Journal of Ultrasound in Medicine最新文献

In the last decades, clinicians reported that patients, after failed or terminated intrauterine or cesarean scar pregnancies, demonstrated increased vascularization of the adjacent uterine muscle layers by ultrasound (US). These "earned" the incorrect diagnosis: uterine arterio-venous malformation (AVM). This misnomer was used without etiologic scrutiny by clinicians and repeated in scientific articles and textbooks. Despite the articles written during the same 10-20 years which tried to encourage caretakers of patients to relinquish the term AVM and use the correct term of enhanced myometrial vascularity (EMV). There still is a degree of ignorance as well as a knowledge gap in the obstetrical and radiological community as to the etiology, pathophysiology, and management of the above clinical entity. This article contains previously published, relevant ultrasound-based data on the subject along with our clinical experience highlighted by examples. We aim to fill this gap by providing illustrative clinical cases of the tools we consider relevant to the clinical diagnosis and management of EMV. We emphasize, that in the majority of cases expectant approach, avoids complications resulting from misdiagnosis and unnecessary treatment as well as pointing out the diagnostic importance of determining the parameters in guiding their treatment.

Ultrasound imaging is vital for musculoskeletal assessment due to its real-time, high-resolution capabilities and safety. While protocols exist for rotator cuff evaluation, comprehensive guidelines for imaging the latissimus dorsi and teres major muscles are lacking. This article fills this gap by presenting a detailed ultrasound protocol for these muscles, essential for shoulder stability and movement in overhead athletes. We review their anatomy, propose a standardized examination approach, and discuss clinical indications, aiming to improve diagnostic accuracy and management of these injuries.

Objectives: To determine the efficacy of quantitative shear wave elastography in differentiating benign and malignant axillary lymph nodes (ALN).

Methods: Exactly 127 lymph nodes from 127 patients with clinically palpable axillary swelling were examined by both B-mode sonography and elastography from November 2022 to March 2024. Gray-scale sonograms were evaluated based on: the short-axis diameter, shape, hilum, maximum cortical thickness, and border of the ALN. Shear wave elastography determined the mean elasticity modulus (E-mean) and elasticity ratio (E-ratio). Fine needle aspiration cytology or histopathological examination was kept as the gold standard and diagnostic performance shear wave elastography was compared.

Results: The data showed that out of 127 lymph nodes, 77 (60.6%) were benign and 50 (39.4%) were malignant based on pathological results. The E-mean for malignant lymph nodes (mean, 73.15 kPa) was higher than that for benign lymph nodes (mean, 21.47 kPa; P < .001). The area under the receiver operating characteristic curve for E-ratio in predicting malignant and benign lymph nodes was 0.897 (95% CI: 0.839-0.955). The E-ratio for malignant lymph nodes was also higher (mean, 10.2) than for benign nodes (mean, 2.95; P < .001). The area under the receiver operating characteristic curve for E-ratio in predicting malignant and benign lymph nodes was 0.816 (95% CI: 0.733-0.899).

Conclusion: Our results showed a significant association between tissue elasticity and pathological correlation.

Objective: To investigate the feasibility of remotely providing routine ultrasound (US) examinations to patients using a fifth-generation-based robot-assisted tele-ultrasonography (RATU) system in a real-world setting.

Methods: Between September 2020 and May 2021, we conducted a prospective and large-scale study using the RATU system to provide US examinations for patients on a limited-source island locate. An on-site radiologist on the island performed US examinations, which served as the reference diagnosis. Five tele-radiologists then remotely conducted RATU examinations from Central Shanghai. We compared the diagnostic performance of the RATU examinations to that of the on-site US examinations. Additionally, we assessed the learning curves of the various tele-radiologists. We also distributed 2 questionnaires to evaluate the usefulness of the clinical application.

Results: In total, 770 patients were enrolled in the study with a mean age of 55.46 ± 15.02 years (ranging from 19 to 80 years). Out of the total, 501 patients were men, and 269 were women. Across all examination types, the diagnosis in 84.3% (649/770) of RATU examinations was consistent with the on-site US examination. The learning curve was not significantly different between tele-radiologists of different seniority. Furthermore, 86.6% (667/770) of participants accepted the RATU examination, and 97.5% (751/770) of patients were willing to pay a fair price.

Conclusion: RATU's diagnostic performance is still helpful for patients in remote areas, even though it may be slightly inferior to on-site US examination.

Objective: This study investigated methods of evaluating the bone fracture healing process using superb microvascular imaging (SMI; two modes color SMI [cSMI] and monochromeSMI [mSMI]), and shear wave elastography (SWE), relative to X-ray, dual-energy X-ray absorptiometry (DXA), and platelet endothelial cell adhesion molecule 1 (PECAM-1) also know as cluster of differentiation 31 (CD-31) staining in a rabbit model.

Methods: This IACUC-approved study involved eight rabbits that underwent a bilateral fibula osteotomy and were followed for 7 or 21 days (Groups 1 and 2 with 4 rabbits in each). Ultrasound examinations using cSMI, mSMI, and SWE were performed on Days 0, 4, 7, 14, and 21 post-surgery. At the final time point, rabbits had X-ray imaging followed by euthanasia and DXA scan. Finally, the fracture areas underwent decalcification, and specimens were stained with CD-31 for pathological analysis. Ultrasound and X-ray findings were compared using ANOVAs or paired t-tests with CD-31 stains and DXA was used as a reference.

Results: Comparing SMI ultrasound images between the last time points for Group 1 (Day 7) and Group 2 (Day 21) showed no statistical significance difference for cSMI (P = .14) and mSMI (P = .06), similarly when compared with CD-31 stains there was no statistical significance difference for cSMI in Group 2 (P = .13). The SWE ultrasound images from the last time points in Groups 1 and showed no statistical significance difference (P = .33), the same results were then compared with DXA and also showed no statistical significance difference (P = .14). When comparing results of the X-ray images from the last time points for Groups 1 and 2 a statistical significance difference was found (P = .01), and when X-ray images were compared with DXA there was a statistical significance difference (P < .001).

Conclusion: Compared with CD-31 stains cSMI on Day 21 was not statistically significant (P = .13). Results comparing SWE with DXA were also not statistically significant (P = .14). These results indicate the potential of using certain ultrasound imaging techniques to monitor the bone fracture healing process.

Objective: Focused ultrasound has emerged as a precise and minimally invasive modality for effective cancer treatment. In this study, we propose a novel method that integrates the mechanical effects of focused ultrasound, known as histotripsy, with heating to enhance both the immediate and sustained cytotoxic effects on cancer cells.

Methods: Our investigation focused on VX2 cancer cells in suspension, examining five experimental groups: blank control, negative control, heating alone, histotripsy alone, and histotripsy with subsequent heating. B-mode ultrasound imaging was utilized to visualize cavitation bubble cloud formation and its motion during histotripsy. The suspension was contained in individually sealed compartments obtained from bubble wrap (referred to as bubble wrap compartments) embedded within the agarose phantom. Residual living cells were examined immediately after treatment and cultured for 96 hours to analyze the growth patterns. Additionally, CFDA SE staining was employed to assess cell proliferation. Furthermore, both intracellular and extracellular heat shock protein 70 (HSP70) levels were measured to investigate the potential initiation of an immune response.

Results: The combination of histotripsy and subsequent heating significantly reduced the normalized concentration of living cells immediately after treatment. It also decreased the proliferation rate of residual cells compared with the other experimental groups. Histotripsy with subsequent heating also increased the generation and release of HSP70, which might potentially enhance an innate anti-tumor immune response in vivo.

Conclusion: Histotripsy and subsequent heating improved the immediate lethal impact on VX2 cancer cells and curtailed the proliferation of residual cancer cells in suspension. This study presents a promising strategy for cancer therapy in the future.

Objectives: The prognostic characteristics of lung point-of-care ultrasound (L-POCUS) to predict respiratory decompensation in patients with emerging infections remains unstudied. Our objective was to examine whether scored lung ultrasounds predict hypoxia among a nonhypoxic, ambulatory population of patients with COVID-19.

Methods: This was a diagnostic case-control study. Three academic emergency departments across the United States collected a convenience sample of nonhypoxic subjects with COVID-19, scored subjects' hemithorax at 7 locations using lung ultrasound, and followed outcomes for 40 days. We defined cases as hypoxia (≤91% by pulse oxygenation) from 2 hours after index presentation to day 40. Follow-up was by telephone plus home pulse oximeter and by chart review. We conducted a logistic regression to test the association between L-POCUS scores and hypoxia. To evaluate lung ultrasound score prediction of a hypoxic event, we calculated sensitivity and specificity at optimal cut off scores and report receiver operating characteristic curve and area under the curve.

Results: We enrolled 163 subjects but excluded 15 (3 duplicate entries; 12 lost to follow up). Median age was 41 years (interquartile range [IQR] 31-56); 83 (56%) were female, and median body mass index was 29 (IQR 25-35). We classified 47 of 148 as hypoxic cases (32%, 95% confidence interval [CI]: 25-40), leaving 101 controls. L-POCUS scores associated with hypoxia by logistic regression (odds ratio = 1.05, 95% CI: 1.02-1.08), with a 5% increase in odds of hypoxia for each 1-unit increase in L-POCUS score. The optimal cut-off score was 15 (sensitivity, 0.60; specificity, 0.73) and the area under the curve was 0·66 (95% CI 0·58-0·75). The correctly classified proportion was 69% (95% CI: 61-76).

Conclusions: Among nonhypoxic COVID-19 patients, higher L-POCUS rubric scores were associated with hypoxia but no scoring threshold strongly predicts hypoxia at 40 days.

Objectives: Our previous studies have found that low-frequency, low-pressure, weakly focused ultrasound (FUS) can induce acoustic droplet vaporization (ADV) of perfluoropentane (PFP) droplets and result in localized liver and prostate tissue controllable cavitation resonance and mechanical damage. To further investigate the mechanical erosion induced by ultrasound and locally injected phase-shift acoustic droplets in rabbit liver.

Methods: The liver of each rabbit was treated with perfluoromethylcyclopentane (PFMCP) alone, FUS combined with PFMCP (FUS + PFMCP), and FUS combined with PFP (FUS + PFP).

Results: Two-dimensional ultrasound images showed that immediately after the completion of FUS + PFP group treatments, a high echogenicity bubble cloud could be observed, while there were no significant differences in the PFMCP and FUS + PFMCP group before and after treatment. The liver necrotic area in the FUS + PFP group was 6.2 times that of the FUS + PFMCP group (P < .05), whereas no liver necrosis was observed in the PFMCP group. At the same time, the number of vacuoles in the liver in the FUS + PFP group was approximately 70 times that of the FUS + PFMCP group (P < .001), whereas no vacuoles were observed in the PFMCP group (P < .001).

Conclusions: Both FUS + PFMCP and PFMCP alone have poor mechanical erosion in liver tissue, and may even cause no damage. Only PFP droplets combined with FUS can cause significant mechanical destruction of liver tissue, leading to tissue necrosis in the droplet injection area.

Objectives: This study analyzed carotid artery remodeling characteristics in early carotid atherosclerosis (ECAS).

Methods: The 1021 participants were evaluated using ultrasonography and categorized into three groups: Group A, 391 participants with increased intima-media thickness (IMT); Group B, 300 participants with atherosclerotic plaque only on the carotid bulb (CB); and the control group (330 participants). The ratios of the diameters in the CB to those in the common carotid artery (D_CCA) and internal carotid artery (D_ICA) were defined as carotid index1 (CI₁) and 2 (CI₂).

Results: Group A had a higher D_CCA, D_CB, and CI₂ than the controls (P < .05). Group B had a smaller D_CB, CI₁, and CI₂ than Group A, and higher D_CCA and smaller CI₁ than the controls (P < .05). Logistic regression showed that CI₂ was a positive influencing factor for increased IMT (OR: 3.42, 95% CI: 1.74-6.70, P < .001), and CI₁ was a negative independent factor for CB plaque formation (OR: 0.11, 95% CI: 0.04-0.28, P < .001). Multiple linear regression showed that only in Group B, the vessel side had a significant influence on CI₁ (β = 0.055, P < .05), while age, sex, body mass index, and cerebrovascular risk factors had no significant correlation with CI.

Conclusions: The CB and common carotid artery showed positive remodeling with increased IMT, however, the CB showed negative remodeling with plaque formation. CI changes were consistent with CB remodeling. CI was an independent influencing factor for ECAS, and it was only affected by vessel side, providing an objective predictive parameter for ECAS.