Journal of Ultrasound in Medicine最新文献

Objectives: Repeated gripping with high grip forces and high rates of grip force development are risk factors for carpal tunnel syndrome. As the nerve's adaptive ability is crucial to prevent disease progression, we investigated how these risk factors influence median nerve deformation and displacement over the time course of a repeated pinch grip task.

Methods: Seventeen healthy participants performed a repeated grip task against a load cell while their carpal tunnel was scanned with ultrasound. The grip task involved pulp-pinching three consecutive times from 0 to 40% maximal voluntary exertion (MVE), performed at three different rates of force development (RFD): 40% MVE/1 second; 2 seconds; and 5 seconds. Ultrasound images were analyzed at 10% MVE intervals. Nerve circularity, width, height, and cross-sectional area were measured to assess deformation. Median nerve displacement was assessed by its change in position relative to the flexor digitorum superficialis tendon of the third digit (FD) in both radioulnar and palmodorsal axes.

Results: Linear mixed modeling indicated that median nerve deformation increased, becoming more circular, with each repeated pulp-pinch (P < .01) and with grip force magnitude (P < .01). However, a faster RFD decreased nerve deformation (P < .01). Furthermore, the nerve displaced ulnarly during pulp-pinching, with greater displacement during the fastest (ie, 40% MVE/1 second) RFD (P < .01).

Conclusions: The median nerve deformed and displaced in response to pulp-pinching; however, faster rates of force development hindered this adaptive response. This likely reflects the viscoelastic properties of the healthy nerve and subsynovial connective tissue, highlighting the importance of tissue compliance in preventing nerve compression.

Smooth muscle hamartoma (SMH) of the skin is a cutaneous benign proliferation of mature smooth muscle. Congenital SMH (CSMH) of the skin represents the most frequent type, and to date, there are no reports on its ultrasonographic pattern. A retrospective study of the color Doppler ultrasound (US) images of six CSMH patients at high and ultra-high frequencies was performed. Demographic data and US characteristics were analyzed. All cases presented a focal area of dermal thickening, decreased dermal echogenicity, and/or distorted dermal regions with prominent hair follicles. A total of 83.3% of cases showed no signs of internal vascularity at color Doppler imaging. Ultrasonographic features can support clinical diagnosis and follow-up of CSMH, which may potentially avoid biopsies.

Fallopian tubes are not usually visible on a transvaginal pelvic scan unless pelvic fluid or pathological processes are present. Depending on the underlying pathological process, they may exhibit different wall thicknesses, grades of vascularization, and variable echogenicity. Recognizing the affected tube and assessing the possible underlying process is of primary importance in clinical practice, as pathological tubes may represent benign pathologies, oncological state, or life-threatening conditions requiring different treatment to preserve fertility. The aim of this pictorial review is to describe the main characteristics of the most common tubal pathologies to help clinicians recognize them.

Objectives: Red-blue neurofibromas (RBNs), found in up to 29% of adult neurofibromatosis type 1 (NF1) patients, present as red-blue macules measuring 1-2 cm in diameter, primarily on the trunk. Despite their prevalence, RBNs often go unnoticed due to their subtle appearance. Ultrasound characterization serves as a diagnostic clue yet lacks comprehensive studies in both adult and pediatric populations. This study aims to define and compare RBNs' prevalence, characteristics, and ultrasound features in adult and pediatric patients with NF1.

Methods: This prospective study involved 118 patients (92 pediatric patients and 26 adults) diagnosed with NF1. Clinical examinations combined with cutaneous ultrasound scans using linear multifrequency probes (L4-12t, L10-22, ML6-15, or L8-18 MHz) were performed in order to determine the prevalence, and clinical and sonographic characteristics of RBN in both populations. Statistical analyses were performed using t tests and chi-square tests.

Results: RBNs were found in 26.3% (31) of the patients after clinical examination, including 179 lesions. RBN prevalence differed significantly between pediatric (10.9%) and adult (66.7%) patients. Lesions were primarily on the trunk and exhibited similar clinical characteristics. Ultrasound reveals RBNs as hypoechoic, oval lesions with irregular borders. Our results show that pediatric RBNs are typically more superficial and hypoechogenic, while adult RBNs are deeper and more heterogeneous.

Conclusion: Ultrasound findings showed subtle differences in lesion depth, morphology, and echogenicity between these 2 age-related groups. These changes highlight ultrasound's role in identifying RBNs in patients with NF1 and monitoring their evolution.

Objectives: Current literature on imaging characteristics of hepatic inflammatory pseudotumor (HIPT) is limited. This study aimed to analyze the contrast-enhanced ultrasound (CEUS) features in HIPT and compare them with contrast-enhanced computed tomography (CECT) and contrast-enhanced magnetic resonance imaging (CEMRI).

Methods: A total of 83 patients with histologically proven HIPT from two medical institutions were included in this study. All patients underwent CEUS within 1 week before surgery or biopsy. Some patients received additional CECT or CEMRI. B-mode ultrasound (BMUS) features, enhancement parameters of CEUS, CECT and CEMRI were analyzed. Chi-square test was used to compare the enhancement patterns and diagnostic sensitivity between CEUS and CECT/CEMRI.

Results: On the BMUS, HIPT mainly appeared hypoechoic (83.5%, 66/79), irregular shapes (62.0%, 49/79), heterogeneous echogenicity (72.2%, 57/79), and unclear boundary (65.8%, 52/79). A total of 61.5% (51/83) lesions exhibited mild hyper- or iso-enhancement in the arterial phase (AP), 59.0% (49/83) lesions had internal nonenhanced areas, and most lesions (71.1%, 59/83) showed early wash-out (<60 seconds) on the CEUS. There were significant differences between CEUS and CECT/CEMRI in enhancement intensity of AP and wash-out pattern (P < .05). The sensitivity in the diagnosis of HIPT among the three had no statistical difference (P>.05).

Conclusions: The CEUS features of HIPT lesions typically include mildly hyper-enhanced or iso-enhanced in AP, rapid wash-out in PVP, and often small nonenhanced areas within the mass. Furthermore, the wash-out pattern of CEUS and CECT/CEMRI are inconsistent, more akin to cholangiocarcinoma. The diagnostic efficacy of the three modalities is similar.

Ultrasound-guided thermal ablation (TA) is a minimally invasive intervention for treating benign thyroid nodules (BTNs). This meta-analysis aims to systematically compare the safety and efficacy of ultrasound-guided TA with surgery in treating BTNs. Relevant studies were identified through searching electronic databases. Included studies focused on comparing TA for BTNs with surgical resection. Primary endpoints encompassed length of hospital stay, procedure time, symptom improvement, cosmetic score, and excellent cosmetic results. Other outcomes include all complications (hypothyroidism, hoarseness, hematoma, blood loss, wound infection, parathyroid injury, chocking, or cough), recurrence, postoperative pain, visual analog scale (VAS) score, scar length, thyroid hormone levels, and finally stress response outcomes. Twenty-six studies (7 randomized controlled trials and 19 cohort studies) were included. Our findings revealed that TA was associated with shorter hospital stays (MD = -3.30, 95% CI [-3.82, -2.79], P < .00001), reduced procedure time (MD = -47.75, 95% CI [-54.89, -40.61] P < .00001), superior cosmetic outcomes (RR = 1.11, 95% CI [1.00, 1.22], P = .04), lower postoperative pain levels, and lower VAS score. Additionally, surgical resection was linked to a higher incidence of hoarseness, hypothyroidism, parathyroid injury, and blood loss. However, no significant differences were observed in rates of wound infection, hematoma, or recurrence between the two treatment modalities. Our meta-analysis suggests that ultrasound-guided TA represents a viable alternative to surgery for treating BTNs, especially for patients unwilling or unable to undergo surgical intervention. This technique was found to be safe and effective. However, future evidence is mandatory to establish TA to a specific type of nodule, to preserve patients from second interventions.

This network meta-analysis aims to identify the best possible combination therapy for individuals suffering from adenomyosis. To identify pertinent research for the network meta-analysis, a comprehensive search was conducted across multiple databases, including PubMed, Embase, Cochrane Library, Web of Science, CNKI, WanFang, and VIP, spanning from their commencement to February 21, 2024. The study's focus was on evaluating outcomes including visual analog scale (VAS) scores for dysmenorrhea, measurements of uterine and lesion volumes, menstrual blood loss, and the rate of disease recurrence. The findings from both direct and indirect comparisons, which were quantitatively assessed using weighted mean differences or relative risk along with their respective 95% confidence intervals, were graphically depicted in forest plots. Additionally, the ranking probability was illustrated, which indicated the likelihood of various high-intensity-focused ultrasound (HIFU) combination therapies being the most effective across each measured outcome. In the final analysis, this network meta-analysis encompassed a total of 31 articles. The results showed that HIFU combined with gonadotropin-releasing hormone agonist (GnRH-a) and progestin was more effective to decrease VAS score for dysmenorrhea than other combined therapies. HIFU combined with progestin was superior to other combined therapies in decreasing uterine volume, lesion size, and recurrence rate. HIFU combined with mifepristone was more effective to reduce menstrual volume compared to other combined therapies. The analysis suggests that regimens incorporating HIFU along with GnRH-a and progestin, or HIFU combined with progestin or HIFU combined with mifepristone might offer superior benefits in the clinical management of adenomyosis. These combined treatment approaches could potentially be more effective options for patients suffering from this condition.

Background: Pulse radiofrequency (PRF) can reduce the persistent pain of herpes zoster (HZ), but some patients still have residual pain and do not achieve satisfactory results. This study aimed to assess the efficacy of PRF combined with transverse abdominal plane (TAP) block for abdominal acute/subacute HZ-related pain.

Methods: A total of 137 acute/sub-acute HZ patients with successful PRF treatment were recruited from the Pain Department of Wuhan No. 1 Hospital between January 2018 and January 2020. There were two groups: the transversus abdominis plane group (TAP group, n = 64) and the normal saline group (NS group, n = 60). Pain intensity, sleep quality, and quality of life were quantified using the visual analogue scale (VAS), the five-item questionnaire and scoring system, and the 36-item Short Form Health Survey (SF-36) questionnaire, respectively. Follow-up assessments were conducted at baseline, 1 day, 3 months, 6 months, and 12 months after the block therapy.

Results: Compared to the NS group, the TAP group showed significantly decreased pain scores 1 day, 3 months, 6 months, and 12 months after block therapy (P < .05). The sleep quality scores were lower in the TAP group than that in the NS group at 6 months (5.0 ± 2.4 vs 6.3 ± 3.7, p = .042), and 12 months after therapy (3.1 ± 1.8 vs 4.1 ± 2.4, p = .031). For quality of life, in comparison to NS group participants, those in the TAP group exhibited significantly higher scores (p < .05) for quality of life at 3 months, 6 months, and 12 months follow-up. There was a significant decrease in the proportion of pregabalin and analgesic medications in the TAP group and NS group at 6 and 12 months after treatment compared to Baseline (p < .001). Furthermore, the results showed that there was a significant difference in VAS, sleep quality scores (SQS), and quality of life between the PRF + TAP group and pharmacological therapies group before and 12 months after treatment (p < .05).

Conclusion: The TAP block is a promising complementary treatment for acute/subacute HZ patients who have undergone PRF treatment. Combining PRF with the TAP block has the potential to alleviate HZ-related pain, enhance the patients' quality of life, and improve their sleep quality.

Objectives: The aim of this study was to compare the anteroposterior length of levator ani hiatus, as well as the presence and the degree of cystocele in women at risk of pelvic floor dysfunction during the postpartum period by transperineal ultrasound performed in the standing and supine positions.

Methods: This was a cross-sectional study including women who delivered vaginally, at risk of pelvic floor dysfunction. After 8-12 weeks postpartum, each woman underwent pelvic floor ultrasound in both standing and supine positions during the Valsalva maneuver to measure the length of hiatal anteroposterior diameter and the cystocele. Demographic and clinical data on pregnancy and delivery were recorded. Women were interviewed to collect subjective symptoms of urinary stress incontinence.

Results: The study involved 100 women at risk of pelvic floor dysfunction following a vaginal delivery. The proportion of women with an anteroposterior hiatal diameter ≥60 mm was significantly higher when measured standing than when measured supine (64.0 vs 47.0%, P = .016). Similarly, the frequency of cystocele detected in the standing position was higher than in the supine position (48.0 vs 17.0%, P < .001). The non-agreement between the examinations performed in these two positions was proved by the value of Cohen's Kappa (0.36, 95% CI: 0.22-0.51). Also, in the subgroup of asymptomatic women, more cases of cystocele were detected in the standing position (29 cases, 39.2%) than in the supine position (12 cases, 16.2%) (P = .003).

Conclusions: Our study shows that transperineal pelvic floor ultrasound in the postpartum period performed in the standing position, compared with the supine position, achieved a higher detection rate of cystocele and enlarged anteroposterior hiatal diameter in women at risk of pelvic floor dysfunction. These findings should be considered when evaluating the criteria to select candidates for pelvic floor rehabilitation.