Ultrasound Findings Research Articles

Comparative Analysis of Large Language Models in Simplifying Turkish Ultrasound Reports to Enhance Patient Understanding

Objective: To evaluate and compare the abilities of Language Models (LLMs) in simplifying Turkish ultrasound (US) findings for patients. Methods: We assessed the simplification performance of four LLMs: ChatGPT 4, Gemini 1.5 Pro, Claude 3 Opus, and Perplexity, using fifty fictional Turkish US findings. Comparison was based on Ateşman’s Readability Index and word count. Three radiologists rated medical accuracy, consistency, and comprehensibility on a Likert scale from 1 to 5. Statistical tests (Friedman, Wilcoxon, and Spearman correlation) examined differences in LLMs' performance. Results: Gemini 1.5 Pro, ChatGPT-4, and Claude 3 Opus received high Likert scores for medical accuracy, consistency, and comprehensibility (mean: 4.7–4.8). Perplexity scored significantly lower (mean: 4.1, p<0.001). Gemini 1.5 Pro achieved the highest readability score (mean: 61.16), followed by ChatGPT-4 (mean: 58.94) and Claude 3 Opus (mean: 51.16). Perplexity had the lowest readability score (mean: 47.01). Gemini 1.5 Pro and ChatGPT-4 used significantly more words compared to Claude 3 Opus and Perplexity (p<0.001). Linear correlation analysis revealed a positive correlation between word count of fictional US findings and responses generated by Gemini 1.5 Pro (correlation coefficient = 0.38, p<0.05) and ChatGPT-4 (correlation coefficient = 0.43, p<0.001). Conclusion: This study highlights strong potential of LLMs in simplifying Turkish US findings, improving accessibility and clarity for patients. Gemini 1.5 Pro, ChatGPT-4, and Claude 3 Opus performed well, highlighting their effectiveness in healthcare communication. Further research is required to fully understand the integration of LLMs into clinical practice and their influence on patient comprehension and decision-making.

Electrocardiographic, Ultrasonographic, and Echocardiographic Findings in Hypothyroidism: A Cross-Sectional Study

Background: Hypothyroidism, a common endocrine disorder, significantly impacts cardiovascular health and thyroid gland structure. Electrocardiography (ECG), ultrasonography (USG) of the neck, and echocardiography (2D Echo) are essential tools for evaluating these complications. Despite the well-known risks, comprehensive assessments combining these modalities are often underutilized in clinical practice. The study evaluated electrocardiographic, ultrasonographic, and echocardiographic findings in hypothyroid patients to identify prevalent abnormalities and associated risk factors. Methods: A total of 260 hypothyroid patients were included. Data collection involved clinical history, blood tests, ECG, USG neck, and 2D Echo. Statistical analysis was done using SPSS version 20, with qualitative variables analyzed using Chi-square tests and quantitative variables using multivariate analysis and logistic regression. Results: The study revealed that 65% of patients had abnormal ECG findings, with sinus bradycardia (20%) and prolonged QT interval (17%) being most common. USG neck showed thyromegaly in 48.1% and nodules in 40% of patients. Echocardiographic assessment indicated systolic dysfunction in 30% and diastolic dysfunction in 40% of patients. Higher TSH levels were significantly associated with increased prevalence of cardiac dysfunction (p < 0.01). Conclusion: Hypothyroidism significantly affects both cardiac function and thyroid gland structure. The study underscores the necessity for comprehensive diagnostic assessments, including ECG, USG, and echocardiography, to detect and manage complications early. Effective control of thyroid function is crucial in mitigating cardiovascular risks. Recommendations: Regular monitoring of thyroid and cardiac health in hypothyroid patients is recommended. Future research should focus on long-term outcomes of integrated diagnostic assessments and the effectiveness of early interventions. Keywords: Hypothyroidism, Electrocardiography, Ultrasonography, Echocardiography, Cardiac Dysfunction

Fetal autopsy: Clinicopathologic correlation in consecutive cases

Background: Fetal and neonatal mortality serves as the most sensitive index of maternal and neonatal care. Congenital malformations remain a common cause of perinatal deaths and account for 10–15% in developing countries. Antenatal anomaly scan has become a standard element of obstetric care and their time for a fetal malformation is about 18 weeks. Fetal autopsy serves as a methodology to confirm the sonogram findings with regard to fetal anomalies. Aims and Objectives: The aim of our present study is to review and evaluate fetal autopsy of stillbirth/fetal losses and to confirm the malformations that were diagnosed by ultrasound. Materials and Methods: A cross-sectional study of a total of 10 cases received during the period of September 2023–October 2023 at the Institute of Obstetrics and Gynaecology. All the cases were spontaneous fetal losses. A standard protocol of autopsy procedure was followed which included external, internal, and histopathological examination. In fetuses with prenatally diagnosed malformations, ultrasound findings were compared with autopsy findings. Results: We analyzed a total of 10 fetuses, which included one chromosomal abnormality, four cardiac anomalies, one multiple anomaly, three central nervous system (CNS) anomalies, and one lethal skeletal dysplasia. The fetal autopsy confirmed the prenatal ultrasound findings in eight cases. Fetuses with CNS abnormality were not appreciated grossly due to early autolysis of the brain in the post-mortem. Conclusion: Prenatal imaging and screening are considered milestone development which detects fetal anomalies. However, the time-tested clinical autopsy which used to be conducted for all hospital deaths to find the cause of death was the norm of yesteryears which threw light on many unidentified causes and many syndromic associations not detected antemortem. Likewise, this case highlights the importance of autopsy correlation with prenatal imaging to highlight the same findings and to detect findings not picked up during imaging.

The New Frontiers of Fetal Imaging: MRI Insights into Cardiovascular and Thoracic Structures.

Fetal magnetic resonance imaging (fMRI) represents a second-line imaging modality that provides multiparametric and multiplanar views that are crucial for confirming diagnoses, detecting associated pathologies, and resolving inconclusive ultrasound findings. The introduction of high-field magnets and new imaging sequences has expanded MRI's role in pregnancy management. Recent innovations in ECG-gating techniques have revolutionized the prenatal evaluation of congenital heart disease by synchronizing imaging with the fetal heartbeat, thus addressing traditional challenges in cardiac imaging. Fetal cardiac MRI (fCMR) is particularly valuable for assessing congenital heart diseases, especially when ultrasound is limited by poor imaging conditions. fCMR allows for detailed anatomical and functional evaluation of the heart and great vessels and is also useful for diagnosing additional anomalies and analyzing blood flow patterns, which can aid in understanding abnormal fetal brain growth and placental perfusion. This review emphasizes fMRI's potential in evaluating cardiac and thoracic structures, including various gating techniques like metric optimized gating, self-gating, and Doppler ultrasound gating. The review also covers the use of static and cine images for structural and functional assessments and discusses advanced techniques like 4D-flow MRI and T1 or T2 mapping for comprehensive flow quantification and tissue characterization.

Distinguishing types and severity of pediatric pneumonia using modified lung ultrasound score.

This study aimed to investigate the diagnostic utility of the modified lung ultrasound score (MLUS) in distinguishing between Mycoplasma pneumonia and viral pneumonia in children and evaluate their severity. A prospective collection of 137 suspected cases of community-acquired pneumonia in children admitted to the Quanzhou Maternity and Children's Hospital in Quanzhou City, Fujian Province, from January 2023 to December 2023 constituted the study cohort. All patients underwent lung ultrasound examinations, and MLUS scores were assigned based on ultrasound findings, including pleural lines, A-lines, B-lines, and lung consolidations. Based on the pathogenic results, the patients were categorized into the Mycoplasma pneumonia (74 cases) and viral pneumonia (63 cases) groups. The severity was classified as mild (110 cases) or severe (27 cases). The diagnostic value of MLUS for Mycoplasma pneumonia and viral pneumonia in children was analyzed. (1) MLUS scores were significantly different between the Mycoplasma pneumonia (15, 10-21) and viral pneumonia (8, 5-16) groups (P = 0.002). ROC curve analysis indicated that using a cut-off value of 11, MLUS exhibited a sensitivity of 70.3%, specificity of 58.7%, and an area under curve (AUC) of 0.653 for diagnosing Mycoplasma pneumonia. Furthermore, large-area lung consolidation on ultrasound images demonstrated good diagnostic performance for predicting Mycoplasma pneumonia, with an AUC of 0.763, a sensitivity of 71.6%, and a specificity of 81.0%. (2) MLUS scores were significantly different between the mild pneumonia (10.5, 5-17) and severe pneumonia (21, 16-29) groups (P < 0.001). ROC curve analysis using a cut-off value of 16 showed a sensitivity of 77.8%, specificity of 73.6%, and AUC of 0.818 for diagnosing severe pneumonia. Multivariate regression analysis revealed that both MLUS and white blood cell count were independent factors influencing the severity. The constructed nomogram model demonstrated robust stability with a sensitivity of 85.2%, a specificity of 74.5%, and an AUC of 0.858 for predicting severe childhood pneumonia. MLUS, coupled with ultrasound signs of large-area lung consolidation, had reference significance for the differential diagnosis of Mycoplasma pneumonia and viral pneumonia in children and can be a preliminary assessment of the severity of viral pneumonia or mycoplasma pneumonia in children.

Ultrasound-guided photoacoustic (US-PA) tomography of the breast: Biochemical differentiation using intrinsic tissue markers—lipids, collagen and hemoglobin with histopathologic correlation

In this pilot study, we investigated the utility of handheld ultrasound-guided photoacoustic (US-PA) imaging probe for analyzing ex-vivo breast specimens obtained from female patients who underwent breast-conserving surgery (BCS). We aimed to assess the potential of US-PA in detecting biochemical markers such as collagen, lipids, and hemoglobin, and compare these findings with routine imaging modalities (mammography, ultrasound) and histopathology results, particularly across various breast densities. Twelve ex-vivo breast specimens were obtained from female patients with a mean age of 59.7 ± 9.5 years who underwent BCS. The tissues were illuminated using handheld US-PA probe between 700 and 1100 nm across all margins and analyzed for collagen, lipids, and hemoglobin distribution. The obtained results were compared with routine imaging and histopathological assessments. Our findings revealed that lipid intensity and distribution decreased with increasing breast density, while collagen exhibited an opposite trend. These observations were consistent with routine imaging and histopathological analyses. Moreover, collagen intensity significantly differed (P < 0.001) between cancerous and normal breast tissue, indicating its potential as an additional biomarker for risk stratification across various breast conditions. The study results suggest that a combined assessment of PA biochemical information, such as collagen and lipid content, superimposed on grey-scale ultrasound findings could aid in distinguishing between normal and malignant breast conditions, as well as assist in BCS margin assessment. This underscores the potential of US-PA imaging as a valuable tool for enhancing breast cancer diagnosis and management, offering complementary information to existing imaging modalities and histopathology.

The Sydney system for lymph node FNA biopsy cytopathology: A detailed analysis of recent publications and meta-analysis and a proposal for the components of an ideal prospective study of a cytopathology reporting system.

The Sydney system for fine-needle aspiration biopsy of lymph nodes has five categories, stressing the role of correlation of cytopathology with clinical, ultrasound, and ancillary findings to achieve diagnosis. The five categories constitute a hierarchical system with increasing risk of malignancy from benign to atypical, suspicious, and malignant categories, which informs recommendations for further workup to achieve a final diagnosis as possible. This article analyzes 10 publications using the Sydney system and a meta-analysis of nine of these studies. The primary goal of the analysis is to ascertain the causes of the large ranges in risk of malignancy for the "atypical" and "inadequate" compared to "benign," "suspicious," and "malignant" categories, which were comparable to well-established reporting systems. Research protocols are proposed to improve future studies. PubMed literature search from January 2021 to December 2023 identified studies evaluating performance of the Sydney system. Ten studies showed heterogeneity with clinical setting, study design, ultrasound use and rapid on-site evaluation, operator, cutoff points for "positive" cases, with inherent partial verification biases, resulting in a wide range of risk of malignancy, specificity, and sensitivity values. Analysis shows the large range is due to heterogeneity of the studies, which suffer from biases and variable statistical analysis that are ultimately included in any meta-analysis, detracting from the usefulness of the risk of malignancy derived by the meta-analysis. Components for ideal analyses of reporting systems are presented.

Whole-exome sequencing revealed a novel mutation of the ALMS1 gene in a Chinese family with Alström syndrome: a case report

BackgroundAlström syndrome (AS) is a rare autosomal recessive disorder that leads to multiple organ fibrosis and failure. Precise diagnosis from the clinical symptoms is challenging due to its highly variabilities and its frequent confusion with other ciliopathies and genetic diseases. Currently, mutations in the ALMS1 gene have been reported as a major cause of AS, thus, it is crucial to focus on the detection and discovery of ALMS1 mutations.Case presentationWe present a case of a 13-year-old Chinese boy weighing 70 kg and standing 168 cm tall. He has two younger brothers. Their parents hail from different ancestral homes in eastern and northern China. The patient’s primary clinical findings included visual impairment at the age of four and progressive hearing loss starting at the age of ten. Subsequently, at the age of twelve, the patient developed hyperlipidaemia and hyperinsulinemia. Ultrasonographic findings indicated the presence of gallstones and mild fatty liver. His Body Mass Index (BMI) significantly increased to 25 kg/m2 (ref: 18.5–23.9 kg/m2). Additionally, echocardiography revealed mild mitral and tricuspid regurgitation. Ultimately, Whole Exome Sequencing (WES) identified a new missense mutation in the ALMS1 gene (NG_011690.1 (NM_015120): c.9536G > A (p.R3179Q)). This missense mutation generated an aberrant splicer and disrupted the stability and hydrophobicity of proteins, which preliminarily determined as “ likely pathogenic”. Therefore, considering all the above symptoms and molecular analysis, we deduced that the patient was diagnosed with AS according to the guidelines. We recommended that he continue wearing glasses and undergo an annual physical examination.ConclusionIn this case report, we report a novel homozygous ALMS1 mutation associated with AS in the Chinese population, which expands the mutation spectrum of ALMS1. Genetic testing indeed should be incorporated into the diagnosis of syndromic deafness, as it can help avoid misdiagnoses of AS. While there is no specific treatment for AS, early diagnosis and intervention can alleviate the progression of some symptoms and improve patients’ quality of life.

Isolated left hypoplasia of the pulmonary artery accompanied by lung hypoplasia and chronic bronchial disease in a cat.

A 2-year-old castrated Russian Blue cat presented with inappetence, depression, and labored respirations. Radiography findings suggested left lung atelectasis; however, the ultrasonography findings did not indicate lung atelectasis. The left pulmonary artery (PA) was abnormally small on echocardiography; further, there were no other cardiac anomalies. Computed tomography revealed an abnormally small left PA and left lung. Furthermore, bronchiectasis and tree-in-bud patterns were observed in the lung lobes. Based on these findings, the cat was diagnosed with isolated left PA hypoplasia, presumed left lung hypoplasia, and feline chronic bronchial disease. Early diagnosis of this disease is important because it can cause serious complications, including recurrent respiratory infection, bronchiectasis, massive hemoptysis, and pulmonary hypertension.

Molecular analysis of 31 cases with fetal skeletal dysplasia.

The aim of this study was to describe the prenatal ultrasound findings of fetuses with skeletal dysplasia and to evaluate the genetic variations by molecular genetic analysis. Between August 1, 2018 and March 1, 2023, we conducted a retrospective case series at a tertiary referral center involving patients with fetal skeletal abnormalities. For cases referred for a possible diagnosis of fetal skeletal dysplasia, an ultrasound database and prenatal genetic counseling records were first searched. Terminated cases diagnosed with skeletal dysplasia by pathologic and radiologic findings and cases with skeletal dysplasia proven by postnatal clinical findings were included in the study. Between 2018 and 2023, a total of 64 cases were diagnosed as skeletal dysplasia based on radiologic findings, pathologic findings, and clinical features. The median week of the first ultrasound performed on patients is 19 0/7weeks, while the median week of the ultrasound in which skeletal dysplasia is suspected is 21 3/7weeks. Although micromelia was evaluated as a common feature in all cases, the most common concomitant anomaly was thoracic hypoplasia. Exome sequencing analysis was achieved in 31 (48 %) of cases. In 31 cases, in total of 35 pathogenic single gene mutations and 5 VUS (variants of uncertain significance) variants composing of 23 autosomal dominant, 10 autosomal recessive and 2 X linked recessive mutations were determined. Prenatal ultrasound findings can lead us to specific diagnoses, and with the appropriate molecular analysis method, a definitive diagnosis can be made without wasting time and money.

Point-of-Care Ultrasound Findings in Occlusive Iliac Vein Thrombus During Pregnancy: A Case Report.

Diagnosing deep venous thromboses and venous thromboemboli (DVT/VTE) in pregnant patients presents a unique challenge for emergency physicians. The risk of DVT/VTE increases during pregnancy, and the potential consequences of misdiagnoses are severe. Point-of-care ultrasonography (POCUS) is frequently a first-line diagnostic imaging modality. However, recent studies have shown a high incidence of thromboses proximal to the common femoral vein during pregnancy, and these would not be visualized using compressive ultrasonography, which traditionally can only visualize thromboses distal to the femoral vein. A 38-year-old female, 25-weeks primiparous, presented to the emergency department with a three-day history of left lower extremity swelling. Point-of-care three-point compression testing was used to evaluate for a DVT; however, no thrombus was visualized. Given high clinical suspicion, color and spectral Doppler testing were performed and demonstrated turbulent flow and reduced respiratory variation in the common femoral vein. This prompted further additional testing for a proximal DVT using magnetic resonance venography, which revealed an occlusive left external iliac thrombus. The patient was subsequently started on daily subcutaneous enoxaparin and discharged home with close follow-up. Emergency physicians play a critical role in evaluations for the presence of DVT/VTE, particularly in pregnant patients. We endorse the use of POCUS with three-point compression testing, as well as color and spectral Doppler imaging, to help identify proximal DVTs in this patient population. This case report can aid physicians in the diagnosis of this pathological condition that if left untreated can have severe consequences.

Basal cell carcinoma and squamous cell carcinoma: Comparison of high-frequency ultrasound and pathology.

Skin neoplasms, particularly basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), are prevalent forms of skin malignancies. To enhance accurate diagnosis, non-invasive techniques including high-frequency ultrasound (HFUS) are crucial. HFUS offers deeper penetration compared to reflectance confocal microscopy (RCM), and optical coherence tomography (OCT), making it valuable for examining skin structures. The aim of this study was to investigate and diagnose localized manifestation of BCC and SCC with HFUS and compare it with pathology results in patients referred to Razi Hospital, Tehran, Iran. This study included patients diagnosed with BCC and SCC, with clinical and pathological confirmation, attending the oncology clinic of Razi Hospital, Tehran, Iran, from 2022 to 2023. Exclusion criteria comprised metastatic and recurrent cases, patients who underwent treatment or surgery, and tumors located in anatomically challenging areas. HFUS with a 20MHz probe and Doppler ultrasound were employed to examine the skin. Tumors were subsequently excised, fixed in formalin, and sent for pathological assessment. Ultrasound findings were compared with pathology results. The study assessed 40 patients, with half diagnosed with SCC and the other half with BCC. The majority of SCC patients were male (80%), while BCC patients were relatively evenly divided between males (65%) and females (35%). The mean age was 59.15±11.9 years for SCC and 63.4±8.9 years for BCC. Cheeks (20%) and lips (35%) were the most common sampling sites for BCC and SCC, respectively. The correlation coefficients for tumor size and depth between ultrasound and pathology were 0.981 and 0.912, respectively, indicating a high level of agreement between the two methods. In BCC patients, there was complete agreement between sonographic loco-regional extension and pathology findings. However, some discordance (30%) was observed in SCC cases. The study demonstrated a strong correlation between ultrasound and pathology in accurately detecting the depth and extent of the tumor. However, due to the inclusion of only patients with positive pathology, it is not appropriate to evaluate the diagnostic test values and compare them with pathology results. Therefore, it is highly recommended to carry out additional studies with larger sample sizes to further validate these findings.

Carotid artery stenosis is related to cerebral small vessel disease magnetic resonance imaging burden

BackgroundCerebral small vessel disease (CSVD) encompasses conditions that affect small blood vessels of the brain, the most common being atherosclerosis. Magnetic resonance imaging (MRI) CSVD markers include lacunar strokes (LS), white matter hyperintensities (WMH), microbleeds, enlarged perivascular spaces (EPVS), and brain atrophy. Large and small cerebral arteries share an anatomical and functional connection, but the role of large vessel atherosclerosis in atherosclerotic CSVD hasn't been established. The aim of this study was to evaluate the involvement of large vessel pathology in atherosclerotic CSVD. MethodsThis cross-sectional study included 98 patients treated at the Neurology Clinic of the University Clinical Center of Serbia in Belgrade, from February 2018 to December 2023, who had atherosclerotic CSVD confirmed by neuroimaging and underwent extracranial color duplex sonography. Data on patients’ gender, age, cerebrovascular risk factors (dyslipidemia, hypertension, diabetes mellitus, smoking status), ultrasonography findings (intima-media thickness - IMT, carotid and vertebral artery stenosis, and hemodynamics), and CSVD imaging markers were collected, and the CSVD MRI burden score was calculated. ResultsAge correlated with LS and WMH (p < 0.05 for both). Hypertension correlated with WMH (p = 0.016), and smoking with LS (p = 0.043). Brain atrophy was more common in women (p = 0.016). The majority of patients had low-grade (<50 %) carotid stenosis. There was a strong correlation between all morphological parameters of internal carotid artery stenosis and the CSVD burden score (p < 0.05 for all). The hemodynamic parameters of internal carotid artery stenosis and morphological and hemodynamic parameters of vertebral artery stenosis didn't correlate with the CSVD burden score. ConclusionsThis study shows a strong correlation between cerebral large and small vessel pathology. We recommend the use of extracranial color duplex sonography in the evaluation of patients with CSVD as a supplementary method for follow-up, as this would allow the identification of patients whose condition might progress.

Can cereal-based oral contrast agents-assisted ultrasound become an alternative to non-contrast magnetic resonance imaging (MRI) in radiological follow-up for pancreatic cystic lesions?

Pancreatic cystic lesions (PCLs) are recommended to be examined by magnetic resonance imaging (MRI), yet MRI still has limitations, such as high costs, the risk of triggering claustrophobia, and relatively low availability compared with ultrasound. Oral contrast agents-assisted ultrasound has been used to examine the gallbladder and stomach, but whether oral contrast agents could improve the accuracy of transabdominal ultrasound (TAUS) for PCLs and could be a potential alternative to non-contrast MRI for PCL follow-up has not been studied. This study aimed to explore the value of cereal-based oral contrast agents in improving the accuracy of PCLs during TAUS. This is a prospective cohort study. Patients with PCL who were admitted to our center between January 2023 and January 2024 were enrolled, and TAUS was performed before and after taking cereal-based oral contrast agents. The imaging quality of the PCL was measured by structural visualization scores. The structural visualization scores of oral contrast agent-assisted ultrasound and non-contrast MRI were also compared. A total of 27 patients with PCLs were enrolled, and 30 PCLs were detected. The sonolucency of the PCL improved after oral contrast agent administration. Before taking the agent, only 30% of patients had satisfactory sonolucency; after taking the oral contrast agent, the corresponding proportion reached 80% (P=0.002). The structural visualization score of the PCL determined by oral contrast agent-assisted TAUS was higher than that determined without the aid of an agent [1 (0-6) vs. 1 (0-3), P=0.001], which was mainly reflected in the increase in the number of visible septa after taking the agent. No significant difference was detected between the structural visualization score of the PCL examined by oral contrast agent-assisted TAUS and that examined by non-contrast MRI and the correlation between the 2 types of scores were satisfactory [1 (0-6) vs. 2 (0-7), P=0.070, Spearman correlation factor r=0.880]. This study used a structured scoring system to confirm that cereal-based oral contrast agents could improve the ultrasound quality of PCLs, and the correlation between the quality of oral contrast agent-assisted ultrasound and non-contrast MRI findings on PCLs was satisfactory. Further research to improve visualization of PCLs on TAUS using oral contrast agents could result in TAUS being a potential alternative to MRI in the follow-up of PCLs in resource-limited situations.

A Study of High-Resolution Ultrasound and Magnetic Resonance Imaging Findings in Shoulder Joint Pain at a Tertiary Care Hospital in Central India.

Objective This study aims to investigate the diagnostic efficacy of high-resolution ultrasound (USG) and magnetic resonance imaging (MRI) in patients with shoulder joint pain at a tertiary care hospital in Central India. Methods This cross-sectional study was conducted at Acharya Vinoba Bhave Rural Hospital from 2021 to 2024. The study population consisted of patients with shoulder pain, without fractures, who were evaluated using USG and MRI. Participants with infective arthritis, rheumatoid arthritis, previous shoulder surgery, or contraindications for MRI were excluded. Data were recorded and analyzed using Microsoft Excel (Microsoft Corporation, Redmond, Washington) and R 4.2.0 software (The R Foundation, Vienna, Austria). Sensitivity, specificity, and receiver operating characteristic (ROC) curves were used to compare the diagnostic performance of USG and MRI. Results A total of 80 patients were included, with 49 (61%) males and 31 (39%) females. The MRI findings showed supraspinatus partial tears in 44 (55%) cases, complete tears in 10 (12.5%), and various other shoulder pathologies. USG detected supraspinatus partial tears in 16 (19.5%) and complete tears in seven (8.8%). Kappa statistics indicated moderate to high agreement between USG and MRI for several pathologies, with near-perfect agreement for complete tears. Conclusion High-resolution USG is a valuable tool for the initial assessment of shoulder joint pain, providing reliable diagnostic information with high agreement levels with MRI for complete tears and certain shoulder conditions. MRI remains indispensable for comprehensive evaluation, particularly for partial tears and complex pathologies.

Phenotypic and genotypic analysis of 11 fetal cases with Bardet-Biedl syndrome.

To present the prenatal sonographic features and genomic spectrum of pregnancies with fetal Bardet-Biedl syndrome (BBS). This was a retrospective study of 11 cases with BBS diagnosed by prenatal ultrasound and confirmed by genetic testing. Clinical and laboratory data were collected and reviewed for these cases, including maternal demographics, prenatal sonographic findings, molecular testing sequencing results, and pregnancy outcomes. All cases had unremarkable first-trimester ultrasound scans without reporting limb malformations. All had second-trimester abnormal ultrasounds: postaxial polydactyly in nine cases (9/11), renal abnormalities in seven (7/11), reduced amniotic fluid volume in two (2/11), central nervous system anomalies in two (2/11), and ascites in three (3/11). Ten fetuses presented with at least two-system anomalies, and one (Case 11) presented with only postaxial polydactyly. Variants were detected in five genes, including BBS2, ARL6/BBS3, BBS7, CEP290/BBS14 and IFT74/BBS22. Ten pregnancies were terminated in the second trimester, while one continued to term. Enlarged hyperechogenic kidneys and postaxial polydactyly are the two most common sonographic features of fetal BBS. Prenatal diagnosis of BBS can be done with ultrasound and genetic testing although the diagnosis may be made in the second trimester.

Accuracy and Prognostic Value of Early Appearance of Ultrasonographic Findings of Placenta Accrete

Accuracy and Prognostic Value of Early Appearance of Ultrasonographic Findings of Placenta Accrete

Intravascular Ultrasound Findings From the Prospective, Multi-Center, Single-Arm Study of the Auryon Laser System for Treatment of Below-the-Knee Arteries

Intravascular Ultrasound Findings From the Prospective, Multi-Center, Single-Arm Study of the Auryon Laser System for Treatment of Below-the-Knee Arteries

Comparative Study of Diluted Hydrogen Peroxide and Sulfur Hexafluoride in the Contrast-Enhanced Ultrasound Assessment of Anal Fistulas.

Endoanal ultrasound for the diagnosis of anal fistulas requires the injection of hydrogen peroxide, but it is often uncomfortable for the patient and possesses potential complications. Novel ultrasound contrast is currently available. We aimed to assess the efficacy and safety of sulfur hexafluoride as an ultrasound contrast agent for the diagnosis of perianal fistula by comparing it with those of 50% diluted hydrogen peroxide. Double-blind superiority study with 4 consecutive visits to perform an ultrasound without contrast, a hydrogen peroxide-enhanced ultrasound, a sulfur hexafluoride-enhanced ultrasound and a rectal exploration in the operating room (the gold standard). The ultrasound images were independently reviewed by three expert surgeon sonographers. This study was conducted at a single university hospital. Data from 176 patients were evaluated. Demographic and exploratory data and the ultrasound findings related to the location of the internal fistula orifice, description of the primary and secondary tracts, and presence of cavities and sphincter defects were analyzed. The complications occurring before and after the contrast agent administration and the presence of pain measured using a score were considered. Eighty-eight patients were included (men: 71.5%; mean age: 48.3 years).62.5% had a complex type and 83.7% had a transsphincteric type. Sulfur hexafluoride-enhanced ultrasounds demonstrated a higher interobserver agreement in determining the secondary tracts (κ= 0.604) and anal fistula height (κ=0.604) compared with other methods. Both hydrogen peroxide-enhanced ultrasound (90.91%) and sulfur hexafluoride-enhanced ultrasound (89.77%) detected the internal orifice more frequently than ultrasounds without contrast (62.5%) (p < 0.001),with no differences between contrast agents (p = 0.810). Sulfur hexafluoride-enhanced ultrasound were less painful than peroxide-enhanced ultrasound (p < 0.001). Most of the patients had transsphincteric anal fistulas. Sulfur hexafluoride proved comparable to hydrogen peroxide in evaluating fistulous tracts and identifying the internal orifice and additionally reduced significantly pain and discomfort. Furthermore, demonstrated a higher interobserver agreement in determining the secondary tracts and anal fistula height compared with other methods. See Video Abstract.

Open distal ureteroureterostomy for non-refluxing duplicated collecting system in children: Multicentric study and mid-term outcomes

When indicated, ureteroceles and ectopic ureters in duplicated collecting systems can be managed via upper or lower urinary tract surgical approaches, or a combination of both. Open ureteroureterostomy (UU) has been described to address these conditions in the absence of lower pole (LP) vesicoureteral reflux (VUR). We report outcomes from multiple centers worldwide with mid-term follow-up. Our study consists of a retrospective review of records and imaging of children who underwent open distal UU via inguinal incision for duplicated collecting system without lower pole VUR in institutions from North America, South America, and the Caribbean. Descriptive statistics and univariate analysis were utilized. The records of 127 patients who underwent open distal UU for double collecting system between 2009 and 2022 were reviewed. Of those, 65% were female (n=82), with a mean age at operation of 18 months (range 3-180). Main presentation at surgery included prenatal hydronephrosis (64%, n=81), followed by febrile urinary tract infections (28%, n=36), and urinary incontinence or other (8%, n=10). The patients with antenatal or incidental diagnosis of hydronephrosis were classified as preoperative Society for Fetal Urology (SFU) grade 3 (n=64) and 4 (n=54) (96%). Those who were classified with SFU grade 0-2 (4%) had symptomatic clinical presentations including febrile urinary tract infections (UTIs) (n=3), urinary incontinence (n=3), and a 12-year-old patient with recurrent abdominal pain (n=1). Mean operative time from skin incision to skin closure was 86min (range 45-240). Mean hospital stay was estimated at 1.1 days (range 0.5-4). In our cohort of 127 patients, 3 (2%) developed Clavien-Dindo grade I (2 with ureteral stent displacement and 1 with a urine leak/managed conservatively), 6 (5%) with grade II (3 febrile and 3 non-febrile UTIs managed with oral antibiotics), and 2 (2%) with grade IIIb complications (urine leaks requiring surgical management), which were appropriately treated. None presented grade IV or V complications. A double J stent was used in 56 patients (44%), and a Penrose drain was left in 10 (8%). A total of 125 children (98%, n=125/127) showed sonographic improvement of hydronephrosis, or resolution of symptoms with stable ultrasound findings. Successful outcome was similar for both ureterocele and ectopic ureter subgroups: 49/49 patients with ureterocele showed 100% improvement, 76/78 children with ectopic ureter showed improvement in 97% of the cases. On univariate analysis, outcomes were similar regardless of the use of ureteral stents (p=0.11). Mean follow-up was 28.2 months (range 12-85). Open distal UU is a good alternative for the definitive surgical management of ectopic ureters and ureteroceles without LP VUR. This multicentric and mid-term follow-up study demonstrates that open distal UU offers high success rates, low morbidity, short operative times and hospital stays, and satisfactory aesthetic outcomes. Additionally, the surgery is performed extra-peritoneally and may not require the use of stents or drains, depending on surgeon preference. Further investigations are being conducted to determine the role of UU in the settings of double collecting systems associated with ipsilateral LP VUR.