High-resolution Ultrasonography Research Articles

Management guidelines for pregnant women living with epilepsy: An integrative literature review

Background: Epilepsy affects more than 50 million people worldwide, with a significant number of safety-related concerns arising in pregnant women. Precise management needs to include a vast array of stepwise protocols; however, no studies have been conducted to compare current South African guidelines to international norms.Aim: The aim of this integrative literature review was to identify discrepancies, if any, in the current protocols for treating pregnant women with epilepsy within the public sector of South Africa when measured against global standards.Method: An integrative literature review was conducted using the Whittemore and Knafl method. The following databases and search engines were used: PubMed, EBSCOhost, Science Direct, Medscape, African Journals Online, Cochrane Library, Google scholar, Google and MedlinePlus. The study included qualitative literature from all levels of evidence from 2006 to 2023. The data were evaluated using the PRISMA flow chart and analysed using the Cooper method. On completion of critical appraisal, 22 articles met the inclusion criteria and were analysed thematically.Results: The review identified several areas that can be enhanced to improve patient management and outcomes such as therapeutic drug monitoring and targeted dosing, folic acid supplementation, the use of antepartum vitamin K, high-resolution ultrasounds, elimination of sodium valproate in women of childbearing potential, monotherapy and endorsing frequent obstetrician visits.Conclusion: The study validated many differences between guidelines used in South Africa and internationally. Some of the prominent findings included areas focused on patient medication, screening, physician visits and pharmacovigilance.Contribution: The findings can be used to enhance and provide evidence-based recommendations in the areas that are not well developed within the current guidelines.

Diagnostic Role of High resolution US and MRI in evaluation of Ulnar nerve Entrapment Neuropathy and soft tissue Injuries around the Elbow Joint

Diagnostic Role of High resolution US and MRI in evaluation of Ulnar nerve Entrapment Neuropathy and soft tissue Injuries around the Elbow Joint

Diagnostic assessment of ulnar nerve thickness in leprosy using high-resolution ultrasonography versus magnetic resonance imaging

Diagnostic assessment of ulnar nerve thickness in leprosy using high-resolution ultrasonography versus magnetic resonance imaging

High-resolution Ultrasound of Peripheral Nerve Disorders.

Peripheral nerve disorders refer to any condition that damages the peripheral nervous system with variable presentations and numerous causes. The diagnosis is usually suspected clinically and then confirmed using electrophysiology. Yet electrodiagnostic studies lack precise anatomical delineation and often cannot determine the underlying cause of the peripheral neuropathy. However, thanks to recent technological advances, high-resolution ultrasound (HRUS) and magnetic resonance (MR) imaging have emerged as exceptional modalities to identify the exact site of pathology and demonstrate the underlying etiology. These developments have led to a multimodality approach to peripheral nerve disorders. Imaging provides anatomical and morphological information while functional evaluation remains derived from electrodiagnostic study. This article reviews the HRUS features of common as well as less frequent peripheral nerve disorders: entrapment neuropathies, traumatic injuries, neuralgic amyotrophy, polyneuropathies, and nerve tumors.

Ultrasound for Postoperative and Iatrogenic Peripheral Nerve Lesions: What Do Radiologists Need to Know?

Iatrogenic nerve injuries are common and require an immediate accurate diagnosis to allow surgical treatment within a short window of opportunity. Targeted investigation using high-resolution ultrasound (US) allows an accurate diagnosis in the acute phase when electrophysiology has a limited role. By identifying the exact site of injury, mechanism, and type of nerve damage, US can help determine the prognosis of the lesion and the need for surgical management. This pictorial review discusses the role of high-resolution US in the work-up of iatrogenic nerve injuries, with an emphasis on US appearances and the clinical knowledge needed by the radiologist to provide solutions to clinical challenges.

Ultrasound Visualization of the Recurrent Laryngeal Nerve: A Prospective Clinical Validation Study.

This study aimed to optimize a lateral transthyroid approach by using high-resolution ultrasonography (HRUS) for recurrent laryngeal nerve (RLN) visualization. In this prospective study of 85 patients undergoing thyroidectomy, the RLN was visualized preoperatively by using a lateral transthyroid approach via HRUS. The inferior thyroid artery, thyroid nodule, and cricoid cartilage were used as landmarks. RLN visibility was graded from poor to excellent. The accuracy of the preoperative localization of the RLN was determined by intraoperative HRUS, neuromonitoring, and surgical findings. RLN visualization and localization were verified intraoperatively by ultrasound-guided stimulation via a neuromonitoring probe in eight patients with extended incisions owing to the need for neck dissection. A total of 110 RLNs were present in 85 patients, and the locations of 103 RLNs detected by preoperative ultrasound were confirmed intraoperatively, with an accuracy rate of 93.6%. All detected RLNs were well visualized at the inferior thyroid artery and thyroid nodule levels. The RLN was visible in 83.5% of cases at the cricoid cartilage level. The maximum short-axis diameter and cross-sectional area of the RLN at all three levels were significantly larger in males than in females (p < 0.05). In total, ten RLNs were bifurcated and two showed tumor invasions. These findings were confirmed intraoperatively. Effective RLN visualization can be achieved using a lateral transthyroid approach via HRUS. The precise localization, prediction of anatomic variation, and invasion of RLN provide significant advantages in the individualized treatment, surgical planning, and nerve protection of patients with thyroid lesions.

The Role of High-Resolution Ultrasound in the Diagnosis of Nerve Trauma New Perspective: A Preliminary Systematic Review and Meta-Analysis of the Recent Evidence.

Precise localization of peripheral nerve injuries and evaluation of their prognosis based on clinical and electrodiagnostic examinations are particularly challenging in the acute phase. High-resolution ultrasound (HRUS) may offer a viable and cost-effective imaging option for assessing the morphology of nerve injuries. Consequently, a systematic review and meta-analysis of studies on the use of ultrasound for diagnosing traumatic nerve injuries were conducted. A total of 15 studies were included, reporting the most recent findings on using HRUS in the diagnosis of traumatic nerve injury. These studies assessed the diagnostic test accuracy of ultrasound for the detection of traumatic nerve injury in 272 participants, with the cross-sectional area at the site of traumatic nerve injury also reported in 1,249 participants. The pooled sensitivity and specificity of the included studies were 92% confidence interval (CI) (0.89-0.95) and 86% CI (0.82-0.89), respectively. The positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 13.76 CI (1.41-134.34), 0.08 CI (0.03-0.18), and 286.23 CI (21.22-3,860.40), respectively. In the summary of the receiver operating characteristic curve, the area under the curve was 0.986, and the Q* index was 0.949. Based on the current literature, HRUS has shown promising results in addition to its availability and feasibility. HRUS can serve as a valuable complement to clinical and electrodiagnostic examinations for diagnosing traumatic peripheral nerve injuries. Further research is recommended to better understand the ultrasound characteristics of these injuries.

A Spectrum of Neural Tube Defects: An Observational Study in the Eastern State of India

Objective: This study aimed to determine the prevalence and types of neural tube defects (NTDs) in eastern India, examine the associated maternal and paternal risk factors, and evaluate the impact of antenatal ultrasonography for early detection and management.Materials and Methods: A four-year observational study was conducted at the IMS and SUM Hospital, SOA University, Bhubaneswar, India, from July 2020 to June 2024. Pregnant women attending the antenatal clinic were screened for NTDs by using high-resolution ultrasonography. Diagnosed cases were further confirmed by postmortem autopsy, when available. Relevant maternal and paternal demographic data, including age, socioeconomic status, consanguinity, body mass index (BMI), hyperthermia, and paternal occupation, were collected. Statistical analysis was performed using Fisher’s exact test to identify significant associations between these factors and NTD occurrence, with significance set at P &lt; 0.05.Results: The incidence of NTDs was 9.12 per 1000 deliveries, with spina bifida (43.4%) being the most prevalent, followed by anencephaly (32.9%), and encephalocele (11.1%). NTDs were significantly associated with maternal age (20-24 years), lower socioeconomic status, consanguinity (12.93% of cases), maternal obesity (BMI ≥30 kg/m²), and hyperthermia (≥100 °F). Fathers engaged in labor-intensive occupations had higher rates of offspring with NTDs (56%). This study highlights the effectiveness of antenatal ultrasonography for early detection and management, particularly in high-risk populations.Conclusion: NTDs continue to pose a significant public health challenge in Eastern India. This study underscores the need for improved prenatal care, genetic counseling, and targeted public health interventions, including folic acid supplementation and lifestyle modifications, to mitigate risk factors. Future research should focus on expanding geographic coverage and integrating genetic analysis to better understand the complex interplay between environmental and genetic factors contributing to NTDs.

Exploring the Utility of High-Resolution Ultrasonography and Color Doppler of Peripheral Nerves in Monitoring Response to Treatment in Leprosy Patients: A Prospective, Observational Study.

Diagnosis and monitoring of nerve function impairment (NFI) presents an ongoing challenge in global leprosy control. This was a prospective, observational study in leprosy patients receiving treatment with cutaneous and neurological examinations done every 3 months for 1 year. High-resolution ultrasonography and color Doppler (HRUS-CD) was performed in all patients at baseline, completion of treatment, and anytime during the study period if a patient had deterioration of nerve function noted clinically. All peripheral nerves were assessed, and parameters studied were cross-sectional area (CSA), length of thickening, endoneural flow signals (ENFS), and distortion in fascicular symmetry. Of 54 treatment-naive leprosy patients, loss of sensation was noted in 37 (68.5%), paresthesia in 20 (37.0%), and neuropathic pain in 7 (12.9%) at baseline presentation. At end of treatment of leprosy, maximum improvement in NFI across all clinical criteria was seen in ulnar and radial nerves (P <0.05). The number of impairments on HRUS-CD decreased consistently, significantly for ulnar (P = 0.009 right ulnar, P = 0.012 left ulnar) and right radial (P = 0.025) nerves, and significant improvements in CSA and ENFS were seen across multiple nerves, which correlated with improvement in NFI as well. Abnormal HRUS-CD findings in the target nerves were significantly associated with multibacillary cases (odds ratio [OR]: 4.33; 95% CI: 0.62-30.31), those in reaction (OR: 9.42; 95% CI: 1.51-58.66), and those older than 40 years (OR: 3.14; 95% CI: 0.49-19.93). This study provides objective evidence of improvement in NFI with anti-leprosy treatment, supporting integration of HRUS-CD imaging in monitoring nerve involvement in leprosy.

Radioanatomy of Salivary Glands

Salivary glands are the first organs of digestion secreting their digestive juices into the oral cavity. Parotid, submandibular, and sublingual glands are the major paired salivary glands in the decreasing order of their size. In addition, multiple small minor salivary glands are noted randomly distributed in the upper aerodigestive tract, including paranasal sinuses and parapharyngeal spaces. The imaging is directed to the major salivary glands. Commonly used imaging methods include plain radiography and conventional sialography. Recently, high-resolution ultrasonography (HRUS) is being increasingly used for targeted salivary gland imaging. However, the advent of cross-sectional imaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI) have revolutionized the imaging of salivary glands. This article illustrates the role of imaging in evaluating the variegated disease pattern of the major salivary glands.

Comparative imaging modalities for diagnosing rotator cuff injuries

Rotator cuff injuries are a significant cause of shoulder pain and dysfunction, with their prevalence increasing with age. Diagnosing these injuries accurately is crucial for determining appropriate treatment strategies. Various imaging modalities, such as high-resolution ultrasonography (HRUS), magnetic resonance imaging (MRI), and magnetic resonance arthrography (MRA), play a pivotal role in identifying rotator cuff injuries. MRI, considered the gold standard, offers detailed insights into tendon degeneration, partial tears, and full-thickness tears. Meanwhile, HRUS is favored for its cost-effectiveness, non-invasive nature, and real-time dynamic assessments. This review compares these imaging techniques, highlighting their diagnostic accuracy, strengths, and limitations in the context of rotator cuff injuries. Although MRI provides comprehensive information on tendon pathology and associated conditions like muscle atrophy, HRUS remains a valuable tool due to its accessibility and accuracy in diagnosing both partial and full-thickness tears. Understanding the comparative efficacy of these imaging modalities is essential for clinicians to make informed decisions about patient management.

Sustained paradoxical vasodilation and blood pressure lowering in response to sympathetic stimulation as markers of disease severity and poor survival in primary AL amyloidosis.

Abstract Background AL patients present sustained paradoxical vasodilation in response to sympathetic stimulation by cold pressor test (CPT). The clinical relevance of this finding is unknown. Purpose We investigated the association between CPT-induced vascular and hemodynamic responses with clinical characteristics of the disease in AL amyloidosis. Methods We consecutively recruited 113 newly diagnosed patients with AL amyloidosis before treatment initiation. High resolution ultrasonography was used to measure the maximum vasodilation of the brachial artery in response to a cold stimulus and 3 minutes after its withdrawal. Systolic (SBP) and diastolic blood pressure (DBP) were measured at the same timepoints. Clinical and laboratory makers of autonomic dysfunction were also measured in a subgroup of the population. All-cause and cardiovascular (CV) mortality were defined as end-points of the study. Results Sustained vasodilation post CPT (%pCPT) was associated with markers of autonomic dysfunction, namely dipping status (p&amp;lt;0.05) and sudomotor dysfunction (p=0.064) and with NYHA stage, baseline NTproBNP and heart failure (p&amp;lt;0.05 for all). DBP%pCPT was associated with the neuropathy symptom scale (NSS Autonomous, p=0.032), while SBP%pCPT was inversely associated with Mayo stage. Vasodilation%pCPT was independently associated with CV death (adjusted HR=1.154, p=0.017) while both DBP%pCPT (HR=0.955, p=0.027) and SBP%pCPT (HR=0.947, p=0.04) were independently associated with all cause death (adjusted for the core model including age, sex, SBP, Mayo stage and nerve involvement). Overall survival was worse in AL patients who demonstrated a decrease in SBP%pCPT than in those who exhibited an increase or kept it stable (log rank test, p=0.024). The same applies to DBP%pCPT(log rank test, p=0.002). Regarding CV death, Vasodilation%pCPT above 5.86% was associated with increased risk of CV death (log rank test, p=0.002). Conclusions In AL amyloidosis, sustained paradoxical vasodilation and decreased SBP and DBP in response to sympathetic stimulation were associated with autonomic dysfunction, more severe cardiac involvement and poor survival.

Arterial-myocardial coupling in primary AL amyloidosis. A validation study of vascular involvement

Abstract Background Primary AL amyloidosis is a rare yet lethal systemic disorder. Previously published own and others’ work indicated that vascular involvement in AL cardiac amyloidosis defined as low blood pressure or paradoxical vasodilation may independently affect survival. Mechanistic data will pave the way to validate the clinical role of vascular involvement in these patients. Purpose We sought to explore the presence of arterial-myocardial coupling in AL amyloidosis by investigating associations between markers of vascular and cardiac involvement. Methods We consecutively recruited n=152 newly diagnosed patients with AL amyloidosis that underwent thorough vascular examination including reactive vasodilation (flow mediated vasodilation, FMD and vasodilation in response to cold-pressor test) using high resolution ultrasonography. Arterial stiffness was evaluated by carotid-femoral pulse wave velocity (PWV) and aortic pressures and markers of arterial wave reflections were estimated using radial artery tonometry. In a subgroup of patients, transthoracic echocardiography (n=152) and cardiac magnetic resonance (CMR) (n=59) were performed. Results Vascular reactivity correlated with global longitudinal strain (GLS), left ventricle ejection fraction (LVEF)/GLS ratio and worse LV volumes. Vasodilation post-cold pressure test was correlated with LV mass. cSBP exhibited a negative correlation with markers of heart involvement, wall thickness markers, GLS, and CMR tissue characterization markers. A positive correlation between cSBP and LVEF, rotation and twist strain, myocardial work and contractility markers and late gadolinium enhancement (LGE). cDBP was associated with systolic function and contractility markers, with myocardial work indices and LGE. A negative relationship with GLS, LA strain, RV GLS and LA diameter and E/e’ was noted. In addition, T2 was negatively correlated with cDBP. SBP was correlated positively with LVEF, contractility markers, and LGE myocardium and negatively correlated with biomarkers of heart involvement, GLS, CMR structure and tissue characterization. DBP was positively correlated with LGE and myocardial work. A negative relation with NTproBNP, E/e’, RVSP, LA diameter and T2 mapping was noted. Time of wave reflections (Tr) was negatively correlated with rotation strain and positively correlated with circumferential strain, LA strain and LV structure. Ai@75 was positively correlated with myocardial work and contractility markers, and LGE. Ai@75 was negatively correlated with markers of heart involvement, LV structure, E/e’, worse GLS and adverse CMR tissue characterization. Conclusion Markers of peripheral vascular dysfunction were associated with cardiac structure and function acquired both with echocardiography and CMR in AL amyloidosis. This arterial-myocardial coupling supports the clinical role of peripheral vascular involvement in this disease and warrants further investigation.

Assessing Femoral Head Medialization in Developmental Hip Dysplasia Type 1 and Type 2 Hip Separation.

The prevalence of developmental hip dysplasia is estimated to be 0.1-2 per 1000 infants. Hip imaging by ultrasonography is considered to be the gold standard method for screening and detecting developmental dysplasia of the hip (DDH), as per the Graf categorization. The classification of hip differentiation into type 1 and type 2 is determined by the alpha angle, as assessed by the Graf classification. Type 1 hips are defined as those with an alpha angle exceeding 60 degrees, whilst type 2 hips are defined as those with measurements falling within the range of 50 to 59 degrees. The computerized patient card in our institution had a compilation of 208 hip photographs taken from 110 patients, with 98 of them being bilateral. The acquisition of these photos occurred from January 2020 to December 2020. A retrospective review was conducted on the ultrasound (US) scans, with a specific emphasis on the outcomes related to type 1 and type 2 hips. There were 108 high-resolution US photos in the type 1 hip group and 100 high-resolution US images in the type 2 hip group. In terms of unilateral or bilateral cases, gender, or age, no statistically significant differences were seen between the two groups (p > 0.05). The FMD model exhibited a sensitivity of 86% and specificity of 70% in effectively predicting the presence of type 1 mature hips when the values surpassed 2.9 mm. The AUC (area under the curve) value achieved was 0.628. The process of diagnostic categorization may occasionally encounter challenges in accurately differentiating between type 1 and type 2 hip separation subsequent to a hip ultrasound examination. The findings of our analysis indicate that the assessment of the FMD is a highly successful method, demonstrating both high specificity and sensitivity in differentiating between various scenarios.

Role of High-Resolution Ultrasound in Assessment of Median and Ulnar Nerve Lesions

Abstract Background Peripheral nerve disorders happen when one or more peripheral nerves are damaged. Damaged nerves may not carry messages correctly, or they may not work at all. As a result, you may have pain, trouble walking, or a variety of other problems, depending on which nerves are involved. Peripheral nerve disorders are very common. There are more than 100 different types. Aim To detect the value of high resolution ultrasound in assessment and characterization of some median and ulnar nerve lesions, Including, mainly, compressive, traumatic and inflammatory nerve injuries. Patients and Methods 26 participants were included in our study either from outpatient clinics (neurology, rheumatology and diabetic clinics) or inpatient wards (vascular surgery department). The study was designed as a case series study; we studied 26 cases with diabetic peripheral neuropathy, carpal tunnel syndrome and traumatic/neoplastic nerve lesions. All selected cases were subjected to proper history taking and ultrasound detection of cross-sectional area (CSA) measurements of median/ulnar nerves in cases of diabetic peripheral neuropathy/carpal tunnel syndrome, compression/flattening of median nerve in cases of carpal tunnel syndrome, loss of integrity in traumatic nerve lesions and neuroma incontinuty in traumatic/neoplastic nerve lesions. Results Regarding the ultrasound findings of the peripheral nerves (median/ulnar nerves), there were 38.5% cases were carpal tunnel syndrome, 23.1% were ulnar nerve diabetic neuropathy and 3.8% were complete tear of digital branch of median N, median N complete transection with neuroma, median N entrapment by scar tissue, median N injury neuroma old crush injury, median N injury with neuroma in continuity, median N injury with small hematoma&amp; bifid median N, median ulnar nerve traumatic injury, ulnar nerve crush injury neuroma, ulnar nerve penetrating wound neuroma and ulnar nerve shwanoma. We found that there are significant increase in ulnar/median nerves CSA among diabetic patients with diabetic peripheral neuropathy (DPN)/patients with carpal tunnel syndrome (CTS), compression/flattening of median nerve in patient with CTS, loss of integrity in cases of traumatic nerve lesions and neuroma incontinuty of traumatic/neoplastic nerve lesions. Conclusion High resolution ultrasound of median and ulnar nerves proved very helpful in the early diagnosis and distinction of various median and ulnar nerves lesions seen in patients with carpal tunnel syndrome, ulnar nerve diabetic neuropathy clinically suspected, patients with median/ulnar nerves traumatic lesions and patients with ulnar nerve neoplastic nerve lesions. Upper limb peripheral nerve ultrasonography can serve as a useful diagnostic tool in the diagnosis of peripheral nerve lesions.

Adhesive Capsulitis of the Shoulder Joint; Correlation between the Utrasonographic and MRI Findings

Abstract Background Adhesive capsulitis “frozen shoulder,” is a debilitating condition characterized by progressive pain and limited range of motion of the glenohumeral joint. It is a condition that typically affects middle-aged women, with some evidence for an association with endocrinological, rheumatological, and autoimmune disease states. Early diagnosis and treatment of adhesive capsulitis can lead to markedly improved clinical management. Diagnosis is usually based on physical examination alone. However, imaging studies can clarify the diagnosis in equivocal cases showing overlapping symptoms with other shoulder pathologies. Aim to correlate between the ultrasonographic and magnetic resonance imaging (MRI) features of adhesive capsulitis of the shoulder (ACS). Material &amp; Method Our study was carried out on 30 patients, of any age group, having shoulder pain and stiffness for longer than 15 weeks. The patients had both US &amp; MRI examinations, the findings of the 2 modalities were recorded and compared. Results There was significant statistical agreement (P value &amp;lt;0.001) between US &amp; conventional MRI, US demonstrated CHL, IGH and rotator interval changes. Conclusion Based on the results, high resolution US with dynamic real-time assessment was proven to be sensitive, specific with significant agreement to conventional MRI in detecting adhesive capsulitis pathology. So US can be used as an initial modality for patients with chronic shoulder pain and limitation of movements.

Non-Acute Shoulder Pain: Correlation between Ultrasonography and MRI Findings

Abstract Background Shoulder pain affects people of all ages and activity levels, from elite athletes to sedentary individuals. The imaging workup of shoulder pain is important because it is the second most common musculoskeletal complaint after back pain for which patients seek medical attention. Magnetic resonance imaging (MRI) is well established as a powerful imaging modality for the shoulder. In the last decade, ultrasound has emerged as an effective imaging option alongside MRI for evaluation of the shoulder. With MRI and ultrasound, clinicians now have two viable advanced imaging options for the diagnostic evaluation of shoulder pain. Aim to assess the value added, sensitivity and specificity of US in non-acute shoulder pain using conventional MRI as a gold standard. Material &amp; Method Our study was carried out on 47 patients, based on age ≥ 18 years, having shoulder pain for 6 months &amp;more. the patients had both US &amp; MRI examination, the findings of the 2 modalities were recorded and compared. Results There was significant statistical agreement (P value &amp;lt;0.001) between US &amp; conventional MRI, US demonstrated SST, SS partial &amp;full thickness tear, LHBT pathologies, AC morphological changes and bursitis. Conclusion Based on the results, high resolution US with dynamic real-time assessment was proven to be fairly sensitive, specific with significant agreement to conventional MRI in detecting different causes of chronic shoulder pain. So US can be used as an initial modality for patients with painful shoulder.

Comparison between Digital Breast Tomosynthesis and Digital Mammography in the Assessment of Breast Cancer across Dense and Nondense Breast

Abstract Background Women's breast cancer is considered a serious public health issue. throughout the world. For asymptomatic women, digital mammography is the primary imaging modality used for breast cancer screening. It also has been shown to reduce breast cancer mortality. Digital breast tomosynthesis provides better detection of the abnormalities especially in females with dense breasts Aim to evaluate the impact of digital breast tomosynthesis (DBT) in comparison to digital mammography (DM) in improving the detection and characterization of breast cancer across the dense and non-dense breasts (according to BI-RADS Atlas) in correlation with ultrasound and histopathology. Material &amp; Method This study included 100 female patients according to our inclusion criteria. All patients performed full-field digital mammography (FFDM) and digital breast tomosynthesis (DBT) were classified according to breast density. To establish a correlation between mammographic findings and cancer diagnosis, high-resolution ultrasound (HHUS) and DBT were used following FFDM as the primary imaging modality. The cancer diagnosis was subsequently confirmed by histopathology. Results The current study was based on histopathology as a reference standard, This was correlated with the final diagnosis; the diagnostic indices of mammography at the whole group were a sensitivity of 73.9%, a specificity of 74.3%, a positive predictive value (PPV) 84.2%, a negative predictive value (NPV) of 60.5%, and a diagnostic accuracy of 74%. Diagnostic indices of DBT were a sensitivity of 100%, a specificity of 88.6%, a PPV of 94.2%, an NPV of 100%, and a diagnostic accuracy of 96%. In patients with dense breasts Radiology ACR (c and d), 78% of cases had changed their BI-RADS scoring with the addition of tomosynthesis. However, in 54% of individuals with non-dense breast ACR (a and b), the addition of DBT to FFDM changed the BIRADS score. Our results showed that 100% of lesions detected by tomosynthesis were malignant tumors. Conclusion We conclude that DBT exceeded Mammography in terms of sensitivity, specificity, and diagnostic accuracy at all breast densities, particularly dense breasts. This is because DBT enables more accurate identification and characterization of breast lesions, which reduces the number of recalled cases and negative biopsies.

Role of ultrasound and magnetic resonance neurography in the detection of median nerve abnormalities in carpal tunnel syndrome

BackgroundThe most prevalent cause of peripheral nerve entrapment is carpal tunnel syndrome, which is characterized by compression of the median nerve at the wrist as a result of nearby or localized microvascular interference as well as structural alterations to the median nerve or adjacent tissues. However, no special information regarding the median nerve or its surroundings is provided by clinical examination or electrophysiological testing. The purpose of this study is to evaluate the effectiveness of magnetic resonance neurography (MRN) and ultrasound in identifying changes and abnormalities of the median nerve in carpal tunnel syndrome.MethodsThe twenty-five patients in this study ranged in age from 27 to 63 years old, with a mean age of 47. There were 18 female patients and seven male patients. All patients were sent to the radiology department from the orthopedics, neurology, outpatient clinic, and neurology department, at Ain Shams Hospital, Faculty of Medicine, Ain Shams University. All of the patients had clinically manifested pain along the median nerve distribution, each of the sixteen patients had hand paresthesia, and four had thenar muscle atrophy.ResultsIn the current study, Ultrasound exhibits low negative predictive value of 67% and specificity of 67%, but high positive predictive value of 95%, sensitivity of 95%, and overall accuracy of 92%. On the other hand, (MRN) exhibits a low negative predictive value of 60% and a high specificity of 75% in the diagnosis of nerve entrapment, but it also displays a high positive predictive value of 95%, sensitivity of 90%, and overall accuracy of 88%. Regarding the assessment of the recurrence cause and post-surgical evaluation is more reliable by Magnetic Resonance Neurography examination.ConclusionsMagnetic resonance neurography and high-resolution ultrasonography can be utilized to diagnose patients with median nerve entrapment and patients who cannot be diagnosed electrophysiologically.MRN is a more accurate method for detecting the exact location of nerve entrapment and evaluating nerve recovery after surgical intervention than nerve conduction studies and electromyography. Additionally, MRN can be used to identify causes that were not previously recognized based on physical examination and electrophysiological tests.

3D fascicular reconstruction of median and ulnar nerve: initial experience and comparison between high-resolution ultrasound and MR microscopy

BackgroundThe complex anatomy of peripheral nerves has been traditionally investigated through histological microsections, with inherent limitations. We aimed to compare three-dimensional (3D) reconstructions of median and ulnar nerves acquired with tomographic high-resolution ultrasound (HRUS) and magnetic resonance microscopy (MRM) and assess their capacity to depict intraneural anatomy.MethodsThree fresh-frozen human upper extremity specimens were prepared for HRUS imaging by submersion in a water medium. The median and ulnar nerves were pierced with sutures to improve orientation during imaging. Peripheral nerve 3D HRUS scanning was performed on the mid-upper arm using a broadband linear probe (10–22 MHz) equipped with a tomographic 3D HRUS system. Following excision, nerves were cut into 16-mm segments and loaded into the MRM probe of a 9.4-T system (scanning time 27 h). Fascicle and nerve counting was performed to estimate the nerve volume, fascicle volume, fascicle count, and number of interfascicular connections. HRUS reconstructions employed artificial intelligence-based algorithms, while MRM reconstructions were generated using an open-source imaging software 3D slicer.ResultsCompared to MRM, 3D HRUS underestimated nerve volume by up to 22% and volume of all fascicles by up to 11%. Additionally, 3D HRUS depicted 6–60% fewer fascicles compared to MRM and visualized approximately half as many interfascicular connections.ConclusionMRM demonstrated a more detailed fascicular depiction compared to 3D HRUS, with a greater capacity for visualizing smaller fascicles. While 3D HRUS reconstructions can offer supplementary data in peripheral nerve assessment, their limitations in depicting interfascicular connections and small fascicles within clusters necessitate cautious interpretation.Clinical relevance statementAlthough 3D HRUS reconstructions can offer supplementary data in peripheral nerve assessment, even in intraoperative settings, their limitations in depicting interfascicular branches and small fascicles within clusters require cautious interpretation.Key Points3D HRUS was limited in visualizing nerve interfascicular connections.MRM demonstrated better nerve fascicle depiction than 3D HRUS.MRM depicted more nerve interfascicular connections than 3D HRUS.Graphical