Journal of Ultrasound in Medicine最新文献

Objectives: To explore and correlate the ultrasonic, clinical, and pathological characteristics of malignant ovarian tumors in children for early diagnosis and pathological typing.

Methods: A retrospective analysis was performed on the ultrasonic examination results, clinical data, and laboratory indicators of 49 cases of pathologically confirmed malignant ovarian tumors in children from January 2020 to December 2024.

Results: (1) Pathological types: Germ cell tumors accounted for 75.5% (immature teratoma 59.5%, endodermal sinus tumor and mixed germ cell tumor each 16.2%), sex cord-stromal tumors accounted for 16.3%, and lymphoma accounted for 8.2%. (2) Ultrasonic characteristics: Tumors were predominantly large (>10 cm, 73.5%), solid (51.0%), with irregular contours (81.6%), calcification (57.1%), and high-risk ovarian-adnexal reporting and data system (O-RADS) 4-5 (98.0%). (3) Significant differences were observed among different pathological types: Germ cell tumors were mostly unilateral, large-sized, and accompanied by calcification, with significantly elevated alpha-fetoprotein (AFP); sex cord-stromal tumors were solid without calcification, and 37.5% were associated with precocious puberty; lymphoma was predominantly bilateral, small-sized, and solid, with elevated lactate dehydrogenase (LDH). (4) Clinical features: Pubertal patients accounted for 32.7%; the primary presenting symptoms were abdominal pain/distension (55.1%).

Conclusions: Childhood malignant ovarian tumors are predominantly germ cell tumors, manifesting as large, solid-predominant, calcified lesions with high-risk ultrasound features. Ultrasonic, clinical, and laboratory features vary significantly by pathological type. Integrating these characteristics (including O-RADS and tumor markers) enables preoperative pathological diagnosis, supporting early multi-dimensional and personalized management.

Objectives: Post-extubation stridor (PES) is a serious complication in pediatric patients following endotracheal intubation and is linked to laryngeal edema. Prior studies suggest that the laryngeal air column width difference (LACWD), measured by point-of-care ultrasound (POCUS), may predict PES. There is a critical need to evaluate whether such techniques can be reliably reproduced among typical providers in the pediatric critical care setting. We aimed to assess the predictive value of LACWD for PES, examine its correlation with endotracheal tube (ETT) cuff pressure, and determine whether LACWD can be measured consistently by multiple POCUS-trained providers.

Methods: We conducted a prospective observational study of 51 mechanically ventilated pediatric patients aged 0-18 years. LACWD was measured using bedside POCUS. A subset underwent duplicate scans by different providers to assess interrater reliability. PES was defined by the presence of inspiratory stridor. Intra- and interrater reliability were evaluated using intraclass correlation coefficients (ICCs).

Results: PES occurred in 14% of patients. There was no significant difference in LACWD between PES and non-PES groups. LACWD showed no correlation with ETT cuff pressure. Intrarater reliability for LACWD measurements was excellent (ICC >0.95), but interrater reliability was poor (ICC = 0.27 for LACWD).

Conclusions: LACWD did not reliably predict PES and showed poor interrater reliability, raising concerns about its practical utility in pediatrics. While POCUS remains an appealing non-invasive tool, our study demonstrates that the current technique lacks the reproducibility required for clinical application across providers. Future advancements may improve feasibility, but current methods are not yet suitable for routine bedside use.

Objectives: To compare the diagnostic performance of International Ovarian Tumor Analysis (IOTA) Simple Rules, Ovarian-Adnexal Reporting and Data System for Ultrasound (O-RADS US), and Subjective Assessment in differentiating benign from malignant adnexal masses.

Methods: This prospective study included 249 women evaluated between May 2021 and June 2025 at a tertiary oncology center. Participants underwent standardized transvaginal ultrasound classified according to IOTA Simple Rules, O-RADS US, and Subjective Assessment by examiners blinded to biomarker and imaging results. Most examinations (78%) were performed by a level 2 radiologist, 11% by a level 3 gynecologist, and 11% by level 2 gynecologist sonographers. Final diagnosis was established by histopathology (n = 243) or ≥2 years of follow-up (n = 6). Diagnostic performance was assessed using sensitivity, specificity, predictive values, accuracy, likelihood ratios, and diagnostic odds ratios (DOR), with pairwise comparisons performed by McNemar's test.

Results: Malignant lesions were associated with older age, larger size, complex morphology, ascites, and higher CA125 (p < .05). O-RADS US achieved the highest sensitivity (98.2%) and negative predictive value (95.9%) but the lowest specificity (33.8%). Subjective Assessment had the highest specificity (75.2%) and accuracy (79.6%) but lower sensitivity (85.6%). Simple Rules demonstrated balanced performance (sensitivity 94.6%, specificity 56.8%). DORs were comparable (17.9-27.6). In terms of accuracy, Simple Rules and Subjective Assessment outperformed O-RADS US, while no statistically significant difference was observed between Simple Rules and Subjective Assessment. Inter-method agreement was highest between Simple Rules and Subjective Assessment (κ = 0.69), followed by Simple Rules and O-RADS US (κ = 0.62), and O-RADS US and Subjective Assessment (κ = 0.41).

Conclusion: O-RADS US maximized sensitivity for malignancy detection, Simple Rules provided balanced accuracy, and Subjective Assessment offered superior specificity. Their complementary use may optimize adnexal mass characterization across clinical settings.

Objectives: To evaluate whether ultrasound-guided preoperative localization of soft tissue masses in the musculoskeletal system using a wireless radar reflector reduces operative times and reoperation rates compared to a control group referred by the same oncology team.

Methods: Retrospective review of SAVI SCOUT radar localizations performed preoperatively for soft tissue masses between 2021 and 2025. All imaging, clinical details, and operative times were evaluated. Comparison was made between the localized group and a control group matched for demographics (age and sex), comorbidities (American Society of Anesthesiologists score), location (trunk versus appendicular; subcutaneous versus deep/subfascial), histopathology (benign versus malignant), and case complexity (primary closure versus flap reconstruction). Cases were performed by the same oncological surgical team referred directly or via the multidisciplinary tumor board during the same time course.

Results: Twenty-four radar localized cases were compared with 24 control cases. Median case time in the SAVI SCOUT group was 52.0 minutes (interquartile range 38.0) and there was no significant difference in case times between the localized and control groups (p > .05). There were no reoperations in the localized group whereas 5 patients in the non-localized control group underwent reoperation for positive margins, though this difference fell short of statistical significance (p = .056). The most common lesions in the localized group were metastatic melanoma (12.5%) and intramuscular myxoma (8.3%), liposarcoma (8.3%), and metastatic leiomyosarcoma (8.3%).

Conclusions: Preoperative localization demonstrated no substantial improvement in operative time compared to the non-localized group. However, re-resection rates were higher in the non-localized group.

Objectives: Acoustic radiation force impulse (ARFI) imaging can quantitatively reflect tissue stiffness through shear wave velocity (SWV). In recent years, ARFI technology has been successfully applied in the diagnosis of liver and breast diseases, and has made some progress in the quantitative assessment and staging of femoral vein and popliteal vein thrombosis. However, research on intramuscular venous thrombosis in the lower limbs is still insufficient. This study aims to evaluate the application value of ARFI technology in the staging of lower limb intramuscular venous thrombosis.

Methods: A prospective cohort of 227 patients with 265 intramuscular venous thromboses was included. According to the time of thrombus formation, they were divided into acute (133 cases, 152 thromboses), subacute (52 cases, 65 thromboses), and chronic (42 cases, 48 thromboses) groups. Gray-scale and Doppler ultrasound characteristics were analyzed, and sampling depth and SWV values were compared among groups. Receiver operating characteristic (ROC) curves were plotted to determine optimal cutoff values for distinguishing different stages.

Results: Acute-phase thrombi typically appear hypoechoic, avascular, and sharply demarcated from the vessel wall. Subacute thrombi are predominantly isoechoic, usually without detectable blood flow, and show indistinct margins in some cases. Chronic thrombi exhibit heterogeneous echogenicity, often demonstrate intrathrombus flow signals, and consistently display poorly defined borders with the vessel wall. The SWV values for the 3 groups of cases were (1.90 ± 0.26) m/s, (2.35 ± 0.34) m/s, and (2.82 ± 0.43) m/s for the 3 groups respectively. One-way ANOVA showed no significant difference in sampling depth (p = .160) but significant difference in SWV values (p < .05). The ROC curve area for distinguishing acute from subacute thrombi was 86.6% (95% CI: 0.818-0.913, p < .05), with a cutoff SWV of 2.01 m/s, yielding 89.2% sensitivity and 70.4% specificity for acute thrombi diagnosis. For subacute versus chronic thrombi, the ROC area was 82.3% (95% CI: 0.743-0.902, p < .01), with a cutoff SWV of 2.63 m/s, achieving 72.9% sensitivity and 87.7% specificity for subacute thrombi diagnosis.

Conclusion: ARFI technology shows high diagnostic efficacy for staging lower limb intramuscular venous thrombosis and can be promoted in clinical practice.

Objectives: To compare the diagnostic efficacy of Doppler ultrasound (DUS) and computed tomography angiography (CTA) in patients with renal artery fibromuscular dysplasia (FMD)-related severe renal artery stenosis (RAS).

Methods: In this retrospective study, 78 patients with hypertension were confirmed FMD-related severe RAS based on clinical and angiographical features. All participants underwent standardized renal DUS and CTA. Two blinded readers independently classified lesions and assessed hemodynamics, with discrepancies resolved by a third senior radiologist. Diagnostic performance of DUS and CTA was compared per segment and overall using digital subtraction angiography (DSA) as the reference standard.

Results: A total of 157 renal arteries were analyzed, 86 of which demonstrated severe stenosis accompanied with abnormal arteriographic features of FMD. Integrated analysis showed higher sensitivity for DUS versus CTA in detecting FMD-related severe stenoses (overall: 97.7% versus 67.4%, p < .001; main renal arteries: 98.5% versus 79.4%, p = .001; accessory/branch arteries: 94.4% versus 22.2%, Δ72.2%, p < .001). Both modalities achieved 100% specificity for accessory/branch lesions. DUS demonstrated 100% specificity for main artery lesions and overall, whereas CTA was 97.7% for main artery lesions and 97.2% overall.

Conclusion: DUS outperformed CTA for FMD-related severe RAS, especially with consistent accuracy across vascular territories, supporting its potential as a preferred imaging modality in FMD evaluation.

Author: Anna Tsai, BA, The Ohio State University College of Medicine

Author: Bryce Dzubara

Author: Kathleen Tong, BA, The Ohio State University College of Medicine

Author: David Bahner, MD, The Ohio State University

Objectives: Ultrasound in medical education continues to grow in medical schools, residency and beyond. Learning ultrasound can be a challenge when medical knowledge is not accompanied by hands on and clinical experience. More than 7 million echocardiograms are performed in the United States of America each year. Cardiac ultrasound performed at the patient bedside can be quickly implemented to provide information regarding a patient's clinical status. However, a 2013 survey indicated that only 20% of internal medicine programs utilized bedside cardiac ultrasound. Residency exposure to ultrasound scanning continues to improve while medical student ultrasound education presents an opportunity for students to get a head start on learning the nuances of how to perform a cardiac ultrasound exam. Thus, the purpose of this initiative was to expose medical students to cardiac ultrasound and echocardiography, increasing understanding of common echocardiogram views, measurements, and their correlations with pathology in clinical care.

Methods: Cardiology faculty and fellows were contacted via email at a quaternary medical center. An ultrasound opportunity was proposed, where interested medical students would learn basic echocardiography alongside incoming cardiology fellows for one-hour sessions. Up to three medical students joined the cardiology fellows each session. The learning cohort participated in acquisition of basic echocardiography views and discussion of relevant anatomy and physiology.

Results: As of this submission, two scanning sessions were conducted within the Division of Cardiovascular Medicine, with six medical students participating. An additional session is in the scheduling process. Student feedback indicated that more advanced echocardiography sessions exploring more advanced views, modes, and measurements would be welcome.

Conclusions: Cardiac ultrasound opportunities abound in clinical medicine. Coordinating clinical opportunities in performing cardiac ultrasound with appropriate supervision is imperative to create the next generation of cardiac ultrasound practitioners. It is feasible to develop an echocardiography scanning session with Cardiology fellows to expose interested medical students to specialty-specific ultrasound. Such sessions can improve ultrasound knowledge, and student feedback indicates medical student interest in more advanced ultrasound education than is routinely offered. Feedback from participating students suggests that earlier implementation in cardiac ultrasound and echocardiography is appropriate for medical student education.