Abdominal Ultrasound Research Articles

Nonalcoholic fatty liver disease and female sexual dysfunction in Egyptian premenopausal women: is there a link between metabolic syndrome and sexual function?

Nonalcoholic fatty liver disease (NAFLD) is a major health problem with a paucity of available information about its impact on female sexual dysfunction (FSD). We aimed to study the association between NAFLD and FSD in Egyptian premenopausal women. Sexually active married premenopausal women who visited our NAFLD outpatient screening clinic (2019 to 2022) were divided into NAFLD and non-NAFLD (control) groups based on liver ultrasound and fatty liver index data. All participants completed the Arabic Female Sexual Function Index (ArFSFI) questionnaire. The resulting data were used to calculate the domains and total scores. FSD is then graded as follows: no FSD (≥28.2), minimal (21.7-28.1), mild (14.5-21.6), moderate (7.3-14.4), and severe (≤7.2). We determined the proportions of patients and controls for whom ArFSFI scores indicated dissatisfaction with their sexual lives. Of 995 women participants whose FSFI scores were available, NAFLD was detected in 487 (48.9%) and absent in 508 (51.1%). The two groups were comparable in age, socioeconomic level, residence, and history of female genital cutting. The NAFLD patients had significantly much lower mean scores for the sexual arousal, lubrication, orgasm, satisfaction, and pain domains of the FSFI (P< .001 for all), while no statistical difference was noticed in the desire domain for NAFLD patients compared with the controls. NAFLD women had significantly lower mean total FSFI scores than the controls (mean [SD] 16.7[6.8] vs 21.7[5.1], respectively; P< .001) with higher rates of FSD (98.5% vs 82.1%; P< .001, respectively). Most NAFLD women had higher FSD grades than controls (%): no FSD (1.5, 17.9), minimal (20.6, 51.8), mild (42.5, 38.8), moderate (26.2, 9.4), and severe (10.7, none), respectively. Given the high prevalence of FSD in patients with NAFLD, greater attention to FSF could improve the quality of life in patients with NAFLD. This study was limited by the lack of testing of sex hormones and some other important factors that were not tested (eg, age, socioeconomic level, residence, and female genital cutting), as these characteristics were previously matched. Strengths of the study include the large study size, to our knowledge the largest to date to investigate the possible link between FSD and NAFLD in premenopausal women, together with the inclusion of the detailed version of the validated ArFSFI. In Egyptian premenopausal women, NAFLD could harm their sexual function.

A case of chronic kidney disease with refractory periodic vomiting and hypertension in a pediatric patient.

Patients with chronic kidney disease (CKD) sometimes experience gastrointestinal symptoms, such as nausea and vomiting. In addition, hypertension and CKD are closely linked, and sustained hypertension in children is associated with the progression of CKD, leading to early cardiomyopathy and premature atherosclerosis. These symptoms substantially affect the quality of daily life of CKD patients, and particularly in children with CKD, they may cause growth retardation. Therefore, establishing effective management methods to alleviate these symptoms is very important. Here, we report a case of a male patient who was born at 34weeks of gestation weighing 1400g. At birth, abdominal ultrasonography displayed left multicystic dysplastic kidney. From 6months after birth, he was frequently hospitalized owing to refractory periodic vomiting. At 9 months old, he was diagnosed as having stage 3a CKD, and at 20 months old, he presented with stage 2 high blood pressure. In Japan, the uremic toxin adsorbent AST-120 and angiotensin-converting enzyme inhibitor-I (ACE-I) are not strongly recommended for CKD patients. However, after the patient underwent combination therapy of AST-120 and ACE-I, his frequent hospitalizations for refractory periodic vomiting ceased, and his blood pressure decreased. These results indicate that AST-120 and ACE-I are effective for refractory periodic vomiting and hypertension associated with CKD. The patient's height, weight, and mental development are catching up smoothly. The cause of the patient's refractory periodic vomiting remains unclear. However, his impaired kidney function owing to congenital anomalies of the kidney and urinary tract may have caused the refractory periodic vomiting and dehydration. The production of uremic toxins in CKD patients is thought to lead to the secretion of proinflammatory cytokines into the circulation. However, our patient had low serum levels of proinflammatory cytokines, and his serum levels of the chemokines CX3CL1 and CCL2 decreased with age, together with improvement in his clinical course. Therefore, some specific chemokines might be diagnostic and/or prognostic biomarkers of CKD.

The gut-pancreas axis: investigating the relationship between microbiota metabolites and pancreatic steatosis.

The prevalence of pancreatic steatosis has increased and it has been linked to the rising prevalence of metabolic syndrome. Metabolic syndrome is known to have a strong connection with changes in intestinal microbiota. The aim of this study was to explore the relationship between pancreatic steatosis and the levels of trimethylamine N-oxide (TMAO) and butyrate. In this study, 136 individuals were randomly selected from outpatient clinics at Firat University Hospital. The study evaluated their demographic characteristics, anthropometric measurements, and biochemical parameters. The presence of pancreatic steatosis was assessed using abdominal ultrasonography. Additionally, the levels of TMAO and butyrate were measured. The mean age of individuals in the study was 44.5 ± 14.6. 84 of the subjects were females. Using the waist circumference, 61 were considered obese and 34 overweight. The detection rate of pancreatic steatosis was found to be 70.6%. The study found that individuals with steatosis had higher average age, presence of hepatic steatosis, BMI, waist circumference measurements, and presence of metabolic syndrome than those without steatosis. A significantly higher butyrate level was detected in those without steatosis (p = 0.001). TMAO levels were slightly higher in patients without steatosis than in those with steatosis; however, this was insignificant. Pancreatic steatosis is highly associated with alterations in levels of microbiota metabolites, indicating a potential role of these metabolites in the pathogenesis of the disease and subsequent therapeutic targets. Several other factors, such as age, hepatic steatosis, diabetes, and waist circumference, have also been identified as potential predictors of pancreatic steatosis.

A rare case of hepatic hydatid cyst in Somalia: a case report

BackgroundEchinococcosis, or hydatid disease, is caused by the larval forms of taeniid cestodes belonging to the genus Echinococcus. Echinococcus granulosus and E. multilocularis are the primary species responsible for human echinococcosis, and mostly they affect the liver. The disease course is typically slow, and the patients tend to remain asymptomatic for many years.Case presentationA case of 19-year-old male Somali from Medina, Saudi Arabia, was presented to the Mogadishu Somali Turkey Recep Tayyip Erdogan Training and Research Hospital with the complaint of right upper quadrant abdominal pain and dysuria for 1 month. A thorough physical examination, laboratory examination, and imaging investigations, including abdominal sonography and computed tomography (CT), were conducted.Both ultrasound and CT scans revealed a cystic lesion in the right lobe of the liver, confirming the diagnosis of a hydatid cyst. Consequently, the patient underwent exploratory laparotomy. It was successfully managed surgically, and the definitive diagnosis was provided by the pathologist, confirming degenerated echinococcal cysts that contain abundant debris. Additionally, the patient received oral albendazole both before and after the surgery and after 7 months and is currently symptom-free.ConclusionsHydatid disease in the liver may persist without symptoms and often goes undiagnosed due to the slow growth of the cysts. The diagnosis needs careful history reporting, physical examination, and appropriate imaging investigations.

A LATE COMPLICATION OF BLUNT TRAUMA IN A CHILD: HEMORRHAGIC PANCREATIC PSEUDOCYST

Trauma is the most important cause of morbidity and mortality in the pediatric population. Pancreatic injury is relatively rare but has high morbidity and mortality when the diagnosis is delayed. However, diagnosis of pancreatic trauma is difficult. Ultrasound is limited for diagnosing pancreatic injury. Magnetic resonance imaging (MRI) is very useful for detecting direct and secondary signs of pancreatic injury and its complications such as abscess, fistula, pancreatitis, and pseudocyst. We presented a 10-year-old boy with a hemorrhagic pancreatic pseudocyst due to blunt trauma that happened a week ago. His laboratory findings showed elevated serum amylase and lipase levels. In abdominal ultrasonography, bilobular thick-walled fluid collections in the pancreatic parenchyma and peripancreatic location were observed. MRI showed hemorrhagic pseudocysts in the pancreas and pancreatic duct injury. The pseudocysts were treated by cysto-gastrostomy. Children should be carefully evaluated for pancreatic injury and late complications such as hemorrhagic pancreatic pseudocyst to reduce mortality after blunt trauma.

Multimodal diagnostic strategies and precision medicine in mucinous ovarian carcinoma: a comprehensive approach.

Mucinous ovarian carcinoma (MOC) represents a distinct entity within ovarian malignancies, characterized by diagnostic challenges due to its rarity and the potential overlap with other tumor types. The determination of tumor origin is important for precise postsurgical treatment. This article highlights the accurate diagnosis and management of MOC, including the use of imaging modalities, serological tumor markers, immunohistochemistry, and genomic analyses. Transabdominal and transvaginal ultrasonography, complemented by MRI and CT, plays a pivotal role in differentiating MOC from other mucinous tumors and in surgical planning, particularly for fertility preservation. Serological markers like CA19-9, CA-125, and CEA, though not definitive, provide valuable preoperative insights. Immunohistochemistry aids in distinguishing primary MOC from metastatic mucinous carcinomas, while genomic profiling offers the potential for precision medicine through the identification of specific molecular signatures and treatment susceptibilities. Despite advancements in diagnostic techniques, no single method conclusively differentiates between primary and metastatic tumors intraoperatively. The paper reviews the origins, diagnosis, and differential diagnosis of primary mucinous ovarian carcinoma highlights the need for a multimodal diagnostic approach and advocates for the inclusion of MOC patients in clinical trials for personalized therapies, recognizing the heterogeneity of the disease at the molecular level.

Comparison of the Size Measurement of Gallbladder Polyps by Three Different Radiologists in Abdominal Ultrasonography.

There is little information regarding the size measurement differences in gallbladder (GB) polyps performed by different radiologists on abdominal ultrasonography (US). To reveal the differences in GB polyp size measurements performed by different radiologists on abdominal US. From June to September 2022, the maximum diameter of 228 GB polyps was measured twice on abdominal US by one of three radiologists (a third-year radiology resident [reader A], a radiologist with 7 years of experience in abdominal US [reader B], and an abdominal radiologist with 8 years of experience in abdominal US [reader C]). Intra-reader agreements for polyp size measurements were assessed by intraclass correlation coefficient (ICC). A Bland-Altman plot was used to visualize the differences between the first and second size measurements in each reader. Reader A, reader B, and reader C evaluated 65, 77, and 86 polyps, respectively. The mean size of measured 228 GB polyps was 5.0 ± 1.9 mm. Except for the case where reader A showed moderate intra-reader agreement (0.726) for polyps with size ≤ 5 mm, all readers showed an overall high intra-reader reliability (reader A, ICC = 0.859; reader B, ICC = 0.947, reader C, ICC = 0.948), indicative of good and excellent intra-reader agreements. The 95% limit of agreement of reader A, B, and C was 1.9 mm of the mean in all three readers. GB polyp size measurement on abdominal US showed good or excellent intra-reader agreements. However, size changes of approximately less than 1.9 mm should be interpreted carefully because these may be within the measurement error.

Role of Lipocalin-2 Levels in Non-Alcoholic Fatty Pancreatic Disease and its Association with Non-Alcoholic Fatty Liver Disease

Abstract Background Lipocalin-2 (LCN2) is a 25-kDa secretory protein with great importance as a sensitive and specific screening and diagnostic biomarker for hepatic inflammation, acute hepatic injury, hepatic cancer, and radiation-induced early phase hepatic damage and lipid abnormalities. However, little is known about LCN2's functions in the homeostasis and metabolism of hepatic lipids or in the development of steatosis as well as its actual role in the event of inflammation. Aim and Objectives To establish a correlation between the levels of lipocalin as a useful biomarker with increasing severity of steatosis in NAFLD and NAFPD patients. Subjects and Methods This was observational prospective case–control study, was conducted at Hepatology Unit of Ain Shams University Hospital on 50 patients diagnosed with NAFPD and 50 healthy age and sex-matched volunteers without NAFPD during a period of 6 months. All patients were subjected to; Full history taking and thorough clinical examination, Anthropometric measurements, Laboratory investigations, and abdominal ultrasonography. Result There was a significant Positive correlation between Lipocalin 2, BMI, LDL (mg/dL), Cholesterol (mg/dL), Insulin (μU/mL) and HOMA-IR in patient group(P-value ≤ 0.001), Conclusion; lipocalin-2 is a good blood biomarker for detection of hepatic and Pancreatic steatosis. The lipocalin levels increase with increasing severity of steatosis. In addition to this, lipocalin will be useful for early diagnosis of NAFLD, NAFPD and convenient to do with other blood tests. The early intervention may prevent high morbidity and mortality and to manage the disease properly.

P-761 Four-dimensional ultrasound using an electronic probe to guide embryo transfer: a feasibility study

Abstract Study question Is four-dimensional ultrasound (4D-US) guided embryo transfer feasible and safe? Summary answer 4D trans-abdominal US with electronic probe is feasible and safe and justifies a formal study for non-inferiority to two-dimensional ultrasound (2D-US) for embryo transfer guidance. What is known already The use of 2D-US to guide embryo transfer is the usual procedure (Eshre/ASRM guidelines, evidence A), and investigations of the benefits of 3D and 4D-US have been inconclusive. 3D-US can locate the embryo flash in the coronal plane immediately after performing embryo transfer but furnishes only retrospective information. 4D-US requires two operators at transfer, and there has been slow image acquisition and poor image quality, not allowing satisfactory comparison of accuracy and precision with other methods. Study design, size, duration Using a high-end ultrasound device (Voluson E10, GE Healthcare, Zipf, Austria) with an electronic 3D-4D probe (eM6C G2), a prospective observational trial with 29 women undergoing mock embryo transfer in a private infertility clinic was performed between October 2023 and January 2024. Exclusion of subjects included BMI greater than 35 (3 cases) and an intramural myoma that impeded 4D-US visualization (3 cases). Participants/materials, setting, methods Two operators expert in U/S performed each procedure. Electronic probe settings were adapted for each subject. To simulate the embryo transfer, a Wallace catheter containing air and fluid was inserted and monitored transabdominally by 4D-US using the electronic probe. The catheter was observed until it reached 1 cm from the fundus and the embryo flash (bubble) identified. Entrance through the cervix was controlled by 2D and 4D. Main results and the role of chance The following variables were recorded: age, BMI, cycle day, use of hormones, endometrial thickness, position of the uterus, presence of fibroids, image quality, difficulty of entrance, visualization of the cervix. The 23 subjects had the following characteristics: mean age 39±6.4, BMI 24.14±4.4. Image quality was optimal in 18 patients and due to a retroverted uterus was suboptimal in 5 subjects. Cannulation of the cervix was difficult in 1. Eight patients were on birth control pills and 15 were on day 6-10 of spontaneous cycles. The mean endometrial thickness was 7.13±3mm. Mean hysterometry was 7.10±0.9mm. Visualization of the cervix with 4D-US was good in 12 subjects, fair in 7 and poor in 4. Visualization of the catheter in the cavity with 4D-US was good in 16 subjects, fair in 2 and poor in 5. The embryo flash was adequately visualized by 4D-US in 18 subjects and less well in 5. Catheter position was correctly identified by comparison 3D-US in 20/23 subjects. There were no adverse effects during or following the procedure. Limitations, reasons for caution Patients with poor image quality, due to obesity, retroverted uterus or fibroids, are not candidates for this technique. The need for two operators limits the practicability of the procedure, increasing the need to show its superiority over the usual practice before it could be adopted clinically. Wider implications of the findings 4D-US for embryo placement is feasible and safe. Studies that compare the accuracy and precision of 4D-US vs 2D-US to guide embryo transfer and the cost/benefit ratio of 4D ultrasound guided embryo transfer are in order.. Trial registration number not applicable for non-clinical trials

The Role of Chest Ultrasound in the Diagnosis of Thoracic Tuberculosis

Abstract Introduction There is limited data on the role of chest ultrasound (CUS) in thoracic tuberculosis (TTB). If the diagnostic accuracy of CUS for pulmonary TB (PTB) is similar to that for CUS in diagnosis of pneumonia, CUS could play an important role in diagnosis of PTB in areas without ready access to chest x-ray. Aim of the work This study aimed to describe the diagnostic features and utility of CUS in TTB. Comparing CUS findings in PTB versus community acquired pneumonia (CAP). Patients and methods Consecutive patients presenting with TTB and CAP to Abbasia Chest hospital between May 2019 to April 2020 were enrolled in this cohort study. CT of the chest, CUS, mediastinal ultrasound (US) and abdominal US to detect pericardial effusion were performed. CUS lesion pattern in thoracic TB, pulmonary TB and CAP cases were recorded. Results Sub-pleural nodules (97 patients, 95%), air-bronchograms (79 patients, 77,45%) and sub-pleural consolidations (SPC) (77 patients, 75.49%) were the most frequent features recorded by CUS in TB patients, CUS was able to report; pleural gap (28 patients, 27%), fragmented pleura (35 patients,34%), sub-pleural fluid collection (3 patients, 2.9%), and sub-pleural nodules (97patients, 95%) not detected by CT with P value &amp;lt; 0.05 for all. CUS was not only equal to CT in visualizing air-bronchogram (24 patients, 96%) and pleural effusion (4 patients,100%) in CAP, but also could detect fragmented pleura (12 patients, 48%) and SPC (8 patients, 32%) not detected by CT with P value &amp;lt; 0.05 for all. Conclusion CUS was more accurate than CT chest in diagnosis of TTB and CAP, it can report new patterns (pleural gap, fragmented pleura, sub-pleural fluid collection, SPN and SPC) not detected by CT.

P-348 Reduced uterine volume after children, adolescent, and young adult chemotherapy exposure. a systematic review and bayesian network meta-analysis

Abstract Study question What is the long-term impact on uterine volume of a childhood and adolescent, and young adult (AYA) exposure to chemotherapy? Summary answer Compared to the control group, uterine volume was clinically significantly decreased after chemotherapy and even more after radio-chemotherapy. What is known already Uterine damage is well-described after pelvic radiotherapy or total body irradiation (TBI) with decreased uterine volume and high obstetrical morbidity. Few studies have reported smaller uterus in AYA cancer survivors treated with chemotherapy only. In these studies, uterus volume was mostly assessed by a transabdominal and/or transvaginal ultrasonography, and primary diagnosis, age at treatment and chemotherapy regimen were heterogeneous. The uterine impact of chemotherapy is still little investigated. Study design, size, duration A systematic review and meta-analysis on comparative studies. Searches were conducted on Medline, Embase and the Cochrane Library from 1990 to April 2023, using the main following search terms: cancer survivors, bone marrow transplantation, chemotherapy, radiotherapy, uterine volume. All studies reporting uterine volume in adult females who have received chemotherapy and/or radiotherapy during childhood and AYA &amp;lt; 25 years were included. Participants/materials, setting, methods Two independent reviewers carried out the study selection, the bias assessment using the ROBINS-I tool and data extraction. The primary outcome was the uterine volume in mL. A Bayesian network meta-analysis (NMA) with meta-regression on parity and serious risk of bias was performed using a random-effects model. Furthermore sensitivity analyses were performed. Therapies were ranked by the surface under the cumulative ranking curve (SUCRA). Differences in means (MD) with 95% credible intervals (CrI) are reported. Main results and the role of chance After review of 2 328 abstracts, 4 studies were selected for the meta-analysis. Uterine volume was assessed through ultrasonography in three articles and magnetic resonance imaging in one. Uterine volume data were available for 245 females after chemotherapy, 153 after radio-chemotherapy and 257 without cancer females (controls). SUCRA were 0.980 for control, 0.510 for chemotherapy and 0.009 for radio-chemotherapy. One study did not display data by parity (n = 165) and had a serious risk of bias, and was excluded in sensitivity analysis. SUCRA showed the same ranking order. In nulliparous females, compared to the control group (n = 152), uterine volume was decreased in the chemotherapy group (n = 138, MD = -12 mL; 95% CrI, -33, 5.7), and even more in the radio-chemotherapy group (n = 97, MD= -30 mL; 95% Crl -50, -13). In parous females, compared to the control group (n = 41), the decrease in the uterine volume tended to be similar in chemotherapy and radio-chemotherapy groups (MD = -27 mL; 95% CrI, -54, 3.2 with n = 43 and -30 mL; 95% CrI, -50, -13 with n = 19, respectively). Limitations, reasons for caution The own responsibility of chemotherapy for inducing uterine damage is hard to be asserted because of the heterogeneity of radiology assay, and of the diversity of chemotherapy regimens, the lack of data concerning the Cyclophosphamide Equivalent dose, and about the hormonal status at the time of the uterine evaluation. Wider implications of the findings Our results suggest a high probability that a childhood and AYA exposure to chemotherapy could induce uterine damage. Further studies are needed to evaluate the potential obstetrical impact of uterine damage caused by chemotherapy alone. Trial registration number PROSPERO CRD42023440219

Evaluation of the Effect of Embryo Transfer Methods on Pregnancy Outcomes: A Retrospective Study and Future Perspectives.

Trans-abdominal ultrasound (TAUS) and transvaginal ultrasound (TVUS) are used for embryo transfer. However, few studies were conducted to compare the methods and assess their effect on pregnancy outcomes. A retrospective cohort study was conducted at Mahdieh Hospital in Tehran, analyzing 506 ICSI cycles with fresh embryo transfer. The study period was from April 2019 to March 2022. Following the evaluation of patients' profile, they were divided into two groups of TAUS (n=250) and TVUS (n=256). The pregnancy outcomes included positive test of β-HCG, history of miscarriage, ectopic pregnancy (EP), clinical pregnancy, and the duration of the embryo transfer were compared between two groups. Mann-Whitney U test, Pearson Chi-Square test, Fisher's exact test, and logistic regression were used for data analysis. The rate of chemical and clinical pregnancy in the TAUS group was higher compared to the TVUS group, which was statistically significant (p<0.05). The rate of live term birth and live preterm birth was higher in the TAUS group compared to the TVUS group, though the difference was insignificant. Moreover, EP and abortion rates were higher in TVUS group compared to the TAUS group, but the differences were not statistically significant. The odds ratio of achieving pregnancy was higher with TAUS compared to TVUS, but this was only statistically significant for the age variable. The use of TAUS method appears to be associated with improved pregnancy outcome, including higher rates of chemical and clinical pregnancy, compared to TVUS. Yet, further research is needed to confirm these findings and elucidate underlying mechanisms.

Clinical phenotype and genotype analysis of progressive familial intrahepatic cholestasis type 3 caused by novel ABCB4 gene mutation

Objective: To investigate the pathogenic mechanism and clinical characteristics of the novel splicing variant of ATP-binding cassette subfamily B member 4 (ABCB4) and provide a basis for subsequent genetic diagnosis. Methods: The clinical data of a 5-year-old child with cholestatic liver disease admitted to the Beijing Children's Hospital of Capital Medical University was retrospectively analyzed. The pathogenic variations were detected by whole exome sequencing and verified by Sanger sequencing, and bioinformatics was used to predict the pathogenicity of the mutation sites. Possible pathogenic variations were verified in vitro by Minigene assay. The clinical outcome was followed after discharge from hospital. Results: The 5-year-old boy had developed cholestasis at the age of 11 months. His physical examination showed obvious enlargement of the liver and spleen. Cholestatic cirrhosis was diagnosed by liver function tests, abdominal ultrasonography, liver biopsy and pathology. The results of genetic analysis showed that the patient was a complex heterozygote of the ABCB4 gene, with a pathogenic mutation c.2860G>A and a novel mutation c.2065-8T>G, derived from the mother and father respectively. The conservative prediction of the c.2065-8T>G site showed that this region was highly conserved and may affect splicing. Minigene assay results confirmed that the c.2065-8T>G mutation resulted in a 7 bp retention of intron 16 in the mature mRNA. In the absence of nonsense-mediated mRNA decay, the amino acid frameshift forms a truncated protein, which is represented by p.Glu689ValfsTer19. The patient was diagnosed as progressive familial intrahepatic cholestasis type 3 (PFIC3) and treated with ursodeoxycholic acid (UDCA). His clinical symptoms improved during 18 months of follow-up. Conclusions: The c.2065-8T>G variant is confirmed to affect the splicing process and exhibits complex heterozygosity with c.2860G>A, which is identified as the cause of the disease. PFIC3 children with this variant showed cholestatic liver disease as the main manifestation with a slow progression and was sensitive to treatment with UDCA.

The Value of CEUS LI-RADS combined with AFP in early diagnosis of hepatocellular carcinoma in low- and high-risk patients.

We found that the occurrence of hepatocellular carcinoma (HCC) has increased significantly in non-cirrhotic individuals, with HCC being frequently overlooked or misdiagnosed. Contrast-enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS) is known to have a high diagnostic quality in high-risk HCC patients. Therefore, we aimed to compare the detection accuracy of CEUS LI-RADS for HCC between low- and high-risk individuals, to confirm its value in low-risk patients at increased risk of HCC, but not yet included in the high-risk groups of LI-RADS. In addition, since CEUS LR-4 and LR-M categories contain a relatively high proportion of HCC, and serum alpha-fetoprotein (AFP) is the most commonly used biomarker for HCC, and the clinically valid, we attempted to further improve the early diagnostic capability of CEUS LI-RADS for HCC in the low-risk and high-risk patients by combining CEUS LR-4 and LR-M categories with AFP. We defined high-risk groups (HR)-included in the high-risk patients of LI-RADS, low-risk groups (LR)-not included in the high-risk patients of LI-RADS and enrolled 189 HCC patients with LR and HR settings in a retrospective study. All lesions were confirmed histopathologically. The CEUS LI-RADS accuracy for detecting HCC in these two patients was compared. In addition, the diagnostic algorithm in our study was proposed (for CEUS LR-4 and LR-M patients with AFP>20 ng/ml). we analyzed the ability of CEUS LI-RADS as a valid method of establishing the early diagnosis of HCC in LR and HR patients by combining LR-4 and LR-M categories with AFP. Through comparative analysis, the specificity of the CEUS LR-5 category for HCC in the HR group was 78.4%, whereas in the LR group, it was 94.2%. Meanwhile, the sensitivity (63.2% vs. 63.0%) and positive predictive value (PPV) (75.0% vs. 88.7%) did not differ between the LR and HR groups ( P = 0.990, P = 0.299). It is noteworthy that there were the high proportion of HCC in CEUS LR-4 and LR-M categories in our cases and when we combined CEUS LR-4 and LR-M categories with AFP significantly improved the sensitivity by 21.0% (84.2%) in the LR group, and by 16.0% (79.0%) in the HR group, with statistically difference in sensitivity after combination in the HR group ( P = 0.014). The CEUS LR-5 category has real meaningful utility in the diagnosis of HCC in both LR and HR patients. The early detection power of the CEUS LI-RADS category for HCC patients was further increased when the CEUS LR-4 and LR-M categories were combined with elevated AFP.

Abdominal Ultrasonography Used for Abdominal Pain in the Rural Outpatient Setting of South Texas: Impact on Patient Outcomes.

Introduction Abdominal ultrasonography is a key diagnostic tool used in complaints of abdominal pain. The rationale for this study is to examine abdominal ultrasonography's impact on the conclusion of care of abdominal pain in a predominantly Hispanic/Latino patient population. Materials and methods A chart review of 350 patients with a new diagnosis of abdominal pain from a rural family practice clinic in Texas was performed. These patients' charts were reviewed for a new diagnosis of abdominal pain, medications prescribed for abdominal pain, whether abdominal ultrasonography was completed, and the number of visits regarding their complaint. The last visit for their abdominal pain was denoted as the conclusion of care of abdominal pain within the clinic. The primary analyses were logistic regressions with conclusion of pain care or number of visits as the outcome and abdominal ultrasound completion as the primary predictor. Results The sample size was 216 of the 350. Patients were excluded due to age under 18 and if the patient's pain was not coded as epigastric, generalized, or right upper quadrant pain. The patient age range was 18-88 years, and they were all of Hispanic/Latino origin. Abdominal ultrasound was completed on 59 of the patients, and 65 patients experienced conclusion of primary care for abdominal pain. Regarding the number of visits for abdominal pain, 69% had one visit, 25% had two visits, and 6% had three or more visits. Patients who had abdominal ultrasounds were more likely to have multiple visits (typically just two visits) but had markedly higher conclusions of care for abdominal pain. These relationships remained when adjusting for demographic and medical covariates such as age, abdominal pain (all types), and medical treatments used. Conclusion In the outpatient rural care of Hispanic/Latino patients residing in the Rio Grande Valley, patients who had a new complaint of abdominal pain were more likely to have conclusion of primary care for abdominal pain, with only a slight increase in primary care healthcare consumption, if abdominal ultrasonography was completed for abdominal pain.

Unraveling the Enigma of Gossypiboma: A Series of 14 Cases Highlighting the Prevalence, Root Causes, and Outcomes in Resource-Limited Settings.

Gossypiboma or textiloma is the unintentional retention of textile material in a patient's body, often occurring during abdominal surgery and involving surgical sponges. The body may respond to this foreign body with an exudative inflammatory reaction or an aseptic fibrotic reaction, encapsulating the cotton material and forming a mass. This rare but dramatic event can lead to life-threatening complications, and due to legal and ethical concerns, few publications exist. There were no published papers regarding this issue in our nation (Yemen). This study aims to report the retained surgical sponges' cases and their associated factors in a resource-limited setting to improve prevention. A retrospective case series study was conducted at hospitals affiliated with Ibb University, Ibb, Yemen, between March 22, 2018, and May 12, 2024. The study included 14 cases of diagnosed and surgically confirmed retained surgical sponges. Data on demographic characteristics, type of operation, and risk factors were gathered and analyzed. Among 15,120 surgical procedures, there were 14 cases of retained surgical sponges with a prevalence rate of 0.09%. The mean age was 32.5±17.0 years, with 10 (71.4%) females and 4 (28.6%) males. Gynecological surgery was the most common causal procedure (n=7, 50.0%). The most common clinical presenting features were abdominal pain in 12 (85.7%), followed by infections and a systemic reaction in 9 (64.3%). The median symptom incubation time was 37 days. 11 (78.5%) patients underwent abdominal X-rays, and 13 (92.8%) had abdominal ultrasounds, with 4 (28.6%) X-rays and 5 (35.7%) abdominal ultrasounds being deemed non-diagnostic. An abdominal-pelvic CT scan was done on 11 (78.5%) individuals, with the results being diagnostic in 10 (71.4%) and non-diagnostic in one (7.1%). The leading causes for gossypiboma occurrence were prolonged surgical procedures > one hour and emergency in 7 (50.0%) cases, followed by multiple surgical team involvement and change in nursing staff during procedures in 5 (35.7%) cases. A gossypiboma or retained foreign body diagnosis can be achieved through comprehensive patient history, radiologist-surgeon interaction, understanding of risk factors, and familiarity with imaging patterns. Safety procedures should be robust and straightforward, and effective communication among surgical professionals can help minimize medical negligence and protect patients in chaotic situations.Furthermore, the surgeon should adhere to the standard prescribed method and report cases of retained surgical sponges.

Combined Role of Transvaginal and Transabdominal Ultrasonography in Diagnosing Adnexal Lesions in Adult Married Women: A Descriptive Cross-Sectional Study

Combined Role of Transvaginal and Transabdominal Ultrasonography in Diagnosing Adnexal Lesions in Adult Married Women: A Descriptive Cross-Sectional Study

Ultrasound findings in 34 newborn foals with uroperitoneum.

Uroperitoneum is a typical disease of the newborn foal, which occurs rarely but regularly. Ultrasonography is considered the most important imaging method for diagnosing this disease. Thus far, only one older case series comprising 31 foals suffering from uroperitoneum has systematically listed results of ultrasound examinations. This paper presents the findings of an ultrasonographic examination of 34 foals with uroperitoneum in order to inform future interpretation of ultrasonographic data in suspected uroperitoneum cases. Ultrasonographic data of 34 neonatal foals up to the age of 14 days diagnosed with uroperitoneum between 2006 and 2022 were analysed. Most foals demonstrated highly increased levels of free (97%), anechogenic (91%) fluid in the abdomen. Although the urinary bladder was frequently visible (50%), bladder wall discontinuity was only occasionally detectable (18%). Transabdominal ultrasonography has proved to be a very reliable imaging method for diagnosing suspected uroperitoneum. It is recommended that it be used in every case of suspected uroperitoneum in order to exclude differential diagnoses.

The American College of Radiology contrast-enhanced ultrasound Liver Imaging Reporting and Data System and its modified version in diagnosing hepatocellular carcinoma via Sonazoid: a meta-analysis.

The American College of Radiology (ACR) developed the contrast-enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS) for pure blood contrast agents, but Sonazoid was not included. Modifications to LI-RADS have been proposed for Sonazoid. The purpose of this meta-analysis was to identify and compare the diagnostic efficacy of the two LI-RADS algorithms of Sonazoid. We searched the PubMed, MEDLINE, Web of Science, Embase, and Cochrane Library databases from databases inception to August 31, 2023, to find original studies on the ACR LI-RADS and/or modified LI-RADS algorithm with Sonazoid used as the contrast agent in patients with high-risk hepatocellular carcinoma (HCC). A bivariate random-effects model was used. Data pooling, meta-regression, and sensitivity analysis were performed for meta-analysis. The Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool was used to assess the methodological quality, and the Deeks funnel plot asymmetry test was used to evaluate the publication bias. A meta-analysis of 10 studies with 1,611 observations was conducted. The pooled data for ACR LI-RADS category 5 (LR-5) and modified LR-5 were respectively as follows: pooled sensitivity, 0.70 [95% confidence interval (CI): 0.64-0.75] and 0.81 (95% CI: 0.76-0.86) (P<0.05); pooled specificity, 0.90 (95% CI: 0.82-0.94) and 0.87 (95% CI: 0.81-0.91) (P>0.05); and pooled area under the summary receiver operating characteristic curve, 0.84 and 0.91. The diagnostic performance of LI-RADS category M (LR-M) of the two algorithms was comparable. Study heterogeneity was observed. The results indicated that modified LR-5 algorithm demonstrated improved diagnostic sensitivity compared with the ACR LR-5 algorithm of Sonazoid, with differences observed between the different versions. Further research is needed to validate and explore the optimal diagnostic criteria for HCC using Sonazoid. Before the database search was conducted, this study was registered on PROSPERO (International Prospective Register of Systematic Reviews; CRD42023455220).

Focused abdominal ultrasonography of horses following colic surgery, as a predictor of postoperative reflux

Focused abdominal ultrasonography of horses following colic surgery, as a predictor of postoperative reflux