Journal of Ultrasound最新文献

Objectives: To determine the incremental diagnostic value of multiparametric quantitative ultrasound-integrating B-mode, Color Doppler, Strain, and Shear Wave Elastography (SWE)-in differentiating benign and malignant breast lesions, using histopathology/FNAC as the gold standard.

Methods: Seventy patients with 87 breast lesions underwent comprehensive ultrasound by a resident and a consultant radiologist (> 20 years' experience) with consensus reporting. Each lesion was evaluated using B-mode (BI-RADS), Color Doppler (vascularity, resistive and pulsatility indices), Strain elastography (strain ratio), and SWE (stiffness in kPa). Pathological correlation was available for all lesions. Diagnostic performance of individual and combined parameters was assessed using sensitivity, specificity, PPV, NPV, accuracy, and ROC analysis. Multivariate logistic regression evaluated incremental value of multiparametric combinations.

Results: B-mode had the highest sensitivity (88.37%) and accuracy (82.76%), Color Doppler the highest specificity (95.45%) but low sensitivity (55.81%), while Strain and SWE showed balanced performance, with SWE achieving the highest accuracy (85.06%) and AUC (0.85). Adding Color Doppler or Strain to B-mode provided no additional benefit. Incorporating SWE improved specificity (88.64%) and accuracy (85.06%). B-mode + Strain + Color Doppler achieved 83.91% accuracy, whereas B-mode + SWE + Color Doppler provided the highest overall performance (sensitivity 86.05%, specificity 86.36%, accuracy 86.21%, AUC 0.86). The four-parameter model (B-mode + Color Doppler + Strain + SWE) showed 83.72% sensitivity, 86.36% specificity, AUC 0.85, and 85.06% accuracy, performing comparably but marginally inferior to the best triple combination (B-mode + Color Doppler + SWE), likely due to redundancy and threshold effects, indicating that adding Strain did not improve performance.

Conclusion: Multiparametric ultrasound enhances lesion differentiation. B-mode ensures sensitivity, Color Doppler confirms benign vascular patterns, and SWE provides quantitative stiffness assessment. Combining morphology, vascularity, and stiffness-particularly B-mode + SWE + Color Doppler-yields the highest diagnostic accuracy.

Introduction: Lung ultrasound (LUS) is a non-invasive imaging method that does not use ionizing radiation, making it particularly useful for evaluating children and adolescents.

Objectives: This study aimed to compare LUS findings in children and adolescents with asthma exacerbation to those with controlled asthma.

Methods: A prospective longitudinal observational study was conducted, following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for reporting observational studies.

Results: Among patients with asthma exacerbation, 33 individuals were analyzed, and the study found that 51.5% of children in the exacerbation group had positive ultrasound findings, compared to only 12.1% in the controlled group. The calculated prevalence ratio was 2.27 (95% CI 1.46-3.55), with a p-value of 0.001, indicating a statistically significant difference in ultrasound findings between the two groups.

Discussion: These findings suggest that lung ultrasound may be a useful tool for identifying changes in children with asthma exacerbations. The significantly higher prevalence of positive findings in the exacerbation group (51.5%) compared to the controlled group (12.1%) suggests that LUS has the potential to detect changes associated with asthma exacerbation. Further research, including multicenter studies, is needed to validate these findings.

Conclusion: LUS demonstrated a higher prevalence of positive findings during asthma exacerbations, suggesting potential clinical utility as an adjunctive tool in pediatric asthma assessment.

Few studies compare acute muscle swelling between upper and lower limbs with blood flow restriction (BFR), and lower pressures may reduce the often-reported discomfort. The purpose was to examine differences in acute muscle swelling, discomfort, and exercise preference between low-load BFR and high-load resistance exercise in upper and lower limbs. Sixty-one participants (25.7 ± 7.9 years; 32 males, 29 females) completed four exercise conditions: upper limbs (UL) randomized to low-load BFR (BFR-UL) or high load (HL-UL), then lower limbs (LL) randomized to low-load BFR (BFR-LL) or HL (HL-LL). BFR-LL was performed at 30% 1RM with four sets to failure at 50 mmHg cuff pressure; HL exercises were at 70% 1RM with four sets of 8-12 reps. Swelling, discomfort (0-10 scale), and exercise preference were assessed. Results were presented as mean [SD]. The most probable predictor of swelling was identified in limbs (posterior inclusion probability = 0.996; BF10 = 846.447; BFincl = 156.329), with strong evidence against a condition × limb interaction for swelling (BFincl = 0.178). Swelling had a greater increase in lower limbs compared with the upper limbs (BF10 = 946.447; BFincl = 158.344), while evidence for condition effects was anecdotal (BFincl = 0.206). There was strong evidence against a set × limb × condition interaction for discomfort (BF10 = 0.083), with no preference for upper limb condition (BF10: 0.236), and anecdotal preferences for the lower limbs (BF10 = 0.626). Acute muscle swelling and discomfort did not differ across conditions, supporting low-load, low-pressure BFR as a practical alternative to high-load training.

Objective: This study examines the potential links between bicuspid aortic valve (BAV) subtype, aortic root shape, and mechanical properties in a patient cohort.

Methods: We retrospectively analyzed 88 patients with BAV undergoing transesophageal echocardiography (TEE). Aortic dimensions and shapes were assessed in all participants, while mechanical properties (aortic strain, distensibility, and stiffness) were measured in 37 patients without significant valve dysfunction.

Results: Among type 1 BAV with raphe (n = 51), 60.8% had type A aortic shape, 35.3% type N, and 3.9% type E. For BAV without raphe (n = 24), 54.2% had type A, 33.3% type N, and 12.5% type E. Type 2 (n = 10) and type 3 (n = 3) BAV showed varied aortic shapes without a clear pattern. Patients with raphe had superior aortic mechanics compared to those without, with higher strain (7.39 ± 2.9 vs. 5.57 ± 2.3), greater distensibility (4.13 ± 2.0 vs. 2.77 ± 1.0 cm²·dyne⁻¹·10⁻⁶), and lower stiffness (6.77 ± 4.4 vs. 8.04 ± 3.1) (p < 0.05 for all).

Conclusion: Aortic shape showed no significant association with BAV subtype. However, reduced distensibility in non-raphe BAV patients suggests a potential for earlier aortic complications, necessitating longitudinal studies.

Background: Multiparametric ultrasound (mpUS) integrates BI-RADS (Breast Imaging Report And Data System) morphological assessment with biomechanical biomarkers, including strain elastography (SE) and shear-wave elastography (SWE), along with microvascular flow (M-Flow). Furthermore real-time computer-aided diagnosis (CAD/AI) systems, including Live Breast Assist and S-Detect are employed to standardize image interpretation, thereby reducing operator dependence.

Purpose: To evaluate the diagnostic accuracy and reproducibility of mpUS supported by CAD/AI versus B-mode ultrasound alone, assessing their concordance with histopathology for the benign/malignant dichotomy and the incremental contribution of SE, SWE, and M-Flow. Additionally inter-operator agreement was quantified.

Materials and methods: In this single-center prospective study 78 consecutive patients presenting with 78 breast lesions, underwent B-mode/BI-RADS evaluation, Color Doppler, M-Flow (percentage of vascularization), SE (strain ratio), and SWE (quantitative stiffness in kPa). Live Breast Assist was semi-automatically employed during data acquisition, while S-Detect provided focal lesion characterization when deemed necessary. Histopathological examination served as the gold standard.

Results: Histology identified 60 malignancies (76.9%) and 18 benign lesions (23.1%).The highest diagnostic performance was shown by M-Flow (AUC 0.926), reaching 95.1% of sensitivity and 82.4% of specificity. SE also showed strong discriminative ability (AUC 0.885). SWE exhibited lower accuracy (AUC 0.658). B-mode alone achieved an AUC of 0.864. Although with a higher false-negative rate compared with the expert operator, Live Breast Assist demonstrated high specificity (88.2%) and an excellent PPV (96.4%). Inter-operator agreement was substantial (κ = 0.63).

Conclusion: mpUS with CAD/AI support enhanced diagnostic accuracy and reproducibility for benign/malignant distinction, providing robust biomechanical and vascular biomarkers. This approach may reduce unnecessary biopsies in indeterminate BI-RADS lesions, though tumor grading remains the purview of pathology.

Background: Accurate splenic volumetry is essential in hematologic and hepatic disorders, particularly for monitoring therapeutic response to JAK-2 inhibitors. Ultrasound-based assessment typically applies the prolate ellipsoid formula using three diameters, although the anteroposterior (AP) measurement is often unreliable. This study aimed to validate an alternative two-diameter approach based on the spherical cap formula.

Methods: Fifteen autopsy cases underwent splenic ultrasound before organ removal. Longitudinal, transverse, and AP diameters were measured to calculate splenic volume using both the prolate ellipsoid and spherical cap formulas. These values were compared with the true organ volume obtained by water displacement. The protocol was subsequently applied to 101 living outpatients for further comparison between formulas.

Results: In cadavers, ultrasound-derived volumes correlated strongly with actual splenic volumes for both formulas (Spearman's ρ = 0.83 for ellipsoid; ρ = 0.80 for spherical cap). Similar agreement was confirmed in living subjects (ρ = 0.94, p < 0.001). The AP diameter showed the greatest variability and lowest reliability. Histologic analysis demonstrated that splenic weight correlates with white pulp trophism rather than volume.

Conclusions: The spherical cap formula, requiring only longitudinal and transverse diameters, provides an accurate and reproducible estimation of splenic volume comparable to the ellipsoid model. Its simplified application may improve consistency in ultrasound volumetry and enhance clinical utility in hematologic and hepatic follow-up.

Objectives: To compare muscle thickness of rectus abdominis, internal oblique, external oblique, and transversus abdominis between rest and PFM isolated contraction.

Design: Cross-sectional reliability study.

Methods: Muscle thickness from rectus abdominis, internal oblique, external oblique and transversus abdominis was obtained from 27 physically active women (age: 26.41 ± 0.77 years) with ultrasound imaging at rest and during three maximum PFM contractions. Two independent analyzers, blinded to the conditions, analyzed 3 images from each muscle and condition using Image-J 1.42q software. Muscle thickness was measured three times on each image. Differences between conditions (rest and PFM contraction) were analyzed with a Student t-test. To verify the outcome measures' inter-analyzer reliability, the intraclass correlation coefficient (ICC), standard error of the measurement (SEM), and minimum detectable change (MDC) were calculated.

Results: TrA showed a significant increase in muscle thickness from rest compared to PFM isolated contraction (p < 0.001; t:-4.137). However, muscle thickness was similar for the two conditions in rectus abdominis (p = 0.093; t:1.746), internal oblique (p = 0.410; t:0.838), and external oblique (p = 0.847; t:0.196). Excellent reliability was found for muscle thickness at rest (r = 0.828-1.000; p < 0.001) and during PFM contraction (r = 0.997-1.000; p = 0.001) for rectus abdominis, internal oblique, external oblique and transversus abdominis muscles. SEM and MDC values from all outcomes were low.

Conclusion: PFM isolated contraction generates a significant contraction of the transversus abdominis muscle, which helps controlling intra-abdominal pressure. The excellent inter-analyzer reliability evidence that abdominal muscles' muscle thickness is reliable when obtained by different analyzers.

Purpose: Small bowel obstruction (SBO) is a common surgical emergency that can lead to significant morbidity, mortality, and healthcare costs, particularly when diagnosis is delayed. In rural and resource-limited emergency settings, advanced imaging techniques like computed tomography (CT) may not be readily available. As a result, clinicians often rely on physical examinations and plain radiographs which can be unreliable. Point-of-care ultrasound (POCUS) provides a rapid, radiation-free and cost-effective diagnostic alternative that can be performed directly at the bedside.

Methods: We conducted a systematic review of published literature evaluating the diagnostic accuracy and clinical utility of POCUS in identifying SBO on the following databases PubMed, Web of Science, Cochrane Library and Google Scholar databases from January 2000 to December 2024. Studies were screened and selected based on the inclusion and exclusion criteria adhering to PRISMA 2020 guidelines.

Results: The sensitivity of POCUS for SBO ranged from 85.0 to 100%, while specificity ranged from 54.0 to 100%. Diagnostic accuracy remained high across a broad range of expertise overcoming operator dependence. Examination durations are approximately 10-11 min, which is markedly shorter than 45-min to 3-h by CT.

Conclusion: POCUS presents as a practical, scalable and cost-saving tool for diagnosing SBO in rural emergency care, addressing significant gaps where CT is not available and also facilitates faster diagnosis by timely identification of specific features. Future efforts should focus on developing validated algorithms for resource-limited settings allowing immediate care management.

Post-cardiopulmonary resuscitation (CPR) liver trauma is a rare complication that can be difficult to identify when the lesion is subcapsular and small in volume. We describe the case of a 52-year-old man, a candidate for organ donation after out-of-hospital cardiac arrest, in whom abdominal computed tomography revealed a non-conclusive hypodense hepatic area. Contrast-enhanced ultrasound (CEUS) revealed a subcapsular avascular zone with a thin peripheral hypervascular rim, consistent with post-cardiopulmonary resuscitation (CPR) liver contusion/hematoma. CEUS is crucial for lesion characterization in the context of decision-making for organ donation, highlighting its role as a problem-solving technique in the evaluation of abdominal trauma in hemodynamically stable patients.

Purpose: Pudendal neuropathy is a debilitating condition often underdiagnosed due to its complex clinical presentation and overlapping symptoms with other pelvic disorders. This review aims to provide an updated synthesis of anatomical, clinical, and technical aspects of ultrasound-guided pudendal nerve infiltration, highlighting its diagnostic and therapeutic relevance in neuropathic pelvic pain.

Methods: A narrative analysis was conducted of the pudendal nerve's anatomy, etiologies of neuropathy, clinical manifestations, diagnostic tools, and image-guided intervention strategies. Particular attention was dedicated to high-resolution ultrasound (HRUS) for anatomical visualization and to the technical considerations underlying perineural injection procedures.

Results: Perineural infiltration of the pudendal nerve provides immediate, partial pain relief after anesthetic administration, with the addition of corticosteroids contributing to sustained relief. Ultrasound guidance minimizes complications and has proven superior to traditional landmark-based approaches. The technique demonstrates feasibility, safety, and reproducibility in clinical practice, for both diagnostic and therapeutic purposes. However, clinical results have varied, and repeated sessions or integration with multimodal strategies, including physical therapy, drug therapy, and lifestyle modifications, have often been required.

Conclusion: Ultrasound-guided pudendal nerve infiltration is a minimally invasive, safe, and effective technique for both diagnosis and treatment of pudendal neuropathy. While offering rapid pain relief and confirming nerve involvement, infiltrations should be considered as part of a broader multimodal management strategy. Future directions include standardization of protocols, refinement of imaging guidance, and exploration of novel injectates or regenerative therapies to optimize long-term outcomes.