Ultrasound Examination Research Articles

Ultrasound measurements and normal findings in the thyroid gland

The present work describes the process of the sonographic examination, normal findings and measurements in the B-mode ultrasound evaluation. Reference is made to anatomical variants in shape, the pyramidal lobe, tubercle of Zuckerkandl, ectopic thyroid tissue, and their significance. Particular attention is paid to the reference values, the very miscellaneous reference values in different geographic regions of the world and influencing factors.

Routine 36-week scan: diagnosis and outcome of abnormal fetal presentation.

First, to report the incidence of non-cephalic presentation at a routine 36-week ultrasound scan, the uptake and success of external cephalic version (ECV) and the incidence of spontaneous rotation from non-cephalic to cephalic presentation. Second, to determine the maternal and pregnancy characteristics that provide a significant contribution to the prediction of non-cephalic presentation at the 36-week scan, successful ECV from non-cephalic to cephalic presentation and spontaneous rotation from non-cephalic to cephalic presentation. This was a retrospective analysis of prospectively collected data from 107 875 women with a singleton pregnancy who had undergone a routine ultrasound scan at 35 + 0 to 36 + 6 weeks' gestation. Patients with breech or transverse/oblique presentation were divided into two groups: those scheduled for elective Cesarean section for a fetal or maternal indication other than abnormal presentation, and those that would potentially require ECV. The latter group was reassessed after 1-2 weeks and, if the abnormal presentation persisted, the parents were offered ECV or elective Cesarean section at 38-40 weeks' gestation. Multivariable logistic regression analysis was carried out to determine which maternal and pregnancy characteristics provided a significant contribution in the prediction of non-cephalic presentation at the 36-week scan, successful ECV from non-cephalic to cephalic presentation and spontaneous rotation from non-cephalic to cephalic presentation. At the 36-week scan, fetal presentation was cephalic in 101 664 (94.2%) pregnancies and either breech, transverse or oblique in 6211 (5.8%). In 0.3% of cases with cephalic presentation at the 36-week scan, there was subsequent spontaneous rotation to non-cephalic presentation, and in half of these, the diagnosis was made during labor or at birth. ECV was attempted in 1584/6211 (25.5%) pregnancies with non-cephalic presentation at the 36-week scan and was successful in only 44.1% of cases. In the remaining 74.5% of cases, ECV was not attempted because of any of the following reasons: ECV was declined; Cesarean section was planned for a reason other than abnormal presentation; ECV was planned for the subsequent 1-2 weeks but, in the meantime, there was spontaneous rotation to cephalic presentation; or there was spontaneous onset of labor or rupture of membranes before planned ECV. In 5513/6211 (88.8%) pregnancies with non-cephalic presentation at the 36-week scan, ECV was not attempted or was unsuccessful, and in 37.7% of these, there was subsequent spontaneous rotation to cephalic presentation. Among the 6211 pregnancies with non-cephalic presentation at the 36-week scan, the presentation at birth was cephalic in 43.8%; in 74.8%, this was due to spontaneous rotation, and in 25.2%, it was due to successful ECV. Multivariable analysis demonstrated that the likelihood of non-cephalic presentation at the 36-week scan, that of successful ECV and that of spontaneous rotation from non-cephalic to cephalic presentation was affected by several maternal and pregnancy characteristics, but the predictive performance for these events was poor, with the area under the receiver-operating-characteristics curve ranging from 0.608 to 0.717 and the detection rate at a 10% false-positive rate ranging from 19.0% to 33.7%. Routine ultrasound examination at 35 + 0 to 36 + 6 weeks' gestation could improve pregnancy outcome by substantially reducing the risk of unexpected abnormal presentation in labor. However, an additional ultrasound scan for fetal presentation should be considered in all women when they present in labor. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Epidural Anesthesia and Pelvic Floor Outcomes in Primiparas: A Retrospective Transperineal Ultrasound Study.

This study evaluated pelvic organ positions in primiparas with painful and painless deliveries using transperineal ultrasound (TPU) and assessed the effects of epidural anesthesia on pelvic floor function. From January 2022 to March 2023, 512 primiparas with vaginal deliveries at our hospital underwent pelvic floor ultrasound examinations 42days postpartum. The study included 138 women with painful deliveries and 375 with painless deliveries. Measurements included the urethral tilt angle (UTA), retrovesical angle at rest (RVA-R), bladder neck-symphysis pubis distance (BSD) at rest, retrovesical angle at Valsalva maneuver (RVA-V), urethral rotation angle (URA), bladder neck descent (BND), rectal ampulla distance, and levator hiatal area (LHa) at maximum Valsalva maneuver. Statistical analysis was performed using SPSS 26.0. No significant differences were found between the painful and painless delivery groups in terms of age, gestational age, newborn birth weight, BMI, UTA, RVA-R, RVA-V, URA, and BND (P > 0.05). Although the second stage and total duration of labor were significantly longer in the painless delivery group, there were no significant differences in the incidences of cystocele, internal urethral orifice opening, uterine prolapse, rectocele, and LHa expansion between the groups (P > 0.05). Transperineal ultrasound showed no significant difference in pelvic floor dysfunction incidence between primiparas with painful and painless deliveries. Epidural anesthesia did not significantly affect pelvic floor function in the early postpartum period.

Use of ultrasonography in the diagnosis of pneumonia in intensive care patients

Aims: A significant portion of respiratory system infections seen in intensive care units is ventilator-associated pneumonia, which has a high mortality rate and diagnosis may be delayed. Bedside lung ultrasonography offers the advantages of standard diagnostic methods as chest radiography or thorax tomography. We aim to evaluate the bedside lung ultrasonography correlation with the chest radiography or thorax tomography Methods: It was conducted prospectively on 60 patients between the ages of 18-85 who were admitted to intensive care with respiratory failure within an 8-month period. Anterioposterior chest radiographs were taken on the first day of mechanical ventilation for the patients included in the study. Ultrasonographic (USG) examination was performed separately for both hemithoraxes and recorded digitally. Simultaneously with the ultrasonographic examination, PEEP, FiO2, blood gas examination results and the highest body temperatures in the last 24 hours were recorded. The quality and quantity of tracheal secretions were evaluated, and sampling was performed for complete blood examination and tracheal aspirate culture-antibiogram. Lung injury score (LIS) and pulmonary infection score (CPIS) were calculated from the data obtained. In this process, independent of the research, the same day examination results of patients who required thorax tomography (CT) for diagnosis and treatment planning were evaluated together with USG and chest radiography. Tomographic examinations were evaluated by a radiologist. Results: In the examination of 120 hemithoraxes of 60 patients we included in the study, we were able to detect 74.17% of the pathological images obtained with chest radiography and ultrasonographic examination with bedside ultrasonography and 70.84% with chest radiography. Of the 20 patients who underwent tomographic evaluation, pathology was observed in 40 hemithoraxes in 92.5% by tomography, in 85% by ultrasonography, and in 75% by chest radiography. While isolated consolidation was detected equally on USG and CT imaging, there was a high false-positive rate of 48% on chest radiography. 58.8% of the patients with consolidation detected by CT, we observed that there was growth in the tracheal aspirate of 56.2% of the patients whose ultrasonographic examination revealed consolidation. Conclusion: Bedside lung ultrasonography is a fast, non-invasive, repeatable and reliable diagnostic method in patients followed in intensive care, and is compatible with traditionally used laboratory and clinical parameters. This reveals that USG, which is known to have other advantages such as cost, applicability, and not using radiopaque, will become an indispensable examination for ICU.

Relationship Between the Sagittal and Coronary Alignment of the Tibiofemoral Joint and the Medial Meniscus Extrusion in Knee Osteoarthritis

Background/Objectives: This study aims to clarify the reproducibility, validity, and accuracy of tibial external-rotation alignment evaluation using ultrasound imaging and to investigate the relationship between medial meniscus extrusion (MME) and tibiofemoral alignment in both the sagittal and coronal planes in knee osteoarthritis (OA). Methods: Study 1 included 10 healthy participants. The tibial external-rotation angle was calculated using MRI. In the ultrasound imaging evaluation, the differences in the distance from the most posterior points of the tibial and femoral condyles to the skin were calculated as the medial and lateral condyle gaps, respectively. The mediolateral (ML) gap was calculated by subtracting the lateral condyle gap from the medial condyle gap. Study 2 included 63 patients with unilateral OA and 16 healthy controls. MME was compared according to the severity of OA, the degree of tibial rotation, and the presence or absence of a tibial posterior shift. Results: Ultrasound imaging examinations showed high intra- and inter-rater reliabilities (0.786–0.979). The ML gap significantly affected the tibial external-rotation angle, determined using MRI. The ML gap of ultrasound imaging was significantly correlated with the ML gap of MRI. MME was significantly higher in the Early OA group than in the Control group. There was no significant difference in MME based on the tibial rotation degree. The group with a tibial posterior shift exhibited significantly more MME than that without a posterior shift. Conclusions: Ultrasound imaging is useful for evaluating knee alignment. MME was found to be associated with the tibial posterior shift.

Diagnostic Efficacy of Multimodal Ultrasound for Mass and Non-Mass Enhancements in Dynamic Contrast-Enhanced MRI of Idiopathic Granulomatous Mastitis and Breast Cancer

PurposeIdiopathic granulomatous mastitis (IGM) poses diagnostic challenges due to its diverse clinical and radiological presentations, often mimicking malignancies. This study aimed to assess the diagnostic efficacy of multimodal ultrasound for mass and non-mass enhancements in Dynamic Contrast-Enhanced MRI (DCE-MRI) of IGM and breast cancer. MethodsA retrospective analysis involved patients confirmed histopathologically with IGM and BC. All patients underwent conventional ultrasound (C-US), ultrasound elastography (UE), contrast-enhanced ultrasound (CEUS), and DCE-MR examinations. Blind experienced radiologists assessed imaging findings. Diagnostic accuracy, sensitivity, and specificity were calculated for mass and non-mass enhancements. ResultsFor mass enhancements (ME), multimodal ultrasound demonstrated strong efficacy (AUC = 0.8651, 95% CI: 0.7431 to 0.9871), exhibiting high sensitivity (83.3%) and specificity (92.4%) in differentiating IGM from breast cancer. However, for non-mass enhancements (NME), multimodal ultrasound showed limited accuracy (AUC = 0.6306) with lower sensitivity (65.6%) and specificity (81.2%) in distinguishing between IGM and breast cancer. ConclusionMultimodal ultrasound displayed good diagnostic efficacy for mass enhancements in DCE-MRI for idiopathic granulomatous mastitis and breast cancer, while for non-mass enhancement patterns, DCE-MRI remains the most valuable radiological modality for comprehensively assessing this condition's complexities.

Evaluation of normal and abnormal fetal renal microvascular flow characteristics of three-dimensional MV-flow imaging

ObjectiveTo evaluate the applicability of three-dimensional MV-Flow imaging for prenatal renal diagnosis. MethodThis prospective study included normal and abnormal kidneys ranging from 20 to 40 weeks gestation between April and July 2023. All participants underwent conventional ultrasound and three-dimensional MV-Flow examinations. The renal volume and microvascular indexes were obtained by the three-dimensional MV-Flow. ResultsA total of 207 normal kidneys from 154 fetuses and 67 abnormal kidneys from 53 fetuses, with conditions such as renal cystic diseases, hyperechoic kidney, large kidney, and small kidney were included. Normal renal volume, vascularization index, and vascularization-flow index increased slightly with gestational age (p < 0.001). No correlation was found between gestational age and flow index (p = 0.604). The microvascular indexes decreased in the fetal renal cystic disease group while renal volume increased. Higher vascularization index and vascularization-flow index were observed in the hyperechoic kidney group. The microvascular indexes of the large and small kidney groups were within the reference range for normal kidneys. Only the autosomal dominant polycystic kidney disease exhibited an absence of distinct subcapsular microvascular flow in the MV-Flow image, referred to as the “thick shell sign”. ConclusionFetal renal volume, vascularization index, and vascularization-flow index increase with gestational age. Quantitative evaluation using 3D MV-Flow imaging reveals varying renal volume and microvascular perfusion characteristics among different fetal renal abnormalities.

Why Portable Handheld Cardiac Ultrasound Devices Ought to Incorporate 3-lead Electrocardiographs: A Mini-narrative Review

Introduction: Transthoracic echocardiography is a non-invasive diagnostic test used to assess the structure and function of the heart in real-time. An examination of the heart's electrical activity is done non-invasively through electrocardiography (ECG). The ECG is primarily used during an echocardiography procedure to assess the heart's rhythm and to synchronise the cardiac cycles with echocardiographic image acquisition; this enables the echocardiographer to acquire images at specific phases of the cardiac cycle. A handheld echocardiograph is not connected to the electrocardiogram, which is a clinical limitation for the point-of-care ultrasound procedure. The objectives of this review are to highlight the reasons why 3-lead electrocardiography should be incorporated into pocket-sized handheld echocardiographs to support clinicians in conducting and reporting complete cardiac investigations. Methods: An in-depth search was made on the PubMed database to find experimental and review studies that assessed the importance of 3-lead ECG in the acquisition of hand-held echocardiographic data. Four related studies were selected for this review. Results: The study found that integrating cardiac point-of-care ultrasound into primary healthcare practices such as family medicine or general practitioners’ practices and training clinicians to accurately perform the procedure can expedite cardiovascular disease diagnosis and treatment in critical and non-critical scenarios. Secondly, recent hand-held cardiac ultrasound examination outcomes are as accurate and precise as standard transthoracic echocardiography and cardiac magnetic resonance imaging. Conclusion: Furthermore, medical device companies should consider integrating and producing new hand-held echocardiographs with configured 3-lead electrocardiographs that are artificial intelligence-enhanced to assist clinicians in precise point-of-care cardiac assessments.

Diagnostic value of 4D pelvic floor ultrasound for postpartum mild to moderate pelvic organ prolapse in primiparas based on medical thermal imaging monitoring

Traditional diagnostic methods often rely on the doctor’s experience, which can lead to missed diagnosis or misdiagnosis. With the development of wireless network medical technology, it provides a new possibility for the diagnosis of pelvic floor ultrasound. The purpose of this study was to evaluate the diagnostic value of 4D pelvic floor ultrasound based on wireless network medical technology in puerperal mild to moderate pelvic organ prolapse, and to explore its feasibility in clinical application. In this study, puerperal women were selected for 4D pelvic floor ultrasound examination after delivery, and image data was transmitted in real time to remote experts for analysis combined with wireless network technology. The sensitivity, specificity and application effect of the technique were evaluated by comparing the ultrasound results with the clinical diagnosis results. The results show that compared with traditional methods, wireless network medical technology can significantly improve the efficiency of image transmission and diagnosis accuracy. Therefore 4D pelvic floor ultrasound based on wireless network medical technology can effectively diagnose the postpartum mild and moderate pelvic organ prolapse of first-time partrients, which has high clinical application value, not only improves the diagnostic efficiency, but also provides a new development direction for telemedicine, and is worthy of promotion and application in clinical practice.

Application of Musculoskeletal Ultrasound in Osteoarthritis

Osteoarthritis is the most common form of arthritis, also called degenerative arthritis in the past. Osteoarthritis mainly affects various joints, including the finger joints and knee joints. As Korea enters an aging society, the severity of osteoarthritis is gradually increasing. Therefore, early diagnosis and treatment are important. Up until now, osteoarthritis has been diagnosed based on clinical symptoms and plain radiography. However, recently, the proportion of ultrasound examinations in the diagnosis of osteoarthritis is gradually increasing. This is because ultrasound examinations are very useful for evaluating osteophytes, cartilage damage, and synovitis, which are pathologic findings of osteoarthritis. Therefore, the purpose of this paper is to help perform ultrasound examinations in actual clinics based on recently published research data.

Development of a Novel Nomogram Based on Ultrasonic Radiomics for Predicting Intrauterine Pregnancy After Frozen Embryo Transfer Cycle.

This study aimed to develop a nomogram for predicting intrauterine pregnancy after an in vitro frozen embryo transfer cycle using endometrial ultrasound radiomics. A total of 211 patients who underwent ultrasound examination on the day of endometrial transformation before the frozen embryo transfer cycle were enrolled. The patients were divided into an intrauterine pregnancy group and a pregnancy failure group based on ultrasound results. Clinical characteristics and radiomic features were analyzed using univariate and multivariate logistic regression analyses. A nomogram prediction model was established based on radiomic signatures and significant clinical factors. The model's robustness was assessed in training and external validation cohorts. Nine radiomic features were selected using least absolute shrinkage and selection operator (LASSO), and the radiomics score (Rad-score) was calculated as the sum of each feature multiplied by the nonzero coefficient from LASSO. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve based on the Rad-score was 0.72, 0.65, and 0.69 in the training, validation, and combined cohorts, respectively. To improve diagnostic efficiency, the Rad-score was further integrated with clinical factors to form a novel predictive nomogram. The results indicated that the AUC increased to 0.81, 0.67, and 0.77 in the training, validation, and combined cohorts, respectively. Decision curve analysis showed that the radiomics nomogram was clinically useful. The radiomics and clinical predictive nomogram can effectively predict intrauterine pregnancy after in vitro frozen embryo transfer and can be further applied in clinical strategy.

Transperineal ultrasound evaluation of pelvic floor muscle function in male patients with constipation

Objective To investigate the application of transperineal ultrasound for assessing pelvic floor muscle (PFM) function in male patients with constipation and to evaluate its clinical value.MethodsThe study included 32 male patients with constipation and 32 healthy controls, all of whom underwent transperineal ultrasound examinations. Measured parameters included the anorectal angle (ARA), levator plate angle (LPA), excursions of the ARA and LPA, and displacements of the bulb of the penis (BP), mid-urethra (MU), urethra-vesical junction (UVJ), and anorectal junction (ARJ) at rest, during maximal voluntary contraction (MVC), and during maximal Valsalva maneuver. Reliability was evaluated in 20 healthy controls using intraclass correlation coefficients (ICCs) and Bland-Altman analysis.Results(1) The ICCs for each parameter measured by both the same and different observers were above 0.84, indicating high repeatability. At least 90% of the measurements by the same and different observers fell within the 95% confidence interval (CI). (2) At rest, the ARA in patients with constipation was significantly larger than in healthy men (P < 0.05). During MVC, LPA, the ARA excursion, LPA excursion, BP displacement, UVJ displacement, and ARJ displacement in constipation patients were also significantly larger than in healthy men (P < 0.05). Furthermore, BP displacement, UVJ displacement, and ARA excursion during maximal Valsalva maneuver in constipation patients were significantly larger than in healthy men (P < 0.05). (3) Receiver operating characteristic curve analysis revealed that the following indicators demonstrated area under the curve (AUC) values exceeding 0.75: ARA excursion of MVC, ARA excursion of maximal Valsalva maneuver, resting ARA, and ARJ displacement of MVC, with AUC values of 0.782, 0.778, 0.770, and 0.765, respectively. No significant differences in diagnostic performance were found among these indicators (P > 0.05). Conclusion Transperineal ultrasound is a reliable and practical technique for assessing the morphology and function of male PFMs. Parameters such as ARA excursion during MVC, ARA excursion during maximal Valsalva maneuver, resting ARA, and ARJ displacement during MVC are valuable for diagnosing PFM dysfunction in constipated patients.

Ultrasound diagnosis of first trimester umbilical cord entanglement in monochorionic monoamniotic twins - case report and review of the literature

BackgroundDiagnosis of umbilical cord entanglement (UCE) by ultrasound (US) in monochorionic monoamniotic (MCMA) twins in the second and third trimesters is common. However, only a few cases have been reported on the diagnosis of UCE as early as the first trimester. Herein, we report a case of the earliest-ever sonographic diagnosis of UCE and demonstrate the feasibility of its diagnosis by US.Case presentationA 32-year-old gravida 2 para 1 woman conceived after assisted reproductive technology (ART) treatment. In transvaginal US examination at 8.5 gestational weeks, two embryos with regular heartbeats in the same amniotic sac and with only one yolk sac were demonstrated. The fetal crown-rump lengths were 20 and 21 mm, appropriate for 8.4 and 8.5 gestational weeks, respectively. HD-flow power Doppler 2D and 3D US demonstrated two tightly entangled umbilical cords of the two fetuses. Spectral Doppler US showed two different heart rates (162 and 167 beats per minute) and blood flow in opposite directions from the point of entanglement of the two umbilical cords. This was consistent with a diagnosis of a first-trimester MCMA pregnancy with UCE. Missed abortion of the two embryos was diagnosed by US examination at 10.5 weeks, and the pregnancy was terminated by dilatation and curettage without further complications.ConclusionsUCE in the first trimester may occur as early as eight gestational weeks, and its diagnosis by ultrasound is feasible. UCE diagnosed in the first trimester may be a poor prognostic factor.

The uterine artery resistivity index is affected by embryo resorption rate at canine pregnancy diagnosis

The uterine artery resistivity index (RI) obtained by Doppler ultrasonography has become a common method in evaluating uterine blood flow during pregnancy for assessing canine fetal and placental conditions. During pregnancy, embryonic vesicle resorptions can be observed by ultrasound and have been found to increase with the aging of the dam. The RI is higher during induced abortion in bitches, while its relationship with early embryo resorptions is not yet clearly defined. The aim of this study was to evaluate whether the uterine artery's haemodynamics at pregnancy diagnosis are related to embryo resorption rates and other pregnancy and dam parameters. The ultrasound examinations were performed 25 ± 4 days post-ovulation (between days 21 and 29). During the examinations, the animals were in lateral recumbency, and both uterine horns were scanned to determine the number and viability of embryos and resorption sites. The left uterine artery was visualized, and the RI was determined. The breed, weight, reproductive anamnesis, and age of the animals were recorded. Forty-four bitches were included, weighing 2.8–39.2 kg, for 50 pregnancy diagnoses performed at ages ranging from 18 to 88 months. Bitches were allocated to different size groups according to their body weight and breed: Medium (M, 10–40.0 kg), Small (S, 5–9.9 kg), and Toy (XS, <5 kg). A linear regression was used to model the RI as the outcome, with size group and age of the dam (above or below the median value), litter size (sum of viable embryos and resorptions), gestational age (days post-ovulation), parity (multiparous vs. primiparous), cystic endometrial hyperplasia (present or not), and either the percentage of resorptions (on litter size) or simply their presence as predictors. The overall model was statistically significant (P = 0.029), with an R2 index of 0.296. A significant relationship with the response was found for gestational age (P = 0.012) and percentage of resorptions (P = 0.045). No significant relationships were found for the other parameters. As reported in the literature, as gestational age increased, RI decreased. Embryo resorptions were observed in 17/50 (34.0 %) pregnancies. As the percentage of resorption sites within the pregnancy increased, the RI also increased. Conversely, the simple presence or absence of resorption sites had no statistically significant effect on the RI. This study describes, for the first time, a significant impact of embryonic resorptions on uterine artery RI at pregnancy diagnosis. Whether these changes are a cause or effect of the abnormal pregnancy remains to be elucidated.

Ovarian-Adnexal Imaging-Reporting and Data System (O-RADS) ultrasound version 2019: a prospective validation and comparison to updated version (v2022) in pathologically confirmed adnexal masses.

To evaluate the diagnostic accuracy and reliability of the Ovarian-Adnexal Reporting and Data System (O-RADS) ultrasound v2019 in classifying adnexal masses (AMs) and compare the old and updated systems (v2022). This prospective study enrolled 977 consecutive women with suspected AMs from three institutions between January 2022 and December 2023. Ultrasound examinations were performed by three experienced radiologists who categorized AMs according to O-RADS ultrasound v2019. The same radiologists retrospectively reviewed the stored ultrasound images and provided the O-RADS ultrasound v2022 classification. Histopathology was used as the reference standard to calculate the diagnostic accuracy of the O-RADS versions in predicting malignant AMs. Inter-observer agreement (IOA) of the O-RADS scoring results was evaluated using the Fleiss kappa (κ) test. The final analysis included 803 women with 855 AMs (219 (25.6%) malignant and 636 (74.4%) benign). Both O-RADS versions demonstrated good diagnostic accuracy, with area under the curve (AUC) values ranging from 0.906 to 0.923 (v2019) and 0.919 to 0.936 (v2022). The updated v2022 showed a slightly higher accuracy (82.5-86.7% vs. 80.7-85.3%), sensitivity (93.6-95.0% vs. 92.2-94.1%), and specificity (78.1-84.1% vs. 76.1-82.9%) compared to v2019. The IOA for the overall O-RADS classification was perfect for both versions (κ = 0.96-0.97). The O-RADS ultrasound classification system demonstrated good diagnostic accuracy and reliability in predicting malignant AMs, with the updated v2022 showing modest improvements. Question Accurate classification of adnexal masses is essential for management. Can updated O-RADS ultrasound v2022 improve diagnostic accuracy and reliability compared to v2019 in predicting malignancies? Findings O-RADS ultrasound v2022 demonstrated slightly higher diagnostic accuracy for identifying malignant adnexal masses compared to v2019, reflecting modest improvements in risk stratification and clinical decision-making. Clinical relevance The updated O-RADS ultrasound v2022 provides improved risk stratification for adnexal masses, enhancing diagnostic confidence, supporting more precise clinical decision-making, and improving patient outcomes through timely intervention or tailored management strategies in ovarian cancer care.

Accuracy of fetal kidney length and transcerebellar diameter in assessment of gestational age in normal and growth restricted fetuses

Background: Accurate monitoring of fetal gestational age is one of the most critical components of prenatal care. Aim: This study intends to determine the accuracy of fetal gestational age estimation using mean fetal kidney length and transcerebellar diameter and comparing their efficacy with other biometric measurements in normal and growth restricted fetuses. Subjects and Methods: Our prospective study was conducted on 251 pregnant women seeking for routine ultrasound examination during the second half of pregnancy at Al-Hussein and Al-Zaharaa university hospitals starting from November 2021 till November 2022 and the following fetal biometric parameters were measured transabdominally during each ultrasound examination including the transcerebellar diameter (TCD), fetal kidney length (FKL), biparietal diameter (BPD), head circumferences (HC), abdominal circumferences (AC) and femur length (FL). Results: The FKL and TCD in the present study correlated well with the assigned GA. The relationship of fetal kidney growth and TCD with GA is statistically significant. The present study hence validates the recommendation that FKL and TCD can be used as an important sonographic parameter for accurate prediction of fetal gestation age especially in IUGR fetuses. Conclusion: Fetal kidney length and TCD are accurate parameters for assessment of gestational age in 2nd half of normal pregnancy. In addition, fetal kidney length and TCD are highly accurate for detection of gestation age in IUGR suspected pregnancies.

Features of the parotid gland anatomical parameters in men depending on the shape of the skull

BACKGROUND:Intravital analysis of parotid gland morphometric parameters in the context of various skull shapes is promi­sing, since it allows systematizing the available information on the parotid gland anatomy. AIM:To identify the features of the parotid gland anatomical parameters in men with different skull shapes according to computed tomography and magnetic resonance imaging. MATERIAL AND METHODS:We conducted a retrospective study based on the examination of computer and magnetic resonance tomograms of the heads of 92men. Depending on the skull shape, the study material was divided into groups: dolichocranes (n=30), mesocranes (n=32), brachycranes (n=30); chamecranes (n=19), orthocranes (n=47), hypsicranes (n=26); taipenocranes (n=33), metriocranes (n=30), acrocranes (n=29). Depending on the face shape, three groups were distinguished: euryenes (n=29), mesenes (n=33), leptens (n=40). A morphometric study of the parotid gland was performed with measurement of the sizes in three planes, as well as the volume of the organ using the technique of measuring internal organs’ volume during ultrasound examination. Statistical analysis was performed using nonparametric methods, such as the Kruskal–Wallis test, Mann–Whitney Utest with Bonferroni correction, and Spearman. RESULTS:In men, the sagittal size of the parotid gland significantly increased from brachycranes (4.22cm on the right, 3.99cm on the left) to dolichocranes [4.77cm on the right (p=0.0001), 4.57cm on the left (p=0.0001)]. A decrease in the frontal size of the gland was revealed from brachycranes ([3.43cm on the right, 3.47cm on the left) to dolichocranes [2.49cm on the right (p=0.0001), 2.47cm on the left (p=0.0001)]. With regard to the shapes of the facial skull, a significant difference in the vertical size of the gland was found [in euryenes 6.12cm on the right, 6.18cm on the left; in leptenes 6.98cm on the right (p0.0001), 6.95cm on the left (p0.0001)]. The frontal size value decreased significantly from euryens (3.42cm on the right, 3.53cm on the left) to leptenes [2.51cm on the right (p0.0001), 2.58cm on the left (p0.0001)]. CONCLUSION:In men with different forms of the cerebral skull, determined by the transverse-longitudinal index, the sagittal size of the parotid gland varies significantly; in men, depending on the shape of both the cerebral and facial skull, the frontal size of the gland changes.

ULTRASOUND APPEARANCE OF THE ENDOMETRIUM AND CLINICAL CORRELATION IN A CASE OF AMENORRHEA

The subject of this paper is the presentation of a clinical case of amenorrhea in a young woman with regular menstrual cycles and a positive pregnancy test. The ultrasound examination of the uterus at 5 weeks and 1 day after the last menstruation showed the absence of a gestational sac and a thin and hypoechoic endometrium. Since the pregnancy test was positive, the ultrasound examination was repeated after 7 days. During this interval, the patient presented a hemorrhage. The ultrasound performed 4 days after showed a thin endometrium with medium echogenicity. Repeating at 48 hours the measurement of the human chorionic gonadotrophin hormone showed low values that decreased, which correlated with the clinical and ultrasound aspects confirmed the diagnosis of early pregnancy failure.

ULTRASOUND EVALUATION OF THE UTERUS AND OVARIES IN A CASE OF AMENORRHEA OCCURING DURING THE ADMINISTRATION OF COMBINED ORAL CONTRACEPTIVES IN A YOUNG SMOKING WOMAN

The subject of this paper is the presentation of a clinical case of amenorheea occuring during the administration of combined oral contraceptives în a young smoking woman. The ultrasound examination of the uterus after 51 days of amenorrhea showed a hyperechoic and thickened endometrium. The measurement of the chorionic gonadotrophin showed a value of 835.8 mUI/ml, which corresponds to a pregnancy of 5 or 6 weeks of gestation. The ultrasound examination was repeted after 66 days of amenorrhea and an intrauterine pregnancy with a viable embryo was observed. The embryo had a crown-rump length of 6.1 mm, corresponding to a pregnancy of 6 weeks and 3 days of gestation.

Impact of Nonalcoholic Fatty Liver Disease on Weight Loss Outcomes After One Anastomosis Gastric Bypass.

Obesity-associated nonalcoholic fatty liver disease (NAFLD) is a significant cause of chronic liver disease. Our study sought to investigate preoperative NAFLD and the effect at 6 months and 2 years after surgery of one anastomosis gastric bypass (OAGB) and its development 6 months after surgery regarding weight loss outcomes. A retrospective cohort study was conducted on patients with severe obesity who underwent primary OAGB at Hazrat-e-Rasool Hospital between March 2020 and June 2021. Preoperative assessments included abdominal ultrasound (US) for NAFLD grading, weight, and biochemical blood tests. Follow-up examinations were performed at 10 days and 1, 3, 6, 9, 12, and 24 months postsurgery, with subsequent US examinations at the 6-month follow-up. Two hundred thirty-one patients were included, with an average age of 40.3±10.5 years and a percentage of 78.4 women. Their mean weight and BMI were 131.2±26.8 and 48.8±8.5, respectively. Six-month grades of NAFLD showed that patients with grade 3 NAFLD had significantly lower TWL% compared with the lower grades. NAFLD grades improved in 72.3% of our patients, remained the same at 21.2%, and worsened at 6.5%. The 6-month TWL% was 28.4±4.3 in the no-change group, 28.4±5.3 for the improved group, and 25.2±14.6 in the worse group. The severity and progression of NAFLD can significantly impact weight loss outcomes post-OAGB, highlighting the importance of monitoring and managing NAFLD in patients undergoing bariatric surgery.