Medical ultrasonography最新文献

Aims: A computer-aided diagnosis (CAD) system for automated evaluation of developmental dysplasia of the hip (DDH) via ultrasound, integrating Deep Learning (DL) for anatomical segmentation and performing α&β angle calculations utilizing the Graf Method is presented. A custom image processing method excludes the inferior ilium's curvature during the baseline definition, enhancing accuracy and replicating radiologists' real-world workflow.

Materials and methods: Our dataset comprised 452 raw images from 370 newborns. For {'validation'+"test"}, {'nv=91'+"nte=45"}≡136 images were reserved (never augmented). Remaining 316 images were augmented to ntr=632 with (0%↔25%) random brightness manipulation for training. Totally (632+136)=768 images were annotated and split with the following true numbers and percentage: {'train',"validation",test}≡{'632',"91",45}≡{'82%',"12%",6%}. U-Net, MaskR-CNN, YOLOv8 and YOLOv11 were used for segmentation. α&β were measured using Method-I (centroid/orientation) and Method-II (Hough transform). An extended set of performance metrics-Precision, Recall, IoU, Dice, mAP-was calculated. Bland-Altman and Intraclass Correlation Coefficient (ICC) analyses compared CAD outputs with expert measurements.

Results: YOLOv11 showed the best segmentation performance (Precision:0.990, Recall:0.993, IoU:0.983, Dice:0.990, mAP:0.991). {ICCα, ICCβ} calculated using Method-I and Method-II were {0.895, 0.907} and {0.929, 0.952}, respectively, with Method-II outperforming Method-I.

Conclusion: A clinically-aligned-CAD-system that integrates anatomical segmentation and α&β measurement-a combination rarely addressed in literature is introduced. By providing a comprehensive and standardized set of metrics, this work overcomes a common bottleneck in DL studies, namely heterogeneity in metric reporting, enabling better cross-study comparisons. Following curvature exclusion, obtained ICCs outperformed previous studies, demonstrating improved inter-rater reliability and strong agreement with expert radiologists, offering both technical robustness and clinical applicability in DDH assessment.

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: To evaluate and compare ultrasound elastography (EUS) findings using strain elastography (SE) and shear wave elastography (SWE) in epidermal cyst and ruptured epidermal cysts, and to assess the intra-observer agreement of each method.

Material and methods: This retrospective study included 194 patients with surgically confirmed epidermal cysts who underwent ultrasonography (US), including SE and SWE. SE scores were classified into four grades according to elasticity, and strain ratio was calculated using adjacent subcutaneous fat as reference tissue. SWE parameters included shear wave (SW) velocity (m/s) and elasticity (kPa), velocity ratio, and elasticity ratio. Repeated measurements obtained during the same examination were used to assess intra-observer agreement.

Results: Ruptured epidermal cysts showed significantly lower SW velocity and elasticity values than un-ruptured epidermal cysts on SWE (p<0.001). SE score and strain ratio did not differ significantly between the two groups. The intra-observer agreement of strain ratio was good, while that of SW velocity and elasticity ranged from moderate to good.

Conclusion: The intra-observer agreement of both SWE and SE parameters was moderate to good. SWE demonstrated significantly lower value in ruptured epidermal cysts, while SE parameters did not. SWE may therefore be a more useful imaging modality for differentiating epidermal cyst rupture and for treatment planning.

Aim: This study aimed to assess the reliability of CEUS LI-RADS diagnosis among radiologists with varying levels of CEUS diagnostic experience, and to propose methods to improve the consistency of CEUS LI-RADS classification diagnosis.

Material and methods: This retrospective study analyzed CEUS and clinicopathological data of 169 consecutive adult patients (18-89 years old) at high risk of hepatocellular carcinoma (HCC) who were admitted to our hospital between July 2019 to August 2021 and underwent CEUS to analyze the consistency of CEUS LI-RADS diagnoses within and between ultrasound diagnostic observers of different seniority.

Results: Among the 169 high-risk HCC patients used for consistency analysis, 3, 13, 27, 29, 29, 32, 21, and 15 were LR-1, LR-2, LR-3, LR-4, LR-M, LR-5, TIV, and LR-NC, respectively. After independent assessment, the inter-observer ICC among the three radiologists was 0.797 (95%CI: 0.748-0.840), indicating good reliability. The intra-group ICCs were 0.671 (95%CI: 0.579-0.746) for residents, 0.788 (95%CI: 0.723-0.839) for junior radiologists, and 0.835 (95%CI: 0.783-0.876) for senior radiologists. After unified learning of simple typical CEUS LI-RADS feature images, the ICC between the three radiologists was 0.952 (95%CI:0.938-0.963); the intra-observer ICC for resident was 0.815 (95%CI:0.757-0.860); the intra-observer ICC for junior radiologist was 0.862 (95%CI:0.817-0.896); and the intra-observer ICC for senior radiologist was 0.913 (95%CI:0.884-0.935).

Conclusion: Compared to the independent learning CEUS LI-RADS v2017 guidelines, unified and simplified CEUS LI-RADS typical sign images can effectively improve the reliability of diagnosis among radiologists with different levels of experience.

Aim: Patients with diarrhea-predominant irritable bowel syndrome (IBS-D) who present with symptom exacerbation [defined by a high IBS-Symptom Severity Scale (IBS-SSS)] may have increased fecal calprotectin (FC). Intestinal ultrasound (IUS) is used to measure bowel wall thickness (BWT). The aim of our study was to measure BWT in IBS-D patients, ulcerative colitis (UC) and healthy controls (HC), and compare BWT, IBS-SSS score, and FC level.

Material and method: Patients with IBS-D and symptom exacerbation (n=100), active UC (n=25), and HC (n=30) were included. FC was measured in all groups. IBS-D patients with an IBS-SSS score >75 and FC level >50 µg/g underwent IUS and colonoscopy.

Results: Patients with IBS-D had a (mean±SEM) IBS-SSS score of 268±11, FC level of 260±46 µg/g, and a normal colonoscopy. IUS showed a significant difference (p<0.0001) between sigmoid BWT for IBS-D (3.16±0.09 mm) and HC (1.6±0.12 mm). Color Doppler signals were also absent. A significant correlation between sigmoid BWT and FC level (r=0.48, p=0.0012) was found in patients with IBS-D.

Conclusion: Compared to HC, sigmoid BWT was significantly increased in IBS-D patients with symptom exacerbation. Sigmoid BWT correlates significantly with FC levels during IBS-D symptom exacerbation.

Ultrasound (US) examinations are not only diagnostic procedures but also psychologically charged experiences that shape patients' perceptions, emotions, and behaviors, a field we term sonopsychology. In obstetrics, US functions as both a clinical and psychosocial milestone: it reassures parents, strengthens maternal-fetal bonding, and provides shared experiences, while simultaneously provoking anxiety, especially in high-risk pregnancies or when abnormal findings are detected. Effective communication, empathetic interaction, and involvement of partners and family are critical in reducing distress and enhancing attachment. In gynecology, US examinations may raise fears related to fertility, chronic disorders, or cancer, with transvaginal studies carrying additional vulnerability due to their intimate nature. Sensitive handling, informed consent, and respectful interaction are therefore essential. Pediatric US presents unique challenges, as cooperation depends on developmental stage, prior experiences, and the emotional climate of the exam. Strategies such as age-appropriate explanations, play, distraction, and parental presence are vital to minimize fear and encourage trust. Across all patient groups, sonopsychology emphasizes that ultrasound is more than imaging; it is a human encounter where communication, empathy, and psychological awareness directly influence outcomes. Future research should refine interventions to reduce "scanxiety," explore child- and family-centered approaches, and optimize the integration of psychological care into routine sonography.

Aims: This study aimed to assess the diagnostic value of transfistular contrast-enhanced ultrasound (CEUS) for branchial cleft fistulas (BCF), using surgical findings as the reference standard.

Materials and methods: Fifty - six patients were initially suspected of having BCF. Among them, 35 patients who underwent two-dimensional ultrasound (2D-US), transfistular CEUS, and prior to surgery were retrospectively enrolled. The diagnostic accuracy of transfistular CEUS and 2D-US for BCF detection was compared. The agreement between CEUS and surgical findings in internal orifice localization and BCF classification was assessed.

Results: Among the enrolled 35 patients, 29 were surgically confirmed as BCF. Postoperative surgical findings served as the reference standard for all analyses. Transfistular CEUS demonstrated superior diagnostic accuracy compared to 2D-US for BCF detection (91.4% vs. 82.9%). Excellent agreement was observed between CEUS and surgical findings in internal orifice localization (κ=0.814, p<0.001). For BCF classification, the accuracy, sensitivity, and specificity of transfistular CEUS were as follows: type I BCF (93.1%, 93.8%, 92.3%), type II BCF (89.7%, 71.4%, 91.3%), and pyriform fossa fistulas (96.6%, 100.0%, and 95.7%), respectively.  Conclusions: As a radiation-free, cost-effective, and non-invasive technique, transfistular CEUS can accurately diagnose BCF, precisely localize its internal orifice, and effectively differentiate its subtypes. For patients clinically suspected of BCF, transfistular CEUS is a reliable preoperative tool for individualized clinical guidance.