Journal of Ultrasound最新文献

Page's kidney is a condition that occurs due to external renal compression, usually caused by a subcapsular haematoma, generating a renal compartmental syndrome with parenchymal damage and renal perfusion alteration. Classically associated with renal trauma, Page's kidney can also arise after invasive renal procedures, such as renal biopsies or percutaneous nephrostomies. Clinically, it can trigger hypertension due to activation of the renin-angiotensin system induced by hypoperfusion secondary to renal parenchymal compression and can also present with varying degrees of renal function impairment. Furthermore, severe acute renal failure may be found particularly in patients with solitary kidneys or renal transplants. We present two cases of Page's kidney after renal biopsy and their PoCUS ultrasound findings. We would like to highlight the reversed diastolic flow on Doppler ultrasound in this entity, a pattern we have found in all two cases.

Purpose: There is growing demand for ultrasound-based minimally invasive procedures, such as biopsy, aspiration, and tube drain. Homemade ultrasound (US) phantoms provide a simple, low-cost method for training young radiology residents. We aimed to compare and finally prescribe low-cost recipes of a US phantom model utilizing available ingredients, providing homogenous images and is stable in our hot, humid weather.

Methods: Five recipes with different ingredients and concentrations were used during five workshops. All participants were asked to fill out a survey assessing the stability, visibility of targets, homogeneity, and persistence of air-filled tracks. Solid and cyst-like targets were used for training and were included in the survey.

Results: Our findings demonstrate that model 3 (1 cup of gelatin powder per 2 cups of cornflower) and model 5 (7 tablespoons of gelatin powder per 4 tablespoons of mucil) yielded the best phantoms in terms of stability and visibility of targets. Model 5 provided the best homogeneity (no layering), but it was the most expensive. Animal tissue within US phantoms was not suitable for recurrent use after 24 h.

Conclusions: Gelatin-based homemade US phantom models were useful in training young radiologists. The best mixture was gelatin and mucil (in a 7:4 ratio), followed by gelatin and cornflower (in a 1:2 ratio).

Purpose: Transesophageal echocardiography (TOE) necessitates meticulous patient preparation. Artificial intelligence (AI) chatbots, such as ChatGPT, hold promise in delivering medical information. This study sought to assess the suitability of the latest iteration, ChatGPT-4 Omni (GPT-4o), as a supplemental resource for providing information on topics related to TOE.

Methods: Fifty questions pertaining to patient education, covering both fundamental knowledge (25) and management aspects (25) of TOE results, were submitted to GPT-4o in three separate sessions. Three senior echocardiographers systematically evaluated the responses using a four-point scale, focusing on their appropriateness, clarity, and consistency. Additionally, they assessed confabulations and the omission of relevant content on a binary scale.

Results: Overall, 94% of GPT-4o's responses were rated as "highly appropriate" across 50 tasks, with 98% deemed "highly comprehensible". Responses related to basic knowledge were 96% appropriate and 100% comprehensible, while management-related responses were 92% appropriate and 96% comprehensible. In total, two responses (4%) were rated negatively as quite inappropriate. Minor inconsistencies were observed in 12% of regenerated responses, with relevant content missing in 6% of inquiries.

Conclusions: GPT-4o demonstrated high accuracy and reliability in addressing patient inquiries related to TOE. These findings suggest that this AI platform could effectively supplement patient education and complement healthcare professionals' guidance, thereby reducing the workload of echocardiography lab staff.

Purpose: This study evaluates the diagnostic contribution of Superb Microvascular Imaging (SMI), and Shear Wave Elastography (SWE) to TI-RADS in differentiating benign and malignant thyroid nodules.

Materials and methods: This prospective study enrolled patients scheduled for thyroid fine-needle aspiration biopsy (FNAB). Grayscale ultrasound, SMI, and SWE of the nodules were performed before FNAB. TI-RADS categories, vascularity patterns, vascularity index, and elasticity indices were recorded. Diagnostic performance was analyzed using ROC curves, logistic regression, and the DeLong test.

Results: A total of 478 thyroid nodules were analyzed, comprising 441 (92.2%) benign and 37 (7.7%) malignant cases (35 papillary and 2 medullary carcinomas). The mean age was significantly higher in the benign group (54.61 ± 11.54 years) compared to the malignant group (46.84 ± 15.38 years, p = 0.005). The most common vascularity type was type 3 (48.5% in benign and 81.1% in malignant). Malignancy rates were significantly higher in nodules with vascularity type 3 compared to type 2 (p < 0.001). ROC analysis identified an optimal SWE cut-off value of 36.9 kPa (p < 0.001), but the VI showed no significant difference (p = 0.662). The combined model consisting of TI-RADS score, SWE mean value, and vascularity distribution type demonstrated the highest diagnostic accuracy, with an AUC of 0.89.

Conclusion: Combination of TI-RADS, SMI, and SWE improves diagnostic accuracy in thyroid nodule assessment. Vascularity type 3 and SWE index value are strong, independent predictors of malignancy. The clinical applicability of these tools has the potential to reduce the number of unnecessary biopsies and to improve the management of patients.

Background: Sepsis and septic shock are life-threatening conditions driven by dysregulated host responses to infection, resulting in multi-organ dysfunction. While early fluid resuscitation is essential, both fluid overload and under-resuscitation can worsen outcomes. Left Ventricular Outflow Tract Velocity Time Integral (LVOT VTI) has emerged as a non-invasive echocardiographic tool to assess fluid responsiveness. This systematic review evaluates the diagnostic performance, cutoff values, and limitations of LVOT VTI as a tool for assessing fluid responsiveness in adult patients with sepsis or septic shock.

Methods: A systematic search of PubMed, Cochrane, Scopus, Web of Science, EMBASE, and CINAHL was conducted through April 13, 2025, following PRISMA 2020 guidelines (PROSPERO ID: CRD420251036927). Eligible studies used transthoracic or transesophageal echocardiography to measure LVOT VTI and assessed changes following passive leg raise (PLR) or volume expansion tests (VET). Fluid responsiveness was defined as a ≥ 10-15% increase in VTI.

Results: Three observational studies including 199 adult patients (20 with sepsis, 179 with septic shock) met inclusion criteria. Two studies used VET (500 mL saline), and one used PLR. Optimal LVOT VTI cutoffs ranged from > 7% to 16%, with sensitivity 78-96%, specificity 91-100%, and AUCs 0.84-0.99. Based on the Newcastle-Ottawa Scale, two studies were rated good quality, and one was fair.

Conclusion: LVOT VTI is a reliable, non-invasive parameter for assessing fluid responsiveness in sepsis and septic shock. Despite limited data, this review supports its integration into bedside fluid management protocols to guide individualized resuscitation strategies.

Prospero registration id: CRD420251036927.

We report a case of a 67-year-old woman suffering from intermittent claudication secondary to severe popliteal stenosis due to compression by a popliteal ganglion cyst extending into the adventitia of the popliteal artery. After declining vein bypass grafting, this patient was successfully treated using ultrasound-guided aspiration of the cyst, which restored normal flow to the popliteal artery. Whilst aspiration of Baker's cysts causing claudication has been attempted before, this represents the first reported case of successful recanalization of the popliteal artery by ganglion cyst aspiration and further supports an important possible aetiology and treatment for cystic adventitial disease.

Purpose: To describe a reproducible ultrasound-guided technique for infiltrating the posterior femoral cutaneous nerve (PFCN) in patients with neuropathic pain involving the posterior thigh and gluteal region.

Methods: High-resolution ultrasound was used to identify the PFCN along its superficial course over the long head of the biceps femoris muscle. Under sterile conditions, a perineural injection was performed using an in-plane approach. Hydrodissection with saline was employed to confirm needle placement. A local anaesthetic, with or without corticosteroids, was administered.

Results: The PFCN was reliably visualised in all procedures, and the targeted infiltration was successfully performed in each case. Patients experienced immediate partial pain relief, and no adverse events were reported. The technique proved feasible, safe, and reproducible in clinical practice.

Conclusion: Ultrasound-guided infiltration of the PFCN is a precise and minimally invasive approach for managing neuropathic pain in the posterior thigh. It enables accurate nerve targeting and provides both diagnostic confirmation and therapeutic benefit. This technique may reduce reliance on systemic medications and guide further management in complex pain syndromes. Additional studies are needed to evaluate long-term outcomes and confirm clinical efficacy.

B-Flow technology represents a significant advancement in vascular ultrasound imaging, offering high-resolution visualization of blood flow without the limitations inherent in conventional Doppler techniques. By employing Coded Excitation and Tissue-Blood Equalization (TBE) technologies, B-Flow enhances the detection of low-velocity and microvascular blood flow while minimizing aliasing artifacts and angle dependency. This innovative technique proves especially useful in abdominal ultrasound, enabling the accurate assessment of vascularization in organs such as the liver, kidneys, pancreas, spleen, and bowel. B-Flow's ability to depict fine vascular details is particularly beneficial in evaluating focal lesions, vascular malformations, portal hypertension, and transplant perfusion. Furthermore, the technique's application extends to both parenchymal and vascular pathologies, demonstrating significant advantages over traditional Doppler methods in terms of spatial resolution and real-time flow visualization. This pictorial essay aims to describe the technological basis of the B-Flow technique, highlighting its advantages and disadvantages, as well as the main clinical applications in abdominal diagnostics.