Journal of Ultrasound in Medicine最新文献

A 2012 review of therapeutic ultrasound was published to educate researchers and physicians on potential applications and concerns for unintended bioeffects (doi: 10.7863/jum.2012.31.4.623). This review serves as an update to the parent article, highlighting advances in therapeutic ultrasound over the past 12 years. In addition to general mechanisms for bioeffects produced by therapeutic ultrasound, current applications, and the pre-clinical and clinical stages are outlined. An overview is provided for image guidance methods to monitor and assess treatment progress. Finally, other topics relevant for the translation of therapeutic ultrasound are discussed, including computational modeling, tissue-mimicking phantoms, and quality assurance protocols.

Double aortic arch with an atretic left aortic arch can resemble like a right aortic arch with an aberrant left subclavian artery or a right aortic arch with mirror image branching. Differentiating these closely resembling fetal aortic arch abnormalities is important for proper prenatal counselling and immediate neonatal evaluation. In this pictorial essay, we describe these three cases and its typical imaging features using conventional and four-dimensional echocardiography.

Objectives: The reported prevalence of adenomyosis ranges widely due to different study populations, diagnostic tests and criteria. Categorizing the severity of disease may prove important. This study aims to develop a semi-quantifiable sonographic method to grade the severity of adenomyosis and assess the feasibility and interobserver reliability of this method.

Methods: Cross-sectional pilot study performed at a gynecology outpatient clinic, included 35 premenopausal women with adenomyosis, not taking hormonal medication. Diagnosis required ≥1 direct sonographic feature of adenomyosis. Two-dimensional (2D) grayscale video clips and 3-dimensional (3D) volumes of the uterus of the first 5 patients were evaluated using 6 offline methods to assess feasibility. Feasible methods were analyzed for interobserver (n = 3) reliability (Fleiss kappa or intraclass correlation) and compared with current ultrasound methods (Cohen's weighted kappa and Spearman's rank correlation). Current methods include real-time estimation (mild/moderate/severe) and counting the individual sonographic features.

Results: "eXtended Imaging virtual organ computer-aided analysis (XI VOCAL) counting" (counting affected slices of 20 parallel slices in the 3D volume), "Multiplanar and 3D rendering (MPR) estimation" (grading volume by eyeballing in multiplanar render mode), and "2D-clip estimation" (grading volume in 2D-clips) emerged as feasible methods. "XI VOCAL counting" and "2D-clip estimation" demonstrated good interobserver reliability, whereas "MPR estimation" had poor reliability. Comparison with real-time estimation showed moderate reliability with all methods. "XI VOCAL counting" and "MPR estimation" correlated positively with the number of sonographic features.

Conclusion: "XI VOCAL counting" demonstrated to be feasible with good interobserver reliability to assess the severity of adenomyosis in an objective, systematic, and semi-quantifiable fashion and should be validated with large-scale studies for future use. Future studies should also explore the association between sonographic severity and symptoms of adenomyosis.

Objective: To assess the reproducibility of standardized 3-dimensional (3D) ultrasound volume analysis of the dimensions and the position of cesarean birth (CB) scar niche relative to the cervix in pregnant women.

Methods: This prospective single-center study in women with 1 previous CB ≥8 cm cervical dilatation acquired ultrasound volumes between 11 and 24 weeks' gestation in a mid-sagittal plane. Two experienced operators processed the volumes using virtual organ computer-aided analysis. A CB scar niche was defined as an indentation at the scar site of ≥2 mm in depth. Niche and cervix volumes were calculated using manual contouring. Agreement for categorical variables was expressed using intraclass correlation coefficient (ICC). The Bland-Altman method was used to assess numerical variable reproducibility.

Results: To achieve the desired statistical power, 52 participants were included. The intraobserver agreement on niche classification relative to the internal os was 100%, with an interobserver kappa coefficient of 0.98 (95% confidence interval [CI] 0.97-0.99, P < .05). The intraobserver ICC for niche volume was 0.94 (95% CI 0.90-0.96; P < .001), with a mean difference of -15.32 mm³ (±109.32). The interobserver ICC was 0.78 (95% CI 0.62-0.87; P < .001), with a mean difference of -21.57 mm³ (±202.01). The ICC for niche/cervix volume ratio were 0.94 (95% CI 0.90-0.96; P < .001) and 0.79 (95% CI 0.63-0.87; P < .001) for intra- and interobserver reproducibility, respectively.

Conclusions: This study demonstrates that 3D CB scar sonographic features are highly reproducible in pregnant women with a history of advanced labor CB. The validated protocol can guide future research on the association with subsequent adverse pregnancy outcomes.

Objectives: Contrast-enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS) is used to definitively diagnose hepatocellular carcinoma (HCC) in patients at risk. However, the user variability associated with CEUS LI-RADS has not been validated in North American and European patients. This study aims to evaluate the inter-reader agreements of CEUS LI-RADS features for, and final categorization of, HCC in patients at risk.

Methods: This retrospective multicenter clinical study used the database of a previous prospective multinational study, evaluating the accuracy of CEUS LI-RADS for HCC diagnosis in patients at risk. All cases were first evaluated by a site physician performing/supervising the CEUS examination. Randomly selected cases were re-evaluated by a blinded central reader. Final diagnosis was confirmed with the reference standard, which was a composite of imaging tests and histology. Cohen's kappa test was used to evaluate inter-reader agreement.

Results: This study included 150 liver nodules and 58.0% (87/150) were confirmed as HCC, 4.7% (7/150) non-HCC malignancies, 22.7% (34/150) had no confirmed final diagnosis, and 14.7% (22/150) were nonmalignant. Inter-reader agreements were substantial for CEUS LI-RADS categorization (κ = 0.61; 95% confidence interval [CI]: 0.51-0.71) and major features assessment (ranged κ = 0.64-0.78), LR-5 (κ = 0.65; 95% CI: 0.52-0.77), and LR-M (κ = 0.67; 95% CI: 0.44-0.90), while for LR-1 and LR-2 categorization was almost perfect (κ = 0.85; 95% CI: 0.65-1.00).

Conclusion: Our study reported a substantial inter-reader agreement for overall CEUS LI-RADS categorization, especially for LR-5 and LR-M, and major imaging features of HCC, further confirming CEUS LI-RADS as a valuable and reliable tool for diagnosis of HCC.

Objectives: To evaluate for distinguishing demographic and sonographic features of small (<3 cm) endophytic angiomyolipomas (AMLs) that differentiate them from endophytic renal cell carcinomas (RCCs).

Methods: This is a Health Insurance Portablitiy and Accountablity Act (HIPAA)-compliant retrospective review of the demographics and ultrasound features of endophytic renal AMLs compared to a group of endophytic RCCs. AMLs were confirmed by identifying macroscopic fat on computed tomography (CT) or magnetic resonance imaging (MRI), while RCCs were pathologically proven. Statistical analysis was used to compare findings in the 2 groups.

Results: There were a total of 66 patients with 66 AMLs, and 28 patients with 28 RCCs. Of the AMLs, 57 of 66 were in females, while 10 of the 28 RCC cases were in females (P < .0001). The mean AML long and short diameters were 11.0 × 9.3 mm and were statistically significantly smaller (P < .0001) than the diameters of the RCCs (23.4 × 22.1 mm). Likewise, the ratio of the long axis to the short axis measurement was statistically significantly different between the 2 groups (P < .0001). Of the studied sonographic features, statistically different features between AMLs and RCCs included an oval versus a round shape (P < .001), respectively, and the presence versus absence of an echogenic margin, respectively. Location of the mass, mass homogeneity, mass lobulation, and presence of cystic components were not distinguishing features using P < .01 levels.

Conclusion: For an endophytic echogenic mass in a female patient, a small size with an oval shape and an echogenic margin is statistically more likely to be an AML than an RCC, which may be helpful with management decisions.

Objectives: Transcranial low-intensity focused ultrasound (LIFU) offers unique opportunities for precisely neuromodulating small and/or deep targets within the human brain, which may be useful for treating psychiatric and neurological disorders. This article presents a novel ultrasound system that delivers focused ultrasound through the forehead to anterior brain targets and evaluates its safety and usability in a volunteer study.

Methods: The ultrasound system and workflow are described, including neuronavigation, LIFU planning, and ultrasound delivery components. Its capabilities are analyzed through simulations and experiments in water to establish its safe steering range. A cohort of 20 healthy volunteers received a LIFU protocol aimed at the anterior medial prefrontal cortex (amPFC), using imaging and questionnaires to screen for adverse effects. Additional development after the study also analyzes the effect of the skull and sinus cavities on delivered ultrasound energy.

Results: Simulations and hydrophone readings agreed with <5% error, and the safe steering range was found to encompass a 1.8 cm × 2.5 cm × 2 cm volume centered at a depth 5 cm from the surface of the skin. There were no adverse effects evident on qualitative assessments, nor any signs of damage in susceptibility-weighted imaging scans. All participants tolerated the treatment well. The interface effectively enabled the users to complete the workflow with all participants. In particular, the amPFC of every participant was within the steering limits of the system. A post hoc analysis showed that "virtual fitting" could aid in steering the beams around subjects' sinuses.

Conclusions: The presented system safely delivered LIFU through the forehead while targeting the amPFC in all volunteers, and was well-tolerated. With the capabilities validated here and positive results of the study, this technology appears well-suited to explore LIFU's efficacy in clinical neuromodulation contexts.

Objective: To determine equations for calculating the Z-scores of fetal cardiac structures between 18⁺⁰ and 34⁺⁶ weeks of gestation, create percentile reference tables and curves for the structures, and assess the intra- and inter-observer reproducibility of the measurements.

Methods: A cross-sectional study was conducted involving 340 normal fetuses from singleton pregnancies between 18 and 34 weeks of gestational age (GA). Nineteen cardiac structures were evaluated: diameters of the mitral, tricuspid, aortic, and pulmonary valve annuli; length, diameter, and area of the left and right ventricles; cardiac area and circumference; and diameters of the ascending aorta, aortic isthmus, main pulmonary artery, right pulmonary artery, left pulmonary artery, and ductus arteriosus. Regression analysis was performed to determine the equations for the mean and standard deviation of all structures using GA, biparietal diameter (BPD), and femur length (FL) as independent variables.

Results: All equations had high coefficients of determination (R²). The best performance was achieved using the GA (R² .819-.944), followed by FL (R² .813-.937) and BPD (R² .792-.934). The structure that demonstrated the highest R² was the cardiac circumference and the smallest was the ductus arteriosus. Reference tables of percentiles 1, 5, 10, 50, 90, 95, and 99, and reference curves of Z-scores were created for all 19 cardiac structures, depending on the GA. All measurements demonstrated good and excellent reproducibility with an inter-observer intraclass correlation coefficient (ICC) of 0.774-0.972 and intra-observer ICC of 0.938-0.993.

Conclusions: Equations were produced to calculate Z-scores as well as percentile tables and curves for 19 fetal heart structures. All the measurements demonstrated good reproducibility.

Objective: To assess embryonic and fetal cardiac growth and development using transvaginal 2-dimensional sonography before 12 weeks of gestation.

Methods: Transvaginal scans for first-trimester dating were performed for 131 normal fetuses at 8-11 + 6 weeks of gestation. The basal-apical length (BAL), transverse length (TL), cardiac circumference (ECC), embryonic cardiac area (ECA), global sphericity index (GSI), and cardio-thoracic area ratio (CTAR) were able to be obtained in 105 normal embryos and fetuses.

Results: Nomograms for several cardiac parameters including BAL, TL, ECC, ECA, GSI, and CTAR were constructed. BAL, TL, ECC, and ECA increased curvilinearly with advancing gestation (R² = 0.97406, 0.980396, 0.978359, and 0.920705, respectively, P < .001). GSI (mean, 1.14; SD, 0.10) and CTAR (mean, 15.7%; SD, 3.3%) values were constant at 8-11 + 6 weeks of gestation. There were significant curvilinear correlations between BAL, TL, ECC, and ECA, and crown-rump length (CRL) (R² = 0.975976, 0.983482, 0.980673, and 0.929936, respectively, P < .001). GSI and CTAR values were not changed with the increase of CRL during this period.

Conclusion: Our results provide nomograms for several cardiac parameters which may improve the understanding of embryonic and fetal cardiac growth and development prior to 12 weeks of gestation.

Objective: This study compared the accuracy of prenatal congenital heart disease (CHD) diagnosed by maternal-fetal medicine specialists (MFMs) and pediatric cardiologists (PCs), using postnatal cardiac findings as the reference standard.

Methods: This retrospective analysis at Siriraj Hospital, Bangkok, Thailand, involved 125 pregnancies with fetal CHD diagnosed by MFMs and evaluated by PCs later. Prenatal CHD diagnoses by either MFM or PC were compared with postnatal diagnoses obtained through echocardiography, cardiac surgery/catheterization, or autopsy. Diagnostic accuracy was classified as (A) correct diagnosis, (B) minor differences not impacting clinical management or outcomes, or (C) major differences affecting prognosis or treatment.

Results: Cardiac sonography by MFM achieved diagnostic accuracies of 73.6% (A), 16% (B), and 10.4% (C), while fetal echocardiography by PC resulted in accuracies of 72% (A), 20% (B), and 8% (C). No statistically significant differences were found between MFM and PC in each category (P = .375-.832). The MFMs' accuracy was highest for tetralogy of Fallot (94.4%; 95% CI, 72.7-99.9%) and lowest for right atrial isomerism (71.4%; 95% CI, 29-96.3%) and pulmonary atresia with ventricular septal defect (57.1%; 95% CI, 18.4-90.1%).

Conclusions: MFMs and PCs demonstrated high and comparable accuracy in prenatal CHD diagnosis. Although PCs tended to outperform MFMs in cases where misdiagnosis could significantly impact neonatal care and outcomes, MFMs can effectively perform primary screening for fetal CHD in all pregnancies. Collaboration with PCs remains essential when fetal CHD is suspected, particularly in complex cases.