Journal of Ultrasound in Medicine最新文献

Objectives: To evaluate the value of the thickness of the frontal lobe (TFL) and foramen magnum-to-cranium distance (FCD) for predicting poor neurodevelopmental outcomes in fetuses with a small head circumference (HC).

Methods: This retrospective observational study included 39 fetuses with HC < -2 standard deviations (SD) and 592 prospectively collected controls with normal growth. TFL was defined as the shortest distance between the upper outer border of the corpus callosum and the upper inner cranial border parallel to the FCD. Reference ranges for FCD and TFL were established in 592 healthy fetuses between 21 and 38 weeks of gestation and applied to fetuses with suspected microcephaly. Diagnostic performance was assessed using sensitivity, specificity, and SD-based thresholds.

Results: Normal reference ranges for FCD and TFL across gestation were established. All fetuses with normal postnatal outcomes had TFL values within the normal range, whereas reduced TFL was observed only in fetuses with poor neurodevelopmental outcomes. For predicting adverse outcomes, TFL <-2 SD showed a specificity of 100%, compared with 88% for FCD <-2 SD. Combining HC <-2 SD with TFL <-2 SD improved identification of fetuses with poor outcomes, including cases with borderline HC measurements (-2 to -3 SD).

Conclusions: When combined with HC, reduced TFL may serve as a highly specific prenatal marker for identifying fetuses at risk for adverse neurodevelopmental outcomes in suspected microcephaly.

Objectives: Ultrasound image segmentation remains a significant challenge due to inherent low contrast and blurred anatomical boundaries. Fully supervised deep learning approaches require extensive annotated datasets, which are costly and labor-intensive to acquire. This study aims to develop an effective semi-supervised segmentation framework for ultrasound images with limited annotations.

Methods: We propose a novel semi-supervised segmentation framework tailored for ultrasound images, leveraging frequency component augmentation and edge mask enhancement to promote structural consistency between weakly and strongly augmented inputs. Specifically, discrete wavelet transform (DWT) is used to decompose ultrasound images into low-frequency and high-frequency sub-bands. A high-frequency component replacement strategy is introduced for strongly augmented images, and an edge mask enhancement module is designed to further emphasize anatomical boundaries.

Results: Experiments conducted on 3 public fetal ultrasound imaging segmentation datasets-PSFHS, HC18, and CCAUI-demonstrate that our method achieves average Dice similarity coefficients (DSC) of 0.81 and 0.91, respectively, using only 10 annotated images. This represents a 2-3% DSC improvement over existing semi-supervised methods such as FixMatch. Ablation studies confirm the effectiveness of both the high-frequency augmentation and edge enhancement components.

Conclusion: The proposed framework offers a promising direction for ultrasound image segmentation in settings with limited annotations, effectively improving segmentation accuracy by combining frequency-domain augmentation and edge-aware enhancement. Code will be available at https://github.com/apple1986/WTEM-SemiSeg.

Objectives: The femoropopliteal (FP) artery is the most frequently revascularized segment in peripheral artery disease (PAD), followed by the iliac segment. Wall shear stress (WSS) is a key local factor implicated in both atherosclerotic plaque formation and restenosis after angioplasty. However, WSS is not routinely assessed in peri-interventional clinical practice. This exploratory study aimed to assess the feasibility and potential utility of measuring WSS in the FP artery segment using ultrasound.

Methods: In this prospective, single-center study, we included patients with symptomatic PAD and evaluated their hemodynamic parameters before and after iliac or FP revascularization. In addition to standard ultrasound examinations-including B-mode, color Doppler, and pulse-wave (PW) Doppler-we performed sonographic vector flow imaging (VFI) and assessed volume flow and the WSS-derived oscillatory shear index (OSI) at 3 predefined segments along the FP axis.

Results: Following iliac or FP revascularization, PW-derived median volume flow increased significantly at all 3 FP sites: in the common femoral artery (CFA) from 211 to 270 mL/minute (p < .01), in the superficial femoral artery (SFA) from 104 to 138 mL/minute (p < .01), and in the popliteal artery (PA) from 37 to 73 mL/minute (p < .001). Median WSS values also increased significantly: in the CFA from 0.69 to 0.93 Pa (p < .001), in the SFA from 0.78 to 1.04 Pa (p < .05), and in the PA from 0.78 to 0.91 Pa (p < .001). By contrast, OSI values showed no significant changes (range 0.0-0.12, all p > .3).

Conclusions: Iliac or FP revascularization procedures result in measurable hemodynamic changes in FP blood flow and vessel wall interaction, which can be readily assessed using peri-interventional ultrasound. The clinical relevance of increased WSS along the FP axis warrants further investigation.

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.