Journal of Ultrasound最新文献

Background: Stroke, a leading global cause of mortality and neurological disability, is often associated with atherosclerotic carotid artery disease. Distinguishing between symptomatic and asymptomatic carotid artery disease is crucial for appropriate treatment decisions. Radiomics, a quantitative image analysis technique, and machine learning (ML) have emerged as promising tools in Ultrasound (US) imaging, potentially providing a helpful tool in the screening of such lesions.

Methods: Pubmed, Web of Science and Scopus databases were searched for relevant studies published from January 2005 to May 2023. The Radiomics Quality Score (RQS) was used to assess methodological quality of studies included in the review. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) assessed the risk of bias. Sensitivity, specificity, and logarithmic diagnostic odds ratio (logDOR) meta-analyses have been conducted, alongside an influence analysis.

Results: RQS assessed methodological quality, revealing an overall low score and consistent findings with other radiology domains. QUADAS-2 indicated an overall low risk, except for two studies with high bias. The meta-analysis demonstrated that radiomics-based ML models for predicting culprit plaques on US had a satisfactory performance, with a sensitivity of 0.84 and specificity of 0.82. The logDOR analysis confirmed the positive results, yielding a pooled logDOR of 3.54. The summary ROC curve provided an AUC of 0.887.

Conclusion: Radiomics combined with ML provide high sensitivity and low false positive rate for carotid plaque vulnerability assessment on US. However, current evidence is not definitive, given the low overall study quality and high inter-study heterogeneity. High quality, prospective studies are needed to confirm the potential of these promising techniques.

Purpose: We aimed to assess the role of shear wave elastography in better characterizing complex cystic and solid ovarian tumors in correlation with other ultrasound features and histopathology.

Materials and methods: The study included 40 patients with 40 unilateral complex cystic or solid ovarian lesions with a mean age of 43.2 ± 13.27 (mean ± SD). All patients were subjected to history taking, tumor markers assessment, ultrasound with Doppler assessment giving an ORADS score, and shear wave elastography assessment. (qualitatively and quantitatively). Correlation was done with the final histopathology.

Results: According to the final histopathological results of the 40 lesions, 14 (35%) were benign, four were borderline (10%), and 22 (55%) were malignant. Ultrasound and Doppler assessments revealed a higher frequency of irregular margins and Doppler score 4 in borderline/malignant patients compared to benign patients. ORADS ultrasound scoring system of the examined lesions showed a statistically significantly higher frequency of ORADS 5 in the malignant group, with ORADS sensitivity, specificity, and Diagnostic accuracy of 96.2%, 57.1, and 82.5%, respectively. Elastographic color mapping scores and elastographic readings were higher in borderline/malignant patients compared to benign patients and it significantly correlated with the Doppler score, ORADS score, color mapping score, and tumor markers.

Conclusion: The study detected significant associations between malignancy and higher tumor markers, marginal irregularity, higher Doppler, and higher ORADS scores. Shear wave elastography positively correlated with tumor markers, Doppler score, and ORADS score. This supports the utility of elastography in discriminating malignant from benign ovarian tumors.

This systematic review and meta-analysis aimed to assess the accuracy and success rate of ultrasound in determining fetal sex. A search was conducted on Medline, Cochrane Library, and EMBASE databases, and the reference lists of selected studies were also reviewed. Meta-analyses were performed using Revman 5.4.1 and Meta-DiSc 2.0. Twenty-eight studies met the criteria for inclusion in the systematic review. Nine studies reported the accuracy rate of first-trimester fetal sex identification, with a mean accuracy of 85% and a median of 87%. Six studies provided accuracy rates for second and third-trimester identifications, with mean and median rates of 92% and 99%, respectively. A pooled sensitivity and specificity analysis shows that the sensitivity increased from 69% at 11 weeks to 89% at 12 weeks to 96% at 13 weeks. Forest plots on the success rates indicated no significant statistical differences between first-trimester ultrasound sex determination and actual birth sex, with p values of 0.06 for males and 0.08 for females. Similarly, second and third-trimester forest plots showed p values of 0.70 for males and 0.14 for females. In conclusion, ultrasound accuracy for fetal sex determination rises from 87% in first to 99% in second trimesters. The success rate shows no significant difference for either trimester. However, male sex is more easily detected in the second and third trimesters, while female sex is more easily detected in the first trimester. The sensitivity of fetal sex detection in the first trimester increases with gestational age. These findings suggest that prenatal ultrasound sex determination can be useful in managing sex-related pregnancy complications.

Objective: The aim of this work is to demonstrate how the chronicity of low back pain can modify the trophism of the paraspinal muscles, by performing an ultrasound and MRI evaluation of the paraspinal muscles in the lumbar spine and correlating it to the time of onset of low back pain.

Materials and methods: An ultrasound evaluation was carried out in the lumbar area with a 5-17 MHz linear probe of the paraspinal muscles of the lumbar region, compared with the MRI of the lumbar spine, in patients presented to our attention for chronic low back pain (> 6 months), from January 2021 to January 2023. In each patient, two series of images were analyzed, in the coronal and sagittal planes.

Results: Between January 2021 and January 2023, a total of 79 patients were retrospectively evaluated by ultrasound for chronic low back pain. The patients, including 46 men and 33 women, had an average age of 51.6 years (min 24-max 74). In the evaluation of the profile of the paravertebral muscles, 22 patients (27.8%) showed hypotrophy of the paravertebral muscles with a concave profile, while the measurement of the thickness of the fascia showed an average thickness of 2.19 mm with a range between 1, 3 and 3.2 mm and an interquartile range of 1.7-2.65 mm. 77.2% of patients with a concave profile showed a thickness of the FTL > 2.5 mm, and an average duration of symptoms of approximately 15.3 months, to demonstrate a correlation between muscle hypotrophy, thickness of the FTL and duration of onset of symptoms.

Conclusion: In the evaluation of chronic low back pain carried out with MRI and ultrasound, the paravertebral musculature profile and the thickness of the thoracolumbar fascia are two instrumental data which, associated with the proposed classification and correlated to the clinical picture, allow to determine the chronicity of the pathological picture.

Aims: Venous congestion is an important determinant of organ dysfunction in patients with pulmonary hypertension. Currently, there are no optimal methods for non-invasive assessment of venous congestion. We aimed to evaluate the accuracy of the recently described venous excess ultrasound grading system (VExUS) to determine the presence of venous congestion in patients with precapillary pulmonary hypertension compared to right heart catheterization.

Methods: We included patients with precapillary pulmonary hypertension undergoing right heart catheterization. VExUS was performed by trained cardiologists simultaneous with catheterization. Correlation and simple logistic regression between invasive hemodynamic measurement and VExUS was performed.

Results: Forty-nine patients with precapillary pulmonary hypertension were included. A significant correlation between VExUS and right atrial pressure (RAP) was found (R = 0.70, p < 0.001). VExUS was an excellent predictor of RAP > 10 mmHg (AUC 0.93, p < 0.001).

Conclusion: Our study provides evidence that VExUS score is a reliable, non-invasive method for assessing right atrial pressure in patients with pre-capillary PH.

Background: Fecal Incontinence (FI) following Obstetric Anal Sphincter Injuries (OASI) and repair is under constant investigation. Ultrasound is reliable in identifying Levator Ani Muscle (LAM) morphology and malfunction.

Objective: To investigate the incidence of levator plate dysfunction by pelvic floor ultrasound in patients with OASI repair and to correlate with patient-reported outcomes.

Methods: A prospective cohort study of patients who had sustained OASI in one year. We reviewed the computerized files to obtain obstetrics variables. We invited OASI patients to undergo anal manometry, 2D Endovaginal, and 2D perineal, and to complete outcome questionnaires at a 6-12-month follow-up. We measured by Ultrasound the distances between the Levator Plate (LP) and Pubic bone (LP-P) and LP and vaginal probe (LP-V) at rest and during squeeze, with delta calculations for these distances (∆ LP-P and ∆ LP-V).

Results: 27 patients completed the study. 15% had FI. All FI patients also had flatus incontinence compared with 8% of FC (p 0.001). The patient's age, long second stage of labor, and high newborn weight were correlated with FI. LP-P resting and LP-P squeeze distances were larger among the FI (p 0.01 for both). LP-V resting and LP-V squeeze were more significant among the FI group (p 0.07, < 0.001). ∆ LP-P was significantly greater among the FC than the FI (0.01).

Conclusions: Patients with normal levator plate function had FC following OASI repair. Given the small sample size, a firm conclusion about FI cannot be reached, but notably, the few patients with FI after OASI repair had abnormal LAM function.

Background: Atherosclerotic plaque in the carotid bifurcation is a major risk factor for ischemic stroke, one of the most frequent causes of death and a leading cause of disability worldwide.

Aim of this work: The aim of our study was to identify differences in atherosclerotic plaque elasticity (measured using shear wave elastography-SWE) and plaque echogenicity among symptomatic and asymptomatic groups.

Methods: Fifty-eight patients with carotid plaques were enrolled in our study. Plaque echogenicity and shear wave elastography assessments given as kilopascals (kPa), were measured.

Results: Plaques from the symptomatic group were predominantly less echogenic and the shear wave elastography values were significantly lower than those in the asymptomatic group. The mean plaque Young's Modulus (YM) of the symptomatic group was 34.23 kPa (kilo pascal) (SD = 22.3 kPa) compared to 64.84 kPa (SD = 35.00 kPa) in the asymptomatic group with P value of < 0.001.

Conclusion: Shear wave elastography is a helpful tool in quantifying elasticity of the carotid plaques and can help to identify the unstable plaque, which would help in proper patient management.

Portal vein thrombosis (PVT) is a rare vascular disorder with an estimated incidence of 2-4 cases per 100,000 inhabitants. Although chronic liver disease (especially cirrhosis), hepatobiliary malignancies, major infectious/inflammatory abdominal diseases, and myeloproliferative disorders are well-recognized predisposing conditions for PVT, various abdominal inflammatory processes can also predispose to visceral venous thrombosis. In this article, we present a case series of three patients with a clinical diagnosis of acute cholecystitis complicated by visceral venous thrombosis. We describe the clinical presentation, imaging findings, therapeutic approaches-including the use of injectable anticoagulants and direct oral anticoagulants (DOACs)-and the impact of venous thrombosis on the timing of definitive surgical treatment. We also discuss the implications of these findings in the context of current knowledge and propose management strategies for similar cases.

Purpose: Distal pectoralis major pathology is complex. Recent anatomical findings have identified the deltopectoral tendon, a structure distinct from the pectoralis major tendon, originating from the clavicular bundle and merging with the distal deltoid tendon. This study aims to characterize the deltopectoral tendon, assess its consistency, and define its relationship to the pectoralis major tendon to improve the understanding of distal pectoralis major pathology.

Methods: This study consisted of a prospective, monocentric, observational cohort design. Forty-six volunteer subjects with no history of trauma to the pectoralis major muscle underwent a systematic ultrasound examination of the muscle's connective skeleton. Complementing this prospective data, a retrospective review of five ultrasound scans documenting pectoralis major injuries was performed.

Results: The deltopectoral tendon was consistently identified on ultrasound. It was observed emerging between the deltoid and the clavicular bundle, adhering superficially to the terminal portion of the pectoralis major tendon, and merging with the anterior intramuscular tendon of the deltoid. The pectoralis major tendon, originating from the sternal and abdominal muscular portions and measuring 32 mm in length, 42 mm in width, and 2.1 mm in thickness, should be analysed independently of the clavicular bundle.

Conclusion: The distal insertion of the pectoralis major consists of two distinct tendons: the pectoralis major tendon and the deltopectoral tendon. The presence of an intact clavicular bundle, signifying the persistence of the deltopectoral tendon, may coexist with a complete rupture of the pectoralis major tendon and should not be mistaken for a partial, non-surgical injury.