Journal of Ultrasound in Medicine最新文献

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.

Objectives: Triple-negative breast cancer (TNBC) exhibits poor chemotherapy response and prognosis due to the lack of targeted therapies and a hypoxic, poorly vascularized tumor microenvironment. This study demonstrated the efficacy of low-power ultrasound-stimulated microbubble (USMB) therapy in enhancing drug delivery and improving the TNBC microenvironment, with a focus on its relationship with nitric oxide (NO).

Methods: A 4T1 murine TNBC model was established. Multi-parametric imaging techniques, including contrast-enhanced ultrasound (CEUS), ultra-resolution microscopy imaging (URM), and photoacoustic imaging (PAI) were innovatively combined to assess tumor perfusion, oxygenation, and drug delivery following USMB treatment. Epirubicin penetration and targeted intratumoral distribution were quantitatively analyzed using high-performance liquid chromatography (HPLC) and CD31 immunofluorescence under confocal microscopy. NO inhibition experiments were conducted to evaluate the involvement of the endothelial NO synthase (eNOS)/NO pathway.

Results: Group USMB significantly increased tumor perfusion within 4 hours post-treatment (p < .001), reduced perfusion-deficient regions, and raised oxygenation to 1.4-fold of baseline. Doxorubicin (Dox) concentration was 3.15-fold higher than the chemotherapy group, with wider distribution. Blocking eNOS/NO signaling markedly attenuated the perfusion-enhancing effects of USMB, implicating NO as a key mediator.

Conclusion: USMB improves the TNBC microenvironment and enhances drug delivery by promoting perfusion and oxygenation, likely via NO signaling. These findings support USMB as a promising strategy for TNBC combination therapy and highlight NO as a potential therapeutic target.

Objective: This study aimed to investigate the effect of fetal growth restriction (FGR) on cortical maturation and fissure development using detailed neurosonography. We compared cortical grades and fissure measurements between FGR and healthy fetuses to determine if growth restriction is linked to delayed cortical maturation in specific regions.

Methods: This observational case-control study included singleton pregnancies at 31-35 weeks of gestation between January 2025 and September 2025. FGR was diagnosed according to the Delphi consensus criteria. All participants underwent obstetric ultrasonography, fetoplacental Doppler, and fetal neurosonography. The depths of the Sylvian, parieto-occipital, calcarine, and cingulate fissures, as well as the insula, were measured and normalized to biparietal diameter (BPD). Cortical maturation was assessed using the Pistorius grading system.

Results: A total of 148 fetuses were analyzed (74 FGR, 74 controls). The FGR group showed higher uterine artery pulsatility index (PI) (P = .015) and lower middle cerebral artery (MCA) PI (P < .001). Neurosonography revealed significantly shallower parieto-occipital (P < .001), calcarine (P < .001), and cingulate (P < .001) fissures in the FGR group, while Sylvian fissure depth showed a nonsignificant trend (P = .057). After normalization to BPD, parieto-occipital/BPD and calcarine/BPD ratios remained significantly lower. In addition to quantitative fissure measurements, cortical maturation was evaluated. Only the Sylvian fissure showed a significantly lower maturation grade (P = .003). Cerebellar, vermian, and corpus callosum measurements were comparable.

Conclusion: FGR is associated with region-specific cortical developmental delay, predominantly involving the parieto-occipital, calcarine, and cingulate fissures, while infratentorial and commissural structures remain preserved. Neurosonography provides a practical, accessible, and reliable tool for detecting these subtle cortical alterations in high-risk pregnancies.