Search

Context: The incidence and recurrence rate of hamstring strain injuries remain persistently high, with recurrent injuries leading to increased time lost during play and extended recovery periods compared with initial injury. Ultrasound imaging assesses important factors such as hamstring fascicle length (FL), pennation angle (PA), cross-sectional area (CSA), muscle thickness (MT), echo intensity (EI), and shear wave elastography (SWE), all impacting athletic performance. However, its reliability must be established before employing any measurement tool in research or clinical settings. Objectives: To determine the reliability and measurement error of ultrasound for assessing hamstring FL, PA, CSA, MT, EI, and SWE among healthy adults and athletes; to synthesize the information regarding the operationalization of ultrasound. Evidence Acquisition: A systematic literature search was done from January 1990 to February 5, 2023, to identify reliability and validity studies of hamstring ultrasound assessment published in peer-reviewed journals with identifiable methodology of outcome measures. Evidence Synthesis: Intraclass correlation coefficient measurement of 14 included studies reported moderate to excellent intrarater, interrater, and test–retest reliabilities of FL, PA, and MT regardless of the site of muscle testing, probe size, and setting, state of muscle, and use of different techniques in the extrapolation of FL. Good to excellent test–retest reliability rates for all hamstring anatomic CSA along midmuscle and different percentages of thigh length using panoramic imaging. Good intrarater reliability of EI regardless of gender and orientation of the probe but with excellent intrarater reliability in transverse scan using maximum region of interest. Good intrarater, interrater, and interday repeatability on SWE with the muscle in a stretched position. Conclusion: Evidence from studies with a predominantly low risk of bias shows that ultrasound is a reliable tool to measure hamstring FL, PA, CSA, MT, EI, and SWE in healthy adults and athletes under various experimental conditions. [ABSTRACT FROM AUTHOR]

Context: Sport-specific adaptations in shoulder rotation range of motion (ROM) and the relationship with humeral torsion have been described in overhead-throwing sports. However, information is lacking for other shoulder-loading sports such as field hockey. Therefore, this study's purpose was to evaluate humeral torsion in elite, male field hockey players and explore its association with shoulder ROM. Design: Cross-sectional study. Methods: Twenty-five male, elite field hockey players were included. Humeral torsion and shoulder external and internal rotation ROM were evaluated bilaterally by ultrasound and an inclinometer smartphone application, respectively. Results: Field hockey players showed a significantly increased humeral retroversion on the dominant compared with the nondominant side (P <.001; Cohen d = 1.75), along with a significantly increased external (P =.004; Cohen d = −0.64) and decreased internal rotation ROM (P =.003; Cohen d = 0.65). This finding illustrates a shift in total shoulder rotational ROM arc. Correlation analysis showed a significant moderate association between the increased humeral retroversion and decreased internal rotation ROM on the dominant side (r =.523). Conclusions: Elite male field hockey athletes show sport-specific adaptations regarding humeral torsion and shoulder rotation ROM, similar to throwing athletes. These findings increase our insight into the field hockey athlete's shoulder, which is essential to optimize performance and assist in correctly interpreting shoulder rotational ROM measurements. [ABSTRACT FROM AUTHOR]

Miliary tuberculosis is a form of disseminated tuberculosis that can be difficult to detect when the classic pattern is absent on chest radiograph and advanced cross-sectional imaging is not readily available. While the focused assessment with sonography for HIV-associated tuberculosis (FASH) protocol for extrapulmonary tuberculosis emphasizes easy-to-teach findings, experienced sonographers may detect additional, subtler signs that can aid in diagnosis. We report a case of a 20-year-old man with miliary tuberculosis diagnosed on computed tomography of the chest. We describe subtle sonographic signs of disseminated tuberculosis including subpleural irregularities and comet-tail artifacts, a bright liver pattern, peritoneal nodules, and a nonspecific sponge spleen pattern. We then discuss important differential diagnoses for each finding. Knowledge of subtle sonographic signs outside of the FASH protocol can aid clinicians in detecting disseminated tuberculosis, including the miliary form, when advanced imaging may not be available.

Image-based deformation estimation is an important tool used in a variety of engineering problems, including crack propagation, fracture, and fatigue failure. These tools have been important in biomechanics research where measuring in vitro and in vivo tissue deformations are important for evaluating tissue health and disease progression. However, accurately measuring tissue deformation in vivo is particularly challenging due to limited image signal-to-noise ratio. Therefore, we created a novel deep-learning approach for measuring deformation from a sequence of images collected in vivo called StrainNet. Utilizing a training dataset that incorporates image artifacts, StrainNet was designed to maximize performance in challenging, in vivo settings. Artificially generated image sequences of human flexor tendons undergoing known deformations were used to compare benchmark StrainNet against two conventional image-based strain measurement techniques. StrainNet outperformed the traditional techniques by nearly 90%. High-frequency ultrasound imaging was then used to acquire images of the flexor tendons engaged during contraction. Only StrainNet was able to track tissue deformations under the in vivo test conditions. Findings revealed strong correlations between tendon deformation and applied forces, highlighting the potential for StrainNet to be a valuable tool for assessing rehabilitation strategies or disease progression. Additionally, by using real-world data to train our model, StrainNet was able to generalize and reveal important relationships between the effort exerted by the participant and tendon mechanics. Overall, StrainNet demonstrated the effectiveness of using deep learning for image-based strain analysis in vivo.

Purpose To clarify the predominant causative plaque constituent for periprocedural myocardial injury (PMI) following percutaneous coronary intervention: (a) erythrocyte-derived materials, indicated by a high plaque-to-myocardium signal intensity ratio (PMR) at coronary atherosclerosis T1-weighted characterization (CATCH) MRI, or (b) lipids, represented by a high maximum 4-mm lipid core burden index (maxLCBI4 mm) at near-infrared spectroscopy intravascular US (NIRS-IVUS). Materials and Methods This retrospective study included consecutive patients who underwent CATCH MRI before elective NIRS-IVUS-guided percutaneous coronary intervention at two facilities. PMI was defined as post-percutaneous coronary intervention troponin T values greater than five times the upper reference limit. Multivariable analysis was performed to identify predictors of PMI. Finally, the predictive capabilities of MRI, NIRS-IVUS, and their combination were compared. Results A total of 103 lesions from 103 patients (median age, 72 years [IQR, 64-78]; 78 male patients) were included. PMI occurred in 36 lesions. In multivariable analysis, PMR emerged as the strongest predictor (P = .001), whereas maxLCBI4 mm was not a significant predictor (P = .07). When PMR was excluded from the analysis, maxLCBI4 mm emerged as the sole independent predictor (P = .02). The combination of MRI and NIRS-IVUS yielded the largest area under the receiver operating curve (0.86 [95% CI: 0.64, 0.83]), surpassing that of NIRS-IVUS alone (0.75 [95% CI: 0.64, 0.83]; P = .02) or MRI alone (0.80 [95% CI: 0.68, 0.88]; P = .30). Conclusion Erythrocyte-derived materials in plaques, represented by a high PMR at CATCH MRI, were strongly associated with PMI independent of lipids. MRI may play a crucial role in predicting PMI by offering unique pathologic insights into plaques, distinct from those provided by NIRS. Keywords: Coronary Plaque, Periprocedural Myocardial Injury, MRI, Near-Infrared Spectroscopy Intravascular US Supplemental material is available for this article. © RSNA, 2024.

INTRODUCTION: Brace treatment is common to address radiological dysplasia in infants with developmental dysplasia of the hip (DDH); however, it is unclear whether bracing provides significant benefit above careful observation by ultrasound. If observation alone is non-inferior to bracing for radiological dysplasia, unnecessary treatment may be avoided. Therefore, the purpose of this study is to determine whether observation is non-inferior to bracing for infants with radiological dysplasia. METHODS AND ANALYSIS: This will be a multicentre, global, randomised, non-inferiority trial performed under the auspices of a global prospective registry for infants and children diagnosed with DDH. Patients will be included if they present with radiological dysplasia (centred hip, alpha angle 43-60°, percent femoral head coverage greater than 35% measured on ultrasound) of a clinically stable hip under 3 months old. Patients will be excluded if they present with clinical hip instability, have received prior treatment or have known/suspected neuromuscular, collagen, chromosomal or lower-extremity congenital abnormalities or syndromic-associated hip abnormalities. Patients will be enrolled and randomised to undergo observation alone or brace treatment with a Pavlik harness for a minimum of 6 weeks. Follow-up visits will occur at 6 weeks, 1 year and 2 years post-enrolment. The primary outcome will be the norm-referenced acetabular index measured on the 2-year radiograph with a 3° non-inferiority margin. A total of 514 patients will be included.The study is anticipated to start in April 2024 and end in September 2028.The primary outcome will be compared between arms with a mixed-effects model with a random intercept for study centre, and a single covariate for the treatment group. If the lower bound of the 95% CI lies within 3° of the mean, we will treat this as evidence for non-inferiority. ETHICS AND DISSEMINATION: Ethics approval has been obtained from the lead sites ethics board (University of British Columbia, Childrens and Womens Research Ethics Board). Ethics approval will be obtained from the local ethics committees or institutional review boards at each institution prior to patient enrolment. It is intended that the results of this study shall be published in peer-reviewed journals and presented at suitable conferences. TRIAL REGISTRATION NUMBER: NCT05869851.

Context: Plantar intrinsic foot muscle strength training is difficult to master to a degree sufficient to elicit muscle hypertrophy in most individuals. It is possible that combining neuromuscular electrostimulation (NMES) and blood flow restriction (BFR) can elicit plantar intrinsic foot muscle hypertrophy regardless of the individual's technique. This study aimed to determine the effects of NMES training with BFR on acute muscle swelling in the abductor hallucis. Design: Randomized, controlled, single-blind trial design. Methods: Forty-eight participants were randomly allocated to the NMES + BFR, NMES, or Sham NMES + BFR groups. All participants received abductor hallucis NMES for 15 minutes. Participants in the NMES + BFR and Sham NMES + BFR groups received NMES with BFR. The intensity of NMES was the sensory threshold in the Sham NMES + BFR group. The cross-sectional area of the abductor hallucis was measured pretraining and posttraining using ultrasonography by a single investigator blinded to the participants' allocations. Results: After 15 minutes of training, the cross-sectional area of the abductor hallucis was significantly increased in the NMES + BFR (P<.001) and the Sham NMES + BFR (P = .004) groups. Moreover, the rate of increase was significantly higher in the NMES + BFR group than in the NMES or the Sham NMES + BFR groups (P<.001 and P = . 001, respectively). Conclusions: Since it is possible that the amount of muscle swelling immediately after training correlates with muscle hypertrophy when training is continued, the results of this study suggest that NMES training with BFR is a training method that can be expected to produce plantar intrinsic foot muscle hypertrophy. Further studies are needed to confirm the long-term effects of NMES training with BFR. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Determine the incremental diagnostic yield of prenatal exome sequencing (pES) over chromosome microarray (CMA) or G-banding karyotype in fetuses with central nervous system (CNS) abnormalities. METHODS: Data were collected via electronic searches from January 2010 to April 2022 in MEDLINE, Cochrane, Web of Science and EMBASE. The NHS England prenatal exome cohort was also included. Incremental yield was calculated as a pooled value using a random-effects model. RESULTS: Thirty studies were included (n = 1583 cases). The incremental yield with pES for any CNS anomaly was 32% [95%CI 27%-36%; I2 = 72%]. Subgroup analysis revealed apparent incremental yields in; (a) isolated CNS anomalies; 27% [95%CI 19%-34%; I2 = 74%]; (b) single CNS anomaly; 16% [95% CI 10%-23%; I2 = 41%]; (c) more than one CNS anomaly; 31% [95% Cl 21%-40%; I2 = 56%]; and (d) the anatomical subtype with the most optimal yield was Type 1 malformation of cortical development, related to abnormal cell proliferation or apoptosis, incorporating microcephalies, megalencephalies and dysplasia; 40% (22%-57%; I2 = 68%). The commonest syndromes in isolated cases were Lissencephaly 3 and X-linked hydrocephalus. CONCLUSIONS: Prenatal exome sequencing provides a high incremental diagnostic yield in fetuses with CNS abnormalities with optimal yields in cases with multiple CNS anomalies, particularly those affecting the midline, posterior fossa and cortex.

OBJECTIVE:  This study aimed to assess factors that influence patients decisions in accepting prenatal diagnostic testing following genetic counseling for increased risk of fetal aneuploidy. METHODS:  This is a retrospective cohort study of women at increased risk of fetal aneuploidy and genetic disorders who had genetic counseling from January 2012 to December 2016 at a single academic center. Demographics, indications for genetic counseling, and rates of diagnostic testing were collected and compared between those who accepted diagnostic testing and those who chose cell free DNA. The variables were analyzed using Chi-square, Fishers exact test, and multiple logistic regression. RESULT:  Of the 2,373 pregnant women who underwent genetic counseling for increased risk of fetal aneuploidy and genetic disorders during the study period, 321 women had diagnostic testing (13.5%). Women at 35 years and older accepted diagnostic testing more than women younger than 35 years (20.7 vs. 11.5%, p

Purpose: Using point-of-care ultrasound (POCUS) to diagnose abdominal aortic aneurysm (AAA) is an essential skill in emergency medicine (EM). While simulation-based POCUS education is commonly used, the translation to performance in the emergency department (ED) is unknown. We investigated whether adding case-based simulation to an EM residency curriculum was associated with changes in the quantity and quality of aorta POCUS performed by residents in the ED.Methods: A case-based simulation was introduced to resident didactics at our academic, Level I trauma center. A case of undifferentiated abdominal pain was presented, which required examination of an ultrasound phantom to diagnose an AAA, with a hands-on didactic. We compared the quantity, quality, and descriptive analyses of aorta POCUS performed in the ED during the four months before and after the simulation.Results: For participating residents (17/32), there was an 86% increase in total studies and an 80%increase in clinical studies. On an opportunity-adjusted, per-resident basis, there was no significant difference in median total scans per 100 shifts (4.4 [interquartile range (IQR) 0–15.8 vs 8.3 [IQR] 3.3–23.6, P = 0.21) or average total quality scores (3.2 ± 0.6 vs 3.2 ± 0.5, P = 0.92). The total number of limited or inadequate studies decreased (43% vs 19%, P = 0.02), and the proportion of scans submitted by interns increased (7% vs 54%, P =

BACKGROUND: Despite the initial evidence supporting the utility of intravascular imaging to guide percutaneous coronary intervention (PCI), adoption remains low. Recent new trial data have become available. An updated study-level meta-analysis comparing intravascular imaging to angiography to guide PCI was performed. This study aimed to evaluate the clinical outcomes of intravascular imaging-guided PCI compared with angiography-guided PCI. METHODS AND RESULTS: A random-effects meta-analysis was performed on the basis of the intention-to-treat principle. The primary outcomes were major adverse cardiac events, cardiac death, and all-cause death. Mixed-effects meta-regression was performed to investigate the impact of complex PCI on the primary outcomes. A total of 16 trials with 7814 patients were included. The weighted mean follow-up duration was 28.8 months. Intravascular imaging led to a lower risk of major adverse cardiac events (relative risk [RR], 0.67 [95% CI, 0.55-0.82]; P

Micro-ultrasound has recently been introduced as a low-cost alternative to multi-parametric MRI for imaging prostate cancer. Early clinical studies have demonstrated promising results; however, robust validation via comparison with whole-mount pathology has yet to be achieved. Due to micro-ultrasound probe design and tissue deformation during scanning, it is difficult to accurately correlate micro-ultrasound imaging planes with ground truth whole-mount pathology slides. In this study, we developed a multi-step methodology to co-register micro-ultrasound and MRI to whole-mount pathology. The three-step process had a registration error of 3.90 ± 0.11 mm and consists of: (1) micro-ultrasound image reconstruction, (2) 3D landmark registration of micro-ultrasound to MRI, and (3) 2D capsule registration of MRI to whole-mount pathology. This process was then used in a preliminary reader study to compare the diagnostic accuracy of micro-ultrasound and MRI in 15 patients who underwent radical prostatectomy for prostate cancer. Micro-ultrasound was found to have equivalent performance to retrospective MRI review for index lesion detection (91.7% vs. 80%), while demonstrating an increased detection of tumor extent (52.5% vs. 36.7%) with similar false positive regions-of-interest (38.3% vs. 40.8%). Prospective MRI review had reduced detection of index lesions (73.3%) and tumor extent (18.9%) but improved false positive regions-of-interest (22.7%) relative to micro-ultrasound and retrospective MRI. Further evaluation is needed with a larger sample size.

OBJECTIVE: To determine the impact of point-of-care ultrasound (POCUS)- guided resuscitation on clinical outcomes in adult patients with shock. DATA SOURCE: We searched MEDLINE, Embase, and unpublished sources from inception to December 2023. STUDY SELECTION: We included randomized controlled trials (RCTs) that examined the use of POCUS to guide resuscitation in patients with shock. DATA EXTRACTION: We collected data regarding study and patient characteristics, POCUS protocol, control group interventions, and outcomes. DATA SYNTHESIS: We identified 18 eligible RCTs. POCUS slightly influences physicians' plans for IV fluid (IVF) and vasoactive medication prescription (moderate certainty), but results in little to no changes in the administration of IVF (low to high certainty) or inotropes (high certainty). POCUS may result in no change in the number of CT scans performed (low certainty) but probably reduces the number of diagnostic echocardiograms performed (moderate certainty). POCUSguided resuscitation probably reduces 28-day mortality (relative risk [RR] 0.88; 95% CI, 0.78-0.99), the duration of vasoactive medication (mean difference -0.73 d; 95% CI, -1.16 to -0.30), and the need for renal replacement therapy (RRT) (RR 0.80; 95% CI, 0.63-1.02) (low to moderate certainty evidence), and lactate clearance (high certainty evidence). POCUS-guided resuscitation may results in little to no difference in ICU or hospital admissions, ICU and hospital length of stay, and the need for mechanical ventilation (MV) (low to moderate certainty evidence). There is an uncertain effect on the risk of acute kidney injury and the duration of MV or RRT (very low certainty evidence). CONCLUSIONS: POCUS-guided resuscitation in shock may yield important patient and health system benefits. Due to lack of sufficient evidence, we were unable to explore how the thresholds of operator competency, frequency, and timing of POCUS scans impact patient outcomes. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study is to evaluate the muscle thickness and walking test in people with hemophilia A and their correlation to joint health and functional impairments. Design: This is a cross-sectional study. Results: Twenty-nine severe/moderate people with hemophilia Awere enrolled. Muscle thickness of quadriceps and medial gastrocnemius was measured using ultrasound. Joint health and functional capacity were assessed using Hemophilia Joint Health Score, Hemophilia Early Arthropathy Detection with Ultrasound, 6-Minute Walking test, Hemophilia Quality of Life Questionnaire for Adults, and Hemophilia Activities List. Quadriceps muscle thickness significantly correlated with Hemophilia Joint Health Score knee, Hemophilia Early Arthropathy Detection with Ultrasound knee, and Hemophilia Activities List. Calf muscle thickness significantly correlated with the Hemophilia Joint Health Score ankle. After adjusted age and body mass index, calf muscle thickness was inversely associated with the Hemophilia Joint Health Score ankle. Six-Minute Walking test was found to significantly correlate with Hemophilia Joint Health Score total, Hemophilia Early Arthropathy Detection with Ultrasound total, Hemophilia Quality of Life Questionnaire for Adults, and Hemophilia Activities List. Conclusions: Muscle thickness and the distance of 6-Minute Walking Test were linked to assessment of joint health, quality of life, and activity participation in people with hemophilia A. Ultrasound measurement of muscle thickness and walking test seem to be useful tools for the assessment of joint health and functional status in people with hemophilia A. [ABSTRACT FROM AUTHOR]

Background: Fifty years since its inception, Light's criteria have aided in classifying pleural effusions (PEs) as exudates if 1 or more criteria are met. Thoracic ultrasound (US) emerges as a non‐invasive technique for point of care use especially if pleural procedures are contemplated. Objective: We aimed to develop a score based on radiological and US features that could separate exudates from transudates without serum and pleural fluid biochemical tests necessary for Light's criteria. Methods: A prospective review of consecutive patients with PE who underwent thoracocentesis was performed. CXRs were evaluated for laterality followed by US for echogenicity, pleural nodularity, thickening and septations. PE was classified as exudate or transudate according to Light's criteria and corroborated with albumin gradient. A score combining radiological and US features was developed. Results: We recruited 201 patients with PE requiring thoracocentesis. Mean age was 64 years, 51% were females, 164 (81.6%) were exudates, and 37 (18.4%) were transudates. Assigning 1‐point for Diaphragmatic nodularity, Unilateral, Echogenicity, Pleural Thickening and Septations, DUETS ranged from 1 to 5. DUETS ≥2 indicated high likelihood for exudate (PPV 98.8%, NPV 100%) with 1% misclassification versus 6.9% using Light's criteria (p < 0.001). Conclusion: DUETS separated exudates from transudates with good accuracy, and could obviate paired serum and pleural fluid tests necessary for Light's criteria computation. Our study reflected real world practice where DUETS performed better than Light's criteria for PE that arose from more than one disease processes, and in the evaluation of patients with PE who have received diuretics. This study aimed to develop an accurate pleural ultrasound based composite score to accurately distinguish between transudates and exudates for clinical use, in evaluation of pleural effusions. The DUETS score was shown to accurately identify exudative effusions and would be particularly useful in clinical scenarios where there are dual pathologies. See relatededitorial [ABSTRACT FROM AUTHOR]

Purpose: To assess the value of routine mid-trimester fetal ultrasound scans in detecting FCs, as well as the related ultrasound and clinical follow-up outcomes. Methods: A retrospective analysis was conducted on 1064 fetuses who underwent standardized ultrasound screening during the mid-trimester. During the examination, high-frequency ultrasound was used to examine the fetal spine. Different frequency ultrasound probes were used to compare and analyze the detection rates of FCs. We conducted follow-up ultrasound observations on all FCs and conducted long-term follow-up observations in terms of the motor function of the children after birth. Results: Among 1064 fetuses detected by ultrasound, a total of 910 fetuses were completely evaluated using high-frequency and low-frequency ultrasound, and 24 FCs were found. In all 24 cases of FCs, 7 cases were detected using low-frequency ultrasound, while high-frequency ultrasound detected all cases. There was a significant difference in the detection rates between the two groups (χ2 = 26.323, P = 0.000). Of all the 24 FCs, 21 cysts disappeared spontaneously (87.5%); one fetus was induced for abortion due to a concurrent cleft lip; after multiple ultrasound examinations, it was found that the cyst persisted in one fetus; one case was not followed up by ultrasound. There was no statistically significant difference in the start of sitting and crawling time between the control group and the FCs group. Conclusion: Routine mid-trimester fetal ultrasound scan detect FCs, particularly when high-frequency ultrasound probes were routinely applied. Most FCs detected by prenatal ultrasound spontaneously disappear and have no impact on the motor function of the fetus after birth (with the conus medullaris located at or above the L3 level). The shortest time interval from the detection to the disappearance of the cyst was 11 days. [ABSTRACT FROM AUTHOR]

Background: Assessing the internal condition of swallowing‐related muscles and muscle strength and size is important because their deterioration may lead to dysphagia. However, there are few reports on stiffness of swallowing‐related muscles measured using shear‐wave elastography (SWE) and their qualitative characteristics. Objectives: We measured stiffness of swallowing‐related muscles using SWE to investigate the relationship between muscle stiffness and body composition as well as other relevant variables in healthy adults. Methods: Thirty healthy adults were included in this cross‐sectional study. We evaluated stiffness of the genioglossus muscle (GGM) and geniohyoid muscle (GHM) using SWE. Skeletal muscle mass index, body mass index (BMI), handgrip strength, tongue pressure, and cross‐sectional areas of the muscles were measured, and we determined their relationship with muscle stiffness. Results: For muscle stiffness, the mean value for the middle GGM was 7.08 ± 1.92 kPa, that for the posterior GGM was 9.31 ± 2.68 kPa, and that for the GHM was 8.84 ± 2.15 kPa. In multiple regression analysis, with stiffness of the posterior GGM as the dependent variable, BMI (β = −.473, p =.039) was a significant negative explanatory variable. However, with the GHM stiffness as the dependent variable, BMI (β =.419, p =.033) was a significant positive explanatory variable. Conclusion: Stiffness of the posterior GGM was positively correlated with BMI and that of the GHM was negatively correlated with BMI. Stiffness, as measured using SWE, has the potential to capture the intramuscular characteristics of swallowing‐related muscles, particularly the posterior GGM. [ABSTRACT FROM AUTHOR]

Objective: The American College of Radiology Thyroid Imaging Reporting and Data System (TI‐RADS) is a widely used method for the management of adult thyroid nodules. However, its use in paediatric patients is controversial because adult fine needle aspiration biopsy (FNAB) recommendations may lead to delayed diagnoses of cancer in children. The objectives of this study were to evaluate the performance of TI‐RADS in paediatric thyroid nodules and to tailor FNAB recommendations for children. Methods: Consecutive surgically resected paediatric thyroid nodules from two tertiary care centres between 2003 and 2021 were reviewed. Ultrasounds were blindly scored by radiologists according to TI‐RADS. Management recommendations based on TI‐RADS were evaluated. Various modelling methodologies were used to determine the optimal cutoff for FNAB in children. Results: Of the 96 patients, 79 (82%) were female and the median age at surgery was 16.1 years. Fifty (52%) nodules were malignant on surgical pathology. The area under the receiver operating characteristic curve of TI‐RADS for predicting malignancy was 0.78. Adult TI‐RADS recommendations would have resulted in 4% of cancerous nodules being lost to follow‐up. Modifications to TI‐RADS (FNAB of all TR3 nodules ≥1.5 cm, FNAB of TR4 and TR5 nodules ≥0.5 cm, surveillance of nodules ≥1 cm, consider surgery for nodules >4 cm) reduced this missed malignancy rate to 0%. Conclusions: TI‐RADS can risk‐stratify paediatric thyroid nodules. However, the system requires modifications to reduce the missed malignancy rate in paediatric thyroid nodules. Our data suggest that lower size thresholds for FNAB are warranted in children. [ABSTRACT FROM AUTHOR]

Summary: Point‐of‐care ultrasonography is a powerful tool for the practitioner in determining diagnosis and prognosis in unwell horses. Proper case selection and patient preparation are keys to successful ultrasonographic examinations of the equine thorax and abdomen. Practitioners can expand the use of their equipment to augment evaluations for multiple clinical complaints. The most common application for body cavity ultrasonography in the adult horse is acute abdominal pain. [ABSTRACT FROM AUTHOR]

To construct a model using radiomics features based on ultrasound images and evaluate the feasibility of noninvasive assessment of lymph node status in endometrial cancer (EC) patients. In this multicenter retrospective study, a total of 186 EC patients who underwent hysterectomy and lymph node dissection were included, Pathology confirmed the presence or absence of lymph node metastasis (LNM). The study encompassed patients from seven centers, spanning from September 2018 to November 2023, with 93 patients in each group (with or without LNM). Extracted ultrasound radiomics features from transvaginal ultrasound images, used five machine learning (ML) algorithms to establish US radiomics models, screened clinical features through univariate and multivariate logistic regression to establish a clinical model, and combined clinical and radiomics features to establish a nomogram model. The diagnostic ability of the three models for LNM with EC was compared, and the diagnostic performance and accuracy of the three models were evaluated using receiver operating characteristic curve analysis. Results: Among the five ML models, the XGBoost model performed the best, with AUC values of 0.900 (95% CI, 0.847–0.950) and 0.865 (95% CI, 0.763–0.950) for the training and testing sets, respectively. In the final model, the nomogram based on clinical features and the ultrasound radiomics showed good resolution, with AUC values of 0.919 (95% CI, 0.874–0.964) and 0.884 (0.801–0.967) in the training and testing sets, respectively. The decision curve analysis verified the clinical practicality of the nomogram. The ML model based on ultrasound radiomics has potential value in the noninvasive differential diagnosis of LNM in patients with EC. The nomogram constructed by combining ultrasound radiomics and clinical features can provide clinical doctors with more comprehensive and personalized image information, which is highly important for selecting treatment strategies. [ABSTRACT FROM AUTHOR]

Introduction: Ambulatory hip arthroscopies are associated with moderate-to-severe pain often requiring opioid analgesia. Novel motor-sparing blocks, the pericapsular nerve group (PENG) and lateral femoral cutaneous nerve (LFCN) block, have shown efficacy in hip surgery. Purpose: We sought to investigate the analgesic benefits of these novel blocks in terms of opioid-sparing and discharge efficiency. Methods: We conducted a retrospective cohort study with propensity score matching of 224 patients who underwent ambulatory elective unilateral hip arthroscopy. One group received a combined PENG and LFCN block (PENG/LFCN, n = 86), while a second group received only a PENG block (n = 26). A control group (n = 112) received no blocks. The primary outcome was postanesthesia care unit (PACU) mean opioid consumption. Secondary outcomes were maximum numeric rating scale (NRS) pain score, intravenous rescue analgesia, and PACU readiness-for-discharge times. Results: The PENG/LFCN-block group required significantly less opioids than the control group in the PACU (25.98 ± 13.04 vs 14.58 ± 5.77, respectively) and were discharged earlier 2.72 ± 1.16 vs 4.42 ± 1.63 hours, respectively). The combined PENG/LFCN group also used less intravenous rescue opioids than the control group (0.47 ± 1.18 vs 1.44 ± 2.1 mg, respectively) and showed a significant difference in the highest NRS pain scores than the control group (6.01 ± 2.38 vs 6.77 ± 2.1 respectively). The PENG block alone group did not show a significant difference in opioid reduction (21.95 ± 15.83 vs 27.72 ± 15.01, respectively). Conclusions: This retrospective study found that in patients who underwent ambulatory elective unilateral hip arthroscopy, a combined PENG and LFCN block was associated with expedited PACU discharge and a clinically significant reduction in postoperative opioid use. Further study is warranted. [ABSTRACT FROM AUTHOR]

Objective: Burnout in sonographers is a prevalent and complex professional hazard associated with poorer quality of work life, productivity, and patient outcomes. This study aimed to understand the prevalence of and work systems factors associated with burnout among a large sample of sonographers. Materials and Methods: Research study registry participants (n = 3659) were invited to complete a follow-up survey about personal and work environment factors, including work hours, break time, coworker and supervisor support, and job satisfaction, overall health, and sleep quality. The Copenhagen Burnout Inventory assessed personal, work-related, and client burnout. Simple and multiple linear regressions were used to identify work systems factors associated with burnout. Results: Of 1389 respondents, over half reported moderate-to-severe personal and work-related burnout, while one-quarter reported moderate-to-severe client burnout. Higher work-related burnout was associated with younger age, working in the Western United States, working full-time, taking fewer weekly break hours, poorer overall health and sleep quality, and lower supervisor support and job satisfaction. Client burnout was associated with poorer sleep quality and lower job satisfaction. Conclusion: Burnout was prevalent in a large sample of sonographers. Multilevel work systems factors are associated with burnout, suggesting collaboration among sonographers, administrators, and organizations is needed to address burnout. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate the effect of a static ultrasonographic (US) examination of the central venous structures before central venous catheterization (CVC) and the success of the procedure. Materials and Methods: In this prospective study, patients who underwent CVC, in an emergency department (ED), were divided into two groups: patients who underwent CVC using the anatomical landmark technique (n = 34) and patients who underwent CVC using a static US examination (n = 33). The procedure times, success rates, and number of catheters used were compared. Results: A total of 67 patients who underwent CVC were included in the study. Compared with the anatomical landmark technique, the static US examination had a higher procedural success rate (P =.001), fewer total interventions (P =.001), and fewer postprocedural catheter dysfunctions (P =.048). While there was no difference in the duration of the CVC between groups (P =.222), the total time spent was longer using a static US examination (P =.022). Conclusion: The static US examination was a practical, easy-to-apply method that could be used for CVC placement in an ED. This study demonstrated sonography had a high success rate in CVC procedures and contributed to a reduction in the number of interventions and catheters used. [ABSTRACT FROM AUTHOR]

Objectives: Point‐of‐care‐ultrasound (POCUS) is increasingly used by pediatric emergency medicine (PEM) fellows, but scant data exists on the accuracy of exam interpretations. Our goal was to determine whether agreement on exam interpretation between quality assurance (QA) faculty (reference standard) and PEM fellows varied by fellowship year or exam type. Methods: Retrospective review of fellow‐performed POCUS exams between January 2019 and June 2022. Negative binomial (NB) random effects regression was used to account for longitudinal measurement of individual fellow performance across 3 years. Fixed effects were exam type and fellowship year. To assess between‐ and within‐user variability across time, a random intercept and slope were included for each fellow. Results: Exactly 3032 exams, performed by 24 fellows, were included. Raw proportion agreement by fellowship year was high for all exam types (≥88%). From the NB model, there was no statistically significant effect of fellowship year on the mean count of agreement. The relative risk (RR) of agreement for exam types was greatest for cardiac vs other types. The standard deviations for the random intercept and random slope were 0.09 and 0.04, respectively, with a correlation of −0.94. Conclusions: PEM fellows generally interpret exams correctly, with little variation through fellowship, although those who began with more basic skills showed more progress over time. Fellowship year did not influence the likelihood of correct interpretation but there was variation across exam type, with the best agreement for cardiac exams. The extent to which disagreements between fellows and QA faculty represent clinically significant errors requires further study. [ABSTRACT FROM AUTHOR]

Insertional Achilles tendinopathy is an umbrella medical term referring to pain and swelling on the posterior aspect of the calcaneus. High‐resolution ultrasound imaging is commonly used in daily practice to assess the pathological changes of the Achilles tendon, cortical bone of the calcaneus, and soft tissues located inside the retrocalcaneal space to optimize the management of relevant patients. To the best of our knowledge, a standardized ultrasound protocol to evaluate the retrocalcaneal bursal complex is lacking in the pertinent literature. In this sense, our step‐by‐step sonographic approach is intended to be an easy and ready‐to‐use guide for sonographers/physicians in daily practice to assess this anatomical complex in patients with Achilles tendinopathy. Needless to say, the peculiar histological features of this V‐shaped synovial/fibrocartilaginous bursa surrounding the posteroinferior wedge of the Kager's fat pad and the retrocalcaneal space make the examination challenging. [ABSTRACT FROM AUTHOR]

This systematic review evaluated accuracy of ureteric jet angles on color Doppler sonography in diagnosing vesico‐ureteric reflux (VUR) in children, using voiding cystourethrogram as the reference standard. Six databases were searched, yielding 13 eligible studies of an initial 429, 7 with comparable data. Risk of bias and applicability were assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS‐2) tool. Most studies demonstrated a correlation between increasing jet angle and VUR severity, but reporting and techniques varied, preventing meta‐analysis. Ureteric jet angle sonography may have potential as a VUR triaging tool. Further investigations with rigorous methodology are required. Funding support was obtained from Queensland University of Technology. PROSPERO Registration CRD42020159799. [ABSTRACT FROM AUTHOR]

Context Thyrotoxicosis requires accurate and expeditious differentiation between Graves' disease (GD) and thyroiditis to ensure effective treatment decisions. Objective This study aimed to develop a machine learning algorithm using ultrasonography and Doppler images to differentiate thyrotoxicosis subtypes, with a focus on GD. Methods This study included patients who initially presented with thyrotoxicosis and underwent thyroid ultrasonography at a single tertiary hospital. A total of 7719 ultrasonography images from 351 patients with GD and 2980 images from 136 patients with thyroiditis were used. Data augmentation techniques were applied to enhance the algorithm's performance. Two deep learning models, Xception and EfficientNetB0_2, were employed. Performance metrics such as accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and F1 score were calculated for both models. Image preprocessing, neural network model generation, and neural network training results verification were performed using DEEP:PHI® platform. Results The Xception model achieved 84.94% accuracy, 89.26% sensitivity, 73.17% specificity, 90.06% PPV, 71.43% NPV, and an F1 score of 89.66 for the diagnosis of GD. The EfficientNetB0_2 model exhibited 85.31% accuracy, 90.28% sensitivity, 71.78% specificity, 89.71% PPV, 73.05% NPV, and an F1 score of 89.99. Conclusion Machine learning models based on ultrasound and Doppler images showed promising results with high accuracy and sensitivity in differentiating GD from thyroiditis. [ABSTRACT FROM AUTHOR]

Aim: To present a rare case of xanthogranuloma affecting the oral cavity of an adult man and to highlight the utility of ultrasound in demonstrating its sonographic features and guiding the surgical procedure. Materials and Methods: Description of a rare case of oral xanthogranuloma in an adult patient, with treatment performed using ultrasound. This tool provides safety as it functions as a real‐time imaging technique that can be utilized during surgeries without exposing the patient to radiation. Results: The case exhibited oral xanthogranuloma as a hypoechoic image with poorly defined borders. Conclusion: Ultrasound is an excellent tool for aiding diagnostic investigation and during surgical procedures, serving as a surgical guide that ensures accuracy and safety. Additionally, ultrasound is a portable, practical and accessible examination, proving to be indispensable in certain clinical and hospital settings. [ABSTRACT FROM AUTHOR]

Background: Postoperative pain management remains a significant challenge for patients undergoing posterior urethroplasty (PU). In a previous study, we proposed a novel technique of combined pudendal nerve (PN) and spermatic cord (SC) block to manage pain after PU. The present trial was conducted to test the hypothesis that this technique is effective for pain control after PU and provides longer-lasting analgesia than caudal epidural block (CB). Methods: Sixty patients undergoing PU were randomized into two groups: Group NB received combined PN and SC block, and Group CB received CB. General anesthesia with a laryngeal mask was performed. The primary outcome was the postoperative analgesic duration, and the secondary outcomes included the Numeric Rating Scale (NRS) scores for pain and the number of patients with different motor scores of the lower limb at 3, 6, 12, and 24 h postoperatively. Results: Two patients in Group CB were withdrawn due to block failure. The postoperative analgesic duration was statistically longer in Group NB compared with Group CB (mean difference [95% confidence interval], 115.78 min [17.80, 213.75]; P = 0.021). The NRS scores for pain at 12 and 24 h after surgery were statistically lower in Group NB compared with Group CB. Group NB had statistically more patients with motor score 0 at 3 h postoperatively than Group CB. Conclusions: PN combined with SC block is an effective technique for postoperative analgesia in PU. This technique can achieve a longer duration of analgesia and lower pain scores, especially 12 h after surgery, than a CB. Trial registration: This study was registered in the Chinese Clinical Trial Register (registration no. ChiCTR2100042971, registration date on 2/2/2021). [ABSTRACT FROM AUTHOR]

Background: Symptomatic heart failure (HF) negatively affects the quantity and quality of skeletal muscles. However, the association between asymptomatic HF and skeletal muscle function remains unclear. We aimed to use ultrasonography to elucidate the association between asymptomatic HF and skeletal muscle function in community-dwelling older adults. Methods: This cross-sectional study comprised community-dwelling older adults aged ≥ 60 years who could perform activities of daily living independently and had never had symptomatic HF (n = 52, 76.3 ± 6.1 years). The participants were classified into three groups namely, non-HF (n = 26), stage A (n = 19), and stage B (n = 7) according to the HF stage criteria of the American Heart Association /American College of Cardiology /Heart Failure Society of America guideline. Skeletal muscle quantity and quality were assessed using ultrasonography (thickness and echo intensity) of the rectus femoris (RF) and vastus intermedius (VI) muscles. The group effects on muscle thickness and echo intensity in each group were assessed using a multivariate analysis. Results: Both muscles consistently demonstrated significant group effects on the thickness and echo intensity. Thicknesses of the RF (p = 0.020) and VI (p = 0.035) were lower in the stage B group than that in the non-HF group. The echo intensities in the RF (p = 0.006) and VI (p = 0.009) were higher in the stage B group than that in the non-HF group. Conclusion: Asymptomatic HF negatively associated with the characteristics of skeletal muscle function, as assessed by ultrasonography in community-dwelling older adults. The stage B HF contributes to reduced skeletal muscle function as well as symptomatic HF. [ABSTRACT FROM AUTHOR]

Introduction: Musculoskeletal ultrasound (MSUS) is integral to routine clinical diagnostics for musculoskeletal and joint disorders. This study aims to establish and validate a sonography course tailored to undergraduate medical students acquiring MSUS-specific skills at a German university. Methods: A blended learning training concept, comprising 24 instruction sessions of 45 min each, was designed based on the current national guidelines of the German Society for Ultrasound in Medicine (DEGUM). This program was integrated into the clinical phase of the undergraduate students' medical education. The self-perceived improvement in competency and the effectiveness of the course design were evaluated using a a 7-point Likert scale questionnaire. Objective learning success was evaluated via a written test and a "Direct Observation of Practical Skills" practical exam. Control groups included medical students without MSUS training (control group 1) and doctors who had completed DEGUM-certified basic MSUS courses (control group 2). Both control groups completed the written test, while control group 2 also took the practical final exam. The study involved 146 participants: 56 were allocated to the study group, 44 to control group 1, and 46 to control group 2. Results: The study group rated their skills significantly higher after the course (p < 0.01). Participants expressed high satisfaction with the course design, the teaching materials, and the teachers. The study group's performance on the final written test was comparable to those of control group 2 (p = 0.06) and significantly superior to control group 1 (p < 0.001). Additionally, the study group's performance on the practical final exam was not significantly different from control group 2 (p = 0.28), with both groups achieving scores exceeding 80%. Conclusion: Both subjective and objective measures of learning suggest that an MSUS course designed for postgraduates can be effectively adapted for undergraduate medical students. Incorporating MSUS training into the clinical curriculum is recommended to enhance future medical professionals' educational experience and practical skills. [ABSTRACT FROM AUTHOR]

Prolonged squatting is a well-documented cause of common peroneal neuropathy, wherein the common peroneal nerve is thought to be compressed between the biceps femoris tendon and the lateral head of the gastrocnemius muscle or the fibular head. However, deep peroneal neuropathy resulting from prolonged squatting has not been previously reported. We present the case of a tile installer who developed unilateral deep peroneal neuropathy following extended squatting, diagnosed through ultrasonography, which identified the bilateral division of the common peroneal nerves between the knee joint and the fibular head. This case underscores the value of ultrasonography, particularly when electrodiagnostic results are inconsistent with clinical expectations. [ABSTRACT FROM AUTHOR]

Background: To prospectively evaluate ultrasound backscatter coefficients (BSCs) of the supraspinatus and infraspinatus muscles and compare with Goutallier classification on magnetic resonance imaging (MRI). Methods: Fifty-six participants had shoulder MRI exams and ultrasound exams of the supraspinatus and infraspinatus muscles. Goutallier MRI grades were determined and BSCs were measured. Group means were compared and the strength of relationships between the measures were determined. Using binarized Goutallier groups (0–2 versus 3–4), areas under the receiver operating characteristic curves (AUROCs) were calculated. The nearest integer cutoff value was determined using Youden's index. Results: BSC values were significantly different among most Goutallier grades for the supraspinatus and infraspinatus muscles (both p < 0.001). Strong correlations were found between the BSC values and Goutallier grades for the supraspinatus (τb = 0.72, p < 0.001) and infraspinatus (τb = 0.79, p < 0.001) muscles. BSC showed excellent performance for classification of the binarized groups (0–2 versus 3–4) for both supraspinatus (AUROC = 0.98, p < 0.0001) and infraspinatus (AUROC = 0.98, p < 0.0001) muscles. Using a cutoff BSC value of −17 dB, sensitivity, specificity, and accuracy for severe fatty infiltration were 87.0%, 90.0%, and 87.5% for the supraspinatus muscle, and 93.6%, 87.5%, and 92.7% for the infraspinatus muscle. Conclusion: BSC can be applied to the rotator cuff muscles for assessment of fatty infiltration. For both the supraspinatus and infraspinatus muscles, BSC values significantly increased with higher Goutallier grades and showed strong performance in distinguishing low versus high Goutallier grades. Relevance statement: Fatty infiltration of the rotator cuff muscles can be quantified using BSC values, which are higher with increasing Goutallier grades. Key Points: Ultrasound BSC measurements are reliable for the quantification of muscle fatty infiltration. BCS values increased with higher Goutallier MRI grades. BCS values demonstrated high performance for distinguishing muscle fatty infiltration groups. [ABSTRACT FROM AUTHOR]

Zinc oxide nanoparticles (ZnO NPs) have recently been applied in various veterinary and medical fields, however, the toxicological evaluations of these NPs in dogs are lacking. Therefore, the current study is designed to assess the impact of exposure to daily subcutaneous (SC) injections of ZnO NPs at different concentrations on various organs of mongrel dogs. Nine dogs were randomly divided into three groups (n = 3 for each) as follows: group (1) served as the control group, whereas groups (2&3) received SC injections of 50 and 100 ppm ZnO NPs (8 and 16 μg/kg bwt), respectively, once/day for 7 days. Our results revealed that ZnO NPs disrupted the oxidant/antioxidant balance in the lungs, liver, and kidneys of dogs in a dose-dependent manner. ZnO NPs induced dose-dependent radiological, ultrasonographical, and histopathological alterations in various organs especially lungs, spleen, liver, and kidneys along with disturbance in both liver and kidney biomarkers levels. Most organs of both ZnO NPs receiving groups displayed strong caspase-3 protein expression. Additionally, it upregulates the transcriptase levels of TNF-α and VEGF, as well as downregulates the antiapoptotic gene IL-10 in lung, kidney, and liver tissue homogenates. It was concluded that the daily SC injections of dogs with ZnO NPs at concentrations of 50 and 100 ppm caused extensive oxidative stress damage in various organs which provoked serious pathological processes such as apoptosis and inflammation. [ABSTRACT FROM AUTHOR]

Background: Post-streptococcal myalgia and myositis are very rare complications of streptococcal infections with group A β-haemolytic streptococci. Data on this condition are scarce and even less is known about findings in clinical imaging. Until today, there are no descriptions of ultrasonographic changes in this condition. Case presentation: We present a case of a 31-year-old female patient with immobilizing myalgia of the left outer thigh following a streptococcal upper respiratory tract infection, accompanied with erythemata nodosa on both shins. Laboratory results indicated post-streptococcal myositis since Creatine kinase, Lactate dehydrogenase and Antistreptolysin antibodies were significantly elevated. An ultrasound of the affected vastus medialis of the left quadriceps femoris muscle was performed, which showed a focal increase in muscle echogenicity with loss of architecture and hypervascularisation in Power Doppler Mode. The diagnosis of focal myositis was confirmed with magnetic resonance imaging. The patient's symptoms as well as the ultrasonographic changes fully resolved under therapy with Ibuprofen and intravenous Ampicillin/Sulbactam. Conclusions: This is the first description of ultrasound findings in this rare condition. We conclude that muscular ultrasound is helpful to identify myositis in post-streptococcal myalgia and myositis. [ABSTRACT FROM AUTHOR]

Background/Objectives: The diagnostic capacity of the preoperative pelvic organ prolapse quantification (POP-Q) system to define surgical pelvic organ prolapse (POP) is sometimes limited. On the other hand, pelvic floor ultrasound can influence the surgical indication for patients with symptomatic POP. Therefore, our objective is to determine how transperineal ultrasound can influence the surgical indication for symptomatic POP. Methods: This is a prospective observational study conducted over two years including patients who underwent corrective surgery for symptomatic POP. All patients underwent a preoperative examination using the POP-Q system to assess POP. Patients in whom the pelvic floor specialist had diagnostic doubts about the stage of POP underwent an ultrasound examination of the POP. Before the surgical procedure and with the patient anesthetized, a new clinical examination was performed using the POP-Q system and surgical correction of the POP was executed when the patient had a decline to stage II or higher. Cohen's kappa coefficient of agreement was used to assess the agreement. Results: Of the 180 patients who met the inclusion criteria, 167 were included (99 with preoperative clinical examination and 68 with preoperative clinical examination and ultrasound study). The kappa index for the diagnosis of surgical uterine prolapse of the preoperative clinical examination (moderate correlation) was lower than the ultrasound examination (very good correlation) (0.493 p < 0.001 and 0.924 p < 0.001). The kappa index for the diagnosis of cervical elongation without surgical uterine prolapse also showed differences between the preoperative clinical examination (good correlation) and the ultrasound examination (very good correlation) (0.749 p < 0.001 and 0.853 p < 0.001). Conclusions: Transperineal ultrasound has a higher concordance than presurgical clinical examination, based on the POP-Q system, for detecting POP with central compartment surgical indication. [ABSTRACT FROM AUTHOR]

To examine the relationship between the lower uterine segment (LUS) thickness and the onset of labor in dichorionic twin pregnancies experiencing threatened preterm labor.This prospective cohort study included dichorionic twin pregnancies between 24 and 32 weeks of gestation, presenting with symptoms of preterm labor. The LUS thickness and mid-anterior wall thickness were measured via transabdominal ultrasonography, cervical length, and posterior cervical lip thickness were measured transvaginally. The presence of the cervical sliding sign and funneling findings were recorded.Among the patients with an onset of labor before the 34th week, the mean LUS thickness was 3.8 ± 0.9 mm, compared to 4.6 ± 1.1 mm in those with an onset of labor at or after 340/7 GW, indicating a statistically significant difference (p=0.012). Similarly, accepting the GW threshold as 350/7 weeks, a statistically significant difference was found in the mean LUS thickness, which was 4.0 ± 1.0 mm in those with an earlier onset of labor and 4.7 ± 1.0 mm in those with a later onset of labor (p=0.022). While univariate analysis indicated that the LUS thickness was a significant predictor (p=0.017 for <34 GW and p=0.028 for <35 GW), multivariate analysis showed a reduced effect (p=0.04 and p=0.06, respectively).LUS was significantly thinner in pregnancies with an onset of labor before the 34th and 35th GW. The measurement of the LUS thickness can be considered an alternative method for predicting spontaneous preterm birth in dichorionic twin pregnancies. [ABSTRACT FROM AUTHOR]

Background: Percutaneous vertebroplasty or kyphoplasty is the preferred procedure for stage I and II Kümmell's diseases (KDs), but there exist controversies on the operative option of stage III KD. This study aimed at exploring the safety and efficacy of ultrasonography-guided canal decompression (UG-CD) combined with vertebroplasty and cement-augmented pedicle screw fixation (CA-PSF) for treating stage III KD with neurological deficit (ND). Methods: Between September 2017 and December 2023, all patients who received the UG-CD combined with vertebroplasty and CA-PSF for managing stage III KD with NDs were reviewed retrospectively with their demographic and operation data, and complications recorded. Besides, the scores of Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI), together with imaging data including the kyphotic Cobb angle (KCA), wedge angle (WA), spinal canal area (SCA) at the narrowest level as well as anterior (AHR) and middle (MHR) height ratios were measured and compared between pre- and post-operation. Results: A total of eleven patients with a mean age of 70.09 ± 2.98 years old were included in our study with their surgical time, hospitalization length, blood loss, and follow-up time being 150.91 ± 17.94 min, 202.09 ± 39.95 ml, 8.18 ± 1.17 days, and 16.91 ± 4.09 months, respectively. During the final follow-up, the KCA, WA, VAS scores, ODI scores, AHR, MHR, and SCA were significantly improved (P < 0.01). Intraoperatively, one case suffered a transient decrease in the motor evoked potential. Another case experienced a cerebrospinal fluid leakage postoperatively that was then successfully treated. Conclusion: UG-CD combined with vertebroplasty and CA-PSF could be a feasible procedure for safely and effectively handling stage III KD with NDs. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Methods Results Conclusions To describe the clinical and ultrasonographic features of uterine perivascular epithelioid cell tumor (PEComa) using standardized terminology.This was a retrospective analysis of patients with uterine PEComa diagnosed and confirmed by pathology and immunohistochemistry at West China Second University Hospital, Sichuan University, Sichuan, China, between January 2010 and September 2023. The Morphological Uterus Sonographic Assessment (MUSA) consensus and the International Endometrial Tumor Analysis (IETA) consensus were utilized for the standardized description of the sonographic characteristics of uterine PEComa. We summarized the clinical and ultrasound features of uterine PEComa in cases from our center and those found in a review of the literature conducted using PubMed from 1 January 2013 to 30 September 2023 (inclusive).Five patients, aged 33–57 (median, 52) years with a total of six uterine PEComa lesions were included in our cohort. All cases had complete ultrasonographic and pathological images. None of the patients had a history of tuberous sclerosis complex. Two patients had malignant PEComa (one patient had two lesions) and three had benign PEComa, originating from the cervix, myometrium or uterine cavity. Patients presented with symptoms including increased vaginal discharge, vaginal bleeding and pelvic or abdominal pain. The three patients with benign PEComa underwent total hysterectomy and bilateral adnexectomy, tumor excision and conservative management, respectively, while both malignant cases underwent total hysterectomy and bilateral adnexectomy followed by chemotherapy. Regular follow‐up (from 6 to 24 months) revealed recurrence in one case. Two lesions were misdiagnosed as uterine fibroids, two as cervical cancer, one as metastatic cervical cancer (with myometrial invasion) and one was indeterminate. Ultrasound examination showed that most lesions displayed regular round or ovoid shapes (66.7%), uniform echoes (66.7%) and hypoechogenicity (66.7%), with one (16.7%) malignant PEComa showing cystic areas and one (16.7%) benign PEComa showing punctate calcifications. All lesions lacked shadowing and the majority showed moderate to abundant vascularity (color score of 3–4, 83.3%). The color score was 2–4 in the periphery in 100% of cases and internally in 83.3% of cases. The three benign PEComas showed similar characteristics in vascular distribution, with scattered internal vessels and peripheral vessels exhibiting a circular pattern. The literature search identified 11 articles describing the ultrasonographic appearance of 18 cases of uterine PEComa, with similar characteristics to those in our cohort.The sonographic features of uterine PEComa include a uniform or non‐uniform hypoechogenic mass, typically round or ovoid with regular margins, occasionally containing cystic areas or calcifications, lacking shadowing and often showing moderate to abundant vascularity. Although the preoperative ultrasound diagnosis of uterine PEComa remains challenging, particularly given the non‐specific nature of the sonographic characteristics described here, dispersed intratumoral vessels and a peripheral circular vascular distribution may serve as diagnostic clues for uterine PEComa, but more cases are needed for confirmation. © 2024 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Background/Objectives: The tibial nerve, commonly misnamed the "posterior tibial nerve", branches into four key nerves: the medial plantar, lateral plantar, inferior calcaneal (Baxter's nerve), and medial calcaneal branches. These nerves are integral to both the sensory and motor functions of the foot. Approximately 15% of adults with foot issues experience heel pain, frequently stemming from neural origins, such as tarsal tunnel syndrome (TTS). TTS diagnosis remains challenging due to a high false negative rate in neurophysiological studies. This study aims to improve the understanding and diagnosis of distal tarsal tunnel pathology to enable more effective treatments, including platelet-rich plasma, hydrodissections, radiofrequencies, and prolotherapy. Methods: Ultrasound-guided techniques were employed to examine the distal tarsal tunnel using the Heimkes triangle for optimal probe placement. Results: The results indicate that the tunnel consists of two chambers separated by the interfascicular septum, housing the medial, lateral plantar, and inferior calcaneal nerves. Successful interventions depend on precise visualization and patient positioning. This study emphasizes the importance of avoiding the calcaneus periosteum to reduce discomfort. Conclusions: Standardizing nerve involvement classification in TTS is difficult without robust neurophysiological studies. The accurate targeting of nerve branches is essential for effective treatment. [ABSTRACT FROM AUTHOR]

We aimed to determine the value of standalone and supplemental automated breast ultrasound (ABUS) in detecting cancers in an opportunistic screening setting with digital breast tomosynthesis (DBT) and compare this combined screening method to DBT and ABUS alone in women older than 39 years with BI‐RADS B‐D density categories. In this prospective opportunistic screening study, 3466 women aged 39 or older with BI‐RADS B‐D density categories and with a mean age of 50 were included. The screening protocol consisted of DBT mediolateral‐oblique views, 2D craniocaudal views, and ABUS with three projections for both breasts. ABUS was evaluated blinded to mammography findings. Statistical analysis evaluated diagnostic performance for DBT, ABUS, and combined workflows. Twenty‐nine cancers were screen‐detected. ABUS and DBT exhibited the same cancer detection rates (CDR) at 7.5/1000 whereas DBT + ABUS showed 8.4/1000, with ABUS contributing an additional CDR of 0.9/1000. Standalone ABUS outperformed DBT in detecting 12.5% more invasive cancers. DBT displayed better accuracy (95%) compared to ABUS (88%) and combined approach (86%). Sensitivities for DBT and ABUS were the same (84%), with DBT + ABUS showing a higher rate (94%). DBT outperformed ABUS in specificity (95% vs. 88%). DBT + ABUS exhibited a higher recall rate (14.89%) compared to ABUS (12.38%) and DBT (6.03%) (p <.001). Standalone ABUS detected more invasive cancers compared to DBT, with a higher recall rate. The combined approach showed a higher CDR by detecting one additional cancer per thousand. [ABSTRACT FROM AUTHOR]

Objective The purpose of this study was to investigate the application value of Chromosomal microarray analysis (CMA) in prenatal diagnosis of nuchal translucency (NT) thickening and nasal bone dyscalcification. Methods The fetuses diagnosed with NT thickening and nasal bone dyscalcification at the Prenatal Diagnosis Center of Meizhou People's Hospital from September 2022 to April 2024, who underwent CMA and karyotype analysis were collected to analyze the relationship between NT thickening and nasal bone dyscalcification and chromosome abnormalities. The detection of chromosomal abnormalities in fetuses with NT thickening, nasal bone dyscalcification and the value of ultrasound combined with CMA in prenatal diagnosis were analyzed. Results In 75 fetuses with NT thickening and/or nasal bone dyscalcification, 11 cases of chromosome aneuploidy were detected by karyotype analysis, and 5 cases of pathogenic copy number variations (CNV) were detected by CMA, with an additional detection rate of 6.7%. The additional diagnosis rates of CMA were 6.0% and 5.0% in fetuses with simple NT thickening and nasal bone dyscalcification, respectively. Conclusion CMA technique is of high value in prenatal diagnosis of fetuses with NT thickening and nasal bone dyscalcification, it can improve the detection rate of fetal chromosomal abnormalities, and the combined application of multiple techniques can provide a more comprehensive evaluation of the fetuses. [ABSTRACT FROM AUTHOR]

Background: Median arcuate ligament syndrome (MALS) poses a considerable challenge in terms of diagnosis due to its manifestation of diverse symptoms linked to constriction of the median arcuate ligament surrounding the celiac artery. The present study introduces an earlier diagnostic modality using ultrasound measurements of the flow velocity of the celiac artery during the inspiratory and expiratory phases, with the latter being higher than the former, to avoid prolonged follow-up of postprandial symptomatology. Case Report: A 46-year-old female patient presented with acute postprandial abdominal pain, which was alleviated by analgesic medication. The findings from the physical examination and laboratory tests were within normal limits. Further investigations were conducted due to persistent symptoms, revealing an elevation in celiac artery flow velocity during expiration on ultrasound. The diagnosis of median arcuate ligament syndrome (MALS) was confirmed through contrast-enhanced CT and angiography. Subsequently, the patient underwent laparoscopic release of the median arcuate ligament, leading to alleviation of symptoms at the 1-year follow-up assessment. Conclusions: Our case report highlights the importance of a dynamic imaging diagnostic strategy for MALS. When encountering challenging postprandial abdominal pain that is hard to diagnose, it could be crucial to utilize abdominal ultrasound to measure the flow velocity of the celiac artery. This approach may serve as a valuable screening method for identifying MALS and, subsequently, prompt the need for further diagnostic tests. [ABSTRACT FROM AUTHOR]

This paper aims to investigate and analyze the correlation between diaphragmatic parameters through ultrasonography and sports performance in various sports disciplines. This systematic review followed the PRISMA methodology. The search strategy was applied in the Medline database through Ovid, EMBASE, LILACS, the Cochrane Central Register of Controlled Trials, and Open Gray. Clinical trials, cohort, case–control, and cross-sectional studies were included, and animal experiments were excluded. A total of 388 studies were identified. After removing duplicates and screening titles and abstracts, sixteen studies were selected for full review, and six were included in the qualitative analysis. The results demonstrated a positive correlation between diaphragm excursion and thickness during inspiration with the anaerobic power, highlighting their importance in high-intensity performance. Additionally, one study reported a positive correlation between diaphragm thickness and aerobic power, suggesting the need for further research. The impact of inspiratory muscle training in Paralympic athletes was also evaluated, providing valuable insights into diaphragmatic adaptation in disabled populations. Ultrasonography is a feasible tool for evaluating the structure and function of the diaphragm, the main element of the respiratory process during sports practice. Its use could contribute to the evaluation and planning of sports training and be a possible indicator of performance improvement. [ABSTRACT FROM AUTHOR]

Background: Cervical dystonia is widely understood to benefit from botulinum toxin injections. The injection practices may be influenced by specific factors, including the method of injection. Three main guidance methods can be used: palpation of anatomical landmarks, ultrasound, and electromyography. We investigated how target muscles and doses of botulinum toxin were modified after the transition from surface anatomy (non-guided) to ultrasound (US-guided), in patients with cervical dystonia. We also determined the long-term dose trend. Methods: We studied a group of 82 patients, who received non-guided injections (median: 16.5 cycles/5.1 years) followed by US-guided injections (median: 12.0 cycles/3.8 years). Results: More muscles, and especially deep muscles, were injected during the US-guided period. The total dose and number of injected muscles were higher when US guidance was used, but the mean dose per muscle was lower. Over the long term, the total dose stabilized, and the mean dose per muscle decreased during the US-guided period. Conclusions: According to our results, the guidance method has a strong impact on the botulinum toxin injection strategy in cervical dystonia (target muscles and dose). Also, the treatment appeared more stable when using US guidance; this could be explained by the good precision of such injections. [ABSTRACT FROM AUTHOR]

Background: Routine Doppler study is a common tool for early diagnosis of Fetal Growth Restriction (FGR) and Small for Gestational Age (SGA) patients. It aimed to determine the role of the Foramen Ovale Pulsatility Index (FOPI) study beside routine Doppler study among patients with FGR and SGA fetuses. Methods: This prospective study was conducted on 35 FGR, 32 SGA, and 33 Appropriate for Gestational Age (AGA) fetuses. Demographic data, amniotic fluid index, neonatal outcome, and Doppler velocimetry, including Umbilical Artery Pulsatility Index (UMAPI), Uterine Artery Pulsatility Index (UTAPI), Middle Cerebral Artery Pulsatility Index (MCAPI), Ductus Venosus Pulsatility Index (DVPI), and FOPI were documented. Kolmogorov-Smirnov normality test, one-way ANOVA, Mann-Whitney U, Kruskal-Wallis, non-parametric pairwise comparisons adjusted for Bonferroni correction, Pearson correlation test, Chi square, Fisher's exact test, and Receiver Operating Characteristic Curve (ROC) analysis with Youden's Index (sensitivity+specificity-1) to estimate cut-off point were used to analyze the data at significance level <0.05 for all tests. Results: FOPI cut-off points were 2.24 (sensitivity=77%, specificity=94%) and 1.15 (sensitivity=90%, specificity=20%) to predict FGR and SGA, respectively. FOPI showed a positive correlation with UMAPI and UTAPI (r=0.52 and r=0.30, P<0.001 and P=0.006, respectively), but not with MCAPI and DVPI (r=0.08 and r=0.12, P=0.50 and P=0.30, respectively). Besides, UMAPI, UTAPI, and FOPI were altered among patients with stages I and II FGR. Umbilical cord potential hydrogen (umbilical cord pH), 1- and 5-min Apgar score significantly increased by Birth weight centile; however, UMAPI, FOPI, and UTAPI significantly decreased. Conclusion: UMAPI is recommended to predict short-term neonatal morbidities and demonstrate the early or late onset FGR. Besides, FOPI is suggested as the first-line Doppler study to detect abnormal growth velocity. More studies are warranted, especially considering long-term neonatal morbidities. [ABSTRACT FROM AUTHOR]

Introduction: Ultrasound (USG) is a safe and cost-effective first-line imaging technique for the diagnosis of acute appendicitis. The objective of this study was to assess the diagnostic efficacy of ultrasound by correlating its findings with histopathological results. Materials and Methods: This retrospective observational study was conducted at the Bharat Ratna Late Shri Atal Bihari Vajpayee Memorial Government Medical College in Rajnandgaon, Chhattisgarh, India, from January 2022 to January 2024. The study encompassed 208 cases of suspected acute appendicitis. Ultrasound scores were determined based on specific sonological criteria and these scores were subsequently compared to histopathological findings to evaluate diagnostic accuracy, sensitivity, and specificity. Results: Out of a total of 208 cases, 190 underwent comprehensive ultrasonographic assessment followed by histopathological examination. The study population was predominantly male, comprising 77.88% of the participants, with 33.17% of patients aged between 11 and 20 years. The retrocecal positioning of the appendix was identified as the most prevalent, occurring in 72.63% of cases. The USG demonstrated a sensitivity of 91.03%, a specificity of 87.37%, and an overall accuracy of 63.16% in the diagnosis of acute appendicitis. The kappa (κ) value was calculated to be 0.589, indicating a moderate level of agreement between the USG findings and the histopathological results. Furthermore, the study revealed variability in diagnostic accuracy contingent upon the ultrasound scoring system employed. Conclusion: Ultrasound is a valuable diagnostic tool for acute appendicitis. However, relatively low accuracy of the ultrasound scoring system indicates that, it should be utilized in conjunction with clinical judgment and, when appropriate, other diagnostic methods. [ABSTRACT FROM AUTHOR]

Background/aim: Breast cancer is the leading cause of death from cancer for women in age group of 20-59 years. It is responsible for 15% of the cancer related deaths in women. Our study attempts to assess the axillary lymph node status in carcinoma breast using combined clinical and radiological examination. Materials and methods: A prospective study was conducted using 82 patients with proven cases of carcinoma breast over a period of 2 years. Patients were subjected to clinical examination and ultrasonography of axilla. Then the histopathological reports of the axillary lymph nodes were studied following surgery. The accuracy of clinical and radiological examination have been assessed with the histopathological reports of the lymph nodes. Results: It was noted that clinical examination has a sensitivity of 53.52% and specificity of 100% in detecting axillary lymph node metastasis, with a PPV of 100%, NPV of 25%, chi square value of 10.792 and a p -value of 0.001 which is statistically significant. However, ultrasonography of axilla has a sensitivity of 77.46% and specificity of 100% in detecting lymph node metastasis, with a PPV of 100%, NPV of 40.74%, chi square value of 25.879 and a p-value of 0.001 which is statistically significant. Conclusion: Ultasonography is a non invasive, safe, easily available, less expensive and a reliable method of assessing the lymphatic spread of carcinoma breast to the axilla. Axillary lymph node status assessment is an important step in staging and management of carcinoma breast. In our study, it is highly specific and has got good sensitivity. Further studies have to be conducted on a larger scale to set axillary ultrasound as the standard investigation in assessing the axillary nodal involvement in carcinoma breast. [ABSTRACT FROM AUTHOR]