Ultrasound最新文献

Purpose: Placenta accreta spectrum encompasses abnormal placental attachment disorders characterised by progressive invasion into the uterine wall. Its incidence is rising due to increasing caesarean section rates and advanced maternal age, posing significant risks such as haemorrhage, uterine rupture and hysterectomy. Early and accurate diagnosis is critical for optimizing maternal and neonatal outcomes.

Findings: Diagnosis of placenta accreta spectrum is possible in early pregnancy using transvaginal ultrasound. Key indicators include caesarean scar pregnancy, anterior myometrial thinning, placental lacunae, loss of the clear zone, bladder wall interruption and uterovesical hypervascularity. These findings facilitate early counselling and tailored management to mitigate emergency surgical complications. Evaluating the gestational sac's relationship with the endometrial cavity in early pregnancy is essential in predicting pregnancy progression and associated risks, including uterine rupture or the need for caesarean hysterectomy. When transvaginal ultrasound provides limited views, transabdominal ultrasound may offer superior views to understand the relationship between the gestational sac and the endometrial cavity. Serial ultrasound monitoring is recommended in women with risk factors, particularly if they are symptomatic, to track pregnancy progression accurately.

Conclusion: This pictorial review consolidates early gestational imaging findings to enhance diagnostic precision. It highlights standardised ultrasound criteria proposed by international consensus groups and explores magnetic resonance imaging as an adjunctive tool for cases with inconclusive ultrasound findings. By providing a comprehensive visual guide, this review aims to improve early detection, refine surgical planning and enhance maternal outcomes in placenta accreta spectrum management.

Introduction: Pulmonary infarction is an ischaemic necrosis resulting from pulmonary arterial occlusion, occurring in approximately one-third of pulmonary thromboembolism cases. While computed tomography angiography remains the gold standard for diagnosis, its use in follow-up is limited by radiation exposure. Thoracic ultrasonography, a bedside, radiation-free and repeatable modality, may serve as an alternative tool for monitoring pulmonary infarction.

Case report: We present a 44-year-old woman who developed sudden dyspnoea and back pain 1 week after venous surgery. Computed tomography angiography confirmed pulmonary thromboembolism, and persistent flank pain was attributed to pulmonary infarction. Thoracic ultrasonography revealed a hypoechoic, pleural-based consolidation in the left hemithorax measuring 19 × 11 mm. The patient was treated with anticoagulation and followed weekly with thoracic ultrasonography. Her symptoms improved, and by the sixth week, the consolidation had completely resolved.

Discussion: Pulmonary infarction has traditionally been associated with poor outcomes in older patients with comorbidities; however, it may also occur in young, otherwise healthy individuals. The clinical significance of pulmonary infarction remains uncertain, although some studies suggest potential associations with delayed recovery and functional impairment. Thoracic ultrasonography demonstrates good sensitivity and specificity in detecting pulmonary infarction and offers several advantages over computed tomography angiography for follow-up, including safety, accessibility and repeatability. Evidence suggests that infarct resolution typically occurs within 6 to 12 weeks, a period during which thoracic ultrasonography may be effectively utilised to monitor lesion regression.

Conclusion: This case highlights the role of thoracic ultrasonography in the follow-up of pulmonary infarction. Although limited to peripheral, pleura-based lesions, thoracic ultrasonography represents a safe, practical and repeatable imaging modality for monitoring pulmonary infarction resolution and may reduce the need for repeated computed tomography angiography in clinical practice.

Background: Delphian (level VI) lymph nodes are often linked to head and neck malignancy, but their relationship with thyroiditis is less well described. Ultrasound is used in the assessment and workup for thyroiditis, but thyroid appearances can be variable and non-specific. The presence of a Delphian lymph node may help to determine the aetiology of inflammatory thyroid disease.

Objective: To investigate whether assessing Delphian lymph nodes on ultrasound can help predict the diagnosis of thyroiditis in children.

Methods: Retrospective review of scans from 70 children (1-17 years old) carried out by a single radiologist at a tertiary paediatric centre. The presence or absence of Delphian lymph nodes was assessed, as well as the thyroid size/volume, echogenicity and vascularity. Biochemical markers, where applicable, and clinical diagnoses were obtained and matched up to radiological findings. Markers included thyroid function tests (TFTs) as well as serum thyroid peroxidase antibody and thyroid receptor antibody.

Results: Twenty-four patients had Delphian lymph nodes identified on ultrasound. There was statistical significance between the presence of Delphian lymph nodes and heterogeneous thyroid architecture (p < 0.001), thyroid enlargement (p = 0.002) and increased thyroid vascularity (p < 0.001). Although no significant association was identified between the size of the Delphian lymph node and the thyroid appearances on ultrasound or the biochemical results, there was a significant association between the presence of Delphian lymph nodes and the clinical diagnosis.

Conclusion: There is a significant association between the presence of Delphian lymph nodes on ultrasound with findings in thyroiditis. These include the presence of key biochemical markers and abnormal thyroid appearances on ultrasound - increased heterogeneity, size and vascularity.

Introduction: Granular cell tumours are rare lesions that can mimic breast carcinoma due to their shared radiological and clinical characteristics. As they are almost always benign, it is important to include these lesions as a differential during triple assessment.

Case report: A 43-year-old female was referred to the breast clinic after an incidental finding of a lesion on her left breast detected on a computed tomography scan. Clinical assessment was unremarkable. Ultrasound revealed a poorly defined hypoechoic lesion with distal acoustic shadowing and perilesional hyperechogenicity. These findings, along with mammographic examination, were considered highly suspicious for malignancy; therefore, ultrasound-guided percutaneous core biopsy was undertaken. This confirmed a diagnosis of granular cell tumours. After multidisciplinary team discussion, the lesion was surgically excised, with annual clinical examination and surveillance mammography arranged for the next 5 years.

Conclusion: Granular cell tumours of the breast are usually benign, although they may have imaging characteristics similar to those of breast malignancy. Biopsy should be performed to confirm the diagnosis as the prognosis and management strategies differ significantly from breast carcinoma.

Introduction: Liver involvement is a rare ongoing occurrence of systemic sarcoidosis, and it can be difficult to recognise.

Methods: A case of how imaging was used to diagnose hepatic sarcoidosis in a 45-year-old male with clinical and biochemical signs of hepatic liver disease is reported.

Results: Hepatic sarcoidosis may initially present with abnormality in liver function. The presence of multiple focal liver lesions may be seen on B-mode ultrasound imaging, suggesting a differential diagnosis of inflammatory, infectious, immunological, or neoplastic pathologies with potential hepatic involvement. In this case, ultrasound imaging, with colour Doppler, was the first tool with which to decide the next steps. The use of colour and pulsed Doppler demonstrated signs of compression of the hepatic microcirculation by liver nodules, compatible with a systemic pathology such as hepatic sarcoidosis. The definitive diagnosis was then reached via liver biopsy.

Conclusions: Superb microvascular imaging, colour-power Doppler, and pulsed Doppler are important adjuncts to B-mode ultrasound imaging of the liver, which allow identification of hepatic microvascular circulation compression necessary to inform a timely diagnosis of hepatic sarcoidosis and inform treatment.

Introduction: Shear wave elastography has been increasingly used as a supplementary tool to assess diffuse thyroid disease. This study aimed to evaluate thyroid shear wave velocity in healthy children, determine the optimal number of shear wave velocity measurements and establish a diagnostic cut-off value to aid in the detection of diffuse thyroid disease.

Methods: We retrospectively analysed children (<16 years) who underwent thyroid ultrasound between 2019 and 2021. Both those with and without thyroid pathology were included consecutively. Shear wave elastography was performed, and 6 and 10 shear wave velocity measurements (m/s) were obtained from the right and left lobes, respectively. Analyses included Student's t-test, Pearson's correlation, receiver operating characteristic curve and Fagan nomogram.

Results: Of 194 children, 144 controls had normal ultrasound findings, while 50 diffuse thyroid disease cases showed echostructural abnormalities in 84%. Shear wave velocity was higher in the diffuse thyroid disease group (2.09 ± 0.34 (1.42-2.88) m/s) than controls (1.75 ± 0.21 (1.38-2.47) m/s) (p < 0.001). The area under the curve was 0.805 ± 0.041 (0.725-0.884); shear wave velocity < 1.75 m/s was associated with a low probability of diffuse thyroid disease (8% (4-14%)). Accuracy fell significantly when measurements were reduced from 10 to 6 (p < 0.001). No laboratory tests confirmed euthyroid status in controls.

Conclusions: Ten shear wave velocity measurements were recommended for optimal shear wave elastography evaluation. A shear wave velocity < 1.75 m/s suggested a low probability of diffuse thyroid disease.

Introduction: This study aimed to evaluate clinical and ultrasonographic markers associated with spontaneous miscarriage in viable first-trimester intrauterine pregnancies.

Methods: A prospective cross-sectional study was conducted between May 2021 and May 2024 involving viable singleton pregnancies (5 + 4 to 10 + 6 weeks of gestation) that underwent transvaginal ultrasound. The ultrasound markers evaluated were gestational sac, yolk sac, fetus, mean gestational sac diameter (MSD), crown-rump length (CRL), subchorionic heamatoma, corpus luteum, fetal heart rate, and basal decidua. Clinical variables included vaginal bleeding, nausea and/or vomiting, and breast pain.

Results: The sample consisted of 258 patients, of whom 215 (83.3%) progressed to term pregnancy and 43 (16.7%) experienced miscarriage. Women with a fetal heart rate < 5th percentile for gestational age had a miscarriage rate of 33.3%. Women with an MSD minus CRL ⩽ 5 mm had a higher percentage of miscarriage (80.0%) compared to those with an MSD minus CRL > 5 mm (15.4%). An MSD minus CRL ⩽ 5 mm and fetal heart rate < 5th percentile were associated with 21.3-fold and 2.8-fold increased risks of miscarriage, respectively. The Hosmer-Lemeshow test indicated good model fit (p = 0.804). No clinical variables or other ultrasound markers were significantly associated with miscarriage.

Conclusion: Fetal heart rate and MSD minus CRL were the only first-trimester ultrasonographic markers significantly associated with spontaneous miscarriage.

Objectives: To compare the performance of ocular pulse elastography with corneal tomography and topography in keratoconus diagnosis.

Methods: This study utilised an open-access dataset of corneal imaging. A total of 35 eyes with a clinical diagnosis of keratoconus and 38 normal eyes were recruited. Patients underwent intraocular measurement, ocular pulse elastography, corneal tomography and topography. Central corneal thickness, corneal axial displacement and stiffness index were obtained from ocular pulse elastography, and thinnest pachymetry and maximum keratometry (Kmax) were reported from corneal tomography and topography. In addition, we evaluated the diagnostic performance of ocular pulse elastography in comparison with corneal tomography and topography.

Results: The ocular pulse elastography diagnostic model, incorporating parameters of central corneal thickness, stiffness index and corneal axial displacement, demonstrated an excellent area under the curve of 0.934 with a sensitivity of 91.4% and a specificity of 81.5%. Among the parameters, central corneal thickness demonstrated the best diagnostic performance, achieving an area under the curve of 0.919, a sensitivity of 97.1% and a specificity of 73.7%. Furthermore, the direct comparison of areas under the curve between the ocular pulse elastography model and corneal curvature-to-thickness (Kmax divided by thinnest pachymetry) revealed a non-significant difference (confidence interval = -0.006 to 0.065, p = 0.112).

Conclusion: In this study, ocular pulse elastography demonstrated excellent diagnostic performance comparable to corneal tomography and topography. These findings suggest that ocular pulse elastography might be incorporated as a promising diagnostic method in keratoconus management, similar to corneal tomography and topography.

Introduction: Undifferentiated paediatric patients can be difficult to correctly classify with the correct condition. This may be, in part, due to the unique differences in how symptoms present as well as the challenges clinicians face in undertaking a complete examination where cooperation may be hindered due to pain, anxiety or limited understanding. Point-of-care ultrasound is now recognised as a valuable tool to assist acute paediatricians in their decision-making and diagnosis when incorporated into their clinical assessment.

Conclusion: We describe six cases which presented to the Paediatric Emergency Department, where point-of-care ultrasound played a crucial role in uncovering malignant or invasive lesions and subsequently expedited further investigations, leading to much quicker diagnosis.