High-resolution Ultrasonography Research Articles

Using High-Resolution Ultrasound to Assess Post-Facial Paralysis Synkinesis-Machine Settings and Technical Aspects for Facial Surgeons.

Background: Synkinesis of the facial musculature is a detrimental sequalae in post-paralytic facial palsy (PPFP) patients. Detailed knowledge on the technical requirements and device properties in a high-resolution ultrasound (HRUS) examination is mandatory for a reliable facial muscle assessment in PPFP patients. We therefore aimed to outline the key steps in a HRUS examination and extract an optimized workflow schema. Methods: From December 2020 to April 2021, 20 patients with unilateral synkinesis underwent HRUS. All HRUS examinations were performed by the first author using US devices with linear multifrequency transducers of 4–18 MHz, including a LOGIQ E9 and a LOGIQ S7 XDclear (GE Healthcare; Milwaukee, WI, USA), as well as Philips Affinity 50G (Philips Health Systems; Eindhoven, the Netherlands). Results: Higher-frequency and multifrequency linear probes ≥15 MHz provided superior imaging qualities. The selection of the preset program Small Parts, Breast or Thyroid was linked with a more detailed contrast of the imaging morphology of facial tissue layers. Frequency (Frq) = 15 MHz, Gain (Gn) = 25–35 db, Depth (D) = 1–1.5 cm, and Focus (F) = 0.5 cm enhanced the image quality and assessability. Conclusions: An optimized HRUS examination protocol for quantitative and qualitative facial muscle assessments was proposed.

Ultrasonographic Spectrum of Cutaneous Cysts With Stratified Squamous Epithelium in Pediatric Dermatology: Pictorial Essay.

High-resolution ultrasound (HRUS) is an important diagnostic method in dermatology, especially in pediatric population. The most common type of cutaneous cysts in children corresponds to cysts with stratified squamous epithelium (CSSE). The objective is to present the different ultrasonographic appearance of histologically proven CSSE in a retrospective review. Epidermoid, milium, trichilemmal, dermoid, and pilonidal cyst and steatocystomas are included. Utility of HRUS in diagnosis of cutaneous lesions is well established. It is important to know-and stay updated-about the wide spectrum of ultrasonographic appearance of CSSE in order to avoid misleading diagnoses.

Evaluation of high-risk patients with dense breast on high-resolution ultrasound for screening and detection of breast cancer where mammography is of low significance

Abstract Background: Early diagnosis of breast cancer is a challenging problem in high-risk patients with dense breast. The risk of breast cancer is many fold higher in dense breast as compared to nondense on one side with limited screening or diagnostic role of mammography on the other side. The aim of our study is to elaborate the role of high-resolution ultrasonography (HR-USG) as adjunct modality to overcome this limitation. Materials and Methods: This is a prospective observational study conducted in the breast care clinic of a tertiary care cancer hospital. Totally, 2720 patients were enrolled for mammography. Out of these, 339 patients were reported according to Breast Imaging Reporting and Data System (BIRADS) as 0 (inconclusive) and were suggested for further evaluation by other modalities. All patients reported for mammography as BIRADS 0, were included in this study for HR-USG. Results: On HR-USG, 33.4% of patients with dense breast were shown to have suspicious (BIRADS 5) lesions. 21.7% had simple cysts. Fibro adenomas and abscess were seen in 18% and in 15% of patients, respectively. Other findings were duct ectasia (4.3%) and galactocele (3.4%). 1.4% of patients were normal on HR-USG. Conclusion: Our study showed HR-USG as a modality of choice that supersedes the diagnostic efficiency of mammography in patients with dense breasts thus enhances early detection and better treatment of breast cancer, decreasing mortality owning to delay in diagnosis.

REGIONAL SCLERAL THICKNESS AS A RISK FACTOR FOR CENTRAL SEROUS CHORIORETINOPATHY.

To evaluate regional sclera thicknesses as possible risk factors for central serous chorioretinopathy (CSC). Patients with CSC and controls were evaluated with contact B-scan ultrasonography using a 20 Mhz concentric phased array ultrasound unit and enhanced depth imaging optical coherence tomography to measure the scleral thickness at the equator and posterior pole. The resultant data were evaluated using univariate analysis and generalized estimating equations. There were 40 patients with CSC with a mean age of 58 years and 23 controls with a mean age of 60.7 years (P = 0.31). The mean subfoveal scleral thicknesses were 1.3 mm in the CSC group and 0.86 mm in the control group (P < 0.001). The mean equatorial scleral thickness was 0.61 mm in the CSC group and 0.42 mm in the control group (P < 0.001). Using generalized estimating equations, the equatorial scleral thickness (P = 0.001), posterior scleral thickness (P < 0.001), and subfoveal choroidal thickness (P = 0.032) were independent predictors of CSC. Once these variables were entered into the equation, neither sex nor age were significant predictors. Generalized estimating equation analysis showed that equatorial, but not posterior, scleral thickness was a significant predictor of subfoveal choroidal thickness. Scleral thicknesses of the posterior and equatorial portions of the eye were found to be significant predictors of CSC, consistent with what was proposed in the theory of venous overload choroidopathy. Direct measurement by high resolution ultrasonography provides independent information about specific regions of the sclera and also avoids making speculative assumptions derived from anterior segment measurements.

A digital myxoid pseudocyst with novel dermoscopic signs

Sir, A 61-year-old female presented to us with a slowly progressive, asymptomatic, localized swelling in the proximal nail fold (PNF) of the left ring finger present for nine months. An examination revealed a discrete, well marginated, skin-colored, firm, non-tender nodule, 8 × 8 mm in size, between the distal interphalangeal (DIP) joint and the PNF of the left ring finger. Besides this, the concomitant nail plate also had longitudinal guttering originating from underneath the PNF and extending until the free edge of the nail plate, corresponding to the possibility of pressure effects of the lesion on the nail matrix (Fig. 1a). Polarized light dermoscopy revealed thick, white, linear structures intermingled with dotted vessels and short, linear, curved, comma-shaped vessels in the center of the lesion (Fig. 2a). High-resolution ultrasonography with power Doppler of the lesion revealed a hypoechoic area without any vascular component (Fig. 2b) and normal appearing interphalangeal joints. Under aseptic precautions, triamcinolone acetonide (TA) at 10 mg/mL was injected intralesionally from its lateral margin until the blanching of the lesion. A transparent, jelly-like material extruded through the entrance of the needle, thus confirming the clinical diagnosis of a digital myxoid pseudocyst (DMP) (Fig. 1b). No recurrence was observed within six months of follow-up (Fig. 1c). A DMP, also called a digital synovial cyst or ganglion cyst, is a benign tumor of the digit. It is not a true cyst as it lacks a cyst wall lined with epithelial cells. It is filled with mucoid materials overproduced by fibroblasts [1]. They arise due to repetitive trauma causing either focal mucinous degeneration of the connective tissue or the leakage of synovial fluid from the DIP joint. Two types of digital mucous cysts are distinguished: the myxomatous, or superficial, type and the ganglion, or deep, type. A DMP may sometimes compress the nail matrix, creating longitudinal depressions in the nail plate, as seen in this case. Nail changes may precede cyst formation by up to six months. Occasionally, the cyst may exert pressure on the nail matrix giving rise to a bluish-red lunula [2]. Salerni et al. described the dermoscopic features of a DMP as bright white areas with a linear, branched, serpentine vascular pattern [3]. Dermoscopy of our case, however, revealed white, linear structures intermingled with dotted vessels and short, linear, curved, comma-shaped vessels. These non-identical dermoscopic patterns could be attributed to the different depth of the DMP in our case to these observed by Salerni et al. The pseudocyst in our case also demonstrated compression effects on the proximal nail matrix indicated by longitudinal guttering in the nail plate, while no such finding was present in the former. In addition, arboriform and polymorphic vascular patterns have also been described. Repetitive puncturing, aspiration, sclerotherapy, and intralesional steroids have been attempted; however, recurrences may develop [4]. Although surgical excision of a DMP with synovectomy shows a lower recurrence rate, it may cause complications such as nail deformities, post-operative pain, and limited post-operative functional use. To conclude, the dermoscopic features of the DMP in the current case may hold an addition to the existing dermoscopic signs, hence aid in the diagnosis of the DMP.

Cardiovascular comorbidities in patients with a severe form of psoriasis: A case-controlled study assessing clinical, biochemical, and radiological parameters

Background: Psoriasis is a common, chronic, inflammatory, and proliferative disorder of the skin, and is associated with elevated lipid levels and exaggerated inflammatory status, which may lead to cardiovascular morbidities and mortalities. Aims: The aim was to estimate the cardiovascular risk profile among psoriatic patients when compared to controls. Settings and Design: This was a case-controlled study performed at a tertiary-care hospital. Methods and Material: One hundred patients with severe psoriasis were evaluated for clinical, biochemical, electrocardiographic, and radiological signs of cardiovascular comorbidities and were compared with one hundred age- and sex-matched controls. Statistical Analysis: IBM Corp. Released 2015. IBM SPSS Statistics for Windows, version 23.0. Armonk, NY: IBM Corp. Results: Males predominated (1.27:1), with the most common age group being 31 to 40 years old. Smoking and alcohol consumption were common among the psoriatic patients (odds ratio = 4.14 and 2.38, respectively). The mean PASI score among the cases was 26.19 ± 10.8, with an extreme effect on their quality of life. The psoriatic patients presented with independent cardiovascular risk factors, including systolic hypertension (148.67 ± 10.91 mm of Hg), elevated fasting blood sugars (129.46 ± 35.64 mg/dL), hypercholesterolemia (152.34 ± 44.56 mg/dL), and hypertriglyceridemia (186.29 ± 29.45 mg/dL), with metabolic syndrome among 41% of the cases. On the electrocardiogram, the P wave was elevated (22%) and the QTc interval was prolonged (20%) among the cases. On high-resolution ultrasonography, the intima–media of the carotid arteries were thickened (0.944 ± 0.132 mm), indicating subclinical atherosclerosis in the psoriatic patients. Conclusions: Early detection and periodic screening for cardiovascular risk factors among psoriatic patients and aggressive therapeutic management are recommended to reduce the disease burden and improve their quality of life.

Sketch guided and progressive growing GAN for realistic and editable ultrasound image synthesis.

Ultrasound (US) imaging is widely used for anatomical structure inspection in clinical diagnosis. The training of new sonographers and deep learning based algorithms for US image analysis usually requires a large amount of data. However, obtaining and labeling large-scale US imaging data are not easy tasks, especially for diseases with low incidence. Realistic US image synthesis can alleviate this problem to a great extent. In this paper, we propose a generative adversarial network (GAN) based image synthesis framework. Our main contributions include: (1) we present the first work that can synthesize realistic B-mode US images with high-resolution and customized texture editing features; (2) to enhance structural details of generated images, we propose to introduce auxiliary sketch guidance into a conditional GAN. We superpose the edge sketch onto the object mask and use the composite mask as the network input; (3) to generate high-resolution US images, we adopt a progressive training strategy to gradually generate high-resolution images from low-resolution images. In addition, a feature loss is proposed to minimize the difference of high-level features between the generated and real images, which further improves the quality of generated images; (4) the proposed US image synthesis method is quite universal and can also be generalized to the US images of other anatomical structures besides the three ones tested in our study (lung, hip joint, and ovary); (5) extensive experiments on three large US image datasets are conducted to validate our method. Ablation studies, customized texture editing, user studies, and segmentation tests demonstrate promising results of our method in synthesizing realistic US images.

Cymbopogon citratus (DC.) Stapf essential oil: Unraveling potential benefits on human skin

The essential oil of Cymbopogon citratus (DC.) Stapf is widely used for the production of fragrances, cosmetics, and detergents. However, there is no information on the effects of formulations containing C. citratus essential oil (EOCC) on human skin. This study aimed to evaluate the effects of formulation containing EOCC on human skin physiology. The study involved participants of both sexes (n=12). Two areas (3 cm x 3 cm) were drawn on both forearms. One randomly chosen area was treated for 14 days, 2 times/day with polyacrylic acid gel containing 5% EOCC and the other was used as a control for the same time period. Transepidermal water loss (TEWL), hydration, epidermal lipids, and biomechanics were measured (D0 and D14). High resolution Sonography images were also obtained. Results revealed a significant decrease in TEWL, a significant increase in hydration, firmness and elasticity, and a decrease in lipids, in the areas treated with EOCC. Sonography showed an increase in echogenicity of the epidermis after applying the formulation indicating that the essential oil penetrates only the most superficial layers of the skin. Results also suggest that formulations containing EOCC are safe for topical application and can improve and protect human skin. Keywords: Cymbopogon citratus; essential oil; citral; lemongrass

Evaluation of extracranial carotid flow velocities in patients presenting with acute ischemic stroke: A clinical study conducted in Turkey

Objective. The mechanism underlying the relationship between carotid flow velocities and stroke events remains unclear. This study aimed to reveal the relationship of flow velocity measurements with risk factors in patients with acute ischemic stroke. Material and methods. A group of patients between the ages of 41-90 who applied to Mengücek Training and Research Hospital in the Eastern Anatolia Region of Turkey between 2014-2015 due to acute ischemic stroke were included. Groups with large artery atherosclerosis and small-vessel occlusion according to the Toast classification were included in the study. Brain tomography and magnetic resonance imaging, echocardiography, high-resolution color Doppler Ultrasonography examinations were performed. Internal carotid artery peak-systolic and end-diastolic flow velocity, common carotid artery peak-systolic and end-diastolic flow velocity, internal carotid artery peak systolic-common carotid artery peak-systolic velocity ratio and common carotid artery intima-media thickness were measured with Doppler Ultrasonography. The relationship between carotid flow velocities and brain infarction volume, comorbid factors, biochemical variables, left ventricular systolic-diastolic dysfunction was defined by using Statistical Package for Social Sciences version 21.0. Outcomes. In acute ischemic stroke groups, a significant negative correlation between common carotid artery end-diastolic flow velocity and brain infarction volume, a significant positive relationship between common carotid artery peak-systolic velocity and smoking, a significant positive correlation between common carotid artery intima-media thickness and blood glucose and hba1c, a significant negative correlation between common carotid artery end-diastolic flow velocity and hypertension, a significant relationship between common carotid artery end-diastolic flow velocity and ischemic heart disease, an increase in cerebral infarction in patients with left ventricular systolic dysfunction and a decrease in Internal carotid artery peak-systolic flow velocity in patients with left ventricular diastolic dysfunction were detected. Conclusions. In clinical practice, Doppler ultrasound is currently the main diagnostic tool for evaluating the diagnosis of carotid stenosis. In stenosis in the carotid artery system, it should be known as a basic rule that the flow velocity in the stenosis area increases, except for in severe stenosis and four basic measurements should be made to determine the degree of stenosis clearly. These measurements are peak systolic flow velocity (PSV), end-diastolic flow velocity (EDV), peak-systolic flow velocity ratio (ICA/CCA PSV). The purpose of sonographic evaluation of the extracranial cerebral arteries is to prevent bad sequelae and permanent deficits together with cerebral infarction.

Cross-sectional area reference values for high-resolution ultrasonography of the lower extremity nerves in healthy Korean adults.

The cross-sectional area (CSA) reference values of the lower extremity nerves in Asians have been rarely reported. For this study, 107 sex- and age-matched, healthy subjects with a mean age of 46 years (range, 24–75 years) were recruited. All subjects underwent standardized nerve conduction studies of the upper and lower extremities. The CSA was measured unilaterally at 12 sites in the lower extremity nerves, including the femoral, lateral femoral cutaneous, sciatic, common peroneal, superficial peroneal, deep peroneal, tibial, and sural nerves. The CSA significantly correlated with height, weight, and body mass index. The CSA was significantly larger in males than females at most nerves except for the lateral femoral cutaneous, common peroneal (fibular head), and superficial peroneal nerves (distal calf). There was no statistically significant difference between the age groups except for the tibial nerve (ankle). The results of this study provide CSA reference values for the lower extremity nerves including small branches and the values can be useful in the ultrasonographic investigation of various peripheral neuropathies in East Asian populations.

Cardiorespiratory Fitness and Carotid Intima-Media Thickness in Physically Active Young Adults: CHIEF Atherosclerosis Study.

Background: The relationship of cardiorespiratory fitness (CRF) with subclinical atherosclerosis affected by the body adiposity has been observed in children, whereas this relationship remains unclear in young adults. Methods and Results: A total of 1520 military recruits, aged 18–40 years, were included in Taiwan in 2018–2020. All subjects underwent detailed physical and blood laboratory examinations. CRF was evaluated by time for a 3000 m run, and subclinical atherosclerosis was evaluated by intima–media thickness of the bulb of the left common carotid artery (cIMT) utilizing high-resolution ultrasonography. Multivariable linear regression analysis with adjustments for age, sex, cigarette smoking, alcohol intake, systolic and diastolic blood pressure, high- and low-density lipoprotein cholesterols, fasting glucose, waist circumference, serum uric acid and serum triglycerides were utilized to determine the correlation between CRF and cIMT. CRF was independently correlated with cIMT (standardized β: 0.11, p < 0.001). Of the cardiometabolic risk markers, serum triglycerides were the only independent risk marker of cIMT (standardized β: 0.063, p = 0.03). In addition, the association of CRF with cIMT did not differ between those with a body mass index (BMI) ≥ 25 kg/m2 and those with BMI < 25 kg/m2 (standardized β: 0.103 and 0.117; p = 0.01 and 0.005, respectively). Conclusions: In physically active young men and women, there was an inverse association of cIMT with CRF, which was observed in both overweight/mild obesity and normal-weight individuals, highlighting the importance of endurance capacity on reducing risk of early atherosclerosis and implying that the moderation effect of body adiposity might not be present in this population.

High-Resolution Ultrasound of the Forefoot and Common Pathologies.

Forefoot pain is common in clinical practice. Careful history taking and routine physical examination are initially performed for diagnosis, but imaging can confirm the clinical suspicion and play a key role in management. Ultrasound (US) can provide a visualization of the fine anatomy of the forefoot and is a useful method for evaluating various lesions causing forefoot pain. In this review, we provide the detailed anatomical structures of the forefoot and their normal appearances on US. We also focus on the most common pathologies affecting the forefoot, including plantar plate tear, sesamoiditis, bone fracture, synovitis, tenosynovitis, bursitis, Morton’s neuromas, and foreign bodies.

High-Resolution Ultrasound of Facial Muscles: Sonoanatomy, Scanning Technique, and Pathological Cases.

The aim of the present work is to review the sonographic appearance of facial muscles with high-frequency transducers and to illustrate a step-by-step scanning technique that enables an effective evaluation of them. In addition, we highlighted the clinical application showing some pathological cases demonstrated with ultrasound (US). The recent technological advances have greatly enlarged the potential of high-resolution US in the evaluation of the face. Furthermore, the clinical indications of this technique are expected to increase in the near future.

Imaging in Pediatric Obstructive Jaundice

Cholestatic jaundice characterized by elevated conjugated bilirubin can be due to multitude of factors in neonates and childhood. Extrahepatic biliary atresia (EHBA), choledochal cyst, neonatal hepatitis, cytomegalovirus (CMV), and biliary plug are some of the common causes in neonate and early infancy. Causes in late infancy and childhood comprises viral hepatitis, choledochal cyst, cholelithiasis, worm infestation, and biliary compression secondary to extrinsic causes (node, collection, tumor). Some serious disorders like biliary atresia must be considered with the emphasis on early diagnosis of treatable causes. In the modern era, with multiple diagnostic modalities available including high-resolution ultrasonography, magnetic resonance imaging (MRI), CT scan, and nuclear imaging [hepatobiliary iminodiacetic acid (HIDA) scan], rapid diagnosis can be made in many surgically treatable cases. The authors will discuss the imaging modality available with advantages, disadvantages, and common indications of each modality, and overview of obstructive jaundice discussing the wide spectrum of causes in neonates and late childhood. Combining available knowledge with careful and meticulous search can help narrow down the diagnosis and initiate prompt treatment.

Nerve high-resolution ultrasound in a 2-year follow-up of radial nerve palsy related to humeral shaft fractures.

High-resolution nerve ultrasonography (HRUS) could have an emerging importance in diagnosis and follow-up of axonopathic radial palsy associated with humeral shaft fractures due to closed trauma. The aim of our study was to establish the role of HURS in this context through a longitudinal multimodal analysis. Clinical, electrodiagnostic (EDX) and HRUS evaluations were prospectively performed at month 1, 3, 6, 12 and 24 from injury, in a continuous series of 19 patients collected in a 5-year study. Clinical severity was scored on MRC of involved muscles, EDX on presence/absence of functional continuity; anatomical continuity and nerve cross sectional area (NCSA) of radial (RN) and posterior interosseus (PIN) nerves were evaluated through HRUS. All patients showed clinical improvement during follow-up; EDX functional continuity was reached by all patients within 12 months; HRUS revealed RN anatomical continuity in all patients and PIN involvement in 74%. RN NCSA progressively reduced during FU, but it was still significantly higher than contralateral at month 24; PIN NCSA became normal within 24 months. When anatomical RN continuity is confirmed by HRUS, good functional outcome is reached even in patients with EDX loss of functional continuity. Together with clinical and EDX evaluations, HRUS may provide useful data in the follow-up of radial palsy due to humeral shaft fractures.

1099-P: Truncal Fat–to–Leg Fat Ratio and Carotid Plaque Score in Patients with Type 2 Diabetes

High truncal fat is known to be a risk factor for cardiovascular disease (CVD) , but high leg fat has a protective effect on CVD. We investigated the association between truncal fat-to-leg fat ratio (TLR) and carotid plaque score PS) in patients with type 2 diabetes (T2D) . A total of 1966 participants aged over 30 years and having T2D were recruited. Truncal fat, leg fat, and appendicular muscle mass (ASM) were measured using dual-energy X-ray absorptiometry and Carotid intima-media thickness (CIMT) and PS were assessed using high-resolution B-mode ultrasonography. High PS was defined as PS ≥ 3. The prevalence of plaque and high PS were 72.0% and 40.0%, respectively. Patients with high PS were more likely to be old, male, and hypertensive and had higher systplic blood pressure (SBP) , diabetic duration (DD) , serum creatinine (Cr) , and TLR, but lower values of diastolic BP, truncal and leg fat, HDL, and estimated glomerular filtration rate (eGFR) than those without high PS. Participants in the highest TLR tertile group were older and more hypertensive and had higher DD, SBP, waist circumference (WC) , body mass index (BMI) , HOMA-IR, glycated A1c (HbA1c) , triglycerides (TG) , serum Cr, CIMT, and PS, but lower ASM/BMI, HDL, and eGFR than those in the lowest TLR tertile group. The prevalence of high PS progressively increased with increasing TLR tertiles (Lowest vs. Middle vs. Highest = 33.4 vs. 41.0 vs. 45.7%, respectively, p &amp;lt; 0.001) . After adjusting age and sex, the odd ratios (ORs) and 95% confidence intervals (CIs) for high PS were 1.39 (1.- 1.79, p = 0.01) in the middle and 1.65 (1.28 - 2.11, p = &amp;lt; 0.001) in the highest tertile groups. After further adjusting for hypertesnsion, WC, BMI, SBP, DD, HbA1c, HOMA-IR, HDL cholesterol, TG, and eGFR, the ORs and 95% CIs in the middle and highest tertile groups remained significant. In conclusion, higher TLR was independently associated with carotid PS in patients with T2D. Therefore, we suggest that high TLR may be a risk factor for early atherosclerosis in patients with T2D. Disclosure J.Shin: n/a.

VASCULAR AGING IN THE YOUNG: CAROTID STIFFNESS POPULATION CENTILES AND ASSOCIATION WITH BLOOD PRESSURE IN THE KIGGS COHORT

Objective: Functional characteristics of the vascular system underly changes associated with aging, such as increasing arterial stiffness. Research suggests that these age-associated changes may be accelerated in the presence of cardiovascular risk factors. So far, normative data on arterial stiffness in unselected adolescents and young adults have been scarce. Recently, measurements of carotid stiffness (cS) parameters have been included in a national health examination survey. Design and method: The population-based KiGGS cohort 11-year-follow-up included high-resolution B-mode sonography with semi-automated edge-detection and automatic electrocardiogram-gated real-time quality control. In 4,305 participants aged 14–28 years, distensibility coefficient (DC), stiffness index ß, Young's (YEM) and Peterson's elastic modulus (Ep) were assessed. Centiles were modelled by sex, age and height simultaneously, using generalized additive models for location, scale and shape. Log- binomial regression models were used to investigate associations of blood pressure with cS &gt; = 90th centile (P90) as outcomes. Hypertensive blood pressure was defined according to German guidelines (&gt; = P95 systolic or diastolic for age, height and sex according to KiGGS centiles until age 17 and &gt; = 140/90 mmHg from age 18). Results: Multivariable models show that hypertensive blood pressure in childhood is associated with an increased risk of elevated cS (&gt; = P90 for age, height and sex) eleven years later for all parameters of cS, with the exception of stiffness index ß (no association). Effect estimates for DC, YEM and Ep range from 1.77 [CI 1.28–2.44] for DC to 1.41 [CI 0.99–2.01] for YEM. Cross-sectional associations of blood pressure with cS parameters show even stronger associations (relative risks between 1.3 and 3.3). Conclusions: Using state-of-the-art sonography and centiles computed with novel statistical methods, this study confirms that, at the population level, hypertensive blood pressure in childhood is linked to increased carotid stiffness in young adulthood. The results emphasize that healthy lifestyles and healthy living environments in childhood and adolescence represent an early investment in cardiovascular health.

Nerve Echogenicity in Polyneuropathies of Various Etiologies-Results of a Retrospective Semi-Automatic Analysis of High-Resolution Ultrasound Images.

Echogenicity of peripheral nerves in high-resolution ultrasound (HRUS) provides insight into the structural damage of peripheral nerves in various polyneuropathies. The aim of this study was to compare nerve echogenicity in different primarily axonal or demyelinating polyneuropathies to examine the significance of this parameter. Performing semi-automated echogenicity analysis and applying Image J, we retrospectively used HRUS images of 19 patients with critical illness polyneuropathy (CIP), and 27 patients with chemotherapy-induced polyneuropathy (CIN) and compared them to 20 patients with chronic inflammatory demyelinating polyneuropathy (CIDP). The fraction of black representing echogenicity was measured after converting the images into black and white. The nerves of patients with progressive CIDP significantly differed from the hyperechogenic nerves of patients with other polyneuropathies at the following sites: the median nerve at the forearm (p < 0.001), the median nerve at the upper arm (p < 0.004), and the ulnar nerve at the upper arm (p < 0.001). The other polyneuropathies showed no notable differences. Altogether, the comparison of echogenicity between different polyneuropathies supports the assumption that there are differences depending on the genesis of the structural nerve damage. However, these differences are slight, and cannot be used to show clear differences between each polyneuropathy form.

The diagnostic role of high-frequency ultrasound in diabetic neuropathy

Diabetic peripheral neuropathy (DPN) is a frequent complication of DM. Advanced DPN can lead to major problems such as diabetic foot ulcers. Early identification of DPN cases will benefit early therapy and motivate patients to participate in their care actively. Early diagnosis is critical to improving prognosis and quality of life for people with DPN. This is due to the absence of symptoms in 50% of patients and the limited sensitivity of neuro-electrophysiology to small fibers. Many studies have shown that high-resolution ultrasound (HRU) is a good noninvasive method for diagnosing DPN. With modern technologies, HRU may be used to screen, diagnose, and monitor DPN, acting as a biomarker and giving novel diagnostic insights The electrodiagnostic alteration in DPN is preceded by morphological abnormalities on ultrasonography. High-resolution ultrasonography of peripheral nerves has the potential to become the first-line study for the diagnosis of DPN. This review work studies the diagnostic Role of High-Frequency Ultrasound in Diabetic Neuropathy

Subcortical Lacerations, a Significant Sign of Shaken Baby Syndrome - Diagnosis with High-Resolution Duplex Sonography.

Subcortical Lacerations, a Significant Sign of Shaken Baby Syndrome - Diagnosis with High-Resolution Duplex Sonography.