Journal of Ultrasound in Medicine最新文献

Objective: To evaluate the clinical application value of ultra micro angiography (UMA) in noninvasively differential diagnosis between benign and malignant renal tumors.

Methods: In this retrospective study, 65 patients diagnosed with solid renal tumors and intended for surgical resection in our hospital between December 2023 and March 2025 were enrolled. All patients underwent B mode ultrasound, color Doppler flow imaging (CDFI) and UMA 1 week before surgery resections. Adler semiquantitative analysis (Grades 0-3) and vascular morphology (patterns A-F) were used to assess the blood flow within the renal tumors. Based on histopathological results after surgery, patients were divided into benign and malignant groups. Using high-level blood flow signals (Grades 2 and 3) and hypervascular supply (patterns E and F) as diagnostic criteria for malignant renal tumors, the diagnostic efficiency of CDFI and UMA were analyzed and compared.

Results: According to surgical resection and histopathological results, patients were divided into benign group (n = 10) and malignant group (n = 55). On UMA, vascular morphology patterns and Adler grades in malignant group were significantly higher than those in benign group (P < .05). More high-level blood flow signals and more complex vascular morphology patterns were detected by UMA than CDFI for malignant renal tumors (91.3% vs. 54.4%, 64.9% vs. 19.3%), with the area under curve of characteristics of 0.71 vs. 0.59, and 0.73 vs. 0.50, respectively.

Conclusions: By sensitively displaying tiny and low-velocity blood flow signals, UMA has potential value in preoperative noninvasively differential diagnosis between benign and malignant renal tumors.

Objective: To investigate the value of transitional phase characteristics on Sonazoid contrast-enhanced ultrasound (S-CEUS) in the differential diagnosis of common focal liver lesions (FLLs).

Materials and methods: This prospective multicenter study enrolled 122 participants with FLLs from 8 medical centers between December 2023 and March 2025. The study comprised 43 cases of hepatic hemangioma (HH), 35 cases of hepatocellular carcinoma (HCC), and 44 cases of liver metastases (LM). All participants underwent standardized S-CEUS examinations. The enhancement characteristics and washout patterns during the transitional phase were analyzed for all participants.

Results: Significant differences were observed among the three types of lesions in terms of early arterial enhancement patterns, time to start of washout, and the degree of enhancement during the transitional phase (P < .01). The optimal diagnostic efficacy was achieved with the following criteria: washout start at 3.5 min for diagnosing HH (AUC = 0.974); mild hypoenhancement observed in 3 and 4 min for diagnosing HCC (AUC = 0.880 and 0.879); and marked hypoenhancement observed between 4 and 6 min for diagnosing LM (AUC = 0.911-0.916).

Conclusion: The dynamic characteristics of the transitional phase in S-CEUS can effectively differentiate common FLLs, providing a valuable basis for precise clinical diagnosis.

Chorionic villus sampling (CVS) is a crucial prenatal diagnostic tool, but a declining number of procedures makes training a challenge. Here we describe a transcervical CVS simulator made from ballistic gelatin. Ninety-three Maternal-Fetal Medicine providers used the simulators during hands-on workshops and completed surveys regarding their fidelity and usefulness in training. Surveys showed median scores of 5 (interquartile range: 4-5) for the fidelity of the ultrasound images, fidelity of the haptic feel, and its usefulness in training. This suggests the simulator will be an effective training tool and provide needed alternative training opportunities for MFM fellows.

Objectives: To assess the diagnostic performance of ultrasound attenuation analysis (USAT) in evaluating hepatic steatosis in patients with metabolic dysfunction-associated steatotic liver disease (MASLD), with magnetic resonance imaging proton density fat fraction (MRI-PDFF) as the reference.

Methods: Participants were recruited. Each participant underwent both USAT and MRI-PDFF examinations on the same day. We employed MRI-PDFF thresholds to classify the stages of hepatic steatosis. Univariable and multivariable linear regression analyses were conducted to identify significant factors influencing USAT. Receiver operating characteristic (ROC) curve analysis was utilized to evaluate the diagnostic performance of USAT in predicting the grade of liver steatosis and compared with visual hepatic steatosis grade (VHSG) and clinical prediction models.

Results: A total of 145 patients took part in this study. The correlation coefficient between USAT and MRI-PDFF was 0.805 (p < .050). USAT varied significantly across different hepatic steatosis grade. Triglyceride (TG) and steatosis grade were significant determinant factors for USAT. The areas under the ROC curve of USAT for predicting steatosis ≥ S1, ≥ S2, and =S3 were 0.90 (cut-off value of 0.61 dB/cm/MHz), 0.92 (cut-off value of 0.71 dB/cm/MHz), and 0.92 (cut-off value of 0.82 dB/cm/MHz), respectively. The diagnostic performance of USAT was statistically better than that of VHSG, Hepatic steatosis index (HSI), and Framingham steatosis index (FSI).

Conclusion: USAT is a promising quantitative tool for the quantitative assessment of hepatic steatosis in patients with MASLD, demonstrating a stronger correlation with MRI-PDFF.

Objectives: This study aimed to develop and validate a multimodal nomogram that integrates ultrasound features, clinical risk factors, and systemic inflammatory markers to predict carotid vulnerable plaques (VPs), assess its precision in recognizing high-risk plaques associated with stroke, and offer personalized clinical interventions.

Methods: A total of 146 patients who underwent carotid endarterectomy (CEA) between April 2024 and May 2025 were enrolled in this prospective study and subsequently divided into a training cohort (n = 100) and a validation cohort (n = 46). The candidate variables comprised clinical characteristics, laboratory parameters, and multimodal ultrasound plaque features. The least absolute shrinkage and selection operator (LASSO) regression was utilized for robust variable selection to mitigate overfitting. A nomogram was developed based on the selected features, and its performance was evaluated using the area under the receiver operating characteristic curve (AUC), calibration curves, decision curve analysis (DCA), and clinical impact curve (CIC).

Results: The LASSO regression analysis identified 8 independent predictors for the nomogram: neutrophil-to-lymphocyte ratio (NLR), intraplaque neovascularization (IPN) grade, smoking history, neutrophil count, body mass index (BMI), plaque echogenicity, C-reactive protein (CRP), and plaque morphology. The nomogram exhibited excellent discriminative capacity, with an AUC of 0.911 (95% CI: 0.851-0.972) in the training cohort and 0.889 (95% CI: 0.786-0.992) in the validation cohort. Calibration curves demonstrated good concordance between predictions and observations, whereas DCA and CIC confirmed the model's favorable clinical utility.

Conclusions: The developed multimodal nomogram accurately predicts carotid VPs, facilitates patient risk stratification, and supports the initiation of targeted preventive therapies for those at the highest risk.

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.