Journal of Medical Ultrasonics最新文献

Purpose: To assess whether intrapartum ultrasound parameters can predict obstetric anal sphincter injury (OASI) in forceps deliveries.

Methods: This retrospective cohort study included women undergoing forceps delivery for live, singleton, term cephalic pregnancies at Showa Medical University Hospital, between April 2021 and September 2024. Ultrasound was performed immediately before forceps application to evaluate angle of progression (AoP), head direction (HD), transperineal ultrasound (TUS) station, and midline angle (MLA) at rest and during pushing. Delta (Δ) values were calculated as differences between pushing and resting. OASI was diagnosed clinically and via transanal ultrasound. Parameters were compared between women with and without OASI. The Benjamini-Hochberg procedure corrected for multiple testing, with significance below < 0.05.

Results: Among 256 women, 23 (8.9%) developed OASI. Maternal, labor, and neonatal characteristics were similar between groups. Several intrapartum ultrasound parameters were significantly associated with OASI: TUS station during pushing (median 3.2 and 4.2, p = 0.002, q = 0.012), ΔTUS station (1.1 and 1.6, p = 0.006, q = 0.042), HD at rest (28° and 38°, p < 0.0001 q < 0.001), HD during pushing (32° and 50°, p < 0.0001, q < 0.001), and ΔHD (3.2° and 10°, p = 0.0005, q = 0.004). HD during pushing showed the best predictive performance (AUC = 0.871), with an optimal cutoff of 36° (sensitivity 0.69, specificity 0.90).

Conclusion: Intrapartum ultrasound, particularly HD during pushing, is a valuable predictor of OASI in forceps deliveries. A cut-off value of 36° may identify women at higher risk and improve forceps delivery safety.

Purpose: While meso/dextrocardia, a cardiac axis abnormality, is associated with various complications and a poor prognosis, few studies have been reported. We aimed to identify and review patients at our hospital who had been diagnosed with fetal meso/dextrocardia.

Methods: The medical records of 29 patients diagnosed with fetal meso/dextrocardia between April 1, 2014 and March 31, 2024 were reviewed.

Results: We identified eight cases of mesocardia and 21 cases of dextrocardia (17 dextropositions and four dextroversions). Right lung hypoplasia (including 3q trisomy, esophageal bronchopleural fistula, and left pulmonary artery sling) was identified in three cases. Five cases of persistent left superior vena cava (PLSVC) were identified [isolated PLSVC (n = 2), VACTERL association (n = 1), trisomy 13 (n = 2)]. Dextroposition was linked to congenital pulmonary airway malformation (eight cases), left pulmonary sequestration (one case), congenital diaphragmatic hernia (six cases), right lung hypoplasia (one case), and VACTERL association with right lung aplasia and esophageal atresia (one case). Dextroversion was associated with asplenia syndrome (two cases), single-ventricle (one case), and Temple syndrome with PLSVC and bilateral hypoplastic pulmonary arteries (one case). Among 29 newborns, six (20.7%) died during the early neonatal period and seven (24.1%) required postnatal multidisciplinary treatment, highlighting a poor prognosis in many cases.

Conclusion: While some patients, such as those with isolated PLSVC, had favorable outcomes, several cases involved severe complications requiring intensive perinatal management. When fetal meso/dextrocardia is detected, it is critical to evaluate fetal anomalies comprehensively and not limit assessment to the heart and lungs.

Purpose: Determining peak height velocity age (PHVA) is crucial for understanding child growth and development and preventing injuries. Previous studies have used anthropometric measurements or X-ray evaluation to predict the timing of PHV, whereas ultrasound provides a radiation-free and portable alternative. This study aimed to predict the years to PHV by assessing multiple secondary ossification centers using ultrasound.

Methods: A total of 12 sites across eight bones were evaluated using ultrasound in 181 children aged 6-12 years between June and December 2019. Height data were tracked from school entry until December 2022, with PHVA calculated using AUXAL software. Multivariable regression analysis was performed using bone maturity as the explanatory variable and the difference between ultrasound measurement age and PHVA as the dependent variable.

Results: A total of 159 participants were included in the final analysis. The hook of the hamate, calcaneus plantar thickness, plantar sesamoid, and tibial tuberosity were identified as significant variables for PHV prediction. The prediction equation was: Years to PHV = 1.206 + (0.562 × calcaneus plantar thickness) - (1.120 × plantar sesamoid) - (0.675 × tibial tuberosity) + (0.229 × hook of the hamate). This model achieved an adjusted R² of 0.782.

Conclusion: Ultrasound evaluation of multiple secondary ossification centers may provide a valuable method for predicting years to PHV.

Purpose: Conventional posterior ultrasound-guided selective cervical nerve root block (SNRB) often fails to deliver injectate reliably into the neural foramen, while fluoroscopic guidance involves radiation exposure and specialized equipment. We developed a novel anterior compression lateral (ACL) ultrasound-guided approach to provide radiation-free, real-time visualization with improved intraforaminal delivery. This study compared ACL with conventional ultrasound (US) and fluoroscopy (FL) in terms of needle placement accuracy and injectate distribution.

Methods: This retrospective single-center cohort study measured needle tip distance from the lateral mass on anteroposterior radiographs. Contrast distribution was classified as foraminal, junctional, or extraforaminal on radiographs and confirmed with axial CT in the US and ACL subgroups. Craniocaudal spread distance was also quantified.

Results: A total of 114 patients with cervical radiculopathy underwent SNRB using FL (n = 56), US (n = 25), or ACL (n = 33). Radiographic intraforaminal distribution occurred in 76.8% of FL, 72.7% of ACL, and 16.0% of US injections (P < 0.0001). Needle tips in US and ACL were positioned more lateral than FL (mean offsets 4.3 ± 6.8 mm and 2.5 ± 3.9 mm vs - 3.5 ± 2.6 mm, respectively). Injectate spread was greater with US (30.8 ± 9.6 mm) and ACL (25.9 ± 15.1 mm) than FL (15.9 ± 10.7 mm) (P < 0.0001). On CT, ACL achieved higher intraforaminal contrast than US (72.7% vs 16.0%, P < 0.0001). No major complications occurred.

Conclusion: The ACL ultrasound-guided approach delivers intraforaminal injectate with accuracy comparable to fluoroscopy while eliminating radiation exposure. It outperforms conventional posterior ultrasound in targeting consistency and offers a precise, accessible option for outpatient cervical SNRB.

Purpose: To describe a novel, minimally invasive, ultrasound-guided Achilles tendon repair technique using a knotless barbed suture and to assess its feasibility in a cadaveric model.

Methods: A midportion Achilles tendon rupture was simulated in a Thiel-embalmed cadaver. The tendon was repaired percutaneously under ultrasound guidance using a 0.6-mm USP 1 knotless barbed suture mounted on a 19-gauge, 3.5-inch curved needle. The needle was advanced intratendinously under continuous ultrasound guidance. Tendon reapproximation was assessed with ultrasound and confirmed by anatomical dissection. The resting plantar flexion angle was measured before and after the repair.

Results: The Achilles tendon repair technique resulted in successful reapproximation of the tendon ends with anatomic alignment. Post-repair ultrasound and dissection confirmed accurate intratendinous suture placement and full tendon continuity. The resting plantar flexion angle increased from 23° to 50° after the repair.

Conclusion: This is the first report of an ultrasound-guided Achilles tendon repair using a knotless barbed suture. The technique appears feasible in a cadaveric model and may represent a promising minimally invasive option for patients requiring improved tendon approximation. Its office-based approach may reduce surgical risks associated with conventional repair and tendon elongation seen with conservative treatment. Further biomechanical and clinical studies are warranted to evaluate its safety, durability, and functional outcomes.

Purpose: The infrapatellar fat pad (IFP) is a source of pain in patients with knee osteoarthritis (OA). Changes in pressure due to knee joint movement may increase IFP stiffness and potentially cause pain. This study aimed to investigate changes in IFP stiffness during knee flexion in knee OA patients.

Methods: Sixteen patients with knee OA and 14 healthy elderly controls participated in this study. IFP stiffness was measured with the patient in the supine position at maximum knee extension, 45°, 90°, and maximum flexion using ultrasound elastography. Stiffness was measured at the superficial layer of the IFP, located beneath the patellar tendon. Additionally, the knee pain score for knee OA patients was assessed using the numeric rating scale and the Intermittent and Constant Osteoarthritis Pain (ICOAP).

Results: Two-way analysis of variance showed a significant main effect for group and joint angle, as well as an interaction effect. IFP stiffness increased with knee flexion. Knee OA patients exhibited significantly higher IFP stiffness at both maximum knee extension and flexion than the control group. A significant correlation was found between IFP stiffness in knee OA patients at 45°, 90°, and maximum knee flexion and ICOAP intermittent pain.

Conclusion: These results suggest that knee movement affects IFP stiffness, with increased stiffness observed in knee OA patients. Increased stiffness in OA patients may contribute to knee pain, particularly at mid-to-deep flexion angles.

Purpose: Dynamic stretching (DS), characterized by repeated movements through the joint range of motion via antagonist muscle contraction, is thought to reduce muscle stiffness through mechanisms such as reciprocal inhibition. However, whether DS effectively decreases muscle stiffness remains unclear. This study aimed to investigate the acute effects of DS on triceps surae muscle stiffness using shear wave elastography.

Methods: Sixteen healthy young adults performed both 120-s DS and control (no stretching) tasks. Shear wave velocities of the medial gastrocnemius (MG), lateral gastrocnemius (LG), and soleus (SOL) muscles were measured as indicators of muscle stiffness before and after DS.

Results: Our findings indicated that DS significantly reduced the shear wave velocity in the MG. However, no significant changes were observed in the shear wave velocities of the LG and SOL.

Conclusion: DS effectively decreased MG stiffness, with no observed effects in the LG or SOL. These findings highlight inter-muscular variability in response to DS and suggest that DS may be particularly beneficial for targeting stiffness in the MG of the triceps surae muscles.

Purpose: This study aimed to evaluate the predictive value of transvaginal three-dimensional (3D) ultrasound imaging parameters for anti-Müllerian hormone (AMH) levels in women of reproductive age.

Methods: A retrospective study was conducted on 492 patients who underwent ovarian reserve function assessments at Hangzhou Traditional Chinese Medicine Hospital. The patients were randomly divided into a training set (n = 420) and a validation set (n = 72). All participants underwent transvaginal 3D ultrasound to measure antral follicle count (AFC), ovarian volume (OV), peak systolic flow velocity (PSV), and resistance index (RI). Morning fasting venous blood samples were collected for AMH level measurement. Pearson correlation analysis was used to assess the relationships between age, AFC, OV, PSV, RI, and AMH. Multiple linear regression analysis was used to construct a unified regression model and a grouped regression model. The performance of the models was evaluated by comparing the root mean squared error (RMSE) and mean absolute error (MAE) between predicted and actual values.

Results: AMH showed a strong negative correlation with age and a positive correlation with OV, AFC, and PSV. AMH was significantly correlated with AFC and OV (r = 0.844 and 0.759, respectively; both P < 0.05), but only weakly correlated with PSV (r = 0.176, P < 0.05). The RMSE and MAE of the grouped regression prediction model were lower than those of the unified regression model.

Conclusion: The grouped regression AMH prediction model developed through multiple linear regression analysis demonstrated favorable performance, enabling accurate individualized prediction of AMH levels, thereby assisting clinicians in evaluating the fertility potential of women of reproductive age.

Purpose: Shear wave velocity (Vs) measurements can be unstable in individuals with obesity or with a skin-capsule distance (SCD) of ≥ 20 mm. However, instability of Vs has also been observed in cases where SCD is not markedly increased; therefore, the present study aimed to investigate the factors contributing to reduced VsN (net amount of effective shear wave velocity), an index that reflects the reliability of individual Vs measurements.

Methods: In total, 317 individuals who underwent community-based health screening were included in this study. We investigated the relationship between VsN and physical findings, laboratory data, SCD, and structure of the SCD (single vs. multilayered) to identify factors associated with decreased VsN.

Results: Multiple regression analysis revealed that body fat percentage (β = - 0.135, p = 0.011), SCD (β = - 0.347, p < 0.0001), and the structure of the SC region (β = - 0.295, p < 0.0001) were independently associated with decreased VsN. In cases where the SCD exceeded 20 mm, the VsN within the SCD was significantly lower in the multilayer structural type [52 (28-75)] than in the single-layer structural type [95 (77-99)] (p = 0.004). Furthermore, even when the SCD was 20 mm or less, the VsN within the SCD was significantly lower in the multilayer structure type [80 (68-89)] than in the single-layer structure type [99 (92-100)] (p < 0.0001).

Conclusion: The results show that, in addition to SCD thickness, its internal structure reduces the VsN and contributes to Vs measurement instability.