Journal of Ultrasound in Medicine最新文献

Pachydermodactyly is a rare and benign acquired digital fibromatosis that can clinically mimic inflammatory arthropathies. We present a case series of three adolescents in whom high-frequency cutaneous ultrasound was essential for the diagnosis, revealing homogeneous, hypoechoic, and non-compressible dermal thickening around the proximal interphalangeal joints without evidence of synovitis, tendon involvement, or bone erosions. Ultrasound also enabled objective monitoring of treatment response following intralesional corticosteroid injections in two cases. Cutaneous ultrasound represents a valuable, non-invasive tool for both the diagnosis and follow-up of pachydermodactyly, avoiding unnecessary invasive procedures.

Carpal tunnel syndrome (CTS) is the most common upper limb entrapment neuropathy and a leading cause of pain, functional impairment, and surgical referral. This article demonstrates the central role of ultrasound (US) across the continuum of CTS care, both for confirming the CTS diagnosis and for guiding treatments ranging from perineural injections to carpal tunnel release. Existing evidence supports integration of US in the diagnosis and management of this condition.

Objectives: Increased intracranial pressure (ICP) is a well-known cause of morbidity and mortality in the emergency department. There are many point-of-care ultrasound methods of identifying increased ICP like optic nerve sheath diameter (ONSD), crescent sign, and optic disc elevation. We studied the diagnostic accuracy of the crescent sign in identifying increased ICP.

Methods: We conducted a prospective observational study on 135 patients with clinical features of raised ICP between October 2021 and April 2023 at a tertiary care center in India. After examining the patients and recording their demographic details, we performed a point of care ultrasound on the eye to observe for crescent sign. This was followed by a CT scan of the head to look for radiological features of raised ICP. The values were recorded and analyzed using STATA.

Results: We recruited a total of 135 participants for the study, 86 males and 49 females. Crescent sign had a sensitivity and specificity of 54% (46, 65) and 100% (95, 100), respectively, with positive and negative predictive values of 100% (90, 100) and 70% (60, 78), respectively, with a diagnostic accuracy of 78% (70, 84) at p-value <.001.

Conclusion: Crescent sign by ultrasound may be a useful marker for identifying raised ICP in ED patients; however, additional studies are needed to further evaluate sensitivity in users of varying training backgrounds.

Objectives: To evaluate whether averaging replicate fetal biometry measurements during an examination improves estimated fetal weight (EFW) accuracy for predicting birthweight compared with a single set and to assess how variability in fetal biometric measurements changes across gestation.

Methods: Secondary analysis of the Eunice Kennedy Shriver National Institute of Child and Health and Human Development (NICHD) Fetal Growth Studies-Singletons. At each study visit, fetal head circumference (HC), abdominal circumference (AC), and femur length (FL) were measured in triplicate to compute EFW at each of 6 study visits (0-5). Variability among replicates was assessed across gestation using boxplots and two-way repeated measures ANOVA. For participants with visit 5 EFW (n = 1101), predictive accuracy of each individual measurement and their averages was compared with birthweight using average percent error and proportion within 10% of birthweight. One-way ANOVA and chi-square tests were applied. Sensitivity analyses included second-to-last visit, subgroups classified as small- or large-for-gestational age, and a subgroup of participants who delivered within 3 days of visit 5.

Results: Across visits, replicate HC, AC, and FL showed minimal variability, with no significant differences among replicates or across gestation. At visit 5, average EFW and standard deviations were similar across individual and averaged measurements. Percent errors ranged from 8.2 to 8.5% (p = .999), and proportion within 10% of birthweight ranged from 64.4 to 66.4% (p = .954). Sensitivity analyses produced similarly null findings.

Conclusions: In a controlled research setting with credentialed sonographers and standardized protocols, averaging replicate fetal biometric measurements did not improve EFW prediction of birthweight. A single high-quality measurement of fetal biometry may be sufficient, although further research is warranted to confirm generalizability to routine clinical practice.

Objectives: The morphological alterations of the tibial nerve in patients with diabetes mellitus, both with and without diabetic peripheral neuropathy (DPN), are challenging to differentiate using B-mode ultrasound. In this study, we assessed the stiffness changes of the tibial nerve by 2-dimensional shear-wave elastography (2D-SWE).

Methods: We gathered data from 70 adults with valid 2D-SWE measurements, comprising 25 individuals in DPN Group A who were diagnosed with DPN and had peripheral nerve symptoms in the past 6 months, 15 individuals in DPN Group B who were diagnosed with DPN but had no peripheral nerve symptoms in the past 6 months, 16 individuals with type 2 diabetes but without DPN, and 14 healthy individuals. The maximal thickness, cross-sectional area, and stiffness of the tibial nerve among groups were analyzed.

Results: DPN Group A had higher tibial nerve stiffness than Group B, non-DPN, and control groups (p < .05). The area under the curve (AUC) for 2D-SWE parameters in detecting increased nerve stiffness was 0.956 for G₁ (mean stiffness) and 0.979 for G₃ (distal stiffness), respectively, with optimal cut-off values of 20.01 and 28.41 kPa.

Conclusions: 2D-SWE is a promising non-invasive technique for early diagnosis of DPN, effectively reflecting changes in nerve stiffness associated with the condition. This method may enhance clinical interventions aimed at preventing disease progression.

Objectives: Adnexal masses during pregnancy are rare. This study aimed to evaluate the clinical application value of 3 prediction models: Assessment of Different NEoplasias in the adneXa (ADNEX), Simple Rules (SR), and Ovarian-Adnexal Reporting and Data System (O-RADS) in pregnant patients with adnexal masses and summarizes the clinical and ultrasonographic characteristics of adnexal masses during pregnancy.

Methods: A total of 65 patients confirmed by surgery and pathology were included in this retrospective single-center study. Three predictive models were applied to assess adnexal masses prior to surgery. The area under the ROC curve (AUC), accuracy, sensitivity, and specificity were calculated to evaluate the diagnostic efficiency of different models.

Results: Of these cases, 62 (95.4%) were benign and 3 (4.6%) were malignant. The median diameter of benign masses was 46.0 mm, while the median maximum diameter of malignant masses was 103.0 mm. The difference in maximum diameters between the 2 groups was statistically significant (p < .05). The performance of the predictive models varied: the area under the ROC curve (AUC) was 0.64, 0.91, and 0.94 for ADNEX, SR, and O-RADS. The differences in AUCs among these models were not statistically significant.

Conclusions: The incidence of malignant adnexal masses during pregnancy is low. Malignant masses, in contrast to benign masses, typically exhibit larger maximum diameters. SR and O-RADS showed good diagnostic efficacy and had certain clinical value in evaluating the benign and malignant of adnexal masses during pregnancy.