High-frequency Ultrasound Research Articles

High-frequency ultrasonography for subungual glomus tumor evaluation - imaging findings.

This article aimed to describe the common imaging features of subungual glomus tumors. The study involved data collected between January 2019 and December 2022. Twenty-three patients with a total of 31 glomus tumors underwent high-frequency ultrasound examinations with a 24-MHz probe. Two experienced radiologists independently evaluated the images, and only data from the more experienced radiologist were used for subsequent analyses. The average size of the tumors was 4.6 mm, and most of them appeared homogeneously hypoechogenic (90.3%). Bone remodeling of the distal phalanx was observed in 87.1% of cases, with an average axial circumference loss of 0.8 mm, indicating the slow and expansive growth of glomus tumors. Intense vascularization was found in 54.8% of cases on Doppler images, and the stalk sign, reflecting the vascular origin of the tumor, was present in 64.5% of cases. The most common clinical feature was pain, reported in 84.6% of cases, with a mean pain scale score of 7.0, indicating a negative impact on patients' lives despite being benign tumors. The study concludes that ultrasound evaluation is highly useful for diagnosing glomus tumors, especially when multiple findings, such as bone remodeling, hypervascularization, and the stalk sign, are present. This method allows for accurate diagnosis, observation of periungual structures, and proper surgical planning, ultimately reducing recurrence rates.

The application value of high-frequency ultrasound in the feasibility assessment of endoscopic retrograde appendicitis therapy in children with appendicitis

Acute appendicitis is one of the common acute abdominal diseases in pediatrics. However, the implementation of radiological examination guided endoscopic retrograde appendicitis therapy (ERAT) in adults is limited in children. Our previous research explored the non-invasive guidance of high-frequency ultrasound (HFUS) for ERAT and achieved good therapeutic effects. This study mainly focuses on exploring the application value of HFUS in the feasibility assessment of ERAT in children with appendicitis. 163 children with appendicitis received ERAT guided by HFUS were analyzed retrospectively. According to the parameters evaluated by HFUS before and during ERAT, the results indicated that the distance between the appendix orifice and the ileocecal valve significantly affected the time required for the guidewire to enter the appendix cavity (P < 0.05). The diameter and the texture of the fecalith, the thickness of the intestinal wall of the appendiceal orifice all had significant effects on the successful removal of the fecalith (P < 0.05). The success rate, treatment time and final flushing effect of the guidewire to reach the blind end of the appendix were significantly affected by the tortuosity of the appendix and whether there was adhesion with surrounding tissues (P < 0.05). HFUS can accurately assess the feasibility of ERAT in children with appendicitis.

Visualization of Human Hand Tendon Mechanical Anisotropy in 3D Using High-Frequency Dual-Direction Shear Wave Imaging.

High-resolution ultrasound shear wave elastography has been used to determine the mechanical properties of hand tendons. However, because of fiber orientation, tendons have anisotropic properties; this results in differences of shear wave velocity (SWV) between ultrasound scanning cross sections. Rotating transducers can be used to achieve full-angle scanning. However, this technique is inconvenient to implement in clinical settings. Therefore, in this study, high-frequency ultrasound (HFUS) dual-direction shear wave imaging (DDSWI) based on two external vibrators was used to create both transverse and longitudinal shear waves in the human flexor carpi radialis tendon. SWV maps from two directions were obtained using 40-MHz ultrafast imaging at the same scanning cross section. The anisotropic map was calculated pixel by pixel, and 3D information was obtained using mechanical scanning. A standard phantom experiment was then conducted to verify the performance of the proposed HFUS DDSWI technique. Human studies were also conducted where volunteers assumed three hand postures: relaxed (Rel), full fist (FF), and tabletop (TT). The experimental results indicated that both the transverse and the longitudinal SWVs increased due to tendon flexion. The transverse SWV surpassed the longitudinal SWV in all cases. The average anisotropic ratios for the Rel, FF, and TT hand postures were 1.78, 2.01, and 2.21, respectively. Both the transverse and the longitudinal SWVs were higher at the central region of the tendon than at the surrounding region. In conclusion, the proposed HFUS DDSWI technique is a high-resolution imaging technique capable of characterizing the anisotropic properties of tendons in clinical applications.

Diagnostic value of high-frequency ultrasonography for painful talocalcaneal coalition and its complications.

To investigate the value of high-frequency ultrasonography in the diagnosis of painful talocalcaneal coalition (TCC) and its complications. Seventy-seven patients (84 feet) with abnormal mass and pain in the medial malleolus were suspected of TCC pre-operatively and examined by high-frequency ultrasonography, radiograph, and CT. The sonographic characteristics of the affected feet were analyzed pre-operatively and compared with the surgical findings. During the operation, 49 feet with TCC and 35 feet with non-TCC were confirmed; pre-operative ultrasonography diagnosed 48 feet with TCC and 36 feet with non-TCC; taking surgery as the gold-standard, the sensitivity, specificity, accuracy, positive-predictive value and negative-predictive value of ultrasound diagnosis of TCC were 87.8%, 85.7%, 86.9%, 89.6%, and 83.3%, respectively. The two were consistent, with κ = 0.732, p < 0.001. High-frequency ultrasonography had high diagnostic efficacy for TCC, with an area under the receiver operating characteristic curve of 0.867. The accuracy of ultrasound and CT in the diagnosis of TCC was significantly higher than that of radiograph, and the difference was statistically significant (p < 0.0167). High-frequency ultrasound could also accurately diagnose complications of TCC, such as tibial nerve compression and tendon displacement, while CT and radiograph cannot show these complications. High-frequency ultrasonography can accurately diagnose TCC and its complications, and locate the body surface accurately. Therefore, high-frequency ultrasonography can be used as a routine examination method to supplement CT and provide clinical assistance in precise surgery. This study is the first to use high-frequency ultrasonography to examine TCC and compare its findings with surgical results to explore the diagnostic value of ultrasonography for TCC and its complications.

Superficial Bifurcated Microflow Phantom for High-Frequency Ultrasound Applications

To evaluate and optimize high-frequency ultrasound (HFUS) imaging techniques that visualize the morphology of microscale vasculatures, many studies have used flow phantoms with straight channels. However, the previous phantoms lack the complexity of microvessels to simulate a realistic vascular environment in a shallow depth. This study was aimed at devising a new protocol for fabrication of a microflow phantom with bifurcated geometry at a superficial region. The proposed protocol involved the following features: (i) a bifurcated flow tract model 300 µm in diameter was debossed on the surface of a tissue slab made of polyvinyl alcohol cryogel, and (ii) a wall-less lumen was created via bonding tissue slabs to put a lid on the debossed flow tract. The structure of the created microflow phantom was evaluated using 2-D and 3-D power Doppler imaging with a 30 MHz HFUS modality. Ultrasound imaging revealed that the desired flow tract with bifurcation was successfully created in the phantom at a depth of 2-5 mm from the ultrasound probe. The diameters of the flow tract measured in the axial direction were 307 ± 3.7 µm in the parent branch and 232 ± 18.2 and 256 ± 23.3 µm in the two daughter branches, respectively. The experiments revealed that the proposed protocol for creating a microscale intricate flow tract with desired dimensions and depth is valid. This new phantom will facilitate further improvement in the ultrasound technologies for the precise visualization of superficial complex vasculatures such as those in skin layers.

Basal Cell Carcinoma Mimicking Dermatofibrosarcoma Protuberans: Case Report

Introduction: Basal cell carcinoma (BCC) is the most common type of carcinoma worldwide. BCC development is the result of a complex interaction between environmental, phenotypic and genetic factors. Presentation is highly heterogeneous, presenting from superficial or nodular lesions with a good prognosis to very extensive lesions in atypical locations clinically and radiologically mimicking other tumors. Case presentation: We present the case of a 34-year-old man with no past medical history, with an asymptomatic nodule that was increasing in size on the right thigh. High-frequency ultrasonography (HFUS) evaluation revealed an oval-shaped lesion with mixed echogenicity and posterior enhancement, with Doppler showing increased vascularization. A biopsy of the lesion was performed with suspicion of dermatofibrosarcoma protuberans, reporting unexpectedly an infiltrative basal cell carcinoma. The tumor was excised with free margins in the final pathology report. Conclusions: HFUS is an increasingly utilized tool that can accompany the study of a malignant lesion. Further studies are required to define more specific criteria for different skin tumors, always in conjunction with histology.

Assessment of the Diagnostic Performance of Clinical Examinations and High-Frequency Ultrasound in Patients With Pigmented Skin Tumors.

To investigate whether the integration of high-frequency ultrasound (HFUS) to routine clinical examinations could improve diagnostic performance and management decision for pigmented skin tumors. Three general practitioners trained previously and a dermatologist independently assessed pigmented skin tumors and rendered management decision based on clinical examinations alone or clinical examinations integrating HFUS. After integrating HFUS, the diagnostic area under the curve (AUC) (0.658-0.693 versus 0.848, all P < .05) and specificity (46.6-58.6% versus 89.7%, all P < .05) for pigmented skin malignancies were improved for general practitioners, meanwhile unnecessary biopsy rate reduced (42.9-53.6% versus 10.7%, P < .001). To the dermatologist, the diagnostic AUC (0.822 versus 0.949, P < .001), sensitivity (81.7% versus 96.7%, P = .012) and specificity (0.828 versus 0.931, P = .031) improved significantly, meanwhile both missed biopsy rate (14.5% versus 4.8%, P = .031) and unnecessary biopsy rate (19.6% versus 7.1%, P = .016) decreased. Additionally, the diagnostic performance of the general practitioner with integrating HFUS could be comparable with the dermatologist based on clinical examinations alone (all P > .05). As a complementary tool of clinical examinations, HFUS could help physicians differentiate pigmented skin malignancies and manage decision.

The growing importance of high-efficiency ultrasound in diagnosis and management of dermatological diseases

Introduction: High-frequency ultrasonography (HF-USG) uses frequency above 20 MHz, which allows to visualize skin layers and measure their thickness. As it is simple, non-invasive and reliable technique, it has become a relevant tool in the field of dermatology along with other methods like for example dermoscopy. It can be used not only for the evaluation, diagnosis and management of various skin diseases, but also for analysis of the healthy skin structure&#x0D; Aim of the study: The aim of this review is to present information on the use of high-efficiency USG and its application in dermatology.&#x0D; Materials and methods: The literature available in the PubMed and Google Scholar data bases was reviewed, using the following keywords: "dermatologic ultrasound", "skin ultrasound, "HFUS dermatology".&#x0D; Conclusions: HFUS has given many opportunities in dermatology. Although ultrasound is not a new thing and it has been used in the field of dermatology for more than four decades, its significance has evolved with improvements in technology. We already have some pathognomonic sonographic features for skin lesions, but this amount will definitely increase due to the growing popularity of HFUS devices in clinical practice.

The utility of high-frequency 18 MHz ultrasonography for preoperative evaluation of acral melanoma thickness in Chinese patients.

Despite the increasing use of preoperative ultrasound evaluation for melanoma, there is limited research on the use of this technique for Acral Melanoma (AM). This retrospective study analyzed the electronic medical records of patients who underwent preoperative evaluation for cutaneous melanoma maximum thickness using an 18 MHz probe and histopathological examination between December 2017 and March 2021 at the Department of Dermatology in Xiangya Hospital, Central South University. A total of 105 patients were included in the study. The mean tumor thickness was 3.9mm (s.d., 2.3), with 63% of the specimens showing ulceration and 44 patients showing lymph node metastasis. The results showed a good correlation between the high-frequency ultrasonography (HFUS) and histopathological thickness measurements, with a Spearman's correlation coefficient of 0.83 [(95% CI 0.73-0.90) (P < 0.001)]. The positive predictive value (PPV) of sonography in identifying tumor thickness was also found to be high. Our study suggests that high-frequency 18 MHz ultrasonography is an effective tool for the preoperative evaluation of AM thickness. The HFUS measurements correlated well with the histopathological thickness measurements, making it a valuable and reliable method for clinicians to assess the thickness of melanoma lesions preoperatively.

Acoustical imaging and myopia

A new blindness epidemic has emerged, and it is predicted that by 2050, half the world population will have low vision from myopia (where images are blurred because the eyeball grows too long for its optical power) and 1 Billion people will be blind from pathologies associated with high myopia for which there are no viable treatments. We will discuss how high frequency ultrasonography was used in early studies to prove across species, including humans, that this excessive eye growth was caused by visual input related to our modern environments. Furthermore, aberrant visual exposure causes signals in the retina that induce the outer skin of the eye (sclera) to remodel, becoming excessively thin and weakened. High frequency ultrasound has also been essential to demonstrate that the biomechanics of the sclera are disturbed in complex ways during the development of myopia. For people who are at risk of developing the pathologies of high myopia, new treatments that aim to strengthen the sclera are in development. Due to its depth of penetration, we will introduce how acoustical imaging combined with other imaging modalities may pave the way for guiding more precise scleral treatments for high myopia.

High-Frequency Ultrasound for Skin Laxity of the Face and Neck: A Five-Year Review

High-Frequency Ultrasound for Skin Laxity of the Face and Neck: A Five-Year Review

Diagnosis of diabetes mellitus using high frequency ultrasound and convolutional neural network

The incidence of diabetes mellitus has been increasing, prompting the search for non-invasive diagnostic methods. Although current methods exist, these have certain limitations, such as low reliability and accuracy, difficulty in individual patient adjustment, and discomfort during use. This paper presents a novel approach for diagnosing diabetes using high-frequency ultrasound (HFU) and a convolutional neural network (CNN). This method is based on the observation that glucose in red blood cells (RBCs) forms glycated hemoglobin (HbA1c) and accumulates on its surface. The study incubated RBCs with different glucose concentrations, collected acoustic reflection signals from them using a custom-designed 90-MHz transducer, and analyzed the signals using a CNN. The CNN was applied to the frequency spectra and spectrograms of the signal to identify correlations between changes in RBC properties owing to glucose concentration and signal features. The results confirmed the efficacy of the CNN-based approach with a classification accuracy of 0.98. This non-invasive diagnostic technology using HFU and CNN holds promise for in vivo diagnosis without the need for blood collection.

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

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

Diagnostic value of high-frequency ultrasound (HFUS) in evaluation of subcutaneous lesions.

It is unknown whether high-frequency ultrasound (HFUS) can evaluate invisible subcutaneous lesions. We aimed to investigate the diagnostic value of HFUS in invisible subcutaneous lesions. Patients with invisible subcutaneous lesions were prospectively recruited from two centres. Before undergoing biopsy or surgery, each lesion was independently evaluated by two clinicians. One provides a clinical diagnosis by only clinical examination and the other provides an integrated diagnosis by combining clinical examination and HFUS information. Diagnoses were classified as correct, wrong, and indeterminate. A total of 391 lesions from 355 patients were enrolled, including 225 epidermoid cysts, 77 lipomas, 25 pilomatrixomas, 21 haemangiomas, 19 dermatofibromas, 11 dermatofibrosarcoma protuberans (DFSP), 7 neurofibromas, and 6 leiomyomas. Using pathological results as the gold standard, diagnostic performance was compared. The number of correct diagnoses increased from 185 (47.3%) by clinical examination alone to 316 (80.8%) after the addition of HFUS (P<0.05). Meanwhile, the indeterminate diagnosis rate decreased from 143 (36.6%) to 10 (2.6%). Using HFUS, the accuracy improved significantly for epidermoid cysts (59.6%vs. 86.7%), lipomas (50.6%vs. 94.8%), pilomatrixomas (0%vs. 48.0%), haemangiomas (23.8%vs. 57.1%), and DFSPs (0%vs. 81.8%) (all p<0.05). However, HFUS did not significantly improve the diagnostic accuracy of dermatofibromas (15.8%vs. 21.1%, p>0.999), neurofibromas (42.9%vs. 71.4%, p=0.625), or leiomyomas (16.7%vs. 100%, p=0.063). Combining HFUS and clinical examination can generally improve the diagnostic accuracy and decrease the indeterminacy of invisible subcutaneous lesions, especially epidermoid cysts, lipomas, pilomatrixomas, haemangiomas, and DFSPs. However, for some rare lesions, HFUS cannot provide useful information.

Self-Supervised Learning With Limited Labeled Data for Prostate Cancer Detection in High-Frequency Ultrasound.

Deep learning-based analysis of high-frequency, high-resolution micro-ultrasound data shows great promise for prostate cancer (PCa) detection. Previous approaches to analysis of ultrasound data largely follow a supervised learning (SL) paradigm. Ground truth labels for ultrasound images used for training deep networks often include coarse annotations generated from the histopathological analysis of tissue samples obtained via biopsy. This creates inherent limitations on the availability and quality of labeled data, posing major challenges to the success of SL methods. However, unlabeled prostate ultrasound data are more abundant. In this work, we successfully apply self-supervised representation learning to micro-ultrasound data. Using ultrasound data from 1028 biopsy cores of 391 subjects obtained in two clinical centers, we demonstrate that feature representations learned with this method can be used to classify cancer from noncancer tissue, obtaining an AUROC score of 91% on an independent test set. To the best of our knowledge, this is the first successful end-to-end self-SL (SSL) approach for PCa detection using ultrasound data. Our method outperforms baseline SL approaches, generalizes well between different data centers, and scales well in performance as more unlabeled data are added, making it a promising approach for future research using large volumes of unlabeled data. Our code is publicly available at https://www.github.com/MahdiGilany/SSL_micro_ultrasound.

Diagnosis of thoracic outlet syndrome with the lower trunk compression of brachial plexus by high-frequency ultrasonography

BackgroundThoracic outlet syndrome (TOS) with the lower trunk compression of brachial plexus (BP) is difficult to diagnosis. This study aimed to summarize the features of thoracic outlet syndrome (TOS) with the lower trunk compression of brachial plexus observed on high-frequency ultrasonography (HFUS).MethodsThe ultrasound data of 27 patients who had TOS with the lower trunk compression of brachial plexus were collected and eventually confirmed by surgery. The imaging data were compared, and the pathogenesis of TOS was analyzed on the basis of surgical data.ResultsTOS occurred predominantly in females (70.4%). Most cases had unilateral involvement (92.6%), mainly on the right side (66.7%). The HFUS features of TOS can be summarized as follows: (1) Lower trunk compression. HFUS revealed focal thinning that reflected compression at the level of the lower trunk; furthermore, the distal part of the nerve was thickened for edema (Affected side: 0.49 ± 0.12 cm vs. Healthy side: 0.38 ± 0.06, P = 0.009), and the cross-sectional area of brachial plexus cords was markedly greater on the injured side than on the healthy side (0.95 ± 0.08 cm² vs. 0.65 ± 0.11 cm², P = 0.004). (2) Hyperechoic fibromuscular bands behind the compressed nerve (mostly the scalenus minimus muscle). (3) Abnormal bony structures: cervical ribs or elongated transverse processes of the 7th cervical vertebra (C7). Surgical results showed that the etiological factors contributing to TOS were (1) muscle hypertrophy and/or fibrosis (100%) and (2) cervical ribs/elongated C7 transverse processes (20.7%).ConclusionTOS with the lower trunk compression of brachial plexus can be diagnosed accurately and reliably by high-frequency ultrasound.

UHFUS: A Valuable Tool in Evaluating Exocrine Gland Abnormalities in Sjögren's Disease.

Sjögren's Disease (SjD) is a chronic autoimmune disorder that affects the salivary and lacrimal glands, leading to xerostomia and xerophthalmia. Ultrasonography of Major Salivary Glands (SGUS) is a well-established tool for the identification of the salivary glands' abnormalities in SjD. Recently, a growing interest has arisen in the assessment of the other exocrine glands with ultrasonography: lacrimal glands (LGUS) and labial salivary glands (LSGUS). The objective of this study is to explore the practical applications of ultra-high frequency ultrasound (UHFUS) in the assessment of lacrimal glands and labial salivary glands. Indeed, UHFUS, with its improved spatial resolution compared to conventional ultrasonography, allows for the evaluation of microscopic structures and has been successfully applied in various medical fields. In lacrimal glands, conventional high-frequency ultrasound (HFUS) can detect characteristic inflammatory changes, atrophic alterations, blood flow patterns, and neoplastic lesions associated with SjD. However, sometimes it is challenging to identify lacrimal glands characteristics, thus making UHFUS a promising tool. Regarding labial salivary glands, limited research is available with conventional HFUS, but UHFUS proves to be a good tool to evaluate glandular inhomogeneity and to guide labial salivary glands biopsy. The comprehensive understanding of organ involvement facilitated by UHFUS may significantly improve the management of SjD patients.

Ultra-High Frequency UltraSound (UHFUS) Assessment of Barrier Function in Moderate-to-Severe Atopic Dermatitis during Dupilumab Treatment.

Atopic dermatitis (AD) is a chronic multifactorial inflammatory disease characterized by intense itching and inflammatory eczematous lesions. Biological disease-modifying drugs, such as dupilumab are recommended for patients with moderate-to-severe AD, refractory to systemic immunosuppressive therapies. Disease monitoring is performed by clinical scores. Since 1970, however, the use of ultrasound and particularly high-frequency ultrasound (HFUS), has identified alterations in dermal echogenicity, called the subepidermal low-echogenic band (SLEB), that correlates with disease severity and response to treatment. We enrolled 18 patients with moderate-to-severe AD, divided into two groups: twelve patients in the dupilumab treatment (Group A) and six patients in standard treatment, from February 2019 to November 2019. We performed ultra-high frequency ultrasound (UHFUS) evaluation of lesional and non-lesional skin, focusing on SLEB average thicknesses measurement, epidermal thickness, and vascular signal in correlation with objective disease scores (EASI, IGA), patient's reported scores (Sleep Quality NRS and Itch NRS), and TEWL and corneometry at baseline (T0), after 1 month (T1) and 2 months (T2). The SLEB average thickness measurement, vascular signal, and epidermal thickness showed a statistically significant reduction in lesional skin of the biological treatment group and no significant reduction in non-lesional skin in both groups. In the lesional skin of the standard treatment group, only epidermal thickness showed a statistically significant reduction. Our study demonstrates that SLEB measurement, vascular signals, and epidermal thickness could be used as objective parameters in monitoring the AD treatment response, while the presence of SLEB in non-lesional skin could be used as a marker of subclinical inflammation and could predict development of clinical lesions, suggesting a pro-active therapy. Further follow-up and research are needed to clarify the association of SLEB decrease/disappearance with a reduction of flares/prolongment of the disease remission time.

A new method to estimate the histological stage of primary biliary cholangitis

ObjectiveTo analyze the diagnostic efficacy of the periportal hypoechoic band (PHB) in the histological stage of patients with primary biliary cholangitis (PBC).MethodsWe prospectively included 77 cases of PBC pathologically or clinically confirmed, and high-frequency ultrasound (HFUS) measurements of the PHB were performed in all included patients. Ludwig staging system of histopathology was used as the gold standard.ResultsThe width of the PHB was positively correlated with histological staging (r = 0.844, p < 0.001). By area under the receiving operating characteristic curve (AUROC), the best cutoff value for PHB for advanced stage (≥ stage 3) was 2.4 mm (AUROC: 0.934; 95%CI: 0.841–0.981) and 0.93 for sensitivity, and 0.91 for specificity, the concordance rates of PHB vs. liver biopsy was 90.3%. The correct rate for early-stage PBC was 87.9% and for the progressive stage was 93.1%. After multi-factor regression analysis, the PHB (OR = 1.331, CI = 1.105–1.603, p = 0.003) and total bilirubin (OR = 1.156, CI = 1.041–1.285, p = 0.007) were independent influencing factors for progressive PBC.ConclusionsMeasurement of the PHB to assess advanced PBC is a simple and effective method. This method may complement current methods for the histological staging assessment of patients with PBC.RegistrationClinical trial registration: ChiCTR 2000032053, 2020/04/19.Clinical relevance statementThe measurement of periportal hypoechoic band (PHB) provides a simple and easy assessment of the degree of disease progression in patients with PBC and provides an important clinical reference in predicting the histological staging of PBC from an ultrasound perspective.Key Points• The PHB is correlated with histological staging in the patient with PBC.• The area under the ROC curves of PHB for detecting advanced stage (≥ stage 3) were 0.934 and 0.93 for sensitivity, and 0.91 for specificity, the concordance rates of PHB vs. liver biopsy was 90.3%. The application of PHB can better assess the advanced PBC.• Measurement of the PHB to assess advanced PBC is a simple and effective method that can significantly reduce the need for liver biopsy.

Ultrasound characteristics of the cervical vagus nerve in patients with type 2 diabetes and diabetic peripheral neuropathy.

Diabetic peripheral neuropathy (DPN) and autonomic neuropathy are commonly coexistent in patients with type 2 diabetes mellitus (T2DM). Current assessment tools for diabetic neuropathy remain complicated and limited. We aimed to investigate the sonographic changes of the cervical vagus nerve in DPN patients with T2DM. Patients with T2DM were divided into a DPN group (DPN, n = 44) and non-DPN controls (NDPN, n = 43) based on electromyogram results. Another 43 healthy controls (CON) were included. High-frequency ultrasound (HFU) of the vagus nerve was performed in all participants. Compared with controls, the honeycomb structure of the vagus nerve in patients with T2DM decreased, p < 0.001. The DPN group had higher cross-sectional area (CSA) of the right vagus nerve than the NDPN group (1.60 ± 0.52 vs. 2.00 ± 0.57 mm2, p =0.001). Logistic regression showed that right vagus nerve CSA was a risk factor of DPN (odds ratio [OR] = 3.924, p = 0.002). Right vagus nerve CSA was positively correlated with diabetes duration (p = 0.003), and negatively correlated with the motor conduction velocity (MCV) of the ulnar, median, and common peroneal nerves (p < 0.001 for all), as well as the sensor conduction velocity (SCV) of the ulnar and median nerve (both p < 0.005). HFU shows thickening of the cervical vagus nerve in patients with DPN, which is a potential diagnostic feature of diabetic neuropathy.