Journal of Ultrasound in Medicine最新文献

Objectives: To quantify the association between skeletal muscle echo intensity (MEI), measured by ultrasound, and clinical markers of insulin resistance and glycemic control, and evaluate MEI's diagnostic accuracy in identifying insulin resistance.

Methods: In this cross-sectional study, 20 adults with obesity (mean body mass index [BMI] 34.4 ± 2.6 kg/m², mean age 33 years, 40% female) and 8 healthy, lean adults (mean BMI 22.5 ± 1.4 kg/m², mean age 25 years, 75% female), all without diabetes or metabolic disease, underwent laboratory testing (HbA_1c, 2-hour oral glucose tolerance testing with insulin for Matsuda Index), muscle ultrasound (deltoid, vastus lateralis), and DEXA for sarcopenia indices. Two blinded research assistants independently analyzed 336 ultrasound images to quantify MEI.

Results: Increased MEI was significantly associated with greater insulin resistance (lower Matsuda Index; r = -.47, p = .011), particularly in women (r = -.56, p = .039). MEI z-scores identified insulin resistance with an AUROC of 0.872 (95% CI 0.742-1.000). At the optimal threshold of z = 1.96, sensitivity was 94.4%, specificity 80%, accuracy 89.3%, and Youden's index 0.744. MEI accurately identified insulin resistance despite normal HbA_1c and fasting glucose. Increased MEI in both muscles suggested global skeletal muscle changes. Among participants with obesity, MEI did not correlate with BMI but was negatively correlated with sarcopenia indices (r = -.56, p = .0096) and body weight (r = -.50, p = .0233).

Conclusions: MEI is an accurate, noninvasive biomarker for insulin resistance and may detect muscle alterations before conventional markers emerge. Its independence from BMI and conventional markers supports MEI's use in early risk stratification and identification of individuals at risk for metabolic dysfunction who might otherwise go undetected.

Breast cancer continues to be one of the most common cancers affecting women worldwide. Yet, early detection and treatment progress remain limited by drug resistance, systemic toxicity and poor tumor specificity. Targeted therapy solves these limitations by directing therapeutic agents to cancerous tissues while protecting healthy cells. Nanocarrier-based delivery systems have improved drug solubility while extending circulation time and enabling controlled drug release at tumor sites. This review examines the current integration of ultrasound (US) as a strong external trigger which boosts nanocarrier-mediated therapy effectiveness. The application of continuous and pulsed US shows potential to enhance drug delivery by improving penetration and site-specific activation and spatiotemporal control of therapeutic release through acoustic cavitation and hyperthermia mechanisms. The application of US-responsive nanocarriers demonstrates promising outcomes in breast cancer models, both in vitro and in vivo, by delivering higher drug concentrations to tumors while minimizing damage to healthy tissues. The research details the US parameters that affect drug release patterns and therapeutic results. Such systems have been investigated for their dual diagnostic and therapeutic (theranostic) capabilities, which enable new personalized and image-guided treatment methods. Various case studies and preclinical evaluations demonstrate the advantages of integrating US with nanocarrier systems. The main obstacles to clinical implementation involve standardizing US protocols and enhancing nanocarrier designs, and addressing regulatory requirements. Our previous research works demonstrate how US-guided mediation can be combined with magnetic induction to create a revolutionary breast cancer treatment approach.

Objectives: To evaluate the accuracy of transcerebellar diameter (TCD) in estimating gestational age (GA) during the third trimester and compare its predictive value with traditional biometric parameters in appropriate-for-gestational-age (AGA), large-for-gestational-age (LGA), and small-for-gestational-age (SGA) fetuses.

Methods: In this prospective cross-sectional study, 229 singleton pregnancies between 28 and 40 weeks were categorized into AGA, LGA, and SGA groups based on estimated fetal weight (EFW) and/or abdominal circumference (AC) percentiles. Standardized ultrasonography was used to obtain biometric measurements, including TCD. Correlation coefficients, accuracy within ±7, ±14, and ± 21-day margins, and simple linear regression analyses were calculated for each group.

Results: TCD showed a strong correlation with GA in all groups (AGA: r = 0.904; LGA: r = 0.920; SGA: r = 0.848). These findings indicate large effect sizes and strong associations between TCD and gestational age across all fetal growth groups. Within ±14 days, TCD accuracy was high across groups (AGA: 88.7%, LGA: 85.0%, SGA: 86.3%; p = .788). Regression models demonstrated high predictive performance in AGA (R² = 0.838) and LGA (R² = 0.891) groups, and moderate performance in SGA (R² = 0.645). TCD outperformed other parameters in LGA and SGA within wider error margins.

Conclusion: TCD is a reliable, growth-pattern-independent parameter for GA estimation in the third trimester and a valuable alternative when conventional measurements are less reliable.

Objectives: The diagnosis of post-thrombotic syndrome (PTS) is based on the presence of typical symptoms and signs in a patient with prior deep vein thrombosis (DVT). This condition occurs as a consequence of venous hypertension associated with deep vein system obstruction and venous valve dysfunction. Although there are no standardized diagnostic tests for this disease, ultrasound findings may be very useful for its diagnosis, prediction, treatment, and follow-up.

Methods: We performed a comprehensive review of the literature available in the scientific databases PubMed and Medline until May 1, 2025, selecting 42 articles of interest, which included the main international clinical practice guidelines. We then summarized the available evidence on the usefulness of Duplex ultrasound in the evaluation of patients with PTS associated with DVT of the lower limbs.

Results: Although the diagnosis of PTS is primarily based on clinical criteria, ultrasound identification of chronic post-thrombotic changes may increase the reliability of clinical diagnostic scores. Residual venous obstruction, assessed 3-6 months after diagnosis of DVT, and to a lesser extent popliteal valve reflux are associated with an increased risk of developing PTS. This finding may be relevant to guide the duration of anticoagulant therapy, but also to identify patients who benefit most from continued treatment with elastic compression stockings to reduce the risk of PTS.

Conclusions: Duplex ultrasound assessment provides complementary information to clinical manifestations in the evaluation of patients with PTS, leading to better diagnostic accuracy. Its findings might also allow predicting PTS after an episode of DVT of the lower limbs, and to optimize therapeutic management.

Objectives: Fetal inguinal hernia (FIH) refers to the descent of abdominal contents through the inguinal canal in the fetus. This uncommon condition could lead to an adverse neonatal outcome if the diagnosis is underestimated. This study aims to elucidate the ultrasonic features, clinical presentation, management, and neonatal outcomes of FIH.

Methods: This case series reports FIHs between 2010 and 2024 at Orleans University Hospital, France. All cases had at least 1 imaging evidence of FIH and the diagnosis was confirmed at birth. In addition, the last 15 years of literature review from the inception to July 2025 were included.

Results: Overall, 3 cases relating to FIH were found at our maternity center. Following the additional data in the literature, 19 cases were reported in the last 15 years, and a total of 29 cases, consisting of our 3 cases, were found in the literature until today. The clinically common characteristics include the male fetus and the right side. The average gestational age at detection was 35 weeks. Regarding features of ultrasound images, the mean size of the mass was 42 mm. Additionally, the presence of Doppler signal, peristalsis, bowel obstruction, and hydrocele were reported at 61.5, 76.5, 28.6, and 40.0%, respectively. Almost all cases required surgical repair after birth without complications.

Conclusions: Although its rarity, awareness of FIH should not be underestimated during antenatal care. Antenatal ultrasound plays an important role in detecting the FIH and monitoring the progression of fetal hernial mass during pregnancy. A good prognosis of isolated FIH could be made if timely multidisciplinary management is performed.

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.