Ultraschall in Der Medizin最新文献

The aim of this systematic review was to investigate the outcomes of pregnancies with fetal cerebral lateral ventricle asymmetry without dilation. We conducted a comprehensive literature search in the Embase, Medline, and Web of Science databases until April 29, 2024, of observational cohort studies that reported fetal ventricular asymmetry without dilation detected on ultrasound or magnetic resonance imaging. Of the 150 studies identified, 6 met the inclusion criteria. Among the cases of non-dilated ventricular asymmetry, 36.8-46.2% progressed to ventriculomegaly on follow-up by neurosonography or magnetic resonance imaging. Additional findings in the central nervous system were observed in 5.5-10.5% of cases, while 7.6% had additional fetal body findings. Abnormal genetic findings were present in 5.1% of cases. Postnatal follow-up indicated no abnormal developmental findings during the first year of life. By the age of 9-11 years, lower writing speed was observed, yet verbal fluency scores were higher than in the general population. In conclusion, non-dilated ventricular asymmetry in fetuses showed the potential for progression to ventriculomegaly, and linkage to genetic abnormalities. Larger prospective studies are essential to fully elucidate the condition's natural history and refine clinical management strategies.

In twin-to-twin transfusion syndrome (TTTS), unbalanced vascular anastomoses lead to a net transfer of fluid from the donor to the recipient. This triggers compensatory mechanisms resulting in fetal vasoconstriction. Hemodynamic modelling has shown that the appearance of a second systolic peak P2, in addition to the main systolic peak P1, in the middle cerebral artery (MCA) Doppler waveform, thus creating a systolic M-sign, may indicate increased fetal vasoconstriction. Hence, the M-sign could be expected in twins with TTTS. The Quintero staging system has been used to stage TTTS. However, TTTS does not always develop in line with the Quintero stages and/or the criteria are not always fulfilled. This study investigates whether the M-sign could be an additional TTTS criterion indicating significant imbalance between the fetuses.38 women who underwent fetoscopic laser coagulation (FLC) for TTTS were included. The MCA Doppler waveforms were retrospectively analyzed for the presence of an M-sign. We subdivided the M-signs into 2 groups: Group A: the main systolic peak P1 dominates P2, i.e., P2/P1 <1; Group B: P2 exceeds P1: P2/P1 >1.Before FLC, an M-sign was found in 17/38 (45%) pregnancies. Both twins showed M-signs in 9 pregnancies, only the recipient in 6, and only the donor in 2. In 6 (35%) fetuses, an M-sign appeared before the Quintero criteria were fulfilled. Postoperatively, M-signs disappeared in all cases.The appearance of an M-sign could be an additional marker of cardiovascular imbalance in monochorionic-diamniotic twins with developing or already present TTTS. Postoperative M-sign disappearance may indicate fetal recovery.

Ultrasound is a relevant tool in the diagnosis and characterization of gallbladder polyps. B-mode imaging can be used for the identification of echogenic formations attached to the gallbladder wall, while advanced techniques such as color Doppler, power Doppler, and micro-flow allow a thorough assessment of polyp vascularization. The integration of CEUS further improves diagnostic accuracy by confirming the integrity of the wall and the absence of pathological washout, which is characteristic of malignant lesions. In recent years, several guidelines have been published on the integrated clinical and ultrasound management of polypoid formations of the gallbladder. This review aims to summarize the main evidence regarding the ultrasound study of gallbladder polyps and to provide the sonographer with a clear and practical approach to the clinical management and follow-up of these patients.

To describe the perfusion patterns of solitary fibrous tumors of the pleura (SFTP) using contrast-enhanced ultrasound (CEUS).Between November 2012 and 2024, six patients with histologically confirmed SFTP underwent B-mode ultrasound (B-US) and CEUS. Parameters from the arterial phase, including flow-in pattern, extent of enhancement (EE; marked or reduced/absent), and homogeneity of enhancement (HE; homogeneous or inhomogeneous) were retrospectively analyzed.All 6 lesions displayed a flow-in perfusion pattern that originated from a peripheral point. Five lesions (83.3%) exhibited arterial hyperenhancement and 1 (16.7%) showed hypoenhancement. HE was inhomogeneous in 5 lesions (83.3%) and homogeneous in 1 (16.7%).On CEUS, all cases showed an arterial flow-in perfusion that originated from a peripheral point in an SFT, which could be a diagnostic clue for the non-invasive diagnosis of SFTPs. Given the risk of tumor seeding, direct surgical resection may be preferable to biopsy in these cases.

In cases of severe or refractory carpal tunnel syndrome (CTS), carpal tunnel release (CTR) can be performed using open surgery, endoscopic techniques, or minimally invasive approaches under high-resolution ultrasound (HRUS) guidance. This study aimed to evaluate the long-term clinical outcomes following HRUS-guided CTR.A retrospective analysis was conducted on 302 HRUS-CTR cases. Patients who were available for a phone interview and had a minimum follow-up period of one year were assessed using the Boston Carpal Tunnel Questionnaire (BCTQ). Symptom severity and functional limitations were compared before and after the procedure.Of the 302 cases screened, 111 cases had to be excluded due to unavailability for the phone call, missing data, or death. Accordingly, 191 cases were included. The average patient age was 60.4 ± 15.5 years (range: 19 to 87 years). 126 cases (66%) were female and 65 cases (34.0%) were male. Overall, there was a significant reduction of 91.9% in CTS-related symptom severity and frequency for all items recorded in the questionnaire. Similarly, a significant reduction of 84.8% in difficulty with all self-reported daily activities was found. In addition, the procedures were performed by four physicians showing no significant differences in technical success and symptoms reduction.HRUS-CTR is a safe and effective method for the treatment of CTS, showing a statistically but mostly clinically significant reduction in symptom severity and hand discomfort, which persisted 1 year after release and should therefore be considered as an alternative approach to open or endoscopic CTR.

To investigate automated breast ultrasound (ABUS) features affecting the use of a multiview convolutional neural network (CNN) for breast lesions according to the level of experience of radiologists.A total of 656 breast lesions (152 malignant and 504 benign lesions) were included and reviewed by 6 radiologists for background echotexture, glandular tissue component (GTC), and lesion type and size without as well as with a multiview CNN. The sensitivity, specificity, and the area under the receiver operating curve (AUC) for ABUS features were compared between 2 sessions according to the level of the radiologists' experience.Radiology residents showed significant AUC improvement with the multiview CNN for mass (0.81-0.91, P=0.003) and non-mass lesions (0.56-0.90, P=0.007), all background echotextures (homogeneous-fat: 0.84-0.94, P=0.04; homogeneous-fibroglandular: 0.85-0.93, P=0.01; heterogeneous: 0.68-0.88, P=0.002), all GTC levels (minimal: 0.86-0.93, P=0.001; mild: 0.82-0.94, P=0.003; moderate: 0.75-0.88, P=0.01; marked: 0.68-0.89, P<0.001), and lesions ≤10mm (≤5mm: 0.69-0.86, P<0.001; 6-10mm: 0.83-0.92, P<0.001). Breast specialists showed significant AUC improvement with the multiview CNN in heterogeneous echotexture (0.90-0.95, P=0.03), marked GTC (0.88-0.95, P<0.001), and lesions ≤10mm (≤5mm: 0.89-0.93, P=0.02; 6-10mm: 0.95-0.98, P=0.01).With the multiview CNN, ABUS performance among radiology residents was improved regardless of lesion type, background echotexture, or GTC. For breast lesions smaller than 10mm, both radiology residents and breast specialists achieved better ABUS performance.

The main goal of fetal growth monitoring is to identify fetuses at increased risk of morbidity and mortality. This study compares 5 commonly used growth charts (Hadlock, FMF, NICHD, INTERGROWTH-21^st, WHO) to assess their ability to identify pregnancies below the 10^th percentile and predict adverse neonatal outcomes.We retrospectively analyzed 572 singleton pregnancies with an estimated fetal weight (EFW) <10^th percentile according to Hadlock, excluding multiple pregnancies or cases with maternal comorbidities. Maternal and neonatal data were collected, and EFW and birthweight percentiles were recalculated using the different growth charts. Statistical analyses assessed the association between these charts and adverse neonatal outcomes.The WHO chart classified the fewest pregnancies below the 10^th percentile and showed significant differences in composite adverse outcomes between the groups (p < 0.05). Despite a lack of statistical significance, the WHO chart had better prediction for NICU admission compared to others. At the 3^rd percentile cutoff, all charts showed similar results for NICU admission and adverse outcomes (p < 0.01). For severe adverse outcomes, only the WHO and FMF charts showed significant differences (p = 0.043, p = 0.029).The WHO chart showed superior performance at the 10^th percentile cutoff, while all charts were comparable at the 3^rd percentile. Notably, the WHO and FMF charts significantly differentiated between patients with severe composite adverse outcomes at the 3^rd percentile to improve the accuracy of diagnosing and predicting neonatal outcomes in small-sized fetuses.

The aim was to evaluate whether elastography changes the accuracy of thyroid nodule malignancy risk classification using the TI-RADS ACR and ATA systems.This was a prospective study with 191 nodules (180 patients). Nodule assessments by B-mode ultrasonography (US) and 2-dimensional shear wave elastography (2D-SWE) were compared with a) fine-needle aspiration biopsy cytological (Bethesda II) and b) post-resection histology results (Bethesda III-VI). Nodules were divided into benign and malignant. B-mode US evaluated echogenicity, composition, dimensions, contours, limits, and presence of halo and echogenic foci. Elastography classified nodules from I (completely softened) to IV (completely hard). The mean nodule deformation value (assessed in m/s and kPa), the deformation ratio between nodule and thyroid parenchyma (TDR), and the deformation ratio between nodule and pre-thyroid musculature (MDR) were calculated.The significant univariate parameters for B-mode were hypoechogenicity, halo, microcalcifications, irregular contours, and ill-defined limits. All parameters were significant for elastography. The MDR (in kPa) was the best elastographic parameter: nodules with MDRs> 1.53 exhibited a higher chance of malignancy (AUC-ROC=0.831). B-mode ACR-TIRADS had an AUC of 0.678; 95% CI: 0.596-0.760, while ATA had an AUC of 0.680; 95%: 0.597-0.763. Multivariable analysis indicated that the combination of prognostic models with any elastographic parameter increased performance. ATA classification, combined with elastogram pattern and MDR (in kPa), increased the AUC to 0.892; 95% IC: 0.845-0.939.2D-SWE can increase the accuracy of the most widespread B-mode prognostic models: TI-RADS ACR and ATA.