Ultraschall in Der Medizin最新文献

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.

Ultrasound is a highly effective imaging tool for assessing abnormalities within the breast. However, especially the identification of malignant tumors of the breast mimicking fibroadenomas (MTMF) by means of breast ultrasound can be challenging. This study aimed to identify reliable imaging characteristics of MTMF.This retrospective study was approved by the local ethics review board. After screening 623 patients, 421 cases with histologically verified fibroadenomas and MTMF between 2011 and 2021 were included. Sonographic features were compared to histopathological results and an algorithm-based quantitative ranking of predictors contributing most to the correct classification of malignant tumors was conducted.A total of 363 benign, 18 intermediate, and 40 malignant lesions were analyzed. Algorithm-based quantitative ranking showed that the most predictive features indicating malignancy were a hyperechoic rim (gain ratio merit 0.135 ± 0.004), an irregular border (0.057 ± 0.002), perilesional stiffening (0.054 ± 0.002), pectoral contact (0.051 ± 0.003), an irregular shape (0.029 ± 0.001), and irregular vasculature (0.027 ± 0.002).Ultrasound findings for fibroadenomas vary, making identification of MTMF challenging. Features such as indistinct margins and increased perilesional echogenicity are predictors for malignancy and should be considered during sonographic evaluation of fibroadenomas and MTMF.

The measurement of fetal cardiovascular function parameters is not yet established in prenatal diagnostics. Now that the research field of fetal programming is becoming increasingly important, this might change. Fetal cardiovascular changes have been described above all in early/severe fetal growth restriction (FGR). The aim of this study was to investigate functional echocardiographic parameters in fetuses with late-onset small for gestational age (SGA)/FGR.A prospective cohort of SGA fetuses (including FGR) and a control group with similar distribution of gestational age were studied. Parameters of systolic, diastolic, and global cardiac function, morphometry and measurements of the fetal abdominal aorta were collected.A total of 149 SGA fetuses and 143 control fetuses were included from 32 weeks until term. The total SGA group was further divided into SGA 3rd-10th (fetuses between the 3rd and 10th weight percentile) and FGR subgroups. In the total SGA group, relative right and left ventricular wall thickness, left E/A ratio, isovolumetric contraction time and left myocardial performance index were significantly increased compared to controls after adjustment for gestational age. MAPSE, TAPSE, ejection time, left cardiac output, and abdominal aortic distensibility were significantly lower. The changes were more pronounced in the FGR subgroup.Even in a group of late-onset SGA/FGR, echocardiographic parameters are already altered in utero.

Kaposiform hemangioendothelioma (KHE) is a rare, locally aggressive vascular tumor with high morbidity and mortality. The aim of this study was to evaluate ultrasonographic findings associated with KHE.The clinical and ultrasonographic findings of a cohort of 64 cases with pathologically proven KHE were retrospectively reviewed and analyzed between November 2014 and February 2021. Two subtypes were divided according to the presence or absence of the Kasabach-Merritt phenomenon (KMP). The KMP risk factors in patients with KHE were analyzed statistically.Among the 64 cases of KHE, 43 (67.2%) were accompanied by KMP. There was a positive correlation between the appearance of KMP and tumor size. KHEs had an increased risk of developing KMP if the lesions measured were >6 cm and if they belonged to the deep or mixed subtype. On ultrasonography, all KHE lesions were heterogeneous, and 81.3% were hypoechoic; 93.8% of KHEs exhibited ill-defined margins, 68.7% had strands branching into the adjacent tissue, and 84.4% presented marked hypervascularity. Elastography showed that central hypoechogenic lesion areas were hard, and surrounding hyperechogenic lesion areas were soft.KHEs can occur in different parts of childrens' bodies. On ultrasonography, the main findings are heterogeneous low erosions, indistinct margins, branching strangulation into adjacent tissues, and obvious hypervascularity. Patients with lesions larger than 6 cm or belonging to deep or mixed subtypes (musculoskeletal infiltrates) are at risk for developing KMP, and clinicians should be vigilant.

To describe the feasibility of our preliminary outpatient fallopian tube catheterization procedure under 3D vaginal ultrasound (US) guidance followed by highly selective hysterosalpingo-foam sonography (HyFoSy) in infertile women diagnosed with proximal tubal obstruction.A prospective trial was conducted from October 2022 to December 2023. 3D vaginal US was used to establish the precise location of the tip of the selective salpingography catheter at the tubal ostium. A roadrunner was used to cannulate the occluded portion of the fallopian tube. After tubal cannulation, ExEm foam was injected under direct US guidance to confirm tubal recanalization and its passage through the fallopian tubes.During the study period, a total of 14 women with proximal tubal occlusion underwent this procedure. Tubal patency was achieved in 92.8% of cases. No immediate and remote complications were observed. To date, 3 (21.4%) of the patients conceived after tubal catheterization and 1 had a live birth.Outpatient fallopian tube catheterization under 3D vaginal US guidance, followed by selective HyFoSy, can be successfully implemented for the diagnosis and treatment of patients with proximal tubal occlusion. The 3D modality allows volume capture of the required acquisition and subsequent post-imaging analysis, thus permitting further examination and study. Additional experience is needed to determine the feasibility of this innovative procedure and to identify the patient subgroups that would benefit the most from this approach.

This CME article explores the evolving role of endosonography in otorhinolaryngology and head and neck surgery. Endosonography offers significant potential to improve imaging inside the upper respiratory tract, particularly with advancements in probe technology and imaging resolution. The article will describe the sonoanatomy of the oral cavity, pharynx, and larynx and the selection of probes and scanning techniques used for the various anatomical sites. Transoral ultrasound can be used to improve the diagnosis of salivary gland diseases, oropharyngeal abscesses, and ultrasound-guided puncture and biopsy. Endoscopic endolaryngeal ultrasound is used especially for diagnosing small laryngeal cancer and determining infiltration status. The article highlights the role of endosonography in managing oncologic diseases, especially in oral tongue carcinoma, where it aids in surgical planning by assessing the depth of invasion. In cases of HPV-positive carcinoma of unknown primary, high-frequency endosonography is crucial for detecting small tumors in the oropharyngeal region. In summary, the article advocates the broader integration of endosonography in clinical practice, highlighting its potential to enhance diagnostic accuracy and improve patient outcomes in head and neck oncology.

This study aimed to identify the structures and tissues of the dorsal aspect of the metacarpophalangeal joint (MCPJ) using ultrasound, with gross anatomy as a comparator and learning source. In addition, the composition of several MCPJ tissues was investigated by histology and immunohistochemistry.The study comprised 3 steps. First, 4 rheumatologist ultrasonographers identified on B-mode imaging the tissue patterns of the structures in the dorsal aspect of the MCPJ in fresh-frozen cadaveric hands. In the second step, 2 anatomists performed dissections on fresh-frozen and embalmed cadaveric hands to characterize the components of the dorsal MCPJ, providing anatomy-based feedback to aid ultrasound tissue interpretation. Histological and immunohistochemical analyses were also conducted on selected dorsal MCPJ tissues. In the third step, the anatomy and histology-based knowledge were applied to identify and evaluate these structures in healthy subjects using B-mode and Doppler mode ultrasound.Ultrasound examination of the cadaveric hands identified the key dorsal MCPJ structures, including the extensor tendon, joint capsule, dorsal plate, synovial recesses, and metacarpal head cartilage. Anatomical and histological analyses further characterized these structures, enhancing their identification in healthy subjects. Additionally, new insight into the histological and immunohistological features of these structures is provided.Ultrasound successfully identified the main structures of the dorsal MCPJ. Integrating anatomical and histological features improved ultrasound imaging observations and confidence.

To evaluate the significance of high-resolution ultrasound (HRUS) and shear wave elastography (SWE) in the diagnosis of diabetic peripheral neuropathy (DPN) to clarify their possible roles as early predictors of the occurrence of this important complication.The study included 90 patients with diabetes mellitus with different clinical stages of DPN as well as 30 healthy controls. A full history, clinical examination, and assessment of both the Toronto Clinical Neuropathy Score (TCNS) and HbA_1c were performed, followed by real-time HRUS and SWE examinations of their right and left tibial and median nerves to assess their cross-sectional area (CSA) and nerve stiffness, respectively.The CSA and stiffness of tibial and median nerves were significantly increased in patients with diabetes compared to controls, with higher values associated with the severity of their DPN. Both parameters were correlated with each other and with the duration of the disease, TCNS, and HbA_1c. The CSA cut-off value of both tibial and median nerves to detect DPN in patients was 13.5 mm², meanwhile, the SWE cut-off values were 68.5 and 61.5 KPa, respectively. SWE showed a higher AUC than CSA for the prediction of DPN.Measurement of the CSA and stiffness of the peripheral nerves could be a reliable tool for early detection of DPN. Therefore, we recommend adding these noninvasive diagnostic parameters as complementary diagnostic tools to the routine follow-up schedule of diabetic complications, especially in long-standing cases.