Ultrasound Measurements Research Articles

Evaluation of intra- and inter-rater agreement on ultrasound measurements of dairy cow teats by operators with different experience levels.

Ultrasound is a valuable, non-invasive technique. It allows for detailed examination, precise measurement, and effective monitoring of teats in dairy cows. This study aimed to evaluate the reliability of ultrasound measurements of teats in dairy cows, specifically focusing on intra- and inter-rater agreement between operators with different levels of experience. The study included 51 healthy Holstein cows, with two operators (experienced and inexperienced) performing measurements on ultrasound images obtained before and after milking. The parameters analyzed were teat-canal length (TCL), teat-end width (TEW), teat-wall thickness (TWT), and teat-cistern width (TCW). Differences in teat measurements before and after milking, as well as between operators, were assessed using the Wilcoxon Signed Rank test and the Mann-Whitney U test, respectively. Intra- and inter-rater agreement was calculated using the intra-class correlation coefficient (ICC). Statistical significance was set at p < 0.05. A total of 402 ultrasound images were analyzed. Significant differences were found in TCL, TWT, and TCW before and after milking, while TEW remained unaffected. Statistically significant differences in TWT and TCW were observed between the two operators, while TCL and TEW did not show significant differences. Intra-rater agreement for the experienced operator was excellent, and for the inexperienced operator, it was good. Inter-rater agreement ranged from good to excellent for most parameters, except for TWT, where it was poor. The study confirms that both milking and operator experience influence teat measurements. However, with proper training, ultrasonography can be a reliable tool for assessing udder health in dairy cows, supporting its use in field conditions.

Optimization and application of renal depth measurement method in the cadmium-zinc-telluride‑based SPECT/CT renal dynamic imaging.

This study aims to evaluate the accuracy of four kidney depth measurement methods-nuclear medicine tomography, nuclear medicine lateral scanning, ultrasound, and Tonnesen's formula-based estimation-using CT measurements as the reference standard. Additionally, it investigates the feasibility of utilizing nuclear medicine tomography and lateral scanning for measuring kidney depth in 99mTc-DTPA renal dynamic imaging. Hollow kidney phantoms mimicking the shape and volume of adult kidneys were 3D printed and filled with 99mTcO4- solution. These phantoms were then subjected to lateral scanning and nuclear medicine tomography using CZT (cadmium-zinc-telluride) SPECT/CT to determine the optimal post-processing method. Forty patients who underwent renal dynamic imaging were recruited for the study. Renal depths were derived from ultrasound, lateral imaging, nuclear medicine tomography, formula-based estimation, and CT measurements. The renal depths obtained through these four methods were for correlation with CT-measured renal depths. Additionally, the absolute differences between renal depths obtained by each method and the CT standard were analyzed and compared across groups. Using kidney phantoms, nuclear medicine tomography images were processed with a Butterworth filter (cutoff frequency = 0.6), and renal outlines in lateral images was manually delineated. In the clinical validation phase, correlation coefficients indicated strong associations between renal depths measured by nuclear medicine tomography (left kidney: R = 0.885, P < 0.05; right kidney: R = 0.927, P < 0.05) and lateral scanning (left kidney: R = 0.933, P < 0.05; right kidney: R = 0.956, P < 0.05) compared to CT measurements. The difference in kidney depth between nuclear medicine tomography and CT measurements were the smallest and statistically significant (left kidney: 0.69 ± 0.51; right kidney: 0.58 ± 0.41, P < 0.05). Using ordered subset expectation maximization (OSEM) in conjunction with a Butterworth filter (fc = 0.6) as the post-processing method, nuclear medicine tomography enables more accurate renal depth measurements without increasing the radiation dose to patients.

Interobserver reliability of sonographic measurement of inferior vena cava and aorta parameters in fasting children in the perioperative period: A prospective observational study

Interobserver reliability of sonographic measurement of inferior vena cava and aorta parameters in fasting children in the perioperative period: A prospective observational study

Tissue Contraction With Helium-Based Plasma Radiofrequency Technology: A Preliminary Report of Initial Ultrasound Findings

Abstract Background Application of helium-based plasma radiofrequency (RF; Renuvion, Apyx Medical, Clearwater, Florida, USA) in the subcutaneous plane results in tissue coagulation and contraction. While traditionally, impact of thermal devices on skin laxity is assessed by measuring changes in skin surface area, this indirect measure does not permit intraoperative assessment or differentiation of effects from various treatments. Objectives To determine the amount of soft tissue contraction achieved by multiple passes of helium plasma RF energy to the subcutaneous connective tissues following power-assisted liposuction (PAL). Methods In this single-center study, 4 subjects were assessed using real-time ultrasound measurements at baseline and following both PAL and each pass with helium plasma RF. Results Based on changes in the distance from the skin (dermal basement membrane) to Scarpa’s fascia, PAL produced an average reduction of 36.7% (SD 14.6, range 24.7%-58.6%) due to the fat removal. Contraction observed with helium plasma RF was greatest for the first pass, with a mean decrease of 27.0% (SD 19.6, range 4.5%-52.1%) in distance relative to distance measured following liposuction. Subsequent passes resulted in additional incremental contraction relative to prior treatment pass: 17.0% (5.1) for pass 2, 7.7% (17.5) for pass 3, and 7.1% (5.5) for pass 4. Overall, helium plasma RF resulted in an average contraction of 44.0% (SD 17.2, range 27.1%-59.4%) in the skin-to-Scarpa-fascia measurement. Conclusions Helium plasma RF improved tissue contraction following PAL by an average of 44% and data suggest that the greatest increase in tissue contraction is obtained by the first treatment pass.

Ultrasound identification of the cementoenamel junction and clinical correlation through ex vivo analysis.

Accurately identifying periodontal landmarks via acoustic imaging is increasingly important. Here, we evaluated the accuracy of cementoenamel junction (CEJ) identification using ultrasound by comparing it to clinical methods in 153 extracted human teeth. The distance between the CEJ to a reference point was measured using two clinical methods (visual examination and tactile sensation) as well as ultrasound imaging. Statistical analyses were performed across all teeth and sub-groups, including tooth types (incisors, cuspids, and molars/premolars), and two classifications: A- vs. B- (visually detectable or undetectable CEJ, respectively); and CL-S vs. CL-D (shallow or deep cervical lesions). In A- or CL-S teeth, ultrasound measurements highly agreed with clinical measurements, showing a 1.72-mm 95% CI for A- and 1.99-mm 95% CI for CL-S compared to visual examination, and a 1.77-mm 95% CI for A- and a 2.10-mm 95% CI for CL-S compared to tactile sensation, respectively. For 80% of A- and 76% of CL-S teeth, the difference between ultrasound and visual examination was within ± 20%. For 81% of A- and 80% of CL-S teeth, the difference between ultrasound and tactile sensation was within ± 20%. The variance of ultrasound versus clinical CEJ identifications showed a significant correlation (r = 0.6607) to the cervical lesion depth. The errors between ultrasound and clinical measurements show no significant bias across different tooth types.

Nomograms of fetal thoracic dimensions from 17 to 37 weeks of gestation

Abstract Introduction: We aimed to construct the nomograms for fetal thoracic parameters among Thai fetuses that were between 17 and 37 gestational weeks, as assessed by three distinct two‐dimensional (2D) measurement techniques (thoracic diameter, circumference and area) and compare our findings with those of previous publications. Methods: A cross-sectional study involving 511 low-risk singleton pregnancies with normal fetuses at Siriraj Hospital, Bangkok, Thailand, was conducted. Using the four-chamber view, fetal thoracic measurements were obtained through three 2D sonographic measurement methods. Reference intervals at 95% and Z-scores were established for all techniques based on gestational age (GA) and biparietal diameter (BPD). Intraclass correlation coefficients (ICCs) were computed to assess reproducibility of the measurement methods. Results: Measurements of fetal thorax size exhibited consistent, proportional increases with advancing GA and BPD across all techniques. Intraobserver and interobserver reliability coefficients for all methods indicated excellent agreement, with all ICCs being at least 0.991. Nomograms of fetal thoracic diameter, circumference and area across GA and BPD were constructed from the obtained values. Discrepancies in Z-score reference ranges for fetal thoracic circumference were noted between the present study and previous research in other populations, particularly among Caucasians. Conclusion: Our study established normal reference ranges for evaluating fetal chest size through three different methods from 17 to 37 weeks of gestation in the Thai population. Nomograms may vary due to population differences, emphasising the importance of using reference values from similar demographic groups. The findings could potentially be used to identify fetuses that are at risk of abnormal thoracic dimensions or thoracic dysplasia.

Ultrasound-Defined Sarcopenia Independently Predicts Acute Decompensation in Advanced Chronic Liver Disease.

It has been shown that in patients with liver cirrhosis, sarcopenia is a predictor of acute decompensation (AD), acute-on-chronic liver failure (ACLF) and death. However, computer tomography (CT), as a suggested standard method for diagnosing sarcopenia, is resource intensive and involves radiation exposure. Therefore, in this study, we evaluate the muscle thickness of quadriceps femoris measured by ultrasound (US) as a prognostic parameter for AD and all-cause mortality in chronic liver disease. Sixty-three patients with chronic liver disease and signs of portal hypertension were analysed in this prospective monocentric study for the occurrence of acute decompensation such as hepatic encephalopathy, ascites, haemorrhage and liver-related death within 1 year. We assessed muscle thickness at three different heights in terms of suitability as a predictor. Among all 63 patients, 15 patients experienced acute decompensation, and 9 patients died due to liver-related death. We found the upper third of the muscle, measured without applying pressure with the transducer, to be the most significant for predicting AD/ACLF [AUC 0.739 (confidence interval (CI) 0.604-0.874, p = 0.006]. A cut-off value of US-defined muscle thickness standardized per height for identifying sarcopenia was determined (1.83 cm/m). Patients with US-defined sarcopenia showed significantly higher rates of AD (38.9% vs. 3.7%, p = 0.001) and all-over 1-year mortality (27.8% vs. 3.7%, p = 0.013). The mean AD free survival time is 8.3 months (95% CI 6.6-9.9) for sarcopenic patients and 11.8 months (95% CI 11.0-12.6) for the non-sarcopenic cohorts. Corresponding CT analysis displayed similar results for AD free survival for both groups (40% AD rate in the sarcopenic group vs. 7% AD rate in the non-sarcopenic group, p = 0.001). The risk for AD was significantly higher in the sarcopenic cohort compared with those without sarcopenia in both US and CT (US: HR 16.6; p = 0.009; 95% CI 2.0-136.0; CT: HR 8.7; p = 0.017; 95% CI 1.5-51.0). CT and US displayed a moderate agreement (p = 0.006; κ = 0.379). Sarcopenia classification based on US measurements is shown to be an independent predictor of AD occurrence within 1 year. This pilot study is the first to suggest that screening for sarcopenia by ultrasonography may be useful for risk assessment in patients with chronic liver disease and signs of portal hypertension.

Multimodal Physical Therapy Management of Subcoracoid Impingement: A Case Report With One-Year Follow-Up and Ultrasound Measurement of Coracohumeral Distance

Multimodal Physical Therapy Management of Subcoracoid Impingement: A Case Report With One-Year Follow-Up and Ultrasound Measurement of Coracohumeral Distance

Voiding sonography: Technical description of a novel ultrasound method for assessment of micturition in women

AbstractVoiding sonography (VS) is a novel non‐invasive method that can be used to assess micturition in real time. When performed in a functional seated position and combined with free uroflowmetry, detailed evaluation of voiding can be conducted. VS presents advantages over current invasive assessment methods such as urodynamics. This methodological paper describes the rationale; advantages and disadvantages of VS; participant preparation; technique; a practical approach to obtain the video/image (including transducer placement to achieve an assessment of voiding with minimal obstruction of urine flow); recommended machine and transducer specifications; and the potential usefulness of ultrasound measurements. These measurements might provide information regarding the function of the pelvic floor muscle and urethral dynamics during voiding. Measures assessed with VS can also provide information regarding urine storage. In summary, VS is a new method to assess female voiding. Future work should evaluate the potential utility of the method to evaluate characteristics and mechanisms for voiding dysfunction in females with a variety of relevant clinical conditions. Use of VS as a screening tool before and after surgical or non‐surgical treatment intervention may also be a future consideration to assess progress and provide feedback to clinicians and patients.

Quantifying Lower Extremity Blood Flow using Low-Dose CT Perfusion: Validation in a swine model

Abstract Background Quantitative assessment of blood flow in peripheral extremities in conjunction with simultaneous CT angiography measurements can improve risk assessment and provide a critical decision-making tool for patients across a wide spectrum of vascular disease severity. Purpose This study assessed the reproducibility and accuracy of lower extremity blood flow measurements with a low-dose first-pass analysis CT perfusion technique. Materials and Methods This prospective study utilized 16 Yorkshire Swine to obtain lower extremity blood flow CT measurements at baseline and under induced femoral stenosis using a vascular occluder. Thirty-three pairs of CT measurements evaluated reproducibility, and 43 CT measurements assessed accuracy against ultrasound flow probe references. Contrast agent and saline chaser were both injected peripherally at a rate of 5 mL/s. Bolus tracking was used, and a pre-contrast and post-contrast helical scan were acquired at the base and approximately the peak of the femoral enhancement (CT angiogram), respectively. The acquired data were then used as analytical inputs into a first-pass analysis model to derive perfusion in mL/min/g. The reproducibility and accuracy of lower extremity perfusion measurements were assessed via Mixed model regression and Bland-Altman analysis. Results Calculated CT perfusion measurements derived from first-pass analysis technique (PCT), and the reference standard ultrasound perfusion measurements (Pref) were related by PCT = 1.06 Pref + 0.00 (r2= 0.90, Root-Mean-Square Error = 0.01 mL/min/g). The first (P1) and second (P2) CT perfusion measurements were related by P2 = 0.98 P1 + 0.02 (r = 0.97, Root-Mean-Square Error = 0.11 mL/min/g). The average effective dose of perfusion measurement using first-pass analysis technique was calculated to be only 2.13 mSv. Conclusion : The low-dose quantitative CT perfusion technique can accurately measure lower extremity perfusion (mL/min/g) using only two helical scans. The CT angiogram and perfusion measurements can be used as a comprehensive technique for morphological and physiological assessment of limb ischemia.

Reliability of Ultrasonographically Acquired Muscle Morphology Based on a Cohort of Men and Women

Objective: The objective was to evaluate intrarater and inter-rater reliability of ultrasonography muscle morphology measurements in men and women, considering morphological differences between the genders. Materials and Methods: Thirty-two healthy subjects (16 male; 16 female; 26.6 ± 4.9 years) participated in two evaluation days. On day 1, subjects were evaluated by a single experienced rater, who repeated the evaluation on the next testing day along with two other raters. Muscle morphology of quadriceps femoris (QMT), rectus femoris (RFMT), vastus intermedius (VIMT), vastus medialis (VMMT), and vastus lateralis (VLMT) muscle thickness, rectus femoris muscle cross-sectional area (RFCSA), vastus lateralis muscle fascicle length (VLFL), and pennation angle (VLPA) were obtained. Reliability was evaluated by intraclass correlation coefficients (ICCs). Results: All intrarater comparisons demonstrated good reliability (ICC &gt;0.90), even after participants’ gender stratification (ICC &gt;0.81). Inter-rater comparisons for RFCSA, and muscle thickness showed good reliability (ICC &gt;0.76). Male’s VLFL and VLPA reliability was considered insufficient (ICC = 0.58 and 0.60, respectively), while female’s was slightly higher (ICC = 0.79 and 0.75, respectively). Conclusion: Ultrasonography has potential to be used to observe changes in muscle size, but pennation angle and fascicle length should be evaluated by the same rater.

Diagnostic Accuracy of Optic Nerve Sheath Diameter Measurement by Ultrasonography for Noninvasive Estimation of Intracranial Hypertension in Traumatic Brain Injury: A Systematic Review and Meta-Analysis.

Intracranial hypertension (IH) is associated with an unfavorable outcome in traumatic brain injury (TBI), and management strategies guided by intracranial pressure monitoring improve prognosis. Owing to the limitations of using invasive devices, measurement of optic nerve sheath diameter (ONSD) by ultrasonography is an alternative noninvasive method. However, its accuracy has not been validated in patients with TBI, so we aim to determine the diagnostic accuracy of measuring ONSD by ultrasonography in patients with TBI to estimate IH, compared with invasive monitoring. Systematic review of electronic databases and manual literature review from inception to June 2023. The analysis included diagnostic accuracy studies of ultrasonographic measurement of ONSD compared with invasive monitoring published in any language and with patients of any age. A qualitative synthesis was performed describing the clinical and methodological characteristics, strengths, limitations, and quality of evidence. In addition, a bivariate random effects model meta-analysis and a hierarchical summary receiver operating characteristics model were performed for the pediatric and adult population separately. Five hundred and forty eight patients of 688 in 16 eligible studies were adults and 120 were children. Pooled sensitivity and specificity of ONSD measurement by ultrasonography were 84% (95% CI, 76%-89%) and 83% (95% CI, 73%-90%), respectively. During the sensitivity analysis, these parameters exhibited consistent values. Pooled area under the curve was 0.91 for adults and 0.76 for children. Optimal threshold for estimating IH was 5.76 mm for adults and 5.78 mm for children. Measurement of ONSD by ultrasonography is a reliable, low-cost, and safe alternative for the estimation of IH with TBI in adults. More robust studies are needed to overcome the high risk of bias and heterogeneity for this analysis.

The strength of associations between ultrasound measures of upper limb muscle morphology and isometric muscle strength: An exploratory study.

Assessing upper limb muscle strength is important for understanding health outcomes, such as daily function and mortality. Ultrasound (US) is increasingly used to evaluate muscle health, but the relationship between its measures of morphology and isometric strength has not been thoroughly explored in upper limb muscles. The aim of this study was to evaluate the associations between US morphological measures and isometric strength in functionally relevant upper limb muscles in healthy adults. Twenty-four healthy volunteers (30.0 ± 10.8 years) underwent B-mode, axial US scans of the first dorsal interosseus (FDI), flexor pollicis longus (FPL), biceps brachii (BB), brachialis (BR), and triceps brachii lateral head (TB). Participants performed corresponding maximal voluntary contractions (MVC), including first digit distal phalanx flexion, second digit abduction, and elbow flexion and extension. US images were segmented to obtain maximal muscle thickness (MT) and cross-sectional area (CSA). Strong positive correlations were found between muscle strength and BB MT (r = .83; p < .001), BR CSA (r = .84; p < .001), and TB MT (r = .70; p < .001). Moderate positive correlations were found for strength and FDI CSA (r = .67; p < .001), FDI MT (r = .47; p < .05), FPL CSA (r = .54; p < .01), and FPL MT (r = .42; p < .05). No significant correlation was found between strength and BR MT (r = .16; p > .05). Our data showed moderate-to-strong associations between US muscle morphology and strength, suggesting that US is likely a good biomarker for strength. However, its use is not "one size fits all." Future investigations should continue to assess this relationship in different muscles and expand the generalizability to clinical populations.

Transvaginal ultrasonography-measured cervical length versus the modified Bishop score for preinduction cervical assessment at term: A randomised controlled trial

Introduction: The inducibility of the cervix for labour induction is usually determined by cervical status evaluation. The Bishop score is historically used to forecast the success of induction of labour, although it is subjective, and not reproducible. However, transvaginal ultrasound measurements of cervical length are rarely used for preinduction cervical assessment. The study compared cervical length measured via transvaginal ultrasound and the modified Bishop score for preinduction cervical assessment at term. Methods: The study involved 72 pregnant, nulliparous women for induction of labour at term. They were randomised into the transvaginal ultrasound group and the modified Bishop score group. The cervix was said to be ‘ripe’ when the transvaginal ultrasound cervical length (CL) was &lt; 28 mm or the modified Bishop score was ⩾ 6. The cervix was considered ‘unripe’ when the Bishop score was &lt; 6 or the transvaginal ultrasound was ⩾ 28 mm. Participants with ripe cervices had induction of labour with an oxytocin infusion, while those with unripe cervices had preinduction cervical ripening with misoprostol. The primary outcome measures were the mode of delivery and the total amount of prostaglandins administered for preinduction cervical ripening. Results: There was no significant difference between the two groups with regard to the mode of delivery ( p = 0.795), the total amount of prostaglandins administered for preinduction cervical ripening (105.0 ± 51.04 µg vs 111.90 ± 52.2 µg; p = 0.0671), the proportion of women who were administered prostaglandins due to an unfavourable cervix (41.7% vs 55.6%; p = 0.812), induction-to-the-active phase of the labour interval (11.00 ± 4.2 hours vs 11.82 ± 4.12 hours; p = 0.407) or the induction-delivery interval (20.15 ± 5.7 hours vs 22.66 ± 4.33 hours; p = 0.06) in both groups, respectively. Compared with those in the Bishop score group (Bishop score ⩾ 6), the induction-to-active phase of labour intervals (6.47 ± 0.77 hours vs 7.33 ± 1.21 hours, p = 0.024) and the induction-to-delivery intervals (14.97 ± 1.0 hours vs 18.39 ± 0.85 hours; p = 0.0001) in the transvaginal ultrasound group (cervical length &lt; 28 mm) were significantly shorter, respectively. Conclusion: Preinduction cervical assessment using transvaginal ultrasound (cervical length &lt; 28 mm) or the modified Bishop score is a successful predictor of the outcome of labour induction A larger multicentre studies are needed to identify optimal cervical length cutoffs and to determine if this could decrease unnecessary prostaglandin use or decrease caesarean section rate.

Ultrasonographic Evaluation of Systemic Venous Congestion in Maintenance Hemodialysis Patients During Fluid Removal.

Fluid overload is a frequent and serious complication in hemodialysis patients. The combination of multiple point of care ultrasound (POCUS) measurements can identify significant venous congestion but its usefulness to determine ultrafiltration (UF) requirements and dry weight is unknown. Therefore, we evaluated prospectively patients in maintenance hemodialysis to establish the correlations between changes in venous congestion parameters and fluid removal. This was a prospective, single-center, observational study. POCUS venous congestion measurments were performed in 22 patients during 32 online post-dilutional hemodiafiltration sessions and findings were correlated with UF volume, central venous pressure and body water composition determined by multifrequency bioelectric impedance analysis (BIA). The pre dialysis weight was on average 1.9 kg above the BIA estimated dry weight, the average initial IVC diameter was <2 cm. An initial abnormal Hepatic Vein (HV) waveform was present in 26% (8) of the measurements. The average UF volume was 2084 ± 655 ml and correlated with changes in inferior vena cava (IVC) diameter (R= 0.34, CI 95% (0.18, 0.56) p < 0.05) but not with any other POCUS venous congestion parameters. Normalization of the IVC diameter and HV waveform was observed during the first UF hour in all initially altered measurements. Diameter reduction in the IVC correlated with total body water volume reduction estimated with BIA when measured immediately after fluid removal (R= 0.34, CI 95% (0.08, 0.56) p<0.05) Conclusion. Reduction in IVC diameter had a modest but significant correlation with UF volume in our patients on maintenance hemodiafiltration. POCUS may be used to monitor patients during UF.

Evaluation of Splint and Exercise Interventions for Carpal Tunnel Syndrome: Insights from Ultrasonographic Measurements.

BACKGROUND Carpal tunnel syndrome (CTS) is a neuropathy caused by the entrapment of the median nerve, which requires effective management strategies. The median nerve is subjected to pressure within the carpal tunnel, resulting in tingling, numbness, and pain in the median side of the hand. We compared the efficacy of splint use with an exercise program vs exercise alone in patients with mild and moderate CTS. MATERIAL AND METHODS Forty-four patients with CTS were enrolled. The patients were randomly divided into 2 groups: splint+exercise and exercise only. A range of assessment tools were used, including ultrasonography, dynamometer, the Leeds Assessment of Neuropathic Symptoms &amp; Signs Pain Score (LANSS), Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) score, and 36-Item Short Form Quality of Life Scale (SF-36) score, to provide comprehensive evaluation. RESULTS The 2 groups had comparable outcomes at the end of treatment. There were no statistically significant differences in Q-DASH (P=0.326, Cohen's d=0.067), SF-36 (P=0.329, Cohen's d=0.218), VAS (P=0.521, Cohen's d=-0.299), or LANSS scores (P=0.627, Cohen's d=0.039) between the groups (P>0.05). The results demonstrate that a targeted exercise regimen, when used in isolation, can elicit outcomes that are comparable to those achieved through the integration of splinting techniques. CONCLUSIONS The study findings align with conflicting existing data on the effectiveness of splint immobilization in conjunction with exercises for CTS. The results support the significance of regular exercises, which can be applied in the home-based setting in CTS management, and offer alternative online management strategies.

Strong association between sarcopenia and visceral fat in the long term after cholecystectomy: A cross-sectional study using the ISarcoPRM algorithm.

Cholecystectomy generally has no adverse effects on health. Studies demonstrating the association between metabolic diseases and long-term effects of cholecystectomy are increasing. preperitoneal fat thickness (PFT) is an important indicator of metabolic syndrome. Metabolic syndrome is a risk factor for sarcopenia. The aim of our study was to investigate the relationship between cholecystectomy and sarcopenia-visceral fat using the ISarcoPRM algorithm, which is an easy, reliable, and inexpensive method based on ultrasound measurement, to evaluate sarcopenia in patients with long-term previous cholecystectomy. This cross-sectional study included participants who had undergone cholecystectomy at least 5 years ago and a control group with similar characteristics. Sarcopenia was assessed using the ISarcoPRM algorithm, incorporating the sonographic thigh adjustment ratio (STAR), grip strength, and chair stand test (CST). Together with low STAR values (<1.0 for females and <1.4 for males), ow grip strength (<19 kg for females or <32 kg for males), and/or prolonged CST duration (≥12 seconds) were used to diagnose sarcopenia. Ultrasound was used to measure the visceral fat thickness. The investigation of sarcopenia and PFT values between individuals with and without cholecystectomy was planned. A total of 158 participants were included, including 89 post-cholecystectomy patients and 69 controls. Binary regression analysis revealed that cholecystectomy was positively associated with sarcopenia (OR = 2.788, 95% CI: 1.054-7.375, P = .039). However, when PFT was included, it was independently associated with sarcopenia (OR = 1.157, 95% CI: 1.067-1.254, P < .001), and the relationship with cholecystectomy disappeared (P > .05). PFT values of 10.0 mm or higher were associated with 5.875 times (95% CI: 2.035-16.961, P = .001) increased odds of sarcopenia. Sarcopenia was 2.8 times more frequent in patients who had undergone cholecystectomy than in those who had not, but this relationship was mediated by increased PFT. The risk of sarcopenia increased up to 5.875 times when the PFT exceeded 10 mm.

Use of real-time ultrasound measurements of fat thickness and longissimus thoracis muscle characteristics for predicting body fat depots in crossbred hair ewes

This study aimed to predict body fat depots using ultrasound measurements (USM) of fat thickness and longissimus thoracis muscle characteristics in crossbred hair ewes. A total of 24 animals with a mean body weight (BW) of 37 ± 4kg and a body condition score of 2.39 ± 0.49 were used. USM was recorded 24h before slaughter and included: subcutaneous fat thickness (SFT), area (LTMA), amplitude (LTA), and depth (LTD) of the l. thoracis muscle and kidney fat thickness (µKFT). After slaughter, the internal fat (IF) was separated, classified, and weighed as mesenteric (MF), omental (OF), or pelvic fat (PF). The left half was then separated into subcutaneous and intermuscular fat (CF), and the muscle and bone tissues were weighed separately and adjusted to take account of the whole animal. Total body fat (TBF) was determined to be the IF plus the CF weights. LTA and LTMA correlated poorly to moderately with fat depots (0.37 ≤ r ≤ 0.74, P < 0.05). Other than CF, µKFT showed poor to moderate correlation with the other depots of body fat (0.44 ≤ r ≤ 0.75, P < 0.05). The regression model used to predict MF had r2 of 0.87 (RSD=0.14kg) and included BW and LTMA (P<0,05). OF and PF were predicted with r2 of 0.55 and 0.44, respectively, including µKFT (RSD = 0.20 and 0.17kg). IF was predicted by empty BW, LTMA, and µKFT with r2 as 0.81 (RSD=0.30kg). For TBF, EBW and LTMA explained 72% of its variation (RSD= 0.59kg). USM of fat thickness and l. thoracis muscle characteristics can improve the accuracy of predicting body energy reserves in crossbred hair ewes.

Prediction of perinatal mortality in early-onset fetal growth restriction: A post hoc analysis of the Dutch STRIDER trial to predict perinatal mortality in early-onset fetal growth restriction

ObjectiveEarly-onset fetal growth restriction affects about 0.3% of pregnancies, posing high perinatal risks due to placental insufficiency. Early-onset fetal growth restriction often coincides with early-onset pre-eclampsia, associated with significant mortality and morbidity. Clinical management varies among clinicians, with emphasis on intensive monitoring and timely delivery. Our objective was to improve clinical prediction of perinatal mortality in early-onset fetal growth restriction for parental counseling. Study designThis was a secondary analysis of prospective cohort data from the Dutch STRIDER trial. The study included 215 pregnant women diagnosed with severe early-onset fetal growth restriction between 20 + 0 and 29 + 6 weeks of gestation, from tertiary and secondary antenatal care centers in The Netherlands. Maternal and fetal characteristics were collected at inclusion, including sonographic and laboratory measurements. Analysis was performed using univariable and multivariable binary logistic regression to create a prediction model for perinatal mortality. The main outcome measures were fetal demise and neonatal mortality up to discharge. Results215 Participants were included for this analysis. Perinatal mortality occurred in 84 (39 %) cases; 51 (24 %) were fetal and 33 (15 %) neonatal. Fetal abdominal circumference, gestational age at diagnosis, estimated fetal weight Multiple of Median, absent or reversed end-diastolic flow of the umbilical artery, umbilical artery pulsatility index Multiple of Median, non-Caucasian ethnicity, male sex, placental growth factor level and uterine artery pulsatility index were independent predictors of perinatal mortality. Randomization allocation (sildenafil or placebo) had no predictive value for mortality. The prediction model including gestational age at diagnosis, estimated fetal weight Multiple of Median and umbilical artery pulsatility index Multiple of Median showed an area under the receiver operating characteristic curve of 0.840 (P < 0.01). Placental growth factor was measured in a subset of patients and was an independent prognostic factor and performed significantly better within the predictive model, however it did not improve the predictive value of the model. ConclusionsPrediction of perinatal mortality in early-onset fetal growth restriction is feasible with commonly available tests and measurements and could support decision making in management of pregnancy. However, implementation in practice requires further studies.

Effect of joint angle positioning on shearwave speed and variability with ultrasound shearwave elastography in asymptomatic Achilles and patellar tendons

This study investigated the impact of joint positioning on ultrasound shear wave elastography measurements in the Achilles and patellar tendons. Twenty-eight healthy adults underwent SWE assessment of shear wave speed (SWS) and coefficient of variation in SWS (CV-SWS) at three ankle positions (neutral, 10° plantar flexion, and 20° dorsiflexion) and two knee positions (90° flexion and full extension), at two academic sites. Participant positioning for ankle testing differed between sites (prone vs long-sitting)—while knee testing used consistent positioning. At the ankle, both joint and participant positioning significantly affected SWS. In the prone position, SWS was lower in neutral compared to dorsiflexed position (3.07 ± 1.13 m/s vs. 3.95 ± 1.03 m/s, p = 0.013). In long-sitting, SWS was lower in neutral compared to plantarflexed position (2.85 ± 0.53 m/s vs. 4.86 ± 1.92 m/s, p = 0.016); and SWS was higher in the plantarflexed position when participants were in long-sitting compared to prone (4.86 ± 1.92 m/s vs. 3.25 ± 1.13 m/s, p = 0.016). Participant positioning affected CV-SWS, with higher variability observed in prone compared to long-sitting in plantarflexed (29.3 ± 15.5 % vs 12.4 ± 9.12 %, p = 0.005) and neutral ankle angles (p = 0.03)At the knee, joint position significantly influenced SWS, with higher values in flexed versus extended positions (6.48 ± 3.1 m/s vs. 4.60 ± 2.3 m/s, p = 0.007). Extending the knee reduced CV-SWS compared to flexed position (14.5 ± 11.2 vs 19.2 ± 13.4, p = 0.044). In conclusion, joint position significantly affected SWS measurements in both the Achilles and patellar tendons, while participant positioning influenced measurement variability. Thus, standardizing joint and participant positioning is important to enhance the reliability of SWE assessments of tendon elasticity.