Journal of Medical Ultrasonics最新文献

Purpose: Tunneled central venous catheters (CVC) are essential medical devices for pediatric patients facing extended treatment periods. This study aimed to demonstrate the usefulness of ultrasound in evaluating complications in subcutaneous tissue associated with unplanned extraction of tunneled CVC.

Methods: Twenty-five patients who underwent ultrasound examination for suspected complications in the subcutaneous tissue associated with tunneled areas from CVC were included. The following patient characteristics and imaging findings were evaluated: infection in subcutaneous tissue, high echogenicity and hypoechoic effusion around the catheter within the subcutaneous tissue, and hyperechoic foci around the catheter. Patients with CVC were classified into two groups: those with and those without unplanned extraction of tunneled CVC. Fisher's exact test was used to compare the two groups.

Results: Nine patients had unplanned extraction of tunneled CVC. A significant difference was found in infection at tunneled areas (presence/absence in patients with vs. those without unplanned extraction = 7/2 vs. 2/14, P = 0.002), as well as in hypoechoic effusion around the catheter within the subcutaneous tissues (presence/absence in patients with vs. those without unplanned extraction = 9/0 vs. 3/13, P < 0.001). However, no significant differences were found in the presence or absence of high echogenicity (presence/absence in patients with vs. those without unplanned extraction = 7/2 vs. 6/10, P = 0.097) or hyperechoic foci around the catheter (presence/absence in patients with vs. those without unplanned extraction = 3/6 vs. 1/15, P = 0.116).

Conclusion: The ultrasound findings were useful for determining the necessity of tunneled CVC extraction. These results will be helpful for improving management of pediatric patients with CVC.

Inflammatory bowel disease (IBD) is an inflammatory disorder in which intestinal homeostasis is disrupted for some reason. Among them, ulcerative colitis (UC) and Crohn's disease (CD) are frequently referred to as IBD in the narrow sense, characterized by relapse episodes and remission periods. The differential diagnosis of IBD involves a broad spectrum of inflammatory or infectious diseases that mimic UC and/or CD, as well as others that may complicate existing IBD. Accordingly, these differential diseases and modifying factors should be considered in their pathological diagnosis, and a careful diagnosis should be made in close collaboration with clinicians. Here, we provide a pathological overview of UC, CD, and their differential diseases, as well as IBD-associated cancers, demonstrating their typical gross and histological features. Further, we introduce a pathological scoring system for biopsy specimens to diagnose IBD that may potentially be integrated into clinical practice.

Purpose: The infrapatellar fat pad (IFP) absorbs mechanical stress in the knee joint owing to flexible morphological changes. The IFP is a key factor in knee osteoarthritis (OA); however, its dynamic feature during walking remains unknown. This study aimed to investigate whether the morphological changes in the IFP during walking involve specific features for patients with knee OA.

Methods: Twelve patients with knee OA, 12 healthy young volunteers, and 12 healthy elderly volunteers were recruited. The IFP was evaluated using ultrasonography, and dynamics were recorded in video mode during walking. The IFP value was identified as the thickness between the patellar tendon and proximal tibial line. The morphological change in the IFP (ΔIFP) was shown as the difference in IFP value between maximum and at initial contact on the waveform. Kinematics and kinetics data were evaluated using a three-dimensional motion analysis system synchronized with ultrasonography, and the knee flexion angle and its moment in the stance phase were evaluated.

Results: In the patients with knee OA, the ΔIFP was lower than that in healthy volunteers, but there was no difference between control groups (knee OA: 1.4 ± 0.3 mm, elderly control: 1.8 ± 0.2 mm, young control: 2.1 ± 0.5 mm, p < 0.05). In all the groups, there was no significant correlation between the IFP values and kinetic parameters, including the range of knee flexion angles and gait speed.

Conclusion: Insufficient morphological changes in the IFP during walking could be a feature of knee OA.

Purpose: The purpose of this study was to compare the value of contrast-enhanced ultrasound (CEUS) plus MicroFlow Imaging (CEUS-MFI), MicroFlow Imaging (MFI) alone, and color Doppler flow imaging (CDFI) in the differential diagnosis of benign and malignant breast lesions.

Methods: A total of 116 patients with 116 breast lesions categorized as Breast Imaging Reporting and Data System (BI-RADS) category 4 were enrolled in this prospective study. CEUS-MFI, MFI, and CDFI were used to evaluate the microvascular morphology and distribution types of breast lesions. Pathological results were considered the gold standard.

Results: Compared with conventional CDFI and MFI, the CEUS-MFI technique can reveal microvasculature and distribution types at a higher resolution in breast masses. The sensitivity, specificity, and accuracy of CEUS-MFI were 96.3%, 80.6%, and 91.4%, respectively. The sensitivity, specificity, and accuracy of MFI were 87.5%, 75.0%, and 83.6%, respectively. The sensitivity, specificity, and accuracy of CDFI were 58.8%, 72.2%, and 62.9%, respectively. The accuracy was significantly different between CEUS-MFI and MFI (P = 0.024), and the accuracy was significantly different between CEUS-MFI and CDFI (P = 0.000). US BI-RADS 4A masses were downgraded based on CEUS-MFI features without any malignancy missed, with the biopsy rate decreasing from 100% (29/29) to 31.0% (9/29).

Conclusion: CEUS-MFI provides improved diagnostic efficacy for breast lesions. The CEUS-MFI technique can be used as an effective supplement to conventional ultrasound in the diagnosis of breast tumors.

Purpose: Knee pain is a characteristic symptom of early-stage knee osteoarthritis. Recently, the association between knee symptoms and infrapatellar fat pad (IFP) degeneration has garnered attention. This study aimed to clarify the association between ultrasound-derived size and echo intensity (EI) in the IFP and knee symptoms.

Methods: A total of 163 community-dwelling older individuals (women, n = 106; age, 75.1 ± 7.0 years) participated. An ultrasound imaging device was used to assess the area and EI of the superficial and deep parts of the central, medial, and lateral IFP and presence of medial meniscal extrusion (MME) and medial tibial osteophytes. Based on the 2011 version of the Knee Society Knee Scoring System (KSS) symptoms category, the participants were classified into a symptomatic (KSS symptom score < 23, n = 74) or asymptomatic (KSS symptom score ≧23, n = 89) group. Logistic regression analyses were performed with groups as dependent variables and EI and area of the IFP as independent variables.

Results: EI of the superficial part of the medial IFP was significantly associated with knee symptoms, adjusting for age, sex, body mass index, MME, and medial osteophytes (p < 0.05). MME was also significantly associated with knee symptoms (p < 0.05). EI of the other parts, area of any parts, and medial osteophytes were not associated with knee symptoms.

Conclusion: These findings suggested the utility of evaluating EI on the superficial part of the medial IFP and MME as the articular structures associated with knee symptoms.

Purpose: To characterize the ultrasonographic findings of patients with early knee osteoarthritis (KOA) and determine which findings were associated with the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscale.

Methods: The study included 98 knees (35 men, 63 women, 60.3 ± 11.5 years) diagnosed with early KOA with no major deformity radiographically, but with pain during activity and tenderness in the medial knee. Synovial hyperplasia in the suprapatellar bursa, knee joint effusion, horizontal tear of the medial meniscus (MM), osteophytes of the medial condyle of the femur and tibia, blood flow signals in the synovium of the suprapatellar bursa, medial collateral ligament bursa, infrapatellar fat pad, MM extrusion (MME) in the supine and upright positions, and the amount of change in MME were observed using ultrasonography.

Results: Correlations (p < 0.05) were found between the presence of synovial hyperplasia of the suprapatellar bursa (r<-0.20) and amount of MME in the upright position (r< - 0.24) and all KOOS subscales. Presence of joint effusion and the four KOOS subscales except quality of life (QOL) were correlated (p < 0.05). Partial correlation coefficients showed correlations (p < 0.05) between knee joint effusion and symptoms (r = 0.299) and activities of daily living (ADL) (r = 0.254) of the KOOS subscales, and between MME in the upright position and symptoms (r= - 0.263), pain (r= - 0.256), and ADL (r= - 0.212).

Conclusion: Quality and difficulty of life of patients with early KOA may be influenced by synovial hyperplasia in the suprapatellar bursa, joint effusion, and MME values in the upright position. Among them, synovial hyperplasia of the suprapatellar bursa and amount of MME in the upright position were independently associated with the KOOS subscales.

Purpose: The concept of non-mass abnormalities of the breast has been employed in Japan for approximately 20 years. Although B-mode findings are classified as non-mass abnormalities, the usefulness of adding color Doppler ultrasonography (US) and strain elastography to B-mode US is unclear. Therefore, we conducted a multicenter study (JABTS BC-07) to establish the diagnostic criteria for breast US, including color Doppler and elastography, for non-mass abnormalities of the breast and verify their diagnostic usefulness.

Methods: We registered US images of non-mass abnormalities of the breast and their clinical and histopathological data from 13 institutions (202 malignant and 183 benign non-mass lesions). Furthermore, we evaluated the centralized image interpretation usefulness of the diagnostic criteria for B-mode and color Doppler US, as well as the sensitivity and specificity when color Doppler US and elastography were added to B-mode US.

Results: Echogenic foci in the mammary gland (odds ratio 3.45, 95% confidence interval [CI] 1.92-6.19, p < 0.0001) and the configuration of internal solid components of the ducts (odds ratio 0.056, 95% CI 0.005-0.591, p < 0.0165) significantly differentiated benign and malignant non-mass abnormalities. The sensitivity of B-mode alone (83.7%) was significantly improved by adding color Doppler US (93.1%) (p = 0.0004); however, adding color Doppler US and elastography to B-mode US made no significant difference in either sensitivity or specificity.

Conclusion: Although adding color Doppler US and elastography to B-mode US improved sensitivity, the diagnostic significance was limited. Therefore, a comprehensive diagnostic method comprising mammography and magnetic resonance imaging is warranted.

The identification and accurate diagnosis of focal liver lesions are important in modern medicine, where diagnostic radiology plays an essential role. This review aimed to examine the hyperechogenicity and histopathological features of focal liver lesions. Hyperechogenic liver lesions can be either benign or malignant. Evidence shows that hyperechogenicity is caused by factors such as fat deposition, sinusoidal dilation, peliotic changes, and pseudoglandular patterns. Fat deposition is a common cause of increased echogenicity in hepatocellular carcinoma (HCC). Meanwhile, sinusoidal dilation and peliotic changes are more frequently observed in larger HCC nodules. Pseudoglandular patterns, characterized by the reflection of ultrasound waves at the walls of numerous acini, are associated with hyperechogenicity in well-to-moderately differentiated HCCs. Moreover, this review comprehensively examined the histological features that may cause hyperechogenic internal echoes in not only HCCs but also localized liver lesions (metastases of adenocarcinoma and neuroendocrine neoplasm, intrahepatic cholangiocarcinoma, cavernous hemangioma, focal nodular hyperplasia, and angiomyolipoma). To make an accurate diagnosis and provide appropriate management, it is important to understand the histopathological basis for hyperechogenicity in focal liver lesions. By maximizing the accuracy of imaging studies and enhancing the radiology-pathology correlation, unnecessary biopsies can be avoided, thereby reducing potential complications and mortality. This review can help facilitate the effective management of patients with focal liver lesions, thereby resulting in timely and appropriate treatment decision-making.