Journal of Ultrasound in Medicine最新文献

Objectives: Intra-amniotic sludge is an independent risk factor for preterm birth. It consists of a biophysical sonographic finding in the amniotic fluid, formed by dense echogenic particles near the cervical internal orifice, due to sterile or infectious inflammatory processes. High-risk pregnancies are usually marked by oxidative stress, which is one of the main triggers for 70 kDa-heat shock proteins (HSP70) expression and release. In the blood, eHSP70 marks cellular stress or damage and plays roles in immune-inflammatory responses. However, the association between sludge, oxidative stress and eHSP70 remained unclear until now. The objective of this study is to evaluate if plasma eHSP70 and redox parameters could distinguish subpopulations with sludge or not.

Methods: We recruited women seeking routine ultrasonography in the second trimester of gestation that met the inclusion criteria. They underwent transvaginal ultrasonography, completed the clinical survey, and provided blood samples for analysis.

Results: Women with sludge exhibited lower antioxidant defense, and eHSP70 levels. They also presented significant changes in the hemogram, suggesting an increase in immune tolerance. In this population, lower HSP70 is associated with a better immunological scenario and proper cervical length to the gestational age.

Conclusion: Blood parameters, oxidative parameters and eHSP70 can indicate intra-amniotic inflammation.

Abscesses are a common esthetic procedure complication that can lead to disfigurement and systemic complications. Accurately identifying the type of abscess is essential for early and appropriate treatment. In this context, the ultrasound (US) has become a pivotal tool for diagnosing and managing abscesses when combined with clinical and laboratory assessment. However, many professionals in the field still have limited knowledge of the subject, especially regarding abscess differentiation. Given this scenario, this article aims to address the US-standard to distinguish between common bacterial, nontuberculous mycobacterial, and sterile abscesses, highlighting the importance of integrating clinical presentation and laboratory findings for accurate differentiation.

Objectives: O-GlcNAcylation plays a key regulatory role in hepatic physiology, and its disruption leads to fibrosis in liver-specific OGT knockout mice (OGT^LKO), making this model valuable for studying advanced metabolic dysfunction-associated steatohepatitis (MASH). Our objective is to demonstrate that shear wave elastography (SWE) is a suitable non-invasive tool to characterize and follow this mouse model of liver injury.

Methods: We weekly monitored non-invasively liver fibrosis progression in OGT^LKO mice from 5 to 8 weeks of age, using SWE on both a high-frequency preclinical ultrasound system (VevoF2), and a clinical reference system (Aixplorer) and assuming the liver as homogeneous, isotropic and purely elastic. Stiffness measurements were then confronted with ex vivo liver histological scoring and major gene transcripts associated with the development of the pathology.

Results: Weekly liver stiffness measurements demonstrated a progressive increase, correlating strongly with histological fibrosis scores (R² > 0.78) and fibrosis-related gene expression (Col3a1, Col6a1). The high-resolution imaging capability of the VevoF2 allowed precise anatomical exploration while delivering SWE measurements consistent with the clinical device (Pearson r = 0.92).

Conclusion: Our study confirms that following liver stiffness fibrosis by SWE in a mouse model of liver injury is a valuable tool that correlates with ex vivo findings. This approach facilitates a better understanding of disease progression and therapeutic evaluation in preclinical models of MASH.

Objectives: To evaluate a scoring system using transvaginal ultrasound (TVS) to predict high-risk endometrial cancer.

Methods: Consecutive patients with endometrial cancer/atypical hyperplasia (n = 266) were preoperatively examined by residents using TVS. Clinical parameters, endometrial morphology and Doppler scores were recorded using a gray scale and Doppler TVS and related to final histopathology at hysterectomy. Multivariate logistic regression was used to correlate imaging and clinical parameters to the presence of high-risk endometrial cancer (defined as FIGO stage Ib-IV or high-grade tumors [grade 3/non-endometroid]) to develop the High-Risk Endometrial Cancer (HIREC) score.

Results: High-risk endometrial cancer (n = 128) and lympho-vascular space invasion (LVSI) (n = 43) were predicted by increased endometrial thickness (ET), age, and Doppler score. The HIREC scoring system, based on age, Doppler score, and ET performed well with an AUC of 78.5% (CI 95%: 73-84) to predict high-risk cancer. By using a 2-step strategy of (1) Preoperative identification of high-grade tumors by biopsy, (2) Assessing the HIREC score, high-risk endometrial cancer could be predicted at a HIREC score of ≥7 with sensitivity, specificity, and accuracy of 72.7, 88.4, and 80.8%. Low-risk endometrial cancer was predicted at HIREC scores of <5 with sensitivity, specificity, and accuracy values of 91.4, 46.4 and 68.1%, respectively.

Conclusions: Low and high HIREC scores effectively predicted low- and high-risk endometrial cancer. The score is a simple point system suitable for the first ultrasound assessment. It may be used in preoperative work-up to select treatment and additional imaging, but it needs to be validated in further studies.

Objectives: To evaluate the discriminatory potential of peritumoral tissue stiffness, as quantified by 2-dimensional shear wave elastography, for distinguishing between hepatocellular carcinoma (HCC) and metastatic liver carcinoma (MLC).

Methods: This study enrolled 31 patients with HCC and 42 with MLC. The mean Young's modulus (E) value was measured to evaluate the intratumoral and peritumoral stiffness of HCC and MLC by using the 2-dimensional shear wave elastography integrated with the shell measurement function. The intratumoral stiffness and the peritumoral stiffness within the 1-, 2-, and 3-mm shells surrounding the target lesion were labeled as E, E_shell1, E_shell2, and E_shell3, respectively. The discriminatory capacity of the E and E_shell parameters to distinguish HCC from MLC was assessed by generating receiver operating characteristic curves.

Results: The E_shell1, E_shell2, and E_shell3 values in patients with HCC were higher than those with MLC, whereas the E values in patients with HCC were lower than those with MLC (p < .05). In addition, the E_shell1, E_shell2, E_shell3, and E values showed good diagnostic performance in differentiating HCC from MLC. Among them, E_shell1 had better diagnostic performance, with a specificity, sensitivity, positive predictive value, and negative predictive value of 64, 88, 59, and 90%, respectively (cut-off value, 19.84 kPa; area under the receiver operating characteristic curve, 0.763).

Conclusions: Quantitative assessment of peritumoral stiffness, particularly within a precisely defined 1-mm shell using advanced shell elastography, significantly enhances the differentiation of HCC from MLC.

Objectives: To explore the ultrasound findings, treatment strategies, and reproductive outcomes in patients with recurrent cesarean scar pregnancy (CSP), providing evidence for clinical management.

Methods: We identified 1371 confirmed CSP from 1517 initially screened cases (2012-2022) through blinded image review. From 159 subsequent live births in this cohort, 27 recurrent CSP cases were matched 1:1 with CSP patients having normal subsequent pregnancies. Baseline characteristics and reproductive outcomes were collected via medical records and structured interviews.

Results: This study revealed the recurrent CSP group showed significantly higher rates of exogenous implantation pattern (33.3% versus 7.4%, OR = 1.96), rich vascularity on color Doppler (81.5% versus 40.7%, OR = 2.80), and embryonic cardiac activity detection (51.9% versus 18.5%, OR = 1.98) than the normal intrauterine pregnancy group after CSP (p < .05) during initial diagnosis. The most commonly used treatment at our hospital is trans-abdominal ultrasound-guided suction curettage, which effectively controls the condition and preserves fertility. However, during long-term follow-up, some patients still face the risks of recurrence infertility.

Conclusions: Recurrent CSP presents characteristic sonographic features at initial diagnosis, among which an exogenous implantation pattern, rich vascular flow signals, and embryonic cardiac activity serve as relevant and significant indicators. Although transabdominal ultrasound-guided suction curettage is effective in managing the condition and preserving fertility, some patients still face long-term risks of recurrence and infertility.

Objectives: This study aimed to develop a multimodal model that integrates habitat radiomics and clinical features for non-invasive prediction of axillary sentinel lymph node (SLN) metastasis in breast cancer (BC).

Methods: We retrospectively analyzed ultrasound images and clinical data from 191 female patients with BC treated at Beijing Luhe Hospital, Capital Medical University from May 2023 to January 2025. Patients were randomly assigned to training and test sets at a 7:3 ratio. Four models were constructed: a traditional radiomics model, a clinical model, a habitat model characterizing the tumor microenvironment, and a multimodal model combining habitat radiomics with clinical features. Model performance was assessed using receiver operating characteristic curve analysis and decision curve analysis.

Results: In the training set, the habitat model achieved an area under the curve (AUC) of 0.869, outperforming the clinical model (AUC = 0.718) and the traditional radiomics model (AUC = 0.771). The multimodal model, integrating habitat analysis and clinical features, yielded the highest AUC (0.900). In the test set, the habitat model again showed superior discriminative ability (AUC = 0.866) compared with the clinical model (AUC = 0.727) and the radiomics model (AUC = 0.662); meanwhile, the multimodal model achieved the highest AUC (0.902).

Conclusion: The habitat model demonstrated superior predictive performance compared with models based solely on ultrasound radiomics or clinical features, and the multimodal approach yielded the best overall accuracy. This combined model offers a promising non-invasive tool for pre-operative assessment of SLN status in patients with BC and may assist clinical decision-making.