Journal of Ultrasound in Medicine最新文献

Objective: To report our experience in the state of Nevada with embedding fetal cardiologists in maternal-fetal-medicine (MFM) clinics and with the current prenatal detection of critical cardiovascular malformations (CCVMs).

Methods: We queried our databases for CCVMs, diagnosed pre- or postnatally, and undergoing fetal demise, elective termination, or born between August 2024 and August 2025. We defined CCVMs as those that required or would have required a therapeutic procedure in the first 60 days.

Results: We identified 70 cases. Of the 70, 66 (94%) had prenatal care. Of the 66 with prenatal care, 62 (94%) were diagnosed prenatally by embedded fetal cardiologists at MFM clinics. For the 62 pregnant women, the reasons for obstetric referrals to MFM care were: 34 (55%) with maternal comorbidities alone, 16 (25%) with maternal comorbidities and suspected fetal anomalies, 9 (15%) with suspected fetal anomalies alone, and 3 (5%) for initial fetal anatomical surveys without maternal comorbidities. For the 62 pregnant women, the indications for fetal cardiologist-attended fetal echocardiograms were: 53 (86%) with a suspected fetal cardiovascular malformation noted on a previous MFM perinatal sonographer's ultrasound, 4 (6%) with a suspected extracardiac fetal anomaly, 4 (6%) with previous poor visualization, and 1 (2%) with a family history of congenital heart disease.

Conclusions: In Nevada, the most recent prenatal detection of CCVMs was 94% statewide. Additionally, 95% of those prenatally diagnosed were products of high-risk pregnancies. Further, embedding fetal cardiologists in all MFM clinics has enhanced the skills of perinatal sonographers and maximized prenatal detection rates statewide.

The post-traumatic formation of myotendinous heterotopic ossification or myositis ossificans traumatica has been an unforeseen complication of muscle contusion-related hematoma in people with hemophilia and von Willebrand's disease. While ultrasound imaging has revolutionized the detection of hemarthrosis and hemarthropathy in bleeding disorders, its clinical use has expanded to the detection of inter- and intramuscular hematomas, as well as the formation of traumatically induced heterotopic ossification. This retrospective multi-center case series includes 29 cases of post-traumatic heterotopic ossification from 9 hemophilia treatment centers, highlighting the effectiveness of high-definition point-of-care ultrasonography for its early detection in people with bleeding disorders.

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.