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).

Correlation between renal sonographic measurements and differential renal function obtained from nuclear renography in children with unilateral hydronephrosis.

INTRODUCTION: Children with higher grades of hydronephrosis often undergo mercaptoacetyltriglycine nuclear renography scans (MAG3) to assess differential renal function (DRF) and drainage. Although MAG3 helps identify the potential need for pyeloplasty, its use incurs increased costs, radiation exposure, and stress for children and families. Several studies demonstrate pyramidal thickness (PT) ≤ 3 mm as a reliable predictive risk factor for pyeloplasty in children with a history of prenatal hydronephrosis. Our hypothesis was that renal sonographic measurements including PT and parenchymal thickness (ParT) correlate with DRF in children with high-grade unilateral hydronephrosis and may be used to better select the need and frequency of MAG3 scans in children at increased risk for diminished relative renal function. The objective of this project was to determine the correlation between sonographic renal measurements and DRF in patients with unilateral hydronephrosis, we assessed: 1) the correlation between PT, ParT, and the ratio of PT/ParT in hydronephrotic kidneys to DRF, 2) the correlation between the ratio of hydronephrotic PT/contralateral non-hydronephrotic PT and DRF, 3) the correlation between the ratio of hydronephrotic ParT/contralateral non-hydronephrotic ParT and DRF, and 4) the correlation between the ratio of (hydronephrotic PT/ParT)/(contralateral non-hydronephrotic PT/ParT) and DRF. MATERIALS AND METHODS: We retrospectively reviewed 71 children with grades 3 or 4 unilateral hydronephrosis. Most patients presented with a history of prenatally detected hydronephrosis at median age (IQR) of 112 days (43-274). Measurements of PT and ParT were completed on 98 renal ultrasounds and DRF was collected from corresponding MAG3 scans. Threshold values were identified visually through scatterplots. Spearman's correlation coefficient and Fisher's p-values were calculated. DISCUSSION: Ratios of PT and ParT in hydronephrotic kidneys to contralateral non-hydronephrotic kidneys were positively correlated with DRF. Ratios of hydronephrotic PT/non-hydronephrotic PT > 0.8 and hydronephrotic ParT/non-hydronephrotic ParT >0.7 occurred more frequently in patients with a DRF >40% (p = 0.11 and p = 0.001, respectively). A PT > 3 mm and ParT >5 mm occurred significantly more frequently in patients with a DRF >40% (p = 0.008 and p = 0.006, respectively). CONCLUSIONS: Renal sonographic measurements including threshold values of PT > 3 mm, ParT > 5 mm, ratio of hydronephrotic PT/contralateral non-hydronephrotic PT (>0.8), and ratio of hydronephrotic ParT/contralateral non-hydronephrotic ParT (>0.7) are good predictors of DRF >40% in unilateral high-grade hydronephrosis. These identified threshold values have potential utility in determining the need for nuclear renal scans in children with high-grade hydronephrosis.

Effects of SGLT2 inhibitors on parameters of renal venous congestion in intrarenal Doppler ultrasonography.

Background: Cardiorenal syndrome is a common condition in clinical practice in which renal venous congestion (VC) plays an important role. Intrarenal Doppler ultrasound (IRD) is a non-invasive method to assess and quantify renal VC. The current study aims to investigate the effects of SGLT2 inhibitor (SGLT2i) therapy on IRD parameters of renal VC. Methods: This prospective observational study included patients with chronic kidney disease (CKD) with or without type 2 diabetes mellitus and/or heart failure (HF) with reduced and preserved ejection fraction who had an indication for standard of care SGLT2i therapy. IRD, assessing venous impedance index (VII), and intrarenal venous flow pattern (IRVF) analysis were performed within the interlobar vessels of the right kidney before and 6 months after initiation of SGLT2i therapy. Results: A number of 64 patients with CKD and a cardiorenal risk profile were included (mean eGFR 42.9 ml/min/1.73 m2; 56% with HF, and 38% with type 2 diabetes mellitus). 17 patients exhibited signs of VC in the IRD. VII was significantly correlated with levels of NT-proBNP, female gender, NYHA class, and was significantly negative correlated with body mass index. After 6 months, a notable decrease in the mean VII of the right interlobar veins by 0.13 (P < .01) was observed. Stratification according to IRVF pattern showed a significant shift towards reduced renal VC pattern after 6 months (P = .03). Conclusions: In this study, SGLT2i therapy resulted in a reduction in renal VC as assessed by IRD. These findings underscore the potential haemodynamic benefits of SGLT2 inhibitors in cardiorenal syndrome and warrant further investigation into their clinical implications.

Evaluation of Sonographic Muscle Measurement Using Established Muscle Markers.

OBJECTIVES: Loss of muscle quantity and function is associated with frailty and reduced quality of life. Sonography is a simple option to quantify muscle mass, which could be included into routine diagnostic workup. This study was designed to prospectively evaluate sonographic measurement and to compare it with established measurements of muscle quantity and function. METHODS: Between March 2020 and May 2022, 723 patients were enrolled in the study. Psoas muscle area index (PMAI) and psoas muscle thickness height index (PMTI) were quantified. Thigh muscle thickness indices (TMTI) were either measured without compression (fTMTI) or under compression (cTMTI). Variation coefficient (VC) as well as intra- and inter-observer reliability were analyzed. The reliability and reproducibility of the sonographic morphometry were assessed using two examiners. Sonographic morphometry was compared with established measurements of muscle using computed tomography and hand grip strength, respectively. RESULTS: In 156 patients, sonographic indices were compared with corresponding CT indices. Of the 723 patients included, sonographic indices were compared with hand strength in 429 patients. Interobserver and intraobserver variability showed better results for the femur indices than for the psoas indices (correlation coefficient: 0.8697/0.9118 vs 0.7502/0.7319). Psoas muscle indices correlated best with the reference standard of the SMI. The optimal cut-off for each muscle index for determining muscle loss according to the SMI and hand grip strength was calculated. CONCLUSION: Sonography can simplify muscle measurement and should be used in the future. Sonographic muscle indices have the potential to simplify evaluation, especially in risk groups such as patients with liver cirrhosis or other wasting disorders.

Association of mammographic and sonographic findings with prognostic molecular factors and hormone receptor expression in malignant breast lesions.

Background: The aim of this study was to determine whether mammographic and sonographic features of malignant breast lesions are correlated with tumor histologic grade, hormonal receptor, human epidermal growth factor receptor 2 (HER2), and Ki-67 status. Materials and Methods: In this retrospective study, imaging and histopathological findings of 187 biopsy-proven breast cancer cases from November 2019 to February 2021 were reviewed. The Chi-square test was used to examine the potential correlation between mammographic and sonographic characteristics with histopathological features such as hormonal receptor, HER2 status, Ki-67 labeling index, and histological grade. Results: We observed that microlobulated margin as well as oval/round morphology in mammograms correlate with triple-negative intrinsic subtype (P = 0.006 and P = 0.004). The presence of calcification in sonography was significantly higher in the luminal-B subtype (P = 0.002). Furthermore, ill-defined margins in mammography were significantly higher in amplified HER2 expression (P = 0.004) in the same manner as an oval/round shape in higher levels of Ki-67 (P = 0.030). Conclusion: Mammography and sonography features may reflect the biological behavior of various subtypes of breast cancer and can detect more aggressive breast cancers that can mimic benign or less malignant appearing lesions. These findings may be an excellent predictor for some subtypes like triple-negative breast cancer. Studying the range of these imaging characteristics may help in better understanding the prognosis, choosing a treatment strategy, and predicting response to treatment.

Nerve sonography to detect intraneural microvascularity in patients with peripheral neuropathy.

OBJECTIVE: We assessed microvessel flow within peripheral nerves using nerve sonography in patients with peripheral neuropathy. METHODS: This study included consecutive patients with peripheral neuropathy who were admitted to our hospital. The patients were divided into two groups: inflammatory neuropathies for immune-mediated neuropathies, such as Guillain - Barré syndrome and chronic inflammatory demyelinating polyneuropathy, and the rest were defined as non-inflammatory neuropathies. We assessed nerve size and intraneural blood flow at four sites on each median and ulnar nerve. Blood flow was evaluated using color Doppler imaging, advanced dynamic flow (ADF), and superb microvascular imaging (SMI) techniques. RESULTS: Thirty-nine patients (median age, 60.0 years; 20 male) were enrolled in this study. An increase in intraneural blood flow was observed in five patients when evaluated by color Doppler, five patients by ADF, and 13 patients by SMI. An overall analysis of the three methods showed that intraneural blood flow was significantly higher in patients with inflammatory neuropathy than in those with non-inflammatory neuropathy (54.2% vs. 0%, p = 0.0005). CONCLUSIONS: Intraneural hypervascularization is more frequent in patients with inflammatory neuropathy than in those with non-inflammatory neuropathy. SIGNIFICANCE: Evaluation of microvessel flow within peripheral nerves may contribute to the diagnosis of peripheral neuropathy.

Dynamic point of care ultrasound is effective in the early diagnosis of anterior cruciate ligament injuries in children and adolescents.

INTRODUCTION: Several studies have proven that ultrasound (US) can improve the efficiency of early diagnostics of anterior cruciate ligament (ACL) injuries. ACL US is mainly performed by sonologists or radiologists. We have very little data on how effective these tests are if they are performed by an orthopaedic surgeon. We also have no information on the applicability of ACL US in children and adolescents. In this retrospective study, we analysed the results of point of care ultrasound (POCUS), which were performed by orthopaedic surgeons on children with suspected ACL injury. MATERIALS AND METHODS: We reviewed the data of children and adolescents who were examined with ultrasound between 2018 and 2021 for suspected ACL injury. ACL POCUS was done immediately after the physical examination, according to a standard technique. The tests were performed by an orthopaedic resident and young and a senior orthopaedic surgeon. The inclusion criteria were as follows: the child's age is between 0-15 years, the growth zones are open, the child later underwent MRI and/or arthroscopy, which confirmed or excluded the fact of an ACL injury. We excluded patients with incomplete recordings and documentation. RESULTS: 119 children met the above criteria. The children were between 8 and 15 years old (mean = 13.29). Positive findings were found in 47, negative findings in 72 children with ACL POCUS. During the subsequent treatment, 57 children underwent only MRI examination, 11 children only arthroscopy, and 51 children both MRI and arthroscopy. The specificity of the test was measured as 0.958 and the sensitivity as 0.917 for complete ACL rupture. Regarding all ACL injuries (complete + partial), we found the sensitivity to be 83.019 and the specificity to be 95.45. The interrater agreement between radiologist and clinicians was 94.957 %. (Cohen's k: 0.8945). CONCLUSIONS: POCUS can indicate functional insufficiency caused by ACL injury in children and adolescents. The biggest advantage of the test is that it is quick and simple, non-invasive. Further prospective diagnostic tests and standardized examination protocols can confirm our favourable experiences.

Intraoperative Doppler flowmetry evaluation of humeral head perfusion after proximal humerus fracture.

Background: Understanding vascularity and assessing the risk of post-traumatic avascular necrosis are crucial for predicting outcomes and identifying optimal treatment options in proximal humerus fractures (PHFs). Until now, Hertel et al have been the only researchers to evaluate the intraoperative perfusion of the humeral head after fracture using Doppler flowmetry in a central single drill hole within the head. This pilot study aims to standardize the evaluation of intraoperative perfusion measurements in different areas of the humeral head in patients with PHF. Methods: In this prospective pilot study, intraoperative semiquantitative Doppler perfusion measurements were conducted during plate osteosynthesis for PHF treatment in our institution between July 2021 and May 2022. The fracture morphology was classified radiologically according to Resch's criteria. Quality of reduction was determined postoperatively to be either anatomical, minor malreduced, or major malreduced according to Peters et al in conventional and computed tomography examinations. Medial hinge integrity and medial metaphyseal extension were assessed radiographically according to Hertel et al. Intraoperatively, after drilling screw holes through the plate, a Doppler probe was inserted through all nine drill holes on the humeral head and at least one on the humeral shaft to successively measure the presence of a pulse to indicate if perfusion is present. Results: A total of ten patients (mean age 59 years, range, 36-83) with a humeral head fracture (2 × 2GL, 3 × 3G, 2 × 4G, 2 × 4GL, 1 × 5aG according to Resch) were included. Nine of the ten patients showed a pulse signal on the humeral shaft. Overall, pulse-synchronous perfusion was detected using Doppler sonography in at least one hole in the humeral head of all patients. In patients with an intact medial hinge (N = 6), pulse-synchronous perfusion could be measured in almost twice as many humeral head holes on average (5.7 vs. 3.0 drill holes) compared to patients with a dislocated medial hinge (N = 4). In patients with metaphyseal extension (N = 3), pulse-synchronous perfusion was measured in an average of 6.7 humeral head holes compared to 3.7 holes in patients without metaphyseal extension (N = 7). Conclusion: Semiquantitative, intraoperative Doppler flowmetry offers a noninvasive and rapid assessment of humeral perfusion which allows an understanding of humeral head perfusion, when used in a standardized fashion to measure flow in different areas of the humeral head.

Sonographic findings associated with complications in pediatric patients with septic arthritis.

OBJECTIVES: Ultrasound is a valuable tool for diagnosing septic arthritis and guiding the development of treatment plans. This study aimed to identify sonographic findings associated with complications in septic arthritis. METHODS: Twelve patients aged <5 years diagnosed with septic arthritis were classified into two groups: those with and without complications. Complications were defined as the destruction of the epiphyseal bone head and metaphysis bone cortex. The following sonographic findings were compared between the two groups using Fisher's exact test: synovial membrane thickness, joint effusion, diminished hyperechoic foci within the epiphyseal bone head, and diminished smooth metaphyseal bone cortex. RESULTS: Overall, 4 of 12 patients developed complications. Joint effusion and synovial membrane thickening were detected in all patients with septic arthritis. The incidence of diminished hyperechoic foci within the epiphyseal bone head was significantly different between the two groups (presence/absence in patients with complications vs. without = 3/1 vs. 0/8, p = 0.018). The incidence of diminished smooth metaphyseal bone cortex was higher in patients with complications than in those without; however, this difference was not statistically significant (presence/absence in patients with complications vs. without = 4/0 vs. 3/5, p = 0.081). CONCLUSION: Ultrasound proved to be an effective diagnostic tool for septic arthritis and also demonstrated its potential in predicting complications of septic arthritis in the pediatric population.

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.

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.

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.

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.

Superb microvascular ultrasound is a promising non-invasive diagnostic tool to assess a ventriculoperitoneal shunt system function: a feasibility study.

The objective of this pilot study was to assess the reliability of superb microvascular ultrasound (SMI) for the measurement of the cerebrospinal fluid (CSF) flow within VPS systems as an indirect sign for shunt dysfunction. Asymptomatic hydrocephalus patients, with a VPS system implanted between 2017 and 2021, were prospectively enrolled in the study. Using SMI, the CSF flow within the proximal and distal catheters were analysed. Before and after pumping the shunt reservoir, intraabdominal free fluid, optical nerve sheath diameter (ONSD), and papilla diameter (PD) were evaluated and correlated with the amount of valve activation. Nineteen patients were included. A flow was detectable in 100% (N = 19) patients in the proximal and in 89.5% (N = 17) in the distal catheter. The distal catheter tip was detectable in 27.7% (N = 5) patients. Free intraabdominal fluid was initially detected in 21.4% (N = 4) patients and in 57.9% (N = 11) at the end of the examination (P = 0.049). ONSD was significantly lower after pump activation (4.4 ± 0.9 mm versus 4.1 ± 0.8 mm, P = 0.049). Both peak velocity and flow volume per second were higher in proximal compared to distal catheters (32.2 ± 45.2 versus 5.6 ± 3.7 cm/sec, P = 0.015; 16.6 ± 9.5 ml/sec versus 5.1 ± 4.0 ml/sec, P = 0.001, respectively). No correlation was found between the number of pump activations and the changes in ONSD (P = 0.975) or PD (P = 0.820). SMI appears to be a very promising non-invasive diagnostic tool to assess CSF flow within the VPS systems and therefore affirm their function. Furthermore, appearance of free intraperitoneal fluid followed by repeated compression of a shunt reservoir indicates an intact functioning shunt system.

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.

Use of a handheld ultrasound device for detecting orbital inflammation.

Purpose: Orbital inflammatory disease has been historically diagnosed with computed tomography (CT) and magnetic resonance imaging (MRI). Orbital ultrasound has served as a non-radiation alternative that has been successful at diagnosing many orbital pathologies but is not commonly used in clinical practice due to need for specialized ultrasound training and equipment needs. We demonstrate use of handheld ultrasound for detecting orbital inflammation. Observations: We present five patients with orbital inflammation where a handheld ultrasound probe was able to capture features consistent with concurrent CT scans. Conclusions and importance: Handheld ultrasound is an accessible and portable method that can assist in the diagnosis and monitoring of orbital pathology.

Microvascular flow imaging of fibroids: A prospective pilot study.

INTRODUCTION: Imaging fibroid vascularity may predict fibroid growth and aid to determine most appropriate therapy. Microvascular (MV) flow imaging is relatively new and is able to detect slow flow in small vessels. Data on feasibility, reproducibility, and reliability of MV-flow imaging in fibroids is lacking. The purpose of our study was to determine the reproducibility of MV-flow imaging and to explore this technique for clinical practice for assessing blood flow in fibroids. MATERIAL AND METHODS: Thirty patients with one or multiple fibroids (diameter 1.5-12.0 cm) were prospectively included. Transvaginal ultrasound scanning was performed in B-mode, 2D MV-Flow™, 2D and 3D power Doppler mode (HERA W10, Samsung) by two experienced gynecologists at a tertiary care clinic from February to December 2021. The primary outcome was intra- and interobserver agreement of the vascular index (VI) and color score (CS). The following parameters: '2D MV-flow VI', '3DPD VI', '2D MV-flow CS' and '2DPD CS' were measured offline in the center, pseudocapsule, and entire fibroid. Secondary offline outcomes for exploring 2D MV-flow for clinical practice, included (1) ability to discern vascular structures, (2) assessing the degree of vascularity via CS and calculating a VI, and (3) determining penetration depth of the ultrasound signal in both power Doppler and MV-flow imaging. RESULTS: All scans of the 30 included patients were of sufficient quality to analyze. Inter- and intra-observer correlations of all studied parameters were good to excellent, both for 2D MV-flow and 2D power Doppler (intercorrelation coefficient 0.992-0.996). Using 2D MV-flow different vascular structures were visible in detail, in contrary to using 2D and 3D power Doppler. In significantly more fibroids central flow could be visualized using 2D MV-flow (63%) than with 2D power Doppler (13%, p = 0.001). Finally, penetration of the ultrasound signal was deeper using 2D MV-flow (3.92 cm) than with 2D power Doppler (2.95 cm, p = 0.001). CONCLUSIONS: Using 2D MV-flow imaging for determining vascularity is highly reproducible. It has potential added value for clinical practice as it depicts detailed vascular structures and the degree of vascularity, especially in the center of the fibroid.

Hyolaryngeal Kinematics in Primary Muscle Tension Dysphonia Determined by Ultrasound.

OBJECTIVES: The purpose of this study was to determine hyolaryngeal kinematics during voicing in people with primary muscle tension dysphonia (pMTD) compared with healthy speakers, and to investigate the relationships between hyolaryngeal displacement and self-perceived vocal function. METHODS: Twenty-six participants, 13 with pMTD and 13 healthy speakers, were assessed using sonography during sustained vowel phonation and rest. Displacement of the hyoid bone and thyroid cartilage was measured from still frames extracted from ultrasound video recordings, with measures normalized to reflect change from rest during voicing for each participant. Vocal function was determined for all participants through self-perceived speaking effort and the Voice Handicap Index-10. RESULTS: Normalized displacement of the hyoid bone and thyroid cartilage was significantly greater during voicing for participants with pMTD than for the healthy speakers. Weak-to-moderate, nonsignificant relationships between hyoid displacement and vocal function measures were evidenced, whereas moderate-to-strong, significant relationships were found for thyroid displacement and vocal function measures. CONCLUSIONS: Displacement of the hyoid and elevation of the larynx during phonation appear to be prominent features of pMTD that differentiate the disorder from healthy phonatory kinematics. Ultrasound imaging provides a sensitive, reliable, noninvasive, and feasible method for objectively determining hyolaryngeal kinematics and may be useful for differential diagnosis and determination of treatment outcomes in pMTD.

The predictive value of transvaginal cervical length and cervical angle ultrasonography in term delivery outcomes: a cohort study.

BACKGROUND: Various techniques have been proposed to predict and evaluate the timing and conditions of childbirth in pregnant women at different stages of pregnancy. Providing precise methods for forecasting childbirth status can reduce the burden on the healthcare system. This study aimed to evaluate the predictive value of transvaginal sonography of cervical length (CL) and cervical angle (CA) on full-term delivery outcomes. METHODS: This cohort study analyzed 151 pregnant women between 37 and 42 weeks of gestational age who were treated at Rasoul Akram Hospital affiliated with Iran University of Medical Sciences from June 2023 to January 2024. All Participants received transvaginal examinations. This study evaluated the accuracy of CL and CA by transvaginal sonography in predicting outcomes like vaginal delivery, cesarean section, necessity for labor induction, and the rate of Premature Rupture of Membranes (PROM). The study used the Receiver Operating Characteristic (ROC) curve to determine the optimal cutoff for predicting birth outcomes. RESULTS: The mean age of the pregnant women was 28.9 ± 4.22 years, while the average duration of pregnancy was 39.8 ± 2.11 weeks. Cesarean delivery was performed on 45 individuals (29.8%) and 106 (70.1%) underwent vaginal delivery. The mean CL overall stood at 21.2 ± 6.4 mm. PROM was observed in 41 cases (27.1%) among full-term pregnancies. A significant difference was noted in mean CL between the cesarean and vaginal delivery groups (24.2 ± 2.4 vs. 20.1 ± 2.1 mm, p = 0.001). The predictive value of a CL measuring 21 mm for cesarean delivery was 72.2% sensitive and 79.1% specific. Similarly, a CL of 22 mm showed 66.6% sensitivity and 80.2% specificity for labor induction. Regarding PROM in full-term pregnancies, a CL assessment demonstrated 59.8% sensitivity and 69.1% specificity. Finally, a CA of 115.2° exhibited 70.3% sensitivity and 78.4% specificity in predicting vaginal delivery. CONCLUSION: The present study showed that evaluating CL and CA via transvaginal sonography demonstrated adequate diagnostic accuracy in predicting spontaneous birth, need for labor induction, cesarean delivery, and incidence of PROM in full-term pregnant women. This method is suggested to be an accurate and appropriate way to predict delivery results.