Journal of Medical Ultrasound最新文献

Background: The portal hypertension leads to variceal bleeding. Spleen stiffness (SS) is useful in estimating esophageal varices risk and less invasive as compared with reference standard method (hepatic venous pressure gradient). Using different methods of ultrasound elastography as well as different novel system provide different value of SS.

Methods: After the approval by the institutional review board, we enrolled volunteers aged over 18 years who had no obesity, excessive alcohol use, history of systemic disease, hepatobiliary disease, or malignancy. Spleen and liver stiffnesses were measured with LOGIQ E10 SWE by two radiologists. Volunteers ingested a 460 kcal liquid meal. The spleen and liver stiffnesses were performed at baseline and 60, 120 and 180 min after meal.

Results: A total of 46 volunteers participate and two volunteers were excluded. The mean SWE SS was 12.6 ± 1.18 kPa. There was no statistically significant difference between sex, age and spleen size. SS trends to decrease with time. In first 2 h after meals, there was no significant difference from baseline. After 3 h, SS significantly decreased from baseline. In contrast, liver stiffness trend to increase with time and significant elevate from baseline at 3 h. Intraclass correlation coefficient between the two radiologists showed fair agreement for SS and substantial agreement for liver stiffness.

Conclusion: Our outcomes may be a reference value for evaluating SS in patients with other illnesses in clinical setting the utilize SWE with LOGIQ E10. SS decreased with time after a meal in normal volunteers and significant difference at 3 h. In contrast, liver stiffness increases with time after a meal in normal volunteers and significant difference at 3 h. There is importance of the operator's expertise in SWE measurement should be considered for SS.

Background: The study was to compare the ultrasonographic (USG) and cone-beam computed tomographic (CBCT) measurements of the width of anterior midpalatal suture (MPS) opening following rapid palatal expansion (RPE).

Methods: The study included 13 patients (boys: 6; girls: 7) with a mean age of 11.85 ± 1.82 years who underwent RPE therapy for maxillary transverse deficiency. The width of the anterior MPS opening was measured in real-time USG, postscan USG image, and CBCT that were obtained immediately after maxillary expansion. The postscan USG and CBCT measurements were performed twice by two examiners at different times. The intraclass correlation coefficient (ICC), Bland-Altman plot, and paired t-test were performed to evaluate intra- and inter-examiner reliability, level of agreement, and systematic error between different measurements.

Results: On serial USG evaluation, the MPS opening was seen as the discontinuity in the margins of the maxillary cortical bone, which was not evident before expansion or after the retention period. The intra- and inter-examiner reliability was high (ICC >0.9) for all the measurements. The Bland-Altman plot showed considerable agreement between the different methods, with maximum observations having a mean difference which was within the 95% limits of agreement (real-time vs. postscan USG: ±0.75 mm; CBCT vs. real-time USG: ±0.93 mm; and CBCT vs. postscan USG image: ±1.09 mm). The systematic differences were not statistically significant (P < 0.05) for all the computed measurements.

Conclusion: USG can be used as a reliable nonionizing imaging modality to assess the anterior MPS opening following RPE.

The left atrium (LA) thrombus is a life-threatening disease that can result in systemic embolization and sudden death if misdiagnosed. Point-of-care ultrasound (POCUS) is an efficient tool able to assist emergency physicians in accurately and promptly identifying patients with LA thrombus. We present a 72-year-old man who presented at the emergency department with out-of-hospital cardiac arrest. The patient received cardiopulmonary resuscitation and achieved spontaneous circulation upon arrival. The patient had a past history of mitral valve regurgitation and valve replacement, followed by warfarin treatment for 5 years. Clinical examination, including POCUS, resulted in a diagnosis of LA thrombus with systemic thromboembolism events affecting the brain, kidney, and lower limbs. Although an emergency thrombectomy was performed immediately, the patient eventually died. POCUS should be performed in patients with any prior history of structural heart disease, especially those who received valve replacement surgery, to identify life-threatening thromboembolism events and facilitate prompt treatment.

Postoperative intestinal fistulae is one of the most feared complications. Despite its downsides, computerized tomography is the most widely used radiological exam to evaluate postoperative intestinal complications. Point of Care Ultrasound (POCUS) is a bedside tool that can sometimes expedite diagnosis and treatment, avoiding the potential downsides of a CT scan. We describe a case in which the use of POCUS yielded prompt identification of relevant signs in a patient suspected of having an intestinal fistula. We discuss the sonographic findings and the benefit of expediting definitive treatment, thus potentially lowering the morbidity of the patient.

Vein of Galen malformation (VoGM) is a rare type of arteriovenous fistula, and its symptoms can range from being asymptomatic to causing life-threatening heart failure. In this case report, we present a 1-month-old infant with the mural type of VoGM, which was identified through newborn screening sonography. Subsequent 1-year follow-up findings with cranial ultrasound are also discussed. Doppler cranial ultrasound proves advantageous for the convenient monitoring of this medically stable infant with VoGM.

This article emphasizes the importance of accurate differential diagnosis in managing abdominal cystic lesions and it highlights the important role of primary care physicians in utilizing imaging tools, especially ultrasound, for accurate screening diagnoses. Various potential diagnoses for abdominal cystic lesions are discussed.

A hiatal hernia (HH) is characterized by the protrusion of the stomach or other abdominal viscera into the mediastinum. The mechanism of increased intra-abdominal pressure is typically associated with this condition. When there are additional contributing factors causing increased abdominal pressure, like ascites resulting from chronic liver disease, it can exacerbate HH symptoms, including dyspnea. The incorporation of point-of-care ultrasonography as an integral component of physical examination enables a precise and objective assessment of dyspnea offering physicians additional clues regarding the underlying etiology. We present a case of a patient who was admitted to the emergency department due to dyspnea and ascites. Through the utilization of point-of-care ultrasound, the diagnosis of an HH was made, identifying it as one of the factors contributing to the patient's shortness of breath.

Ultrasonographic descriptions of Warthin's tumor (WT) vary from a predominately macrocystic appearance (anechoic with internal septations) to microcystic (multiple, diffuse, 1-2 mm anechoic areas). While the current first-line treatment for WTs is surgical excision, ultrasound-guided ethanol sclerotherapy (UGES) demonstrates success in macrocystic WTs, with aspiration of the cystic contents followed by injection of the sclerosing agent. Typically, microcystic tumors are thought to be unresponsive to sclerotherapy. In this case, we report the first application of ethanol sclerotherapy without ultrasound-guided aspiration for the treatment of a microcystic WT. The patient presented with a 2.0 cm × 1.97 cm × 3.05 cm right parotid mass of 9 years' duration. UGES was performed in clinic under local anesthesia through injection of 97% ethanol in the three separate components of the target lesion. Six months postprocedure, ultrasound evaluation demonstrated a volume reduction rate of 78.53%. The patient reported significant cosmetic improvement and no observed complications.

Background: Studies have demonstrated that a qualitatively and quantitatively assessed hyperechoic deltoid muscle on ultrasound (US) was accurate for the earlier detection of type 2 diabetes (T2D). We aim to demonstrate the utility of automated skeletal muscle US radiomics and machine learning for the earlier detection of T2D and prediabetes (PreD) as a supplement to traditional hemoglobin A_1c (HbA_1c) testing.

Methods: A sample of 1191 patients who underwent shoulder US was collected with five cohorts: 171 "normal" (without T2D), 69 "screening" (negative pre-US, but positive HbA_1c post-US), 190 "risk" (negative, but clinically high-risk and referred for HbA_1c), 365 with "PreD" (pre-US), and 396 with "diabetes" (pre-US). Analysis was performed on deltoid muscle US images. Automatic detection identified the deltoid region of interest. Radiomics features, race, age, and body mass index were input to a gradient-boosted decision tree model to predict if the patient was either low-risk or moderate/high-risk for T2D.

Results: Combining selected radiomics and clinical features resulted in a mean area under the receiver operating characteristic (AUROC) of 0.86 with 71% sensitivity and 96% specificity. In a subgroup of only patients with obesity, combining radiomics and clinical features achieved an AUROC of 0.92 with 82% sensitivity and 95% specificity.

Conclusion: US radiomics and machine learning yielded promising results for the detection of T2D using skeletal muscle. Given the increasing use of shoulder US and the increasingly high number of undiagnosed patients with T2D, skeletal muscle US and radiomics analysis has the potential to serve as a supplemental noninvasive screening tool for the opportunistic earlier detection of T2D and PreD.

Background: Osteoarthritis (OA) is a frequently complex joint disease that involves all joint components, including cartilage degeneration and new bone development. Dickkopf-1 (Dkk-1) regulates bone growth and repair in OA. The purpose of this study is to determine Dkk-1 blood levels in individuals with primary knee joint OA, as well as their associations with disease progression and severity.

Methods: This study included 45 individuals with primary OA of the knee and 45 healthy participants. Demographic data, body mass index, Visual Analog Scale, and Western Ontario and McMaster Universities Arthritis questionnaire scores were gathered. On radiography, the Kellgren and Lawrence score was acquired. The knee joint ultrasonography results were documented. The blood level of Dkk-1 was determined using the enzyme-linked immunosorbent assay method.

Results: Dkk-1 levels in the blood were substantially higher in patients with OA than in healthy persons. Serum Dkk-1 levels appeared to have a significantly inverted relationship with radiological OA grades in knee OA (P < 0.001). Dkk-1 serum levels were significantly lower in individuals with ultrasonographic knee effusion (median = 3.2, interquartile range [IQR] = 3.1-4.16) than in those without effusion (median = 4.79, IQR = 4.04-5.09). Furthermore, there was a strong correlation between Dkk-1 levels and ultrasonographically measured femoral cartilage thickness.

Conclusion: Dkk-1 is an interesting radiological indicator associated with degenerative articular joint disease. It may have a crucial function in slowing the process of degeneration in knee OA and reflecting the disease's radiographic and clinical severity.