Ultraschall in Der Medizin最新文献

Ectopic pregnancy - any pregnancy outside the uterine cavity - affects 1-2 % of all pregnancies. While the diagnosis and treatment of the most common ectopic pregnancy (tubal pregnancy which accounts for > 90 % of cases) is established, other forms, such as Caesarean scar pregnancy, pose an increasing challenge. This article describes the different forms of ectopic pregnancies and the respective therapeutic options.

Evaluation of the possible role of microvascular imaging (MI) for the detection of vascularization of renal lesions, while comparing it with contrast-enhanced ultrasound (CEUS).137 patients (160 renal lesions, 64 solid and 96 cystic) were enrolled in this single-center, retrospective, observational study. For solid masses, both the intralesional and the peripheral vascularization was analyzed and quantified by MI and then compared to peak enhancement on CEUS. Regarding cystic lesions, we evaluated the presence or absence of vascularization within the cystic wall and/or septa. MI results were compared with CEUS findings using Pearson's Chi square test. An optimal size cut-off for renal lesions was determined with the Youden test.For solid lesions, a statistically significant correlation (p <0.05) was observed between the MI parameters and the peak enhancement on CEUS. The detection rate (DR) for lesional vascularization on MI was 87.5%, while if we consider only lesions larger than the optimal cut-off (14mm), the DR increases to 98%. In cystic lesions, the MI showed a high specificity (93.9%) in predicting CEUS results and a high positive predictive value (84.2%). The concordance was 100% in Bosniak I lesions and 80% in Bosniak IV lesions, while it was lower for the other classes. Furthermore, we found a statistically significant correlation (p <0.05) between Bosniak grade and lesional vascularity on MI.Our preliminary study shows that MI cannot replace CEUS, but could reduce its use, especially in solid lesions larger than 14mm and in cysts classified as Bosniak IV, a goal that is particularly important in an active surveillance setting.

Vascularization assessment is crucial for the diagnosis of ovarian masses. However, its subjectivity often results in suboptimal interobserver agreement. This study evaluated the impact of the OvAi denoising algorithm on IOTA color score assignment and perceived image quality in adnexal mass ultrasound.In this multicenter prospective study (May 2018-August 2022), color/power Doppler videos of 100 adnexal masses from 100 women were acquired in 2 outpatient clinics. Six experts, 5 moderately experienced, and 8 beginner examiners assessed IOTA color score and image quality before and after applying the denoising algorithm. Interobserver agreement regarding color score assignments was measured using Fleiss' Kappa, and perceived image quality changes were tested via Chi-square.Interobserver agreement regarding color score assignment was fair across all observer groups (κ: 0.296-0.396) and remained unchanged post-denoising. In benign lesions, CS1 increased (+14.9%), while CS2-CS4 decreased. In malignant cases, CS1 and CS2 increased (+76.2% and +30.8%), with a smaller reduction in CS3 (-3.7%) and CS4 (-21.4%). The CS4 decrease was less marked in malignant than in benign lesions (-21.4% vs. -38.3%). A significant improvement in perceived image quality was observed in all observer groups (p < 0.05).The OvAi algorithm improved perceived image quality without significantly impacting interobserver agreement. Continued development may enable more objective and automated color score assignments, potentially reducing interobserver variability and supporting diagnostic reliability.

Ultrasound plays a central role in the diagnosis, monitoring, and management of liver diseases. Assessing hepatic fibrosis is essential in chronic liver disease, and several diagnostic modalities are available. The gold standard remains percutaneous liver biopsy, an invasive method using a 16-18-gauge needle. A breakthrough came in 2003 with transient elastography (TE), a non-invasive technique that measures liver stiffness (kPa) via elastic wave propagation. Later, shear wave elastography (SWE), integrated into modern ultrasound systems, was developed to assess tissue elasticity. SWE generates shear waves (SWs) through acoustic radiation force, assuming tissues to be linearly elastic and homogeneous, and provides quantitative stiffness data. Recent evidence shows hepatic tissue is viscoelastic, with wave propagation varying by frequency. Quantifying viscosity remains a challenge. Fibrosis affects viscoelastic properties and shear wave speed (SWS), while necroinflammation predominantly alters the viscous component, influencing the shear wave dispersion slope (SWDS). This review provides an overview of ultrasound elastography methods, including stiffness and viscosity assessment, their physical principles, and clinical applications in hepatology.

Arteria lusoria (AL), a rare vascular variant (prevalence of 0.5-3.2%), is linked to a right non-recurrent laryngeal nerve (RNRLN), thereby increasing nerve injury risk during thyroid and parathyroid surgery. This study evaluates ultrasonography (US) for preoperative AL detection.Retrospective analysis of 1406 hyperparathyroidism patients undergoing 18F-fluorocholine PET/CT with subgroup analysis in 270 patients with "expert US" performed on-site. An experienced senior radiologist assessed the US Y-image (brachiocephalic artery division), with low-dose CT as the standard of truth for AL confirmation.18F-fluorocholine PET/CT analysis found 22 cases of AL (prevalence: 1.57%). US identified 259 Y-images, excluding AL, confirmed by CT. Five absent Y-images indicated AL, all were confirmed by CT. Six non-assessable Y-images were AL-negative on CT. US performance: sensitivity 100% (95% CI: 0.463-1), specificity 98% (95% CI: 0.95-0.99), negative predictive value (NPV) 100%, accuracy 98%.US Y-image assessment reliably excludes AL with an NPV of 100%, offering a non-invasive tool to reduce RNRLN injury risk in thyroid and parathyroid surgery.

Purpose Gastrointestinal ultrasound is a well-established method for diagnosing and following Crohn's disease (CD). The aim of this study was to investigate whether wall layer data measured on gastrointestinal ultrasound could predict endoscopic activity in CD. Materials and methods 64 CD patients underwent a gastrointestinal ultrasound examination and endoscopy ± 2 weeks apart in a single-centre prospective study. Bowel wall thickness and the thickness of individual wall layers corresponding to mucosa, submucosa and the proper muscle wall were measured and compared with simple endoscopic score of Crohn's disease (SES-CD) in the worst affected bowel segment where SES-CD >2 was defined as activity. Results There was increased absolute thickness of mucosa (1.8 versus 1.1mm, p =0.001), submucosa (2.8 versus 1.2mm, p <0.001) and proper muscle (1.6 versus 1.1mm, p =0.006) in patients with endoscopic activity. After a ROC analysis Youden's index suggested a 1.8 mm cut off for submucosal thickness and disease activity giving 90% sensitivity, 78.3% specificity and 84.9% accuracy. In contrast, a bowel wall thickness of 3 mm had a 97.3 % sensitivity, 52.0 % specificity and 79.0% accuracy. The submucosa was also relatively thicker (0.45 versus 0.36, p=0.008) while the proper muscle was relatively thinner (0.25 versus 0.34, p=0.001) in endoscopic activity. Conclusion Patients with Crohn's disease and endoscopic activity had increased thickness of all bowel wall layers in affected areas. Measurements of the submucosa may be used to assess disease activity with similar results as bowel wall thickness.

To describe the ultrasound (US) features of a complication in patients who have undergone surgery for carpal tunnel syndrome (CTS): the incomplete release of the transverse carpal ligament (TCL).Reports from two institutions were searched using the keywords "persistent CTS" and "incomplete TCL release". Post-surgical US examinations were performed using a standardized approach at both institutions, first assessing the muscles supplied by the median nerve (MN) and then conducting a detailed evaluation of the MN course at the wrist. To avoid misinterpreting ligament regrowth, patients with recurrent symptoms two months or later after surgery were excluded. Only cases showing clear compression by the TCL were selected.A total of 46 patients were identified with incomplete release of the TCL, with the average uncut portion of the ligament measuring 6.7 mm. The proximal margin of the TCL was incompletely released in 65% of the cases, while the distal margin was affected in 35%. Symptoms in these patients persisted after surgery, and, in 52%, they were worse than before surgery. A reduction in thenar muscle bulk was observed in 37 patients. Follow-up clinical data were available in eight patients, with three undergoing US evaluation after revision surgery.US can effectively demonstrate the incomplete release of the TCL, visualized as a fibrillar uncut structure compressing the MN and producing an hourglass appearance of the nerve. In addition, US may help detect other factors that contribute to persistent symptoms and help to guide revision surgery.

Thickening of the medial plantar proper digital nerve (MPPDN) along the medial aspect of the big toe is frequently observed incidentally during high-resolution ultrasound examinations in asymptomatic individuals. However, the clinical significance of these findings remains unclear, as no study has definitively linked them to symptoms. Although the localization and visualization of the medial plantar nerve using ultrasound have been documented, its cross-sectional area has not yet been utilized to assess thickening at this specific site. The study aimed to assess the frequency and specific locations of MPPDN thickening in asymptomatic individuals and to identify associated characteristics.In this prospective study, high-resolution ultrasound examination of the MPPDN was performed on asymptomatic volunteers. The cross-sectional areas and their changes along the course of the nerve are evaluated descriptively. Potential contributing demographic factors in participants are captured.56 asymptomatic volunteers, 30 women and 26 men (median age: 28, range: 20-69) participated in this study. 22 individuals (39.3%) showed thickening of the MPPDN at the interphalangeal joint either in one or both feet. More participants above the median population age of 28 showed thickening of the MPPDN (15 [57.7%] versus 7 [23.3%] p = 0.009).Thickening of the MPPDN is frequently observed in asymptomatic individuals, with the likelihood of these findings increasing with age. The pathological significance should however not be overestimated and should be assessed in a clinical context.

Multiparametric ultrasound (MPUS) integrates B-mode, Doppler techniques and microvascular imaging, contrast-enhanced ultrasound (CEUS) and elastography, enhancing diagnostic precision across a wide spectrum of scrotal diseases. Developed under the auspices of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB), these guidelines provide evidence-based recommendations for the clinical use of MPUS in scrotal imaging. Based on the Oxford Centre for Evidence-Based Medicine framework, this document outlines the diagnostic value of MPUS in acute scrotal pain, trauma, infertility, focal and extratesticular lesions, cryptorchidism, and testicular incidentalomas. The recommendations highlight CEUS as the reference method for vascular assessment and elastography as a complementary tool for tissue characterization. These guidelines aim to standardize MPUS practice and promote its integration into routine scrotal imaging.