Journal of Ultrasonography最新文献

Aim: There is a need to evaluate the tissue deformation index of lateral abdominal muscles using M-mode ultrasound in a cohort of healthy subjects to establish a convenient reference point for clinical reasoning in patients. The aim of the study was to assess differences in the tissue deformation index between individual lateral abdominal muscles regardless of body side, compare these differences in the tissue deformation index on the right and left sides of the body, and evaluate side-to-side differences in the tissue deformation index within individual lateral abdominal muscles.

Material and methods: In a group of 126 healthy volunteers (59 females), the postural response of lateral abdominal muscles to external perturbation in the form of rapid arm abduction with load was recorded on both sides of the body, and the tissue deformation index was calculated.

Results: The mean values of the tissue deformation index form an increasing gradient from deep to superficial lateral abdominal muscles: 0.06%/ms for the transversus abdominis, 0.084%/ms for the internal oblique and 0.151%/ms for the external oblique (p <0.001). Side-to-side intra-muscle differences were significant only for the transverse abdominis (right: 0.047%/ms; left: 0.070%; p <0.01).

Conclusions: The tissue deformation index values differ significantly among individual lateral abdominal muscles and form a characteristic gradient: transversus abdominis < internal oblique < external oblique. The transversus abdominis muscle shows significant asymmetry in the tissue deformation index between the left and right sides of the body.

Aim: Aiming to offer a diagnostic tool to aid examiners with correct hip typing and decision-making about patient management, members of the Board of the International Interdisciplinary Consensus Committee on DDH Evaluation (ICODE - https://www.icode.expert), introduced the cross-platform mobile application (Android and iOS) called "ICODE Hip US Calculator".

Material and methods: The examination steps of Graf's hip sonography technique were converted into computer code and formed the basis for the development of a mobile phone application. An algorithmic approach, based on a series of conditional sentences, was followed for the development of the application (e.g. if … and … or … then). Coding of the algorithm was carried out by a Greek software development company.

Results: A cross-platform mobile phone application which calculates Graf's hip type (according to the date of birth, the date of examination, and the alpha and beta angles) was constructed. The calculated hip type is then linked to simple management recommendations (discharge, rescan, refer).

Conclusions: "ICODE Hip US Calculator" may be used by trained health professionals to help them decide upon the hip type and the management of the baby after the scan. Hip typing is precisely calculated, and management proposals are simple and straightforward. This means that the application may be used in screening settings to help with patient management, increase the examiner's confidence, and improve patient flow.

Aim: The Nordic hamstring curl appears effective in reducing the incidence of injury in physically active young adults, likely through its capacity as an eccentric exercise to increase muscle stiffness. Although eccentric exercises have been shown to increase muscle stiffness, medium- and long-term Nordic hamstring curl training programs have not demonstrated an effect on muscle stiffness. This study examined the acute effects of a single session of Nordic hamstring curls on the stiffness of the biceps femoris, semitendinosus, and semimembranosus muscles using ultrasound shear wave elastography, an accepted method for measuring passive muscle stiffness.

Material and methods: Twenty physically active adults (ages 19-27 years) were randomly assigned to either the Nordic hamstring curl group (n = 10) or the control group (n = 10). Shear wave elastography was performed on the dominant kicking leg for both groups. The exact location of the probe was marked to ensure the same area was assessed during post-testing. Both groups performed a 5-minute cycle ergometer warm-up followed by three 30-second standing static stretches. The Nordic hamstring curl group then performed three sets of six repetitions of the eccentric phase of the Nordic hamstring curl with 1-minute rest intervals between sets. All subjects then rested for five minutes before shear wave elastography was performed.

Results: Repeated measures ANOVA revealed no significant main effects or interactions for the biceps femoris or semitendinosus (p >0.05). However, analysis of the semimembranosus was inconclusive due to variability of measurement values.

Conclusions: These results are in agreement with findings indicating that long- and short-term Nordic hamstring curl training has no impact on hamstring stiffness, although the effects of Nordic hamstring curl on reducing the probability of hamstring injury are still valid.

Aim: This study aimed to evaluate the effects of diabetes mellitus and cervical dilatation on cesarean section scar healing.

Material and methods: This prospective study included pregnant women diagnosed with diabetes mellitus and healthy control pregnant women. The study group was divided into active labor and pre-active labor based on cervical dilatation, and the diabetic group was categorized into gestational diabetes and preexisting diabetes mellitus. Vaginal ultrasound was performed in the entire study group at six months postpartum, and the location of the cesarean scar was evaluated.

Results: There were 170 participants in the study; 85 were diabetic, and the remaining 85 were healthy controls. Niche frequency in diabetes mellitus cases was not different from that in healthy controls (p = 0.420). The mean residual myometrial thickness, proximal residual myometrial thickness, and distal residual myometrial thickness were lower in the diabetic group (p = 0.001). Residual myometrial thickness and niche presence in the diabetic group with active labor was not statistically different from the diabetic group without active labor (p >0.05). Additionally, residual myometrial thickness was thinner in the gestational diabetes mellitus group than in the preexisting diabetes mellitus group (3.61 ± 1.78 mm vs. 4.76 ± 2.82 mm, p = 0.032).

Conclusions: There was no significant difference in niche frequency between diabetic cases and healthy controls. When comparing the gestational diabetes mellitus group and the preexisting diabetes mellitus groups, there was no difference in the presence of niches. Niche presence was more common in diet-regulated diabetic patients compared with the insulin-regulated group. Cervical dilatation at the time of cesarean section did not affect niche presence in diabetic cases.

Aim: Diastasis recti is a common contour abnormality of the anterior abdominal wall, where an increased distance between the rectus abdominis muscles results in a visible or palpable bulge in this area. This study aimed to characterize this clinical entity in children.

Material and methods: Anatomy of the rectus abdominis muscles and the linea alba, with a special focus on the interrectus distance (distance between two bellies of the rectus abdominis muscles), was studied using ultrasound. Anthropometric and ultrasonographic assessments were performed on 38 children aged 7-12 years. According to the clinical definition of bulging in the epigastrium, diastasis was diagnosed in 12 children (31.6%), significantly more often in boys than in girls (50.0% vs. 6.3%). Other clinical and anthropometric variables, such as age, history of preterm birth, body mass, body mass index, waist circumference, and height, were not significantly associated with diastasis recti.

Results: Diastasis recti, defined by the ultrasonographic criterion of interrectus distance >20 mm, was found in 10 children (26.3%), with no significant differences between boys and girls. Still, there was a moderate agreement between these two modes of diagnosing diastasis: the Cohen's kappa coefficient was 0.49. This suggests that ultrasonographic measurement of the interrectus distance should not be considered an alternative and more precise method of diagnosing diastasis.

Conclusions: Our study indicates that diastasis recti is quite common in the pediatric population, especially among boys. However, more studies are needed in children to understand the functional relevance and natural course of this clinical entity.

The aim of this paper is to present our experience in transabdominal ultrasonography of ileocecal valve lesions. The ileocecal valve, located in the central part of the ileocecal bowel segment, is rarely the primary site of disease processes. It is usually involved by pathologies in adjacent bowel segments. These are primarily infectious diseases such as yersiniosis, campylobacteriosis and salmonellosis. Typical location of Crohn's lesions also promotes valve involvement. The appearance of the lesions in these cases is characterized by a symmetrical submucosal thickening of the bowel involved over a longer segment. Non-malignant valvular hyperplasia is relatively commonly identified as lipomatosis, manifested by symmetrical enlargement and smooth outlines. However, valvular lipoma causing an asymmetrical hyperechoic bulge is a rare finding. ileocecal valve lipomatosis or lipoma should not be misdiagnosed as a lipoma of the cecoascending part of the colon and, the other way round, a right colonic lipoma should not be mistaken for a fatty valve. Polyps on the ileocecal valve, although sometimes detected, were not identified in our material. Adenocarcinoma, which is found in the cecum in approximately ¼ of cases, is the most common malignancy, followed by neuroendocrine tumor and, rarely, lymphoma. In three cases of malignant involvement of the ileocecal valve, we observed irregular hypoechoic thickening with complete loss of wall stratification, with the lesions causing symptoms of small bowel obstruction in two of these cases. The nearly forgotten ileocecal valve syndrome, also known as Bauhin's ileocecal valve syndrome, characterized by intermittent right iliac fossa pain, is also briefly discussed. Transabdominal ultrasound can be used as an initial diagnostic tool in some of these pathologies.

Objective: Thrombosis is a common complication of umbilical artery catheterization. The purpose of this study was to compare the novel ultralow umbilical artery catheter position (catheter tip at the junction of the umbilical and internal iliac arteries) versus the conventional high umbilical artery catheter position (tip in the aorta, above the diaphragm) for the incidence of thrombosis.

Study design: This study was conducted in a nonacademic, tertiary-referral neonatal center. The insertion and placement of the umbilical artery catheter was performed under continuous ultrasound guidance. Serial ultrasound examinations were performed to identify thrombosis in 38 consecutive newborns with an umbilical artery catheter placed in the novel ultralow position. The control group consisted of 50 infants with an umbilical artery catheter placed in the standard position.

Results: The incidence of thrombosis requiring anticoagulant treatment was 22% in neonates with an umbilical artery catheter in the standard position. No thrombosis was detected in those with an umbilical artery catheter placed in the ultralow position. The study and control groups had similar catheter indwelling times (mean, 8.2 ± 4.1 vs. 8.5 ± 4.0 days, p = 0.687).

Conclusions: This is the first report to present a novel position for the placement of umbilical artery catheters. The preliminary findings for the novel ultralow umbilical artery catheter position indicate that it may provide a safety benefit over the conventional umbilical artery catheter position.

Aim: The purpose of this study is to present the ultrasound appearance of a previously undescribed-at-imaging variant of the ulnar nerve near the Guyon's canal.

Material and methods: The ultrasound database of one of the authors, who has more than 10 years of experience in peripheral nerve ultrasound, was searched for the phrases "UN variant" or "UN loop." The other two authors, with more than 10 years of experience in nerve imaging, retrospectively reviewed the static sonograms as well as the videoclips stored, to confirm the findings.

Results: Between October 2019 and October 2023, six cases were found in five patients, where ultrasound demonstrated previously undescribed-at-imaging anatomical variations of the distal ulnar nerve on six distal forearms. The variant was symptomatic in three cases in which possible distal compression was clinically suspected. A branch of the ulnar nerve made a loop around the flexor carpi ulnaris, which also presented with a variation of normal anatomy. In symptomatic patients, the diameter of the aberrant branch (retrospectively measured) was significantly enlarged.

Conclusions: High-resolution ultrasound can accurately demonstrate ulnar nerve variants even when only small nerve fascicles are involved, which may be clinically relevant and misinterpreted. Loops of the ulnar nerve are rare, but likely under-recognized. We think that symptoms are generally tolerated by patients if the motor branch of the ulnar nerve is not affected, as in our cases.

Aim: The present study aimed to assess the diagnostic efficacy of contrast-enhanced voiding urosonography (ceVUS) using SonoVue for evaluating duplex kidneys, and to compare it with fluoroscopic voiding cystourethrography (VCUG).

Material and methods: Forty-six children with duplex kidneys confirmed by surgical intervention or cystoscopy were included in the study, resulting in a total of 46 duplex kidneys and 46 normal kidneys (138 pyeloureteral units).

Results: The overall sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of RBUS for diagnosing duplex kidney disease were 73.91%, 80.43%, 79.07%, and 75.51%, respectively. The diagnostic performance of RBUS and ceVUS in detecting duplex kidney yielded an overall sensitivity, specificity, PPV, and NPV of 89.13%, 84.78%, 85.42%, and 88.64%, respectively. The sensitivity, specificity, PPV, and NPV of VCUG in diagnosing duplex kidney disease were 17.31%, 86.96%, 57.14%, and 51.23%, respectively. For the 42 pyeloureteral units with VUR, Cohen's weighted kappa value for the agreement between ceVUS and VCUG in grading VUR was 0.702 (95% CI, 0.551 ~ 0.854; p <0.05).

Conclusions: RBUS effectively diagnoses duplex kidneys with renal pelvic dilation, while ceVUS can further elucidate whether reflux occurs in the upper or lower moiety in cases of duplex kidneys with VUR. Compared to VCUG, both RBUS and ceVUS provide more intuitive diagnoses for duplex kidneys with VUR and ureterocele. Additionally, there is good consistency between ceVUS and VCUG in grading VUR. CeVUS is recommended as an initial evaluation method for patients suspected of having duplex kidneys associated with urinary tract infections.

Aim: Our objective was to determine the factors associated with the successful maturation of arteriovenous fistulas during hemodialysis.

Material and methods: This prospective study included patients treated with hemodialysis and predialysis patients. Clinical, biochemical, sociodemographic, vascular ultrasound mapping, flow-mediated dilatation, and surgical factors were analyzed. Success in the maturation process was defined by ultrasonographic criteria at six weeks.

Results: Thirty-seven patients were included. With a mean ± standard deviation age of 40 ± 14 years, 73% were male, 65% had type-2 diabetes mellitus, and 95% had hypertension. Arteriovenous fistulas were brachycephalic in 18 patients (49%), brachymedian in nine patients (24%), brachycommunicating posterior in five patients (14%), brachibasal in three patients (8%), radiocephalic in two patients (8%), and radiocephalic in two patients (5%). Fourteen percent of patients had unsuccessful maturation. The vein diameter was 4.3 ± 1.0 mm (maturation group) vs 3.2 ± 0.9 mm (non-maturation group), p = 0.04. The artery diameter was similar: 4.5 ± 0.6 vs 4.5 ± 0.4, p = 0.88. Logistic regression analysis revealed that the diameter of the vein for which the surgery was performed was the factor associated with successful maturation in our population, odds ratio = 4.77 (1.14-19.97), p-value = 0.032.

Conclusions: It is highly important to plan vascular access in patients to perform vascular mapping and measure veins and arteries in patients. Vein measurement is a significant factor in successful maturation of the arteriovenous fistulas.