B-mode Ultrasonography Research Articles

Assessment of fetal development during mid and late term pregnancies by standard B-Mode ultrasonography in Shetland ponies

Transrectal and transabdominal ultrasonography is an established method to monitor pregnancy, fetal growth and wellbeing in different species. Growth charts with multiple bio-morphometric parameters to estimate days of gestation and days before parturition exist in small companion animals, sheep and goats, riding type horses and large ponies but not in small horse breeds like Shetland ponies. The aim of this study was to apply fetal biometric assessment and detailed description of physiologic fetal development to mid and late term pregnancies in Shetland mares and to generate reference data for clinical practice and for future research. Fetal parameters were collected starting on day 101 of pregnancy in five Shetland mares. The fetal biometric parameters determined consisted of aortic diameter, eye diameter, combined rib and intercostal distance (CRID), stomach length and width and different heart morphology parameters in sagittal and frontal plane. Additionally, fetal activity and organ development in terms of differentiation and changes in echogenicity were recorded. Considering reliably assessable parameters, fetal CRID was the best predictor for gestational age with ± 13.6 days and fetal aortic diameter the most accurate for prediction of days until parturition with ± 16.2 days.

The Relationship of Carotid and Brachial Artery Wall Thickness Measurement with Cardiovascular Risk Scoring in Individuals Living with HIV.

This study aimed to investigate whether human immunodeficiency virus (HIV) infection affects carotid and brachial artery wall thickness and whether measurement of this thickness contributes to traditional cardiovascular risk scoring in individuals living with HIV. The patient group included people living with HIV who were followed up in the infectious disease clinic, and the control group included patients without HIV. In both groups, carotid artery intima-media thickness (cIMT) was measured with B-mode ultrasonography (B-USG). cIMT 0.9 mm and above was considered subclinical atherosclerosis. The patient group consisted of 66, and the control group consisted of 40 participants. The median cIMT of the patient and control groups was 0.92 (0.45-1.45) mm and 0.55 (0.35-1.25) mm, respectively (p<0.001). Brachial artery IMT was significantly higher in the patient group with 0.45 (0.30-0.76) mm, while it was 0.35 (0.17-0.50) mm in the control group (p<0.001). Although the difference between the cIMT and brachial artery IMT results of the patient and control groups was significant between 18-59 years of age, this difference disappeared in older ages. In the patient group, subclinical atherosclerosis was detected with cIMT in individuals under 30 years of age for whom FRS (Framingham risk score) could not be calculated and in low-risk groups according to FRS (20% and 62.9%, respectively). cIMT and brachial artery IMT were found to be significantly higher in people living with HIV. The cIMT measurement seems to be very useful in calculating the CVD risk in individuals living with HIV, especially at young ages, in catching patients who are overlooked by traditional scoring systems.

Post-Chemotherapy Canine Lymphomatous Lymph Node Observations on B-Mode and Strain Elastographic Ultrasound.

Canine multicentric lymphoma (CML) is a prevalent hematopoietic neoplasm that initially responds well to treatment but often relapses due to chemotherapy resistance. Evaluation of treatment response is essential for effective management. Ultrasound (US) can differentiate between benign and lymphomatous lymph nodes (LLNs). However, its utility in monitoring LLNs post chemotherapy is limited. This study aimed to compare US parameters of LLNs during the first 3 weeks post treatment and evaluate their diagnostic performance compared with the conventional method for assessing treatment response. This study included 95 LLNs from 15 dogs with CML and 60 normal lymph nodes (NLNs) from 15 healthy dogs. US, including B-mode and elastography, was performed pre-treatment and weekly for 3 weeks post treatment, and compared with the results of NLNs. LLNs were categorized into partial response and stable disease groups using the conventional method. US scores were established by combining B-mode and elastography parameters. The results showed significantly higher values of LLNs in the short-to-long axis ratio, elastographic scales, and blue-to-green color histogram compared with NLNs. Additionally, LLNs at pre-treatment had significantly higher values than LLNs post treatment. US scores significantly differed among the healthy, partial response, and stable disease groups. In conclusion, B-mode US, elastography, and US scores demonstrated changes during chemotherapy consistent with the conventional method and can be used in conjunction with the conventional method to evaluate the treatment response of CML.

Evaluation of the intramammary distribution of breast lesions detected by MRI but not conventional second-look B-mode ultrasound using an MRI/ultrasound fusion technique

The objective of this study was to evaluate the intramammary distribution of MRI-detected mass and focus lesions that were difficult to identify with conventional B-mode ultrasound (US) alone. Consecutive patients with lesions detected with MRI but not second-look conventional B-mode US were enrolled between May 2015 and June 2023. Following an additional supine MRI examination, we performed third-look US using real-time virtual sonography (RVS), an MRI/US image fusion technique. We divided the distribution of MRI-detected mammary gland lesions as follows: center of the mammary gland versus other (superficial fascia, deep fascia, and atrophic mammary gland). We were able to detect 27 (84%) of 32 MRI-detected lesions using third-look US with RVS. Of these 27 lesions, 5 (19%) were in the center of the mammary gland and 22 (81%) were located in other areas. We were able to biopsy all 27 lesions; 8 (30%) were malignant and 19 (70%) were benign. Histopathologically, three malignant lesions were invasive ductal carcinoma (IDC; luminal A), one was IDC (luminal B), and four were ductal carcinoma in situ (low-grade). Malignant lesions were found in all areas. During this study period, 132 MRI-detected lesions were identified and 43 (33%) were located in the center of the mammary gland and 87 (64%) were in other areas. Also, we were able to detect 105 of 137 MRI-detected lesions by second-look conventional-B mode US and 38 (36%) were located in the center of the mammary gland and 67 (64%) were in other areas. In this study, 81% of the lesions identified using third-look US with RVS and 64% lesions detected by second-look conventional-B mode US were located outside the center of the mammary gland. We consider that adequate attention should be paid to the whole mammary gland when we perform third-look US using MRI/US fusion technique.

Multi-View disentanglement-based bidirectional generalized distillation for diagnosis of liver cancers with ultrasound images

B-mode ultrasound (BUS) mainly reflects the tissue structural, morphological, and echo characteristics of liver tumors, and contrast-enhanced ultrasound (CEUS) offers supplementary information on the dynamic blood perfusion pattern to promote diagnostic accuracy. Transfer learning (TL) is capable of improving the performance of BUS-based computer-aided diagnosis (CAD) for liver cancer by transferring information from CEUS. However, most multi-view TL algorithms cannot fully capture the view-common together with the view-unique information of three CEUS phase images in the source domain to further promote knowledge transfer. To this end, a multi-view disentanglement-based bidirectional generalized distillation (MD-BGD) algorithm is proposed to explore and learn more potential knowledge from three typical CEUS phase images for multi-view transfer. MD-BGD consists of the multi-view feature disentanglement module and the bidirectional distillation module. The former explores more potential and transferable privileged information by disentangling three CEUS phase image features in the source domain into view-common and view-unique components. The latter develops a bidirectional generalized distillation algorithm to enhance the multi-view knowledge transfer between the source and the target domains, guided by shared labels. Therefore, the BUS-based CAD model is significantly improved by our proposed MD-BGD. MD-BGD is evaluated on the bi-modal ultrasound imaging dataset. It gains the best results of 90.75±2.20 %, 89.50±3.49 %, and 91.89±3.78 %, on accuracy, sensitivity, and specificity, respectively. These results indicate the effectiveness of MD-BGD in the diagnosis of liver cancer.

A model combining BI-RADS® descriptors from pre-treatment B-mode breast ultrasound with clinicopathological tumor features shows promise in the prediction of residual disease after neoadjuvant chemotherapy

PurposeTo create a simple model using standard BI-RADS® descriptors from pre-treatment B-mode ultrasound (US) combined with clinicopathological tumor features, and to assess the potential of the model to predict the presence of residual tumor after neoadjuvant chemotherapy (NAC) in breast cancer (BC) patients. Method245 female BC patients receiving NAC between January 2017 and December 2019 were included in this retrospective study. Two breast imaging fellows independently evaluated representative B-mode tumor images from baseline US. Additional clinicopathological tumor features were retrieved. The dataset was split into 170 training and 83 validation cases. Logistic regression was used in the training set to identify independent predictors of residual disease post NAC and to create a model, whose performance was evaluated by ROC curve analysis in the validation set. The reference standard was postoperative histology to determine the absence (pathological complete response, pCR) or presence (non-pCR) of residual invasive tumor in the breast or axillary lymph nodes. Results100 patients (40.8%) achieved pCR. Logistic regression demonstrated that tumor size, microlobulated margin, spiculated margin, the presence of calcifications, the presence of edema, HER2-positive molecular subtype, and triple-negative molecular subtype were independent predictors of residual disease. A model using these parameters demonstrated an area under the ROC curve of 0.873 in the training and 0.720 in the validation set for the prediction of residual tumor post NAC. ConclusionsA simple model combining standard BI-RADS® descriptors from pre-treatment B-mode breast US with clinicopathological tumor features predicts the presence of residual disease after NAC.

Parathyroid Adenoma Orientation for Gland Embryologic Origin on Ultrasonography

Accurate preoperative localization is critical to success in targeted parathyroidectomy for primary hyperparathyroidism. To determine if the association between the long axis of a parathyroid adenoma (PTA) candidate and strap musculature on sagittal ultrasonography (US) can be used to predict the embryologic origin of the gland. This diagnostic study was performed using the Stanford Research Repository. Patients 18 years or older with primary hyperparathyroidism who underwent parathyroidectomy between January 2009 and October 2021 were considered. Additional inclusion criteria were having clear sagittal view of the adenoma candidate on US, confirmation of the gland of origin intraoperatively, and confirmation of hypercellular parathyroid on final pathology. Data were analyzed from October 2021 to June 2022. B-mode US and surgical parathyroidectomy. The index test was using US to measure the angle between the long axis of an adenoma candidate and the strap musculature in the sagittal plane. This angle was used to test whether inferior and superior PTAs could be accurately assigned. The hypothesis was formulated prior to data collection. A total of 426 patients (mean [range] age, 61.1 [20-96] years; 316 [74.2%] female) with 442 adenomas met inclusion criteria. Of the 442 adenomas, 314 (71.0%) had measurable angles, of which 204 (46.2%) were assigned a superior origin, 238 (53.8%) were assigned an inferior origin, and 128 (29%) were indeterminate. Of the surgically identified superior PTAs, 144 (70.6%) had a definable angle, and of the surgically identified inferior PTAs, 170 (71.4%) had a definable angle. The receiver operating characteristic analysis found 94° as the optimized angle for differentiating true negatives from true positives, with an overall sensitivity of 74% and specificity of 72%. This supported using 90° as a break point for US review. True positives were considered superior adenomas with an angle greater than 90°; true negatives were inferior adenomas with an angle less than 90°. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of angulation analysis for determining PTA origin were 72.2% (95% CI, 64.9%-79.5%), 73.5% (95% CI, 66.9%-80.1%), 69.8% (95% CI, 62.5%-77.1%), 75.8% (95% CI, 69.3%-82.3%), and 72.9%, respectively. A subgroup analysis of 426 adenomas using the posterior carotid artery border on transverse US as a surrogate for predicting gland origin showed the following for sensitivity, specificity, positive predictive value, negative predictive value, and accuracy: 49.5% (95% CI, 42.6%-56.4%), 82.3% (95% CI, 77.3%-87.3%), 71.4% (95% CI, 63.9%-78.9%), 64.6% (95% CI, 59.1%-70.1%), and 66.9%, respectively. This diagnostic study showed that PTA angulation on sagittal plane US can be used to predict gland of origin and guide surgery. The relationship between adenoma and posterior carotid artery border on transverse US can also be used to predict gland origin. These easy-to-apply US-based tests can be used in conjunction with other imaging modalities to guide targeted parathyroidectomy.

Muscle ultrasound: a reliable bedside tool for dietitians to monitor muscle mass

Objectives: Monitoring muscle mass (cross-sectional area [CSA]) and quality (echogenicity) using ultrasound may help optimise nutrition support in the critically ill. However, to date, ultrasound imaging has not been included in the undergraduate training of dietitians, who are mostly responsible for the nutrition care of critically ill patients. This study assessed the accuracy and reliability of bedside imaging performed by a dietitian trained according to standardised methodology, followed by blinded analyses. Methods: Two operators (a trainer and dietitian trainee) performed B-mode ultrasonography of the rectus femoris quadriceps muscle. For inter-rater accuracy, imaging was performed independently on 32 subjects by both operators, and for intra-rater reliability both obtained a second image on 15 subjects. A blinded assessor performed analyses (CSA and echogenicity) on all images. In a subset of 11 subjects, a musculoskeletal sonographer repeated all measurements. Inter- and intra-rater reliability were determined by calculating intraclass correlation coefficients (ICC), based on an absolute-agreement, 2-way mixed-effects model. An ICC > 0.75 was classified as good and > 0.90 as excellent. Results: Intra- (ICC = 0.9–0.94) and inter-rater (ICC = 0.85–0.95) reliability of the imaging performed was good to excellent. No statistically significant differences were found between the two operators (mean difference for CSA = 0.18 cm2, 95% CI = −0.38–0.03, p = 0.08; mean difference for echogenicity = 6.88, CI = −0.71–14.78, p = 0.07). Inter-rater reliability for image analyses was excellent (ICC = 0.97–1.0). Conclusion: Bedside ultrasound performed by a dietitian trained according to standardised methodology shows good to excellent reliability and reproducibility. Training dietitians to perform bedside ultrasound may help to monitor muscle mass and quality in the critically ill.

Evaluation of Achilles Tendon in Type 2 Diabetes Mellitus Patients Using Sonoelastography

Abstract Background Diabetes mellitus is an endocrine disease associated with several metabolic disorders and long-term complications. Achilles tendon is the largest and strongest tendon in the human body playing a crucial role in foot biomechanics. Hyperglycaemia in Diabetes Mellitus aids the deposition of glycosylated end products in most tissues including the Achilles tendon, which in turn alters its structure and function. Objectives The study aims to investigate the differences in Achilles tendon thickness and stiffness in people with and without type 2 diabetes mellitus. Patients and Methods This is a case control study, where the Achilles tendons of 20 type 2 DM patients and 21 non-diabetic controls were examined for the thickness and stiffness. Achilles tendon thickness was measured using B-mode ultrasonography while its stiffness was evaluated by compression elastography. Results This study included 20 type 2 DM patients (40 Achilles tendons), and 21 non-diabetic controls (42 Achilles tendons). The Achilles tendon thickness was significantly higher in the diabetic group with a mean thickness of 4.23 ± 0.95 mm, compared to 3.06 ± 0.83 mm in the control group (p &amp;lt; 0.01). A statistically significant difference of the Achilles tendon stiffness was also established. The diabetic group showed a greater percentage of soft tendons (47.5%) compared to the control group (16.7%). The diabetic group also showed a smaller percentage of hard tendons (52.5%) compared to the control group (83.3%) (p &amp;lt; 0.05). Conclusion Achilles tendons of type 2 DM patients are both thicker and softer than their non-diabetic counterparts.

Ultrasound Evaluations of Major Salivary Gland Pathology

No single sonographic feature is enough to distinguish gland disorders. Major salivary gland diseases are either localized or diffuse. Imaging must identify neoplastic from non-neoplastic diseases using Ultrasound, which is a non-invasive, low-cost, and accessible imaging method for the major salivary gland evaluation. Color Doppler in addition to B-mode ultrasound assesses gland enlargement and detects inflammatory, benign, and malignant gland enlargement. Moreover, this study aims to assess the diagnostic effectiveness of ultrasonography in diagnosis of major salivary gland pathology. Method: Ninety Major Salivary Gland swelling patients underwent preoperative ultra-sonography with a high-frequency linear probe. Echotexture, internal Calcification, focal lesion borders, lymphadenopathy, tumor shape, duct dilatation, and blood supply distribution were examined using color Doppler and B-mode Ultrasound. Result: A histological investigation of 62 tumors identified 18 malignant and 44 benign, with 68.2% of the benign group being pleomorphic adenoma and 61.1% of the malignant group being mucoepidermoid carcinoma. The rest of the cases, 28 cases were inflammatory, 50% of which were sialolithiasis. The sonographic features of malignant and benign differ significantly in echogenicity, posterior echo-enhancement, vascularity, morphology, and homogeneity and Calcification. All groups show considerable differences in duct dilatation, duct calcification, and homogeneity. Conclusion: Ultrasonography demonstrating excellent diagnostic efficacy in assessing salivary gland function, based on these results Ultrasonography may help reduce unnecessary biopsies especially in inflammatory cases.

Ultrasonographic and histopathological investigation of the effect of N-acetylcysteine on doxorubicin-induced ovarian and uterine toxicity in rats

BackgroundThis study aimed to investigate the mitigating effect of N-acetylcysteine (NAC) on doxorubicin (DOX)-induced ovarian and uterine toxicity in rats using laboratory tests, ultrasonographic (US) imaging, and histopathology analysis.MethodsForty-eight rats were divided into six groups (n = 8) as follows: Group A (control) (0.5 mL saline administered intraperitoneally [IP]), Group B (a single 10 mg/kg dose of DOX administered IP on day 1), Group C (a single 10 mg/kg dose of DOX administered IP 24 h before sacrifice), Group D (100 mg/kg of NAC administered IP for 21 days), Group E ( a single 10 mg/kg dose of DOX administered IP on day 1 and 100 mg/kg of NAC administered IP for 21 days), and Group F (100 mg/kg of NAC administered IP for 21 days and a single 10 mg/kg dose of DOX administered IP 24 h before sacrifice). The ovaries were examined using B-mode US on days 1, 14, and 21, and the histopathological examinations of the ovaries and the uterus were undertaken after sacrifice on day 22.ResultsHistomorphological analyses showed that ovarian weight decreased after DOX administration in Group B but not in Group E. US revealed a transient increase in ovarian size in Group B and E, reverting to baseline levels over time, as well as a progressive increase in peritoneal fluid in Groups B and E. Group B exhibited a significant decrease in the thickness of the endometrium and myometrium and uterine cornual length, which was not observed in Group E. Histopathological examination showed that DOX caused a decline in follicular count, especially in primordial, secondary, and Graafian follicles, and resulted in follicular atresia, predominantly in Group B. Destructive degeneration/necrosis and vascular changes were most prominently seen in the corpus luteum of Groups C and B. In NAC-treated rats (Groups E and F), although germ cell damage was present, atretic follicles and vascular changes, such as hyperemia and congestion, were reduced. The anti-müllerian hormone (AMH) level was the highest in Group F.ConclusionsNAC, an antioxidant, attenuated DOX-induced gonadotoxicity in rats.

Testicular ultrasound measurement of testicular volume and epididymis diameters: Prediction of semen quality in a prospective study

AbstractPurposeTo identify the most predictive ultrasound parameters for the assessment of male infertility by a multiparametric study.Materials and MethodsA total of 64 males were recruited in the study group and 14 men in the control group. At first, grey-scale and color and Power Doppler ultrasonographic imaging was used to analyze testicular morphological characteristics and detect intratesticular abnormalities. Various ultrasound parameters of B-mode US and strain-elastography were related to total sperm count (TSC).ResultsThe prevalence of varicocele was not significant (P = 0.33), though presented a 2.53-fold odds ratio The strain ratios of both testes, the volume of the left testis and the size of the left appendix were most associated with the results of semen analysis according to a Variable Importance in the Projection (VIP) score of &gt;1. The first latent variable from the PLS analysis explained a significant amount of variance in TSC, concentration, and motility parameters (P &lt; 0.0002) and showed that bilateral strain ratio, the size of the testis, and the volume of left appendix were the most significant US predictors of the pathological semen and sperm cell features.ConclusionsOur results showed that B-mode US with strain elastography is among more sensitive US approaches in evaluating male fertility.

William M. Feinberg Lecture: Asymptomatic Carotid Stenosis: Current and Future Considerations.

Asymptomatic high-grade carotid stenosis is an important therapeutic target for stroke prevention. For decades, the ACAS (Asymptomatic Carotid Atherosclerosis Study) and ACST (Asymptomatic Carotid Surgery Trial) trials provided most of the evidence supporting endarterectomy for patients with asymptomatic high-grade stenosis who were otherwise good candidates for surgery. Since then, transfemoral/transradial carotid stenting and transcarotid artery revascularization have emerged as alternatives to endarterectomy for revascularization. Advances in treatments against atherosclerosis have driven down the rates of stroke in patients managed without revascularization. SPACE-2 (Stent-Protected Angioplasty Versus Carotid Endarterectomy-2), a trial that included endarterectomy, stenting, and medical arms, failed to detect significant differences in stroke rates among treatment groups, but the study was stopped well short of its recruitment goal. CREST-2 (Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trial) will be able to clarify whether revascularization by stenting or endarterectomy remains efficacious under conditions of intensive medical management. Transcarotid artery revascularization has a favorable periprocedural risk profile, but randomized trials comparing it to intensive medical management are lacking. Features like intraplaque hemorrhage on MRI and echolucency on B-mode ultrasonography can identify patients at higher risk of stroke with asymptomatic stenosis. High-grade stenosis with poor collaterals can cause hemispheric hypoperfusion, and unstable plaque can cause microemboli, both of which may be treatable risk factors for cognitive impairment. Evidence that there are patients with carotid stenosis who benefit cognitively from revascularization is presently lacking. New risk factors are emerging, like exposure to microplastics and nanoplastics. Strategies to limit exposure will be important without specific medical therapies.

Effectiveness of two-dimensional shear-wave sonoelastography in the diagnosis and follow-up of infantile hypertrophic pyloric stenosis

IntroductionWe sought to determine the effectiveness and utility of two-dimensional shear-wave sonoelastography (2D-SW-SE) in the diagnosis and postoperative follow-up of infantile hypertrophic pyloric stenosis (IHPS).Materials and MethodsTwenty-three infants were included in the study, 13 in the IHPS group and 10 in the control group (CG). Preoperative B-mode ultrasonography measurements (longitudinal length and single-wall thickness of the pylorus) and 2D-SW-SE measurements (pylorus tissue stiffness and shear-wave propagation speed) were compared between the groups. The infants with IHPS then underwent Ramstedt pyloromyotomy and were invited for follow-ups on the tenth day and the first, third, and sixth months postoperatively. Measurements taken at the follow-ups were compared with the preoperative values.ResultsNo differences were found between the groups regarding age, gender, body weight, or week of birth. The pyloric lengths in the IHPS group were longer than in the CG (p < 0.001), and the single-wall thicknesses were thicker (p < 0.001). The pylorus in the IHPS group was four times stiffer than in the CG (27.4 kPa versus 7.66 kPa), and the shear-wave propagation speed in the tissue was higher (1.34 m/s versus 2.69 m/s; p < 0.001). Both values decreased over time in the IHPS group and were normal by the third postoperative month.Conclusions2D-SW-SE can be used as an assistive imaging tool alongside B-mode ultrasound for diagnosing IHPS. It can also be used to identify inadequate surgery by detecting whether the pyloric tissue has softened at follow-up.

Artificial intelligence in hepatocellular carcinoma diagnosis: a comprehensive review of current literature.

Hepatocellular carcinoma (HCC) diagnosis mainly relies on its pathognomonic radiological profile, obviating the need for biopsy. The project of incorporating artificial intelligence (AI) techniques in HCC aims to improve the performance of image recognition. Herein, we thoroughly analyze and evaluate proposed AI models in the field of HCC diagnosis. A comprehensive review of the literature was performed utilizing MEDLINE/PubMed and Web of Science databases with the end of search date being the 30th of September 2023. The MESH terms "Artificial Intelligence," "Liver Cancer," "Hepatocellular Carcinoma," "Machine Learning," and "Deep Learning" were searched in the title and/or abstract. All references of the obtained articles were also evaluated for any additional information. Our search resulted in 183 studies meeting our inclusion criteria. Across all diagnostic modalities, reported area under the curve (AUC) of most developed models surpassed 0.900. A B-mode US and a contrast-enhanced US model achieved AUCs of 0.947 and 0.957, respectively. Regarding the more challenging task of HCC diagnosis, a 2021 deep learning model, trained with CT scans, classified hepatic malignant lesions with an AUC of 0.986. Finally, a MRI machine learning model developed in 2021 displayed an AUC of 0.975 when differentiating small HCCs from benign lesions, while another MRI-based model achieved HCC diagnosis with an AUC of 0.970. AI tools may lead to significant improvement in diagnostic management of HCC. Many models fared better or comparable to experienced radiologists while proving capable of elevating radiologists' accuracy, demonstrating promising results for AI implementation in HCC-related diagnostic tasks.

The association of structural versus load-dependent large artery stiffness mechanisms with cerebrovascular damage and cortical atrophy in humans.

Large central arterial stiffness is a risk factor for cerebrovascular damage and subsequent progression of neurodegenerative diseases, including Alzheimer's disease and dementia. However, arterial stiffness is determined by both the intrinsic components of the arterial wall (structural stiffness) and the load (i.e., arterial blood pressure) exerted upon it by the blood (load-dependent stiffness). This study aimed to determine the degree to which structural and/or load-dependent mechanisms of central arterial stiffness are associated with cerebrovascular damage. Among 128 healthy individuals (aged 63±6, age range: 50-80 years, 42% men), aortic and carotid artery stiffness was measured via carotid-femoral pulse wave velocity and B-mode ultrasonography, respectively. Using participant-specific exponential models, both aortic and carotid artery stiffness were standardized to a reference blood pressure to separate their structural and load-dependent stiffness mechanisms. Magnetic resonance imaging was used to derive total, periventricular, and deep cerebral white matter lesion volume (WMLV) and global cortical thickness. After adjusting for common cardiovascular disease risk factors, a 1 m/s increase in structural aortic stiffness was associated with 15% greater total WMLV (95% confidence interval [CI] = 0.01, 0.27, P = 0.036), 14% greater periventricular WMLV (95%CI = 0.004, 0.25, P = 0.044) and 0.011mm lower cortical thickness (95%CI = -0.022, -1.18, P = 0.028). No association was observed between structural carotid stiffness and WMLVs (total, periventricular, and deep), and neither aortic nor carotid load-dependent stiffness was associated with WMLVs or cortical thickness. Structural, not load-dependent, mechanisms of aortic stiffness are related to cerebrovascular-related white matter damage.

Systemic immune-inflammation index mediates the association between metabolic dysfunction-associated fatty liver disease and sub-clinical carotid atherosclerosis: a mediation analysis.

Limited research has been conducted to quantitatively assess the impact of systemic inflammation in metabolic dysfunction-associated fatty liver disease (MAFLD) and sub-clinical carotid atherosclerosis (SCAS). The systemic immune-inflammation index (SII), which integrates inflammatory cells, has emerged as a reliable measure of local immune response and systemic inflammation Therefore, this study aims to assess the mediating role of SII in the association between MAFLD and SCAS in type 2 diabetes mellitus (T2DM). This study prospectively recruited 830 participants with T2DM from two centers. Unenhanced abdominal CT scans were conducted to evaluate MAFLD, while B-mode carotid ultrasonography was performed to assess SCAS. Weighted binomial logistic regression analysis and restricted cubic splines (RCS) analyses were employed to analyze the association between the SII and the risk of MAFLD and SCAS. Mediation analysis was further carried out to explore the potential mediating effect of the SII on the association between MAFLD and SCAS. The prevalence of both MAFLD and SCAS significantly increased as the SII quartiles increased (P<0.05). MAFLD emerged as an independent factor for SCAS risk across three adjusted models, exhibiting odds ratios of 2.15 (95%CI: 1.31-3.53, P < 0.001). Additionally, increased SII quartiles and Ln (SII) displayed positive associations with the risk of MAFLD and SCAS (P < 0.05). Furthermore, a significant dose-response relationship was observed (P for trend <0.001). The RCS analyses revealed a linear correlation of Ln (SII) with SCAS and MAFLD risk (P for nonlinearity<0.05). Importantly, SII and ln (SII) acted as the mediators in the association between MAFLD and SCAS following adjustments for shared risk factors, demonstrating a proportion-mediated effect of 7.8% and 10.9%. SII was independently correlated with MAFLD and SCAS risk, while also acting as a mediator in the relationship between MAFLD and SCAS.

Clinical utility of salivary and lacrimal gland ultrasonography in primary Sjögren's syndrome.

This review discusses the clinical utility of salivary gland ultrasonography (SGUS) and lacrimal gland ultrasonography (LGUS) in primary Sjögren's syndrome (SjS). Several studies have shown that SGUS findings improve the diagnostic performance of the recent SjS classification criteria. Lacrimal gland ultrasonography findings can also aid in the diagnosis of SjS. However, SGUS and LGUS findings correlated with salivary or lacrimal gland function and minor salivary gland biopsy findings. A better treatment response to rituximab and salivary stimulants was observed in SjS patients with lower SGUS scores. In addition, the clinical implications of Doppler ultrasonography and ultrasound elastography of the salivary and lacrimal glands were investigated in patients with SjS.This review highlights the advantages of SGUS and LGUS in the diagnosis and prediction of salivary and lacrimal gland functions and treatment response in patients with SjS. Additionally, modalities other than B-mode ultrasonography, such as Doppler ultrasonography and ultrasound elastography, have been actively studied to demonstrate the clinical utility of SjS. Ultrasonography has great advantages such as immediate performance and interpretation, no harmful complications, and no discomfort to patients. Therefore, SGUS and LGUS are potentially useful diagnostic and predictive tools for SjS.

Comparison of Testicular Sonography and Elastography Findings With Semen Parameters in Cases Investigated for Infertility.

This study aimed to investigate the correlation between testicular shear wave elastography (SWE) values and semen analysis results in men with infertility. This was a retrospective case-control study. Patients were categorized as normal, abnormal, or azoospermic based on sperm analysis results. Testicular volume was measured using B-mode ultrasonography using the Lambert formula. Subsequently, 40-80 regions of interest measuring 1.5 × 1.5 mm were manually positioned in both testicles based on their size, and two-dimensional SWE was applied through virtual touch imaging quantification software. The patients had a mean age of 33.79 ± 6.3 years, with semen analysis revealing normal results in 15 patients (22.4%), pathological findings in 35 patients (52.2%), and azoospermia in 17 patients (25.4%). Right, left, total, and mean testicular volumes were significantly lower in patients with azoospermia compared to those in both normal and impaired semen parameters (P < .05). Conversely, testicular elastography scores were higher in patients with azoospermia than in the other groups (P < .05). The significant negative correlation between volume and elastographic findings remained independent of age (r = 0.4, P < .001). The accuracy rates for detecting impaired semen parameters and azoospermia were 94.3% and 94.1%, respectively, after considering factors such as age, testicular volume (right/left/total), and elastography (right/left/total). Notably, the total mean elastography score ranked first, with 100% in the independent normalized importance distribution of these variables. SWE can be used effectively alone or in combination with other diagnostic tools to evaluate histopathological changes in the testicles of male patients with infertility.

Simulating federated learning for steatosis detection using ultrasound images

We aimed to implement four data partitioning strategies evaluated with four federated learning (FL) algorithms and investigate the impact of data distribution on FL model performance in detecting steatosis using B-mode US images. A private dataset (153 patients; 1530 images) and a public dataset (55 patient; 550 images) were included in this retrospective study. The datasets contained patients with metabolic dysfunction-associated fatty liver disease (MAFLD) with biopsy-proven steatosis grades and control individuals without steatosis. We employed four data partitioning strategies to simulate FL scenarios and we assessed four FL algorithms. We investigated the impact of class imbalance and the mismatch between the global and local data distributions on the learning outcome. Classification performance was assessed with area under the receiver operating characteristic curve (AUC) on a separate test set. AUCs were 0.93 (95% CI 0.92, 0.94) for source-based partitioning scenario with FedAvg, 0.90 (95% CI 0.89, 0.91) for a centralized model, and 0.83 (95% CI 0.81, 0.85) for a model trained in a single-center scenario. When data was perfectly balanced on the global level and each site had an identical data distribution, the model yielded an AUC of 0.90 (95% CI 0.88, 0.92). When each site contained data exclusively from one single class, irrespective of the global data distribution, the AUC fell in the range of 0.34–0.70. FL applied to B-mode US images provide performance comparable to a centralized model and higher than single-center scenario. Global data imbalance and local data heterogeneity influenced the learning outcome.