Ultrasound Journal最新文献

Study design: Prospective observational diagnostic accuracy study.

Methods: This study evaluated Doppler parameters of the fetal main pulmonary artery (MPA) as potential non-invasive predictors of RDS and to assess their relationship with gestational age and postnatal respiratory outcomes. Pulsed-wave Doppler of the fetal MPA was performed and Doppler indices-pulsatility index (PI), resistance index (RI), peak systolic velocity (PSV), and acceleration time/ejection time ratio (At/Et)-were recorded over three cardiac cycles and averaged. Values were compared after delivery between neonates with and without RDS.

Results: In normally developing fetuses, PI and RI decreased while At/Et increased with advancing gestational age. In contrast, fetuses who developed RDS showed persistently low At/Et and elevated PI and RI values. Cutoff values of At/Et < 0.24, RI > 0.8, and PI > 2.16 were effective in predicting RDS. The severity of RDS was associated with greater deviations from these values. Altered Doppler indices were found to be independent predictors of RDS in preterm neonates.

Conclusion: Fetal MPA Doppler parameters serve as reliable, non-invasive predictors of RDS and the severity of RDS in preterm neonates.

With the evolving challenges of modern warfare, battlefield medical support systems are often required to enhance capabilities in rapid response, flexible deployment, and modular integration. Ultrasound diagnostic systems, appreciated for their portability and ability to provide real-time imaging without ionizing radiation, have been investigated for potential use in early injury screening and rapid assessment in combat and pre-hospital settings. This review provides an overview of representative battlefield-adapted ultrasound systems, such as the Sonosite M-Turbo, Edge II, and GE Vscan Extend, and discusses their reported limitations, including issues with deployment reliability, image quality, operational complexity, and telecommunication capability. Emerging technological directions are explored, including artificial intelligence-assisted diagnosis, multimodal integration, adaptation to extreme environments, and integration with unmanned platforms. Furthermore, a conceptual framework is proposed, focusing on areas such as research and development, standardization, deployment at combat nodes, and training infrastructure, which may contribute to future advancements. The goal is to provide insights that could guide the future development and strategic planning of next-generation tactical medical imaging systems.

Pancreatic cancer is often associated with intractable pain due to tumor invasion of surrounding neural structures and visceral organs. Conventional pain management strategies, including opioids, are often insufficient and associated with significant side effects. The erector spinae plane block (ESPB) is an inter-fascial regional anesthesia technique that can be considered in managing abdominal pain. Besides being a simple block performed, ESPB is also very effective because it provides visceral, somatic and neuropathic pain coverage. This case series highlights the potential role of ESPB as an adjunctive therapy for acute pain management of pancreatic cancer patients at the emergency department, with discussion on its technical aspect, advantages and limitations.

Aim: To evaluate the reliability and reproducibility of the TE Air wireless handheld ultrasound device in clinical cardiac imaging by comparing its performance with a high-end reference system.

Methods: 161 patients for good-quality echocardiographic images were included in this prospective study. Each patient underwent sequential imaging using both the TE Air device (Mindray) and the high-end reference device (Philips EPIQ 7 C). Nine standard cardiac views were acquired. Image quality was assessed manually by two blinded echocardiographers and via proprietary AI software, respectively. The following key parameters were analyzed basing on the images: diastolic thickness of interventricular septal (IVSTd) and left ventricular posterior wall (LVPWTd), left ventricular end-diastolic (LVDd) and end-systolic diameter (LVDs), aortic diameter (AOD), left atrial anteroposterior diameter (LAD), Early (E) and late (A) diastolic velocities of the mitral valve in PW mode, as well as early diastolic velocities at the septal (EmS) and lateral (EmL) mitral annulus. Regional wall motion abnormality (RWMA), bicuspid aortic valve (BAV), atrial septal defect (ASD), left ventricular ejection fraction (LVEF) and valvular regurgitation degree were independently evaluated.

Results: The TE Air demonstrated comparable image quality to the high-end reference system in both manual (64.95 ± 1.24 vs. 64.19 ± 1.63, P = 0.28) and AI-based evaluations (65.07 ± 1.02 vs. 63.80 ± 1.68, P = 0.06). Structural measurements showed high inter-device consistency, with ICCs of 0.77/0.74 for IVSTd/LVPWTd, 0.95/0.96 for LVDd/LVDs, and 0.82/0.98 for AOD/LAD (all P < 0.001). Functional parameters also demonstrated strong agreement (ICC: 0.91/0.92 for mitral E/A waves; 0.79/0.85 for EmS/EmL; P < 0.001). The TE Air had sensitivities of 81.8% for RWMA, 100% for ASD and BAV, and 93.5% for LVEF < 50%. Diagnostic agreement was excellent for LVEF (κ = 0.96, P < 0.001) and valvular regurgitation (weighted κ = 0.89, P < 0.001).

Conclusion: The TE Air wireless handheld ultrasound device exhibits high agreement with high-end reference device in image quality, measurements, and clinical diagnoses, supporting its potential for widespread use in point-of-care ultrasound (POCUS) clinical applications.

Background: This study aimed to develop and validate an interpretable radiomics model using quantitative features from B-mode ultrasound (BMUS) and contrast-enhanced ultrasound (CEUS) for predicting macrotrabecular-massive (MTM) hepatocellular carcinoma (HCC).

Methods: From October 2020 to September 2023, 344 patients (mean age: 58.20 ± 10.70 years; 275 men) with surgically resected HCC were retrospectively enrolled from three medical centers. Radiomics features were extracted from BMUS and CEUS, followed by a multiple-step feature selection process. BMUS_R model (based on BMUS radiomics features), BM + CEUS_R model (based on BMUS and CEUS radiomics features) and hybrid_R+C model (integrated clinical indicators and radiomic features) were established. These radiomics models' performance was compared with conventional clinic-radiological (C_C+R) model using area under the receiver operating characteristic curve (AUC). SHapley Additive exPlanations (SHAP) method was used to interpret model performance. The model's potential for predicting recurrence-free survival (RFS) was further analyzed.

Results: Among ten distinct machine learning classifiers evaluated, the AdaBoost algorithm demonstrated the highest classification performance. The AUCs of the BM + CEUS_R model for identifying MTM-HCC were higher than the BMUS_R model and the conventional clinic-radiological model in both validation (0.880 vs. 0.720 and 0.658, both p < 0.05) and test sets (0.878 vs. 0.605 and 0.594, both p < 0.05). No statistical differences were observed between the BM + CEUS_R model and the hybrid_R+C model in either set (p > 0.05). Additionally, the AdaBoost-based BM + CEUS_R model showed promising in stratifying early recurrence-free survival, with p < 0.001.

Conclusion: The AdaBoost-based BM + CEUS_R model shows promise as a tool for preoperatively identifying MTM-HCC and may also be beneficial in predicting prognosis.

Background: Nystagmus, a critical diagnostic sign of vertigo and dizziness, reflects disturbances in the vestibular system. The accurate characterisation of nystagmus aids in distinguishing between peripheral and central causes, such as benign paroxysmal positional vertigo (BPPV) and stroke, respectively. Traditional methods for assessing nystagmus involve visual inspection or the use of Frenzel goggles. However, in cases where patients are unable to keep their eyes open owing to severe vertigo, such an evaluation becomes challenging. To date, sonographic imaging has not been used as a diagnostic method for nystagmus. We present a case in which ocular ultrasonography was used to assess nystagmus and aid in the diagnosis of BPPV.

Case presentation: A 56-year-old woman presented with recurrent vertigo exacerbated by positional changes. Clinical examination revealed no spontaneous nystagmus or neurological deficits. Because the patient was unable to keep her eyes open during positional testing, ocular ultrasonography was performed using a 9-MHz linear transducer. Imaging revealed direction-changing horizontal nystagmus, consistent with the apogeotropic variant of lateral semicircular canal BPPV. The diagnosis was subsequently confirmed by an otolaryngologist using Frenzel goggles. The patient was conservatively managed.

Conclusions: This is the first report on the use of ocular ultrasonography to assess nystagmus. Despite certain limitations, this technique may be a valuable supplementary tool, particularly in settings in which conventional examinations are hindered or unavailable. Ophthalmic sonography has the potential to enhance vestibular assessments in emergency and outpatient settings.

Background: Postoperative cardiac ICU patients are at increased risk of developing venous thromboembolism (VTE), yet early identification of prethrombotic state (PTS) remains challenging. Nurse-led point-of-care ultrasound (POCUS) offers a non-invasive, real-time tool for vascular screening that may enhance early risk stratification.

Objectives: To determine the prevalence of PTS in postoperative cardiac ICU patients using a nurse-led POCUS protocol, identify associated clinical risk factors, and evaluate the feasibility and clinical value of integrating this screening model into routine nursing care within an interprofessional framework.

Methods: This cross-sectional study included 123 adult patients following cardiac surgery. ICU nurses trained in POCUS independently performed bedside color Doppler scans to detect the "blizzard" sign in lower limb veins. Demographic, clinical, and laboratory data were collected. Multivariate logistic regression was used to identify independent predictors of PTS. The nurse-led POCUS protocol was implemented collaboratively with doctors, who provided image verification and clinical oversight as needed.

Results: The "blizzard" sign was observed in 61.8% of patients, most commonly in the popliteal and posterior tibial veins. Nine patients developed deep vein thrombosis, all of whom had prior severe, diffuse-type "blizzard" signs. Independent predictors of PTS included prolonged bed rest (OR 1.016, P = 0.031), elevated peak platelet count (OR 1.007, P = 0.041), and increased postoperative C-reactive protein levels (OR 1.015, P < 0.001). The nurse-led POCUS protocol was implemented successfully with doctor oversight and demonstrated high feasibility and diagnostic yield.

Conclusion: Nurse-led POCUS is a feasible, non-invasive approach for early identification of PTS in postoperative cardiac ICU patients. Embedding such screening protocols into nursing workflows may support timely thromboprophylaxis, expand nursing roles in advanced assessment, and enhance interprofessional ICU care delivery.

Purpose: Utilizing ultrasonic imaging technology, this study assessed and compared the thickness and elasticity features of the abdominal and spinal back muscles in patients with idiopathic scoliosis to those of healthy individuals. The objective was to elucidate the mechanical adaptations in spinal muscles among IS patients.

Methods: This cross-sectional study included 38 patients diagnosed with idiopathic scoliosis and 33 healthy controls. Outcome measures comprised the Cobb angle, spinal curvature, muscle thickness, and muscle elasticity. Ultrasound elastography imaging was employed to assess the thickness and elasticity of the erector spinae, rectus abdominis, external oblique, and transverse abdominis muscles bilaterally at corresponding spinal levels. The objective was to document and compare the ultrasonic imaging characteristics of these muscles in individuals with idiopathic scoliosis and in the normal population.

Results: The study findings indicated that idiopathic scoliosis patients had significantly lower body weight than the control group, with C7-CSVL notably greater in the idiopathic scoliosis group than in healthy individuals. Muscle thickness was substantially reduced on both the concave and convex sides at T6, T10, and L3 levels of the erector spinae, as well as in the rectus abdominis (RA) and transverse abdominis (TrA) muscles, relative to the normal cohort. Additionally, idiopathic scoliosis patients exhibited increased elasticity in the erector spinae muscle on the convex side at T6, while the elasticity of the erector spinae muscle on the concave side at L3 was significantly lower compared to healthy individuals.

Conclusions: This study, utilizing ultrasound elastography imaging technology, unveiled distinct features in individuals with mild idiopathic scoliosis, including decreased muscle thickness in the erector spinae at T6, T10, and L3 levels, as well as heightened elasticity in the thoracic region and reduced elasticity in the lumbar region. The findings presented in this study provide insights for diagnostic strategies in individuals with early-stage scoliosis.

Introduction: This study was designed to investigate the utility of cerebrovascular reactivity (CVR) metrics, derived from transcranial colour-coded Doppler ultrasound (TCCD). Three main CVR metrics were examined as potential markers for cerebrovascular risk associated with mild cognitive impairment (MCI), a stage between normal cognition and dementia.

Methods: We investigated 122 eligible, stroke-free, healthy, community-based Chinese adults (mean age, 65.34 ± 6.86 years). Cognitive performance was assessed using the validated Hong Kong version of the Montreal Cognitive Assessment. On a scale of 0-30, participants with low scores < 26 (modelled according to level of education) were designated to have a mild neurocognitive disorder or MCI. Following the measurement of cerebrovascular conductance (CVC) derived from cerebral blood flow and mean arterial pressure, three physiologic CVR metrics were assessed. The CVR assessments were based on restricted 30 s breath-holding, 60 s hyperventilation, and an unrestricted breath-holding index (BHI), respectively quantified using transcranial colour-coded Doppler ultrasound. The predictabilities and associations between CVR metrics, haemodynamic parameters, and cognitive performance were statistically investigated.

Results: Using TCCD, BHI emerged as the most accurate and robust metric of CVR for predicting mild cognitive disorders [AUC 0.827 (95% CI 0.725, 0.930)] and independently predicted overall cognitive performance, highlighting its clinical value for early identification of at-risk individuals. The three CVR metrics outperformed CVC in predicting mild cognitive impairment and were distinctively correlated. Although CVR measures by breath-holding and BHI were closely related (r = 0.704, 95% CI 0.598, 0.786, p < 0.001), Bland-Altman analysis revealed that they are not interchangeable, indicating the importance of metric selection for accurate cerebrovascular assessment.

Conclusion: The BHI, derived from simple and clinically tolerable methods, demonstrates clear potential to enhance the prediction and early identification of vascular cognitive impairment in healthy adults. By leveraging insights from cerebral haemodynamics, TCCD-based cerebrovascular risk screening may enable more effective and targeted interventions, ultimately contributing to better long-term cognitive health outcomes.

Background: Determining the optimal timing for fluid removal in critically ill patients remains a challenge. This study evaluated the utility of Doppler ultrasound, specifically intrarenal venous flow (IRVF) patterns and venous excess ultrasound (VExUS) scores, and their associations with fluid removal outcomes, hemodynamic parameters, and clinical endpoints.

Methods: In this prospective observational exploratory study, 52 intensive care unit (ICU) patients who underwent fluid removal were enrolled. Baseline IRVF patterns and VExUS scores were assessed, with follow-up evaluations performed daily for three days. The primary outcome was to evaluate whether IRVF patterns were associated with successful fluid removal, defined as achieving a negative fluid balance for at least two consecutive days. Secondary outcomes included associations with central venous pressure (CVP), NT-proBNP, cumulative fluid balance, and clinical outcomes.

Results: Thirty-one patients (59.6%) achieved successful fluid removal. A discontinuous baseline IRVF pattern was independently associated with successful fluid removal (adjusted odds ratio 4.31, 95% CI 1.02-18.18; P = 0.047). This pattern demonstrated high sensitivity of 87.1% (95% CI 70.2-96.4), moderate specificity of 42.9% (95% CI 21.8-66.0), and accuracy of 69.2% (95% CI 54.9-81.3). VExUS scores grades 2-3 demonstrated high specificity of 85.7% (95% CI 63.7-97.0) but low sensitivity of 29.0% (95% CI 14.2-48.0), with an accuracy of 51.9% (95% CI 37.6-66.0). An improvement in the IRVF pattern was significantly correlated with a reduction in NT-proBNP levels (P = 0.048). However, neither IRVF patterns nor VExUS scores improvements were associated with changes in fluid balance, CVP, or clinical outcomes such as 28-day mortality, ventilator-free days, or ICU length of stay.

Conclusions: Discontinuous IRVF patterns at baseline were significantly associated with fluid removal success, representing a physiologically based marker for deresuscitation readiness. More large-scale studies are warranted to validate these findings and explore long-term implications. Trial registration ClinicalTrials.gov identifier NCT06216119. Registered 22 January 2024, https://clinicaltrials.gov/study/NCT06216119.