Ultrasonography最新文献

Ductal abnormalities, such as dilated ducts with intraductal lesions, are frequently the primary ultrasound findings prompting biopsy and resulting in the early diagnosis of breast cancer or high-risk lesions. However, the Breast Imaging Reporting and Data System (BI-RADS) ultrasound lexicon provides limited guidance on these findings, categorizing them merely as associated features. To address this limitation, this review presents a critical analysis of existing literature and proposes a new classification encompassing three distinct subtypes: dilated ducts alone, dilated ducts with intraductal echoes, and intraductal masses. Additionally, an interpretation algorithm is introduced that incorporates lesion size and suspicious ultrasound features to guide BI-RADS assessment. This structured approach aims to standardize terminology, improve diagnostic accuracy, and promote consistent management of ductal abnormalities, especially in asymptomatic women.

Purpose: This study aimed to fabricate and evaluate breast tissue-equivalent phantoms with varying glycerol concentrations, focusing on their physical properties (density, elasticity, and acoustic parameters) and ultrasound image quality metrics, including echogenicity and lesion geometric accuracy.

Methods: Four phantom types were fabricated, each consisting of a polyvinyl chloride: dioctyl phthalate: glycerol mixture at varying ratios: 7%:93%:0% (background phantom A); 7%:88%:5% (background phantom B); 7%:83%:10% (background phantom C); and 7%:78%:15% (background phantom D). The phantoms contained spherical lesions (0.85, 1.10, and 1.45 cm) composed of gypsum, silicone rubber, and graphite. Physical properties such as density, elasticity, speed of sound, and acoustic impedance were measured for each phantom. Ultrasound image quality was assessed using signal-to-noise ratio, contrast-to-noise ratio, and geometric accuracy metrics.

Results: Background phantoms with higher glycerol concentrations demonstrated increases in density (1.012 to 1.073 g/cm3), elasticity (6.340 to 10.458 kPa), speed of sound (1,532.68±16.35 to 1,578.28±15.63 m/s), and acoustic impedance ([1.55±0.030 to 1.69±0.014]×106 kg/m2/s). Lesion size variation was less than 6.43%, indicating high geometric accuracy. Phantoms B, C, and D exhibited better echogenicity and clearer image contrast compared to phantom A, which showed an anechoic pattern.

Conclusion: Background phantom B demonstrated equivalence to breast tissue, and adding a specific concentration of glycerol allowed the mimicry of acoustic properties of target tissues, thereby improving image quality. This phantom can enhance ultrasound diagnostic skills and provide a cost-effective, self-build option suitable for medical training.

Purpose: This study aimed to investigate the association of carotid plaque biomechanical parameters and elasticity-measured using high-frame rate vector flow imaging (VFI) and shear wave elastography (SWE)-with the occurrence of ipsilateral ischemic stroke in patients with mild stenosis.

Methods: The study included 122 patients with mild carotid stenosis involving a single plaque between September 2023 and April 2024 who underwent B-mode ultrasound, high-frame rate VFI, and SWE examinations. Based on head computed tomography or magnetic resonance imaging findings, participants were classified as symptomatic (with ipsilateral ischemic lesions) or asymptomatic. Wall shear stress, oscillatory shear index, and turbulence (Tur) index were quantified on both downstream and upstream plaque surfaces, and the Young modulus (YM) was measured for distinct plaque regions. Multivariate logistic regression models were employed to evaluate correlations between these imaging-derived parameters and ipsilateral ischemic stroke.

Results: A higher Tur index on the plaque's downstream surface and a lower mean YM within the plaque were significantly associated with ipsilateral ischemic stroke in patients with mild carotid stenosis. Moreover, the combined use of high-frame rate VFI and SWE demonstrated superior predictive performance for stroke risk compared with either modality alone.

Conclusion: High-frame rate VFI and SWE enable detection of biomechanical features and stiffness in high-risk plaques among patients with mild carotid stenosis. Their combined application may yield valuable non-invasive biomarkers for stratifying stroke risk in this population.

This study highlights the role of intraoperative sonography (IOS) using a high-frequency transducer in living donor liver transplantation (LDLT) with modified right-lobe grafts. IOS is pivotal for the real-time assessment of vascular patency and anastomotic integrity, providing crucial insights into hepatic artery, portal vein, and hepatic vein configurations. The technique's high spatial resolution allows for the early detection of potential vascular complications, which are significant predictors of postoperative outcomes. Through detailed illustrations of vascular anastomoses and hemodynamics, this article discusses technical and anatomical considerations of IOS and demonstrates its effectiveness in screening and managing vascular complications in LDLT, thereby enhancing surgical precision and patient safety.

Purpose: This study investigated whether strict adherence to the Korean Thyroid Imaging Reporting and Data System (K-TIRADS) biopsy indications could reduce inconclusive cytology results and evaluated associated clinical factors.

Methods: This retrospective study included 2,440 nodules from 2,256 patients who underwent initial fine-needle aspiration (FNA) for thyroid nodules from January to December 2022. Inconclusive specimens were defined as Bethesda categories I and III, while conclusive specimens comprised Bethesda categories II, IV, V, and VI. Nodules smaller than the K-TIRADS biopsy threshold were considered FNA not-indicated nodules. Clinical factors included patient age, sex, ultrasound features, nodule size, number of needle passes, and operator experience. Univariate and multivariate logistic regression analyses were performed to assess the associations between clinical factors and inconclusive results.

Results: Among 2,440 nodules, 900 yielded initial inconclusive biopsy results, while 1,540 provided conclusive results. Independent predictors of inconclusive biopsy results included FNA not-indicated nodules, nodules sized 0 to 5 mm, operator experience of less than 1 year, older age, and K-TIRADS category 4 (P<0.001, P=0.006, P=0.003, P=0.001, and P<0.001, respectively). Among K-TIRADS category 4 nodules, the presence of suspicious ultrasound characteristics was negatively associated with inconclusive biopsy results (P=0.004).

Conclusion: FNA not-indicated nodules, nodule size of 0 to 5 mm, operator experience of less than 1 year, older age, and K-TIRADS category 4 were factors associated with inconclusive biopsy results. Strict adherence to the K-TIRADS biopsy indications may reduce inconclusive cytology results.

Ultrasonography (US) is a sensitive and radiation-free technique for diagnosing deep vein thrombosis (DVT). Therefore, when DVT is clinically suspected but not detected on US, radiologists should consider a range of alternative differential diagnoses. This review article presents the imaging findings of clinical conditions that mimic DVT, which can be distinguished using a multimodal radiologic approach. Additionally, DVT mimics can be categorized into two groups based on whether a flat or normal waveform is observed on Doppler US. This article details the imaging findings and clinical presentations of DVT mimics, organized by these classifications. This information may help radiologists make more accurate diagnoses, enabling patients to receive appropriate treatment in a timely manner.

Purpose: Fetal echocardiography is the primary diagnostic tool for assessing the atrioventricular (AV) time interval. Establishing a reference range for this parameter throughout pregnancy is essential for the early detection of potential abnormalities. The aim of this study was to develop a Z-score equation and establish specific percentiles for the AV time interval in normal fetuses between 16 and 33+6 weeks of gestation.

Methods: A multicenter, prospective, cross-sectional study was conducted between 2018 and 2022. A large sample of pregnant women meeting specific eligibility criteria was included, while cases with potential confounders were excluded. Two-dimensional echocardiography with pulsed Doppler techniques was employed, focusing on the left ventricular inflow and outflow. Data were rigorously analyzed with careful assessment of measurements and normalization procedures.

Results: In total, 1,309 echocardiograms were performed, and 1,183 pregnant women were included after applying the eligibility criteria. Detailed percentiles for each gestational age were determined, and a Z-score equation was formulated. A very weak correlation was observed between AV interval measurement and gestational age (r=0.16, P<0.001). In addition, the correlation between AV interval measurement and fetal heart rate was weak (r=-0.21, P<0.001). The Z-score for the AV interval measurement in milliseconds was derived as follows: Z-score=(AV interval measurement-111.3)/8.6.

Conclusion: This study provides a reference range and Z-score equation for the AV interval, which may enhance the accuracy of monitoring fetuses at risk for developing atrioventricular block-especially in pregnant women with specific antibodies-thus facilitating earlier diagnosis and treatment.

In 2023, nonalcoholic fatty liver disease was renamed metabolic dysfunction-associated steatotic liver disease by the American and European liver associations. This new nomenclature recognizes metabolic dysfunction as the central driver of the disease, and the diagnostic criteria now require the presence of hepatic steatosis plus at least one of five cardiometabolic risk factors. B-mode ultrasonography remains the most common and practical method for detecting hepatic steatosis, although newer ultrasound techniques based on attenuation, backscatter, and speed of sound have gained traction as tools to diagnose and quantify hepatic steatosis. Additionally, ultrasound elastography is increasingly used in routine clinical practice to assess liver fibrosis, diagnose cirrhosis, and identify clinically significant portal hypertension.

Purpose: This study compared the diagnostic performance of two attenuation imaging (ATI) modes-low-frequency (3 MHz) and high-frequency (4 MHz)-for assessing hepatic steatosis, with histopathological hepatic fat fraction (HFF) as the reference standard.

Methods: This prospective single-center study enrolled participants with suspected metabolic dysfunction-associated steatotic liver disease (MASLD) scheduled for liver biopsy or surgery between June 2023 and June 2024. Attenuation coefficient (AC) values were consecutively measured using low- and high-frequency ATI modes, while the skin-to-region of interest distance (SRD) was measured simultaneously. Spearman correlation analysis evaluated the relationships of AC with HFF and SRD, and linear regression identified factors affecting AC. Diagnostic performance was evaluated using the area under the receiver operating characteristic curve (AUROC).

Results: In total, 119 participants (mean age, 37.2±12.0 years; 87 men) were included, with 73 (61.3%) diagnosed with MASLD. HFF ranged from 0% to 50%. The AC values in the lowfrequency mode were significantly higher than those in the high-frequency mode (0.61 vs. 0.54 dB/cm/MHz, P<0.001). HFF significantly influenced AC in both modes, whereas SRD affected AC only in the high-frequency mode (P<0.001). AC correlated positively with HFF in both modes (rs≥0.514, P<0.001) and negatively with SRD in the high-frequency mode (rs=-0.338, P<0.001). The AUROC for hepatic steatosis did not differ significantly between the two modes (0.751 vs. 0.771, P=0.609).

Conclusion: The low-frequency mode produced higher AC values than the high-frequency mode and demonstrated comparable diagnostic accuracy for assessing hepatic steatosis. Unlike the high-frequency mode, the low-frequency mode was not influenced by SRD.

Purpose: This study aimed to evaluate the contrast-enhanced ultrasound with Sonazoid (Sonazoid-CEUS) features of hepatocellular carcinoma (HCC) in patients with non-alcoholic fatty liver disease (NAFLD).

Methods: In this retrospective study, patients who underwent surgical resection and were histopathologically diagnosed with NAFLD or cirrhosis-related HCC were included. All patients received Sonazoid-CEUS examinations within 1 week prior to hepatic surgery. The enhancement patterns of HCC lesions were evaluated and compared between the two groups according to the current World Federation for Ultrasound in Medicine and Biology guidelines. Multivariate logistic regression analysis was used to assess the correlations between Sonazoid-CEUS enhancement patterns and clinicopathologic characteristics.

Results: From March 2022 to April 2023, a total of 151 patients with HCC were included, comprising 72 with NAFLD-related HCC and 79 with hepatitis B virus (HBV) cirrhosis-related HCC. On Sonazoid-CEUS, more than half of the NAFLD-related HCCs exhibited relatively early and mild washout within 60 seconds (54.2%, 39/72), whereas most HBV cirrhosis-related HCCs displayed washout between 60 and 120 seconds (46.8%, 37/79) or after 120 seconds (39.2%, 31/79) (P<0.001). In the patients with NAFLD-related HCC, multivariate analysis revealed that international normalized ratio (odds ratio [OR], 0.002; 95% confidence interval [CI], 0.000 to 0.899; P=0.046) and poor tumor differentiation (OR, 21.930; 95% CI, 1.960 to 245.319; P=0.012) were significantly associated with washout occurring within 60 seconds.

Conclusion: Characteristic Sonazoid-CEUS features are useful for diagnosing HCC in patients with NAFLD.