Medical ultrasonography最新文献

The use of gray-scale and color Doppler ultrasound as a first-line imaging modality for wrist pain can be advantageous, especially in cases of clinically suspected carpal tunnel syndrome. This report presents the case of a medical sonographer who exhibited acute wrist pain secondary to a thrombosed persistent median artery after excessive stress loading on her scanningwrist. Ultrasound is able to easily diagnose this rare condition, which may at times be associated with carpal tunnel symptoms due to mass effect from the expanded aberrant artery.

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.

Emergency ultrasound, or point-of-care ultrasound (POCUS), has been established into daily patient care over the last decades. The use of abdominal and pelvic ultrasound in clinical practice has the potential to improve the efficiency and safety of pediatric emergency care. This article will provide a review of current applications of pediatric emergency abdominal and urogenital ultrasound, forming the second part of the series.

Aim: This meta-analysis evaluates the diagnostic accuracy of ultrasound (US) for bone fractures over the past 47 years, comparing it to established imaging standards.

Material and methods: We adhered to PRISMA 2020 guidelines to search Medline, EMBASE, and the Cochrane Library using tailored search strategies. The primary outcome, US diagnostic performance, was analyzed across various subgroups including clinical relevance, patient age, and anatomical considerations. The QUADAS-2 tool was employed to assess study quality and minimize bias.

Results: From 5,107 initially identified studies, 75 met the inclusion criteria, encompassing 7,769 participants and 3,575 diagnosed fractures. The majority of studies were prospective (79%) and compared US primarily with plain radiography (76%) and CT scans (19%). Of these, 61 studies were amenable to systematic analysis, revealing US to have a sensitivity and specificity of 91% (95% CI: 90%-92%) and 91.3% (95% CI: 90.5%-92.1%), respectively. Likelihood ratios were favorable, with a positive value of 9.955 and a negative value of 0.087, and an odds ratio of 132.67. The area under the curve stood at 0.9715, indicating high diagnostic accuracy despite significant heterogeneity (I²=81.3% for sensitivity, 89.3% for specificity).

Conclusion: The evidence supports US as a highly accurate diagnostic tool for bone fractures, rivalling standard imaging methods like CT and radiography. Its notable diagnostic efficacy, combined with advantages in reducing pain, wait times, and radiation exposure, advocates for its broader application. Further validation in large-scale, randomized trials is essential to integrate US more fully into clinical guidelines for fracture management.

In this series of articles on comments and illustrations of the World Federation for Medicine and Biology (WFUMB) guidelines on contrast-enhanced ultrasound (CEUS), the topics on very rare focal liver lesions (FLL) are discussed. This article describes the diverse changes of focal liver lesions in peliosis hepatis and the typical changes in porphyria. Although the focus is on the appearance on ultrasound and CEUS, the clinical context is always considered. While peliosis may be a surprising finding on puncture, lesions in porphyria cutanea tarda may be typical visual diagnoses that obviate the need for biopsy. If only you knew. This article aims to sharpen the clinician's eye. It provides knowledge of the clinical presentation and US and CEUS imaging of peliosis hepatis and porphyria.

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