Journal of Ultrasound in Medicine最新文献

Objectives: To evaluate a scoring system using transvaginal ultrasound (TVS) to predict high-risk endometrial cancer.

Methods: Consecutive patients with endometrial cancer/atypical hyperplasia (n = 266) were preoperatively examined by residents using TVS. Clinical parameters, endometrial morphology and Doppler scores were recorded using a gray scale and Doppler TVS and related to final histopathology at hysterectomy. Multivariate logistic regression was used to correlate imaging and clinical parameters to the presence of high-risk endometrial cancer (defined as FIGO stage Ib-IV or high-grade tumors [grade 3/non-endometroid]) to develop the High-Risk Endometrial Cancer (HIREC) score.

Results: High-risk endometrial cancer (n = 128) and lympho-vascular space invasion (LVSI) (n = 43) were predicted by increased endometrial thickness (ET), age, and Doppler score. The HIREC scoring system, based on age, Doppler score, and ET performed well with an AUC of 78.5% (CI 95%: 73-84) to predict high-risk cancer. By using a 2-step strategy of (1) Preoperative identification of high-grade tumors by biopsy, (2) Assessing the HIREC score, high-risk endometrial cancer could be predicted at a HIREC score of ≥7 with sensitivity, specificity, and accuracy of 72.7, 88.4, and 80.8%. Low-risk endometrial cancer was predicted at HIREC scores of <5 with sensitivity, specificity, and accuracy values of 91.4, 46.4 and 68.1%, respectively.

Conclusions: Low and high HIREC scores effectively predicted low- and high-risk endometrial cancer. The score is a simple point system suitable for the first ultrasound assessment. It may be used in preoperative work-up to select treatment and additional imaging, but it needs to be validated in further studies.

Objectives: To evaluate the discriminatory potential of peritumoral tissue stiffness, as quantified by 2-dimensional shear wave elastography, for distinguishing between hepatocellular carcinoma (HCC) and metastatic liver carcinoma (MLC).

Methods: This study enrolled 31 patients with HCC and 42 with MLC. The mean Young's modulus (E) value was measured to evaluate the intratumoral and peritumoral stiffness of HCC and MLC by using the 2-dimensional shear wave elastography integrated with the shell measurement function. The intratumoral stiffness and the peritumoral stiffness within the 1-, 2-, and 3-mm shells surrounding the target lesion were labeled as E, E_shell1, E_shell2, and E_shell3, respectively. The discriminatory capacity of the E and E_shell parameters to distinguish HCC from MLC was assessed by generating receiver operating characteristic curves.

Results: The E_shell1, E_shell2, and E_shell3 values in patients with HCC were higher than those with MLC, whereas the E values in patients with HCC were lower than those with MLC (p < .05). In addition, the E_shell1, E_shell2, E_shell3, and E values showed good diagnostic performance in differentiating HCC from MLC. Among them, E_shell1 had better diagnostic performance, with a specificity, sensitivity, positive predictive value, and negative predictive value of 64, 88, 59, and 90%, respectively (cut-off value, 19.84 kPa; area under the receiver operating characteristic curve, 0.763).

Conclusions: Quantitative assessment of peritumoral stiffness, particularly within a precisely defined 1-mm shell using advanced shell elastography, significantly enhances the differentiation of HCC from MLC.

Objectives: To explore the ultrasound findings, treatment strategies, and reproductive outcomes in patients with recurrent cesarean scar pregnancy (CSP), providing evidence for clinical management.

Methods: We identified 1371 confirmed CSP from 1517 initially screened cases (2012-2022) through blinded image review. From 159 subsequent live births in this cohort, 27 recurrent CSP cases were matched 1:1 with CSP patients having normal subsequent pregnancies. Baseline characteristics and reproductive outcomes were collected via medical records and structured interviews.

Results: This study revealed the recurrent CSP group showed significantly higher rates of exogenous implantation pattern (33.3% versus 7.4%, OR = 1.96), rich vascularity on color Doppler (81.5% versus 40.7%, OR = 2.80), and embryonic cardiac activity detection (51.9% versus 18.5%, OR = 1.98) than the normal intrauterine pregnancy group after CSP (p < .05) during initial diagnosis. The most commonly used treatment at our hospital is trans-abdominal ultrasound-guided suction curettage, which effectively controls the condition and preserves fertility. However, during long-term follow-up, some patients still face the risks of recurrence infertility.

Conclusions: Recurrent CSP presents characteristic sonographic features at initial diagnosis, among which an exogenous implantation pattern, rich vascular flow signals, and embryonic cardiac activity serve as relevant and significant indicators. Although transabdominal ultrasound-guided suction curettage is effective in managing the condition and preserving fertility, some patients still face long-term risks of recurrence and infertility.

Objectives: This study aimed to develop a multimodal model that integrates habitat radiomics and clinical features for non-invasive prediction of axillary sentinel lymph node (SLN) metastasis in breast cancer (BC).

Methods: We retrospectively analyzed ultrasound images and clinical data from 191 female patients with BC treated at Beijing Luhe Hospital, Capital Medical University from May 2023 to January 2025. Patients were randomly assigned to training and test sets at a 7:3 ratio. Four models were constructed: a traditional radiomics model, a clinical model, a habitat model characterizing the tumor microenvironment, and a multimodal model combining habitat radiomics with clinical features. Model performance was assessed using receiver operating characteristic curve analysis and decision curve analysis.

Results: In the training set, the habitat model achieved an area under the curve (AUC) of 0.869, outperforming the clinical model (AUC = 0.718) and the traditional radiomics model (AUC = 0.771). The multimodal model, integrating habitat analysis and clinical features, yielded the highest AUC (0.900). In the test set, the habitat model again showed superior discriminative ability (AUC = 0.866) compared with the clinical model (AUC = 0.727) and the radiomics model (AUC = 0.662); meanwhile, the multimodal model achieved the highest AUC (0.902).

Conclusion: The habitat model demonstrated superior predictive performance compared with models based solely on ultrasound radiomics or clinical features, and the multimodal approach yielded the best overall accuracy. This combined model offers a promising non-invasive tool for pre-operative assessment of SLN status in patients with BC and may assist clinical decision-making.

Objective: To evaluate the diagnostic value of the nine Morphological Uterus Sonographic Assessment (MUSA)-defined ultrasonographic features for adenomyosis and develop an ultrasound scoring system to improve diagnostic accuracy.

Methods: This retrospective study analyzed ultrasound images from patients who underwent total hysterectomy between May 2023 and December 2024, in accordance with the MUSA consensus. The cohort was split into training and testing sets. Ridge regression was applied to the training set to develop an ultrasound scoring system based on the regression coefficients of each sign, which was subsequently validated in the test set. Correlations between the ultrasound score and preoperative hemoglobin, dysmenorrhea were evaluated.

Results: Interrupted junctional zone and myometrial cysts showed highest specificity (89.0%, 88.5%), hyperechoic islands highest sensitivity (69.2%). In the training set, the scoring system achieved an area under the curve (AUC) of 0.948 (95% CI 0.901-0.990), sensitivity 86.3%, specificity 87.3%, accuracy 86.8%. In the testing set, AUC was 0.894 (95% CI 0.856-0.931), sensitivity 79.4%, specificity 83.9%, accuracy 81.7%. No significant correlation existed between ultrasound score and hemoglobin (ρ = 0.017, P = .824), but a weak positive correlation was found with Visual Analogue Scale (VAS) scores (ρ = 0.178, P = .016).

Conclusion: All nine MUSA features contribute to adenomyosis diagnosis, but no single sign is sufficiently accurate alone. The ultrasound scoring system significantly enhances transvaginal ultrasound diagnostic performance and shows strong clinical potential. Higher scores correlate modestly with greater dysmenorrhea severity.

Objectives: To evaluate the performance of a CNN-based (convolutional neural networks-based) AI software for automatic recognition and measurement of minimal levator hiatus in transperineal ultrasound volumes from postpartum women, and to assess its agreement with manual measurements in different functional states.

Methods: We conducted a retrospective analysis of 100 transperineal ultrasound volumes measured independently by two sonographers (one junior, one senior) using a SonoScape S60 ultrasound system. Manual measurements included anteroposterior diameter (AP), left-to-right diameter (LR), levator hiatus area (HA), which were assessed at rest, during maximum pelvic floor contraction maneuver, and during maximum Valsalva maneuver. The levator-urethra gap (LUG) was additionally measured during contraction. The same volumes were identified and measured using automated CNN-based software (Auto PF software, SonoScape). When automatic identification failed, manual slice adjustment was permitted before reattempting automated measurement. The automatic recognition rate was recorded in different functional states. Inter-rater reliability between manual and automated measurements was evaluated using intraclass correlation coefficient (ICC) and Bland-Altman analysis.

Results: The overall automatic recognition rate was 86.69%, varying by functional state: 94% at rest, 86.17% during contraction, 79.80% during Valsalva. Automated measurements showed good agreement with manual measurements for HA, AP and LR (ICC > 0.75), excellent agreement with the senior sonographer's measurement for HA, AP (ICC > 0.90). The senior sonographer's measurements demonstrated higher concordance with automated results. Furthermore, the agreement was poorest for LUG measurements.

Conclusions: Automated software is feasible for the recognition and measurement of LH in postpartum women, which can reduce the inter-observer variability, standardize pelvic floor assessment and improve workflow efficiency. Our study supports the clinical utility of CNN-based AI ultrasound software, but optimization is needed for LUG measurements to enhance clinical applicability.

Objectives: The sononeoperfusion effect involves the use of ultrasound-stimulated microbubbles (USMB) to enhance tumor perfusion, which may alleviate hypoxic conditions within solid tumors. This study aimed to compare this effect induced by diagnostic ultrasound (DUS) and low-intensity therapeutic ultrasound (TUS) with similar parameters.

Methods: Sixteen rabbits were included in the study and transplanted with VX2 tumors. They were randomized into 2 groups and received crossover USMB treatments of DUS and TUS under similar parameters, with an additional sham ultrasound as a control. Contrast-enhanced ultrasound was performed to calculate the peak intensity (PI), area under the curve (AUC), and perfusion area rate. The increase ratios of PI, AUC, and perfusion area rate were analyzed to compare the sononeoperfusion effects induced by DUS and TUS. Additionally, subjective visual assessments were carried out by 2 independent observers.

Results: PI, AUC, and perfusion area rate significantly increased after DUS and TUS treatments. There were no significant differences in increase ratios of PI, AUC, and perfusion area rate between DUS and TUS. Additionally, both observers agreed that there were no significant differences in visual assessments.

Conclusion: There are no significant differences in sononeoperfusion effects induced by DUS and low-intensity TUS with similar parameters.

Objectives: Colorectal cancer (CRC) is the third most common cancer globally and is frequently diagnosed at metastatic stages. As an alternative to the current standard of care, a novel high-intensity-focused ultrasound (HIFU)-based boiling histotripsy (BH) method has the potential to provide an ultrasound (US)-guided approach for non-invasive mechanical fractionation of CRC metastases and enhancement of anti-tumor immune response for inoperable primary CRC.

Methods: Young's modulus of the autopsy human sigmoid colon cancer was first measured using shear wave elastography. Volumetric BH lesion was then produced in the cancer sample ex vivo using a 2-MHz 9-element annular array (67.5° focusing angle) targeting a 3D-grid (5 × 5 foci across 2 transverse layers with 1-mm spacing) under B-mode US guidance. Each focus received 150 pulses of 1-ms duration (peak positive/negative pressures and shock amplitude P+/P/A_s = 91/-13/78 MPa, acoustic power and initial intensity within the pulse W₀ = 125.5 W and I₀ = 2.7 W/cm²) delivered at 0.1-s intervals (1% duty cycle). The obtained lesion was analyzed via B-mode imaging and histologically with hematoxylin-eosin and Masson's trichrome.

Results: Young's modulus of the autopsy CRC sample was 38 ± 10 kPa and aligned with clinical values for rectal adenocarcinomas. BH treatment was successfully guided in real-time using B-mode US: the treated area was hyperechoic during BH and hypoechoic post-treatment. Histology confirmed the presence of intact mucinous colon carcinoma outside the BH lesion, and fractionated cells and damaged stroma with disrupted collagen fibers within the lesion.

Conclusions: This ex vivo pilot study demonstrates the potential of BH for non-invasive non-thermal US-guided treatment for CRC and metastases.

Objectives: To evaluate the feasibility and inter-rater reliability of bedside muscle ultrasonography for detecting muscle loss in critically ill pediatric patients.

Design: A single-center prospective cohort study was conducted (January 2024-January 2025).

Methods: Critically ill children frequently experience rapid muscle loss, a complication associated with intensive care unit (ICU)-acquired weakness, prolonged mechanical ventilation, and increased morbidity. Early detection of muscle wasting may enable targeted interventions to mitigate these adverse outcomes.

Patients: Critically ill children (aged 2-18 years) requiring invasive mechanical ventilation for >24 hours.

Interventions: Serial ultrasound assessments of the quadriceps femoris muscle thickness and cross-sectional area were performed at baseline and during ICU stay. Potential risk factors (eg, corticosteroid use, neuromuscular blockade, hyperglycemia, and nutritional status) were recorded.

Results: Of the 35 patients enrolled in the study, 14 (40%) had significant muscle loss (defined as loss of ≥10% of muscle mass compared to the baseline assessment) detected by decreased muscle thickness, and 20 (57%) had muscle loss detected by reduced cross-sectional area. Muscle loss occurred 3-10 days into their critical illness and invasive mechanical ventilation. Stepwise multivariable logistic associations showed that patients with a lower ratio of actual-to-goal protein intake at the time of scan had higher odds of muscle loss, as it was associated with >10% decrease in cross-sectional area (adjusted OR 3.2, CI 1.22, 3.56) and that a higher mean level of C-reactive protein was associated with a significant decrease in muscle thickness (adjusted OR 1.7, CI 1.23, 3.34).

Conclusion: Bedside muscle ultrasonography is a feasible, and practical tool for early detection of muscle loss in critically ill children. Its noninvasive nature, portability, and cost-effectiveness support its potential integration into routine ICU monitoring to guide early rehabilitative or nutritional interventions. Further multicenter studies are warranted to validate these findings.