Colour Doppler Sonography of the Ovarian Vein: Recognition and Associated Lesions.

AIM: The purpose of this study was to evaluate the diagnostic value of colour Doppler sonography for ovarian veins. The clinical incidence of ovarian venous lesions is relatively low and often overlooked. The ovarian veins are located deep in the pelvis, and they are relatively elongated, which could make medical imaging more difficult. Therefore, there is limited literature on the diagnosis of ovarian venous disease. The purpose of this study was to evaluate the diagnostic value of colour Doppler sonography towards ovarian vein. METHODS: A total of 37 consecutive patients with clinically suspected ovarian venous disorders were included. All the patients underwent colour Doppler sonography. CTV was performed in 31 patients, while retrograde phlebography was performed in 6 patients. CT/phlebography was the established diagnostic criterion for ovarian vein disorders. The SPSS 22.0 program was used for statistical analysis. Sensitivity, specificity, and positive and negative predictive values for colour Doppler sonography were calculated. k-test was used to evaluate consistency between colour Doppler sonography and CT/phlebography. RESULTS: In the 37 patients,18 cases were positive for ovarian vein disorders and 19 cases were negative, as assessed with colour Doppler sonography. The associated lesions included ovarian vein thrombosis (7 cases), ovarian varicocele (3 cases), and ovarian venous leiomyoma (8 cases). The calculated values of sensitivity, specificity, and positive and negative predictive value were 94.4%, 94.7%, 94.4%, and 94.7%, respectively. The overall accuracy rate was 94.9%. The k level of the degree of agreement between CT/phlebography and colour Doppler sonography was 0.892. CONCLUSION: Colour doppler sonography can provide sufficient imaging information. In clinical ultrasonography, attention should be paid to recognizing and detecting ovarian venous lesions.

Foot pain in children and adolescents: a problem-based approach in musculoskeletal ultrasonography.

Various etiologies and risk factors contribute to foot pain in children and adolescents, including conditions such as Kohler's disease, Sever's disease, Iselin's disease, rigid flat foot, accessory navicular, Freiberg's disease, sesamoiditis, os trigonum syndrome, and more. High-frequency musculoskeletal ultrasonography can show both the bone surface and the surrounding soft tissue clearly from various angles in real-time, thereby providing a higher level of detail that is helpful for identifying the etiology of foot pain and monitoring disease progression compared with other imaging modalities. This review provides an overview of the epidemiology, pathophysiology, clinical manifestations and characteristic ultrasonographic findings of select foot pain conditions in children and adolescents.

The diagnostic value of ultrasonography in evaluation of the intraneural vascular anomalies of peripheral nerves.

BACKGROUND: The imaging diagnosis of intraneural vascular anomalies of peripheral nerves mostly depended on magnetic resonance imaging (MRI), whereas high-frequency ultrasonography evaluation of intraneural vascular anomalies has been seldom done. PURPOSE: To evaluate the diagnostic value of ultrasonography in the diagnosis of intraneural vascular anomalies of peripheral nerves. MATERIAL AND METHODS: A total of 69 consecutive patients seen at Shandong Provincial Hospital Affiliated to Shandong First Medical University between February 2013 and June 2022, each with a clinical suspicion of intraneural vascular anomaly, were included. The ultrasonographic images of intraneural vascular anomalies of peripheral nerves were analyzed and the ultrasonographic features were summarized. These data were compared with MRI, which served as the gold standard for the diagnosis of intraneural vascular anomalies. The kappa statistic was adopted to determine the level of agreement. The sensitivity, specificity, positive and negative predictive values, accuracy, and Youden index of high-frequency ultrasonography as a diagnostic tool were assessed. RESULTS: Ultrasonography findings were positive in 20 of 69 patients with a clinical suspicion of intraneural vascular anomaly. The diagnosis was confirmed by MRI in 21 patients. There was one false-positive result and two false-negative results by ultrasonography. The κ value was 0.896. The sensitivity, specificity, positive and negative predictive values, accuracy, and Youden index of ultrasonography were 90.5%, 97.9%, 95%, 95.9%, 95.7%, and 0.884, respectively. CONCLUSION: Ultrasonography could be an accurate, reliable, and convenient imaging tool for the diagnosis of intraneural vascular anomalies of peripheral nerves.

Multimodal ultrasound evaluation of asymptomatic ulnar nerve dislocation at the cubital tunnel.

Background: Ultrasonography has received broad acceptance as an effective peripheral nervous imaging examination. Shear wave elastography (SWE) can quantitatively assess the stiffness of nerves; however, little research has been conducted on elastography for ulnar nerve dislocation. The purpose of this study was thus to investigate the characteristics of multimodal ultrasound, including high-resolution ultrasonography and SWE, for asymptomatic ulnar nerve dislocation at cubital tunnel. Methods: In this prospective cross-sectional study, 41 participants were recruited in Shandong Provincial Hospital Affiliated to Shandong First Medical University in July 2022. The inclusion criteria for participants were being in good health and being 18-60 years of age. Meanwhile, the exclusion criterion was a history of upper limb pain or fractures, peripheral neuropathy, or systemic or immunological diseases. Finally, 38 participants were enrolled. Two ultrasound doctors measured the maximum diameter, the maximum cross-sectional area (CSA), and the shear modulus of the ulnar nerve at the cubital tunnel independently. Another two ultrasound doctors determined whether dislocation was present during dynamic elbow flexion and extension and divided the elbows into a dislocation group and a control group. The descriptive statistics and independent sample t-test were used for data analysis, and intragroup correlation coefficient (ICC) was used to determine the consistency of evaluation between observers. Results: Ulnar nerve dislocation was observed in 15.8% (12/76) of the ulnar nerves. There was no significant difference in the maximum diameter between the dislocation group (0.194±0.022 cm) and the control group (0.181±0.023 cm) (t=1.888; P=0.063). The CSA and SWE of the ulnar nerve were 0.064±0.009 cm2 and 43.629±6.737 kPa in the dislocation group, respectively, and were 0.050±0.008 cm2 and 31.293±7.858 kPa in the control group, respectively. There were significant differences between the two groups in terms of CSA (P<0.001) and SWE (P<0.001). The ICCs of the maximum diameter, CSA, and SWE values between observers were 0.970, 0.900, and 0.915, respectively. Conclusions: Multimodal ultrasound consisting of high-resolution ultrasonography combined with elastography can comprehensively and quantitatively evaluate the morphological changes and mechanical properties of the dislocated ulnar nerve and monitor disease progress.

Diagnostic value of high-frequency ultrasound in omohyoid muscle syndrome.

PURPOSE: To investigate the diagnostic value of high-frequency ultrasound in omohyoid muscle syndrome. MATERIAL AND METHODS: A retrospective analysis of 11 patients diagnosed with omohyoid muscle syndrome was carried out, and the characteristics of high-frequency ultrasound images were summarized. RESULTS: Ultrasonography of the omohyoid muscle showed a narrow band of hypoechoic muscle bundle. The ultrasonographic manifestation of omohyoid muscle syndrome showed a thickening of the omohyoid muscle on the affected side. The omohyoid muscle on the affected side bulged forward during swallowing and lifted the overlying sternocleidomastoid muscle. The difference between the thickness of the omohyoid muscle intermediate tendon on the affected side and the healthy side at rest was statistically significant (t = 58.23, P < 0.001). The difference between the thickness of the affected omohyoid muscle intermediate tendon at rest and during swallowing was statistically significant (t = 14.57, P < 0.001). There was no statistically significant difference between the thickness of the omohyoid muscle intermediate tendon on the healthy side at rest and during swallowing (t = 0.56, P > 0.05). CONCLUSION: High-frequency ultrasound is the preferred imaging method in the diagnosis of omohyoid muscle syndrome.

The role of ultrasonography in diagnosing acute closed volar plate injury of proximal interphalangeal joint.

BACKGROUND: Acute closed volar plate injury of the proximal interphalangeal joint (PIP) is a common hand injury. In the past, there were few objective evaluation imaging methods for the degree of volar plate injury. The purpose of this study was to investigate the role of high frequency ultrasonography in diagnosing volar plate injury, and to explore whether ultrasound can provide a beneficial guidance to clinical decision-making and appropriate treatment adopting through accurate US classification of volar plate injury. METHODS: From May 2019 to may 2022, 41 patients diagnosed with volar plate injury were included in this study. All patients underwent ultrasonography and X-ray examinations. The sonographic features were analyzed. A new kind of classification of volar plate injury based on ultrasonography findings was described. RESULTS: Either an injury of volar plate or an avulsion fracture of middle phalangeal base was identified clearly on ultrasonography, according to which volar plate injury could be divided into three types: A, B and C. Type A, avulsion fracture of the middle phalangeal base without volar plate rupture; Type B, full thickness tear of the volar plate without avulsion fracture; Type C, partial thickness tear of the volar plate. The average thickness of the three types of injured volar plate measured by ultrasound was 0.33 ± 0.05 cm, and the average thickness of the volar plate at the same site of the corresponding finger on the contralateral side was 0.22 ± 0.03 cm. There was significant difference between the two group (t = 11.823, p = 1.2476 *10^(-14)). CONCLUSIONS: High frequency ultrasonography could be a reliable, accurate, convenient and non-radioactive diagnostic imaging technique in the evaluation of acute closed volar plate injury of PIP. And ultrasound could provide a beneficial guidance to clinical decision-making and appropriate treatment adopting through accurate US classification.

Comparative analysis of ultrasound diagnosis and pathological characteristics of external jugular venous aneurysm.

PURPOSE: This study aimed to investigate the diagnosis of the external jugular venous aneurysm on color Doppler ultrasound and its relationship with pathological characteristics. METHODS: A retrospective analysis of 17 patients with external jugular venous aneurysm admitted to the Provincial Hospital Affiliated with Shandong First Medical University from May, 2010, to June, 2020, was performed. The color Doppler ultrasound characteristics of 17 patients with external jugular vein aneurysms were analyzed and summarized, which were then compared with postoperative pathological outcomes. RESULTS: All 17 patients with external jugular venous aneurysms were presented with cystic structures adjacent to and communicated with the external jugular vein. Color Doppler flow imaging showed a bidirectional venous flow signal in the communication between the cystic structure and the external jugular vein. Among the 17 patients, ultrasound diagnosis showed true venous aneurysm due to degenerative changes in the venous wall in 8 cases, venous pseudoaneurysm in 4 cases, and external jugular venous aneurysm in 5 cases, and postoperative pathology indicated degenerative changes in the venous wall in all 17 patients. CONCLUSION: Bidirectional blood flow at the communication between the cystic lesion and the external jugular vein on color Doppler ultrasound should not be the criterion for the diagnosis of external jugular venous pseudoaneurysm, which requires pathological support.

Diagnostic value of high-frequency ultrasound for Poland syndrome.

BACKGROUND: The imaging diagnosis of Poland syndrome is mostly computed tomography (CT) or magnetic resonance imaging (MRI), whereas high-frequency ultrasound for the diagnosis of Poland syndrome is relatively rare. PURPOSE: To investigate the diagnostic value of high-frequency ultrasound for Poland syndrome. MATERIAL AND METHODS: A retrospective analysis of 15 patients diagnosed with Poland syndrome was performed, and the characteristics of ultrasound images were summarized. RESULTS: High-frequency ultrasound clearly depict the anatomical structures of each layer of the chest wall in patients with Poland syndrome. Ultrasonography mainly showed partial or total absence of the pectoralis major muscle on the affected side, and some of which were combined with the absence of the pectoralis minor muscle. The difference was statistically significant in the thickness of the affected chest wall compared with the healthy side (P < 0.01). Out of 15 cases with Poland syndrome, 11 were associated with ipsilateral brachydactyly or syndactyly, and high-frequency ultrasonography showed that the bifurcation position of the common palmar digital artery on the affected finger was lower than that on the healthy side. CONCLUSION: High-frequency ultrasound is an effective imaging method for the diagnosis of Poland syndrome.

The role of ultrasonography in diagnosis of neuralgic amyotrophy.

OBJECTIVE: To investigate the value of high frequency ultrasound in diagnosis of neuralgic amyotrophy. MATERIALS AND METHODS: From January 2010 to December 2020, the ultrasonographic images of 117 patients with neuralgic amyotrophy diagnosed by the Department of Neurology and hand & foot surgery of Shandong Provincial Hospital Affiliated to Shandong First Medical University were retrospectively analyzed. The ultrasonographic features were summarized. RESULTS: High frequency ultrasound could clearly show the degree of the affected nerves: No ultrasonic findings were found in 12 cases (10%). The affected nerves were thickening and hypoechogenicity with loss of normal fascicular definition in 28 cases (24%). The affected nerves showed hourglass-like changes, including constriction and torsion in 77 cases (66%). In addition, ultrasound can determine the extent of the lesion, and microvascular imaging can display small blood flow signal within the nerve. There was a significant statistical difference between the diameter of the thickened nerve fascicle and the diameter of the nerve fascicle at the corresponding site of the contralateral normal limb. CONCLUSIONS: High frequency ultrasound is a valuable imaging method for diagnosis of neuralgic amyotrophy.

Study on the Crush Injury Model of the Sciatic Nerve in Rabbits by Conventional Ultrasound and Elastography.

BACKGROUND: The crush injury model of the sciatic nerve in rabbits is a common nerve injury model, but there is little literature on the evaluation of nerve stiffness by ultrasound elastography. PURPOSE: To explore the value of ultrasound elastography in diagnosing crush injury of the sciatic nerve in rabbits. MATERIALS AND METHODS: Forty cases of crush injury model of the sciatic nerve in rabbits were examined by conventional ultrasound and elastography. The sonographic manifestations and stiffness of the model were analyzed, and the regularity of nerve injury with time was summarized. RESULTS: Ultrasound could clearly show the location, range, and thickness of the injured nerve in this model. The thickness of the injured area reached a peak in the 2nd week and returned to normal thickness in the 8th week. The nerve stiffness of the injured area increased gradually with time. CONCLUSION: Conventional ultrasound combined with elastography can comprehensively and quantitatively evaluate the morphological changes and mechanical properties of the injured sciatic nerve in rabbits, which may be of great significance to the repair and rehabilitation of peripheral nerve crush injuries.

Associations of left renal vein entrapment with IgA nephropathy and Henoch-Schönlein purpura nephritis.

OBJECTIVES: The aims of the study were to identify whether left renal vein (LRV) entrapment was more prevalent in IgA nephropathy (IgAN) and Henoch-Schönlein purpura nephritis (HSPN) compared with other types of renal diseases, and the association of LRV entrapment with glomerular incidental IgA and galactose-deficient-IgA1 (Gd-IgA1) deposition. METHODS: A total of 797 patients with biopsy-proven kidney diseases have been screened for LRV entrapment by color Doppler ultrasound, and the prevalence of LRV entrapment in different types of renal diseases were then analyzed. Propensity score matching analysis was used to adjust for age, gender, and body mass index. Immunostaining of Gd-IgA1 with KM55 was performed in paraffin-embedded sections of renal biopsy specimens. RESULTS: LRV entrapment was diagnosed in 47 patients (6%) with several kinds of renal diseases in our cohort. A total of 32 (68%) LRV entrapments were combined with expanded IgAN (idiopathic IgAN and HSPN). The prevalence of LRV entrapment in expanded IgAN was significantly higher than that in non-expanded IgAN (17 vs. 2%, p < 0.001), even after adjustment for age, gender, and body mass index by propensity score matching analysis (13 vs. 2%, p < 0.001). Removing expanded IgAN and LN, glomerular incidental IgA deposition was observed to be significantly more common in patients with LRV entrapment compared with patients without it (43 vs. 9%, p < 0.001). Furthermore, in glomerular diseases with incidental IgA deposits, significantly much larger proportion of patients with LRV entrapment were positive for glomerular Gd-IgA1 in contrast to patients without LRV entrapment (5/5 vs. 5/17, p = 0.01). CONCLUSIONS: LRV entrapment coexisted with several kinds of renal diseases, with a significantly higher prevalence in patients with idiopathic IgAN and HSPN. In patients of LN and IgAN-unrelated disease with LRV entrapment, glomerular IgA and Gd-IgA1 deposition was more common compared with patients without LRV entrapment.

The role of ultrasonography in diagnosing hourglass-like fascicular constriction(s) of the anterior interosseous nerve.

BACKGROUND: In the past, the diagnosis of hourglass-like fascicular constriction(s) of the anterior interosseous nerve mostly depended on electrophysiological examination, by which the location could not be diagnosed. There are few studies on the evaluation of hourglass-like fascicular constriction(s) by ultrasonography. PURPOSE: To evaluate the role of ultrasonography in the diagnosis of hourglass-like fascicular constriction(s) of the anterior interosseous nerve. MATERIAL AND METHODS: A retrospective analysis of 12 patients with hourglass-like fascicular constriction(s) of the anterior interosseous nerve was carried out, and the characteristics of the high-frequency ultrasonographic images were summarized and compared with surgical exploration. RESULTS: The 12 cases of hourglass-like fascicular constriction(s) of the anterior interosseous nerve were all located in the median nerve of the distal upper arm, including nine cases of single hourglass-like fascicular constriction and three cases of multiple hourglass-like fascicular constrictions. High-frequency ultrasonography can accurately locate the hourglass-like fascicular constriction(s) of the anterior interosseous nerve and the extent of neuropathy. The ultrasonographic images of hourglass-like fascicular constriction(s) of the anterior interosseous nerve showed single or multiple hourglass-like change(s) in the median nerve of the distal upper arm. The nerve fascicles on both sides of the affected nerve with hourglass-like change thickened. CONCLUSIONS: High-frequency ultrasonography could be a reliable, convenient, and non-invasive diagnostic imaging method for hourglass-like fascicular constriction(s) of the anterior interosseous nerve.

The role of ultrasonography in the diagnosis of talocalcaneal coalitions.

BACKGROUND: Patients with talocalcaneal coalitions (TCC) often undergo computed tomography (CT). However, ultrasonography diagnosis of TCC has been seldom done according to the literature. PURPOSE: To investigate the accuracy of ultrasonography in diagnosing TCC compared to CT. MATERIAL AND METHODS: Ninety-seven consecutive patients with a clinical suspicion of TCC were included. Ultrasonography was used to assess the classification and complication of TCC. The main sonographic criteria for a positive diagnosis in cases of osseous coalition were the joint space between the medial surface of talar head and the underlying sustentaculum tali of calcaneus disappearing and being replaced by a continuous hyperechoic bony structure. In cases of fibrous coalition, ultrasonography revealed a reduced space of the joint associated with an irregular, angular appearance of its outline and hypoechoic fibrous tissue inside. These data were compared with CT findings. κ statistic was applied to determine the level of agreement. The sensitivity, specificity, positive and negative predictive values, accuracy, and Youden index of ultrasonography as a diagnostic method were assessed. RESULTS: Ultrasonography findings were positive in 20 of 97 patients with a clinical suspicion of TCC. The diagnosis was confirmed by CT in 21 patients. There were one false-positive result and two false-negative results by ultrasonography. The κ value was 0.907. The sensitivity, specificity, positive and negative predictive values, accuracy, and Youden index of ultrasonography were 90.5%, 98.7%, 95.0%, 97.4%, 96.9%, and 0.892, respectively. CONCLUSION: Ultrasonography could be a reliable, accurate, and non-radioactive diagnostic imaging method in diagnosis of patients with suspected TCC.

Diagnostic value of color Doppler sonography for spontaneous isolated superior mesenteric artery dissection.

The present study aimed to evaluate the clinical significance of color Doppler sonography (CDS) in the diagnosis of spontaneous isolated superior mesenteric artery dissection (SISMAD). The ultrasonographic images of 19 patients with SISMAD confirmed by computed tomography angiography (CTA) were retrospectively analyzed and the ultrasonographic features were summarized. The paired t-test was used to statistically analyze the differences in parameters determined by CTA vs. CDS, including the minimal inner diameter (MID), cross-sectional area (CSA), diameter and area stenosis rate, and flow rate of the true lumen. Of the 19 patients, 18 (94.7%) were diagnosed with SISMAD with correct classification by CDS. There was no significant difference between CTA and CDS with regard to minimal ID, CSA, diameter stenosis and area stenosis rate, and flow rate of the true lumen (all P>0.05). CDS was indicated to be an effective imaging modality for the diagnosis of SISMAD.

Diagnosis and treatment of acquired arteriovenous fistula after lower extremity deep vein thrombosis.

BACKGROUND: Deep vein thrombosis (DVT) is a rare cause of arteriovenous fistula (AVF). The pathogenesis of acquired AVF after DVT remains unclear, and publications focusing on therapy and follow-up are also inadequate. In this study, the diagnosis and treatment of 24 patients with acquired AVF in the lower extremity after DVT was reported. METHODS: This is a retrospective study. We studied 24 patients with acquired AVF after DVT who were screened by ultrasound and confirmed by arteriography or computed tomographic arteriography (CTA) in our hospital. Treatments included simple compression therapy (SCT), venous hypertension-relieving therapy (VHRT) and transarterial embolization; VHRT included iliac vein stenting and Palma-Dale surgery (fem-fem bypass). RESULTS: All 24 patients exhibited symptoms in the left lower extremity including swelling (24 cases, 100%), pain (14 cases, 58.33%), pigmentation (13 cases, 54.17%) and ulcers (8 cases, 33.33%). No cardiac enlargement or cardiac insufficiency was reported in any case. The initial ultrasound screening suggested PTS in all 24 cases, with arterialized waveform in veins in 24 cases and high-velocity turbulent flow within the fistulas in 16 cases. The AVF recurrence rate of embolization was 66.7% (4/6). In 7 patients who underwent SCT, the circumference difference of bilateral lower limbs at the 1-year follow-up was not significantly different from that before treatment (thigh, P=0.413; calf, P=0.478). In 14 patients who underwent VHRT, the circumference difference of bilateral lower limbs at the 1-year follow-up was significantly smaller than that before treatment (thigh, P=0.000; calf, P=0.001), and the follow-up difference value of the Venous Insufficiency Epidemiological and Economic Study-Quality of Life (VEINES-QOL) scores was significantly higher than that in the SCT group (1 month, P=0.012; 6 months, P=0.000; 1 year, P=0.000; 2 years, P=0.003). CONCLUSIONS: Ultrasound plays an important role in screening and diagnosing AVF. Iliac vein obstruction rather than AVF was most likely the primary cause of the symptoms. Due to the high recurrence rate of DVT, transarterial embolization of AVF is not effective; thus, VHRT should be recommended as the preferred treatment.

Electrophysiological examination and high frequency ultrasonography for diagnosis of radial nerve torsion and compression.

This study aims to evaluate the value of electrophysiological examination and high frequency ultrasonography in the differential diagnosis of radial nerve torsion and radial nerve compression.Patients with radial nerve torsion (n = 14) and radial nerve compression (n = 14) were enrolled. The results of neurophysiological and high frequency ultrasonography were compared.Electrophysiological examination and high-frequency ultrasonography had a high diagnostic rate for both diseases with consistent results. Of the 28 patients, 23 were positive for electrophysiological examination, showing decreased amplitude and decreased conduction velocity of radial nerve; however, electrophysiological examination cannot distinguish torsion from compression. A total of 27 cases showed positive in ultrasound examinations among all 28 cases. On ultrasound images, the nerve was thinned at torsion site whereas thickened at the distal ends of torsion. The diameter and cross-sectional area of torsion or compression determined the nerve damage, and ultrasound could locate the nerve injury site and measure the length of the nerve.Electrophysiological examination and high-frequency ultrasonography can diagnose radial neuropathy, with electrophysiological examination reflecting the neurological function, and high-frequency ultrasound differentiating nerve torsion from compression.

The Role of High Frequency Ultrasonography in Diagnosis of Acute Closed Mallet Finger Injury.

To evaluate the role of high frequency ultrasonography in diagnosis of acute closed mallet finger injury. 36 patients diagnosed with mallet finger were included in this study. All patients underwent ultrasonography, magnetic resonance imaging(MRI) and X-ray examinations. A new kind of classification of acute mallet finger injury based on ultrasonography findings was described. The difference in terms of extensor tendon injury and bony fragment identification ability among the three types of examinations were described respectively. Either an injury of extensor digital tendon or an avulsion fracture of distal phalangeal base was identified clearly on ultrasonography. Among the 36 cases, avulsion fracture of the distal phalangeal base was found without extensor tendon rupture in Type A, complete rupture of the extensor tendon was found without avulsion fracture in Type B, and contusion of the extensor tendon was found in Type C. Compared with X-ray, ultrasonography and MRI could show the extensor tendon injury clearly. While compared with MRI, ultrasonography and X-ray was more sensitive in showing bony fragment. High frequency ultrasonography could be an accurate, reliable, and non-invasive diagnostic imaging method in diagnosis of acute close mallet finger injury.

Preoperative deep vein thrombosis in patients with cervical spondylotic myelopathy scheduled for spinal surgery.

INTRODUCTION: The prevalence of deep vein thrombosis (DVT) and its risk factors in patients with cervical spondylotic myelopathy (CSM) before spinal surgery are poorly understood. We investigated this association with a retrospective cross-sectional study. PATIENTS CONCERNS: The study cohort consisted of all consecutive patients with CSM who were scheduled for spinal surgery at our institution from 2013 to 2015. DVT was defined as an intraluminal filling defect in a lower extremity vein identified by Doppler ultrasonography. OUTCOMES: Of the 396 patients with CSM, 16 (4%) had DVT. Compared with patients without preoperative DVT, patients with preoperative DVT were older (62.75 ±â€Š8.79 vs 53.03 ±â€Š10.95 years, P = 0.001), had higher D-dimer concentrations (2.23 ±â€Š4.15 vs 0.43 ±â€Š0.90 mg/L, P = 0.04), had experienced longer duration of CSM (7.56 ±â€Š7.08 vs 4.01 ±â€Š6.37 months, P = 0.03), had lower Japanese Orthopaedic Association lower limb motor dysfunction scores (1.68 ±â€Š1.25 vs 2.54 ±â€Š0.91, P = 0.01), and had a history of ischemic cardiovascular events (33.3% vs 2.1%, P = 0.02). The area under the curve for the ability of D-dimer levels to predict DVT was 0.858 (95% confidence interval: 0.764-0.951; P < 0.0001). A D-dimer level of 0.54 mg/L detected DVT with a sensitivity and specificity of 87.5% and 83.2%, respectively. Abnormal D-dimer levels and ischemic cardiovascular events history were independent predictors of DVT. CONCLUSION: Patients with CSM who were scheduled for surgery often presented with preoperative DVT. Preoperative vascular screening should be considered for patients with CSM, especially for those who are older, have had longer duration of CSM, have poor lower limb mobility, and have a heart disease history. Inferior vena cava filter insertion and anticoagulation treatments should be considered for CSM patients with preoperative DVT.

Elasticity of healthy Achilles tendon decreases with the increase of age as determined by acoustic radiation force impulse imaging.

AIMS: The objective of the study was to investigate the value of acoustic radiation force impulse (ARFI) and its application in Achilles tendon elasticity of healthy volunteers. METHODS: Bilateral Achilles tendons of 56 healthy individuals were included in the study. The subjects were divided into four age groups. Shear wave velocities (SWVs) of each tendon in the states of relaxation and tension were measured using ARFI technology. We selected the middle section of the Achilles tendon for ARFI measurement. Each Achilles tendon was examined by a musculoskeletal radiologist. Longitudinal images of each tendon were obtained by ultrasound and ARFI elastography. A quantitative assessment of the tissue stiffness was made with virtual touch tissue quantification. RESULTS: Significant differences in SWVs of Achilles tendon were found between any two age groups in the same status (P < 0.05) and between different status in subjects aged 25-35 years (P < 0.05) and 36-45 years (P < 0.05). SWV of Achilles tendon increased with increasing age in both states of relaxation and tension, which was consistent with the histological feature of ageing tendons. However, there were no significant differences between men and women within any group in the same status (P > 0.05) or between different states in subjects aged 46-55 years (P = 0.308) and 56-65 years (P = 0.362). CONCLUSIONS: ARFI imaging provides quantitative information about tendon stiffness and represents an excellent supplementary technique to B-mode ultrasound. Furthermore, the elasticity of healthy tendon decreases with increasing age in subjects without disease and long-term heavy load lifting.