Journal of Ultrasound最新文献

The infrapatellar fat pad (IFP), a key intra-articular knee structure, plays a crucial role in biomechanical cushioning and metabolic regulation, with fibrosis and inflammation contributing to osteoarthritis-related pain and dysfunction. This review outlines the anatomy and clinical value of IFP ultrasonography in static and dynamic assessment, as well as guided interventions. Shear wave elastography (SWE), Doppler imaging, and dynamic ultrasound effectively quantify tissue stiffness, vascular signals, and flexion-extension morphology. Due to the limited penetration capability of ultrasound imaging, it is difficult to directly observe IPF through the patella. However, its real-time capability and sensitivity effectively complement the detailed anatomical information provided by MRI, making it an important supplementary method for MRI-based IPF detection. This integrated approach creates a robust diagnostic pathway, from initial assessment and precise treatment guidance to long-term monitoring. Advances in ultrasound-guided precision medicine, protocol standardization, and the integration of Artificial Intelligence (AI) with multimodal imaging hold significant promise for improving the management of IFP pathologies.

Aim: Evaluating fluid responsiveness (FR) is crucial in managing critically ill patients. Measurement of respiratory variations of blood flow (V_peak) is physiologically sound, but blood flow sampling through the aortic valve (AV-V_peak) is not always feasible. We assessed the feasibility of suprasternal V_peak (SS-V_peak), at ascending or descending aorta level, as alternative to AV-V_peak.

Methods: Observational prospective study in spontaneously breathing healthy volunteers. We report the overall feasibility of AV- and SS-V_peak, and calculated their interchangeability, the mean bias with limits of agreement (LoA) and percentage error (PE). We defined FR as a 10% increase in cardiac output measured non-invasively with finger-cuff method after passive leg raising.

Results: We enrolled 67 volunteers; SS-V_peak was feasible in 65 volunteers (97%), with sampling in the ascending and descending aorta in 22/65 (33.8%) and 43/65 (66.2%) volunteers, respectively. AV-V_peak was feasible in 64 volunteers (95.5%). When both V_peak were obtained (n = 62), interchangeability using a 12% cut-off was 67.7% (poor agreement with kappa coefficient 0.19 [-0.02;0.41]). Clinical concordance at ascending aorta level was non-significantly higher (16/22, 73% vs 26/40, 65%; p = 0.583). Prediction of FR with SS-V_peak using the 12% cut-off was poor: sensitivity 85%; specificity 9%; positive predictive value 82%; negative predictive value 11%. Bland-Altman's analysis revealed a mean bias -2.6% [-4.3%;-1.0%] with LoA ranging from -15.2% [- 18.1%;- 12.4%] to 10.0% [7.2%;12.8%]. The mean PE was 7.87%.

Conclusions: We report excellent feasibility for SS-V_peak, though with moderate interchangeability and accuracy; however, we found poor precision and poor performances in predicting FR in healthy volunteers.

Objective: This systematic review aims to evaluate the effectiveness of intraoperative ultrasound (iUS) in achieving gross total resections (GTR) and identifying tumor remnants in low-grade glioma (LGG) surgeries.

Methods: A search of Medline, Cochrane, and Scopus databases until 8th August 2024 was performed to retrieve relevant studies, while reference lists were also scanned. Studies were selected based on predetermined inclusion and exclusion criteria, and their methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool.

Results: Thirteen studies were included: 1 prospective randomized controlled trial, 10 prospective studies and 2 retrospective studies. Of these, five studies had a high risk of bias, and eight had significant concerns regarding applicability. One study provided only mean volumes of tumor remnants, while the remaining 12 studies included a total of 352 patients. Eight studies used 2D B-mode iUS, and five used 3D navigated iUS. There was considerable variability in iUS characteristics, reference methods, and outcome measures. Linear array iUS generally demonstrated superior characteristics, and 3D iUS showed promising potential. Sensitivity ranged from 21.05% to 100%, and GTR percentages varied from 10.71% to 100%, while specificity ranged from 66.67% to 100%. Data on remnant volumes were available from only three studies.

Conclusions: From the available literature no safe assumptions on neither the diagnostic accuracy nor the efficacy of iUS in LGG resections can be made.

Minoxidil is a drug designed for the treatment of arterial hypotension. Due to its secondary effect of hypertrichosis, it is also used for alopecia treatment. We present a case of a 50-year-old female patient who was orally consuming Minoxidil for medical reasons. She presented with severe hypotension, requiring vasoactive drugs, and evidence of myocardial injury was detected using speckle tracking echocardiography. It is worth noting that the patient did not have any coronary heart disease, and the myocardial injury was found to be associated with Minoxidil consumption. Remarkably, the patient showed signs of reversal 72 h after stopping the drug. To our knowledge, this is the first reported case of subendocardial injury associated with Minoxidil, using speckle tracking echocardiography. In the resolution of the case, it was essential to rule out differential diagnoses, administer vasopressors, and use the speckle tracking echocardiography, which allowed for the objective assessment of myocardial injury and the monitoring of the patient during their hospitalization.

Purpose: To evaluate the impact of first-trimester screening for preeclampsia (PE) and its association with adverse perinatal outcomes.

Methods: A retrospective cohort study was conducted in women with (Group I) or without (Group II) first-trimester screening for PE between 11 and 13 + 6 weeks using maternal characteristics, mean arterial pressure, and uterine artery Doppler. Women were classified as low and high risk using a cut-off value of 1:150 according to the Fetal Medicine Foundation guidelines.

Results: A total of 2442 pregnant women were analysed, 988 in Group I and 1434 in Group II, of whom 204 were at high risk and 1230 at low risk for PE. Group II had higher maternal age (28.0 vs. 26.0 years, p < 0.001), Apgar score at the 1st minute (9.0 vs. 8.0, p < 0.001), Apgar score at the 5th minute (9.0 vs. 8.0, p < 0.001) and lower gestational age at delivery (39.1 vs. 39.4 weeks, p < 0.001) than Group I. Group II was found to have a lower risk of gestational hypertension (p < 0.001), higher risk of delivery < 34 weeks (p = 0.06), and lower risk of spontaneous delivery < 37 weeks (p < 0.001). Women at high risk of PE had a higher risk of delivery < 34 weeks (6.9% vs. 1.2%, p < 0.001), delivery < 37 weeks (16.7% vs. 8.0%, p < 0.001), PE < 34 weeks (2.9% vs. 0.5%, p = 0.005), PE < 37 weeks (4.9% vs. 1.0%, p = 0.0007) and PE > 37 weeks (2.9% vs. 0.5%, p = 0.005). Among women at high risk of PE, 61.3% (125/204) used aspirin (ASA) 100 mg by 37 weeks' gestation. The ASA use was associated with a lower risk of PE > 37 weeks' gestation (0.8% vs. 6.3%, p = 0.033).

Conclusion: First-trimester screening for PE did not reduce the risk of preterm or term PE. First-trimester screening was associated with a lower risk of gestational hypertension and preterm PE. High risk pregnancies had a higher risk of preterm and term PE and of preterm and term delivery. ASA use was associated with lower risk of term PE.

Purpose: This study evaluated the quality of ultrasound images obtained during peripheral vascular catheter insertion using a transparent film designed to maintain puncture site sterility during ultrasound-guided puncture.

Methods: Images were collected from 10 healthy adult participants with and without film, focusing on the radial artery, forearm cephalic vein, and median cubital vein. In total, 300 ultrasound still images were assessed using a 10-point Likert scale.

Results: Image quality was significantly lower at all sites with the film (mean total image quality: radial artery, 5.2 vs. 6.0: p = 0.019; forearm cephalic vein, 6.1 vs. 7.6: p < 0.001; median cubital vein, 6.0 vs. 7.4: p < 0.001). However, the clinical nurse's evaluation of puncture feasibility showed no significant difference for the radial artery (80.0% vs 96.7%) and forearm cephalic vein (100.0% vs 100.0%).

Conclusion: Compromised image quality using the film does not negatively affect the puncturability of the radial artery and forearm veins. This finding underscores the potential for maintaining sterile conditions during procedures without compromising the ability to successfully perform puncture, thereby improving patient outcomes and procedural efficiency.

Acute abdominal pain is a frequent emergency department presentation requiring prompt and accurate diagnosis to guide timely management. Ultrasound imaging plays a critical role in the differential diagnosis of this symptom, offering several advantages including wide availability, cost-effectiveness, and real-time assessment without ionizing radiation. Color and spectral Doppler further enhance diagnostic accuracy by allowing the assessment of blood flow and vascular patterns, which is crucial for identifying ischemic processes. Additionally, ultrasound can help distinguish between gynecological and non-gynecological conditions, such as appendicitis, urinary tract pathologies, or gastrointestinal abnormalities, thereby guiding more targeted investigative pathways or treatment modalities. The rapid, bedside application of ultrasound is especially valuable in unstable patients, ensuring expedited triage and intervention. In certain cases, a negative or inconclusive ultrasound may necessitate further imaging with computed tomography or magnetic resonance imaging. However, ultrasound remains the first-line modality, particularly in pregnant women, to minimize radiation exposure. By integrating ultrasound findings with clinical data and laboratory results, clinicians can establish a precise diagnosis, avoid unnecessary procedures, and initiate timely therapeutic interventions, ultimately improving patient outcomes.

The Testicular Juvenile Granulosa Cell Tumor (JGCT) is a rare testicular neoplasm that appears in the first months of life as a painless testicular mass. Following an accurate radiological ultrasound diagnosis, through which the cystic appearance of the lesion is observed, and histological confirmation, showing follicular growth pattern and an immunoreactivity for inhibin, the treatment process involves, when feasible, conservative surgery. We present the case of a 2-months old infant with a bilateral JGCT of the testis and we review the classical findings of the patology.

Purpose: To investigate the intrasession (test) and intersession (retest) reliability of rehabilitative ultrasound imaging (RUSI) in measuring the thickness of rectus capitis posterior major (RCPM) and oblique capitis superior (OCS) in patients with chronic non-specific neck pain (CNNP).

Methods: Thirty-three CNNP patients (age 35 $\pm$ 12.82 years, 24 women and 9 men) participated in the study. One examiner measured the thickness of the right and left RCPM and OCS in their resting position. For intrasession reliability, two measurements were conducted with an interval of 15 min. As for the intersession reliability, measurements were repeated with an interval of 3 to 4 days after the first session. Intraclass correlation coefficients (ICC), standard error of measurement (SEM), minimal detectable change (MDC), coefficient of variation (CV), and Bland-Altman plots were used for data analysis.

Results: The ICC results for intrasession and intersession reliability ranged from 0.89 to 0.95 and 0.84 to 0.91, respectively. The SEM ranged from 0.35 to 0.57, while the MDC ranged from 0.97 to 1.58. The Bland-Altman plots demonstrated good agreement and no bias.

Conclusion: The current study found RUSI to be a reliable instrument for measuring the thickness of RCPM and OCS in CNNP patients.