Journal of Ultrasound in Medicine最新文献

Objectives: Based on pelvic floor ultrasound and Glazer pelvic floor surface electromyography parameters in postpartum patients with stress urinary incontinence (SUI), this study aims to establish a model and explore its clinical value in predicting the disease.

Methods: A total of 193 postpartum women admitted to our hospital were enrolled and divided into the SUI group (67 cases) and non-SUI group (126 cases) according to the occurrence of SUI at 6-8 weeks postpartum. The recruitment period is from May 2023 to May 2025. This study has been approved by the Ethics Review Committee of our institute (Approval No: 2025-33). All subjects are patients attending our department (all patients provide verbal consent, witnessed by outpatient medical records). Clinical data, 3-dimensional pelvic floor ultrasound parameters, and Glazer pelvic floor sEMG parameters were collected from both groups. Univariate and multivariate analyses were performed to screen independent factors, based on which a nomogram model was established. Receiver operating characteristic (ROC) curves and clinical decision curves were plotted.

Results: Significant differences were observed between the 2 groups in neonatal body weight, maternal weight at follow-up, bladder neck mobility (BNM), urethral rotation angle (URA), posterior vesicourethral angle (PVA), levator hiatus area (LHA), pelvic floor fast contraction force, tonic contraction force, and endurance (all p < .05). Multivariate analysis identified URA, PVA, pelvic floor fast contraction force, tonic contraction force, and endurance as independent risk factors for SUI. The ROC curve showed an area under the curve (AUC) of 0.838. The decision curve indicated that the net benefit curve was higher than both the "All" line and the "None" line.

Conclusion: The established model demonstrates high predictive value for postpartum SUI. The combination of pelvic floor ultrasound and Glazer pelvic floor electromyography can improve the diagnostic accuracy of SUI.

Congenital anomalies of salivary glands (SG) are rare and include aplasia, hypoplasia, ectopic/accessory SG, tumors and ductal atresia. While ectopic and accessory SG do not require treatment, aplasia/hypoplasia leads to xerostomia with resultant oral health deterioration. Ductal atresia leads to the formation of mucus retention cysts, requiring surgical excision after birth. Recognizing the normal sonoanatomy of SG during routine mid-trimester fetal ultrasound scans is essential for detecting congenital anomalies. The purpose of this study is to describe the normal sonographic appearance of SG and devise a scanning protocol for assessment of SG and associated temporomandibular structures.

Objectives: To investigate the dimensions of infratentorial brain structures in fetuses with prenatally diagnosed congenital heart disease (CHD) and determine whether these measurements differ based on the expected pattern of fetal brain oxygen delivery.

Methods: This prospective case-control study was conducted at a tertiary perinatal center. A total of 112 singleton pregnancies between 28 and34 weeks of gestation were enrolled, comprising 56 fetuses with CHD and 56 healthy controls. CHD cases were classified into 2 groups based on expected fetal brain oxygen delivery: Class A (n = 29, expected oxygen supply) and Class B (n = 27, expected normal oxygen supply). Detailed neurosonographic evaluation was performed using standardized protocols to measure infratentorial structures including cerebellar vermis (craniocaudal diameter [CCD], anteroposterior diameter [APD], circumference, and area), trans-cerebellar diameter, and brainstem structures (pons, midbrain, and medulla oblongata APDs). Maternal demographic characteristics, pregnancy course, and outcomes were retrieved from the hospital database.

Results: Demographic characteristics were comparable between groups except for gestational age at delivery (38.23 ± 1.41 versus 38.87 ± 1.19 weeks, p = .011) and birth weight (3121 ± 477 g versus 3336 ± 318 g, p = .006), which were significantly lower in the CHD group. Fetuses with CHD demonstrated significantly smaller vermis CCD (Class A: 19.3 ± 1.65 mm, Class B: 19.2 ± 1.39 mm versus Controls: 20.6 ± 0.84 mm, p = .001) and vermis area (Class A: 2.70 ± 0.07 cm², Class B: 2.71 ± 0.11 cm² versus Controls: 2.86 ± 0.24 cm², p = .001). Brainstem measurements revealed significantly reduced pons APD (Class A: 12.2 ± 1.62 mm, Class B: 12.1 ± 1.10 mm versus Controls: 13.4 ± 1.45 mm, p = .001) and medulla oblongata APD (Class A: 8.4 ± 0.87 mm, Class B: 8.3 ± 0.98 mm versus Controls: 9.2 ± 0.96 mm, p = .001). Trans-cerebellar diameter, vermis APD, vermis circumference, and midbrain APD showed no significant differences between groups. Importantly, no significant differences were observed between Class A and Class B CHD groups for any measured parameter.

Conclusion: Fetuses with CHD exhibit significant reductions in specific infratentorial brain measurements, including cerebellar vermis dimensions and brainstem structures (pons and medulla oblongata), compared to healthy controls. These abnormalities are present regardless of the CHD classification based on expected cerebral oxygen delivery, suggesting that the impact of CHD on fetal brain development is more complex than previously understood. These findings support the implementation of comprehensive neurosonographic evaluation in all fetuses with CHD and highlight the need for further research correlating prenatal infratentorial measurements with long-term neurodevelopmental outcomes.

Objectives: To evaluate the intra- and interobserver reproducibility of placental shear wave elastography (SWE) in healthy third-trimester singleton pregnancies.

Methods: This prospective study included 80 women with singleton pregnancies between 28 and 37 weeks of gestation. Placental stiffness was measured using point SWE at central and peripheral regions. Each participant was evaluated twice by 1 observer and once by another. Intraclass correlation coefficients (ICCs) were calculated to assess reproducibility.

Results: Placental SWE showed moderate reproducibility. In anterior placentas, intraobserver ICCs were 0.681 for peripheral and 0.715 for central regions, while interobserver ICCs were 0.630 and 0.701, respectively. In posterior placentas, intraobserver ICCs were 0.785 for peripheral and 0.765 for central regions, with interobserver ICCs of 0.717 and 0.753, respectively. In the total cohort, peripheral SWE velocity had an intraobserver ICC of 0.728 and interobserver ICC of 0.672, while central SWE velocity demonstrated comparable values, with intraobserver ICC of 0.729 and interobserver ICC of 0.727.

Conclusion: Placental SWE demonstrated moderate intra- and interobserver reproducibility, with minor variations depending on placental location. Despite these differences, measurement reliability was sufficiently acceptable to support its feasibility as a noninvasive adjunct in placental assessment.

Objectives: The mechanism of neurological recovery after surgical decompression is still unclear for degenerative cervical myelopathy (DCM). This study aims to analyze the relationship between microvasculature in the post-decompressed spinal cord segments and neurological recovery and further design a prediction model of recovery.

Methods: This prospective cohort study analyzed data from a cohort of patients with DCM who underwent surgical decompression from May 2023 to May 2024 at a single center. Intraoperative ultrasound ultrafast Doppler imaging was performed to evaluate the microvasculature of post-decompressed spinal cord segments. Differences in 5 microvascular indexes between post-decompressed spinal cord segments and normal spinal cord segments were calculated for each participant. All participants were followed up for 1 year to obtain modified Japanese Orthopedic Association (mJOA) scores. Participants were divided into favorable and unfavorable recovery groups based on a threshold of 50% for the recovery rate of mJOA scores. The Mann-Whitney U test compared microvascular indexes between the 2 groups. Kolmogorov-Arnold Network was further introduced to predict neurological recovery based on the proposed microvascular indexes.

Results: Forty-eight participants (median age, 59 years [IQR, 54-66 years]; 36 males) were included. Thirty-seven participants had a favorable recovery. All 5 microvascular indexes were associated with neurological recovery (all p < .05). The proposed prediction model achieves an accuracy of 94% (45 of 48) and an area under the receiver operating characteristic curve (AUC) of 0.98 (95% CI: 0.90, 1.00).

Conclusions: Microvasculature of post-decompressed spinal cord segments is associated with neurological recovery and can effectively predict neurological recovery.

Objectives: Obesity is closely associated with the occurrence and progression of breast cancer. While body mass index (BMI) is widely used to diagnose obesity, it has certain limitations. Subcutaneous fat thickness (SFT) also serves as an indicator of body composition. However, studies on breast SFT are scarce. This study aims to investigate the relationship between BMI, breast SFT, and ultrasound features of breast cancer, as well as their associations with tumor proliferation and invasiveness.

Methods: This study retrospectively analyzed the relationship between BMI and clinical and ultrasound characteristics in 1670 patients. Among them, breast SFT was measured in 470 patients using mammography and ultrasound, and the correlation between SFT and BMI was assessed. The relationship between ultrasound-measured SFT and pathological as well as ultrasound features was also analyzed. The correlation between breast SFT, BMI, and somatic gene mutations was analyzed in 234 patients.

Results: Patients with BMI ≥24 kg/m² exhibited more malignant ultrasound features. SFT measured by mammography was correlated with SFT measured by ultrasound (r = 0.565, p < .001). Both BMI and SFT measured via mammography (r = 0.578, p < .001) and ultrasound (r = 0.485, p < .001) showed significant correlations. Breast SFT varied significantly among tumors with different shapes (p = .025), boundaries (p < .001), and posterior echo features (p < .001). The area under the curve (AUC) for breast SFT predicting irregular shape, halo, and posterior shadowing was 0.605, 0.666, and 0.632, respectively, with cutoff values of 8.65, 8.35, and 8.35 mm. Patients with breast SFT ≥8.6 mm demonstrated significantly elevated Ki67 levels (p = .004). No differences in somatic mutation frequencies were found at a threshold of 8.60 mm for fat thickness or at a BMI of 24 kg/m². However, at BMI ≥22 kg/m², mutation frequencies were higher.

Conclusions: BMI and breast SFT are associated with malignant ultrasound features. While both have diagnostic value, BMI is more reliable than fat thickness for predicting cancer proliferation and invasion, with a BMI threshold of 22 kg/m² offering higher diagnostic value than 24 kg/m².

Objective: To determine the proportion of cases of lower extremity symptoms attributable to underlying musculoskeletal (MSK) rather than thrombotic etiologies in emergency versus non-emergency settings.

Methods: We retrospectively reviewed all lower extremity Venous Doppler ultrasounds performed on emergency department (ED) and non-ED patients over a 1-year period at a single institution. Using radiology report data mining software, keywords including tear, tendon, hematoma, and muscle were used to identify cases of MSK pathology of the lower leg. All reports were also reviewed for findings of venous thrombosis. Statistical significance between ED and non-ED patients for both incidental MSK pathology and venous thrombosis was assessed using chi-squared tests.

Results: A total of 5714 lower extremity Doppler ultrasounds were performed at a single institution during the 1-year period, 1829 in the ED and 3885 in non-ED settings. Sixty-nine of 1829 (3.8%) ED patients had incidental MSK pathology of the lower extremity compared to 53/3885 (1.4%) in the non-ED setting (p < .001). Two hundred sixty-seven of 1829 (14.5%) ED patients had evidence of venous thrombosis and/or chronic post-thrombotic change. When combined with thrombotic pathology as positive cases, incidental MSK injury accounted for 69/336 (20.5%) of ED cases with positive sonographic findings.

Conclusions: MSK pathology of the lower leg is significantly more likely to contribute to lower extremity symptoms in the ED compared to a non-ED setting. Therefore, a brief sonographic evaluation of the MSK apparatus may be beneficial in a subset of ED patients, particularly those with focal pain but no identifiable thrombotic etiology.

Objectives: This study aimed to develop and validate machine-learning (ML) models that integrate ultrasonic radiofrequency (RF) time-series signals with gray-scale image features for the preoperative differentiation of breast lesions classified as category 4A of the Breast Imaging Reporting and Data System.

Methods: A dataset comprising RF signals, 2D ultrasound features, and pathological diagnoses from 130 BI-RADS 4A lesions (128 patients) was analyzed. Five ML models (logistic regression [LR], support vector machine [SVM], k-nearest neighbor [k-NN], and gradient boosting [GB]) were evaluated.

Results: Among 31 features (28 RF-derived and 5 2D image features), 6 key features were selected through feature selection. The LR model achieved the highest area under the curve (0.81, 95% confidence interval: 0.66-1.00), though no statistically significant differences were observed among models (DeLong test, p > .05). Artificial intelligence-assisted diagnosis improved accuracy across physician seniority levels (p < .05): junior (≤3 years: 52.28% versus baseline 27.28%), intermediate (4-10 years: 79.54% versus 45.46%), and senior (≥10 years: 81.91% versus 63.63%).

Conclusion: The integration of RF time series and 2D features via LR demonstrates potential to reduce unnecessary biopsies by enhancing diagnostic precision, particularly for less experienced clinicians.