Ultrasound Examination Research Articles

Correlation of adenomyosis features to live birth rates after the first IVF/ICSI treatment, when using the revised Morphological Uterus Sonographic Assessment group definitions.

Data regarding the impact of adenomyosis on the outcomes after invitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) treatment are conflicting. Standardized diagnostic criteria are prerequisites for studying a potential association between adenomyosis and IVF/ICSI treatment outcomes. This study aims to examine the cumulative live birth rate (CLBR) after the first IVF/ICSI treatment in women with or without direct or indirect features of adenomyosis, using the revised Morphological Uterus Sonographic Assessment (MUSA) group definitions. This was a prospective cohort study of 1037 women aged 25-≤39 years, undergoing their first IVF/ICSI treatment between January 2019 and October 2022. The presence of MUSA features of adenomyosis was assessed prior to treatment start. The CLBR after the first IVF/ICSI treatment was 424/1037 (40.9%, 95% CI, 37.9-43.8) in the total cohort. Women with direct features of adenomyosis had lower CLBR, 25/102 (24.5%; 95% CI, 17.5-31.5) than women without, 399/935 (42.7%; 95% CI, 39.5-45.8), p < 0.001. The adjusted relative risk (aRR) for live birth for women with direct features of adenomyosis compared to women without was 0.62 (95% CI, 0.43-0.88), p = 0.007. Direct features were associated with a higher risk of miscarriage after frozen embryo transfer, aRR 2.88 (95% CI, 1.49-5.57), p = 0.002. Women with indirect features had a lower CLBR [50/188 (26.6%, 95% CI, 20.3-32.9)] than women without [399/935, (42.7%, 95% CI, 39.5-45.8)], aRR 0.58 (95% CI, 0.45-0.75), p < 0.001. For features located in the inner myometrium, the aRR for live birth was 0.29 (95% CI 0.11-0.74), p = 0.010 and for the outer myometrium 2.61 (95% CI 1.42-4.8), p = 0.002. An interrupted junctional zone was the single feature that impacted CLBR the most. The presence of direct or indirect MUSA features of adenomyosis correlates to reduced live birth rates in women undergoing their first IVF/ICSI treatment. Features located in the inner myometrium, particularly an interrupted junctional zone, reduced the chance of live birth the most, whereas location in the outer myometrium was associated with higher chances of live birth. Systematic ultrasound examinations should be considered for women scheduled for IVF/ICSI treatment, for adequate counseling on the chances of successful treatment.

A Comparative Study on the Consistency of Ultrasound and X-Ray in Assessing Risser Sign.

Adolescent idiopathic scoliosis (AIS) is a 3-dimensional spinal deformity involving lateral curvature, sagittal plane imbalance, and vertebral rotation. In China, AIS affects over 3 million individuals, with 300,000 new cases annually. AIS impacts physical and psychological well-being, necessitating tailored treatment plans based on growth risk factors. This study evaluates the consistency of ultrasound and X-ray assessments of the Risser sign in AIS patients and explores correlations between iliac crest distance and pelvic rotation degree. This prospective study enrolled 80 patients diagnosed with AIS from June to September 2023 at Changzhou Sports Hospital. Eligible participants were aged 10-18 with a Cobb angle >10°. Ultrasonographic examinations were conducted by 3 experienced physicians using the VINNO V10 portable ultrasound system. The primary outcome was the Risser stage determined by X-ray and ultrasound, with secondary outcomes including thoracic and thoracic-lumbar segment rotation angles. Statistical analyses included kappa statistics, correlation analyses, and multiple regression. Among the 77 valid cases, 154 iliac wings were evaluated, with a high concordance rate of 77% between ultrasound and X-ray assessments. kappa values for left and right iliac crests were 0.723 and 0.808, respectively. Grouping Risser grades (0-1, 2-3, and 4-5) into 3 categories yielded kappa values of 0.93, 0.96, and 0.93, indicating high consistency. Significant correlations were found between iliac crest distances and rotation angles (left iliac crest distance and left thoracic rotation angle, r = 0.56, P < .001; right iliac crest distance and right thoracic-lumbar rotation angle, r = 0.69, P < .001; right iliac crest distance and right thoracic rotation angle, r = 0.39, P < .01). Ultrasound is a reliable, radiation-free alternative to X-ray for assessing the Risser sign in AIS patients. Despite observed inconsistencies in intermediate Risser grades, ultrasound's ability to reduce radiation exposure and provide consistent results makes it a valuable tool in clinical practice. Further research is needed to optimize ultrasound techniques and explore its potential for early detection and intervention in scoliosis management.

The Role of Ultrasound-Based Monitoring of Bladder Volume in Patients with Prostate Cancer during CyberKnife Stereotactic Radiosurgery

(1) Background: For patients irradiated due to prostate cancer, monitoring of bladder volume (BV) is crucial for accuracy of radiation delivery and minimizing exposure to surrounding healthy tissues. Due to the limited imaging capabilities of the CyberKnife system, ultrasound imaging plays a vital role in the monitoring of bladder filling. (2) Methods: A study was carried out in 142 prostate cancer patients treated with the CyberKnife system. Bladder ultrasound (US) was performed before each RTH session to assess real BV (rBV). The double US assessment of rBV was performed by two independent operators or a single operator during 177 and 495 RTH sessions, respectively, giving, in total, 1344 BV assessments. (3) Results: The mean BV in the first and second US assessment was 214.7 mL and 218.1 mL, respectively, while the mean planning bladder volume (pBV) was 340.8 mL. A pBV was significantly higher than an rBV. The mean difference between the US and CT assessment of BV was the smallest in the 100–349 mL group and the largest in the group above 349 mL. The Passing–Bablok regression results confirmed the reliability of the ultrasound (US) measurements. (4) Conclusions: The introduction of US-based BV assessment in patients irradiated due to prostate cancer using CyberKnife seems to be a crucial element in controlling the reproducibility of the treatment plan and should be a standard procedure. The pBV should be within the range of 200–300 mL. The US examination prior to CT scanning for planning is recommended to ensure the optimal range of BV for CT.

Hypoechoic ultrasonographic findings in the patellar ligaments are common in riding and trotting horses in training (116 cases).

Patellar ligament (PL) injuries are increasingly being reported in horses, but few studies have described the normal PL ultrasonographic appearance in horses. The aims of this prospective observational study were to describe the ultrasonographic appearance of the PLs and infrapatellar fat pad in a population of horses in training and to relate the ultrasonographic findings to objectively measured movement asymmetry. B-mode and color Doppler ultrasonographic examination of the PLs and infrapatellar fat pad in both hind limbs and objective gait analyses were performed on the 116 riding and trotting horses included in the study. The association between ultrasonographic findings, horse age, and movement asymmetry during the trot was then investigated. Distinct or diffuse hypoechoic regions were commonly found in the intermediate PL (24/116; 20.7%), especially in the caudal aspect of the mid-third of the ligament. The infrapatellar fat pad had a hypoechoic striated appearance in all horses except one, in which it was hyperechoic. No association was found between ultrasonographic findings in the PLs and infrapatellar fat pad and lameness. It is important to recognize that there is biological variation in PL appearance, which may or may not be associated with pain in this area, therefore emphasizing the use of local analgesia to determine the location of the lameness.

Type 1 diabetes mellitus; ovarian reserve; anti-Müllerian hormone; ovarian function

BACKGROUND: Prolonged course of diabetes mellitus often leads to the development of vascular complications, insufficiency of ovarian function. The occurrence of diabetes mellitus in women before pregnancy (pregestational diabetes mellitus) it can have various adverse consequences for the mother, fetus, child and the course of pregnancy. Pregnancy planning in women with pregestational diabetes significantly improves the outcomes of pregnancy and childbirth. AIM: The aim of this study was to analyze gonadotropic and ovarian function parameters in patients with type 1 diabetes mellitus depending on the age of onset, duration and compensation level of the disease. MATERIALS AND METHODS: The patients included into this clinical prospective study were divided into two groups. The main group consisted of 216 patients with type 1 diabetes mellitus aged 18 to 39 years (mean age: 27.1 ± 3.1 years). The control group consisted of 30 healthy women of reproductive age. Chemiluminescent immunoassay was used to determine blood serum levels of anti-Müllerian hormone, follicle-stimulating hormone, luteinizing hormone, prolactin, estradiol, testosterone, free testosterone, and sex hormone-binding globulin from day 2 to day 5 of the menstrual cycle. Serum progesterone levels were measured on days 20–23 of the menstrual cycle for three consecutive cycles. Glycated hemoglobin levels were also studied in the blood serum of patients with type 1 diabetes mellitus. All the patients underwent pelvic ultrasound examination to assess the cohort of antral follicles and ovarian volume. RESULTS: The average age of menarche in patients with type 1 diabetes mellitus who developed the disease at the age of under 10 years was 14.2 ± 1.2 years. This was higher than in the group of girls with the onset of the disease over the age of 10 years (13.5 ± 1.2 years) and in women of the control group (11.9 ± 1.1 years). When assessing the ovarian reserve in patients with type 1 diabetes mellitus, we found a decrease in anti-Müllerian hormone level and antral follicle count in the group of women with disease onset at the age of under 10 years. We did not find differences in the ovarian reserve parameters in patients depending on disease duration. Normogonadotropic normoprolactinemic ovarian insufficiency was detected in 154 (71.3%) of 216 patients, while the rest 62 (28.7%) women had an ovulatory menstrual cycle. In patients with anovulation, luteal phase deficiency and ovulatory menstrual cycle, we found no differences between the age of development of type 1 diabetes mellitus, its duration, glycated hemoglobin levels, total daily insulin dose and insulin dose per kilogram of body mass. In patients receiving intensive insulin therapy with continuous subcutaneous insulin infusion, glycated hemoglobin level was lower than in those receiving multiple dose insulin injection therapy. CONCLUSIONS: The average age of menarche in patients with type 1 diabetes mellitus is higher than in healthy women. The ovarian reserve parameters in patients with early onset of the disease, before 10 years of age, are lower than in patients who developed type 1 diabetes mellitus after 10 years of age. Duration of pregnancy planning period depends on compensation level of the disease and lasts from six to 12 months. This requires the doctor and patient to prepare for the implementation of reproductive tasks as early as possible, especially in patients whose disease onset occurred in pre-pubertal period.

Assessment of dietary intake in patients with metabolic dysfunction-associated steatotic liver disease using the Ukrainian version of the EPIC-Norfolk Food Frequency Questionnaire: A cross-sectional study

Metabolic dysfunction‑associated steatotic liver disease (MASLD) is prevalent worldwide. Studies demonstrate a possible association between diet and MASLD. However, data regarding patients in Ukraine are lacking. Objective — to study dietary habits and meeting recommended dietary intake in patients with MASLD. Materials and methods. Adults with MASLD aged 18 years and older (n=29) receiving care in outpatient settings who fully completed the adapted and validated Ukrainian version of the EPIC‑Norfolk Food Frequency Questionnaire (FFQ) were included in the analysis. Liver steatosis was confirmed by ultrasound examination, and diagnosis of MASLD was based on the criteria defined by the American Association for the Study of Liver Diseases. As a reference for recommended dietary intake, data from the Dietary Guidelines for Americans, 2020—2025 years were used. FETA software was used to calculate nutrient data from the FFQ. The one‑sample t‑test, t‑test, the one‑sample signed rank sum test, and Mann‑Whitney test were used to assess the differences between the sample and the reference data. The chi‑squared test was used to analyse categorical data. Results. The mean age of participants was 41.4±12 years, 69% of participants being female. The mean body mass index was 35.4±7.9 kg/m2. Participants consumed more protein, than recommended by current dietary recommendations. Women also tended to have higher energy intake and consume more fat, saturated fatty acids, and carbohydrates than recommended. The median fibre intake was 19.36 g (Q1; Q3 : 13.29; 26.45), which is lower than the recommended 14 g per 1000 kcal (p=0.0015). Dietary intake of most vitamins and micronutrients was met. However, women and men consumed less than 600 IU of vitamin D daily. Among all patients with MASLD, sodium intake (3829.5±1559.3 mg) was significantly higher than recommended (2300 mg, p&lt;0.0001). Approximately 62% of participants take dietary supplements, with vitamin D being the most popular choice. Conclusions. Our study showed that patients with MASLD in Ukraine tend to exceed recommended protein and sodium intake and, at the same time, have low fibre and Vitamin D consumption. High energy intake and saturated fatty acids consumption are also of concern.

7394 Testicular Function in Young Adults with Growth Hormone (GH) Deficiency Previously Treated with GH: Comparison with Normal Controls

Abstract Disclosure: R. Cannarella: None. A. Crafa: None. S. Sapienza: None. M.M. Caruso: None. A.E. Calogero: None. Background: We have previously reported that treatment with recombinant human growth hormone (rhGH) can influence testicular growth and puberty onset in children with GH deficiency (GHD), and suggested GH as a determinant of testicular growth in childhood (doi: 10.3389/fendo.2021.619895). Limited evidence is available on testicular function in post-pubertal GHD patients. Objective: This prospective controlled study was undertaken to evaluate testicular function in young GHD adults previously undergone to GH treatment. Patients and Methods: Post-pubertal patients with non-syndromic GHD (&amp;gt;18 years), in whom GH therapy was discontinued after reaching the therapeutic goal, were required to have a complete evaluation of testicular function. Those who agreed were enrolled in our study. Age-matched healthy men older than 18 years served as controls. Exclusion criteria were: the presence of varicocele, urogenital infections, cryptorchidism, hypospadias, hypogonadism, testicular trauma or torsion, and other congenital or acquired disorders capable of interfering with testicular function. The study outcomes were: serum gonadotropins and total testosterone (TT), conventional sperm parameters, and testicular volume (TV) measured by ultrasound examination. Between-group analysis was performed using the Student’s t-test for independent samples or the Mann-Whitney test, for normally or non-normally distributed variables, respectively. Data were reported as mean±standard deviation for non-skewed data and median (interquartile range) for skewed data. Results: 26 patients with GHD and 25 age-matched controls (18.8±3.3 years vs. 20.1±3.6 years; p=0.18) were enrolled. Patients and controls did not differ for serum luteinizing hormone [2.6 (1.5-4.9) IU/L vs. 3.5 (2.8-4.8) IU/L); p=0.2], follicle-stimulating hormone [3.4 (2.2-4.3) IU/L vs. 3.1 (2.3-4.3) IU/L); p=1.0], and TT [5.7 (4.7-6.8) ng/dL vs. 6.0 (5.1-7.4) ng/dL); p=0.4] levels. At semen analysis, GHD patients had lower semen volume (2.1±1.4 mL vs. 3.5±1.5 mL; p=0.002), total sperm count [135.0 miL/ejaculate (54.3-229.0) vs. 231.3 miL/ejaculate (124.8-285.0); p=0.03], progressive motility [25.5% (15.0-34.0%) vs. 32.0% (30.0-36.5); p=0.02], and total motility [56.0% (49.0-62.0) vs. 66.5% (62.5-70.0); p=0.0001] compared to controls. No difference was found in sperm concentration [73.0 miL/mL (45.0-92.0) vs. 68.0 miL/mL (39.0-90.0); p=1.0] and normal morphology [8.5% (7.0-12.0) % vs. 10.0% (7.5-14.0); p=0.3]. Importantly, GHD patients had lower right (13.3±3.4 mL vs. 16.9±4.1 mL; p=0.001) and left (12.5±3.4 mL vs. 16.3±3.8 mL; p=0.0005) TV. Conclusion: This study provides the first evidence of lower TV and slightly worse semen parameters in patients with GHD compared to healthy controls. Serum GH levels during growth may be important for achieving normal testicular volume and spermatogenesis in adulthood. Presentation: 6/2/2024

9277 Testicular Function in Young Adults with Growth Hormone (GH) Deficiency Previously Treated with GH: Comparison with Normal Controls

Abstract Disclosure: R. Cannarella: None. A. Crafa: None. S. Sapienza: None. M.M. Caruso: None. A.E. Calogero: None. Background: We have previously reported that treatment with recombinant human growth hormone (rhGH) can influence testicular growth and puberty onset in children with GH deficiency (GHD), and suggested GH as a determinant of testicular growth in childhood (doi: 10.3389/fendo.2021.619895). Limited evidence is available on testicular function in post-pubertal GHD patients. Objective: This prospective controlled study was undertaken to evaluate testicular function in young GHD adults previously undergone to GH treatment. Patients and Methods: Post-pubertal patients with non-syndromic GHD (&amp;gt;18 years), in whom GH therapy was discontinued after reaching the therapeutic goal, were required to have a complete evaluation of testicular function. Those who agreed were enrolled in our study. Age-matched healthy men older than 18 years served as controls. Exclusion criteria were: the presence of varicocele, urogenital infections, cryptorchidism, hypospadias, hypogonadism, testicular trauma or torsion, and other congenital or acquired disorders capable of interfering with testicular function. The study outcomes were: serum gonadotropins and total testosterone (TT), conventional sperm parameters, and testicular volume (TV) measured by ultrasound examination. Between-group analysis was performed using the Student’s t-test for independent samples or the Mann-Whitney test, for normally or non-normally distributed variables, respectively. Data were reported as mean±standard deviation for non-skewed data and median (interquartile range) for skewed data. Results: 26 patients with GHD and 25 age-matched controls (18.8±3.3 years vs. 20.1±3.6 years; p=0.18) were enrolled. Patients and controls did not differ for serum luteinizing hormone [2.6 (1.5-4.9) IU/L vs. 3.5 (2.8-4.8) IU/L); p=0.2], follicle-stimulating hormone [3.4 (2.2-4.3) IU/L vs. 3.1 (2.3-4.3) IU/L); p=1.0], and TT [5.7 (4.7-6.8) ng/dL vs. 6.0 (5.1-7.4) ng/dL); p=0.4] levels. At semen analysis, GHD patients had lower semen volume (2.1±1.4 mL vs. 3.5±1.5 mL; p=0.002), total sperm count [135.0 miL/ejaculate (54.3-229.0) vs. 231.3 miL/ejaculate (124.8-285.0); p=0.03], progressive motility [25.5% (15.0-34.0%) vs. 32.0% (30.0-36.5); p=0.02], and total motility [56.0% (49.0-62.0) vs. 66.5% (62.5-70.0); p=0.0001] compared to controls. No difference was found in sperm concentration [73.0 miL/mL (45.0-92.0) vs. 68.0 miL/mL (39.0-90.0); p=1.0] and normal morphology [8.5% (7.0-12.0) % vs. 10.0% (7.5-14.0); p=0.3]. Importantly, GHD patients had lower right (13.3±3.4 mL vs. 16.9±4.1 mL; p=0.001) and left (12.5±3.4 mL vs. 16.3±3.8 mL; p=0.0005) TV. Conclusion: This study provides the first evidence of lower TV and slightly worse semen parameters in patients with GHD compared to healthy controls. Serum GH levels during growth may be important for achieving normal testicular volume and spermatogenesis in adulthood. Presentation: 6/2/2024

8402 The Usefulness Of The Contrast-Enhanced Ultrasound (CEUS) In Preoperative Localization Of Parathyroid Gland Adenomas

Abstract Disclosure: A. Żyłka: None. K. Dobruch-Sobczak: None. H. Piotrzkowska-Wróblewska: None. P. Góralski: None. J. Gałczyński: None. E. Bakuła-Zalewska: None. M. Dedecjus: None. Objectives: Preoperative localization of parathyroid gland adenomas in patients diagnosed with primary hyperparathyroidism (pHPT) is challenging process. The aim of the study was to assessed the usefulness of contrast-enhanced ultrasound (CEUS) as complimentary diagnostic modality to conventional ultrasonography for detection of hyperfunctioning parathyroid gland lesions. Methods: Between the years 2021 and 2022, 36 adult patients (33 women and 3 men, aged 37-76) diagnosed with pHPT, underwent high-resolution ultrasound (US) and CEUS of parathyroid gland adenomas, suspected after fine-needle aspiration biopsy with positive parathormone (PTH) wash-out results and/or avid in 99mTechnetium -sestamibi scintigraphy. During CEUS examination 1.5 ml of SonoVue contrast has been injected and followed by analysing of qualitative CEUS enhancement features. All patients were qualified to surgical treatment according to clinical symptoms, laboratory and imaging findings and underwent parathyroidectomy with histopathologic results confirming parathyroid gland adenomas. Analysis of the B-mode features and visual CEUS enhancement patterns was performed retrospectively. Ten CEUS qualitative parameters of lesions were assessed including: homo- or heterogenous enhancement; hyper- or hypoenhancement; distribution of contrast in wash-in phase as: centripetal, centrifugal or combined and in wash-out phase as: centrally, peripherally or combined. Then the model was extended using the results based on US B-mode imaging which involved size, echogenicity, calcifications, cystic components and vascularity patterns assessed in Color Doppler (CD) and superb microvascular imaging (SMI). Results: Histopathologic results included 36 parathyroid adenomas (in 33 women and 3 men), the medium size 18.8mm (±11.1) and volume 3.7mm3 (±8.2). In B-mode US examination the majority of lesions were assessed as hypoechoic (n=36; 100%) with dominant inhomogenous echostructure (n=20; 55.5%), mixed vascularity (n=24; 66.6%) and polar vessel observed in 14 lesions (38.8%). There were no adenomas with calcifications, cystic components were observed only in 4 nodules (11.1%). In the CEUS study, dominated qualitative features were homogenous (n=22; 61,1%) and hyperenhancement (n=27; 75%), with centripetal distribution of contrast in wash-in phase (n=24; 66,6%) and dominant centrally wash-out of the contrast (n=20; 55,5%). Conclusions: Preliminary results indicate ultrasonographic patterns characteristic for parathyroid gland adenomas in multiparametric ultrasound involved CEUS examination, which seemed to be valuable tool for localization hyperfunctional parathyroid glands. Further multicenter studies should be performed to standardize qualitative CEUS features in order to diagnose primary hyperparathyroidism preoperatively. Presentation: 6/1/2024

8402 The Usefulness of the Contrast-Enhanced Ultrasound (CEUS) in Preoperative Localization of Parathyroid Gland Adenomas

Abstract Disclosure: A. Żyłka: None. K. Dobruch-Sobczak: None. H. Piotrzkowska-Wróblewska: None. P. Góralski: None. J. Gałczyński: None. E. Bakuła-Zalewska: None. M. Dedecjus: None. Objectives: Preoperative localization of parathyroid gland adenomas in patients diagnosed with primary hyperparathyroidism (pHPT) is challenging process. The aim of the study was to assessed the usefulness of contrast-enhanced ultrasound (CEUS) as complimentary diagnostic modality to conventional ultrasonography for detection of hyperfunctioning parathyroid gland lesions. Methods: Between the years 2021 and 2022, 36 adult patients (33 women and 3 men, aged 37-76) diagnosed with pHPT, underwent high-resolution ultrasound (US) and CEUS of parathyroid gland adenomas, suspected after fine-needle aspiration biopsy with positive parathormone (PTH) wash-out results and/or avid in 99mTechnetium -sestamibi scintigraphy. During CEUS examination 1.5 ml of SonoVue contrast has been injected and followed by analysing of qualitative CEUS enhancement features. All patients were qualified to surgical treatment according to clinical symptoms, laboratory and imaging findings and underwent parathyroidectomy with histopathologic results confirming parathyroid gland adenomas. Analysis of the B-mode features and visual CEUS enhancement patterns was performed retrospectively. Ten CEUS qualitative parameters of lesions were assessed including: homo- or heterogenous enhancement; hyper- or hypoenhancement; distribution of contrast in wash-in phase as: centripetal, centrifugal or combined and in wash-out phase as: centrally, peripherally or combined. Then the model was extended using the results based on US B-mode imaging which involved size, echogenicity, calcifications, cystic components and vascularity patterns assessed in Color Doppler (CD) and superb microvascular imaging (SMI). Results: Histopathologic results included 36 parathyroid adenomas (in 33 women and 3 men), the medium size 18.8mm (±11.1) and volume 3.7mm3 (±8.2). In B-mode US examination the majority of lesions were assessed as hypoechoic (n=36; 100%) with dominant inhomogenous echostructure (n=20; 55.5%), mixed vascularity (n=24; 66.6%) and polar vessel observed in 14 lesions (38.8%). There were no adenomas with calcifications, cystic components were observed only in 4 nodules (11.1%). In the CEUS study, dominated qualitative features were homogenous (n=22; 61,1%) and hyperenhancement (n=27; 75%), with centripetal distribution of contrast in wash-in phase (n=24; 66,6%) and dominant centrally wash-out of the contrast (n=20; 55,5%). Conclusions: Preliminary results indicate ultrasonographic patterns characteristic for parathyroid gland adenomas in multiparametric ultrasound involved CEUS examination, which seemed to be valuable tool for localization hyperfunctional parathyroid glands. Further multicenter studies should be performed to standardize qualitative CEUS features in order to diagnose primary hyperparathyroidism preoperatively. Presentation: 6/1/2024

Evaluation of early and systematic ultrasound examination to determine postoperative dehiscence after small intestinal surgery (114 cases in dogs and cats).

To evaluate the feasibility and reliability of early ultrasound diagnosis for postsurgical bowel dehiscence and find the most reliable ultrasound criteria for dehiscence identification. Additionally, to determine the impact of early ultrasound detection of leakage in terms of survival and duration of hospitalization. Finally, to assess the need for systematized screening or checkup of the population at risk of dehiscence only. 31 cats and 83 dogs. A retrospective, records-based study was performed on 83 dogs and 31 cats (114 total) undergoing small intestinal surgery. Epidemiologic data, clinical signs, surgical procedures, pre- and postoperative ultrasound findings at 48 to 96 hours, hospitalization duration, complications, and general outcomes were recorded. Univariate and multivariate analyses were used to identify ultrasound findings associated with dehiscence. Dehiscence was suspected by ultrasound for 0 of 31 cats and 7 of 83 dogs (2 of 49 for enterotomy and 5 of 34 for enterectomy). Every suspected dehiscence was confirmed during revision surgery except one enterectomy revision, which was declined by the owner. Neither this case nor those without ultrasound evidence of dehiscence developed clinical signs of intestinal leakage. Direct visibility of wall discontinuity, presence of gas bubbles, and liquid in vicinity of the intestinal surgical site were statistically associated with early dehiscence. Survival rate after the second surgery was 83%. Median hospitalization time after the second surgery for dehiscence was 2 days (minimum, 2 days; maximum, 4 days). Postoperative ultrasound examination between 48 and 96 hours after intestinal surgery allows early and sensitive detection of intestinal dehiscence. Survival rate after revision surgery was significantly higher than that associated with septic peritonitis.

Catheter-related internal jugular vein thrombosis in neonates and long-term consequences: a prospective cohort study.

The incidence of central venous catheter-related thrombosis and the long-term effects of thrombosis on catheterized veins in neonates is unknown. We therefore determined the incidence of central venous thrombosis, identified associated risk factors, and evaluated outcomes at 6 months. We enrolled neonates aged less than 28 days scheduled for major intestinal or cardiac surgery whom we expected to require central venous catheters for at least 48 hours. Catheter size, insertion method, and puncture site were determined by the attending anesthesiologist. The duration of catheterization was also determined by clinical need. Central venous thrombi were diagnosed by color Doppler ultrasound imaging within 48 hours after catheter removal; results were not shared with clinicians. Ultrasound examinations were repeated 1, 3, and 6 months after discharge. We enrolled 188 neonates over 2 years. The median duration of catheter insertion was 12 days. 128 (68%) of the neonates had central venous thrombi at the catheter site, all of which were asymptomatic. Among patients with thrombi, 29 (23%) had complete vessel occlusion and 5 (4%) had venous stenosis at 6 months after discharge. Thrombi therefore spontaneously resolved by 6 months in 73% of the neonates. CVC/vein diameter ratio, duration of catheterization, and catheter dysfunction were independent risk factors for vessel thrombus. Complete vessel occlusion was most common in patients whose thrombus occupied more than 58% of the vessel at the initial assessment. Covert central venous thrombosis is frequent in neonates who have central venous catheters, and complications are most common in patients who have large intravascular thrombi. Neonates with large intravascular thrombi should be followed, and considered for anticoagulation.

Perineal hernia in a pregnant Angus heifer (Bos taurus)

AbstractThis case report details a perineal hernia in a 3‐year‐old Angus heifer in late gestation. The heifer had a gradually increasing swelling of the perineal region since 2 weeks. Upon palpation, the swelling was painless, hard and non‐reducible. Ultrasonographic examination revealed a hernial sac enclosing the non‐pregnant horn of the uterus, filled with homogenous hypoechoic fluid. Based on the anamnesis and clinical examination, a tentative diagnosis of perineal herniation was made. Considering the deteriorating clinical condition of the cow and the possible risk of dystocia, the viable calf was delivered by Caesarean section. The cow recovered with a reducible hernial sac, which was decided not to correct surgically due to its large size. After 7 days, the cow showed no further complications and was discharged. In conclusion, although rare, a perineal hernia involving the uterus should be considered in the differential diagnosis of perineal swellings in pregnant cows.

Assessment of thyroid nodule risk stratification knowledge and utilization among Polish physicians: a pilot study.

Ultrasonography is the primary diagnostic tool for evaluating thyroid nodules. The Thyroid Imaging Reporting & Data System (TIRADS) aims to standardise assessment and reduce fine-needle aspiration biopsies through risk stratification. This pilot study examined knowledge and utilisation of TIRADS among Polish physicians, their perception of the usefulness of TIRADS application and the extent of knowledge of individual nodule features included. An internet-based questionnaire about TIRADS use in clinical practice was sent out to Polish Ultrasound Society members. Information on the responder's experience with thyroid ultrasound and knowledge and use of TIRADS was assessed and analysed. Out of 159 physicians, 66.6% did not use TIRADS despite 43.4% being aware of its existence. EU-TIRADS was the most commonly adopted classification (50.9%). Participants who adopted TIRADS were younger (p = 0.047) and more likely to be radiologists (p < 0.01). TIRADS use was more prevalent in university clinical hospitals (p = 0.02), among physicians doing thyroid ultrasound as their primary professional activity (p < 0.01), those performing > 100 thyroid ultrasound examinations per year (p < 0.01) and those involved with thyroid fine-needle aspiration biopsy (p < 0.01). The purposes of TIRADS adoption (p < 0.01) and included imaging features (p < 0.01) were more accurately recognized by TIRADS users. TIRADS utilization among Polish clinicians is limited, despite awareness of the classification's existence. Knowledge of TIRADS components and the purpose of its application among users is satisfactory. Further training and TIRADS adoption should be encouraged, especially in the light of the recent EU-TIRADS-PL guidelines recommended by the Polish Scientific Societies.

Early menstrual cycle impacts of oestrogen and progesterone on the timing of the fertile window.

What is the effect of oestrogen and progesterone at the beginning of the menstrual cycle in delaying entry into the fertile window? Both oestrogen and progesterone contribute to a delay in the onset of the fertile window. Oestrogen enhances cervical mucus secretion while progesterone inhibits it. Observational study. Daily observation of 220 menstrual cycles contributed by 88 women with no known menstrual cycle disorder. Women recorded cervical mucus daily and collected first-morning urine samples for analysis of oestrone-3-glucuronide, pregnanediol-3-alpha-glucuronide (PDG), FHS, and LH. They underwent serial ovarian ultrasound examinations. The main outcome measure was the timing within the cycle of the onset of the fertile window, as identified by the appearance of mucus felt or seen at the vulva. Low oestrogen secretion and persistent progesterone secretion during the first week of the menstrual cycle both negatively affect mucus secretion. Doubling oestrogen approximately doubled the odds of entering the fertile window (OR: 1.82 95% CI=1.23; 2.69). Increasing PDG from below 1.5 to 4µg/mg creatinine was associated with a 2-fold decrease in the odds of entering the fertile window (OR: 0.51 95% CI=0.31; 0.82). Prolonged progesterone secretion during the first week of the menstrual cycle was also statistically significantly associated with higher LH secretion. Finally, the later onset of the fertile window was associated with statistically significant persistently elevated LH secretion during the luteal phase of the previous menstrual cycle. This post hoc study was conducted to assess the potential impact of residual progesterone secretion at the beginning of the menstrual cycle. It was conducted on an existing data set because of the scarcity of data available to answer the question. Analysis with other datasets with similar hormone results would be useful to confirm these findings. This study provides evidence for residual progesterone secretion in the early latency phase of some menstrual cycles, which may delay the onset of the fertile window. This progesterone secretion may be supported by subtly increased LH secretion during the few days before and after the onset of menses, which may relate to follicular waves in the luteal phase. Persistent progesterone secretion should be considered in predicting the onset of the fertile window and in assessing ovulatory dysfunction. The authors declare no conflicts of interest. No funding was provided for this secondary data analysis. N/A.

Correlation of Necrotizing Enterocolitis (Nec) on Radiology Examination of Plain Abdomen Photo and Ultrasonography (USG)

Introduction: Necrotizing enterocolitis (NEC) is an inflammatory condition caused by infectious agents with a background of immaturity of local defense mechanisms and hypoxic-ischemic damage to the intestinal mucosa. Plain abdominal radiography can be used to examine this condition. The results of diagnostic imaging of the neonatal gastrointestinal tract have relatively limited accuracy, and limit improvements in diagnostic efforts and determine the severity. The results of the examination can also be used with ultrasound. This study aims to analyze the correlation of NEC examination using plain radiography and ultrasound. Methods: This type of research uses a retrospective cohort study. The subjects of the study were 39 patients who underwent plain radiography and ultrasound examinations related to NEC conditions. The data source for this study is secondary data obtained through an intermediary media, namely PACS. The secondary data source for this study is data that has been recorded at the Radiology Installation of Hasan Sadikin Hospital in the period January 2023-June 2024. The Spearman correlation test was used to test the hypothesis of a correlation between NEC examinations using plain radiography and ultrasound. Results: The results of the Spearman correlation test showed no significant correlation between NEC examination using plain radiographs and USG with a correlation coefficient value of 0.138. The findings that can be taken from this study are that there is an increase in grade in patients who undergo USG examination. This finding proves the importance of conducting USG examination to confirm NEC conditions more accurately. Conclusion: There is no significant correlation between NEC examination using plain radiographs and USG. Examination using USG can confirm NEC more accurately, as evidenced by an increase in grade in 43.58% of study subjects.

Blood Flow of the Infraspinatus Muscle in Individuals With and Without Shoulder Pain and Myofascial Trigger Points: A Color Doppler Ultrasound and Reliability Study.

Myofascial trigger points (MTrPs) are potential contributors to shoulder pain and can lead to local ischemia and hypoxia, thus causing pain. Color Doppler ultrasound (US) has been used to examine the vascular environment around MTrPs, but has not been used to examine blood flow impairments in patients with shoulder pain and MTrPs. The reliability of color Doppler US for measuring infraspinatus muscle blood flow also has not been established. This study aimed to investigate differences in blood flow between individuals with and without shoulder pain and the reliability of Doppler US for measuring infraspinatus muscle blood flow. Forty participants were enrolled, 20 with shoulder pain and MTrPs and 20 without. Color Doppler US examination was performed twice on each participant to measure peak systolic velocity (PSV), end-diastolic velocity (EDV), resistive index (RI), and pulsatile index (PI) of the infraspinatus muscle. The symptomatic participants had significantly higher PSV (ie, impaired blood flow) than the asymptomatic participants. There were no significant between-group differences in EDV, RI, and PI. The results also demonstrated good-to-excellent intra-rater reliability for color Doppler US measurements of PSV, EDV, RI, and PI for both groups. This study demonstrated differences in blood flow near MTrPs in the infraspinatus muscle between individuals with and without shoulder pain. It also established good-to-excellent reliability of color Doppler US in measuring infraspinatus muscle blood flow. These findings suggest color Doppler US is a useful tool to identify vascular impairments for shoulder pain associated with MTrPs.

Patient satisfaction using handheld ultrasound at emergency department in Jordan University Hospital

IntroductionThe use of portable ultrasound equipment in emergency medicine has shown the capacity to greatly improve patient care in the swiftly changing field. This research evaluates the influence of the Butterfly POCUS device on patient contentment in the Emergency Department at Jordan University Hospital.Materials and MethodsWe conducted a cross-sectional survey of 98 patients to examine their satisfaction levels after undergoing an ultrasound examination. We then evaluated these levels in relation to demographic and clinical characteristics.ResultsSeventy eight percent of the patients expressed a high level of satisfaction with their evaluation. This satisfaction level was consistent across all patient demographics, with no notable differences. Significantly, there was a clear correlation between greater satisfaction levels and higher first pain ratings, indicating that the technology effectively addresses patient concerns and enhances the diagnostic experience.ConclusionThe findings of our study support the wider use of portable ultrasound technology in emergency care settings, emphasizing its ability to greatly enhance patient satisfaction and outcomes. Further investigation should include multicenter trials to authenticate these results and investigate the long-term effects on clinical practice.

Diagnosis and Analysis of Vasa Previa Types With Flow HD Glass Body.

To explore the value of applying flow high definition (HD) glass body in prenatal diagnosis of vasa previa and to preliminarily discuss the types of vasa previa. Two-dimensional ultrasound, flow HD, and flow HD glass body were used to image the umbilical cord insertion site and placenta, observe the cervical internal os and surrounding areas, and retrospectively analyze cases of vasa previa. There were 15 cases of vasa previa, including 14 cases of singleton pregnancies and 1 case of twin pregnancy, with a total of 22 vasa previa, including 10 veins and 12 arteries. There was 1 case with 3 vessels, 5 cases with 2 vessels, and 9 cases with a single vessel. Among them, in 3 cases of vasa previa detected at 12, 14, and 24 weeks, respectively, the vasa previa were relocated to a normal position at 24, 29, and 35 weeks of gestation when re-examined. Routine 2-dimensional ultrasound examination in this group showed tubular or circular hypoechoic areas near the cervical internal os, but vasa previa could not be confirmed. Flow HD could display color blood flow at and near the cervical internal os in 15 cases, but it was difficult to continuously show the course and source of the blood vessels under the chorion. Flow HD glass body from multiple angles could display the relationship between 15 cases of 22 vasa previa and the placenta and cervix. Combined with color Doppler blood flow spectra, flow HD glass body could determine the types of vasa previa. Flow HD glass body imaging can clearly display vasa previa, showing their origin and the spatial relationship with the cervix and placenta in a 3-dimensional manner, displaying the course and attachment points of umbilical vessels under the chorion. It can observe the area of interest at any angle, and combined with color Doppler blood flow spectra, it can judge the vasa previa of the umbilical vein, providing a more definite imaging basis for clinical management.

B-355 Assessment of Calcitonin Cutoff Values for Post-Thyroidectomy Surveillance in Patients with Medullary Thyroid Carcinoma: Findings from a Single-Center Investigation

Abstract Background Patients with sporadic or hereditary Medullary Thyroid Carcinoma (MTC) often undergo total thyroidectomy and lymph node dissection, with postoperative surveillance relying on serum calcitonin levels and ultrasound examinations. According to American Thyroid Association (ATA) guidelines, detectable levels of serum calcitonin and Carcinoembryonic Antigen (CEA) post-thyroidectomy suggest potential disease persistence or recurrence, necessitating frequent monitoring for early detection. This study sought to reassess the role of postoperative calcitonin levels in identifying possible tumor recurrence. Methods A retrospective analysis was conducted using Siemens Atellica to test calcitonin levels in 562 samples collected between 09/27/2022 and 08/11/2023, at least 3 months post-total thyroidectomy. Imaging studies performed within 6 months of the calcitonin assessment were also reviewed. Sample pools with calcitonin concentrations near 3.00 and 5.00 pg/mL were utilized to determine the limit of quantification (LoQ). CEA results were included for comparison. Additionally, 16 serum samples were analyzed using the Roche Cobas system at a reference laboratory. Results Precision analysis around 3.00 and 5.00 pg/mL revealed coefficients of variation (CVs) of 16.49% and 8.87%, respectively. Comparison of calcitonin levels between Siemens Atellica and Roche Cobas systems demonstrated consistent levels &amp;lt; 5.00 pg/mL in 15 out of 16 samples, indicating alignment and reliability between the platforms. A calcitonin cutoff of 1.89 pg/mL yielded 43% sensitivity and 67% specificity, while a cutoff of 5.00 pg/mL resulted in 0% sensitivity and 100% specificity. Conclusions Our findings suggest that a 5 pg/mL calcitonin cutoff on the Siemens Atellica platform may be suitable for identifying tumor persistence or recurrence in post-thyroidectomy patients within our institution. However, individual laboratories should establish their LoQ criteria when interpreting calcitonin levels for postoperative monitoring of tumor recurrence.