Journal of Ultrasound in Medicine最新文献

Objectives: This study aims to apply high-frequency ultrasound (HFUS) in conjunction with ultra-micro angiography (UMA) technology to observe the ultrasound characteristics of facial lesions in patients with papulopustular rosacea (PPR). It will also quantitatively evaluate the changes before and after treatment, thereby assessing the feasibility and application value of this combined technique in evaluating the treatment efficacy for PPR.

Methods: We conducted a prospective study involving 63 patients with PPR who visited the dermatology department between May 2024 and March 2025. Two attending dermatologists independently evaluated the most severe lesions on each patient's cheeks (marked area) and performed follow-up evaluations at the end of the fourth week of treatment, as well as calculated the therapeutic efficacy index. We utilized HFUS, equipped with a 33 Hz linear array probe, in conjunction with UMA technology to conduct ultrasound scans of the marked areas of patients at baseline and at the end of the fourth week of treatment. This allowed us to obtain ultrasound characteristics and perform statistical analyses.

Results: The dermatologists classified the PPR patients based on the therapeutic efficacy index into cured (6 cases), significantly improved (23 cases), improved (29 cases), and ineffective (5 cases). By the end of the fourth week of treatment, significant changes were observed in non-quantitative features, including epidermal morphology, the subepidermal low-echogenic band, dermal echogenicity, sebaceous gland echogenicity, and the echoes of inflammatory papules, compared to baseline (p < .01). Simultaneously, quantitative parameters, including thickness ratio, maximum diameter of hair follicles, maximum diameter of facial skin microvessels, peak systolic velocity, time average maximum velocity, and color pixel percentage (CPP), all significantly decreased (p < .01). Spearman correlation analysis indicated a strong correlation between quantitative parameters, such as CPP and the relative change ratio of color pixel percentage, and the therapeutic efficacy index at the end of the fourth week of treatment (0.70 ≤ |r| < 0.90, p < .01).

Conclusions: HFUS combined with UMA technology can be effectively used for the quantitative evaluation of treatment efficacy in PPR.

Objectives: To determine whether a fetal right ventricular (RV) free-wall pericardial effusion (PE) is associated with alterations of ventricular geometry and function.

Methods: Retrospective review of 1373 second- and third-trimester fetuses between 20 and 39 weeks of gestation was done to identify fetuses with a PE. Diastolic function was assessed via pulsed Doppler of RV and left ventricular (LV) inflow tracts, with monophasic filling in the presence of contralateral biphasic inflow classified as abnormal. End-diastolic RV and LV area, width, length, and sphericity were measured as well as systolic function. Z-score equivalent percentiles were computed for the above measurements. Statistical comparisons used published normative controls, with abnormalities defined as z-score equivalent percentiles (<10th or >90th percentile). Segmental movement of the ventricular free wall and septum was classified as hyperkinetic, hypokinetic, akinetic, and paradoxical.

Results: Four-chamber view (4CV), RV, and LV area, length, and mid-chamber width <10^th percentile was more frequent than controls. Diastolic disturbance was selective to the RV: 87% (26/30) showed a monophasic tricuspid A-waveform with preserved mitral inflow. Systolic assessment revealed decreased (<10th percentile) RV and LV fractional area change, mid-chamber fractional shortening, as well as LV cardiac output and ejection fraction to be more frequent than controls as well as global and free-wall strain >90th percentile. Segmental analysis demonstrated high rates of paradoxical septal motion (33% LV, 73% RV) and regional akinesis.

Conclusion: A localized right free-wall PE is associated with altered chamber geometry, selective diastolic impairment, discordant systolic deformation, and frequent paradoxical septal motion.

Objectives: Levator avulsion is a risk factor for pelvic organ prolapse (POP) and treatment failure. The current gold standard for diagnosis is tomographic translabial ultrasound (TLUS) in the axial plane. Avulsion is usually described as full or partial, unilateral or bilateral. Further classification into Type I where there is a hyperechoic "connection" to the sidewall, and Type II when there is no such connection has been suggested. The objective is to compare associations between avulsion types and POP.

Methods: A retrospective study on archived datasets of 931 women seen at a tertiary urogynecological service. All had undergone a standardized interview, pelvic organ prolapse quantification (POPQ) examination and 4D TLUS. Postprocessing of archived ultrasound volume data was performed. Associations of avulsion types and POP symptoms and signs were tested.

Results: Mean age was 57.8 years (19-94), mean body mass index (BMI) was 29.6 kg/m² (16.9-65.4). A total of 496 (53%) reported prolapse symptoms. Overall, 741 (80%) were diagnosed with significant prolapse on POPQ, 639 (66%) on imaging. Avulsion was found in 194 (21%). An assessment of avulsion type could be undertaken in 188 women. Type I avulsions were found in 136 women (15%), Type II in 52 (6%). Type II avulsion was not found to be more predictive of symptoms and signs of POP compared to Type I avulsion (all p > .017 versus all p < .001).

Conclusion: Type II avulsion, which is supposed to represent more severe trauma, does not seem to convey any additional risk of symptoms and/or signs of prolapse compared to Type I avulsion. It does not seem to be necessary to distinguish between these two avulsion types on transperineal ultrasound.

Objectives: To identify the optimal vaginal stimulation region by examining the effect of intravaginal electrical stimulation (IVES) on pelvic floor muscles (PFM) as seen on transperineal ultrasound (TPUS).

Methods: Open-label cross-sectional study of women presenting with pelvic organ prolapse. Women ≥18 years and English speaking were included. Exclusion criteria were any contraindications for IVES. NeuroTrac® Continence was used for IVES. Simultaneously, TPUS was performed to assess levator hiatus (LH) length. Initially, the IVES probe was placed with the tip at the posterior fornix, then retracted in 2 cm increments. The primary outcome was the identification of the optimal target region for IVES as defined by the largest reduction in LH length. Secondary outcomes included patient acceptability, and the feasibility of performing IVES and TPUS simultaneously. Statistical analysis was performed with SPSS28.

Results: On maximum voluntary PFM contraction, a 5.75% reduction in LH length was seen (p = .002). Comparatively, when IVES was applied with the tip of the probe at or 2 cm distal to the posterior fornix, 10.83% and 10.17% reductions in LH length were seen, respectively (both p = .002). At 4 and 6 cm distal locations, 6.00% (p = .002) and 3.17% (p = .016) reductions were observed, respectively.

Conclusion: Intravaginal electrical stimulation should be performed near the posterior fornix. IVES and TPUS can be performed concomitantly.

Objectives: This study investigated risk factors for abnormally invasive placenta (AIP) in singleton pregnancies and developed a risk prediction model using clinical and basic ultrasound features for AIP screening.

Methods: A retrospective analysis was conducted on 16,735 singleton pregnancies (with/without AIP) delivering at the First Affiliated Hospital of Sun Yat-sen University (2017-2021). Eighteen clinical and 3 basic ultrasound features were recorded. AIP was confirmed via placental pathology or intraoperative observations. The cohort was randomly split into development (70%) and validation (30%) sets. Univariate/multivariate logistic analyses and multicollinearity tests identified AIP predictors. Three models (clinical-only, basic ultrasound-only, combined) were constructed; their performances were compared to select the final model, visualized as a nomogram. Model performance was evaluated using receiver operating characteristic curves (ROC), area under the curves (AUC), calibration curves, and decision curve analysis (DCA) (1000 bootstraps, 5-fold cross-validation).

Results: AIP was confirmed in 161 cases (0.962%). Independent predictors included a history of placenta accreta spectrum (PAS), advanced maternal age, assisted reproductive technologies (ART), pre-pregnancy obesity, placenta previa/low-lying placenta, and placental location (p < 0.05). In the validation set, the combined model had an AUC of 0.844 (95% CI 0.775-0.913), versus 0.781 (95% CI 0.701-0.862) for basic ultrasound-only and 0.698 (95% CI 0.626-0.770) for clinical-only. The nomogram of the combined model showed good discrimination; calibration curves and DCA confirmed satisfactory calibration and clinical utility.

Conclusion: The combined clinical-basic ultrasound model outperforms single-component models in AIP prediction. Its nomogram has good predictive performance, enabling clinicians to quickly screen high-risk pregnant women for AIP.

Objectives: To develop a multimodal predictive model that integrates intratumoral and peritumoral radiomic features, contrast-enhanced ultrasound (CEUS) quantitative parameters, and clinical characteristics to enhance preoperative World Health Organization/International Society of Urological Pathology (WHO/ISUP) grading accuracy for clear cell renal cell carcinoma (ccRCC).

Methods: This retrospective study analyzed preoperative CEUS data from 186 histopathologically confirmed ccRCC patients, who were randomly divided into training (n = 148) and testing (n = 38) cohorts. Radiomic features were extracted and selected from intratumoral regions and 5-mm peritumoral regions on CEUS images, and 6 logistic regression (LR)-based predictive models were subsequently constructed: 5 standalone models (Intra, Peri5mm, ImageFusion5mm, IntraPeri5mm, and C-CEUS) and 1 combined model that integrated features from the best-performing radiomic model and C-CEUS. Additionally, subgroup analyses based on tumor size and CEUS wash-in rate were performed to verify the combined model's stability. Finally, a nomogram derived from the combined model was established for intuitive preoperative prediction of WHO/ISUP grades.

Results: The radiomic model of IntraPeri5mm demonstrated the highest discriminative performance among the 4 radiomic features. The area under the curve (AUC) reached 0.785 in the testing cohort. Multivariate analysis identified delta perfusion index (dPI) and Maximum diameter on the largest cross-section (sizemax) as independent predictors of the WHO/ISUP grading (all p < .05). The combined model incorporating IntraPeri5mm radiomic features, clinical variables (sizemax), and CEUS parameters (dPI) demonstrated improved predictive accuracy, with AUC of 0.852 (0.706-0.998) in the testing cohort and an accuracy of 0.842 (95% CI: 0.687-0.940). Moreover, the AUC values for all subgroups exceeded 0.80.

Conclusion: The combined model which may enhance personalized risk stratification outperformed single-modality approaches in preoperative WHO/ISUP grading of ccRCC.

Objectives: This study aims to evaluate the diagnostic value of a novel multimodal approach combining transperineal ultrasound (TPUS), transrectal dual-plane ultrasound, and shear wave elastography (SWE) in predicting stress urinary incontinence (SUI).

Methods: A total of 70 women diagnosed with SUI and 110 healthy controls were included. Clinical data such as age, body mass index (BMI), mode of delivery, and relevant medical history were collected. Pelvic floor ultrasound was performed using TPUS and transrectal dual-plane ultrasound. Key parameters, including bladder neck mobility, urethral rotation angle, urethral length, and urethral stiffness measured by SWE, were recorded and analyzed. Statistical analysis was conducted using SPSS version 27.0, and a multifactorial predictive model was developed.

Results: Significant differences were observed between the SUI and control groups in bladder neck mobility (p = .034), urethral rotation angle (p = .059), and urethral stiffness measured by SWE (p < .001). The average Young's modulus of the urethral sphincter was significantly lower in the SUI group (39.22 ± 5.83 kPa) compared to the control group (52.11 ± 9.24 kPa). Age and average urethral sphincter elasticity were identified as independent risk factors for SUI. The multifactorial model demonstrated high clinical applicability with an AUC of 0.891 (sensitivity: 84%, specificity: 80%).

Conclusions: The combination of TPUS, transrectal dual-plane ultrasound, and SWE provides a reliable, non-invasive diagnostic tool for predicting SUI. The study highlights the importance of urethral stiffness and bladder neck mobility in the pathophysiology of SUI. This multi-modal approach shows strong potential for early detection and personalized treatment strategies. This multimodal approach offers a non-invasive, reliable tool for early SUI detection and personalized management.

Objectives: To establish reference ranges for Doppler indices of the maternal ophthalmic artery in low-risk pregnancies during the second and third trimesters.

Methods: This retrospective cross-sectional study included 358 low-risk pregnancies between 20 and 41 weeks of gestation. Doppler ultrasound of the maternal ophthalmic artery was performed, and the following indices were calculated: pulsatility index (PI), resistance index (RI), peak systolic velocity (PSV), second peak systolic velocity (P2), end diastolic velocity (EDV), and the ratio between peak systolic velocities (PR). Polynomial regression analysis was used to model the fit of a polynomial equation for each Doppler index as a function of gestational age. The 5th, 50th, and 95th percentiles were determined for each gestational age interval.

Results: A significant negative correlation was observed between gestational age and RI (r = -0.11, p = .025) and PSV (r = -0.219, p = .0003), while a significant positive correlation was found between gestational age and PR (r = 0.14, p = .007). No significant correlations were observed between gestational age and PI, P2, or EDV. Reference intervals for each Doppler index were established according to gestational age, providing the 5th, 50th, and 95th percentiles.

Conclusion: This study provided reference intervals for Doppler indices of the maternal ophthalmic artery in low-risk pregnancies during the second and third trimesters. These reference values may aid in the interpretation and clinical application of Doppler findings, particularly in the context of predicting and monitoring preeclampsia.