Ultrasound in Medicine and Biology最新文献

The aim of this study was to explore the qualitative and quantitative characteristics of PTC on contrast-enhanced ultrasound (CEUS) in predicting central cervical lymph node metastases (CLNM). This prospective study analyzed a dataset of grayscale US and CEUS images in 201 nodules with biopsy-confirmed PTC. Seven grayscale US features and five qualitative CEUS parameters were employed to develop the approaches. Four quantitative CEUS parameters of the time-intensity curve were obtained and compared between PTC and adjacent thyroid tissue (ATT), as well as within different PTC groups. The diagnostic performance of an equation with quantitative CEUS parameters were compared with grayscale US features and qualitative CEUS for predicting central CLNM. The patients were divided into three groups based on their final pathological results: 28 patients in the macro-metastases group, 95 patients in micro-metastasis group, 78 patients confirmed to have no metastases. Independent predictive grayscale US and qualitative CEUS features included size, capsule contact and heterogeneity on CEUS. In quantitative CEUS parameters, there were significant differences in peak intensity (PI) between PTC and ATT in all three groups (p < 0.05). Significant differences in PI were also observed among three groups (p < 0.05). A PI ratio of PTC and ATT greater than or equal to 1 was found to be a more sensitive index for predicting central CLNM. The quantitative CEUS-assisted US equation demonstrated the best diagnostic performance. A grayscale US and CEUS equation with PI ratio based on quantitative CEUS was developed for predicting occult central CLNM and it is considered highly valuable in the clinical management of PTC.

Objective: Shoulder pain mainly originates from subacromial pain syndrome (SAPS), with the supraspinatus (SS) and infraspinatus (IS) muscles most often affected. Speckle-tracking ultrasonography (STU) is a non-invasive method to quantify muscle deformation. However, reliability and agreement with software post-processing procedures (inter-rater) and symptom-related variance (test-retest) for the same rater are unknown. This study aimed to assess the inter-rater reliability and agreement of STU post-processing procedures and the test-retest reliability and agreement of STU for evaluating SS and IS muscle function in patients with SAPS and a healthy control group METHODS: Twenty-four SAPS patients were assessed for inter-rater and test-retest (+1 week) variability, with the addition of 22 matched (age/gender) controls for the test-retest analysis. STU recordings were post-processed using EchoPAC software. Reliability was assessed using the intra-class correlation coefficient (ICC) and minimal detectable change (MDC). Agreement was evaluated using Bland-Altman plots RESULTS: Inter-rater reliability for SAPS shoulders was good-excellent (ranges: ICC 0.87-0.97; MDC 1.4-2.2% strain) and test-retest poor-moderate (ranges: ICC 0.16-0.59; MDC 3.5-8.9% strain). For the controls, test-retest showed good-excellent reliability (ranges: ICC 0.83-0.96; MDC 1.8-3% strain). Agreement was high for SAPS shoulders between raters. Test-retest agreement was moderate for the controls and low for SAPS shoulders CONCLUSION: STU showed excellent inter-rater reliability for post-processing strain measurements of the SS and IS muscles. However, test-retest reliability was low in SAPS patients, likely due to symptom-related variability. While STU shows promise for assessing muscle function, its clinical applicability and feasibility remain unexplored.

Objective: Previous development of a breast biopsy marker that can be readily detected using color Doppler twinkling has been reported, but the cause of twinkling remains unclear. The objective is to better understand the mechanism for twinkling by exploring the effects of microbubbles on the surfaces of markers that twinkle compared to those that do not.

Methods: Twinkling metallic clinical markers and twinkling polymethyl methacrylate (PMMA) markers were evaluated in a pressure chamber. The hydrostatic pressure around the markers was increased from 0 to 1000 psi. To evaluate the effects of internal and external structures on twinkling, micro-CT scans were conducted to analyze the internal voids and surface roughness of the markers. A low-twinkling PMMA sample and a non-twinkling metal rod were also tested.

Results: Twinkling markers exhibited decreased twinkling as the hydrostatic pressure increased. PMMA markers mixed for approximately 75% of the time required to reach the hardening phase of the polymerization reaction exhibited the highest twinkling signals under increased pressure. Internal voids were found to have no correlation with twinkling. Samples with higher surface roughness values (S_a and full width at half maximum in the y-dimension) were found to correlate with twinkling (p = 0.037 and p = 0.011, respectively).

Conclusion: These results support oscillating microbubbles on surfaces as a cause of twinkling. Prior work connecting surface roughness to twinkling is, hence, corroborated by the microbubbles present on rougher surfaces.

Objective: To evaluate effects of various sections, operational methods, and measurement techniques of shear wave elastography (SWE) on the assessment of rectus femoris stiffness.

Methods: This study included 43 healthy volunteers who underwent rectus femoris SWE using different sections (cross-sectional and longitudinal), operation methods (hand-held, thick coating couplant, and acoustic pad), and measurement methods (circular, multipoint, and tracing). Two sonographers evaluated the inter-observer and intra-observer consistency of SWE longitudinal-section measurements for the first 20 healthy volunteers.

Results: The longitudinal section had lower median values of shear wave velocity (SWV) and shear modulus (1.7 m/s vs. 1.9 m/s, 9.3 kPa vs. 11.4 kPa), whereas the transverse section exhibited higher coefficients of variation (17.14% vs. 10.94%, 33.80% vs. 27.70%). Excellent inter-observer agreement on SWV and shear modulus was observed for the longitudinal section (ICC: 0.97, 0.96, 95% CI: 0.883-0.991, 0.800-0.988; p < 0.001). The intra-observer agreement for SWV was substantial (ICC = 0.64) while that for the shear modulus was moderate (ICC = 0.23). Median SWVs of the handheld, thick-coated couplant, and acoustic-pad methods decreased in order (1.9 m/s, 1.7 m/s, 1.6 m/s, respectively). The handheld method had the lowest coefficient of variation (CV) compared to the other two methods (10.94%, 13.87%, and 14.56%, respectively). No statistically significant differences were observed in SWV measurements and CV between circle, multipoint, and tracing methods (p > 0.05).

Conclusion: The longitudinal section and handheld method offered enhanced stability when measuring muscle stiffness; shear SWV exhibited superior consistency compared to shear modulus. The region-of-interest tracing method was straightforward and had an extensive measurement range.

Background: Rotator cuff tendinopathy (RCT) is a common clinical diagnosis of pain and dysfunction in the shoulder. In conjunction with clinical tests, diagnostic ultrasound (US) is beneficial in the diagnosis of RCT through its ability to visualise tendon structural change. However, there is currently no standardised method to assess RCT with US.

Aims/purpose: The primary aim of this systematic review was to identify the common US parameters used to diagnose RCT with US. The secondary aim was to determine whether a nominal or ordinal scale should be used to diagnose RCT with US.

Methods: A systematic review was conducted in July 2024 according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Studies were selected based on the following inclusion criteria: adults with RCT diagnosed with US, defined classification criteria for symptomatic tendinopathy, the US parameter used to measure structural change was reported with a grading scale (nominal or ordinal) and retrievable in full English text. Primary diagnosis of previous shoulder operations, partial or full-thickness tears, were excluded. Study quality was assessed using the Joanna Briggs Institute Critical Appraisal tools by two independent reviewers.

Results: A total of 1286 records were identified; eight studies met the inclusion criteria. The quality of the studies ranged from poor (12%) to good (88%). The most common US parameters were echogenicity (88%, n = 7), thickness (88%, n = 7), vascularity (50%, n = 4) and calcification (25%, n = 2). A nominal grading scale was most commonly utilised when assessing echogenicity (86%, n = 6 of 7), thickness (71%, n = 5 of 7) and calcification (100%, n = 2 of 2), while an ordinal scale was utilised in 100% of studies assessing vascularisation. Additionally, it was noted positioning and operator experience varied between studies.

Conclusion: This systematic review demonstrates the heterogeneity between methods used to diagnose RCT through US. Future studies should develop a standardised method to assess echogenicity, thickness, vascularisation and calcification in RCT, potentially using an ordinal scale to align with tendinopathy research in the lower limb.

Objective: Early assessment of treatment response following locoregional therapy remains a challenge in managing hepatocellular carcinoma (HCC). Recent advancements in contrast-enhanced ultrasound (CEUS) have demonstrated significant potential in the early assessment of tumor viability. This study compared the evaluation capabilities of CEUS and CT/MRI in assessing treatment response to hepatic arterial infusion chemotherapy (HAIC) and transarterial chemoembolization (TACE).

Materials and methods: This study included patients who had received TACE or HAIC between 2010 and 2024. 1:1 propensity score matching was used to reduce confounding bias between the TACE and HAIC groups. A comparative analysis was carried out using pathological complete response of treated lesions as the reference standard to assess the diagnostic performance of CEUS and CT/MRI across different treatment strategies.

Results: A total of 154 patients with 167 observations were ultimately included. In the propensity score matching cohort, CEUS and CT/MRI demonstrated similar diagnostic performance, with no significant differences in sensitivity (96% vs 92%, p = 0.07) or specificity (67% vs 57%, p > 0.99). Additionally, CEUS showed comparable results between HAIC and TACE groups in both sensitivity (98% vs 94%, p = 0.61) and specificity (50% vs 77%, p = 0.35).

Conclusion: CEUS demonstrated no significant difference in diagnostic performance compared with CT/MRI in evaluating HCC treatment response to HAIC and TACE.

Objective: To establish reference intervals and intervention cutoffs for lateral ventricles in extremely pre-mature infants.

Methods: This prospective study recruited neurologically healthy extremely pre-mature infants born or treated at two Chinese Grade 3A Hospitals between 2021 and 2024. Upon enrollment (U1), anterior horn width (AHW), ventricular index (VI) and thalamo-occipital distance (TOD) were measured to establish reference values and surgical intervention cutoffs. Four weeks later, the same indices were measured (U2). We analyzed the correlations between AHW, VI and TOD and independent variables in U1 data using multiple linear regressions and compared the time-varying trends of AHW, VI and TOD between U1 and U2 data via mixed linear models.

Results: A total of 353 extremely pre-mature infants were included. Special attention was paid to the 97th percentile and 4 mm above it, internationally regarded as upper reference limits and intervention cutoffs for post-hemorrhagic ventricular dilation, respectively. The AHW, VI and TOD were all positively correlated with birth weight (p values <0.05) and increased over time (p values <0.001).

Conclusion: The study presents reference values and intervention cutoffs for AHW, VI and TOD in extremely pre-mature infants and provides an extensive comparison of all available reference values.

Objective: Ultrasound Targeted Microbubble Destruction (UTMD) technology enhances microvascular blood perfusion, with adenosine triphosphate (ATP) release from red blood cells (RBCs) playing a crucial role. However, the precise mechanisms remain unclear. This study aimed to investigate the role of Piezo1 in regulating ATP release from RBCs by UTMD.

Methods: RBCs were collected from rats, and UTMD was carried out using a modified ultrasonic thrombolysis device with lipid-fluorine microbubbles. RBCs were treated with the Piezo1 activator Yoda1, the Piezo1 blocker GsMTx4 or the Pannexin1 (Panx1) blocker carbenoxolone, prior to UTMD. ATP release was assessed using a bioluminescence assay with an in vivo imaging system, and intracellular calcium (Ca²⁺) concentration was determined by laser confocal microscopy. Data-independent acquisition proteomic analysis was conducted to identify differential protein expression in the UTMD and Control groups.

Results: UTMD-induced Piezo1 activation promoted ATP release from RBCs by facilitating Ca²⁺ influx. Proteomic analysis highlighted differentially expressed proteins, including Dematin, Protein 4.1, Moesin and Myosin, suggesting their involvement in the process. Additionally, Panx1 likely contributed as a downstream regulator of activated Piezo1.

Conclusion: Our findings suggest that UTMD enhances ATP release from RBCs via a synergistic mechanism: Piezo1-mediated Ca²⁺ influx as the primary pathway, and non-Piezo1 pathways (including sonoporation) as complements. UTMD-induced Ca²⁺ influx is dominated by Piezo1-independent mechanisms. Panx1 acts as a key downstream effector. Although our results show Panx1 inhibition reduces ATP release, direct evidence of Piezo1-Panx1 interaction remains to be established. Proteomic data suggest cytoskeletal remodeling may play a role in this process. This knowledge may contribute to the development of new therapeutic strategies for improving microcirculatory perfusion.

Objective: By using lung ultrasound and Venous Excess Ultrasound Grading System (VExUS) to assess fluid tolerance, four congestion types can be identified: fluid tolerant (no congestion), pulmonary congestion, systemic congestion and both pulmonary and systemic congestion. The primary aim is to describe the epidemiology of these congestions types.

Methods: This is a pre-planned secondary analysis of a prospective observational cohort study. Fluid tolerance was defined as absence of congestion on ultrasound. Pulmonary congestion was defined as a bilateral B-profile. Systemic congestion was defined as VExUS ≥ 2, and pulmonary and systemic congestion were used when both were present. Primary outcome was the prevalence of congestion types. Secondary outcomes were associations between congestion types, associations with left (LVF) and right ventricular function (RVF) and cumulative fluid balance.

Results: A total of 87 (63%) of 138 patients were fluid tolerant, 36 (27%) had pulmonary congestion, 8 (6%) systemic congestion and 7 (5%) both pulmonary and systemic congestion. Between the first and second measurement 16 out of 87 (18%, 95% CI: 11%-28%) fluid tolerant patients developed pulmonary congestion and 8 out of 36 (22%, 95% CI: 11%-40%) patients with pulmonary congestion switched to fluid tolerance. No association was found between pulmonary and systemic congestion. A positive association was found for reduced LVF and pulmonary congestion (OR 2.1 [95% CI: 1.03-4.6]), and reduced RVF and systemic congestion OR 4.3 (95% CI: 1.5-15.6). No association between cumulative fluid balance and any type of congestion was found.

Conclusion: Most critically ill patients are fluid tolerant at admission. Pulmonary congestion is the most prevalent congestion type. Pulmonary and systemic congestion seldom occur simultaneously; therefore, both need to be assessed.

Objective: This study aimed to evaluate the feasibility, safety, and preliminary efficacy of high-intensity focused ultrasound (HIFU) ablation for treating soft tissue tumors (STTs) located in challenging anatomical regions (e.g. adjacent to critical nerves, blood vessels, joint areas, or recurrent tumors).

Materials and methods: A retrospective analysis was conducted on 11 patients with locally unresectable recurrent STTs treated with under ultrasound-guided HIFU from January 2024 to December 2024. The cohort included recurrent desmoid tumors (3 cases) and other complex soft tissue sarcomas (8 cases), all histologically confirmed. Tumor locations encompassed intra-abdominal, abdominal wall, chest wall, extremities, scapular region, and pelvic region. Treatment efficacy was assessed via ablation volume, adverse events (graded by CTCAE v5.0), and imaging follow-up (contrast-enhanced MRI/CT).

Results: All patients underwent successful HIFU treatment, targeting 18 tumor lesions. The median non-perfusion volume ratio (NPVR) post-HIFU was 93.24%. At 3-month follow-up, 12 lesions exhibited significant shrinkage, while 6 remained stable. Mild adverse events included transient skin edema, mild pain, and orange-peel-like skin changes (case 3).

Conclusion: As a noninvasive modality, HIFU demonstrated favorable local control and safety in managing STTs in challenging locations. For surgically high risk or recurrent lesions, HIFU effectively controlled tumor progression and improved extremity function.