Ultrasound Journal最新文献

Background Diagnosis and monitoring of extrapulmonary tuberculosis (EPTB) remains challenging. Ultrasound such as the extended focused assessment for HIV-associated tuberculosis (eFASH) protocol might improve diagnosis and monitoring of treatment responses. This study determined the diagnostic accuracy of eFASH for EPTB and its value in monitoring EPTB treatment response compared with clinical signs and symptoms. Methods We performed a post-hoc analysis of a trial assessing eFASH impact on management of adults with suspected EPTB. Participants who had baseline and follow-up ultrasound examinations were included. We assessed the diagnostic accuracy of eFASH and compared the evolution of eFASH and clinical signs and symptoms in participants with definite EPTB, stratified by favorable treatment outcomes at 6 months. Results In 296 included participants (95 with definite EPTB, 201 with no definite EPTB),  the most common eFASH signs were pleural effusion (47%) and pulmonary B-lines with subpleural granular artefacts (34%). Pleural effusion was the only sign that persisted beyond 6 months. eFASH had a sensitivity of 93.7% (95% CI, 86.8-97.6) and a specificity of 37.8% (95% CI, 31.1- 44.9) for definite EPTB. At 2 months, favorable outcomes were similar between participants with full and partial resolution of eFASH signs (83% versus 81%). In contrast, a higher proportion of favorable outcomes was seen in participants with full resolution of clinical signs and symptoms (90% versus 60%). Conclusion eFASH shows high sensitivity but low specificity for definite EPTB. Ultrasound can be used alongside clinical signs and symptoms to monitor treatment response in patients with EPTB.

Background: Pregnancy is a time of significant hemodynamic changes. Maintaining adequate cardiac output (CO) and uteroplacental perfusion is a priority in parturients, for favorable maternal-fetal outcomes. Blood pressure is commonly used as a surrogate for CO, although it may poorly correlate with stroke volume (SV) and CO in some cases. An alternative approach is SV estimation using transthoracic echocardiography (TTE) based on the velocity-time integral (VTI) of the left ventricular outflow tract (LVOT). Although VTI has been validated as a tool to estimate SV and CO in acute care contexts, its feasibility and utility in obstetric anesthesia remain unexplored. Therefore, the objective of this study is to evaluate the feasibility and reproducibility of LVOT VTI measurements in parturients during labor.

Methods: Following research ethics board approval, 55 full term pregnant female patients with a singleton pregnancy were recruited. TTE was used to calculate the LVOT VTI for each patient by the same anesthesiologist twice. Feasibility of obtaining the LVOT VTI was evaluated using time for image acquisition and the 3-Point Likert Scale for Imaging Quality. Intraclass correlation coefficients (ICC) were used to estimate intra-rater reliability.

Results: LVOT VTI was obtained for all participants on both attempts. Mean time needed to obtain measurements was 63.7 seconds (95%CI 56.5 to 70.8) on the 1st attempt and 44.2 seconds (95%CI 38.7 to 49.8) on the 2nd attempt. Eighty-one (73.6%) images were rated as optimal, 29 (26.3%) were rated as suboptimal. Intra-rater reliability was excellent (ICC was 0.94 (95%CI 0.92 to 0.95).

Conclusion: In singleton parturients, LVOT VTI measurements can be routinely obtained in a timely fashion with excellent intra-rater reliability during labor. These results support the feasibility of LVOT VTI to estimate and trend SV.

Background: Point-of-care ultrasound (POCUS) training programs are increasingly implemented in low- and middle-income countries (LMICs) to strengthen diagnostic capacity. Qualitative and sustainable implementation of POCUS capacity requires evaluation of training concepts and programs. In this review we collate approaches of how POCUS training programs and trainee competencies are evaluated in LMICs.

Methods: This review presents a secondary analysis of data from a previous systematic scoping review that included 53 original studies on POCUS training in LMICs, identified through July 2023. Reported evaluation methods for POCUS training were extracted and categorized according to the Donabedian (structure - process - outcome) and Miller/De Biasio (levels of competence) frameworks. Data synthesis focused on the type, timing, and scope of evaluation across structural, procedural, and outcome domains.

Results: POCUS training evaluation approaches were highly heterogeneous, with most studies using multiple methods. Pre- and post-course assessments predominated, focusing mainly on knowledge and technical skills. Competence evaluations covered all levels of the Miller/De Biasio framework, though most targeted lower-order levels, while workplace-based assessments were infrequent. When mapped to Donabedian's model, outcome evaluations dominated, whereas structural and process assessments were inconsistently reported. Few studies demonstrated contextual adaptation, validity testing, or long-term evaluation of training outcomes.

Conclusions: POCUS training evaluation in LMICs remains inconsistent and focuses primarily on short-term outcomes and basic competency levels. Applying Donabedian's and Miller/De Biasio's frameworks reveals critical evaluation deficiencies across system and learner dimensions and establishes a conceptional basis for more comprehensive and sustainable POCUS evaluation strategies.

Background: Enlarged lymph nodes (LN) pose diagnostic challenges for people with HIV (PWH). While tuberculosis (TB) is a common cause in low-income settings, lymphomas and Kaposi's sarcoma must also be considered. Ultrasound and symptoms cannot distinguish between these conditions, and histology is often needed, but limited resources in low-income countries restrict sampling. To minimize the need for excisional biopsies, we introduced an algorithm for ultrasound-guided core-needle biopsies (CNB) after negative fine-needle aspiration (FNA) results by Xpert-Ultra (Cepheid, USA).

Methods: At the Lighthouse clinic in Lilongwe, Malawi, patients with peripheral lymphadenopathy underwent an ultrasound-guided FNA. Negative Xpert-Ultra results prompted CNB using Tru-Cut needles, with samples sent for pathology. We retrospectively analyzed 12 months of cross-sectional data, including histology results and abdominal ultrasound findings.

Results: In 2024, 53 CNBs were performed, 96%in PWH. No significant complications were observed. A conclusive diagnosis was reached in 77% of cases, with the most common diagnoses being hematological malignancies (54%), reactive LN (15%), Kaposi's sarcoma (12%) and metastatic carcinoma (10%). Infections, including granulomatous inflammation were found in 10% of cases. Hypoechoic spleen lesions were more frequent in patients with hematological diseases (p=0.03).

Conclusion: Ultrasound-guided CNB of enlarged peripheral LN is a safe, effective addition to routine ART clinics. After negative Xpert-Ultra FNA, hematological malignancies were common. Abdominal ultrasound findings were frequently abnormal overall and hypoechoic spleen lesions were more common in patients with hematological abnormalities.

Background: Lung ultrasound (LUS) is nowadays an important tool to evaluate the state of lung surface. However, it is strongly operator-dependent, leading to reduced reproducibility of LUS analysis. Even though LUS acquisition protocols can improve LUS reproducibility and help standardizing LUS exams, human operators can guarantee only a limited precision in intercepting the optimal imaging plane. Hence, in this study, we assess the possibility to automatically intercept the optimal imaging plane in LUS examinations, i.e., the imaging plane perpendicular to the pleural plane (PP), by extracting three features, then utilized to guide a UR5e robotic arm handling an ultrasound probe.

Methods: The main focus of this study consists on evaluating the potential of these three features in estimating the PP position with respect to the probe. To do so, we designed a simplified but highly controllable environment, where PP was mimicked with a steel plate (to simulate a highly reflective acoustic interface), while intercostal tissues were mimicked with a 2-cm-thick beef meat. The environment was imaged with a linear probe connected to an ULA-OP platform, which was held by an UR5e, programmed to explore 8 different paths of acquisitions with a rotational angle (RA) ranging from -20º to 20º (1º step size). This resulted in 328 positions that could be explored; each position with RA=0º corresponds to the optimal imaging plane. Radiofrequency data were acquired and post-processed to form normalized log-scale B-Mode images. A rectangular region of interest, defined to include PP, was considered to compute mean intensity at each depth of the region of interest, along lateral dimension. Mean intensity as a function of depth was then utilized to extract three different features, then fed to genetic algorithms to solve optimization problems to guide UR5e towards the optimal imaging plane.

Results and conclusions: Genetic algorithms converged towards an average error < 1º after exploring only 18 positions, showing strong potential in automatic probe placement for LUS.

Background: In-vitro-fertilization (IVF) failure rates remain above 65% with unknown causes. Uterine receptivity, largely determined by uterine peristalsis, is believed to play a key role in the IVF success. Accurate assessment of uterine peristalsis holds the potential for improving the success rate of embryo implantation.

Methods: This prospective study includes 62 IVF patients from multiple fertility centers under three different clinical settings. Four-minute B-mode transvaginal ultrasound (TVUS) scans were performed one hour before embryo transfer (ET). 25 features related to frequency, amplitude, power, velocity, and coordination were extracted using strain analysis from TVUS speckle tracking results. Three probabilistic classifiers, i.e., support vector machine (SVM), K-nearest neighbors (KNN), and adaptive boosting (AdaBoost), were employed to discriminate uterine activity as either favorable or adverse to clinical pregnancy rate. Prior to machine learning, feature selection was performed by categorized feature ranking and sequential forward selection. The proposed method was evaluated by a nested 8-fold cross validation.  Results: Our results suggest that features related to coordination and frequency of the uterine peristalsis are strongly associated with clinical pregnancy. SVM demonstrates the best classification performance between successful and unsuccessful pregnancies, with an average area under the ROC curve of 0.81.

Conclusions: We developed a machine learning framework to improve the prediction of IVF outcome based on multi-center TVUS recordings. Our SVM model identified significant uterine motion features and demonstrated reliable and generalizable classification performance. This work can provide useful means to support clinicians for clinical decision-making prior to ET and possibly enhance IVF success rates.

Objective: To evaluate the benefit of three-dimensional (3D) ultrasound over two-dimensional (2D) imaging in diagnosing fetal dural sinus malformations (DSM) and to explore the correlation between sonographic features, such as thrombosis and sinus involvement, with perinatal and postnatal outcomes.

Methods: This retrospective case series included 8 fetuses diagnosed with DSM at our center from 2020 to 2025. All cases underwent 2D and 3D ultrasound, with findings correlated to perinatal and postnatal outcomes. A literature review was conducted using PubMed, Embase, and Web of Science, with keywords: "fetal dural sinus malformation," "prenatal ultrasound," and "3D ultrasound."

Results: The median gestational age at diagnosis was 27 weeks (range 20-35). Lesions involved the torcular Herophili (4/8), torcular and superior sagittal sinus (2/8), superior sagittal sinus (1/8), and posterior fossa venous region (1/8). Associated anomalies included hydrocephalus, mild ventriculomegaly, fetal growth restriction (FGR), and pleural and peritoneal effusions. 2D ultrasound identified cystic or anechoic lesions (18 × 19 mm to 90 × 110 mm), with 62.5% showing thrombosis. 3D ultrasound enhanced lesion delineation, venous continuity, thrombus morphology, and confirmed the absence of arterialization. Genetic testing (cfDNA and/or CMA) was normal in all cases. Among the 8 pregnancies, two were terminated, one resulted in fetal demise, and five were liveborn. Four (50%) had favorable neurodevelopmental outcomes at 29-60 months.

Conclusions: Combined 2D/3D ultrasound improves prenatal DSM assessment, with key features, particularly thrombosis, correlating with adverse outcomes. 3D ultrasound should be integrated into routine diagnostic protocols.

Aim: To identify the core components of obstetric point-of-care ultrasound (POCUS) training programs while simultaneously evaluating the effectiveness of these programs using the Analyze, Design, Develop, Implement, and Evaluate (ADDIE) model.

Methods: This systematic review and meta-analysis followed a PROSPERO-registered protocol (CRD42024566260) and adhered to PRISMA2020, Cochrane Handbook, and JBI Manual guidelines. Comprehensive searches from database inception to September 22, 2024, covered international and Chinese databases to identify studies evaluating obstetric POCUS training. Two independent reviewers screened studies, assessed methodological quality with JBI tools, and extracted data on study, participant, intervention, and outcome characteristics. Training content was mapped to the ADDIE instructional design model via thematic and framework analyses. Meta-analyses of comparable quantitative outcomes used random-effects models. Integrating quantitative and qualitative findings, this review systematically evaluated the effectiveness and implementation of obstetric POCUS training programs.

Results: Systematic synthesis showed that obstetric POCUS training significantly improved healthcare providers' competencies, including knowledge, skills, sustained use, and clinical decision-making. Training also increased antenatal care attendance and identification of high-risk pregnancies, while reducing referrals and optimizing resource use. However, limitations were noted in needs assessment, implementation flexibility, and outcome evaluation. Using thematic and framework analyses combined with the ADDIE model, we systematically organized training phases and key components to provide a scientific basis for program improvement and optimization.

Conclusions: Obstetric POCUS training effectively enhances clinical competencies and improves maternal and neonatal health outcomes. Applying the ADDIE model offers a replicable, practical, and sustainable approach for developing standardized training programs. Future obstetric POCUS training should leverage the ADDIE model and adapt to local contexts to improve maternal and neonatal health globally.

Background: Timely diagnosis of acute ischemic stroke can aid optimal treatment. Optic nerve sheath diameter (ONSD) can determine increased intracranial pressure (ICP) in such cases. The purpose of this study is to determine the value of ONSD in estimating the severity of acute ischemic stroke.

Methods: Patients with acute ischemic stroke who were referred to a stroke center were studied. The ONSD of both the right and left sides was measured by ultrasound on the day of admission. Ischemic stroke severity was determined based on the NIHSS.

Results: A strong correlation was found between increased right and left ONSDs and severity of ischemic stroke determined by the initial NIHSS score. Based on ROC curve (receiver operating characteristic curve) analysis, both cut points of 5.65 mm for right ONSD (with 100% sensitivity of and 86% specificity) and 5.75 mm for left ONSD (with a 100% Sensitivity and 88% specificity) were able to predict severe stroke. The value of the right ONSD (Area Under the Curve = 0.959) and the left ONSD (Area Under the Curve = 0.942) indicated a strong predictive value.

Conclusions: Ultrasound as a feasible and non-invasive modality might play a role in determining the severity of an acute ischemic stroke, and could be considered a promising first-line decision making tool.

Background: Patients supported with veno-arterial extracorporeal membrane oxygenation may receive an intra-aortic balloon pump to reduce left ventricular afterload and improve aortic diastolic pressure. However, the effect of this combined mechanical support on cerebral hemodynamics is not uniform and can be influenced by intra-aortic balloon pump timing. Bedside transcranial Doppler offers a rapid, noninvasive way to detect maladaptive cerebral flow patterns and to guide patient-device interaction in real time.

Case presentation: We describe a postcardiotomy adult patient on peripheral veno-arterial extracorporeal membrane oxygenation with concomitant intra-aortic balloon pump assistance (1:1) who developed a reduction in cerebral oximetry. Transcranial Doppler of the middle cerebral artery showed increased pulsatility and reduced diastolic velocity, findings consistent with a transient decrease in cerebral perfusion pressure and compatible with balloon deflation asynchrony. Temporary suspension of balloon assistance improved the waveform. Deflation was then synchronized with the electrocardiogram so that it was completed at the onset of systole. Repeat transcranial Doppler performed minutes later showed restoration of diastolic flow and a lower pulsatility index, while extracorporeal support was maintained unchanged and the patient remained hemodynamically stable.

Conclusions: In patients receiving veno-arterial extracorporeal membrane oxygenation and intra-aortic balloon pump support, cerebral blood flow may deteriorate if balloon timing is not aligned with the native cardiac cycle. Transcranial Doppler can detect these timing-related neurohemodynamic alterations at the bedside and can confirm their reversibility after simple, ECG-guided optimization of deflation. Integrating transcranial Doppler into multiparametric monitoring may help personalize mechanical circulatory support and protect cerebral perfusion in this high-risk population.