Medical ultrasonography最新文献

Breast contrast-enhanced ultrasound (CEUS)has been used in clinical practice for nearly two decades. CEUS provides real-time assessment of microvascular perfusion, offering valuable functional information complementary to conventional ultrasound. Nonetheless, the lack of standardization in relevant techniques has hindered the widespread adoption and further development of this technology. As a specialized committee, Superficial Organs and Peripheral Vessels Committee of Chinese Association of Ultrasound in Medicine and Engineering has always been committed to standardizing the clinical application of ultrasound. This expert consensus aims to standardize examination procedures, image interpretation, and reporting for diagnostic settings. It outlines key indications and provides recommendations on acquisition techniques, qualitative and quantitative analysis of enhancement patterns, and standardized lexicon for reporting.

Aim: This review was done to evaluate diagnostic accuracy of LUS against established ARDS reference standards in adult populations.

Material and methods: Four electronic databases were searched through June 2025 without language restrictions. Two reviewers independently screened studies, extracted data, and assessed quality using QUADAS‑2. Bivariate random‑effects models generated pooled sensitivity, specificity, likelihood ratios, diagnostic odds ratios (DORs), and hierarchical summary receiver‑operating characteristic (HSROC) curves. Subgroup analyses explored pattern‑ versus score‑based protocols and prospective study designs. Publication bias was assessed via Deeks' funnel‑plot test.

Results: Fourteen studies (531 ARDS-positive; 1354 ARDS-negative; pre‑test probability=28%) met inclusion criteria. Overall pooled sensitivity was 0.84 (95%CI: 0.69-0.92) and specificity 0.94 (95%CI: 0.83-0.98), with an AUROC of 0.95 (95%CI: 0.93-0.96). The positive likelihood ratio was 13.3 (95%CI: 5.0-35.9) and negative likelihood ratio 0.17 (95%CI: 0.09-0.34), corresponding to a DOR of 77 (95%CI: 26-227). Pattern‑based protocols achieved sensitivity 0.82 and specificity 0.96 (AUROC=0.96), while score‑based approaches yielded sensitivity 0.90 and specificity 0.83 (AUROC=0.93). Deeks' test indicated potential publication bias (p=0.004).

Conclusions: LUS demonstrates excellent rule‑in and rule‑out performance for ARDS in critically ill adults, rivalling CT accuracy without its drawbacks. Adoption of standardized LUS protocols and integration into ARDS diagnostic pathways could enhance early detection, optimize management, and reduce reliance on ionizing imaging.

Percutaneous electrical nerve stimulation (PENS) has gained increasing relevance as a minimally invasive neuromodulation technique for managing musculoskeletal pain and peripheral neuropathies. Its efficacy and safety largely depend on accurate needle placement near target nerves under ultrasound (US) guidance. However, comprehensive didactic resources detailing peripheral nerve visualization remain limited. This paper aimed to develop an educational US-based manual to identify major peripheral nerves of the gluteal region, integrating anatomical, clinical, and sonographic perspectives. A narrative, anatomy-driven approach was used to describe the sonoanatomy and clinical relevance of five key nerves in the gluteal area: superior and inferior gluteal nerves, pudendal nerve, sciatic nerve, and posterior femoral cutaneous nerve. For each structure, probe placement, optimal scanning planes, and characteristic US appearances were systematically illustrated using standardized positioning and technical parameters based on high-end diagnostic ultrasound equipment.

Aim: Liver steatosis is a growing global health concern with significant medical and economic implications. This study aimed to evaluate USFF (ultrasound fat fraction) for steatosis assessment as compared to controlled attenuation parameter (CAP).

Materials and methods: Liver steatosis was assessed in the same session by QUS (Samsung Medison RS85) and CAP (FibroScan Compact M530) in a cohort of 169 patients. For QUS, TAI and TSI measurements were acquired, then Fat Fraction (%) was calculated and displayed. The CAP cut-off values for S1, S2 and S3 were 248, 268 and 280 dB/m, respectively. ROC analysis was performed to identify the best cut-off values for USFF for each steatosis stage.

Results: Of the 169 patients, 52.6% had at least moderate steatosis by CAP. Moderate correlations were observed for TSI vs. CAP (r=0.66), TAI vs. CAP (r=0.83), and TSI vs. TAI (r=0.68), with good diagnostic performance (TSI AUROC=0.82, TAI AUROC=0.81). A strong correlation between USFF and CAP was also found (r=0.81, p<0.001). The best USFF cut-off value to identify at least mild steatosis in all patients was >5% with very good performance (AUROC=0.90) for moderate steatosis the cut-off value was >7.5% (AUROC=0.92) and for severe steatosis, >10% (AUROC=0.91).

Conclusion: USFF seems to be a promising tool for diagnosing liver steatosis, with a very good performance.

Reliable and reproducible sonographic measurements are essential for accurate liver assessment, both in daily clinical practice and in research. Reference values enable clinicians to differentiate between physiological and pathological findings and thus support diagnostic accuracy, follow-up, and therapeutic decision-making. This comprehensive review synthesizes current evidence on normal liver size as assessed by ultrasound, with a particular focus on measurement techniques, standard values, anatomical variants, and the clinical contexts in which these parameters are relevant. Special attention is given to the influence of patient-related factors such as body constitution, sex, age, and ethnicity. The role of right, left, and caudate lobe measurements is discussed in detail, outlining their relevance in conditions such as hepatomegaly, vascular disorders, or post-resection follow-up. Limitations of currently available data are acknowledged, especially regarding interobserver variability and lack of global uniformity. Future priorities include the establishment of consensus-based international reference standards and the integration of emerging technologies, such as artificial intelligence and advanced image analysis tools, to enhance reproducibility, reduce variability, and improve clinical utility. Ultimately, standardized liver measurements should form an integral part of multiparametric ultrasound examinations to optimize patient care.

Aims: To visualize the process of esophageal speech in patients who underwent laryngectomy using diagnostic ultrasound.

Material and methods: Three patients with different surgical reconstructions (total laryngectomy, pharyngo-laryngo-esophagectomy with gastric tube reconstruction, and pharyngo-laryngo-cervical-esophagectomy with free jejunal reconstruction) were studied. Ultrasound with a linear probe observed organ vibration and dimensions at the 5th-7th cervical vertebrae during rest, air swallowing, and phonation. Cross-sectional lateral and anteroposterior diameters were measured.

Results: Lateral diameters (mm) during rest, air swallowing, and sound production were 15, 18, and 15 for the esophagus; 24, 27, and 23 for the gastric tube; and 19, 32, and 20 for the jejunal graft, respectively. Longitudinal motion of the esophagus and gastric tube lumen coincided with artifact, while jejunal villi movements were noted. Air swallowing induced an oval organ shape, and lateral diameters shortened during sound production.

Conclusions: Vibratory activity spanning over 4 cm was observed at the 5th-7th cervical vertebrae. Each organ displayed distinct vibration patterns, with luminal shape changes during sound production. These findings offer new insights into the biomechanics of esophageal speech and understanding of postoperative rehabilitation.

Aim: To evaluate the ultrasonographic features of male breast nodules classified as Breast Imaging Reporting and Data System category 4.

Material and methods: A retrospective analysis of 79 breast nodules from 77 male patients, classified as Breast Imaging Reporting and Data System category 4 after ultrasonography, was conducted. The ultrasonographic features of benign and malignant nodules were evaluated and compared. Independent risk factors for malignancy were identified by logistic regression analysis. In addition, we conducted a subgroup analysis comparing the ultrasonographic features of gynecomastia and malignant nodules in male breasts.

Results: Differences were found in age of onset, calcifications, aspect ratio greater than 1/2, Adler grading of blood flow, and axillary lymph nodes. The presence of calcifications was an independent risk factor for malignancy in males. The results of the comparison between gynecomastia and breast cancer were essentially consistent with the former. However, the differences in calcifications were not as significant as those observed in the former.

Conclusions: We identified differences in age of onset, calcification, aspect ratio greater than 1/2, blood flow, and axillary lymph nodes between benign and malignant male breast nodules classified as Breast Imaging Reporting and Data System category 4, with calcification being an independent risk factor for malignancy. These features can help determine the nature of the nodules and guide biopsy decisions.

Aims: This study aims to estimate the degree of sonographers as a source of systematic variance for Shear Wave Elastography (SWE) values.

Materials and methods: Two studies estimated variance in SWE measurements: 1) within-subjects and between-sonographer differences, and 2) between-sonographer differences alone. Both used a block design with six trained sonographers scanning six healthy liver volunteers using the same machine. Following training, each sonographer obtained ten SWE measurements from the right liver lobe for each volunteer per manufacturer guidelines.

Results: When patients were scanned on different days, intraclass correlation coefficient (ICC)=0.23 was achieved, and when scanned on the same day, ICC=0.83, indicating that 17% of the variability was due to differences between sonographers. This 17% inter-sonographer variability translated into statistical and potentially clinically significant differences between sonographers-one sonographer had a SWE value of (4.99) and another (5.43), p<0.01, almost passing a clinical threshold.

Conclusion: SWE values are influenced by a sonographer effect, highlighting the need to standardize protocols to minimize systematic variability between sonographers. Multiple scans are justified for patients with SWE values near clinical thresholds. Since healthy volunteers exceeded the manufacturer-defined threshold, inherent variability between sonographers could challenge the reliability of clinical thresholds in practice.

Aim: Caudal epidural injection is used for lumbosacral radicular pain but there is a risk of vascular injection. An ultrasound-guided catheter-over-needle technique was proposed to reduce this risk. This study compared the incidence of vascular injections between the catheter-over-needle and Tuohy needle methods for caudal epidural injections.

Material and methods:  This prospective, randomized clinical trial included patients aged ≥19 years with degenerative lumbar disease accompanied by radicular pain who were unresponsive to non-invasive treatments and scheduled for caudal epidural injection. The participants were randomized into two groups: catheter-over-needle and Tuohy needle groups. Under ultrasound guidance, the contrast medium was injected and observed in real time using fluoroscopy. An independent physician assessed the vascular injection rates.

Results: The incidence of vascular injection was significantly lower in the catheter-over-needle group (15.7%) than in the Tuohy needle group (37.5%; p=0.014). Chronic pain lasting >12 months was a significant risk factor for vascular injection (p=0.035). However, no statistically significant association was found between sacral opening depth and vascular injection, although the sacral opening depth was shorter in patients who received intravascular injections.

Conclusions: The catheter-over-needle technique significantly reduces the risk of vascular injection. The depth of the sacral opening may also influence vascular injection.