS method (1.9 s).

Conclusions: The joint sparse regularization model, by exploiting the correlation of image frequency-domain structures, effectively improves resolution (reducing FWHM by 26-61%) and contrast while preserving speckle textures. It provides an efficient and robust solution for ultrasound inverse problem reconstruction.

Objectives: To develop and validate an ultrasonography-based machine learning (ML) model for predicting malignant endometrial and cavitary lesions.

Methods: This retrospective study was conducted on patients with pathologically confirmed results following transvaginal or transrectal ultrasound from 2021 to 2023. Endometrial ultrasound features were characterized using the International Endometrial Tumor Analysis (IETA) terminology. The dataset was ranomly divided (7:3) into training and validation sets. LASSO (least absolute shrinkage and selection operator) regression was applied for feature selection, and an extreme gradient boosting (XGBoost) model was developed. Performance was assessed via receiver operating characteristic (ROC) analysis, calibration, decision curve analysis, sensitivity, specificity, and accuracy.

Results: Among 1080 patients, 6 had a non-measurable endometrium. Of the remaining 1074 cases, 641 were premenopausal and 433 postmenopausal. Performance of the XGBoost model on the test set: The area under the curve (AUC) for the premenopausal group was 0.845 (0.781-0.909), with a relatively low sensitivity (0.588, 0.442-0.722) and a relatively high specificity (0.923, 0.863-0.959); the AUC for the postmenopausal group was 0.968 (0.944-0.992), with both sensitivity (0.895, 0.778-0.956) and specificity (0.931, 0.839-0.974) being relatively high. SHapley Additive exPlanations (SHAP) analysis identified key predictors: endometrial-myometrial junction, endometrial thickness, endometrial echogenicity, color Doppler flow score, and vascular pattern in premenopausal women; endometrial thickness, endometrial-myometrial junction, endometrial echogenicity, and color Doppler flow score in postmenopausal women.

Conclusion: The XGBoost-based model exhibited excellent predictive performance, particularly in postmenopausal patients. SHAP analysis further enhances interpretability by identifying key ultrasonographic predictors of malignancy.

Diagnosis of ovarian malignancy in radiology is challenging, as there is significant overlap in imaging appearances along the spectrum of benign to malignant disease. In 2021, the American College of Radiology introduced the Ovarian-Adnexal Reporting and Data System (O-RADS) to standardize lesion description and improve consistency of interpretation and management of suspicious masses based on standard greyscale and Doppler ultrasound. Although endovaginal ultrasound (EVS) is well-established as a first-line investigation for ovarian lesions, it previously lacked the ability to show blood flow at the capillary level, severely limiting its contribution to patient care. The introduction of microbubble contrast agents and the subsequent development of contrast-enhanced ultrasound (CEUS) software techniques for endovaginal probes have allowed ultrasound to characterize perfusion-level vascularity of ovarian masses comparable to magnetic resonance (MR) and computed tomography (CT) scans. Today, there is limited North American literature addressing the utilization of CEUS in ovarian cancer. Given the advantages of EVS and CEUS, we propose a lexicon to standardize the description of qualitative and quantitative CEUS parameters with respect to ovarian masses. We emphasize the need for future development of specific CEUS criteria, including quantitative thresholds to aid in the differentiation of benign and malignant blood flow criteria. Our recommendation includes a safe, non-invasive, readily available technique, which provides high accuracy for diagnosis.