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Diagnostic ultrasound in the diagnosis of carpal tunnel syndrome is firmly established. Preoperative evaluation is based on quantitative parameters such as measurement of the pathologically enlarged cross-sectional area of the nerve. The value of postoperative ultrasound lies in the visualization of the anatomy and the conclusions that can be drawn from it. It focuses on the semiquantitative sonographic parameters of nerve compression. Nerve lesions and persistent strictures can be visualized and clearly localized. In recurrent disease, the primary focus is to dynamically exclude postoperative scarring, which results in a reduction of nerve gliding.

This article describes the technical principles and indications for the most often encountered diagnostic imaging modalities in veterinary dentistry and oral surgery; with extensive coverage of intraoral (and extraoral) dental radiographic imaging and interpretation through detailed example figures of common dental and maxillofacial diseases in the dog and cat. Multidetector/multislice computed tomography (MDCT/MSCT) and emergent technologies such as cone-beam computed tomography (CBCT) are presented here in detail. Magnetic resonance imaging (MRI) and diagnostic ultrasound, which are used less frequently, are briefly discussed.

Objective To identify risk factors associated with an inaccurate diagnosis, delayed referral, and/or inappropriate ultrasound in consecutive referrals for an undescended testicle (UDT). Methods This study was approved by the institutional review board. Data was prospectively collected for all children referred to University of Oklahoma's pediatric urology service from August 2019 to February 2020. The data was imported into SAS vs 9.4 for analysis. We categorized the “quality” of referral by a point system using 3 factors (no previous ultrasound, ≤18 months, correct location). An optimal referral had an accurate testicular examination, was referred by 18 months of age, and no diagnostic ultrasound. Results We collected 75 referrals. Thirty-nine (52.0%) had confirmed UDT, requiring surgery. Twenty-seven (69.2%) had an accurate initial examination. Forty-one (54.7%) were outside the optimal age. Thirty-four were considered low quality (0-1 qualities) and 41 were high quality (2-3 qualities). Seven (9.3%) were optimal (3/3 qualities). Referrals that needed intervention were statistically more likely to be higher quality. Conclusion Increased quality of UDT referrals directly correlated with the likelihood for treatment. This study reveals a need for more education on UDT referral in the community. By improving referring provider knowledge and skills, we can minimize unnecessary referrals.

Shoulder ultrasound (US) examination is the most frequent US application in the musculoskeletal field. This review article critically analyzes the scientific literature concerning new horizons, pitfalls, and advantages in shoulder US and its translation to clinical practice. Although sonographic appearance of shoulder pathologies such as tendinopathy, tendon tear, bursal pathologies, degenerative changes, calcifications, joint abnormalities, and different signs is important, awareness of different shoulder US pitfalls, dynamic assessments, axillary recess evaluation, post-surgical changes, elastography, and other new advancements in this field will be essential for the expert sonographer. Acknowledgment of new techniques and pitfalls in the shoulder US will improve diagnosis and treatment of different shoulder pathologies.

The advent of localization-based super-resolution ultrasound (SRUS) imaging creates a vista for precision vasculature and hemodynamic measurements in brain science, cardiovascular diseases, and cancer. As blinking fluorophores are crucial to super-resolution optical imaging, blinking acoustic contrast agents enabling ultrasound localization microscopy have been highly sought, but only with limited success. Here we report on the discovery and characterization of a type of blinking acoustic nanodroplets (BANDs) ideal for SRUS. BANDs of 200-500 nm diameters comprise a perfluorocarbon-filled core and a shell of DSPC, Pluronic F68, and DSPE-PEG2000. When driven by clinically safe acoustic pulses (MI < 1.9) provided by a diagnostic ultrasound transducer, BANDs underwent reversible vaporization and reliquefaction, manifesting as "blinks", at rates of up to 5 kHz. By sparse activation of perfluorohexane-filled BANDs-C6 at high concentrations, only 100 frames of ultrasound imaging were sufficient to reconstruct super-resolution images of a no-flow tube through either cumulative localization or temporal radiality autocorrelation. Furthermore, the use of high-density BANDs-C6-4 (1 × 108/mL) with a 1:9 admixture of perfluorohexane and perfluorobutane supported the fast SRUS imaging of muscle vasculature in live animals, at 64 μm resolution requiring only 100 frames per layer. We anticipate that the BANDs developed here will greatly boost the application of SRUS in both basic science and clinical settings.

Rotator cuff repair is performed to effect healing of the enthesis; to restore shoulder comfort, strength, and function; to prevent tear propagation; and to prevent progression of atrophic muscle changes (fatty degeneration, fatty infiltration, and fatty atrophy) that eventually occur. Non-retracted and moderately retracted rotator cuff tears usually heal after repair, and muscle atrophy may recover over time. It follows that early rotator cuff repair is beneficial for many patients with chronic but reparable rotator cuff tears. Diagnostic ultrasound can provide quantitative information about the recovery of both muscle and tendon and represents a viable alternative to magnetic resonance imaging for evaluating healing after rotator cuff repair.

Epidermal inclusion cyst is a relatively common benign lesion of the skin, and it can occur anywhere in the hair-bearing area of the body. It usually appears as an asymptomatic mass, which is less than 4 cm in size. However, rarely it can occur as a large mass in the axilla, and in such cases, the location and size tend to cause more complications. The author encountered a patient with a large epidermal inclusion cyst of the axilla. Ultrasound examination showed an oval-shaped hypoechoic subcutaneous mass with dermal attachment, intralesional echogenic reflectors, filiform anechoic areas, and no vascularity. These characteristic imaging features could lead to an accurate preoperative imaging diagnosis without biopsy and avoid subsequent complications. Excision of the mass was performed due to discomfort because of the large size and growing nature of the lesion, and histological examination confirmed the diagnosis of an epidermal inclusion cyst. Therefore, recognition of diagnostic ultrasound features of this entity may enable an accurate preoperative diagnosis, even when it has an unusual size and location.

Introduction Musculoskeletal diagnostic ultrasound is an expanding clinical tool and increasingly used at point of care in clinical practice. Criticism around the accuracy of this modality is often attributed to operator dependence. This study evaluated the accuracy of a sonographer’s reporting against shoulder surgery. Methods A musculoskeletal sonographer performed same-day ultrasound scans prior to elective shoulder surgery procedures. The sonographer was blinded to clinical history and previous investigations. A brief physical examination of resisted external rotation and resisted abduction strength was performed prior to scanning. Scan results were reported using British Elbow and Shoulder Society (BESS) reporting criteria. The sonographer attended surgery to gain immediate visual feedback. Sonographic reports and magnetic resonance imaging (MRI) reports were graded (1= complete agreement; 2 = minor discrepancy unlikely to alter patient care; 3 = potentially significant discrepancy; 4 = definite, significant discrepancy) against surgical findings. The accuracy of sonographic reporting was correlated with patients’ body mass index (BMI). Results Fifty-four cases were compared and correlations evaluated. Grade 1 (complete agreement) was reported 87.0% ( n = 47), Grade 2 (minor discrepancy) 9.3% (n = 5) and Grade 3 (potentially significant discrepancy) 3.7% (n = 2). Sonographic reports closely correlated (Grade 1 or 2 scores) with surgical findings in 96% of cases. Conclusions The musculoskeletal sonographic reporting had a high correlation with surgery findings. Ultrasound was more accurate than MRI in reporting full thickness rotator cuff tears. Clinical weakness in resisted external rotation or abduction did not correlate with imaging. Ultrasound was found to be unreliable in detecting rotator cuff tears in participants with a BMI ≥ 35.

Background and Aim The adverse effects of smartphone size and weight on the hand and hand function have not been studied extensively. This study aimed to investigate the changes to the flexor pollicis longus tendon and median nerve using diagnostic ultrasound for high and low addiction smartphone users. Methodology In this cross-sectional study, 54 healthy male university students were divided into two groups according to the Smartphone Addiction Scale: high and low users. Demographic data, hand grip strength (kg), pinch strength (kg), and smartphone weight, length and width were measured and recorded. Diagnostic ultrasound examination determined the cross-sectional area of the median nerve (mm2) and flexor pollicis longus tendon (mm2) of the dominant and non-dominant hand. Result The cross-sectional area of the median nerve was significantly higher in the high-user group (7.4±1.3 mm2) than the low-user group (6.7±1.0 mm2). The correlation of phone weight, length and width with median nerve area was respectively positive, higher and significant (0.718, 0.747, and 0.733; p Conclusion The findings of the current study demonstrates that change to the median nerve and flexor pollicis longus tendon, could be linked to the width, weight and length of the smartphone and high addiction.

Pseudoaneurysms of the superficial temporal artery are rare. They commonly occur after blunt trauma to the frontotemporal region of the head. There have been less than 400 cases of superficial temporal artery pseudoaneurysms reported. We present a case of a patient referred for a pulsatile head mass. Physical examination and color Doppler ultrasound confirmed the diagnosis of a superficial temporal artery pseudoaneurysm (STA PSA). This was treated with ultrasound guided thrombin injection with complete resolution. Anatomical distribution, diagnosis, and treatment of STA PSA are discussed.

Many radiologists are interested in providing affordable care to underserved populations but are unsure how to accomplish it. We present a model for providing imaging services to the underserved with an emphasis on the challenges we encountered and strategies we used to overcome them. In partnership with our medical school's student-run free clinic, we developed a community-based ultrasound service that provides diagnostic ultrasound examinations to an uninsured urban population to address the need of timely access to care and integrated follow-up care. Image storage and reporting were fully integrated with our existing imaging informatics and electronic medical record systems. Radiology residents play a central role in the operation of the service while gaining hands-on ultrasound experience, in partnership with volunteer sonographers, radiology attendings, and medical students.

To assess the diagnostic performance of contrast-enhanced ultrasound (CEUS) for additional MR-detected enhancing lesions and to determine whether or not kinetic pattern results comparable to dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) of the breast can be obtained using the quantitative analysis of CEUS.In this single-center prospective study, a total of 71 additional MR-detected breast lesions were included. CEUS examination was performed, and lesions were categorized according to the Breast Imaging-Reporting and Data System (BI-RADS). The sensitivity, specificity, and diagnostic accuracy of CEUS were calculated by comparing the BI-RADS category to the final pathology results. The degree of agreement between CEUS and DCE-MRI kinetic patterns was evaluated using weighted kappa.On CEUS, 46 lesions were assigned as BI-RADS category 4B, 4C, or 5, while 25 lesions category 3 or 4A. The diagnostic performance of CEUS for enhancing lesions on DCE-MRI was excellent, with 84.9% sensitivity, 94.4% specificity, and 97.8% positive predictive value. A total of 57/71 (80%) lesions had correlating kinetic patterns and showed good agreement (weighted kappa = 0.66) between CEUS and DCE-MRI. Benign lesions showed excellent agreement (weighted kappa = 0.84), and invasive ductal carcinoma (IDC) showed good agreement (weighted kappa = 0.69).The diagnostic performance of CEUS for additional MR-detected breast lesions was excellent. Accurate kinetic pattern assessment, fairly comparable to DCE-MRI, can be obtained for benign and IDC lesions using CEUS.자기공명영상에서 추가적으로 발견된 조영증강 병소에 대한 조영증강 초음파의 진단 능력을 평가하고 조영증강 초음파의 정량 분석을 사용하여 유방 동적 조영증강 자기공명영상과 유사한 운동 패턴 결과를 얻을 수 있는지 분석하였다.단일 센터 전향적 연구로 진행하였고, 총 71개의 자기공명영상에서 추가적으로 발견된 조영증강 병소가 포함되었다. 이러한 병소에 대해 조영증강 초음파를 시행하였고 Breast Imaging-Reporting and Data System (이하 BI-RADS)에 따라 분류하였다. 그리고 모든 병소의 BI-RADS 분류를 조직학적 결과와 비교하여 조영증강 초음파의 민감도, 특이도 및 진단 정확도를 계산하였다. 조영증강 초음파와 동적 조영증강 자기공명영상의 운동 패턴 사이의 일치도는 가중 카파 분석을 사용하여 평가되었다.조영증강 초음파에서 총 46개의 병소가 BI-RADS 4B, 4C, 5로 분류되었고, 25개의 병소가 BI-RADS 3, 4A로 분류되었다. 자기공명영상에서 추가적으로 발견된 조영증강 병소에 대한 조영증강 초음파의 진단 능력은 84.9%의 민감도, 94.4%의 특이도 및 97.8%의 긍정적 예측값으로 우수하였다. 총 57/71 (80%) 병소는 조영증강 초음파와 동적 조영증강 자기공명영상 운동 패턴 결과가 일치하였고 가중 카파 값 0.66으로 좋은 일치도를 나타냈다. 부분 군 분석에서 양성 병소는 우수한 일치를 보였고(가중 카파 값 = 0.84), 관내암종은 좋은 일치를 보였다(가중 카파 값 = 0.69).MRI에서 추가 검출된 유방 결절에 대한 조영증강 초음파의 진단 능력은 우수했다. 양성 및 관내암종 병소에서 동적 조영증강 자기공명영상과 조영증강 초음파의 운동 패턴 결과는 좋은 일치도를 보였다.

Background Failure of fascial sliding may occur in cases of excessive or inappropriate use, trauma, or surgery, resulting in local inflammation, pain, sensitization, and potential dysfunction. Therefore, the mechanical properties of fascial tissues, including their mobility, have been evaluated in vivo by ultrasound (US) imaging. However, this seems to be a method that is not yet properly standardized nor validated. Objectives To identify, synthesize, and collate the critical methodological principles that have been described in the literature for US evaluation of deep fascia sliding mobility in vivo in humans. Methods A systematic literature search was conducted on ScienceDirect, PubMed (Medline), Web of Science and B-On databases, according to the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines. The OCEBM LoE was used to evaluate the level of evidence of each study. Results From a total of 104 full-text articles retrieved and assessed for eligibility, 18 papers were included that evaluate the deep fasciae of the thoracolumbar (n = 4), abdominal (n = 7), femoral (n = 4) and crural (n = 3) regions. These studies addressed issues concerning either diagnosis (n = 11) or treatment benefits (n = 7) and presented levels of evidence ranging from II to IV. Various terms were used to describe the outcome measures representing fascial sliding. Also, different procedures to induce fascial sliding, positioning of the individuals being assessed, and features of US devices were used. The US analysis methods included the comparison of start and end frames and the use of cross-correlation software techniques through automated tracking algorithms. These methods had proven to be reliable to measure sliding between TLF, TrA muscle-fascia junctions, fascia lata, and crural fascia, and the adjacent epimysial fascia. However, the papers presented heterogeneous terminologies, research questions, populations, and methodologies. This two-part paper reviews the evidence obtained for the thoracolumbar and abdominal fasciae (Part 1) and for the femoral and crural fasciae (Part 2). Conclusion The US methods used to evaluate deep fascia sliding mobility in vivo in humans include the comparison of start and end frames and the use of cross-correlation software techniques through automated tracking algorithms. These seem reliable methods to measure sliding of some fasciae, but more studies need to be systematized to confirm their reliability for others. Moreover, specific standardized protocols are needed to assess each anatomical region as well as study if age, sex-related characteristics, body composition, or specific clinical conditions influence US results.

Dougho Park,1 Byung Hee Kim,1 Sang-Eok Lee,1 Dong Young Kim,2 Yoon Sik Eom,2 Jae Man Cho,3 Joong Won Yang,3 Mansu Kim,3 Heum Dai Kwon3 1Department of Rehabilitation Medicine, Spine and Joint Center, Pohang Stroke and Spine Hospital, Pohang, Republic of Korea; 2Department of Orthopedic Surgery, Spine and Joint Center, Pohang Stroke and Spine Hospital, Pohang, Republic of Korea; 3Department of Neurosurgery, Spine and Joint Center, Pohang Stroke and Spine Hospital, Pohang, Republic of KoreaCorrespondence: Dougho ParkDepartment of Rehabilitation Medicine, Spine and Joint Center, Pohang Stroke and Spine Hospital, 352, Huimang-Daero, Nam-Gu, Pohang, 37659, Republic of KoreaTel +82 54 289 9171Fax +82 54 289 9100Email parkdougho@gmail.comPurpose: A bifid median nerve (BMN) is not a rare variant. This study aimed to investigate the features of carpal tunnel syndrome (CTS) accompanied by BMN.Patients and Methods: In this retrospective study, we defined a BMN group as CTS with BMN and a non-bifid median nerve (NMN) group as CTS without BMN. All hands were assigned to four severity grades according to the findings of electrodiagnosis (EDx): very mild, mild, moderate, and severe. The cross-sectional area (CSA) of the median nerve, palmar bowing of the flexor retinaculum, and persistent median artery (PMA) were assessed by ultrasonography. Numerical pain rating scale (NRS) and symptom duration were assessed as clinical variables.Results: Sixty-four hands (57 patients) and 442 hands (341 patients) were enrolled in the BMN and the NMN groups, respectively. BMN was prevalent in 12.6% of all CTS hands. The distribution of EDx severity grade was milder in the BMN group than in the NMN group (P< 0.001). The CSA of the BMN group was 16.2± 4.1 mm2, slightly larger than 15.1± 4.2 mm2 in the NMN group (P=0.056). The BMN group showed higher NRS than the NMN group (5.5± 1.5 and 4.4± 1.7, respectively; P< 0.001). In the subgroup analysis, NRS was significantly higher in the BMN group than in the NMN group at all EDx severity grades. In the BMN group, the PMA group showed greater EDx severity (P=0.037) and higher NRS (6.0 and 5.0, respectively; P=0.012) than the non-PMA group. The radial side branch’s CSA was larger than that of the ulnar side branch (10.0 mm2 and 6.0 mm2, respectively; P< 0.001).Conclusion: CTS with BMN presented more severe symptoms and relatively milder EDx severity. When assessing the severity of CTS with BMN, the clinical symptoms should primarily be considered, as well as we should complementarily evaluate the EDx and ultrasonography.Keywords: carpal tunnel syndrome, bifid median nerve, electrodiagnosis, diagnostic ultrasound, pain measurement

Background: Endoscopic submucosal dissection has become popular. However, this can cause serious complications. In this case, esophageal perforation caused bilateral tension pneumothorax.Case: A 60-year-old man with esophageal adenoma underwent endoscopic submucosal dissection under general anesthesia. The peak airway pressure was 25 cmH2O after induction but abruptly increased to 40 cmH2O after 30 min. Respiratory sounds were barely heard. The lack of lung sliding in either (right-dominant) lung on ultrasound. Within minutes, oxygen saturation and systolic blood pressure decreased to 52% and 70 mmHg. Emergent needle thoracostomy, followed by chest tube insertion, was performed on right chest and his vital signs stabilized. Upon transfer to intensive care unit, oxygen saturation and blood pressure decreased again; therefore, a left chest tube was inserted. Conclusions: Pneumothorax due to esophageal perforation can lead to life-threatening tension pneumothorax. Anesthesiologists should be aware of the risks and emergency treatment. Ultrasound can be useful for immediate bedside patient-care decisions.

Background The use of multiparametric magnetic resonance imaging (mpMRI) within active surveillance of prostate cancer programmes is identified by the UK National Institute for Health and Care Excellence (NICE guideline NG 131 2019) as having a role for monitoring disease. The widespread demands on mpMRI capacity may limit its use in surveillance. It is therefore timely to review the options that modern ultrasound imaging present to this cohort of patients in the monitoring of prostate cancer. Methods Between April and September 2020, 10 databases were searched to recruit studies for the review. Three reviewers evaluated the publications for inclusion. Characteristics including the inclusion criteria for the study cohort, how disease was determined, identification of disease progression, and the modality and mode of imaging used were reviewed. Given the paucity of full text articles, a meta-analysis was not possible. A narrative review was undertaken. Results In total, 12 studies, utilising the range of ultrasound parameters of B-mode, micro-ultrasound, colour Doppler, contrast ultrasound and elastography were included. The review demonstrated that micro-ultrasound offers promise as an imaging tool comparable with mpMRI. However, this is an emerging technology with limited availability. Analysis of the data further demonstrated that by combining the diagnostic features provided by multiple modes reviewed, ultrasound has a role in the diagnostic imaging of patients on active surveillance. Conclusion Providing a multiparametric approach is utilised, stable ultrasound findings may allow for increased intervals between biopsy for men on surveillance. The advent of micro-US offers promise as an imaging modality within an active surveillance pathway but requires further verification.

The ability to monitor cavitation activity during ultrasound and microbubble-mediated procedures is of high clinical value. However, there has been little reported literature comparing the cavitation characteristics of different clinical microbubbles, nor have current clinical scanners been used to perform passive cavitation detection in real time. The goal of this work was to investigate and characterize standard microbubble formulations (Optison, Sonovue, Sonazoid, and a custom microbubble made with similar components as Definity) with a custom passive cavitation detector (two confocal single-element focused transducers) and with a Philips EPIQ scanner with a C5-1 curvilinear probe passively listening. We evaluated three different methods for investigating cavitation thresholds, two from previously reported work and one developed in this work. For all three techniques, it was observed that the inertial cavitation thresholds were between 0.1 and 0.3 MPa for all agents when detected with both systems. Notably, we found that most microbubble formulations in bulk solution behaved generally similarly, with some differences. We show that these characteristics and thresholds are maintained when using a diagnostic ultrasound system for detecting cavitation activity. We believe that a systematic evaluation of the frequency response of the cavitation activity of different microbubbles in order to inform real-time therapy monitoring using a clinical ultrasound device could make an immediate clinical impact.

Background: Predicting difficult intubation (DI) is a key challenge, as no single clinical predictor is sufficiently valid to predict the outcome. We evaluated the effectiveness of four upper airway ultrasonographic parameters in predicting DI. The validity of the models using combinations of ultrasonography-based parameters was also investigated.Methods: This prospective, observational, double-blinded cohort trial enrolled 1,043 surgical patients classified as American Society of Anesthesiologists physical status I–III without anticipated difficult airway. Preoperatively, their tongue thickness (TT), invisibility of hyoid bone (VH), and anterior neck soft tissue thickness from the skin to thyrohyoid membrane (ST) and hyoid bone (SH) were measured by sublingual and submandibular ultrasonography. The logistic regression, Youden index, and receiver operator characteristic analysis results were reported.Results: Overall, 58 (5.6%) patients were classified as DI. The TT, SH, ST, and VH had accuracies of 78.4%, 85.0%, 84.7%, and 84.9%, respectively. The optimal values of TT, SH, and ST for predicting DI were > 5.8 cm (sensitivity, 84.5%; specificity; 78.1%; AUC, 0.880), > 1.4 cm (sensitivity, 81%; specificity, 85.2%; AUC, 0.898), and > 2.4 cm (sensitivity, 75.9%; specificity, 85.2%; AUC, 0.885), respectively. VH had a sensitivity and specificity of 72.4% and 85.6% (AUC, 0.790. The AUC values of the five models (with combinations of three or four parameters) ranged from 0.975–0.992. ST and VH had a significant impact on the individual models.Conclusions: SH had the best accuracy. Individual parameters showed limited validity. The model including all four parameters offered the best diagnostic value.

A review of current techniques of instrumental and laboratory diagnosis of crystal arthropathies is presented. Advantages and disadvantages of various methods of diagnostic radiology and diagnostic radiologic criteria employed in primary and differential diagnosis of crystal deposits are discussed in relation to their etiology and clinical peculiarities. It is proven from a wide pool of published studies that the method of ultrasonic diagnosis is the most available one, has no contraindications and demonstrates the best sensitivity and specificity in the diagnosis of crystalline arthropathy.

The aim of the study was to compare the dynamics of oral and oropharyngeal muscles contraction during swallowing in normal individuals and in patients with malignant tumors depending on the clinical disease using ultrasound. Materials and methods. The study included 29 patients aged 38–55 years (men), normtrophic, who were treated in the Department of Head and Neck Tumors of Podolsk Regional Oncology Center for malignant tumors of the tongue, floor of the mouth and oropharynx. Among them, there were 12 patients with cancer of the lateral tongue surface, 9 - with oral mucosa cancer and 8 – with tongue base cancer. Scanning was performed in the sagittal and frontal planes with a 7.5 MHz sensor in two modes (B and M) at rest and during swallowing in several stages on the TOSHIBA device (Model USDI-A500A/EL; Serial No. ELA14Z2082). B-mode was the main one in all the studied areas where one image frame was vertically lined up. The swallowing act was assessed in M-mode (a length of the axial movement). The obtained indicators were compared with the normal ones. Results. The work was carried out to verify the musculoskeletal complex involved in the act of swallowing. Measurements of several indicators were performed revealing a violation of the swallowing act, namely a decrease in indicators in the longitudinal and lateral examination of the sublingual muscle group in B-mode and M-mode in patients diagnosed with cancer of the tongue base and mucosa of the mouth floor. In addition, a deviation and displacement of the musculoskeletal complex to the healthy contralateral side with preserved muscle function in patients diagnosed with the lateral tongue surface cancer was revealed by M-mode ultrasound of the swallowing act. Conclusions. In patients with malignant tumors of the lateral tongue surface, the longitudinal examination of the sublingual muscle group in B-mode ultrasound showed decreased indicators by 7 % and in the lateral projection of the anterior belly of the digastric muscle in M-mode – by 3.5 times. In tongue base cancer, the mentohyoid distance was merely 4 mm reduced during the act of swallowing, and in the longitudinal projection of the sublingual muscle group - by only 5 %. In oral mucosa cancer, there was the lowest reduction in the mentohyoid distance, about 4 mm when swallowing, (in healthy people 8–12 mm) and decreased indicators in longitudinal examination of the sublingual muscle group by 8 % in B-mode, in lateral M-mode ultrasound – by 2 mm.

The article presents materials about the history of ultrasonography in veterinary practice, analyzes the literature dealing with the liver, spleen and pancreas examination, and indicates the prospects of research methods in the future. Abdominal ultrasonography of animals was used for the first time mainly for pregnan-cy diagnostics. Today, this technique is an important diagnostic procedure in veterinary medicine, which is used to study the majority of normal and pathologically changed animal structures, providing a fast, non-invasive way to supplement the information obtained from clinical examination and radiography. Ultrasound examination is based on the principle of echolocation, the waves sent by the sensor pass through body tis-sues and are displayed and decoded by the device and converted into an image, which allows a veterinary medicine specialist to assess the condition of internal organs, tissues and cavities. With increasing using ul-trasonographic examinations by veterinary doctors in practice, it becomes clear that ultrasound diagnostics is a valuable means of detecting lesions of the abdominal cavity. Liver assessment is one of the main ad-vantages of applying animal abdominal ultrasound examination. Indications include hepatomegaly, jaundice, ascites, suspected diaphragm rupture, weight loss, and possible liver metastases. Today, the meth-ods of sonographic examination are being improved and supplemented. Further implementation in practice and in-depth study of pathologies in this area with the help of ultrasonography will allow determine objec-tively the condition of the abdominal cavity and its organs in animals and assess the severity of the disease development. The introduction of high-quality, portable diagnostic ultrasound equipment has continued this development and the demand for ultrasonography due to its diagnostic value continues to increase. The con-ducted analysis of the literature and available Internet sources allowed us to assess the current state of im-plementing sonography in veterinary practice and prospects for further development the diagnosing of the liver, spleen and pancreas condition, indicate areas of potential technique development in the future.

International audience; Black tattoo ink comprises hydrophobic carbon black nanoparticles. We hypothesized that black tattoo ink demonstrates transient dynamic activity in an ultrasound field. Brightness-mode sonography was performed on cylindrical receptacles of different bore diameters, filled with black tattoo ink, water, saline, or air, using pulsed ultrasound with center frequencies of 13 MHz and 5 MHz. The scattering from black ink itself lasted less than ten minutes. At 13-MHz sonication, a transient drop in sound speed was observed, as well as a transient lessening of scattering from distal phantom tissue. The linear acoustic attenuation coefficient of pure black ink was measured to be 0.15±0.01 dB cm^{−1} MHz^{−1}, equal to whole blood. Low-intensity ultrasonic tattoo removal would be of interest as an alternative to techniques that damage surrounding tissue.

Background: Because of the large forces and high frequency of throwing, the upper extremity experiences repetitive stresses that lead to acute and chronic adaptations. While the importance of pennation angle and muscle thickness as predictors of muscle force production has been shown in other populations and other joints, there has been little research done that examines these variables in the shoulders of baseball players. Purpose: (1) To examine the chronic effect pitching has on the rotator cuff muscle architecture (pennation angle and muscle thickness) in healthy professional baseball pitchers, and (2) to examine the correlation between muscle architecture and clinical measures of strength and range of motion (ROM). Study Design: Cross-sectional study; Level of evidence, 3. Methods: Twenty-eight healthy professional pitchers were recruited during the 2019 spring training. Internal rotation (IR) and external rotation (ER) strength were measured with a handheld dynamometer and IR and ER ROM were measured with an inclinometer. A diagnostic ultrasound machine was utilized to capture images of humeral retroversion, as well as the pennation angle and muscle thickness of the infraspinatus and teres minor muscles. ImageJ software was used to quantify the pennation angle and muscle thickness. Results: There were no significant differences between the dominant and nondominant arms for ER or IR strength. Also, no pennation angle and muscle thickness differences were found between the dominant and nondominant arms. A weak positive relationship between infraspinatus muscle thickness (superficial and total) and ER strength ( P = .016, R = 0.287 and P = .009, R = 0.316) and a moderate negative relationship between soft tissue glenohumeral internal rotation deficit (GIRD) and the bilateral difference of the teres minor deep pennation angle ( R = −0.477, P = .008) were observed. No other significant relationships were noted. Conclusion: Our results are contrary to current literature as we expected to see a stronger dominant arm, with a larger pennation angle and greater muscle thickness. Interestingly, we found that ER strength was positively related to only the thickness of the infraspinatus muscle, and that soft tissue GIRD was positively related to only the side-to-side adaptation of the pennation angle within the deep portion of the teres minor. This suggests that when posterior shoulder tightness occurs, specifically the architecture of the teres minor muscle is involved. However, the organization to which these players belonged has a very extensive training protocol throughout the year that emphasizes bilateral training during a large majority of the exercises. Therefore, the results may not be generalizable to all professional players.

Introduction. In the early hours and days after traumatic or surgical event it is essential to determine type of peripheral nerve injury accurately.Objective. To assess performance of diagnostic ultrasound (US) in patients with traumatic and intraoperative nerve injuries during the early hours and days after trauma or surgery.Materials and methods. 106 patients with clinical signs of extremity nerve injuries were included into the study. A total of 113 limb nerves were investigated with US.Results. US sensitivity in the detection of complete nerve rupture was 100% (95% CI: 39,8-100%), specificity — 99,0% (94,7100,0%); for nerve compression with the bone sensitivity was 100% (66,4-100%), specificity — 100% (96,3-100%); for nerve compression with fixation devices sensitivity was 100% (66,4-100%), specificity — 100% (15,8-100%) и 100% (88,4-100%).Conclusion. Nerve US is a reliable method for the evaluation of extremity nerve injury, the method can be recommended for use in the early hours and days after trauma or surgery.

This paper is intended to provide anatomic perspective for those interested in performing or considering ultrasound-guided radiofrequency ablation (RFA) of thyroid, parathyroid, and other neck pathology. The central location of the thyroid and parathyroid glands means that vital neck structures are present on all sides. Traditional anatomic assessment of the thyroid and parathyroids is focused on characteristics within these glands and, when more comprehensive, includes attention to regional lymph nodes. The anatomic assessment of the candidate for RFA requires further attention to the detailed anatomy adjacent to and en route to the thyroid. It is critically important to recognize structures that are otherwise often ignored during diagnostic ultrasound, in order to perform proper patient selection, complete RFA procedures safely, and avoid complications. Research and reports on complications and outcomes of thyroid RFA provide insight into process improvement, which includes incorporation of ultrasound anatomy of the neck into the approach. The following discussion and images should serve to enhance the safety of thyroid and neck RFA and aid in proper patient selection.

This case report describes clinical and imaging findings in a patient with an acute dorsal Lisfranc ligament tear and repair. A 23-year-old female presented with right-sided dorsal midfoot pain that extended into her right ankle, from an inversion injury that occurred while jumping between trampolines. Multimodality imaging demonstrated widening of the first cuneiform/s metatarsal space, complete fibrillar disruption of the dorsal Lisfranc ligament, and subcutaneous edema on the dorsal aspect of the first and second metatarsals and cuneiforms, consistent with a dorsal Lisfranc ligament tear. Lisfranc injuries are common with direct crush and plantar flexion mechanisms of injury. Multiple imaging modalities, including radiography, magnetic resonance imaging (MRI), computed tomography (CT), and diagnostic ultrasound, are useful in evaluating these injuries. Since the Lisfranc ligaments are important stabilizers of the foot, surgery is the treatment of choice.

Diagnostic ultrasound (DUS) is, arguably, the most common technique used in obstetrical practice. From A mode, first described by Ian Donald for gynecology in the late 1950s, to B mode in the 1970s, real-time and gray-scale in the early 1980s, Doppler a little later, sophisticated color Doppler in the 1990s and three dimensional/four-dimensional ultrasound in the 2000s, DUS has not ceased to be closely associated with the practice of obstetrics. The latest innovation is the use of artificial intelligence which will, undoubtedly, take an increasing role in all aspects of our lives, including medicine and, specifically, obstetric ultrasound. In addition, in the future, new visualization methods may be developed, training methods expanded, and workflow and ergonomics improved.

Background: Diagnostic ultrasound or sonography is an image which can provide valuable information for diagnosing and treating a variety of diseases and conditions. This experiment was done to check the performance and evaluate the ultrasonic imaging system. There were three tests performed in this experiment: dead zone (transducer ring-down), vertical measurement calibration, and horizontal measurement calibration. Methods: The evaluation was made by performed all the tests with different depth on two different multipurpose phantom model #539. The tests were also performed by two different probes which were curved and flat (linear probe). The images were taken, and the measurements were made by electronic calipers on the ultrasound machine system. Observations and evaluations were done via all images and measurements taken. Results: The images formed by two various probes were different. The penetration settings were different since the depths were different. The depth influenced the penetrations to the formed image. From the comparison of all results and measurements recorded were all under the accepted value of the standard that was given by the manufacture of the phantom. Conclusion: Therefore, it can be concluded that the measurements were all not exceeding 2% of the standard value given based on the result that we get.

Introduction In this study, the use of lung ultrasonography (LUS) to diagnosis lung findings was evaluated in patients with suspected COVID-19 who were admitted to the emergency department (ED). Methods This observational clinical study was conducted in the ED of the Ankara City Hospital during the period April 1–30, 2020. Patients who were admitted to the ED were triaged as COVID-19 infected and who agreed to undergo LUS/LCT (lung computed tomography) were included in the study. Results Included in the study were 40 patients who had been prediagnosed with COVID-19. Pneumonia was detected with LCT in 32 (80%) patients, while the LUS examination identified pneumonia in 23 patients. The most common finding in LCT was ground-glass opacity (n = 29, 90.6%). Of the 23 patients with pneumonia findings in LUS, 15 (65.2%) had direct consolidation. Among the 32 patients who were found to have pneumonia as a result of LCT, 20 (62.5%) had signs of pneumonia on LUS examination, and 12 had no signs of pneumonia. In addition, 3 patients showed no signs of pneumonia with LCT, but they were misdiagnosed with pneumonia by LUS. The sensitivity of LUS in the diagnosis of pneumonia in the COVID-19 patients was 62.5%, while its specificity was 62.5%. In addition, its positive predictive value was 87.0%, and its negative predictive value was 29.4%. Conclusion LUS may also be used in the diagnosis of pneumonia in COVID-19 patients because it is a valuable and accessible bedside diagnostic tool. Electronic supplementary material The online version of this article (10.1007/s10049-020-00807-3) shows RT-PCR results of patients with a definitive diagnosis of COVID-19 by lung computed tomography and patients with pneumonia detected by lung ultrasonography. The article and additional material are available at www.springermedizin.de. Please enter the title of the article in the search field. You will find the additional material under “Ergänzende Inhalte” in the article.

Purpose: To investigate the effect of diagnostic ultrasound on corneal apoptosis in rats.Methods: 24 male rats were randomly divided into 4 groups: control group, 10, 20 and 30 min group. The eyeballs of rats were irradiated continuously for different time lengths by Siemens ACUSON S2000 color Doppler ultrasound diagnostic instrument. 24 hours later, the animals were killed and the corneas were taken for Tunel apoptosis detection. The apoptosis rates of corneal epithelial cells, stromal cells and endothelial cells were calculated.Results: Apoptotic cells were detected in corneal epithelial cells, stromal cells and endothelial cells of normal rats. There was no significant difference between the 10 min group and the control group (P>0.05). The apoptosis rate of 20 min and 30 min groups was significantly higher than that of the control group. With the extension of irradiation time, the apoptosis rate of corneal epithelial cells, stromal cells and endothelial cells increased.Conclusion: 20 min of rat eyeball irradiated by diagnostic ultrasound can increase the apoptosis of corneal cells, and the apoptosis is aggravated with the prolongation of ultrasound irradiation time. Keywords: Cornea; Ultrasonography; Apoptosis; Epithelial cells

OBJECTIVE Although epidemiological studies have failed to show the harmful effects of ultrasound in humans, as a form of energy, ultrasound has the potential to cause bio-effects in tissues. Therefore, clinical guidelines have been established for ultrasound technology related to human safety, which include Thermal (TI) and mechanical (MI) indices. The appropriate TI and MI ranges for embryonic examinations are between 0-1.0 and 0-0.4, respectively. The accepted TI and MI ranges are 0-2.0 and 0-1.9, respectively, for general ultrasound examinations. In addition, the scan duration should be kept as low as possible. Therefore, the present study aimed at evaluating the scan duration, TI, and MI as measures of acoustic output during ultrasound studies. METHODS A cross-sectional descriptive study was conducted for patients undergoing pregnancy checkups, routine checkups, and initial diagnosis ultrasound examinations. Samples were selected from imaging departments of 4 educational hospitals based on convenience sampling and 321 checklists completed by direct observation of ultrasound examinations. RESULTS For pregnancy scans, the mean TI and MI were obtained as 0.32 ± 0.27 and 1.15 ± 0.13, respectively. For non-pregnancy examinations, the mean value of TI and MI were 0.30 ± 0.29 and 1.07 ± 0.35, respectively. Therefore, mean TI for pregnancy and non-pregnancy examinations and mean MI for non-pregnancy studies obtained lower than the permitted values, while the mean MI was higher than the permitted level for first trimester of pregnancy. Also, relatively suitable scan durations were seen in reviewed studies. CONCLUSION From this study, it may be concluded that the reported ultrasound scans were safe.

Background: Syndesmotic instability, when subtle, is challenging to diagnose and often requires visualization of the syndesmosis during applied stress. The primary aim was to assess normal distal tibiofibular motion in the sagittal plane using dynamic ultrasound under stress conditions. The secondary aim was to evaluate the reliability of dynamic stress ultrasonography. Methods: Twenty-eight participants without history of ankle injury were included. Sagittal fibular translation was generated by applying a manual force to the fibula from anterior to posterior and from posterior to anterior. Distance between the ultrasound probe and the fibula was taken at two predefined points: 1) no force applied and, 2) during maximum force application. Each participant was scanned twice by two independent examiners, and each scan was analysed by two independent examiners. Three participants were scanned a second time by the same examiner who analysed these films twice to assess for intraobserver agreement. Means of exam 1 versus exam 2 were compared using a mixed linear model. Agreement among observers was calculated using intraclass correlation coefficients (ICC) interpreted as 0.4, poor; 0.4 〈 ICC < 0.59, acceptable; 0.6 < ICC < 0.74, good; ICC 〉 0.74, excellent. Results: Fifty-six ankles were included in the study, including 16 (57%) males and 12 (42%) females. Average anterior to posterior fibular sagittal translation was 0.89 ± 0.6 mm and posterior to anterior fibular sagittal translation was 0.49 ± 1.1 mm. Anterior to posterior translation means of exam 1 versus exam 2 showed no significant differences, means of 0.81 mm [0.7–0.9] versus 0.77 mm [0.7–1.0], and posterior to anterior means [95% CI] of 0.42 mm [0.3–0.5] versus 0.44 mm [0.2–0.6] (p-values 0.416 and 0.758, respectively). Excellent Inter- and intraobserver agreement was found for all measurements taken. Conclusion: Dynamic ultrasound allows one to effectively and readily evaluate sagittal translation of the distal tibiofibular joint. It is able to afford bilateral comparisons, which becomes critical as the amount of syndesmotic instability approaches greater degrees of subtlety.

FAST ultrasound is a medical procedure to assess for free fluid following physical trauma. FAST images can often be difficult to interpret and requires operators to be properly trained. Traditional...

The aim of our study is to analyze viscosity characteristics of focal liver lesions (FLLs) and the diagnostic performance of shear wave dispersion (SWD) in differentiating benign and malignant FLLs. Between January 2018 and April 2018, 58 consecutive patients (median age 57, age range 21-74 years, 37 males) with 58 FLLs located on the right lobe of liver were prospectively studied. The Aplio i900 series diagnostic ultrasound system (Canon Medical systems) equipped with a curvilinear PV1-475BX transducer (1-8 MHz) was used. SWD slope and viscosity measurements were expressed as mean ± standard deviation for both liver tumors and background liver parenchyma. Histopathological results after surgery were regarded as the gold standard for diagnosis. Final diagnosis included 40 cases of malignant and 18 cases of benign FLLs. The mean viscosity value were 14.78 ± 1.86 m/s/kHz for hepatocellular carcinoma (n = 30), 14.81 ± 2.35 m/s/kHz for liver metastasis lesions (n = 10), 13.23 ± 1.31 m/s/kHz for hemangioma (n = 13), and 13.67 ± 2.72 m/s/kHz for focal nodular hyperplasia (n = 5). Malignant FLLs showed higher mean viscosity values (14.79 ± 3.15 m/s/KHz) than benign FLLs (13.36 ± 2.76 m/s/KHz) (p 0.05). The best performing cut-off value of lesion viscosity was 13.15 m/s/kHz (sensitivity 83.3 %; specificity 56.5 %; area under the curve (AUC) 0.71) for malignancy) (p 0.05). The analysis of SWD slope and liver viscosity parameters provide additional viscoelastic information about FLLs before operation. Ziel der Studie ist es die Viskosität fokaler Leberläsionen (FLL) zu bestimmen und die Aussagekraft der Scherwellendispersion zur Differenzierung von benignen und malignen Leberraumforderung zu validieren. Zwischen Januar und April 2018 wurden 58 konsekutive Patienten (medianes Alter der Patienten 57 (21–74) Jahre, 37 Männer) mit FLL im rechten Leberlappen prospektiv untersucht. Die Untersuchungen erfolgten mit einem hochauflösenden Ultraschallgerät Canon Aplio i900, ausgerüstet mit einem kurvilinearen Schallkopf PV1-475BX (1–8 MHz). Die Scherwellendispersion und Viskositätmessungen wurden ausgedrückt als Mittelwert ± Standardabweichung, sowohl für die FLL, als auch für das Leberparenchym. Der Goldstandard war die histopathologische Untersuchung der FLL nach chirurgischer Resektion. Die finale Diagnose beinhaltete 40 Patienten mit malignen und 18 Patienten mit benignen FLL. Die mittleren Viskositätswerte lagen bei 14,78 ± 1,86 m/s/kHz für hepatozelluläre Karzinome (n = 30), 14,81 ± 2,35 m/s/kHz für Lebermetastasen (n = 10), 13,23 ± 1,31 m/s/kHz für Hämangiome (n = 13) und 13,67 ± 2,72 m/s/kHZ für fokale noduläre Hyperplasien (n = 5). Maligne fokale Leberläsionen zeigten (14.79 ± 3.15 m/s/KHz) höhere Viskositätswerte als gutartige fokale Leberläsionen (13.36 ± 2.76 m/s/KHz) (P 0,05). Bei einem angenommenen Wert von 13,15 m/s/kHz betrug die Sensitivität für die richtige Erkennung maligner Raumforderungen 83,3 %, die Spezifität 56,5 %, die Fläche unter der Kurve (area under the curve (AUC) 0,71, p 0,05). Die Analyse der Leberviskositätsmessung mittels Scherwellendispersion gibt zusätzliche Informationen zur Charakterisierung fokaler Leberläsionen.

This article continues a previously published review, “3D ultrasound: Current state, emerging trends and technologies,” which was the first part in a cycle addressing 3D/4D ultrasound technologies. The first part explained the basic mechanisms for obtaining three-dimensional ultrasound images and considered the physical basis, advantages, and drawbacks associated with the use of transducers and the main methods of volumetric scanning. The present article describes the capabilities of the state-of-the-art diagnostic ultrasound scanners to visualize 3D/4D data.

Piriformis syndrome (PS) is a syndrome consisting of symptoms that occur due to compression of the sciatic nerve at the level of the piriformis muscle (PM). The most commonly reported complaints (cardinal features) are radiation to the ipsilateral tight, buttock pain, and reproduction of pain on prolonged sitting. In this study, we report a 64 years old female case presented with peroneal neuropathy symptoms without gluteal pain and sciatica and treated using ultrasound-guided PM injection successfully.

Heterotopic ossification (HO) is a frequent complication after spinal cord injury (SCI). This review article critically analyzes the scientific literature of HO after SCI and offers expert opinion on how past research translates to clinical practice. Triple-phase bone scintigraphy has been the gold standard for diagnosing HO; however, recent research suggests diagnostic ultrasound may be more convenient, cost-effective, and safe. Currently, routine pharmaceutical prophylaxis for HO after SCI is not recommended. Range of motion exercises are advised to prevent and treat HO. Etidronate was approved for HO treatment, but it is no longer available in the USA. Evidence to support the use of alternate bisphosphonates is lacking. Surgical resection is reserved for select cases where the primary goal is improving function. HO is a common complication after SCI, and continued research is needed to improve diagnosis, prevention, and treatment.

Aim The objective of this survey was to understand the global trends of imaging assessments in persons with haemophilia, focusing on point-of-care ultrasound (POCUS). Insights into the barriers impeding its widespread proliferation as a frontline imaging modality were obtained. Methods The survey opened in September of 2017 and closed in May of 2018. Haemophilia Treatment Centres (HTCs) treating both paediatric/adult patients were the population of interest. A REDCap survey of 25 questions was disseminated to 232 clinical staff in 26 countries. Results The majority of respondents (88.3%, 91/103) reported that POCUS is most useful to confirm or rule out a presumed acute joint bleed. European HTCs reported the highest routine use of POCUS at 59.5% (22/37) followed by HTCs in the "Other" countries of the world at 46.7% (7/15) and North American HTCs at 43.9% (25/57). At the time of the survey, physiotherapists were identified as the clinical staff who perform POCUS 52.8% (28/53) of the time, in contrast with nurses/nurse practitioners who represent only 5.7% (3/53) of users. The greatest perceived barriers to the implementation of POCUS are the lack of trained healthcare professionals who can perform POCUS at 69.2% (74/107) and the overall time commitment required at 68.2% (73/107). Conclusion Despite POCUS being used in 49.5% (54/109) of sampled HTCs, it is still utilized almost 30% less globally than full diagnostic ultrasound. A list of barriers has been identified to inform HTCs which challenges they will likely need to overcome should they choose to incorporate this imaging modality into their practice.

The prevalence of Osgood-Schlatter disease (OSD) and related factors were investigated in junior high school students. The musculoskeletal injuries of 619 students in junior high school in Japan were examined. The incidence of Osgood-Schlatter disease and factors associated with prevalence of the disease were investigated by means of a questionnaire on sports team membership and bone/joint pain, measurement of subjects’ height and weight and any increase, evaluation of the stage of tibial development using a diagnostic ultrasound device, and evaluation of OSD and musculoskeletal injuries. OSD was seen in 4.8% of subjects. It was more common in boys and in the epiphyseal stage of tibial development, coinciding with the growth spurt. The prevalence of OSD was higher in subjects who belonged to a sports team than in those who did not belong to a sports team. The results of multiple logistic regression analysis for factors relating to onset of OSD in junior high school students showed significant associations with gender (male) and weight increase. Individuals in the growth-spurt period have a high risk of OSD, consequently, musculoskeletal examination using ultrasound, as well as exercise coaching aimed to prevent overuse, are important.

Background Baseball pitchers frequently develop varying levels of posterior shoulder tightness (PST) and often present with characteristics associated with subacromial impingement. Purpose To determine if a group of baseball pitchers with excessive PST (bilateral internal rotation ROM difference >18 ° and bilateral total arc of motion difference >5 °) have differences in subacromial joint space, forward scapular posture, or glenohumeral elevation range of motion (ROM) when compared to a control group. Study Design Descriptive, cross-sectional study. Methods Thirty-five asymptomatic professional baseball pitchers with excessive PST were matched with 35 pitchers with acceptable levels of PST. The investigators measured subacromial space using diagnostic ultrasound, glenohumeral elevation ROM using a digital goniometer, and scapular posture using a double square, and were blinded to the group of each participant. Separate t-tests were used to determine significant differences between groups (p

Objective To compare foot posture, plantar sensation, plantar fascia thickness, intrinsic foot muscle performance, and abductor hallucis morphology in individuals with and without plantar heel pain (PHP). Design Cross-Sectional. Setting Laboratory. Participants Sixteen individuals with PHP and sixteen matched healthy participants. Main outcome measures Static foot posture, plantar sensation, plantar fascia thickness, intrinsic foot muscle performance and abductor hallucis morphology were evaluated. Foot posture was assessed with the Foot Posture Index-6. Abductor hallucis morphology and plantar fascia thickness were measured utilizing diagnostic ultrasound. Plantar foot sensation was assessed at the head of the first metatarsal and medial longitudinal arch using Semmes-Weinstein Monofilaments. Intrinsic foot muscle performance was assessed using the intrinsic foot muscle test (IFMT). Mann-Whitney U and independent t-tests were used to examine between group differences. Results Individuals with PHP exhibited a more pronated foot posture and greater plantar fascia thickness at the proximal insertion compared to healthy controls. Plantar sensation thresholds were higher in the PHP compared to healthy controls at the head of the first metatarsal. There were no group differences in abductor hallucis morphology or IFMT performance. Conclusions Individuals with PHP exhibited a more pronated foot posture, thicker plantar fascia, and diminished plantar tactile sensation.

The vast majority of clinicians associate diagnostic ultrasound with a tool that is designed for the living patient. However, it is of course possible to apply this imaging technology to evaluate the recently deceased patient for postmortem diagnosis, or even just examine postmortem tissue. We describe several cases in which ultrasound-enabled providers obtain answers in postmortem examinations and discuss potential future strategies and applications. In addition, we will also illustrate the use of sonography in minimally invasive post-mortem tissue sampling (MITS), an approach that can be used in post-mortem minimally invasive autopsies as well as for establishing ultrasound diagnostic parameters in new medical fields such as periodontal and dental implant specialties.

Although ultrasound cannot penetrate a tissue/air interface, it images the lung with high diagnostic accuracy. Lung ultrasound imaging relies on the interpretation of “artifacts,” which arise from the complex reverberation physics occurring at the lung surface but appear deep inside the lung. This physics is more complex and less understood than conventional B-mode imaging in which the signal directly reflected by the target is used to generate an image. Here, to establish a more direct relationship between the underlying acoustics and lung imaging, simulations are used. The simulations model ultrasound propagation and reverberation in the human abdomen and at the tissue/air interfaces of the lung in a way that allows for direct measurements of acoustic pressure inside the human body and various anatomical structures, something that is not feasible clinically or experimentally. It is shown that the B-mode images beamformed from these acoustical simulations reproduce primary clinical features that are used in diagnostic lung imaging, i.e., A-lines and B-lines, with a clear relationship to known underlying anatomical structures. Both the oblique and parasagittal views are successfully modeled with the latter producing the characteristic “bat sign,” arising from the ribs and intercostal part of the pleura. These simulations also establish a quantitative link between the percentage of fluid in exudative regions and the appearance of B-lines, suggesting that the B-mode may be used as a quantitative imaging modality.

Background: With recent improvements in transducer strength, image resolution, and operator training, ultrasound (US) provides an excellent alternative imaging modality for the diagnosis of rotator cuff tears. Purpose: To evaluate the diagnostic accuracy of US for partial- and full-thickness rotator cuff tears and biceps tendon tears, compare diagnostic values with those of magnetic resonance imaging (MRI) using arthroscopy as the reference standard, assess longitudinal improvements in accuracy, and compare diagnostic values from operators with different training backgrounds. Study Design: Systematic review; Level of evidence, 3. Methods: The PubMed and Cochrane Library databases were systematically searched for full-text journal articles published between January 1, 2010, and April 1, 2020. The inclusion criteria were studies that evaluated the diagnostic accuracy of US for rotator cuff tears or biceps tendon tears utilizing arthroscopy as the reference standard. The exclusion criteria were studies with Results: In total, 23 eligible studies involving 2054 shoulders were included. US demonstrated a higher median diagnostic accuracy for supraspinatus tendon tears (0.83) and biceps tendon tears (0.93) as compared with subscapularis tendon tears (0.76). US was found to have a higher median accuracy (0.93) for full-thickness supraspinatus tears than partial-thickness tears (0.81). US had superior median sensitivity for partial-thickness supraspinatus tears when performed by radiologists as opposed to surgeons (0.86 vs 0.57). Meta-analysis of the 5 studies comparing US and MRI demonstrated no statistically significant difference in diagnostic sensitivity, specificity, or accuracy for any thickness supraspinatus tears (P = .31-.55), full-thickness tears (P = .63-.97), or partial-thickness tears ( P = .13-.81). Conclusion: For experienced operators, US is a highly sensitive and specific diagnostic modality for the diagnosis of supraspinatus tears and demonstrates statistically equivalent capability to MRI in the diagnosis of both full- and partial-thickness rotator cuff tears.

Polymer nanoparticles and microparticles have been used primarily for drug delivery. There is now growing interest in further developing polymer-based solid cavitation agents to also enhance ultrasound imaging. We previously reported on a facile method to produce hollow poly(lactic-co-glycolic acid) (PLGA) microparticles with different diameters and degrees of porosity. Here, we investigate the cavitation response from these PLGA microparticles with both therapeutic and diagnostic ultrasound transducers. Interestingly, all formulations exhibited stable cavitation; larger porous and multicavity particles also provided inertial cavitation at elevated acoustic pressure amplitudes. These larger particles also achieved contrast enhancement comparable to that of commercially available ultrasound contrast agents, with a maximum recorded contrast-to-tissue ratio of 28 dB. Therefore, we found that multicavity PLGA microparticles respond to both therapeutic and diagnostic ultrasound and may be applied as a theranostic agent. Ministry of Education (MOE) Ministry of Health (MOH) National Medical Research Council (NMRC) Accepted version The authors acknowledge the support from the Ministry of Education in Singapore under the Tier 1 grant scheme (RG144/18, RG127/19). This research is supported by the Singapore Ministry of Health’s National Medical Research Council under NMRC/OFYIRG/0034/2017.

Passive cavitation mapping (PCM) has been developed to localize and quantify acoustic cavitation during ultrasound exposure, showing broad application prospects in ultrasound treatments. The traditional PCM algorithm, time exposure acoustics (TEA), produces poor image resolution when using diagnostic ultrasound arrays due to the limited diffraction modes. Although several advanced reconstruction algorithms have been developed, the limitation of imaging resolution still cannot be broken fundamentally. This work proposes a super-resolution PCM method implemented with diagnostic ultrasound arrays inspired by the rapid development of ultrasound super-resolution imaging techniques. This method uses a Gaussian fit to TEA-reconstructed original images to localize single cavitation sources, and combines the localization results of all sources to generate a super-resolution image. The super-resolution PCM method is preliminary tested by simulations and in vitro experiments. The simulation results show that this method localize the sources with an error of 46.48 and 38.66 µm for the linear and concentric-circle tracks. The experimental results suggest that this method can spatially resolve multiple cavitation sources in a local small area, having the potential to provide a tiny-scale observation tool for the studies on acoustic cavitation and benefit cavitation-mediated ultrasound treatments.

Targeted ultrasound contrast agents, known as microbubbles (MBs), are used to enhance the utility of diagnostic ultrasound molecular imaging. Previous studies, both in vitro and in vivo, have demonstrated that normalized singular spectrum area (NSSA) can be used to differentiate adherent MB signals from free MB signals as well as from background tissue. We developed a simulation approach to test the hypothesis that the intermediate NSSA values observed in adherent MBs were due to small displacements occurring during exposure to blood flow. We also compared the NSSA mapping result from the simulation with the experimental result. A strong linear correlation between the NSSA values in simulation and experiment suggest that our simulation is reproducing the physical interactions occurring in experimental data and giving rise to the observable NSSA.

High intensity focused ultrasound (HIFU) uses about 800 times the diagnostic ultrasound power, which converges at a focal point to deliver energy above 60 degrees Celsius resulting in cell death by means of coagulation necrosis and cavitation destruction. This article is a reflection of my journey in gynaecological surgery, from basic laparotomy to minimally invasive surgery (MIS) to virtual surgery of noninvasive technology. This work also states an opinion shared by a lot of MIS colleagues in Asia. I am indeed fortunate to witness the transformation, revolution and disruption of surgery in gynecology in my lifetime. I think HIFU has allowed us to achieve the basic tenets of surgery, one of less pain, minimal complications, optimal destruction of a diseased organ, and optimal conservation of the human body. In this article, I will focus on HIFU treatment of uterine fibroids and adenomyosis. Uterine fibroids or myomas are common benign growths of the uterus and occurs in 20% to 50% of reproductive females. Adenomyosis involves endometrial lining cells that invade into the body of the uterus, like rust into the body of a car. Both uterine fibroids and adenomyosis can cause pain, heavy menstrual bleeding, and anemia. They can compress surrounding organs as they grow, leading to urinary, bowel, vascular and obstructive complications. Fertility may also be compromised.