Ultrasound Journal最新文献

Background: Several studies have suggested a positive association between elevated lung ultrasound scores (LUS) and large patent ductus arteriosus (L-PDA), although findings remain inconsistent. Lung ultrasound score, a semi-quantitative measure of pulmonary aeration loss, has been proposed as a surrogate marker of excessive lung fluid, which may reflect the hemodynamic burden of a significant PDA. The aim of this study was to assess the association between LUS and L-PDA in preterm neonates beyond the initial transitional period and examine its correlations with echocardiographic measures of ductal shunting. This is a cohort retrospective study that included preterm infants born at < 29 weeks' gestation who underwent LUS within 24 h of targeted neonatal echocardiography. Infants were categorized as having L-PDA (diameter ≥ 1.5 mm, left-to-right shunt) or no/small PDA (< 1.5 mm). Clinical characteristics, LUS, and echocardiographic parameters including PDA diameter, left atrial-to-aortic root (LA: Ao) ratio, and left ventricular output (LVO) were compared. Statistical analyses included univariate, multivariate, and correlation assessments.

Results: Among 119 infants included in the analysis, 56 (47%) had L-PDA, and 63 (53%) had no or small PDA. Infants with L-PDA had significantly lower gestational age and higher rates of invasive ventilation.

Lus, la: Ao ratio, and LVO were significantly elevated in the L-PDA group (all p < 0.001). LUS correlated with PDA diameter (r = 0.27, p = 0.003) and respiratory severity score (r = 0.49, p < 0.001). Furthermore, LUS was found to be independently predictive for L-PDA (adjusted OR 1.5; 95% CI: 1.1-1.9). Each 1-point increase in LUS was associated with a 0.14 mm increase in PDA diameter. Inter-rater reliability for LUS was strong (IRR = 0.86).

Conclusion: Beyond the transitional period, LUS was significantly associated with PDA size and independently predicted L-PDA in extremely preterm infants.

Background: Fetal growth restriction (FGR), preeclampsia, and other placental disorders are leading contributors to perinatal morbidity and mortality, primarily due to impaired uteroplacental perfusion. Existing imaging modalities, such as Doppler ultrasound and fetal MRI, provide indirect or limited functional insights into placental and fetal perfusion, constraining timely clinical intervention.

Objective: To evaluate contrast-enhanced ultrasound (CEUS) as a promising, safe, and real-time tool for assessing placental perfusion and its potential application in maternal-fetal medicine through comprehensive analysis of methodological parameters, safety profiles, and emerging computational techniques.

Methods: A comprehensive synthesis of preclinical and clinical studies was conducted, focusing on the safety, efficacy, and current use of CEUS in pregnancy. Key findings were drawn from animal models (rats, sheep, macaques) and human studies involving 256 pregnant individuals, with detailed analysis of imaging protocols, contrast agent characteristics, and quantification methods.

Results: CEUS utilizes intravascular microbubble contrast agents (1-8 μm diameter) that do not cross the placental barrier, enabling safe maternal imaging. However, size distribution analysis reveals sub-micron populations (8-20% by number) requiring careful evaluation. Preclinical models confirm CEUS ability to detect placental perfusion Changes with 54% reduction in perfusion index following uterine artery ligation (p < 0.001). Human studies demonstrate zero clinically significant adverse events among 256 cases, though critical gaps exist including absent biomarker monitoring and long-term follow-up. Emerging AI-enhanced analysis achieves 73-86% diagnostic accuracy using ensemble deep learning architectures. Current limitations include significant protocol heterogeneity (MI 0.05-0.19, frequency 2-9 MHz) and absence of standardization.

Conclusion: CEUS presents a compelling solution for perfusion imaging in pregnancy, offering functional, bedside imaging without fetal exposure to contrast agents. However, methodological limitations, knowledge gaps regarding long-term outcomes, and the distinction between conventional microbubbles and emerging nanobubble formulations demand systematic research investment. Clinical translation requires standardized protocols, comprehensive safety monitoring including biomarker assessment, ethical oversight, and long-term outcome studies to support integration into routine obstetric care.

Background: Pulsus alternans (PA) is an intriguing phenomenon and a clinically rare entity. Accurately assessing cardiac function in patients with PA remains challenging. This study aims to investigate the myocardial mechanical characteristics and non-invasive hemodynamic profiles of PA patients using multiple echocardiographic imaging modalities.

Methods: Clinical and echocardiographic data were retrospectively analysed from 16 patients diagnosed with PA by echocardiography at our hospital between January 2021 and May 2025. In this study, the characteristics of PA were elaborated by multiple echocardiographic methods, and the non-invasive hemodynamic profile was determined by pulse-wave Doppler.

Results: Sixteen patients were enrolled. Seven were classified as NYHA class III and six as class IV. Elevated levels of NT-proBNP and hs-cTNT were observed in most patients. Follow-up ranged from 1 to 44 months, and five patients experienced adverse outcomes, including heart transplantation, rehospitalisation, and death. Within this cohort, three patients exhibited biventricular PA, while 13 patients presented with left ventricular (LV) PA. Key hemodynamic parameters varied significantly: LVOT-VTI_{strong beat} ranged from 11.3 cm to 29.2 cm, LVOT-VTI_{weak beat} from 6.8 cm to 22.1 cm, and the variation rate between strong and weak beats (∆LVOT-VTI) ranged from 19 to 52%. Global longitudinal strain (GLS) was significantly reduced in 14 patients (range: - 1.2% to - 10.4%), while peak strain dispersion (PSD) increased (range: 47 ms to 117.5 ms). Two patients were excluded from strain analysis due to suboptimal imaging. Hemodynamic parameters (LVOT-VTI_{strong beat}, LVOT-VTI_{weak beat} and ∆LVOT-VTI) showed strong correlations with GLS in PA patients (r = 0.806, P = 0.001; r = 0.642, P = 0.018 and r = 0.611, P = 0.027, respectively). NT-proBNP was significantly positively related to adverse outcomes in PA patients (r = 0.669, P = 0.012).

Conclusion: Echocardiography is essential for evaluating cardiac function in patients with PA. This study used multiple echocardiographic methods to delineate the characteristics of this intriguing clinical phenomenon. Non-invasive hemodynamic parameters are potentially important for prognosis assessment, and myocardial strain assessment provides valuable insights into myocardial mechanical features. A comprehensive analysis using multimodality imaging is crucial for accurately identifying this disease, potentially enhancing the understanding of the pathophysiological mechanism of PA.

Recent discoveries have identified that physiological anti-inflammatory reflexes are triggered by vagus nerve stimulation (VNS), which offers neuromodulation- performed via implantable or transcutaneous devices-potential therapeutic opportunities. A novel, noninvasive technique using spleen-targeted focused ultrasound stimulation (sFUS) can replicate these effects by triggering the vagus nerve, opening new possibilities for immunomodulation. Early findings suggest that sFUS may evolve into a therapeutic tool to modulate inflammatory responses across a number of diseases. This short communication presents preclinical evidence of efficacy in diverse models of inflammation, discusses the mechanisms underlying sFUS, explores potential translational steps into human application and discusses future directions.

Background: Central venous catheters (CVC) are essential in medicine for monitoring, drug and fluid administration, and renal replacement therapy. Complications such as arrhythmias, endothelial damage, thrombosis, or hemothorax might arise from incorrect positioning. Despite evidence showing their reduction using ultrasound to guide insertion and correct tip positioning, and greater accuracy for tip position assessment vs. chest-X-ray (CXR), ultrasound adoption greatly varies worldwide. This study, conducted by the World Interactive Network Focused On Critical Ultrasound (WINFOCUS) aimed to assess global practices in CVC insertion and tip position confirmation.

Methods: A web-based survey was conducted (April-September 2023) among WINFOCUS members/affiliates across five continents. It assessed clinical backgrounds, CVC insertion and tip position check methods, and reasons for not using ultrasound. Developed by WINFOCUS Research sub-committee, the survey was emailed, with two reminders. Data were analyzed using SPSS 27.0.

Results: A total of 1,227 respondents (5.1% response rate) participated, mainly from Europe (33.5%), Asia (28.3%), and the Americas (30.9%), with 95.4% being physicians. Over half (51.3%) had over six years of experience and placed over 200 CVC, mostly using ultrasound guidance (70% of cases). The internal jugular vein (IJV) was the preferred insertion site (74%). Ultrasound was used for pre-insertion assessment (55%) and vessel puncture (57%) but less for guidewire confirmation (44%). CXR remained the primary method for tip position assessment (52%), while only 12% relied solely on bedside ultrasound. Barriers to exclusive ultrasound use included institutional guidelines (33.9%) and medico-legal concerns (13.8%).

Conclusions: Despite evidence favoring ultrasound for CVC insertion and tip position confirmation, its use remains inconsistent, with CXR still widely used. This survey underscores the need for standardized protocols and training to enhance US adoption, improve patient safety, and reduce CXR reliance.

As a crucial medical imaging modality, ultrasonography has emerged as a pivotal tool for tumor diagnosis and treatment owing to its non-invasive nature, real-time imaging capability, and superior resolution. Recent technological advancements have demonstrated unique advantages in early tumor screening, staging, and localization. Contrast-enhanced ultrasound (CEUS), utilizing microbubbles (MBs) and nanobubbles (NBs) to target vascular biomarkers, significantly enhances tumor visualization and demonstrates high sensitivity in molecular imaging. Multimodal ultrasound (MU), incorporating techniques such as elastography and automated breast volume scanning (ABVS), achieves improved diagnostic accuracy when combined with MRI/CT. The applications of ultrasound in localized and systemic tumor therapy have expanded considerably. High-intensity focused ultrasound (HIFU) enables thermal ablation of solid tumors, while low-intensity focused ultrasound (LIFU) facilitates sonodynamic therapy (SDT) through reactive oxygen species (ROS) generation mediated by sonosensitizers. Ultrasound-assisted drug delivery systems (US-DDS) leverage MB/NB cavitation effects to enhance chemotherapeutic agent delivery efficiency, overcome biological barriers, including the blood-brain barrier, and modulate immune responses. These technological breakthroughs have provided novel therapeutic options for cancer patients, garnering significant clinical interest. This review systematically examines current applications of ultrasound imaging and therapy in oncology, evaluates its potential clinical value, analyzes existing technical limitations, and discusses future development prospects. The article aims to provide innovative perspectives for tumor diagnosis and treatment while offering references for clinical practice.

Background: The implementation of ultrasound as point-of-care technique within the medical education has been broadly studied to understand its applicability in clinical settings. More research has been conducted to specifically understand the use of clinical ultrasound in the medical curriculum to learn anatomy. The results of publications on anatomical skills and knowledge outcomes of students related to ultrasound are contradictory. The objectives of this study were to identify and describe common study types and educational programs conducted in anatomy teaching with clinical ultrasound and to describe the impact on learning outcomes.

Methods: A literature search from the databases Scopus, PubMed and Google scholar was conducted with keywords related to anatomy learning, ultrasound and medical education. Data from publications were extracted following quantitative and qualitative methods previously described in the literature and adapted to measure the educational outcome.

Results: In total, 1615 records were detected within all three databases after removing duplicates, 194 were found relevant to the topic and included in the review. Of 194, 128 articles were original studies categorized by their study types and outcomes. A large proportion of the studies were conducted at a single institute, and students were mainly evaluated with post-tests only or with pre- and post-tests. Vascular and cardiac anatomical landmarks were the most frequently instructed areas with ultrasound while ocular and prostate/testicular landmarks were the least. Students agreeing to participate in the ultrasound training were highly motivated and described the sessions as valuable for future clinical practice. The evaluation of anatomical knowledge and skills of students following ultrasound training varied widely, and no clear consensus emerged. Long-term assessments of ultrasound-related anatomy competencies were notably underrepresented in the reviewed studies.

Conclusions: The use of clinical ultrasound in undergraduate anatomy education is implemented through diverse teaching formats and is widely appreciated by medical students. However, standardized methods to assess anatomical understanding of medical students through ultrasound are lacking, impeding the comparison of educational outcomes across studies. Further research is needed to evaluate the long-term retention of skills and knowledge to better determine the effectiveness of ultrasound-based teaching.

Background and objective: The EFSUMB recommends the use of handheld ultrasound devices in many point-of-care cases, including primary care. However, it is necessary to continue training in conventional ultrasound examinations. Our aim is to analyze the diagnostic accuracy of handheld ultrasound devices in abdominal pathology compared with conventional high-end ultrasound scanners.

Methodology: Agreement study between two ultrasound techniques, (1) POCUS (point-of-care ultrasound), with a General Electric^® Vscan Air device and (2) standard ultrasound with a high-end Samsung RS 80^® ultrasound scanner. Cohen's kappa was used for the analysis. The study was conducted between November 2022 and September 2023 in the general ultrasound unit of the San Francisco de Asís University Hospital in Madrid. It included all patients from the emergency department and the inpatient unit who have been referred for abdominal ultrasound.

Results: A total of 93 patients were included (52.7% were women and the mean age was 65.6 (23.6) years). As regards body mass index (BMI), 11.8% had a BMI over 30 kg/m². Of the scans performed, 69.9% were abdominal and the rest urological. Overall, the degree of agreement between the two tests was 89%, with 100% for liver and bladder pathology, 86.2% for renal pathology and 82.5% for complicated renal pathology. Intestinal (73.3%) and pancreatic (58.1%) pathologies showed the lowest correlation.

Conclusions: The degree of agreement of handheld devices is high (89%), especially in renal and bladder pathologies, where ultrasound is decisive in decision-making. The agreement is weaker in pancreatic and gastrointestinal tract pathologies.