Objectives: Ultrasound-guided percutaneous needle fenestration (UPNF) and percutaneous needle tenotomy (UPNT) are minimally invasive procedures commonly used to treat chronic tendinopathies. However, these techniques can be painful, potentially limiting patient tolerance, satisfaction, and procedural feasibility. Although local anesthetics (LAs) provide analgesia, their potential inhibitory effects on tenocyte activity and the efficacy of orthobiologics raise concerns regarding their impact on tendon healing. The objectives of this study is to propose a practical, anatomy-based approach for the use of ultrasound-guided peripheral nerve blocks (USG-PNBs) as a strategy to reduce pain and improve patient comfort during UPNF and UPNT, with or without orthobiologic adjuncts.
Methods: We reviewed commonly affected anatomical sites in chronic tendinopathies and identified corresponding peripheral nerve targets that can be reliably and safely blocked under ultrasound guidance. For each condition, we outline appropriate nerve block techniques, anatomical landmarks, and recommended patient positioning to optimize procedural analgesia.
Results: A set of targeted USG-PNBs was defined for commonly treated tendinopathies, including supraspinatus tendinopathy, lateral and medial epicondylitis, gluteus medius and/or minimus tendinopathy, patellar tendinopathy, Achilles tendinopathy, and plantar fasciopathy.
Conclusion: Ultrasound-guided peripheral nerve blocks represent a practical and effective approach to manage pain during percutaneous procedures for chronic tendinopathies. By reducing procedural discomfort and avoiding the potential drawbacks of peritendinous LAs, these techniques may enhance patient tolerance, procedural success, and overall clinical outcomes.
Developmental dysplasia of the hip (DDH) causes preventable morbidity when diagnosis is delayed. We review advances that address screening gaps: 3-dimensional (3D) ultrasound for volumetric visualization with retrospective plane selection; artificial intelligence (AI)-assisted 2-dimensional (2D) cine sweeps that add automated quality control and classification for lightly trained operators; and open-source software and datasets that enable external validation and standardization. A pragmatic pathway is universal newborn screening using brief AI-assisted 2D sweeps, with abnormal or indeterminate results referred for confirmatory 3D ultrasound to define dysplasia patterns and guide care. Implementation studies and consensus standards for acquisition and reporting are priorities.
Background: Gestational diabetes mellitus (GDM) is a common complication observed during pregnancy, with its global prevalence increasing in recent years. GDM has been linked to adverse myocardial remodeling in the fetus and impaired fetal cardiac function. This study seeks to evaluate the impact of GDM on fetal global cardiac function using dual-gate Doppler ultrasound (DD) technology, and to investigate the potential benefits and advantages of DD technology in assessing fetal cardiac function.
Methods: A cohort consisting of 56 pregnant women diagnosed with gestational diabetes mellitus between 24 and 28 weeks of gestation (GDM group) was selected, alongside a control group of 55 pregnant women with normal glucose levels at the same gestational age. Both the conventional pulsed combined method and the dual-gate (DD) method were utilized to evaluate the ultrasound parameters of fetal global cardiac function in both groups. These parameters included isovolumic contraction time (ICT), isovolumic relaxation time (IRT), and ejection time (ET), from which the Tei index was subsequently calculated.
Results: The ICT, IRT, and Tei index of the left heart in the GDM group were significantly elevated compared to the control group (P < .05). Although ET in the GDM group, as assessed by the combined method, demonstrated a decreasing trend, this difference did not achieve statistical significance (P > .05). Conversely, the ET determined by the DD method in the GDM group was significantly reduced compared to the control group (P < .05). Right ventricular Tei index measurements showed poor consistency, with intraobserver ICCs of 0.56 for the separated measurement and 0.58 for the DD method, and interobserver ICCs of 0.50 and 0.53. As a result, right ventricular Tei indices were excluded from the final analysis.
Conclusion: Pregnant women with GDM will cause an increase in the Tei index of the fetal left global cardiac function, indicating that the intrauterine hyperglycemic environment can cause damage to the global fetal cardiac function. The global fetal cardiac function was impaired in both the well-controlled and poorly controlled GDM groups, suggesting that early detection of GDM and the fetal cardiac dysfunction caused by GDM are necessary. The measurement of the Tei index of the left heart in the fetus using dual-gate Doppler technology can help detect the fetal cardiac dysfunction caused by GDM at an early stage, while the application of dual-gate Doppler technology in the overall cardiac function of the right heart still faces significant challenges.
Objectives: The role of ultrasound in small bowel stricturing Crohn's disease (CD) is unclear. We aimed to investigate whether intestinal ultrasound can be used to monitor treatment response, guide treatment strategy, and predict outcomes in small bowel stricturing CD.
Methods: We performed a multicenter retrospective study of 121 consecutive patients with small bowel stricturing CD who received biological therapy for at least 3 months. Two kinds of ultrasonographic response were evaluated: inflammation response (improvement in bowel wall thickness and vascular intensity) and stricture response (inflammation response with no luminal narrowing). Treatment was optimized when no inflammation response or loss of inflammation response was detected. Cox regression analysis was performed to investigate the predictors of CD-related hospitalization.
Results: The rate of inflammation response increased from 57.0% at the end of induction therapy (date 1) to 67.8% 1 year later (date 2) (p = .031). No significant difference was observed for the rate of stricture response between date 1 and date 2 (28.1% versus 27.3%, p = 1.000). Ultrasound led to 91 treatment optimizations, after which 29 patients achieved inflammation response and 9 achieved stricture response. Multivariate analysis showed that stricture response at the end of induction therapy was independently associated with a decreased risk for CD-related hospitalization (hazard ratio 0.29, 95% CI 0.09-0.96; p = .043).
Conclusion: Intestinal ultrasound can be used to monitor treatment response and guide treatment strategy in small bowel stricturing CD. Early stricture response on intestinal ultrasound is associated with improved outcomes.
Objectives: To analyze obstetric ultrasound utilization and expenditures per live birth delivery among the commercially insured from 2016 to 2022 and present updated trends and variation in use by type of ultrasound and across subgroups.
Methods: In this retrospective United States-based cohort study, obstetric ultrasound utilization and expenditures during pregnancy were measured for a cohort of all deliveries with at least 28-week gestation that resulted in a live birth between January 1, 2017 and December 31, 2022, using the Health Care Cost Institute commercial claims database. We report utilization trends and the clinical and sociodemographic factors correlated with utilization using descriptive statistics and negative binomial regression.
Results: In our sample of 1,731,823 pregnancies, there were an average of 5.3 (SD ± 3.9) claims for obstetric ultrasounds per live birth delivery. After adjusting for covariates, the number of ultrasounds per live birth increased by 8.3% and inflation-adjusted spending for these ultrasounds increased 5.6% over the 7-year study period (p < .001); though utilization decreased during the COVID-19 pandemic in 2020. Follow-up ultrasound (CPT 76816) was the fastest growing procedure.
Conclusion: Obstetric ultrasound utilization and expenditures increased from 2016 to 2022. Information on the variation in patterns and trends related to obstetric ultrasound use may assist policy makers in their assessment of resource utilization and approach to reimbursement design, such as obstetric bundled payments.
Objectives: Delivering bad or unexpected news is a challenging and potentially distressing task for radiologists. In developing nations, growing health literacy will likely drive more patients to be more interested in learning the details of their diagnosis. This study aimed to provide foundational insight into Ethiopian radiologists' and radiology residents' preferences and associated factors for breaking bad news during ultrasound examinations.
Methods: We conducted a nationwide online survey study among practicing radiologists and clinical radiology residents across 6 residency programs, with a target study population of approximately 500. We used a pretested, standardized, self-administered questionnaire. Descriptive analysis was performed using SPSS 26.
Results: The study achieved a response rate of 36.2% (181 respondents). 92 (50.8%) were radiologists and 89 (49.2%) were clinical radiology residents. Preference for breaking bad news was dependent on the severity of ultrasound findings; 105 respondents (58%) disagreed or strongly disagreed with communicating severe ultrasound findings, while only 18 (9.9%) and 23 (12.7%) would not communicate bad news if the ultrasound showed no or mild abnormalities, respectively.
Conclusion: The tendency to communicate bad news during ultrasound examination decreases as the severity of the diagnosis worsens. This points to a gap in handling difficult news in imaging practice. Agreement on communication roles, informed by research with patients and doctors, is needed. Structured training can strengthen trust, visibility, and patient-centered care.
Objective: To correlate the sonographic severity of adenomyosis, assessed with real-time ultrasound and a novel semi-quantified method (XI-VOCAL counting and categories) with adenomyosis-associated symptoms.
Methods: This observational study was conducted in a tertiary referral outpatient clinic. We consecutively included 115 participants with ≥1 direct ultrasonographic adenomyosis feature; those with dominant myoma, malignancy, pelvic infection, pregnancy, breastfeeding, inadequate imaging, postmenopause, or hormonal medication use were excluded. A routine clinical protocol was followed for anamnestic and ultrasound data. Menstrual bleeding was assessed subjectively (three-point scale) and with a pictorial blood loss analysis chart (PBAC). Dysmenorrhea, dyspareunia, and chronic pelvic pain were evaluated using a numeric rating scale (NRS). A retrospective questionnaire was sent for missing items. Real-time severity was scored by experienced gynecologists. XI-VOCAL-based severity was assessed independently and blinded to clinical data, providing two severity scores: XI-VOCAL counting and XI-VOCAL categories. Correlations with symptoms were analyzed using Jonckheere-Terpstra, linear and logistic regression.
Results: The real-time severity (severe vs mild) showed a strong correlation with adjusted PBAC (β 590.01, 95% CI 207.16-972.86, P < .01) and subjective blood loss assessment (OR 5.48, 95% CI 1.14-26.28, P < .05). Additionally, a strong correlation was found between XI-VOCAL counting and XI-VOCAL categories with adjusted PBAC score (XI-VOCAL counting: β 53.15, 95% CI 12.06-94.24, P < .05; XI-VOCAL categories (severe vs mild): β 627.36, 95% CI 165.92-1088.81, P < .05). No correlations were found with adjusted dysmenorrhea, chronic abdominal/pelvic pain, or dyspareunia.
Conclusion: Both real-time severity and XI-VOCAL-assessed severity correlate with adjusted PBAC scores and subjective blood assessment. XI-VOCAL appears more standardized, while real-time assessment may be influenced by symptom severity. Larger studies correcting for pain-related confounders are needed.
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