Ultraschall in Der Medizin最新文献

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.

Cystocele is a pelvic floor dysfunction disease to which women are prone after childbirth. The accuracy of pelvic floor ultrasound as the most commonly used examination method is influenced by subjective factors such as doctor experience and fatigue level, making it challenging to achieve high accuracy, consistency, and repeatability of diagnosis. This study aims to propose a high-precision and fully automatic cystocele evaluation method based on pelvic floor ultrasound video images.This study retrospectively collected pelvic floor ultrasound images of 158 female G1P1 (first gestation and first parturition) patients from 2020 to 2024. According to the ultrasound diagnosis made by two senior doctors as the standard, 81 cystoceles and 66 non-cystocele patients were enrolled. Firstly, the ResNet34-UNet was used for automatic urethra segmentation. Then, key points were generated based on the automatically extracted urethra centerline. Features such as urethral key point displacement, urethral curvature change, and urethral inclination angles and their change were extracted for patients between rest and maximum Valsalva states. The support vector machine (SVM) classification model was used for cystocele prediction.This study constructed two classification models to predict cystocele. One extracted the above features based on the automatic urethra segmentation, while the other extracted them based on the doctor-annotated urethra. The experimental results show that both models have achieved good prediction results, with AUCs of 91.37% and 98.58%, respectively. Model performance based on the urethral image delineated by the doctor is better, with an AUC improvement of 7.21% based on the independent test set.The proposed method can achieve high-precision, repeatable, fully automatic quantitative cystocele evaluation in pelvic floor ultrasound examinations.

Rheumatoid arthritis (RA) is a systemic autoimmune disease of unknown etiology that causes progressive and destructive inflammation in the joints. Superb microvascular imaging (SMI) is a new ultrasound technique that allows visualization of slow blood flow in synovitis. This study aimed to report on the clinical value and utility of the SMI technique and its grading for monitoring RA by determining the correlation with clinical disease activity scores (DAS 28) and power Doppler ultrasound (PDUS).All RA patients with clinically apparent synovitis were assessed using DAS 28. Synovitis was investigated with PDUS and SMI and each joint was graded semi-quantitatively. All assessments were carried out at baseline and repeated at least at the 4-month follow-up. Correlations between scores were investigated using Spearman's correlation.60 RA patients with 552 affected joints were recruited. Clinical and sonographic scores were significantly improved at follow-up (p<0.001). SMI showed significantly more joint count and flow signal scores than clinical examination and PDUS. Moderate correlations were found between the SMI score and clinical scores (p<0.001, 0.586 for SMI score vs. DAS 28-CRP, p=0.001, 0.432 for SMI vs. DAS 28-ESR). There were also stronger correlations between the SMI score and PDUS score at both baseline and follow-up (p<0.001, r = 0.817, 0.842 respectively).SMI provides greater utility and ability to detect synovial vascularity and to monitor disease activity than PDUS. A new activity scoring system based on SMI and clinical objective findings is required to improve reliability and validity.

Breast ultrasound has been established for many years as an important method in addition to mammography for clarifying breast findings. The goal of the Best Practice Guidelines Part III of the DEGUM breast ultrasound working group is to provide colleagues working in senology with information regarding the specific medical indications for breast ultrasound in addition to the current ultrasound criteria and assessment categories published in part I and the additional and optional sonographic diagnostic methods described in part II. The value of breast ultrasound for specific indications including follow-up, evaluation of breast implants, diagnostic workup of dense breast tissue, diagnostic workup during pregnancy and lactation, and the diagnostic workup of breast findings in men is discussed. Each section after the general information section contains a description of specific pathologies, followed by a short summary and DEGUM recommendations for the particular indications. The latest S3 guidelines and AGO guidelines were taken into consideration.