Journal of Ultrasound最新文献

Purpose: B-lines are among the key artifact signs observed in Lung Ultrasound (LUS), playing a critical role in differentiating pulmonary diseases and assessing overall lung condition. However, their accurate detection and quantification can be time-consuming and technically challenging, especially for less experienced operators. This study aims to evaluate the performance of a YOLO (You Only Look Once)-based algorithm for the automated detection of B-lines, offering a novel tool to support clinical decision-making. The proposed approach is designed to improve the efficiency and consistency of LUS interpretation, particularly for non-expert practitioners, and to enhance its utility in guiding respiratory management.

Methods: In this observational agreement study, 644 images from both anonymized internal and clinical online database were evaluated. After a quality selection step, 386 images remained available for analysis from 46 patients. Ground truth was established by blinded expert sonographer identifying B-lines within rectangular Region Of Interest (ROI) on each frame. Algorithm performances were assessed through Precision, Recall and F1 Score, whereas to quantify the agreement between the YOLO-based algorithm and the expert operator, weighted kappa (kw) statistics were employed.

Results: The algorithm achieved a precision of 0.92 (95% CI 0.89-0.94), recall of 0.81 (95% CI 0.77-0.85), and F1-score of 0.86 (95% CI 0.83-0.88). The weighted kappa was 0.68 (95% CI 0.64-0.72), indicating substantial agreement algorithm and expert annotations.

Conclusions: The proposed algorithm has demonstrated its potential to significantly enhance diagnostic support by accurately detecting B-lines in LUS images.

Purpose: Graphene-polymer nanocomposites significantly impact dental filler and antibacterial applications. The study aims to overcome some problems dental filers present and improve their properties and antibacterial activity. Synthesis graphene oxide (GO) and poly (methyl methacrylate) (PMMA) were used to reinforce two types of commercial hybrid/nano-dental fillings.

Methods: Developed acoustic-solution-sonication-casting methods were applied to fabricate the new graphene-polymer-dental filler nanocomposites. The structure, morphology, rheological and mechanical properties, and antibacterial of the newly fabricated filling-PMMA/ GO nanocomposites were investigated.

Results: Fourier transform infrared (FTIR) showed a significant interaction between the filling and the additional materials. The X-ray diffraction (XRD) analysis revealed a considerable change in crystalline behavior. Optical microscope (OM) with field emission scanning electron microscopy (FESEM) pictures demonstrated a substantial change in the morphology of the samples with a homogeneous and fine dispersion of the nanomaterials in the filler matrix. Multi-frequency ultrasound mechanical properties measured the ultrasonic velocity, absorption coefficient, compressibility, bulk modulus, and other mechanical properties that notably enhanced after GO contributed up to 325% of the ultrasonic absorption coefficient compared with hybrid/nano-fillers. Rheological properties were measured as viscosity, absorption coefficient, and specific viscosity, which significantly improved after adding PMMA and incorporating GO up to 57% of the viscosity, compared with hybrid/nano-fillers. The inhibition zone of moth bacteria, such as Enterococcus faecalis and E. staph bacteria, improved after the contribution of GO nanosheets up to 46%.

Conclusion: Nanofillers nanocomposites presented better properties and inhabitances zone diameter of antibacterial.

Objective: This study aimed to evaluate the efficacy and safety of a novel ultrasound-guided percutaneous tenotomy technique for treating chronic tendinosis of the common extensor tendon (CET) in the elbow (lateral epicondylitis).

Methods: The study was conducted on 25 elbows from 13 cadavers without prior local injuries. Each CET tenotomy was performed using a Mikro 64 scalpel under ultrasound guidance to ensure precision and safety. Key anatomical structures, including the lateral collateral ligament (LCL), radial nerve, and posterior antebrachial cutaneous nerve, were monitored to assess safety margins and detect potential complications.

Results: In the 20 evaluated cases, the mean distance from the CET section to the radial epicondyle (DET) was 5.86 mm (range 5.96-12.8 mm), while the distance to the proximal LCL margin (DELCL) averaged 8.62 mm (range - 0.96-6.82 mm), yielding a confident tenotomy length of 2.76 mm. Partial LCL injury occurred in four cases without affecting joint stability, and no nerve injuries were observed. Incomplete CET sections were found in four cases, with residual fibers primarily along the medial and lateral margins.

Conclusion: The ultrasound-guided percutaneous tenotomy technique demonstrated safety and effectiveness in an anatomical setting. This minimally invasive approach may offer a viable surgical alternative for refractory lateral epicondylitis, minimizing the risk of complications and promoting a shorter recovery period.

Background: Duplex carotid ultrasound is a non-invasive imaging test that is essential for assessing carotid artery disease, particularly in determining the presence and severity of atherosclerosis and the risk of cerebrovascular events. However, the interpretation of ultrasound results can differ widely due to variations in diagnostic criteria, lack of standardization in scanning methods, and differing approaches to evaluating carotid intimal medial thickness (CIMT), plaques, and stenosis. These inconsistencies create challenges in clinical practice and the reproducibility of results. While various protocols for CIMT, plaque measurement, and stenosis grading are available in the literature, a standardized global protocol is still lacking. This article presents a scoping review of current carotid duplex ultrasound scanning and reporting protocols. It aims to identify existing protocols and guidelines for carotid ultrasound scanning and reporting, highlight variations, and propose a standardized approach to enhance diagnostic accuracy and clinical outcomes in carotid atherosclerosis.

Methods: Using predefined search protocols developed in collaboration with the specialized librarian from the University of Pretoria, we searched different databases and gray literature to identify existing protocols on carotid ultrasound including scanning technique, carotid intimal medial thickness, carotid plaques, and carotid stenosis grading. Due to limitations in the length of the review, and the existence of a large number of protocols, this review focused on the protocols developed and published by institutions and professional societies rather than individual articles.

Results: Among 2496 articles identified from databases and 22 from other sources, 17 articles met the criteria for this review. The most common criteria that was found following this review are those established by the Society of Radiologists in Ultrasound (SRU) in 2003. The researchers further noted that these criteria were, however, been criticized for relying heavily on peak systolic velocities, a measurement that, when used alone, can be misleading. Literature further demonstrated that other researchers and professional societies have called for consensus on unified criteria for the diagnosis of carotid atherosclerosis.

Conclusion: While carotid ultrasound is an important, non-invasive, and widely available method for evaluating carotid atherosclerosis, the variations in scanning techniques, measurements, and cut-off values underscore the need for standardized diagnostic criteria. Standardization is essential to provide consistent patient care and ensure accurate examination in various clinical settings. This will lead to the reduction of stroke and cardiovascular incidence which are the leading causes of death worldwide and more prevalent in low-income countries.

Purpose: To evaluate the inter- and intra-assessor reliability of ultrasonographic assessment of swallowing-related muscle indices in healthy young adults.

Methods: Three examiners conducted ultrasonographic evaluations on healthy young adults (n = 34, age: ≥ 20 years) examining the thickness and area of the geniohyoid muscle, anterior belly of the digastric muscle, tongue, and the mylohyoid, masseter, and depressor anguli oris muscles. To assess inter-rater reliability, each examiner evaluated each assessment item for one subject three times on the same day. Intra-rater reliability was assessed by rater No. 3 re-evaluating the participants 4-7 days after the initial measurement, using the retest method. Image analysis was conducted by a single examiner utilizing an ultrasonography measurement tool. Statistical analysis was performed using intraclass correlation coefficients (ICCs) for intra- and inter-rater reliability.

Results: The study included 34 participants (male: 17, female: 17; age: 25 ± 2 years, body mass index: 20.3 ± 1.7 kg/m²). For intra-rater reliability for thickness of the geniohyoid muscle, ICC = 0.94 [95% CI (0.89, 0.97)], and ICC = 0.90 [95% CI (0.81, 0.93)] for the area of the anterior belly of the digastric muscle. For inter-rater reliability, ICC = 0.93 [95% CI (0.88, 0.96)] and 0.86 [95% CI (0.77, 0.92)] for the thickness of the geniohyoid muscle, and area of the anterior belly of the digastric muscle, respectively.

Conclusions: The inter- and intra-assessor reliability of ultrasound assessments of swallowing-related indices in young healthy subjects was good, exhibiting particularly high accuracy for the geniohyoid muscle and the anterior belly of the digastric muscle.

Background: Pneumothorax is a potentially life-threatening complication in critically ill patients. Lung ultrasound (LUS) is highly accurate for bedside diagnosis, with the lung point sign being specific for pneumothorax. A variant, the heart point sign, has been described in isolated case reports as a marker of left-sided pneumothorax, but its clinical relevance remains incompletely understood.

Methods: We retrospectively reviewed intensive care unit cases at Sanatorio Los Arcos (Buenos Aires, Argentina) from January 2018 to July 2024. Patients were included if the heart point sign was documented during cardiac ultrasound performed as part of the hemodynamic assessment following the diagnosis of pneumothorax by lung ultrasound. The sign was evaluated in B-mode and, when available, M-mode, and defined as the visualization of the heart during diastole that disappeared during systole, coinciding with a lung pattern showing absent lung sliding and A-lines. Clinical data, confirmatory imaging, and management strategies were obtained from medical records.

Results: Ten patients (median age 56 years, IQR 45-65; 50% male) exhibited the heart point sign. Most patients (80%) were on invasive mechanical ventilation, and two required vasopressor support. The sign was visualized in parasternal (6/10) and apical (4/10) views. Pneumothorax was confirmed by CT (5/10), chest radiography (3/10), or ultrasound alone (2/10). Etiologies included central line placement (5/10), surgical complications (2/10), failure of lung re-expansion (1/10), spontaneous pneumothorax (1/10), and lung abscess rupture (1/10). Management consisted of chest tube insertion (6/10), video-assisted thoracoscopic surgery (3/10), and conservative observation (1/10).

Conclusion: The heart point sign is an infrequent but highly specific sonographic marker of left-sided pneumothorax. It can be assessed in B-mode and M-mode, reflecting the dynamic interaction between cardiac motion and interposed pleural air. Recognition of this sign provides rapid bedside confirmation, complementing classical ultrasonographic findings and enhancing diagnostic confidence in critically ill patients.

Objective: To systematically reveal the spatiotemporal distribution, collaboration networks, and thematic evolution of global transrectal ultrasound (TRUS) research in prostate cancer from 2015 to 2024 using bibliometric analysis and visualization.

Methods: A total of 12,894 relevant articles from the Web of Science database were analyzed using VOSviewer and CiteSpace for co-occurrence networks, burst detection, and density visualization, combined with social network analysis (SNA) and kernel density estimation (KDE) to decode country/institution collaboration patterns and geographical agglomeration.

Results: Annual publications peaked at 1800 in 2019, with a secondary surge in 2023 (1563 articles) driven by AI applications (e.g., AI-assisted biopsy). Mean citations per article reached 7.8 in 2020, coinciding with the release of GLOBOCAN 2020 and the rise of teleultrasound research. The United States (5333 articles) and Canada formed the North American core cluster (edge weight 5333 × 1099), while the UK (1287 articles) and Germany served as secondary hubs in Europe. Asian countries showed scattered distributions, though South Korea (2015-2017 burst strength 7.64, elastography) and Australia (2019-2022 burst strength 8.33, focal ablation) emerged as regional technical frontiers. The University of Toronto (242 articles) led TRUS-targeted biopsy research, while the University of Michigan became a rising affiliation due to TRUS-AI integration (post-2020 annual publications > 50). The high-impact journal J Clin Oncol (5783 citations) focused on fusion biopsy, with annual articles increasing from 42 to 117.Keywords shifted from "systematic biopsy" (2015-2017) and "radiotherapy planning" (2018-2020) to "AI-assisted diagnosis" (2021-2024 burst strength 20.6) and "teleultrasound" (COVID-19-related studies, annual growth 19%), reflecting technology-driven clinical transformation.

Conclusion: TRUS research exhibits significant regional inequality and technological iteration, with AI integration and multimodal fusion (e.g., MRI-TRUS fusion) as future priorities. Strengthening cross-regional collaboration is recommended to promote technological equity, particularly for low-cost TRUS innovations in resource-constrained regions.

Background: CEUS is increasingly used beyond hepatobiliary imaging; its pleuro-pulmonary applications remain limited, especially for device assessment.

Case description: We describe a postoperative patient with moderate right pleural effusion and associated middle-basal atelectasis causing hypoxemic respiratory failure. After ultrasound-guided insertion of a 12-Fr pigtail drain, the catheter trajectory and tip could not be confidently visualized due to limited patient mobilization and small-bore caliber. A second-generation UCA (sulfur hexafluoride) diluted 1 mL in 10 mL saline was instilled through the drain. CEUS immediately demonstrated contrast egress from the catheter tip, confirming intrapleural position, and opacified the effusion, delineating the pleural cavity and the atelectatic lung. Enhancement dissipated within ~ 4 min. The drain was then left on gravity with an anti-reflux valve; no adverse events occurred.

Conclusion: Intrapleural CEUS via an indwelling chest drain is a rapid, bedside, radiation-free method to confirm catheter placement and map loculations, potentially improving interventional safety and follow-up.

Endometrial cancer arising in adenomyosis (EC-AIA), i.e., malignant transformation of the endometrium within adenomyotic foci, is a very unusual condition. We report a postmenopausal woman who had an unexpected diagnosis of uterine serous carcinoma (USC) arising from adenomyosis. A 55-year-old woman complained of anorexia with weight loss and mild abdominal pain. Pelvic cystic masses were shown by computed tomography (CT). CA125 in serum was 44.86 u/ml. Ultrasound detected a 50 × 36 mm subserous cystic-solid mass. It was misdiagnosed as a subserous uterine fibroid with cystic degeneration. The postoperative histopathological diagnosis was USC. This is the first time to discuss the ultrasound diagnosis of EC-AIA. The de novo cystic area in adenomyosis in postmenopausal women may indicate malignant transformation. Ultrasound is the first imaging choice for gynecological masses. Presenting the ultrasound image and identifying the factors that may contribute to misdiagnosis can help raise the examiner's attention to this condition and inform the diagnostic workup in the future.

Severe soft tissue infections, such as necrotizing fasciitis and myositis, represent a critical challenge in contemporary medical practice due to their rapid progression and the devastating consequences they can entail. One of the main obstacles to their management is early diagnosis, which is complicated by the lack of evident cutaneous findings in the early stages of the disease. While CT is considered a precise diagnostic tool, it doesn't always influence the clinical management of each patient. In this context, ultrasound emerges as a valuable option, with high sensitivities and specificities, allowing for effective differentiation between severe infections and other pathologies. We present the case of a patient with necrotizing myofasciitis, in which the combination of clinical findings and PoCUS quickly identified the severity of the situation and facilitated tailored management adapted to the clinical context at that moment. This case illustrates the importance of ultrasound as a diagnostic tool, not only for the early identification of these infections but also for reducing the time to definitive treatment.