Medical ultrasonography最新文献

Aim: The aim of the study was to develop machine learning algorithms (MLA) for diagnosing acute graft dysfunction (AGD) in kidney transplant recipients based on contrast-enhanced ultrasound (CEUS) analysis of the graft.Materials and methods: This prospective study involved 71 patients with kidney transplant undergoing CEUS during follow-up. AGD wasdefined as an increase in serum creatinine levels of at least 25% compared to the baseline of the last three months. The control group consisted of patients with stable kidney graft function (SGF). The top five CEUS parameters that achieved the best discrimination between the AGD and SGF groups were selected based on ANOVA testing and then employed as input for training MLA (naïve Bayes (NB), k-nearest neighbors (k-NN), and logistic regression (LR)). The models were validated by leave-one-out cross-validation.

Results: Among the 111 CEUS analyses, 21 corresponded to the AGD group and 90 to the SGF group. CEUS analyses yielded 44 parameters, from which five were selected: the wash out rate in segmental arteries,time to peak in segmental arteries, medullary mean transit time, renal mean transit time, and medullary time to fall. These five parameters were employed as input for MLA, yielding an AUROC of 0.68 for NB and k-NN and 0.72 for LR. The inclusion of graft survival in the MLA significantly improved discrimination accuracy, yielding an AUROC of 0.79 for NB, 0.76 for k-NN,and 0.81 for LR.

Conclusions: The use of MLA represents a promising strategy for analyzing CEUS-derived parameters in the setting AGD.

Aims: Hepatic epithelioid hemangioendothelioma (HEHE) is a rare vascular tumor that primarily affects the liver. This study aimed to analyze the characteristics of conventional ultrasound (US) and contrast-enhanced ultrasonography (CEUS) in HEHE.

Material and methods: This multi-center case series study enrolled patients diagnosed with HEHE from five hospitals in China between August 2004 and October 2022. Data on conventional US and CEUS characteristics were collected and analyzed.

Results: A total of 41 patients with HEHE were included, comprising 14 males and 27 females with a mean age of 50.62±11.43 years. The mean size of the lesion was 4.51±2.92 cm. Among these patients, 29 were confirmed through surgical resection and 12 through liver biopsy. Conventional US imaging identified three types of HEHE: multifocal type in 35 patients (85.4%), single nodular type in 1 patient (2.4%), and giant type in 5 patients (12.2%). US revealed proximity to the liver capsule in 29 patients (71%), hypoechoic appearance in 36 patients (88%), heterogeneity in 4 patients (10%), and hyperechoic appearance in 1 patient (2.4%). CEUS also demonstrated three distinct enhancement patterns: peripheral marginal enhancement with centripetal filling in the arterial phase and washout in the portal venous and venous phases (23 patients), eterogeneous enhancement in the arterial phase with washout in the subsequent phases (7 patients), and mild hyperenhancement in the arterial phase with resolution in later phases (9 patients). A hypo-enhancement pattern in the portal venous and venous phases was observed in 38 patients, suggesting a higher degree of malignancy.

Conclusion: HEHE exhibits specific US findings, primarilypresenting as multiple hypoechoic lesions distributed under the liver capsule.

Aims: The purpose of our study was to determine resident radiologists' accuracy in diagnosing carotid atherosclerotic plaque and to assess any factors leading to incorrect findings.

Materials and methods: The results of preliminary carotid scanning performed by radiology residents from December 1, 2021, to August 1, 2022, were retrospectively reviewed. These scans received an instant review by experts. The discrepancy rates of the resident radiologists were evaluated using expert diagnoses. Then, the plaque detection rate of the resident radiologists was investigated for different plaque characteristics. The causes of incorrect stenosis diagnoses were analyzed.

Results: In the investigation of carotid plaque detection, a total of 274 carotid scans from 137 patients were evaluated in our hospital. The overall agreement rate of plaque detection was 90.9%. Echolucent plaques, plaques in the lateral or near wall, and plaques in the carotid bulbs were more likely to be misdiagnosed by resident radiologists. A total of 325 plaques were included in the investigation of carotid artery stenosis classification. The overall agreement rate of stenosis evaluation was 67.7%. The misclassification of moderate stenosis was greater than that of mild and severe stenosis (p=0.0003). The sensitivity was as low as 55.56%. Nonstandard sonographic techniques and incorrect application of interpretive criteria were two main causes.

Conclusions: Resident radiologists could accurately and efficiently detect carotid plaques. Scanning by resident radiologists can expand access to ultrasound services. Only the diagnosis of moderate stenosis by resident radiologists was not satisfactory and may require a specialized review from experienced radiologists.

The manifestation of benign hematological infiltration in the liver is a challenge due to their rare occurrence and therefore, limited awareness and the general need for biopsy and histological confirmation. Owing to the rarity of these lesions, there are limited data concerning their appearance on ultrasound and, specifically, contrast-enhanced ultrasound. In a series of papers, we have compiled the US and CEUS characteristics of rare FLL, where there are few reports and images available, in order to build up a library of these cases. This paper describes the US and CEUS features of benign hematological FLL which include hepatic extramedullary hematopoiesis (EMH), hemophagocytic lymphohistiocytosis (HLH) and reactive lymphoid hyperplasia (RLH). Although these lesions occur rarely in the liver, their correct identification is imperative for appropriate patient`s management.

Loffler endocarditis is a rare disease associated with high mortality rates, therefore early diagnosis and prompt treatment are crucial factors in managing this condition effectively. The clinical manifestations are nonspecific which can lead to misdiagnosis easily. Here we report a case of rare idiopathic hypereosinophilic syndrome with Loffler endocarditis as the first presentation, first suspected acute coronary syndrome, diagnosed correctly by cardiac ultrasound. The purpose is to improve our understanding of the ultrasound manifestations of this disease.

Intra-articular hyaluronic acid (HA) injections are widely used for the treatment of symptomatic knee osteoarthritis. Adverse reactions were described in a limited number of patients and consist in local inflammatory reactions and severe acute inflammatory reactions (pseudosepsis). We present the case of a 71-year-old woman who experienced a severe acute adverse effect immediately (within minutes) following intraarticular HA administration, attributed to HA precipitation. The severe very early local manifestations were accompanied by important systemic reactions, necessitating treatment with systemic corticosteroids besides joint lavage.

Aim: The utility of the venous excess ultrasound (VExUS) score in predicting mortality remains uncertain in acute kidney injury (AKI) patients.

Material and methods: This was a post-hoc study involving 246 AKI patients presenting to a tertiary care emergency department. Venous ultrasound assessments were conducted to determine the VExUS score. Cox regressionanalysis was used to identify predictors of 6-month mortality.

Results: The study found no significant association between the VExUS score and 6-month mortality in AKI patients in the regression analyses. However, in the subgroup analyses, VExUS grades 2-3 were associated with lower survival rates in the cardiorenal subgroup (HR: 3.98 [95% CI: 1.33-11.93]), and in AKI grade 1 (HR: 4.07 [95% CI: 1.74-9.49]). This association was not present in other AKI subgroups. The predictors of mortality included higher age (OR: 1.024; 95% CI 1.005-1.043), malignancy (OR: 2.186; 95% CI 1.408-3.392), lower systolic blood pressure (OR: 0.990; 95% CI 0.982-0.998), elevated pulse (OR: 1.013; 95% CI 1.005-1.022), and higher lactate levels (OR: 1.210; 95% CI 1.097-1.334).

Conclusion: The VExUS score did not predict 6-month mortality in the general cohort of AKI patients in the emergency department. However, VExUS grades 2-3 were associated with lower survival rates in the cardiorenal subgroup and patients with AKI grade 1.

Aims: Peripheral artery disease (PAD) represents a high burden on the healthcare and social assistance systems. Revascularization reduces symptoms, amputation rate and increases the chances of social reintegration. Our aim was to evaluate the benefits of vascular duplex ultrasonography (DUS) for identifying patients suitable for direct percutaneous transluminal angioplasty (PTA) without the need for a prior angiography.

Material and methods: We included in the study 251 patients with PAD evaluated by DUS. Depending on the DUS findings the patients were split in two groups: group I, 143 patients (57%), in which selective angiography and direct PTA was performed and group 2, 108 patients (43%), in which invasive arteriography was considered necessary prior to a decision for revascularization. Results: The first group had a similar success rate (92.3% vs. 86.1%; p=0.111), but with a reduction in radioscopy time (minutes) (17.2 vs. 20.8; p=0.013), iodine contrast volume (ml) (190 vs. 227.5; p<0.001), days of hospitalization (4 vs. 7; p<0.001) and by 44.75% (p<0.001) of hospitalization costs when compared to the second group.

Conclusions: DUS allows the optimal selection of patients who can benefit from direct PTA. This strategy has a high success rate, with a significant decrease in radioscopy exposure time, volume of iodine contrast needed, duration and hospitalization costs, when compared to arteriography and PTA in two different sessions.

Aims: Performing prophylactic central lymph node dissection for papillary thyroid microcarcinoma (PTMC) patients with clinically negative lymph node metastasis remains controversial - not all patients with PTMC are suitable for active surveillance. Therefore, we aimed to establish a nomogram based on ultrasound features for predicting CLNM in PTMC.

Material and methods: This retrospective study included 636 patients with PTMC, in which the CLNM status was pathologically confirmed. Univariate and multivariate regression analyses were conducted to screen for risk factors associated with CLNM. Then, a CLNM prediction model was established, receiver operating characteristic, calibration, and decision curve analyses were used to assess the model's performance.

Results: Five variables, including age, sex, combined CLNM status, tumor size, and capsule invasion, were included in the nomogram. The values of the area under the receiver operating characteristic curve in the training and validation datasets were 0.720 (95% confidence interval [CI], 0.649-0.791) and 0.704 (95% CI, 0.622-0.786), respectively.

Conclusions: An ultrasound-based nomogram was successfully established, of which the predictive model shows excellent predictive performance and can be used to evaluate the status of CLNM in PTMC. Thus, patients with high nomogram scores should be considered for prophylactic central neck dissection.

Aim: To investigate the application of ultrasound along with clinical features for the differential diagnosis of low-grade appendiceal mucinous neoplasm (LAMN) and acute suppurative appendicitis (ASA).

Material and methods: The ultrasound and clinical data of 76 patients with histopathologically confirmed LAMN (31 patients) and ASA (45 patients) were retrospectively analyzed. Univariate analysis and binary logistic regression analysis of the influencing factors were conducted to identify LAMN and ASA. The AUROC was calculated to analyze the diagnostic efficacy of these independent factors. A four-grid table was established to determine the diagnostic efficacy of the ultrasound marks for diagnosing LAMN.

Results: Patient age and appendix short diameter in the LAMN group were found to be significantly higher than those in the ASA group. The neutrophil ratio and thickness of the appendix wall in the LAMN group were significantly lower than they were in the ASA group. Patient age (OR=1.112, p=0.015) and appendix short diameter (OR=1.476, p=0.008) were independent risk factors for LAMN. The AUROCs for age and short diameter were 0.898 [95% CI: 0.807, 0.956] and 0.953 [95% CI: 0.879, 0.988], respectively. The LAMN group tumors were characterized by the appearance of an "onion skin" sign or a purely cystic mark on sonograms, with specificities of 100% for both. Neutrophil ratio (OR<0.001, p=0.064) and thickness of the appendix wall (OR=0.776, p=0.414) were not independent risk factors for ASA.

Conclusion: Employing ultrasonography with clinical features is useful for distinguishing LAMN from ASA. Patient age, short diameter of the appendix, and sonographic appearance of "onion skin" or purely cystic mark could be key factors in diagnosing LAMN.