Journal of Ultrasound in Medicine最新文献

Objectives: To evaluate the feasibility and inter-rater reliability of bedside muscle ultrasonography for detecting muscle loss in critically ill pediatric patients.

Design: A single-center prospective cohort study was conducted (January 2024-January 2025).

Methods: Critically ill children frequently experience rapid muscle loss, a complication associated with intensive care unit (ICU)-acquired weakness, prolonged mechanical ventilation, and increased morbidity. Early detection of muscle wasting may enable targeted interventions to mitigate these adverse outcomes.

Patients: Critically ill children (aged 2-18 years) requiring invasive mechanical ventilation for >24 hours.

Interventions: Serial ultrasound assessments of the quadriceps femoris muscle thickness and cross-sectional area were performed at baseline and during ICU stay. Potential risk factors (eg, corticosteroid use, neuromuscular blockade, hyperglycemia, and nutritional status) were recorded.

Results: Of the 35 patients enrolled in the study, 14 (40%) had significant muscle loss (defined as loss of ≥10% of muscle mass compared to the baseline assessment) detected by decreased muscle thickness, and 20 (57%) had muscle loss detected by reduced cross-sectional area. Muscle loss occurred 3-10 days into their critical illness and invasive mechanical ventilation. Stepwise multivariable logistic associations showed that patients with a lower ratio of actual-to-goal protein intake at the time of scan had higher odds of muscle loss, as it was associated with >10% decrease in cross-sectional area (adjusted OR 3.2, CI 1.22, 3.56) and that a higher mean level of C-reactive protein was associated with a significant decrease in muscle thickness (adjusted OR 1.7, CI 1.23, 3.34).

Conclusion: Bedside muscle ultrasonography is a feasible, and practical tool for early detection of muscle loss in critically ill children. Its noninvasive nature, portability, and cost-effectiveness support its potential integration into routine ICU monitoring to guide early rehabilitative or nutritional interventions. Further multicenter studies are warranted to validate these findings.

Objectives: The primary objective of this study was to describe the indications for performing point-of-care ultrasound (POCUS) in prehospital settings. The secondary objective was to assess its impact on the diagnostic workup when its use was initiated by the emergency physician (EP) dispatched with a mobile intensive care unit (MICU).

Methods: This prospective observational cohort study was conducted within the MICU of Toulouse University Hospital from December 1, 2022, to May 31, 2023. All adult patients managed by the Toulouse MICU for whom the EP performed a POCUS examination were eligible for inclusion. EP was asked to state the diagnostic hypothesis being evaluated and to rate its likelihood before and after POCUS assessment. The hypothesis and the evaluation of the EP before and after POCUS were compared to the final diagnosis at hospital discharge.

Results: Over the 6-month study period, 83 had a POCUS by a MICU. The indications for performing POCUS were: high-energy trauma (n = 50 [60%]), chest pain (n = 20 [24%]), dyspnea (n = 9 [11%]), abdominal pain (n = 3 [4%]), and cardiac arrest (n = 1 [1%]). The diagnostic impression was more often consistent with the final diagnosis after POCUS than before (58 [70%] vs. 36 [43%]; P < .001). POCUS modified the diagnostic assessment wrongly in 7 (8%) patients and rightly in 28 (34%) patients.

Conclusion: The most frequent indications for prehospital POCUS were high-energy trauma, chest pain, and dyspnea. POCUS improved the rate of initial diagnostic assessments consistent with the final diagnosis.

High-frequency ultrasound (HFUS) is valuable for assessing skin lesions, supporting diagnosis, treatment monitoring, and surgical planning. This study evaluates deep learning models for binary classification of HFUS images acquired in B-mode and Doppler mode. Two single-input CNNs were trained with each modality, while Unity and Cascade architectures combined both. The HFUS-Doppler model achieved the best performance (95.0% accuracy, AUC 0.98), followed by Unity (90.5% accuracy, AUC 0.97). Cascade showed lower accuracy but greater confidence in malignant predictions. Probability distribution analysis revealed differences in model certainty near the decision threshold. Results indicate that combining B-mode and Doppler can enhance diagnostic performance, depending on network design and data quality, supporting the potential of customized deep learning for non-invasive HFUS-based skin lesion classification.

Objectives: To explore the ultrasound diagnosis of fetal acrania-exencephaly-anencephaly sequence before 11 weeks of gestation.

Methods: A retrospective multicenter study was carried out in 5 medical institutions in Guangxi Zhuang Autonomous Region. The crown-rump length (CRL), occipitofrontal diameter (OFD), and anteroposterior abdominal diameter (AAD) were measured in the median sagittal view. The ratios of AAD/OFD and CRL/OFD were computed. The correlations among various growth parameters of the normal group of fetus were analyzed. The receiver operating characteristic (ROC) curve was plotted, and the area under the curve (AUC) value was calculated to predict the acrania-exencephaly-anencephaly sequence. Additionally, the cranial ultrasound image characteristics of fetus with the acrania-exencephaly-anencephaly sequence at 11 weeks of gestation were analyzed.

Results: As the CRL of normal fetuses increased, both OFD and AAD also increased. Spearman correlation analysis revealed positive correlations for both parameters, with r values of 0.99 and 0.97 (P < .01), respectively. The ROC curves of AAD/OFD and CRL/OFD in predicting the acrania-exencephaly-anencephaly sequence indicated areas under the curves of 0.998 (95% CI 0.993-1.000, P < .01) and 1.00 (95% CI 1.000-1.000, P  < .01), respectively. The optimal threshold of AAD/OFD was 0.874, with a sensitivity of 97.1% and a specificity of 100%. The optimal threshold of CRL/OFD was 2.261, with a sensitivity of 100% and a specificity of 99.7%. Morphological alterations in the cephalon were observed in all 34 cases.

Conclusion: The CRL/OFD is a reliable indicator for predicting the acrania-exencephaly-anencephaly sequence. When combined with cranial ultrasound morphological changes, it can accurately diagnose the acrania-exencephaly-anencephaly sequence before 11 weeks of gestation. However, diagnosis at this stage still requires reconfirmation after 11 weeks to enable doctors and parents to make the ultimate decision.

Objectives: Fetuses with ductal constriction (FDC), pulmonary hypertension and right ventricular overload after maternal exposure to PGE2 inhibitors-nonsteroidal anti-inflammatory drugs (NSAIDs) or polyphenols (PF)-have increased septum primum excursion index (SPEI), the ratio between maximal septum primum displacement and left atrial diameter. The objective of this study is to assess SPEI behavior and its correlation to mean pulmonary artery pressure (MPAP) after ductal constriction (DC) resolution.

Methods: Cohort study comparing SPEI and MPAP during and 2 weeks after DC reversal, following discontinuation of NSAIDs and PF. Criteria for DC diagnosis were systolic velocity >1.40 m/second, diastolic velocity >0.30 m/second, and pulsatility index <2.2. MPAP was estimated by Dabestani equation: MPAP = 90 - (0.62 × pulmonary artery acceleration time).

Statistical analysis: t-test and Pearson's correlation.

Results: Fifty-two pregnant women with FDC were evaluated. Following reversal, mean PI increased from 1.89 ± 0.20 to 2.54 ± 0.27 (p < .001), mean SPEI decreased from 0.75 ± 0.13 to 0.42 ± 0.12 (p < .001), and MPAP decreased from 70.33 ± 5.52 mmHg to 53.27 ± 6.68 mmHg (p < .001), with a significant correlation between MPAP and SPEI (r = 0.690).

Conclusion: After resolution of fetal DC, the SPEI decreases, this effect being correlated with reduction in MPAP.