Journal of Ultrasound in Medicine最新文献

Objectives: To evaluate whether averaging replicate fetal biometry measurements during an examination improves estimated fetal weight (EFW) accuracy for predicting birthweight compared with a single set and to assess how variability in fetal biometric measurements changes across gestation.

Methods: Secondary analysis of the Eunice Kennedy Shriver National Institute of Child and Health and Human Development (NICHD) Fetal Growth Studies-Singletons. At each study visit, fetal head circumference (HC), abdominal circumference (AC), and femur length (FL) were measured in triplicate to compute EFW at each of 6 study visits (0-5). Variability among replicates was assessed across gestation using boxplots and two-way repeated measures ANOVA. For participants with visit 5 EFW (n = 1101), predictive accuracy of each individual measurement and their averages was compared with birthweight using average percent error and proportion within 10% of birthweight. One-way ANOVA and chi-square tests were applied. Sensitivity analyses included second-to-last visit, subgroups classified as small- or large-for-gestational age, and a subgroup of participants who delivered within 3 days of visit 5.

Results: Across visits, replicate HC, AC, and FL showed minimal variability, with no significant differences among replicates or across gestation. At visit 5, average EFW and standard deviations were similar across individual and averaged measurements. Percent errors ranged from 8.2 to 8.5% (p = .999), and proportion within 10% of birthweight ranged from 64.4 to 66.4% (p = .954). Sensitivity analyses produced similarly null findings.

Conclusions: In a controlled research setting with credentialed sonographers and standardized protocols, averaging replicate fetal biometric measurements did not improve EFW prediction of birthweight. A single high-quality measurement of fetal biometry may be sufficient, although further research is warranted to confirm generalizability to routine clinical practice.

Objectives: The morphological alterations of the tibial nerve in patients with diabetes mellitus, both with and without diabetic peripheral neuropathy (DPN), are challenging to differentiate using B-mode ultrasound. In this study, we assessed the stiffness changes of the tibial nerve by 2-dimensional shear-wave elastography (2D-SWE).

Methods: We gathered data from 70 adults with valid 2D-SWE measurements, comprising 25 individuals in DPN Group A who were diagnosed with DPN and had peripheral nerve symptoms in the past 6 months, 15 individuals in DPN Group B who were diagnosed with DPN but had no peripheral nerve symptoms in the past 6 months, 16 individuals with type 2 diabetes but without DPN, and 14 healthy individuals. The maximal thickness, cross-sectional area, and stiffness of the tibial nerve among groups were analyzed.

Results: DPN Group A had higher tibial nerve stiffness than Group B, non-DPN, and control groups (p < .05). The area under the curve (AUC) for 2D-SWE parameters in detecting increased nerve stiffness was 0.956 for G₁ (mean stiffness) and 0.979 for G₃ (distal stiffness), respectively, with optimal cut-off values of 20.01 and 28.41 kPa.

Conclusions: 2D-SWE is a promising non-invasive technique for early diagnosis of DPN, effectively reflecting changes in nerve stiffness associated with the condition. This method may enhance clinical interventions aimed at preventing disease progression.

Objectives: Adnexal masses during pregnancy are rare. This study aimed to evaluate the clinical application value of 3 prediction models: Assessment of Different NEoplasias in the adneXa (ADNEX), Simple Rules (SR), and Ovarian-Adnexal Reporting and Data System (O-RADS) in pregnant patients with adnexal masses and summarizes the clinical and ultrasonographic characteristics of adnexal masses during pregnancy.

Methods: A total of 65 patients confirmed by surgery and pathology were included in this retrospective single-center study. Three predictive models were applied to assess adnexal masses prior to surgery. The area under the ROC curve (AUC), accuracy, sensitivity, and specificity were calculated to evaluate the diagnostic efficiency of different models.

Results: Of these cases, 62 (95.4%) were benign and 3 (4.6%) were malignant. The median diameter of benign masses was 46.0 mm, while the median maximum diameter of malignant masses was 103.0 mm. The difference in maximum diameters between the 2 groups was statistically significant (p < .05). The performance of the predictive models varied: the area under the ROC curve (AUC) was 0.64, 0.91, and 0.94 for ADNEX, SR, and O-RADS. The differences in AUCs among these models were not statistically significant.

Conclusions: The incidence of malignant adnexal masses during pregnancy is low. Malignant masses, in contrast to benign masses, typically exhibit larger maximum diameters. SR and O-RADS showed good diagnostic efficacy and had certain clinical value in evaluating the benign and malignant of adnexal masses during pregnancy.

Transcarotid artery revascularization (TCAR) is a novel hybrid surgical and endovascular procedure that uses common carotid artery access via surgical exposure to stent an internal carotid artery stenosis. TCAR is increasingly used due to its lower risk of periprocedural stroke compared to transfemoral carotid artery stenting. We review the pre-operative imaging workup as well as normal post-operative imaging findings following TCAR. We also review complications following TCAR, which include immediate complications related to access site injury (hematoma, dissection, pseudoaneurysm and thrombosis) as well as more delayed complications such as intra-stent restenosis.

Fetal abdominal aorta-hepatic artery-umbilical vein fistulas are rare congenital vascular-related malformations. This study aimed to assess the diagnostic efficacy of ultrasound in detecting fetal aorta-hepatic artery-umbilical vein fistulas using high-definition flow (HD-flow) render mode and spatiotemporal image correlation (STIC) technology. The study emphasizes six case analyses of abdominal aorta-hepatic artery-umbilical vein fistula using HD-flow render mode and STIC. Postnatal outcome evaluations were performed at our medical facility. The fistulas formed a connection between the abdominal aorta and the umbilical vein. HD-flow render mode and STIC were acquired in all six cases. In three cases, fistulas with a diameter >3 mm were associated with extracardiac structural abnormalities and congenital heart defects. The incidence of heart failure was higher when the ratio of the fistula diameter to the umbilical vein diameter was >0.65 and to the abdominal aorta diameter was >0.9. Three fetuses were viable to survive, while three did not, including one that died in utero. HD-flow render mode and STIC facilitate a more accurate and comprehensive observation of the hemodynamics of the fetal abdominal aorta-hepatic artery-umbilical vein fistula, enabling the early diagnosis of related complications and determination of prognosis.

Objectives: To evaluate the relationship between umbilical and renal artery Doppler indices in fetuses with growth restriction (FGR) and to examine their association with amniotic fluid index (AFI), early- and late-onset subtypes, and perinatal outcomes.

Methods: This prospective observational study included 151 singleton FGR pregnancies between 24 and 37 weeks of gestation. Doppler measurements of the umbilical, middle cerebral, ductus venosus, and renal arteries were performed by a single perinatologist. Fetuses were classified into four groups according to umbilical artery (UA) flow pattern: normal resistance, increased resistance, absent end-diastolic flow (AEDF), and reversed end-diastolic flow (REDF). Associations between Doppler indices, AFI, and neonatal outcomes were analyzed using Spearman correlation, while group comparisons were performed with the Kruskal-Wallis and Wilcoxon rank-sum tests. Multivariable linear and logistic regression analyses were used to assess independent associations.

Results: Renal artery pulsatility and resistance indices did not differ significantly among UA flow groups, whereas a modest decline in the systolic/diastolic ratio was observed with increasing UA severity. Middle cerebral artery pulsatility index and cerebroplacental ratio decreased progressively, while ductus venosus pulsatility index increased across severity groups (all p < 0.001). Renal Doppler indices were significantly lower in early-onset FGR but showed no independent association with NICU admission or neonatal death after adjustment.

Conclusions: Renal artery Doppler parameters provide complementary physiological insight into fetal hemodynamic adaptation in growth-restricted pregnancies, particularly in early-onset cases and those complicated by preeclampsia; however, their independent predictive value for neonatal outcomes appears limited.