Abdominal Ectopic Pregnancy: A Case Report of an Uncommon Complication of Pregnancy Without Prenatal Care.

Ectopic pregnancy (EP) is a life-threatening condition requiring a high clinical suspicion. This diagnosis must be considered in all female patients of reproductive age presenting with abdominal pain or discomfort who may possibly be pregnant. Ectopic pregnancies occur in a small percentage of all pregnancies and are a significant cause of maternal morbidity and mortality. Abdominal ectopic pregnancy (AEP) is a rare and potentially fatal form of ectopic pregnancy where the implantation occurs in the abdominal cavity. We present the following case of a 23-year-old female who was transferred following an initial workup for abdominal pain and subsequently found to have an abdominal ectopic pregnancy at 37 weeks gestation. After transferring to our emergency department, the patient continued to have abdominal pain and her presenting FAST exam was positive for free fluid concerning for active hemorrhage and hematoma. Her clinical presentation was consistent with ruptured abdominal ectopic pregnancy, and she was taken to the operating room for emergent exploratory laparotomy and delivery. Her clinical course was complicated by adherent placenta and re-bleeding with significant hemoperitoneum requiring re-entry laparotomy and transfusion. We present the details of this case along with the diagnostic imaging and management of the rarely seen and life-threatening condition of secondary abdominal ectopic pregnancy (AEP).

Relationship Between Lower Esophageal Sphincter Muscles Thickness and Their Response to Pneumatic Dilation in Patients With Achalasia.

Background: Prognostic factors play a major role in managing achalasia patients treated with pneumatic dilatation (PD) and understanding the pathophysiology of the disease. In this regard, the muscular thickness of the lower esophageal sphincter (LES) has drawn attention in recently published studies. Methods: Patients with newly diagnosed achalasia were included consecutively in this study, and Endoscopic Ultrasound (EUS) was used to determine the thickness of longitudinal and circular muscles of LES. To determine the recurrence of symptoms, patients were followed up for one year using the Eckardt questionnaire. The relationship between pre-treatment LES muscle thickness and symptom recurrence was investigated. Results: Seventeen of nineteen treated patients were enrolled in this study and the data of sixteen patients was analyzed. Although not statistically significant, those with thinner LES had recurrent symptoms ( p-value = 0.08). Patients with a thicker LES (5.1 mm vs. 4.6 mm) initially responded better to pneumatic dilatation ( p-value = 0.03). After initial therapy, severe pain (daily pain) was strongly associated with symptom recurrence. Conclusions: Severe retrosternal chest pain and a thin LES appear to be surrogate markers for advanced disease and poor outcomes. Pre-treatment integrated relaxation pressure (IRP) seems to be a promising predictor of PD prognosis. Due to the study's heterogeneous population, the findings cannot be generalized to all achalasia patients, and larger-scale studies are necessary to confirm these findings.

Transvaginal sonographic screening of abnormal intra-amniotic structure around internal cervical os at 18-21+6 weeks of gestation.

OBJECTIVE: To detect an abnormal intra-amniotic structure around the internal cervical os using transvaginal sonography at 18-21+6 weeks of gestation. METHODS: In this cohort study, during a 12-month period from July 2022 to June 2023, 395 transvaginal scans were performed for second-trimester cervical-length screening in singleton pregnancies at 18-21+6 weeks of gestation. Nine abnormal intra-amniotic structures (AIAS), 87 low-lying placentas (LLP, second-trimester placenta previa or placental margin within 2 cm from internal cervical os), and 299 controls (not LLP and no abnormal finding around internal cervical os) were diagnosed. Sonographic features of AIAS and delivery outcomes in the three groups were compared. RESULTS: Sonographic features of nine AIAS cases were: two single bands, one single broad band, one multiple bands, one single tubular, and one multiple tubulars. Blood flow was noted in seven cases. Seven AIAS had disappeared by 26 weeks, one was resolved at 34 weeks, and one (vasa previa and parachute placenta) remained until delivery. Incidences of emergency cesarean section, abnormal placenta and umbilical cord, and abnormal deliveries in AIAS were significantly higher than those in LLP and control groups (P = 0.031). Blood losses during delivery in AIAS and LLP groups were significantly greater than in the control group (P = 0.004), but there was no significant difference in blood loss between AIAS and LLP groups. CONCLUSION: The incidence of AIAS around the internal cervical os in the second trimester was 2.28% (9/395 fetuses). Mid-second-trimester transvaginal sonographic screening for the detection of AIAS around the internal cervical os including vasa previa may be essential to reduce perinatal morbidity.

Spinal subdural empyema in an immunocompetent patient: illustrative case.

BACKGROUND: Spinal subdural empyemas are a rare presentation of rapid neurological decline, progressing from radiculopathy to complete paralysis and sensory loss. Although pathogenic mechanisms have been hypothesized, their occurrence in this population of patients remains unclear. OBSERVATIONS: The authors present the third documented case of an isolated spinal subdural empyema of unclear etiology in an immunocompetent patient with no established risk factors. LESSONS: Successful treatment requires prompt clinical suspicion, radiological diagnosis, and surgical evacuation along with empirical antibiotic treatment. Radiological clarification of the subdural versus the epidural location of the empyema is difficult, while intraoperative durotomy for exploration risks subdural dissemination. In these cases, intraoperative ultrasonography would be a useful adjunct and decision aid. https://thejns.org/doi/10.3171/CASE24464.

Cesarean Scar niche: Comparison of Transvaginal Ultrasound Findings and Uterine Tissue Samples after Hysterectomy.

BACKGROUND: The cesarean scar (CS) niche, a consequence of incomplete wound healing, can lead to gynecological complications and affect future pregnancies. While internal niches have been well-studied, external and bidirectional niches are also important. OBJECTIVES: We aimed to conduct a comparative analysis of the prevalence and measurements of different types of niches. STUDY DESIGN: This cross-sectional study examined 200 patients with prior cesarean delivery (CD) undergoing hysterectomy due to abnormal uterine bleeding. It evaluated internal, external, and bidirectional niche prevalence, measurements (height, residual myometrial thickness, and adjacent myometrial thickness), and classification in hysterectomy specimens compared to pre-hysterectomy TVS reports. The secondary outcome was to determine niche presence in uterine tissue samples based on the number of previous CDs. RESULTS: The mean age of the study participants was 48.19 years, with 30% having undergone only one CD. Notably, 83.5% had niches detected via sonography, while 91% had niches identified in uterine tissue samples post-hysterectomy (p-value =0.008). Internal niches were common, with significant associations between niche presence and the number of previous CDs. 23.3% of patients with one CD had internal niches. Additionally, external niches were detected in 4% of hysterectomy samples but not observed in ultrasound reports. Key parameters such as RMT and AMT differed notably between ultrasound and tissue samples, highlighting discrepancies in niche detection methods. RMT ranged from 2.8-24 mm (7.68 ± 3.09 mm) in ultrasound reports versus 0-25 mm (4.28 ± 2.71 mm) in tissue samples (p < 0.001). AMT ranged from 6-29 mm (17.08 ± 4.53 mm) in ultrasound reports versus 7.5-30 mm (16 ± 5.03 mm) in tissue samples (p < 0.001). This study underscores the importance of accurate niche assessment in patients with prior CD. CONCLUSIONS: We performed a comparative analysis of niche prevalence and measurements in gross specimens and TVS reports. The results highlight the importance of considering external and bidirectional niches, in addition to internal niches. These niches can reduce residual myometrial thickness and increase future pregnancy complications. Furthermore, we demonstrated that niche formation can occur after a single CD.

Substantia nigra hyperechogenicity and brain ventricular size as biomarkers of early dementia with Lewy bodies.

BACKGROUND: Diagnosis of dementia with Lewy bodies (DLB) is challenging, especially in the earlier stages of the disease, owing to the clinical overlap with other neurodegenerative diseases such as Alzheimer's (AD) and Parkinson's disease (PD). We aimed to identify the transcranial sonography (TCS) parameters that can help us to detect early DLB patients. METHODS: In this cross-sectional study, we prospectively recruited newly diagnosed DLB patients with less than 3 years from the onset of cognitive symptoms. For comparison purposes, we also included AD and PD patients, with a disease duration of less than 3 years, and a control group. TCS was performed to assess the substantia nigra (SN) echogenicity, the width of the third ventricle, and the frontal horns of the lateral ventricles. Subsequently, TCS images were analyzed with the medical image viewer Horos in order to quantify the intensity of the echogenicity of the SN. Univariate analysis and a logistic regression model were used to identify which variables can predict the diagnosis of DLB. RESULTS: One hundred and seven participants were included (23 DLB, 26 AD, 27 PD and 31 controls). The median age of DLB patients was 75(72-77) years, with a disease duration of 2 years. DLB and PD patients showed higher SN hyperechogenicity rates (72.73% and 81.82%, respectively) and a greater area of the SN compared to AD patients and controls (p < 0.001). DLB and AD patients had wider ventricular systems than the other study groups. The SN hyperechogenicity predicted a diagnosis of DLB with an odds ratio of 22.67 (95%CI 3.98; 129.12, p < 0.001) when compared to AD patients. Unilateral and bilateral widened frontal horns predicted diagnosis of DLB compared to PD with an odds ratio of 9.5 (95%CI 0.97; 92.83, p = 0.053) and 5.7 (95%CI 0.97; 33.6, p = 0.054), respectively. CONCLUSIONS: Echogenicity of the SN and widening of the frontal horns of lateral ventricles can predict the diagnosis of early DLB in this cohort of newly diagnosed patients, when compared to AD and PD patients. Transcranial sonography, a non-invasive tool, could be helpful for the diagnosis of DLB at its earlier stages.

Neck triangle nerve enlargement in hereditary transthyretin amyloidosis correlates with changes in the autonomic, cardiac, and gastrointestinal systems.

BACKGROUND: Hereditary transthyretin amyloidosis (ATTRv) is a hereditary disease that affects multiple bodily systems. Although sonography generally reveals enlargement of nerves in the limbs, the brachial plexus, and vagus nerve, the clinical significance of these findings remains unclear. METHODS: We performed sonographic measurements of the median nerve, cervical spinal nerves at the C5-C7 level, and the vagus nerve in patients with ATTRv and healthy controls. Clinical profiles and cardiac and gastrointestinal examination results were also collected for linear regression analysis. RESULTS: We recruited 47 patients with ATTRv (males/females: 34/13, age: 65.6 ± 5.3 years). The sampled segments were all significantly larger than those of the controls. In the clinical profiles, the sum of the Z scores of the neck triangle nerves (cervical spinal nerves and vagus nerve) and of all nerves (cervical spinal nerves, vagus nerve, and median nerve at the wrist) significantly correlated with the familial amyloid polyneuropathy stage, onset of autonomic nervous system (ANS) symptoms, and autonomic symptom scores. On cardiac examinations, several ultrasonography and magnetic resonance imaging parameters (primarily those that reflect heart volume) were found to be significantly correlated with the sum of the Z scores of the cervical spinal nerves but not with the Z score of the vagus nerve. In gastrointestinal evaluation, the cross-sectional area of the vagus nerve was correlated with gastric emptying time parameters on scintigraphy. CONCLUSIONS: Neck triangle nerve enlargement on sonography correlated with parameters related to ANS dysfunction, indicating that nerve enlargement observed on ultrasonography may serve as a potential surrogate biomarker of ATTRv.

Bedside 3D ultrasound fistula maturation assessment by non-expert sonographers provides equivalent accuracy to formal duplex sonography: A prospective clinical trial.

BACKGROUND: EchoSure is an automated point-of-care 3D ultrasound (3DUS) designed to be used by dialysis technicians without advanced ultrasound training. The EchoMark/EchoSure System is a two-part system comprised of a bioresorbable implant, EchoMark, and a diagnostic ultrasound imaging platform, EchoSure. EchoSure was designed to enable any healthcare personnel in a dialysis clinic setting to obtain non-invasive, direct measurements of flow and vessel parameters that are critical quantifications used in the assessment of AVF maturation and readiness for hemodialysis cannulation. OBJECTIVE: In this pilot feasibility study, we sought to explore whether use of an automated 3DUS could enable fistula assessment by non-experts and obtain measurement accuracy comparable to expert sonographer Duplex. METHOD: This was a 20 subject prospective multicenter trial conducted at four sites in the United States. All subjects had an EchoMark implanted under their AVF during the fistula creation procedure. Subjects were evaluated at 2-weeks post-op with EchoSure and Duplex, followed by monthly assessments until either the 4-month visit or until radiographic maturation was achieved, whichever was longer. Beyond monthly ultrasound assessments, clinical follow-up continued every 6 months between months 6 and 24. RESULT: Technical success of EchoMark implantation was demonstrated in 100% of subjects. Technical success of EchoSure was 99% across all scans. The mean percent difference in flow rate measurements between EchoSure and Duplex was -9.2% with a standard deviation of 38.1% compared to a mean percent difference of -15.7% with a standard deviation of 35.5% between Duplex measurements taken at the cannulation zone and brachial artery. Pearson correlation between EchoSure and Duplex was 0.708 versus 0.716 for the two Duplex measurements. Radiographic maturation was achieved in 70% of study subjects by 30 days and continued to rise to 90% through 90 days and 95% through 180 days after baseline. CONCLUSION: This study demonstrates the feasibility and accuracy of an automated 3D ultrasound system for assessment of maturation at the dialysis bedside by non sonographers.

Reliability of Rehabilitative Musculoskeletal Sonography for Measuring the Visible Cross-Sectional Area of Suboccipital Muscles.

Aims The primary aim of this study is to assess the reliability of rehabilitative sonography as a non-invasive imaging technique for measuring the visible cross-sectional area (CSA) of the deep suboccipital muscles. Objectives Objectives involve determining both the intra-rater and inter-rater reliability of sonographic measurements to ensure consistent and reproducible results across different sessions and examiners. The ultimate goal is to validate rehabilitative sonography as a reliable tool for clinical and research applications in the assessment and management of musculoskeletal (MSK) conditions involving the deep suboccipital muscles. Design and setting Seventeen participants, including nine women and eight men without neck or vertebral pain, were evaluated using MSK sonography. The visible CSA of suboccipital muscles was assessed using real-time B-mode sonography in a sitting position with a linear probe (5 cm, 7.5 MHz) aligned perpendicularly to the muscle fibers of the rectus capitis posterior minor (RCPM) in one sonogram and the obliquus capitis inferior (OCI) and rectus capitis posterior major (RCPMJ) in another. Two experienced examiners performed sonography measurements, and the procedure was repeated one hour and again one day later. Results Intra-class correlation coefficient (ICC) values for Examiner 1 were 0.84 and 0.79 for RCPM, 0.84 and 0.71 for RCPMJ, and 0.86 and 0.77 for OCI at the one-hour and one-day repetitions, respectively. ICC values for Examiner 2 were 0.86 and 0.77 for RCPM, 0.77 and 0.86 for RCPMJ, and 0.61 and 0.64 for OCI at the one-hour and one-day repetitions, respectively. Inter-rater ICC values were 0.77 for RCPM, 0.82 for RCPMJ, and 0.68 for OCI. Standard error of measurement (SEM) values for Examiner 1 were 11.63 and 13.92 mm² for RCPM, 10.30 and 7.91 mm² for RCPMJ, and 22.84 and 34.61 mm² for OCI. SEM values for Examiner 2 were 11.82 and 13.40 mm² for RCPM, 11.91 and 7.04 mm² for RCPMJ, and 39.20 and 37.73 mm² for OCI. SEM values between examiners were 13.74 mm² for RCPM, 10.36 mm² for RCPMJ, and 36.03 mm² for OCI. Conclusions These findings suggest that sonography is a reliable method for measuring the CSA of the RCPM, RCPMJ, and OCI muscles, provided that the examiners are well-trained and consistent in their techniques and that the average of three measurements is used.

Combined radiographic and ultrasound evaluations to decipher joint involvement in the hands of patients with systemic sclerosis.

OBJECTIVE: The objective of this study was to explore the etiologies and contributing factors of synovial and tenosynovial involvement in SSc, as well as to assess the phenotype of patients with these synovial and tenosynovial features. METHODS: 171 SSc patients with hand manifestations (either vascular, skin or joint manifestations) who underwent standard X-rays of both hands and hand ultrasound (US), were included. Two independent evaluators recorded the presence or absence of acro-osteolysis, calcinosis, microcrystalline and degenerative rheumatisms, including osteophytosis on X-Rays. The presence of synovitis and tenosynovitis (active or fibrotic) was assessed through US by a third evaluator, blinded for X-ray parameters. RESULTS: In multivariate analysis, the characteristics associated with active synovitis and tenosynovitis were CRP>10mg/L (p = 0.013), fibrotic tenosynovitis on US (p = 0.005), anti-RNA polymerase III antibodies (p = 0.043) and poly-osteophytosis on hand X-rays (p = 0.001). After exclusion of patients with RA (n = 5) and/or poly-osteophytosis (n = 53), 14 remaining patients (12.7%) had active synovitis and/or tenosynovitis on US. In multivariate analyses, parameters associated with active synovitis and/or tenosynovitis in this selected population were scleroderma renal crisis (p = 0.012) and fibrotic tenosynovitis on US (p < 0.001). CONCLUSION: Our study confirms that osteophytosis is a significant contributor of joint involvement in SSc patients based on real life data. After exclusion of potential confounders, more than 10% of SSc patients still had active synovitis and/or tenosynovitis on US, providing indirect evidence for the existence of a specific SSc-related synovial and/or tenosynovial involvement.

Musculoskeletal disorders among sonographers: a systematic review and meta-analysis.

INTRODUCTION: The job of sonographers exposes them to numerous ergonomic risk factors, making the sonography profession one of the high-risk job groups vulnerable to musculoskeletal disorders (MSDs). The present systematic review and meta-analysis specifically examined the prevalence of MSDs among sonographers. MATERIALS AND METHODS: The present review study was carried out in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. The protocol of the study was registered in the international prospective register of systematic review (PROSPERO) with the code CRD42024507972. Searches were conducted in databases including PubMed, Scopus, Web of Science, Science Direct, SID, ISC, and Google Scholar, without imposing a time limit until February 7th, 2024. The random-effects model was employed for meta-analysis, and the I2 index was used to assess heterogeneity among studies. Finally, data analysis was performed using STATA (version 14). RESULTS: Based on the search in different databases, a total of 4367 articles were identified. Finally, after screening, selecting, and quality evaluation of the studies, 30 studies were considered for meta-analysis in which 13,916 sonographers were examined. According to the results of the meta-analysis, the overall prevalence of MSDs among sonographers was reported as 75.80% (95% CI: 65.37-86.23, I2 = 99.7%, P < 0.001). Additionally, the prevalence rates of these disorders in the neck (63.73%), shoulder (60.13%), upper back (53.69%), lower back (49.84%), wrist (44.41%), elbow (27.46), hip (24.93%), knee (19.59), and ankle (16.92%) were determined. CONCLUSION: Given the relatively high prevalence of MSDs among sonographers and the importance of reducing specific risk factors associated with their duties, it is recommended to consider solutions such as carrying out ergonomic assessments and interventions, as well as providing training programs and appropriate corrective exercises to mitigate MSDs among sonographers.

Ultrasound-guided drainage of a popliteal ganglion cyst extending to the adventitia of the popliteal artery: a case report of cystic adventitial disease of synovial origin.

We report a case of a 67-year-old woman suffering from intermittent claudication secondary to severe popliteal stenosis due to compression by a popliteal ganglion cyst extending into the adventitia of the popliteal artery. After declining vein bypass grafting, this patient was successfully treated using ultrasound-guided aspiration of the cyst, which restored normal flow to the popliteal artery. Whilst aspiration of Baker's cysts causing claudication has been attempted before, this represents the first reported case of successful recanalization of the popliteal artery by ganglion cyst aspiration and further supports an important possible aetiology and treatment for cystic adventitial disease.

Sonographic evaluation of spondylolysis: technique description and feasibility study of diagnostic ultrasound for the detection of L5 pars interarticularis fractures.

Objective: Technique description and verification of L5 pars interarticularis (L5PI) using diagnostic ultrasound (DUS). Methods: Asymptomatic 10-year-old male subject was scanned with diagnostic ultrasound applying a linear array transducer (8-13 MHz) over L5/S1 facets; long-axis slide cephalad to capture both superior (SAP) and inferior articulating process (IAP) of L5. Contiguous hyperechoic cortex with deep acoustic shadowing between the SAP and IAP was assumed to be L5PI. To confirm in vivo technique representing L5PI, two spine models (plastic, human spine) were scanned to verify authors' assumption. Metallic paperclip was placed over L5PI then DUS image captured. Lastly, a subject with known spondylolysis was imaged and sonographic appearance of L5PI compared. Results: The structures localized with the metal paperclip on L5PI models were equivalent to the in vivo DUS image. Spondylolysis demonstrates an abrupt step-off defect at L5PI. Conclusion: We report the first technique description and verification of the L5PI using DUS.

L'évaluation échographique de la spondylolyse: une description de la technique et une étude de faisabilité de l'échographie diagnostique pour la détection des fractures de l'isthme interarticulaire de la L5. Objectifs: La description de la technique et la vérification de l'isthme interarticulaire de la L5 (IIL5) à l'aide d'ultrasons diagnostiques (USD). Méthodes: Un sujet masculin asymptomatique âgé de 10 ans a été scanné à l'aide d'une échographie diagnostique utilisant un transducteur linéaire (8­13 MHz) sur les facettes de la L5/S1; un glissement en direction céphalique sur grand axe pour capturer le processus d'articulation supérieur (PAS) et inférieur (PAI) de la L5. Le cortex hyperéchogène contigu avec ombrage acoustique profond entre le PAS et le PAI a été supposé être de l'IIL5. Afin de confirmer la technique in vivo représentant l'indice de l'IIL5, deux modèles de colonne vertébrale (plastique, colonne vertébrale humaine) ont été scannés pour vérifier l'hypothèse des auteurs. Un trombone métallique a été placé sur l'IIL5 puis une image d'USD a été prise. Enfin, un sujet présentant une spondylolyse connue a été imagé et l'aspect échographique de l'IIL5 a été comparé. Résultats: Les structures localisées avec le trombone métallique sur les modèles de l'IIL5 étaient équivalentes à l'image d'USD in vivo. La spondylolyse montre un défaut abrupt de décrochage à l'IIL5. Conclusion: Nous rapportons la première description technique et la vérification de l'IIL5 à l'aide d'USD.

Improved bladder diagnostics using multiparametric ultrasound.

This comprehensive review examines recent advancements in the integration of multiparametric ultrasound for diagnostic imaging of the urinary bladder. It not only highlights the current state of ultrasound imaging but also projects its potential to further elevate standards of care in managing urinary bladder pathologies. Specifically, contrast-enhanced ultrasound (CEUS) and elastography show significant improvements in detecting bladder tumors and assessing bladder wall mechanics compared to traditional methods. The review also explores the future potential of ultrasound-mediated nanobubble destruction (UMND) as an investigational targeted cancer therapy, showcasing a novel approach that utilizes nanobubbles to deliver therapeutic genes into tumor cells with high precision. Emerging AI-driven innovations and novel techniques, such as microvascular ultrasonography (MVUS), are proving to be powerful tools for the non-invasive and precise management of bladder conditions, offering detailed insights into bladder structure and function. These advancements collectively underscore their transformative impact on the field of urology.

Ultrasound Diagnosis of Clavicle Fractures in Newborns: A Systematic Review.

BACKGROUND: Fractures of the clavicle are the most common birth injury among newborns. Aim of this systematic review was to provide a comprehensive analysis of the role of ultrasound (US) in diagnosing clavicular fractures in neonates. METHODS: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) using PubMed and Embase, including studies focusing on US in neonatal clavicle fracture. Age at US, number of cases examined by US and X-ray, US and X-ray diagnoses, US probe used, fracture site were systematically extracted. RESULTS: A total of 231 articles were found. We ultimately selected 7 publications that satisfied the inclusion criteria, involving 136 patients examined between 3 days and 3 weeks of age, with 135 confirmed fractures. US was performed on all patients and correctly diagnosed all fractures (135/135, 100%). X-ray was performed on 94/136 patients (69.1%) and correctly diagnosed 89/93 fractures (95.7%). Fracture site was: medial in 2/79, middle in 37/79, and lateral in 40/79. In the remaining 57 cases, site was not reported. CONCLUSIONS: This review indicates that ultrasound is extremely reliable in diagnosing clavicle fractures in newborns and should be considered as the gold standard in this context.

The superior value of radiomics to sonographic assessment for ultrasound-based evaluation of extrathyroidal extension in papillary thyroid carcinoma: a retrospective study.

BACKGROUND: Extrathyroidal extension was related with worse survival for patients with papillary thyroid carcinoma. For its preoperative evaluation, we measured and compared the predicting value of sonographic method and ultrasonic radiomics method in nodules of papillary thyroid carcinoma. PATIENTS AND METHODS: Data from 337 nodules were included and divided into training group and validation group. For ultrasonic radiomics method, a best model was constructed based on clinical characteristics and ultrasonic radiomic features. The predicting value was calculated then. For sonographic method, the results were calculated using all samples. RESULTS: For ultrasonic radiomics method, we constructed 9 models and selected the extreme gradient boosting model for its highest accuracy (0.77) and area under curve (0.813) in validation group. The accuracy and area under curve of sonographic method was 0.70 and 0.569. Meanwhile. We found that the top-6 important features of xgboost model included no clinical characteristics, all of whom were high-dimensional radiomic features. CONCLUSIONS: The study showed the superior value of ultrasonic radiomics method to sonographic method for preoperative detection of extrathyroidal extension in papillary thyroid carcinoma. Furthermore, high-dimensional radiomic features were more important than clinical characteristics.

Automatic Transcranial Sonography-Based Classification of Parkinson's Disease Using a Novel Dual-Channel CNXV2-DANet.

Transcranial sonography (TCS) has been introduced to assess hyper-echogenicity in the substantia nigra of the midbrain for Parkinson's disease (PD); however, its subjective and resource-demanding nature has impeded its widespread application. An AI-empowered TCS-based PD classification tool is greatly demanding, yet relevant research is severely scarce. Therefore, we proposed a novel dual-channel CNXV2-DANet for TCS-based PD classification using a large cohort. A total of 1176 TCS images from 588 subjects were retrospectively enrolled from Beijing Tiantan Hospital, encompassing both the left and right side of the midbrain for each subject. The entire dataset was divided into a training/validation/testing set at a ratio of 70%/15%/15%. Development of the proposed CNXV2-DANet was performed on the training set with comparisons between the single-channel and dual-channel input settings; model evaluation was conducted on the independent testing set. The proposed dual-channel CNXV2-DANet was compared against three state-of-the-art networks (ConvNeXtV2, ConvNeXt, Swin Transformer). The results demonstrated that both CNXV2-DANet and ConvNeXt V2 performed more superiorly under dual-channel inputs than the single-channel input. The dual-channel CNXV2-DANet outperformed the single-channel, achieving superior average metrics for accuracy (0.839 ± 0.028), precision (0.849 ± 0.014), recall (0.845 ± 0.043), F1-score (0.820 ± 0.038), and AUC (0.906 ± 0.013) compared with the single channel metrics for accuracy (0.784 ± 0.037), precision (0.817 ± 0.090), recall (0.748 ± 0.093), F1-score (0.773 ± 0.037), and AUC (0.861 ± 0.047). Furthermore, the dual-channel CNXV2-DANet outperformed all other networks (all p-values < 0.001). These findings suggest that the proposed dual-channel CNXV2-DANet may provide the community with an AI-empowered TCS-based tool for PD assessment.

Artificial Intelligence for Contrast-Enhanced Ultrasound of the Liver: A Systematic Review.

INTRODUCTION: The research field of artificial intelligence (AI) in medicine and especially in gastroenterology is rapidly progressing with the first AI tools entering routine clinical practice, for example, in colorectal cancer screening. Contrast-enhanced ultrasound (CEUS) is a highly reliable, low-risk, and low-cost diagnostic modality for the examination of the liver. However, doctors need many years of training and experience to master this technique and, despite all efforts to standardize CEUS, it is often believed to contain significant interrater variability. As has been shown for endoscopy, AI holds promise to support examiners at all training levels in their decision-making and efficiency. METHODS: In this systematic review, we analyzed and compared original research studies applying AI methods to CEUS examinations of the liver published between January 2010 and February 2024. We performed a structured literature search on PubMed, Web of Science, and IEEE. Two independent reviewers screened the articles and subsequently extracted relevant methodological features, e.g., cohort size, validation process, machine learning algorithm used, and indicative performance measures from the included articles. RESULTS: We included 41 studies with most applying AI methods for classification tasks related to focal liver lesions. These included distinguishing benign versus malignant or classifying the entity itself, while a few studies tried to classify tumor grading, microvascular invasion status, or response to transcatheter arterial chemoembolization directly from CEUS. Some articles tried to segment or detect focal liver lesions, while others aimed to predict survival and recurrence after ablation. The majority (25/41) of studies used hand-picked and/or annotated images as data input to their models. We observed mostly good to high reported model performances with accuracies ranging between 58.6% and 98.9%, while noticing a general lack of external validation. CONCLUSION: Even though multiple proof-of-concept studies for the application of AI methods to CEUS examinations of the liver exist and report high performance, more prospective, externally validated, and multicenter research is needed to bring such algorithms from desk to bedside.

Comparison of Endometrial Polyp Characteristics in Transvaginal Sonography and Hysteroscopy in Predicting Endometrial Malignancies in Premenopausal and Postmenopausal Women.

Background: Hysteroscopy is known as the gold standard for endometrial polyps diagnosis and its findings on vascularity, size, and number of polyps can indicate malignancy, but it is a relatively expensive method with some complications. Ultrasound is a common part of the gynecological examination, and with technological advances, its ability to predict pathological outcomes has increased. This study aimed to determine the accuracy of ultrasound in diagnosing the characteristics of endometrial polyps. Materials and Methods: This diagnostic value study was performed on 300 premenopausal and postmenopausal women over 40 years of age with endometrial polyps referred to Alzahra and Beheshti hospitals in Isfahan. The characteristics of endometrial polyps were evaluated by transvaginal ultrasonography and hysteroscopy and biopsy specimens were sent for pathological evaluations. Results: In this study, 103 premenopausal women and 197 postmenopausal women were evaluated. Malignancy was confirmed by pathology in 4 premenopausal women (2%) and 2 postmenopausal women (2%). In both hysteroscopy and ultrasound methods, the frequency of vascularity was significantly different in postmenopausal and premenopausal women, but the other features of the polyp were not significantly different in them. Ultrasonic sensitivity in detecting the presence of vascularity, polyps larger than 1.5 mm, more than 1 polyp, and the presence of pedicle were 39.04, 57.38%, 91.93 and 94.95%, respectively, its specificity were 98.94, 36.47, 99.57 and 98.89% respectively. Conclusion: A comparison of the characteristics of polyps in both ultrasound and hysteroscopy methods shows that hysteroscopy has been more effective in diagnosing malignancy and ultrasound has not have acceptable sensitivity in diagnosing size and vascularity.

Clinical Utility of Ultrasonographic Guidance for Arterial Catheterization in Patients with Obesity: A Randomized Controlled Trial.

OBJECTIVES: To compare the success and complication rates of radial artery catheterization using ultrasound guidance versus the conventional palpation technique in obese patients by anesthesia residents with similar levels of experience in both methods, and to measure the skin-to-artery distance of radial, brachial, and dorsalis pedis arteries using ultrasound with standardized anatomic landmarks. DESIGN: Prospective, randomized controlled trial SETTING: Single tertiary center PARTICIPANTS: Eighty adults with a body mass index (BMI) ≥30 kg/m2 INTERVENTIONS: Ultrasound guidance or conventional palpation method MEASUREMENTS AND MAIN RESULTS: The primary outcome was the first-attempt success rate of arterial catheterization. The skin-to-artery distance of the radial artery was significantly greater in the BMI groups of 40 to 49 kg/m2 and ≥50 kg/m2 compared to the BMI group of 30 to 39 kg/m2 (mean difference, 1.0 mm; 95% confidence interval [CI], 0.4-1.7; p = 0.0029) for BMI 40-49 kg/m2 vs 30-39 kg/m2 and 1.5 mm (95% CI, 0.6-2.4 mm; p = 0.0015) for ≥50 kg/m2 vs 30-39 kg/m2. Similar findings were observed for the brachial artery. BMI was inversely associated with first-attempt success rates (p = 0.0145) and positively with time to successful catheterization (p = 0.0271). The first-attempt success and vascular complication rates of catheterization did not differ significantly between the ultrasound guidance group (65.0% and 52.5%, respectively) and the conventional palpation group (70.0% [p = 0.6331] and 57.5% [p = 0.6531], respectively). CONCLUSION: The results of this study do not support the routine use of ultrasonography during radial arterial catheterizations for obese adults when junior practitioners perform the procedure.