Journal of Ultrasound in Medicine最新文献

Objectives: Fetal inguinal hernia (FIH) refers to the descent of abdominal contents through the inguinal canal in the fetus. This uncommon condition could lead to an adverse neonatal outcome if the diagnosis is underestimated. This study aims to elucidate the ultrasonic features, clinical presentation, management, and neonatal outcomes of FIH.

Methods: This case series reports FIHs between 2010 and 2024 at Orleans University Hospital, France. All cases had at least 1 imaging evidence of FIH and the diagnosis was confirmed at birth. In addition, the last 15 years of literature review from the inception to July 2025 were included.

Results: Overall, 3 cases relating to FIH were found at our maternity center. Following the additional data in the literature, 19 cases were reported in the last 15 years, and a total of 29 cases, consisting of our 3 cases, were found in the literature until today. The clinically common characteristics include the male fetus and the right side. The average gestational age at detection was 35 weeks. Regarding features of ultrasound images, the mean size of the mass was 42 mm. Additionally, the presence of Doppler signal, peristalsis, bowel obstruction, and hydrocele were reported at 61.5, 76.5, 28.6, and 40.0%, respectively. Almost all cases required surgical repair after birth without complications.

Conclusions: Although its rarity, awareness of FIH should not be underestimated during antenatal care. Antenatal ultrasound plays an important role in detecting the FIH and monitoring the progression of fetal hernial mass during pregnancy. A good prognosis of isolated FIH could be made if timely multidisciplinary management is performed.

Objectives: To determine whether a fetal right ventricular (RV) free-wall pericardial effusion (PE) is associated with alterations of ventricular geometry and function.

Methods: Retrospective review of 1373 second- and third-trimester fetuses between 20 and 39 weeks of gestation was done to identify fetuses with a PE. Diastolic function was assessed via pulsed Doppler of RV and left ventricular (LV) inflow tracts, with monophasic filling in the presence of contralateral biphasic inflow classified as abnormal. End-diastolic RV and LV area, width, length, and sphericity were measured as well as systolic function. Z-score equivalent percentiles were computed for the above measurements. Statistical comparisons used published normative controls, with abnormalities defined as z-score equivalent percentiles (<10th or >90th percentile). Segmental movement of the ventricular free wall and septum was classified as hyperkinetic, hypokinetic, akinetic, and paradoxical.

Results: Four-chamber view (4CV), RV, and LV area, length, and mid-chamber width <10^th percentile was more frequent than controls. Diastolic disturbance was selective to the RV: 87% (26/30) showed a monophasic tricuspid A-waveform with preserved mitral inflow. Systolic assessment revealed decreased (<10th percentile) RV and LV fractional area change, mid-chamber fractional shortening, as well as LV cardiac output and ejection fraction to be more frequent than controls as well as global and free-wall strain >90th percentile. Segmental analysis demonstrated high rates of paradoxical septal motion (33% LV, 73% RV) and regional akinesis.

Conclusion: A localized right free-wall PE is associated with altered chamber geometry, selective diastolic impairment, discordant systolic deformation, and frequent paradoxical septal motion.

Objectives: To establish reference ranges for Doppler indices of the maternal ophthalmic artery in low-risk pregnancies during the second and third trimesters.

Methods: This retrospective cross-sectional study included 358 low-risk pregnancies between 20 and 41 weeks of gestation. Doppler ultrasound of the maternal ophthalmic artery was performed, and the following indices were calculated: pulsatility index (PI), resistance index (RI), peak systolic velocity (PSV), second peak systolic velocity (P2), end diastolic velocity (EDV), and the ratio between peak systolic velocities (PR). Polynomial regression analysis was used to model the fit of a polynomial equation for each Doppler index as a function of gestational age. The 5th, 50th, and 95th percentiles were determined for each gestational age interval.

Results: A significant negative correlation was observed between gestational age and RI (r = -0.11, p = .025) and PSV (r = -0.219, p = .0003), while a significant positive correlation was found between gestational age and PR (r = 0.14, p = .007). No significant correlations were observed between gestational age and PI, P2, or EDV. Reference intervals for each Doppler index were established according to gestational age, providing the 5th, 50th, and 95th percentiles.

Conclusion: This study provided reference intervals for Doppler indices of the maternal ophthalmic artery in low-risk pregnancies during the second and third trimesters. These reference values may aid in the interpretation and clinical application of Doppler findings, particularly in the context of predicting and monitoring preeclampsia.

Objectives: To investigate the dimensions of infratentorial brain structures in fetuses with prenatally diagnosed congenital heart disease (CHD) and determine whether these measurements differ based on the expected pattern of fetal brain oxygen delivery.

Methods: This prospective case-control study was conducted at a tertiary perinatal center. A total of 112 singleton pregnancies between 28 and34 weeks of gestation were enrolled, comprising 56 fetuses with CHD and 56 healthy controls. CHD cases were classified into 2 groups based on expected fetal brain oxygen delivery: Class A (n = 29, expected oxygen supply) and Class B (n = 27, expected normal oxygen supply). Detailed neurosonographic evaluation was performed using standardized protocols to measure infratentorial structures including cerebellar vermis (craniocaudal diameter [CCD], anteroposterior diameter [APD], circumference, and area), trans-cerebellar diameter, and brainstem structures (pons, midbrain, and medulla oblongata APDs). Maternal demographic characteristics, pregnancy course, and outcomes were retrieved from the hospital database.

Results: Demographic characteristics were comparable between groups except for gestational age at delivery (38.23 ± 1.41 versus 38.87 ± 1.19 weeks, p = .011) and birth weight (3121 ± 477 g versus 3336 ± 318 g, p = .006), which were significantly lower in the CHD group. Fetuses with CHD demonstrated significantly smaller vermis CCD (Class A: 19.3 ± 1.65 mm, Class B: 19.2 ± 1.39 mm versus Controls: 20.6 ± 0.84 mm, p = .001) and vermis area (Class A: 2.70 ± 0.07 cm², Class B: 2.71 ± 0.11 cm² versus Controls: 2.86 ± 0.24 cm², p = .001). Brainstem measurements revealed significantly reduced pons APD (Class A: 12.2 ± 1.62 mm, Class B: 12.1 ± 1.10 mm versus Controls: 13.4 ± 1.45 mm, p = .001) and medulla oblongata APD (Class A: 8.4 ± 0.87 mm, Class B: 8.3 ± 0.98 mm versus Controls: 9.2 ± 0.96 mm, p = .001). Trans-cerebellar diameter, vermis APD, vermis circumference, and midbrain APD showed no significant differences between groups. Importantly, no significant differences were observed between Class A and Class B CHD groups for any measured parameter.

Conclusion: Fetuses with CHD exhibit significant reductions in specific infratentorial brain measurements, including cerebellar vermis dimensions and brainstem structures (pons and medulla oblongata), compared to healthy controls. These abnormalities are present regardless of the CHD classification based on expected cerebral oxygen delivery, suggesting that the impact of CHD on fetal brain development is more complex than previously understood. These findings support the implementation of comprehensive neurosonographic evaluation in all fetuses with CHD and highlight the need for further research correlating prenatal infratentorial measurements with long-term neurodevelopmental outcomes.

Objectives: Based on pelvic floor ultrasound and Glazer pelvic floor surface electromyography parameters in postpartum patients with stress urinary incontinence (SUI), this study aims to establish a model and explore its clinical value in predicting the disease.

Methods: A total of 193 postpartum women admitted to our hospital were enrolled and divided into the SUI group (67 cases) and non-SUI group (126 cases) according to the occurrence of SUI at 6-8 weeks postpartum. The recruitment period is from May 2023 to May 2025. This study has been approved by the Ethics Review Committee of our institute (Approval No: 2025-33). All subjects are patients attending our department (all patients provide verbal consent, witnessed by outpatient medical records). Clinical data, 3-dimensional pelvic floor ultrasound parameters, and Glazer pelvic floor sEMG parameters were collected from both groups. Univariate and multivariate analyses were performed to screen independent factors, based on which a nomogram model was established. Receiver operating characteristic (ROC) curves and clinical decision curves were plotted.

Results: Significant differences were observed between the 2 groups in neonatal body weight, maternal weight at follow-up, bladder neck mobility (BNM), urethral rotation angle (URA), posterior vesicourethral angle (PVA), levator hiatus area (LHA), pelvic floor fast contraction force, tonic contraction force, and endurance (all p < .05). Multivariate analysis identified URA, PVA, pelvic floor fast contraction force, tonic contraction force, and endurance as independent risk factors for SUI. The ROC curve showed an area under the curve (AUC) of 0.838. The decision curve indicated that the net benefit curve was higher than both the "All" line and the "None" line.

Conclusion: The established model demonstrates high predictive value for postpartum SUI. The combination of pelvic floor ultrasound and Glazer pelvic floor electromyography can improve the diagnostic accuracy of SUI.

Objectives: Levator avulsion is a risk factor for pelvic organ prolapse (POP) and treatment failure. The current gold standard for diagnosis is tomographic translabial ultrasound (TLUS) in the axial plane. Avulsion is usually described as full or partial, unilateral or bilateral. Further classification into Type I where there is a hyperechoic "connection" to the sidewall, and Type II when there is no such connection has been suggested. The objective is to compare associations between avulsion types and POP.

Methods: A retrospective study on archived datasets of 931 women seen at a tertiary urogynecological service. All had undergone a standardized interview, pelvic organ prolapse quantification (POPQ) examination and 4D TLUS. Postprocessing of archived ultrasound volume data was performed. Associations of avulsion types and POP symptoms and signs were tested.

Results: Mean age was 57.8 years (19-94), mean body mass index (BMI) was 29.6 kg/m² (16.9-65.4). A total of 496 (53%) reported prolapse symptoms. Overall, 741 (80%) were diagnosed with significant prolapse on POPQ, 639 (66%) on imaging. Avulsion was found in 194 (21%). An assessment of avulsion type could be undertaken in 188 women. Type I avulsions were found in 136 women (15%), Type II in 52 (6%). Type II avulsion was not found to be more predictive of symptoms and signs of POP compared to Type I avulsion (all p > .017 versus all p < .001).

Conclusion: Type II avulsion, which is supposed to represent more severe trauma, does not seem to convey any additional risk of symptoms and/or signs of prolapse compared to Type I avulsion. It does not seem to be necessary to distinguish between these two avulsion types on transperineal ultrasound.