Journal of Ultrasonography最新文献

Background: Transesophageal echocardiography enables visualization of structures within the spinal canal, particularly in the upper thoracic and lower cervical regions, but its diagnostic performance and clinical roles remain unclear.

Aim: To systematically review studies evaluating the ability of transesophageal echocardiography to depict spinal canal anatomy and its potential diagnostic, monitoring, and interventional applications.

Material and methods: A PRISMA-guided systematic review (PROSPERO CRD420251074380) was conducted to identify human studies evaluating transesophageal echocardiography for imaging spinal canal structures. PubMed/MEDLINE, Embase, and Web of Science were searched from inception to September 2025; screening and de-duplication were supported by Rayyan, and findings were synthesized narratively.

Results: Thirteen studies met the inclusion criteria. Transesophageal echocardiography consistently identified key landmarks such as the epidural space, dura mater, subarachnoid compartment, and catheter position, with the best visualization reported in the upper thoracic and lower cervical segments. Reported applications included adjunctive diagnosis of selected pathologies, intraoperative assessment of spinal perfusion, and procedural guidance. Image quality and feasibility were influenced mainly by patient habitus and anatomy. Safety signals were favorable, although systematic assessment was lacking. No study provided robust comparative accuracy versus magnetic resonance imaging or computed tomography, and standardized outcome measures were uncommon.

Conclusions: Transesophageal echocardiography shows promise for real-time visualization of spinal canal structures and select intraoperative and interventional uses. However, current evidence is limited to small, heterogeneous studies. Rigorous prospective research including standardized imaging endpoints and comparative evaluations is needed to define its diagnostic accuracy, safety, and clinical impact.

Aim: To identify anatomical variations in the cervical vagus nerve using ultrasonography and assess their relationship with age, sex, side, site, and proximity to the thyroid gland.

Materials and methods: A cross-sectional observational study was conducted on 347 patients undergoing routine or clinically indicated neck ultrasonography. High-frequency linear ultrasound probes were used to scan the cervical region bilaterally. The cervical vagus nerve was identified relative to the common carotid artery and internal jugular vein, and its anatomical course was classified using a reference C-I axis. Anatomical variation types and proximity to the thyroid gland in potentially vulnerable configurations were recorded. Demographic factors, including age and sex, were analyzed in association with variation prevalence.

Results: Anatomical variations of the cervical vagus nerve were observed in 132 of 347 participants (38%). There was a statistically significant left-sided predominance (67.1%) compared to right-sided variations (6%) (p <0.001). Eight patients had bilateral variations. The most common type was the anteromiddle variation, followed by anterolateral, anteromedial, and medial types. Variation prevalence increased with age and was higher in males than in females (46.6% vs. 34.4%, p = 0.033). In 69 cases, the cervical vagus nerve was located less than 2 mm from the thyroid gland, with 13 abutting it directly.

Conclusion: Ultrasonography is a valuable, non-invasive imaging modality for identifying anatomical variations of the cervical vagus nerve. Awareness of these variations is essential for surgical planning and for preventing iatrogenic nerve injury, especially during procedures like thyroidectomy, vagus nerve stimulation, and radiofrequency ablation, particularly in older patients and on the left side of the neck. Preoperative mapping of the nerve using ultrasonography could, therefore, be considered as a routine measure.

Introduction: Prostate cancer is the most prevalent non-cutaneous malignancy in men. Mucinous adenocarcinoma is a rare histological variant, accounting for less than 0.5% of cases. Its distinctive imaging and histopathological features present unique diagnostic challenges.

Case presentation: A 57-year-old male presented with sexual dysfunction, painful ejaculation, and hematuria. Clinical examination revealed a markedly enlarged prostate. Imaging studies, including scrotal and transrectal ultrasound, computed tomography, and multiparametric magnetic resonance imaging (MRI), demonstrated a complex, multilobulated prostatic mass with fluid-fluid levels and imaging features suggestive of mucin accumulation. Prostate biopsy confirmed adenocarcinoma with predominant mucinous features, including trabecular and cribriform patterns, and an ISUP grade group 4, indicating an aggressive tumor. On MRI, mucinous adenocarcinoma typically appears as a multicystic lesion with high T2 signal intensity and minimal diffusion restriction, which may delay diagnosis. These imaging characteristics differ from those of conventional prostate adenocarcinoma and can mimic benign cystic lesions.

Discussion: Histopathological diagnosis is often challenging due to the extracellular mucin content. While treatment generally follows standard protocols for high-grade prostate cancer, including surgery, radiotherapy, and hormonal therapy, the rarity of this variant leaves many questions regarding prognosis and optimal management unanswered.

Conclusion: Awareness of the distinct imaging and histopathological features of mucinous adenocarcinoma is crucial for accurate diagnosis and appropriate management. Further research is needed to better understand its clinical behavior and to establish evidence-based treatment guidelines.

Aim: Pneumothorax is a potentially life-threatening condition whose diagnosis can be challenging. Ultrasound chest examination is generally fast and user-friendly, but in non-expert hands or with uncooperative patients, it may still be difficult and time-consuming. Adding another tool to support the suspicion of pneumothorax might be useful, potentially enhancing the diagnostic accuracy of standard ultrasound chest examination. We evaluated the feasibility of standardized bilateral ultrasound image comparison as a potential new tool for pneumothorax diagnosis.

Materials and methods: We enrolled 60 subjects (30 with pneumothorax and 30 controls) and collected bilateral ultrasound images of their chests (each image contained one frame from the left lung and one from the right lung). Ten physicians (eight blinded to diagnosis) divided into five groups according to expertise evaluated the images for potential grayscale differences and/or horizontal artifacts between the two frames. All images were then analyzed with image analysis software for grayscale pixel assessment (one sub-analysis for the entire area under the pleural line, one for a 100-pixel-wide rectangle under the pleural line).

Results: All clinicians achieved good results in terms of diagnostic accuracy and inter-operator reliability, even those unexperienced in ultrasound. Mean, range, and median grayscale pixel ratio between the pneumothorax side and the healthy side in a single patient proved to be the most reliable parameters, reaching excellent sensitivity and specificity. Combining these parameters proved to be an excellent diagnostic tool (ROC area under curve = 1.00, p-value = 0.02).

Conclusions: Standardized bilateral thoracic ultrasound image comparison may be a potential new tool for the diagnosis of pneumothorax.

Aim: To assess whether ultrasound (US)-guided intercostal nerve blocks (ICNBs) provide non-inferior efficacy in the management of acute zoster pain (ZAP) and potential prophylaxis for post-herpetic neuralgia as compared to conventional thoracic paravertebral blocks (TPVBs).

Material and methods: A total of 192 patients with ZAP were reviewed. Their records were stratified into two cohorts: those who underwent US-guided TPVBs (TPVB cohort) and those who received US-guided ICNBs (ICNB cohort). The ICNB cohort was matched using a propensity score method in a 1:1 ratio. The primary endpoint was non-inferiority of Herpes zoster (HZ)-related illness burden within 30 days (HZ-BOI₃₀) post-procedure. Secondary outcomes included procedure time, rescue analgesic use, post-herpetic neuralgia occurrence, health-related quality of life, and adverse events.

Results: Mean score of HZ-BOI₃₀ was 87.92 ± 21.84 and 85.64 ± 17.01 in the TPVB and ICNB cohorts, respectively, with a mean difference of 2.28 (95% confidence interval (CI): -5.68, 10.24). Non-inferiority was met, as the 95% CI for the absolute difference in HZ-BOI₃₀ fell within the predefined non-inferiority margin of 15 points. Comparable improvements in post-herpetic neuralgia incidence, EQ-5D-3L scores, and rescue analgesic requirements were observed in both cohorts across all follow-up time points (all p >0.05). In contrast, the ICNB approach was associated with shorter procedure times (p <0.001) and reduced discomfort and pain during needle insertion (p <0.001). There were no complications, including pneumothorax, nerve injury, or intravascular injection in either study cohort.

Conclusions: US-guided ICNBs were non-inferior to TPVBs in alleviating ZAP and preventing post-herpetic neuralgia, while also demonstrating a favorable safety profile. These findings suggest that the ICNB technique might be a promising alternative for managing ZAP.

Aim of the study: Skin ultrasonography and elastography provide information on superficial tissue anatomy and elasticity. Floppy eyelid syndrome is characterized by eyelid hyperlaxity and is associated with several ophthalmic and systemic conditions, such as obstructive sleep apnea. This study evaluates the diagnostic role of ultrasonography and elastography in floppy eyelid syndrome.

Methods: This is a prospective case-control study. Patients were recruited from the Oculoplastic Service of the Department of Ophthalmology at the University Hospital of Heraklion, Crete, Greece. The diagnosis of floppy eyelid syndrome was based on the eversion of the upper eyelid upon unassisted digital traction. Cataract surgery candidates without floppy eyelid syndrome were consecutively recruited as controls. Patients with a history of previous eyelid pathology or surgery were excluded. Ultrasound examination was performed using high-frequency linear probes (GE E9) for B-mode imaging and shear wave and strain elastography. Upper airway measurements included tongue thickness and upper airway length. Clinical and demographic findings were recorded.

Results: Twenty-eight patients were included (14 with floppy eyelid syndrome, 14 controls). Orbicularis muscle elasticity in kPa was significantly higher in the floppy eyelid syndrome group, compared with controls (independent samples t-test score 2.64, p = 0.04). Tongue thickness and upper airway length were also significantly correlated with several eyelid B-mode and elastography parameters in patients with floppy eyelid syndrome, including subcutaneous fat and orbicularis muscle thickness and elasticity.

Conclusions: Findings from this feasibility study imply that ultrasound and elastography parameters may be used in the evaluation of floppy eyelid syndrome and support an association between eyelid elasticity and upper airway anatomical parameters in this condition.

Aim: The purpose of the study was to create an ultrasound protocol dedicated to patients with multiorgan trauma.

Material and methods: The authors aimed to develop an ultrasound protocol dedicated to patients with multiorgan trauma based on the following: Advanced Trauma Life Support management (ABCDE protocol), available ultrasound protocols for trauma patients, known point-of-care cardiac protocols, and the authors' experience. The indications for the test and the technical requirements necessary for its proper execution are also specified, and the technique of performing the CRAFT test is described.

Results: POCUS-CRAFT represents five components of trauma patient evaluation. C (Cranium): Transcranial Doppler or transorbital ultrasound to assess for elevated intracranial pressure; R (Respiratory): Evaluation of the chest for pneumothorax and pleural hematoma; A (Abdomen): Evaluation of the peritoneal and pelvic cavity for free fluid; F (Cardiac Function): Diagnosis of pericardial tamponade and assessment of left ventricular systolic function; T (Trauma Integration): Integration of ultrasound findings with a complete physical examination of the trauma patient, with emphasis on the clinical context.

Conclusions: POCUS CRAFT is an integrated ultrasound protocol designed for trauma patients. It expands upon the eFAST protocol by adding components for neurological and functional myocardial evaluation. Currently, CRAFT is the only point-of-care protocol that incorporates trauma-related sequelae that can be detected by ultrasound while highlighting the importance of clinical context.

Aim: The gold standard nerve conduction study for diagnosing carpal tunnel syndrome is often painful and has variable diagnostic accuracy. This study aimed to evaluate the diagnostic performance of shear wave elastography in correlation with nerve conduction study.

Material and methods: A prospective case-control study was conducted on 50 participants (50 wrists), including 25 carpal tunnel syndrome cases diagnosed by nerve conduction study and 25 healthy controls. Shear wave elastography assessed the stiffness of the median nerve at three locations: outside the carpal tunnel, at the inlet, and at the outlet. Cross-sectional area measurements were also obtained using B-mode ultrasound. Receiver operating characteristic curves were used to evaluate diagnostic performance.

Results: Shear wave elastography and cross-sectional area demonstrated high diagnostic accuracy for carpal tunnel syndrome, with a cut-off value of ≥63.5 kPa inside the tunnel (mean of inlet and outlet values) and a cross-sectional area cut-off of ≥0.08 cm² at the inlet of the tunnel offering optimal performance. While cross-sectional area provided high sensitivity, shear wave elastography showed superior specificity; their combination improved overall diagnostic accuracy. Shear wave elastography values did not significantly differ across carpal tunnel syndrome severity grades based on nerve conduction study (p >0.05). However, shear wave elastography at the tunnel inlet differentiated severe carpal tunnel syndrome from non-severe cases (p = 0.045), with a cut-off of ≥126 kPa predicting severe carpal tunnel syndrome with 100% sensitivity, 77% specificity, and an area under the receiver operating characteristic curve of 0.871.

Conclusions: Shear wave elastography is a reliable, non-invasive modality for carpal tunnel syndrome diagnosis, offering excellent specificity, particularly when combined with cross-sectional area. Additionally, shear wave elastography at the tunnel inlet may help identify severe carpal tunnel syndrome, supporting timely clinical decision-making and prioritization of intervention.

Aim: Sarcopenia is a significant predictor of postoperative morbidity and mortality in liver transplant recipients. Traditional assessment tools such as computed tomography (CT) and bioelectrical impedance analysis have limitations in clinical use. This study aimed to evaluate the utility of ultrasonography (USG) in assessing abdominal muscle thickness as a marker of sarcopenia.

Material and methods: This prospective observational study was conducted at a tertiary liver transplant center between September 2023 and May 2024. USG was used to measure the thickness of the external oblique (EO), internal oblique, and transversus abdominis (TA) muscles in 41 liver transplant recipients and 41 healthy donors. Sarcopenia was also assessed using CT-based L3 skeletal muscle index (L3-SMI) and hand grip strength. Correlations with disease severity (Model for End-Stage Liver Disease, Child-Turcotte-Pugh (CTP)), postoperative outcomes, and ascitic fluid volume were analyzed.

Results: Abdominal muscle thickness was significantly lower in recipients compared to donors (EO: 2.9 ± 1.0 mm vs. 4.5 ± 1.8 mm; TA: 2.2 ± 0.7 mm vs. 3.2 ± 1.0 mm; p <0.001). Sarcopenia prevalence was 78% by L3-SMI and 82.9% by hand grip strength. ROC analysis demonstrated that EO <3.6 mm and TA <2.55 mm predicted sarcopenia in males with high sensitivity and specificity. Muscle thinning correlated with higher CTP scores, greater ascitic fluid volume, and prolonged intensive care unit stay.

Conclusions: USG-derived abdominal muscle thickness, especially EO <3.6 mm and TA <2.55 mm in males, is a reliable, non-invasive marker for sarcopenia in liver transplant candidates. It correlates with disease severity and postoperative morbidity, supporting its utility in pre-transplant risk stratification.