Ultrasonographic Parameters Research Articles

Nomogram for preoperative prediction of high-volume lymph node metastasis in the classical variant of papillary thyroid carcinoma.

The objective of our study was to construct a preoperative prediction nomogram for the classical variant of papillary thyroid carcinoma (CVPTC) patients with a solitary lesion based on demographic and ultrasonographic parameters that can quantify the individual probability of high-volume (>5) lymph node metastasis (HVLNM). In this study, a total of 626 patients with CVPTC from December 2017 to November 2022 were reviewed. Their demographic and ultrasonographic features at baseline were collected and analyzed using univariate and multivariate analyses. Significant factors after the multivariate analysis were incorporated into a nomogram for predicting HVLNM. A validation set from the last 6 months of the study period was conducted to evaluate the model performance. Male sex, tumor size >10 mm, extrathyroidal extension (ETE), and capsular contact >50% were independent risk factors for HVLNM, whereas middle and old age were significant protective factors. The area under the curve (AUC) was 0.842 in the training and 0.875 in the validation set. The preoperative nomogram can help tailor the management strategy to the individual patient. Additionally, more vigilant and aggressive measures may benefit patients at risk of HVLNM.

The evaluation of vascular flow in clubfoot: a resistive index and peak systolic velocity study.

Resistive index (RI) and peak systolic velocity (PSV) are important Color doppler ultrasonography (CDU) parameters indicating the microcirculation and flow velocity in tissues. We aim to determine the changes in vascular flow characteristics in clubfoot after Ponseti treatment. There were three groups: the clubfoot group, the healthy group (the unaffected feet with unilateral deformities) and the control group. The Pirani severity scoring and CDU examinations of the foot were performed at initial admission and the 6th-month follow-up after Ponseti treatment. A total of 34 feet of 24 patients were included in the study. The mean age at initial treatment was 20.9 ± 22.5 days. The RI and PSV values of the clubfeet and the healthy group were similar. Resistive index values were significantly lower, and PSV values were significantly higher in the control group. After Ponseti treatment, only RI of the dorsalis pedis artery decreased, but PSV increased for all of the arteries. Recurrence of the deformity deteriorates the improvement in vascular development. Resistive index and PSV values were not related to the initial severity of the deformity. The RI values were higher, and PSV values were lower in clubfoot patients compared with the normal control group. Vascular pathology is a component of clubfoot, and treatment success improves vascular development. The improvement of microcirculation and blood flow velocity together was detected only in the dorsalis pedis artery. The effect of vascular flow change on prognosis was not detected.

Diaphragmatic Activation Correlated with Lumbar Multifidus Muscles and Thoracolumbar Fascia by B-Mode and M-Mode Ultrasonography in Subjects with and without Non-Specific Low Back Pain: A Pilot Study

Background and Objectives: The diaphragm, the lumbar multifidus muscles, and the thoracolumbar fascia (TLF) execute an important role in the stability of the lumbar spine and their morphology has been modified in subjects with non-specific low back pain (NS-LBP). While it is true that three structures correlate anatomically, the possible functional correlation between them has not been investigated previously in healthy subjects nor in subjects with NS-LBP. The aim of the present study was to examine this functional nexus by means of a comparison based on ultrasonographic parameters of the diaphragm, the lumbar multifidus muscles, and the TLF in subjects with and without NS-LBP. Materials and Methods: A sample of 54 (23 NS-LBP and 31 healthy) subjects were included in the study. The thickness and diaphragmatic excursion at tidal volume (TV) and force volume (FV), the lumbar multifidus muscles thickness at contraction and at rest, and the TLF thickness were evaluated using rehabilitative ultrasound imaging (RUSI) by B-mode and M-mode ultrasonography. The diaphragm thickening capacity was also calculated by thickening fraction (TF) at tidal volume and force volume. Results: There were no significant differences recorded between the activation of the diaphragm and the activation of the lumbar multifidus muscles and TLF for each variable, within both groups. However, there were significant differences recorded between both groups in diaphragm thickness and diaphragm thickening capacity at tidal volume and force volume. Conclusions: Diaphragmatic activation had no functional correlation with the activation of lumbar multifidus muscles and TLF for both groups. Nevertheless, subjects with NS-LBP showed a reduced diaphragm thickness and a lower diaphragm thickening capacity at tidal volume and force volume, compared to healthy subjects.

Evaluation of Sciatic Nerve Stiffness Using Shear Wave Elastography in Patients with Unilateral Diabetic Foot Ulcers.

To evaluate the stiffness of the sciatic nerve by shear wave elastography (SWE) and to determine whether SWE can be used to predict diabetic foot ulcer (DFU) in a patient with diabetic peripheral neuropathy (DPN). Sixteen patients (thirty-two lower limbs) with unilateral DFU were studied retrospectively. The ultrasonographic parameters including cross-sectional area (CSA) of sciatic nerve, intraneural blood flow, peak systolic velocity (Vmax) and resistive index (RI) in the intraneural artery of the sciatic nerve, and the SWE stiffness value of the sciatic nerve were measured. The examinations of arteries of the lower limbs were also performed by ultrasound. According to the presence or absence of DFU, the 32 lower limbs were divided into two groups: the DFU group and the non-DFU group. The ultrasonographic parameters were compared between these two groups. There was no significant difference (p > 0.05) between the two groups for CSA, intraneural blood flow, Vmax and RI in the intraneural artery of the sciatic nerve, and numbers of severe artery stenosis or full occlusion of the artery in the lower limbs. However, SWE stiffness values in the sciatic nerve in the DFU group are higher than the non-DFU group (p < 0.05). When the SWE stiffness values were used for prediction of DFU in patients with DPN, the area under the ROC curve (AUC) was 0.727 (95% CI: 0.541-0.868). When the best SWE stiffness value of 24.48 kPa was taken as a cutoff for prediction of DFU, the sensitivity was 62.50% (95% CI: 35.4-84.8%), and the specificity was 75% (95% CI: 47.6-92.7%). Sciatic nerve stiffness is significantly higher in lower limbs with DFU. SWE is a noninvasive imaging method that may be used to evaluate sciatic nerve stiffness, then potentially predict DFU in patients with DPN.

DOP15 Intestinal ultrasound correlates with colonoscopy and biomarkers, and can be used in a tight monitoring approach to assess response to therapy in Crohn’s disease: a multicentre prospective study

Abstract Background Intestinal ultrasound (IUS) is a non-invasive monitoring tool increasingly being used to assess response to therapy in Crohn’s disease (CD). Herein we describe the longitudinal evolution of IUS parameters, and its correlation with clinical, laboratorial and endoscopic parameters during the first year of infliximab (IFX) therapy. Methods Prospective multicentre cohort study of patients with active CD starting IFX. Harvey-Bradshaw index (HBI), C-reactive protein (CRP), fecal calprotectin (FC) and IUS were performed at week (W) 0, 14, 30 and 54. Ileocolonoscopy was performed at W0 and W54. IFX through levels (ITL) were measured at W14, 30 and 54. Clinical remission (CR) was defined as HBI&amp;lt;5 and laboratorial remission (LR) as CRP &amp;lt;0.5mg/dL and FC &amp;lt;150ug/g. IUS response was defined as a reduction &amp;gt;25% in bowel wall thickness (BWT) and IUS remission as normalization of BWT (≤3mm), color doppler sign (CDS≤1), wall stratification and inflammatory fat. The IBUS-SAS score was used to assess disease activity and includes BWT, doppler sign, stratification and inflammatory fat. Endoscopic response was defined as 50% reduction of SES-CD in most affected segment and endoscopic healing as total SES-CD &amp;lt;3. Results 62 patients with CD (50% male; mean age 36±15y) were included: all with IUS at W0 and W14, 58 (94%) patients with IUS at W30 and 53 (85%) at W54. Following therapy initiation there was a positive evolution of all assessed parameters; IUS response and remission increased gradually from baseline to week 54 (Table 1 and Figure 1). Figure 2 illustrates the reduction of BWT and IBUS-SAS score from baseline to week 54. The reduction of BWT and IBUS-SAS were significantly more pronounced in the first 14 weeks of therapy (BWT: DW0-14 vs DW14-30, p=0.015; IBUS-SAS: DW0-14 vs DW14-30, p=0.004; DW0-14 vs DW30-54, p=0.037). There was a good agreement between IUS and colonoscopy for evaluation of the most affected segment at baseline (kappa 0.788, p&amp;lt;0.001). In all time points, there was a significantly fair to moderate correlation between ultrasonographic parameters (BWT, CDS and IBUS-SAS score) and laboratorial biomarkers (specially fecal calprotectin) (Table 2). After induction (week 14), there were also a fair correlation between IBUS-SAS and ITL (r=-0.277, p=0.034). Conclusion We found a significantly fair to moderate correlation between IUS parameters and laboratorial and endoscopic parameters during the first year of infliximab therapy. BWT and IBUS-SAS score reduction was more pronounced during induction therapy. IUS can be reliably used to monitor disease activity longitudinally, in a tight monitoring strategy.

Measurement of amniotic fluid volume

The qualitative or semi-quantitative assessment of amniotic fluid volume (AFV) is a standard component of every ultrasound in the second and third trimesters of pregnancy. AFV abnormalities are associated with various pregnancy complications. In clinical practice, ultrasound (US) assessment of AFV is used in conjunction with other clinical and sonographic parameters (biophysical profile, non-stress test, estimated fetal weight on ultrasound, clinical examination) to make effective medical decisions to maintain fetal well-being in the management of pregnancies with obstetric complications. US is the most common AFV assessment technique, in which AFV is determined on a basis of the opinion of a physician (qualitatively) or on a basis of the value of the maximum vertical pocket (MVP) and amniotic fluid index. These techniques are well suited for detecting fetuses with normal AFV; however, they have insufficient accuracy for diagnosing oligohydramnios and polyhydramnios. Furthermore, ultrasound AFV assessment in twins poorly corresponds with the reference values for oligohydramnios and polyhydramnios. Despite this, it is advisable to use qualitative and semi-quantitative (MVP) methods for AFV assessment. Results for each twin are interpreted using the same MVP criteria as those for single fetuses.

P312 Retrospective study using ultrasonography in predicting clinical relapse of Crohn's disease

Abstract Background Endoscopy is the standard modality for inflammatory bowel disease, but it is invasive and poorly tolerated. On the other hand, trans-abdominal ultrasonography (US) is minimally invasive, inexpensive, and has excellent characteristics not found in other examinations, such as the ability to detect minute changes in the intestinal wall. It would be clinically useful if US could predict clinical relapse. Methods Of 185 patients with CD who underwent US between April 2011 and April 2021, we retrospectively evaluated 75 patients who were in clinical remission (CDAI &amp;lt; 150) at the time of their first US at our hospital for clinical relapse and maintenance of remission at 1 year after the procedure. The severity of US was evaluated by US-CD (0-52 points in total), which divided the intestine into four segments(ileum, right-sided colon, transverse colon, and left-sided colon) and was calculated the following US parameters: bowel wall thickness (BWT) (0–3), loss of stratification (0–2), degree of blood flow signaling by a color Doppler study (0–3), presence of increasing echogenicity mesentery (0–2), and intestinal stenosis (0–3). US images were analyzed and interpreted in a consensus manner by two technologists with more than 10 years of experience, blinded to the patient's clinical information. Results Of the 75 cases, 58 were males and 17 were females with a median age of 30 years (range 18-58), median BMI of 20.6 kg/square meter (range 16.2-32.5), 23 cases were ileal type, 47 cases were ileocolonic type, and 5 cases were colonic type. Sixty-eight patients remained in clinical remission during the observation period, and 7 patients had clinical relapse (CDAI &amp;gt; 150). The median CDAI at US was 71 (range 14-143), median CDAI at relapse was 189 (range 151-288), and median observation period was 365 days (range 6-365). The median time to relapse was 193 days (range 166-288). ROC analysis was performed on the US-CD, and the highest AUC of 0.820 was obtained when the cutoff value was 11. Six patients in the relapse group and 20 patients in the remission maintenance group had US-CD of 11 or higher, and 1 patient in the relapse group and 48 patients in the remission maintenance group had a score of less than 11. The sensitivity was 85.7%, specificity was 70.6%, positive predictive value was 23.1%, and negative predictive value was 98%. Logistic regression analysis identified "US-CD 11 or higher" as a factor contributing to clinical relapse (p=0.018). Conclusion US-CD ≥11 is a prognostic predictor of clinical relapse in CD.

P767 Intestinal ultrasonography predicts short term clinical remission in patients with moderate-to-severe ulcerative colitis

Abstract Background Intestinal ultrasonography (IUS) is a non-invasive, easily accessible and low-cost procedure to visualize the colon and determine disease activity, extent and treatment response in IBD. Our aim was to investigate whether ultrasonographic parameters predict short-term clinical remission in ulcerative colitis (UC). Methods Consecutive patients (pts) with moderate-to-severe UC (total Mayo score&amp;gt;6) starting biological therapies or small molecules were included. Patients were evaluated at baseline by clinical, biochemical, endoscopic (endoscopic Mayo score), and IUS assessments. IUS, doppler and elastographic parameters assessed at baseline before starting therapy were: bowel wall thickening (BWT), echopattern, blood flow (adapted Limberg’ score), Milan Ultrasound criteria (MUC) and shear wave elastography values. The most affected colonic segment was used for all imaging assessments. Clinical remission at 3 months was defined as partial Mayo Score=0-1. Predictive factors of clinical remission at 3 months were analyzed by logistic regression. ROC curve analysis was used to identify the best cut-off of BWT in predicting clinical remission. Results Thirty-one UC pts were enrolled (12 males [39%]; median age: 45 years, range 18-72; median disease duration: 108 months, range 3-312). Sixteen per cent of pts had left colitis and 84% had extensive UC according to the Montreal criteria. Forty-eight per cent of pts were treated with Anti-TNFs, 39% with vedolizumab, 10% with ustekinumab and 3% with tofacitinib. At baseline, 84% of patients had moderate disease and 16% severe disease according to the total Mayo score. A lower total Mayo score and partial mayo score at baseline were predictive of clinical remission at 3 months after starting biological therapy or small molecules than endoscopic Mayo score (OR 0.58, 95% CI 0.33-0.99, p=0.03; OR 0.55, 95% CI 0.29-0.99, p=0.037; OR 0.57, 95% CI 0.16-1.93, p=0.36, respectively; Figure 1, panels A-C). A lower BWT, Limberg’ score and MUC at baseline were predictive of clinical remission at 3 months (OR 0.19, 95% CI 0.05-0.72, p=0.0023; OR 0.22, 95% CI 0.06-0.77, p=0.004; OR 0.48, 95% CI 0.21-0.83, p=0.001, respectively; Figure 1, panels D-F). The most accurate cut-off value of BWT for predicting clinical remission was &amp;lt;6 mm with sensitivity and specificity of 70% and 82%, respectively (Figure 1, panel G). Conclusion IUS easily predicts early clinical remission in patients with moderate-to-severe UC after therapy.

Comparison of ultrasound-based measures of inferior vena cava and internal jugular vein for prediction of hypotension during induction of general anesthesia

ABSTRACT Background Hypotension after GA induction may induce organ injury. Ultrasonographic IVC and IJV studies for intravascular volume assessment and hypotension prediction were established. This study compared between them in prolonged hypotension during induction of GA prediction. Methods One-hundred sixty three adult patients, of ASA physical status I & II, for elective surgery under GA were screened. One hundred thirty three patients were included. Preoperative ultrasonographic IVC parameters (dIVC max, dIVC min & CI) and IJV parameters (IJV area in supine and Trendelenberg positions & IJV change rate) measurements were recorded with baseline MBP. After anesthetics administration, MBP was recorded every minute for 15 minutes. Intubation was established after 3 minutes. Study used hypotension definition as over 20% decrease from baseline MBP. Prolonged hypotension definition used was hypotension duration ≥ 2 minutes. Severe hypotension definition used was decreased MBP from baseline value over 40%. Results Six patients didn’t satisfy inclusion criteria; seventeen patients showed low IVC visualization and 133 patients were involved. The prolonged hypotension after GA induction incidence was 63.2% (84 patients), while severe hypotension incidence was 9% (12 patients). IJV change rate > 0.28 predicted prolonged post-induction hypotension with specificity 76% (95% confidence interval, 61–87%) and sensitivity 55% (95% confidence interval, 44–66%). IJV change rate > 0.35 predicted severe post-induction hypotension with specificity 72% (95% confidence interval, 63–80%) and sensitivity 75% (95% confidence interval, 43–95%). Alternatively, no IVC measure reliably estimated prolonged or severe post-induction hypotension. Conclusion IJV surpasses IVC in prolonged post-induction hypotension prediction with moderate predictive value.

The impact of FSH stimulation and age on the ovarian and uterine traits and histomorphometry of prepubertal gilts

This study investigated the effect of age and follicle stimulating hormone (FSH) treatment on the estradiol (E2) plasma concentration, ovarian follicle development, endometrial histomorphometry, and ultrasonographic parameters of the ovaries and uterus in prepubertal gilts. Thirty-five prepubertal gilts were grouped according to age (140 or 160 d), and within each age, gilts were allotted to receive 100 mg of FSH (treated; G140 + FSH [n = 10] and G160 + FSH [n = 7]) or saline solution (control; G140 + control [n = 10] and G160 + control [n = 8]). The total dose of FSH was divided into 6 similar doses administered every 8 h (days 0–2). Before and after FSH treatment, blood sample was collected, and transabdominal scanning of the ovaries and uterus was performed. Twenty-four hours after the last FSH injection, the gilts were slaughtered and their ovaries and uterus were processed for histological and histomorphometric analysis. The histomorphometric parameters of the uterus differed (P < 0.05) between prepubertal gilts at 160 d and 140 d of age. Moreover, changes (P < 0.05) in uterine and ovarian ultrasound images occurred between 140 and 160 d of age. Age and FSH treatment did not affect (P > 0.05) E2 plasma concentrations. Follicle stimulating hormone treatment did not affect (P > 0.05) the early stage of folliculogenesis in the prepubertal gilts; however, the number of early atretic follicles decreased (P < 0.05) after the FSH treatment. Follicle stimulating hormone administration increased (P < 0.05) the number of medium follicles and decreased (P < 0.05) the number of small follicles in 140 and 160 d old gilts. In the endometrium, luminal/glandular epithelium height and glandular diameter increased (P < 0.05) after FSH treatment. Thus, injections of 100 mg of FSH stimulate the endometrium epithelium and induce follicular growth to a medium follicle size without affecting the preantral stages in prepubertal gilts; also, the uterine macroscopic morphometry does not change from 140 to 160 d of age.

Feasibility study of automated cardiac motion quantification to assess left ventricular function in type 2 diabetes

The global incidence of diabetes and related complications is gradually increasing, with cardiovascular complications being the leading cause of death in the diabetic population. The purpose of this study was to examine left ventricular function in individuals with type 2 diabetes mellitus (T2D) and conduct a feasibility analysis using automated cardiac motion quantification (aCMQ) approach. A total of 150 T2D patients with a history of diabetes mellitus dating back more than 10 years were chosen, and we treated 87 patients with T2D that had been present for less than 15 years as group I, 63 patients with T2D that had been present for more than 15 years as group II, and 50 healthy volunteers as the control group. From the three groups, clinical information, conventional ultrasonography parameters, and mitral annular plane systolic excursion (MAPSE) parameters were gathered. aCMQ technique was used to collect longitudinal strain and circumferential strain in the left ventricle. Tissue motion mitral annular displacement technique (TMAD) in aCMQ was used to collect parameters related to TMAD, and cardiac motion quantification (CMQ) was used to collect two-dimensional global longitudinal strain (2D-GLS) to compare the degree of difference between the aforementioned three groups. The differences between longitudinal strain groups in aCMQ were all statistically significant and gradually decreased with increasing disease duration. Most TMAD parameters were lower in groups I and II than in the control group, and TMAD parameters gradually decreased with increasing disease duration. The results of the LV global longitudinal strain and 2D-GLS using Bland–Altman analyses showed high agreement between and within groups, Pearson correlation analysis showed a significant positive correlation (r = 0.18, P < 0.05), and the AUC of ROC curves predicting the value of left ventricular function in patients with T2D was 0.723 and 0.628, respectively. With significant positive correlations between MAPSE, s', and the majority of the TAMD parameters (P < 0.05), TAMD, MAPSE, and s' demonstrated high inter- and intra-group agreement using Bland–Altman analyses, and the three had predictive value in assessing left ventricular function in T2D patients by ROC curve. Reduced longitudinal strain and reduced mitral annular displacement were seen in patients with different disease stages of T2D, so the application of aCMQ and TAMD was effective in detecting altered left ventricular function in patients with T2D. aCMQ had higher value in predicting left ventricular function in patients with T2D compared to CMQ for overall longitudinal strain, and the software performed the depiction automatically, reducing manual errors. MAPSE parameters and s ' can replace the TMAD technique for assessing mitral annular motion and was simpler to perform, saving operational time.

Effectiveness of Pelvic Ultrasonography in the Diagnosis of Central Precocious Puberty and Its Differentiation from Similar Conditions

Background: Differentiation of patients with central precocious puberty (CPP) from healthy individuals and patients with CPP-like conditions [isolated premature thelarche (IPT) and isolated premature adrenarche (IPA)] is important for selecting an appropriate treatment. The gonadotropin-releasing hormone stimulation test is used as the gold standard for differentiating CPP from other conditions. Despite its high specificity, this test has disadvantages, such as low sensitivity, time-consuming sampling, and need for multiple blood samples. Objectives: This study aimed to investigate the use of pelvic ultrasonography (US) and its parameters in distinguishing CPP patients from those with similar conditions and healthy individuals. Patients and Methods: In this case-control study, a total of 183 patients, who were referred to the endocrinology department of Ali Asghar Hospital in Tehran, Iran for the evaluation of CPP, were recruited cconsecutively from 2015 to 2019. All the participants were Iranians and classified based on the clinical and laboratory findings. Pelvic US parameters were evaluated in all groups. One-way analysis of variance (ANOVA) was used to compare the mean values of continuous variables between the groups. Moreover, a post-hoc test was performed for pairwise comparisons between the groups if the result of ANOVA test was statistically significant. Finally, the receiver-operating characteristic (ROC) curve analysis was performed to determine the best cutoff points for US parameters. Results: Of 183 children, 62 were allocated to the control group (33.87%), 93 to the CPP group (50.81%), 16 to the IPT group (8.74%), and 12 to the IPA group (6.55%). The results showed no significant difference between the groups regarding chronological age and body mass index, while the bone age (107.76 ± 19.81 months) (P &lt; 0.001) and height (129.53 ± 8.97 cm) were significantly higher in the CPP group compared to the other groups (P = 0.003). All US parameters were significantly different between the CPP and control groups. There were also significant differences between CPP patients and those with IPT and IPA in terms of all parameters, except for the cervical anteroposterior diameter and ovarian volume. The best parameters for differentiating CPP from other conditions were the uterine volume (cutoff value, 1.40; 75.27% sensitivity; 75.56% specificity), uterine transverse diameter (cutoff value, 13.5 mm; 72.04% sensitivity; 71.11% specificity), and fundus/cervix (F/C) ratio (cutoff value, 0.98; 78.49% sensitivity; 70% specificity). Conclusion: The pelvic US parameters can improve the diagnosis of CPP and play an auxiliary role in distinguishing the treatment needed. Based on the findings, the best diagnostic parameter and its cutoff value can vary depending on ethnicity and type of study.

Preoperative ultrasonographic evaluation of the airway vis-à-vis the bedside airway assessment to predict potentially difficult airway on direct laryngoscopy in adult patients—a prospective, observational study

BackgroundUnanticipated difficult airway remains a challenge for the anesthesiologist with no established standard criteria to predict difficulty in intubation. Our aim was to correlate the pre-anesthetic ultrasonographic (USG) airway assessment parameters with Cormack-Lehane (CL) grade at direct laryngoscopy view under general anaesthesia.This was a prospective, observational study on 150 adult patients between 18 and 70 years with the American Society of Anesthesiologist—Physical Status 1–2 requiring general endotracheal anesthesia for elective surgery.ResultsThe incidence of difficult laryngoscopy was 22.7%. The sonographic distance from anterior neck surface to epiglottis (ANS-E) > 1.67 cm was observed to be a statistically significant USG predictor of difficult laryngoscopic view with sensitivity of 64.71% and specificity of 78.45% (p = 0.000). The sonographic distance from anterior neck surface to hyoid bone (ANS-H) or to anterior commissure (ANS-AC) did not corelate with difficult laryngoscopy. The ultrasound (US) parameters had higher negative than positive predictive value.ConclusionsWe found ANS-E distance to be the most significant predictor of difficult laryngoscopy in our study. USG is a useful tool to identify the “at-risk” patients for difficult airway.

A prospective cohort study: can advanced ultrasonography replace magnetic resonance imaging in the diagnosis of placental adhesion disorders?

To define and compare the diagnostic accuracy of ultrasonography (USG) and magnetic resonance imaging (MRI) for the placental adhesive disorder (PAD). A prospective study was conducted between January 2019 and February 2020 in a tertiary referral university hospital. A total of 115 placenta previa cases were included in the study during the third trimester of gestation. USG examination was performed, and the placenta was scanned in a systematic manner using gray-scale ultrasound, color Doppler flow mapping, and 3-D imaging for each participant. Thereafter, all participants underwent an MRI examination. USG and MRI findings were compared with histopathological findings. Loss of the retroplacental sonolucent zone (71%[95% CI 47-88]) and an irregular retroplacental sonolucent zone (71% [95% CI 47-88]) were the most sensitive USG parameters. For MRI, the uterine bulging parameter was the most sensitive (60% [95% CI 36-80]) andspecific (91% [95% CI 83-96]) findings, and it had thehighest accuracy rate (85% [95% CI 77-91]). Overall, the USG sensitivity, specificity, and accuracy rates were 77% (95% CI 54-92), 87% (95% CI 79-93), and 85% (95% CI 77-91), respectively. The MRI sensitivity, specificity, and accuracy rates for all participants were 81% (95% CI 59-94), 85% (95%CI 76-92), and 84% (95% CI 76-90), respectively. In the diagnosis of PAD, the specificity and accuracy of USG are higher than that of MRI, whereas the sensitivity of MRI is better than that of USG.

Biochemical and ultrasonographic markers in fetal surveillance

Introduction/Objective. Fetal growth restriction (FGR) is associated with increased fetal and neonatal mortality and morbidity. The study objective was to investigate the correlation of maternal blood biochemical markers routinely determined in the first and second trimester screening and ultrasound fetal surveillance parameters in the prediction of fetal growth and condition in singleton pregnancies. Methods. In the first trimester we measured serum levels of beta subunit of human chorionic gonadotropin (?HCG) and pregnancy-associated plasma protein A (PAPP-A). In the second trimester we measured values of chorionic gonadotropin (HCG), alpha fetoprotein (AFP), unconjugated estriol (E3) and inhibin A, also examined ultrasonographic biometric fetal parameters, amniotic fluid index (AFI) and Doppler resistance indexes. FGR was defined as ultrasonographically determined fetal weight and growth parameters below the 10th percentile for the gestational age. Obtained biochemical and ultrasonographic parameters were correlated. Results. Study included 104 singleton pregnancies. ?HCG in the first trimester correlated negatively with fetal growth in the second and third trimester, and the second trimester AFI. Increased PAPP-A correlated positively with elevated resistance index in medial cerebral artery, lower biophysical profile scores, and intermediate type of non-stress test. Lower values of E3 were associated with FGR. Elevated serum AFP levels were linked to oligoamnion in the third trimester. There was no correlation of inhibin A levels with fetal condition. Conclusion. First and second trimester biochemical markers of pregnancy (?HCG, PAPP-A, HCG, AFP and E3) in combination with ultrasonographic biophysical parameters of fetus have predictive value for fetal growth and development.

Sonographic evaluations of the skeletal muscles in patients with Pompe disease.

Pompe disease usually has muscle weakness due to glycogen accumulation. Heckmatt scale is commonly used to grade the pertinent findings of ultrasound. Nonetheless, it is difficult to detect subtle changes of the muscle. Besides, no ultrasonographic parameter has been proposed to predict the motor functions of Pompe disease. Therefore, we aimed to find out an ultrasonographic parameter that can quantify the muscle involvement and correlate with the motor functions in Pompe disease. Eighteen patients with Pompe disease were enrolled. The echo heterogeneity index (standard deviation divided by mean echogenicity values by ImageJ analysis) and shear modulus were recorded from rectus femoris, biceps femoris, tibialis anterior, medial gastrocnemius, biceps brachii and triceps brachii muscles. Motor functions, including manual muscle strength, 6-min walk and four-limb stair climb tests were assessed. Correlations between ultrasonographic parameters and Heckmatt scale and motor functions were analyzed. The echo heterogeneity index, but not the shear modulus, was negatively correlated with the Heckmatt scale rating in all muscles. The echo heterogeneity indices of tibialis anterior (r=0.698, p=0.008) and medial gastrocnemius (r=0.615, p=0.025) muscles showed positive correlations with the walking distance. Besides, the echo heterogeneity indices of four lower limb muscles were negatively correlated with the duration of stair climbing. The echo heterogeneity index but not the shear modulus can be used to quantitatively describe the muscle involvement in Pompe disease. In addition, lower echo heterogeneity indices of lower limb muscles are associated with worse motor functions in these patients.

A Prospective study of Preoperative sonographic and Doppler parameters as predictors of improvement in semen analysis parameters after varicocelectomy

TITLE:-A Prospective study of Preoperative sonographic and Doppler parameters as predictors of improvement in semen analysis parameters after varicocelectomy OBJECTIVE:-To assess correlation between preoperative size of varicoceles, presence of reflux on sonogprahy and colour Doppler and improvement in semen analysis parameters after varicocelectomy. METHODS:-This is a prospective comparative study and was carried out between November 2021 to September 2022. During the study period, 40 consecutive patients (Patients with 16-40 years of age) presented to surgical outdoor with clinical presentation and eventual radiological diagnosis of varicocele were included. Preoperative and post operative samen anlysis was done and comparision done between semen parameters and usg color doppler findings. RESULTS: In this study, a total of 40 patients were evaluated. There was a signifificant positive correlation between the degree of reflux preoperatively and the improvement index i.e. P &lt; 0.001 in group with reflux &gt;2sec, also there was a positive correlation between the vein diameter and the improvement index i.e. P=/&lt;0.001 in group with vein size &gt;3mm. CONCLUSION: The best preoperative sonographic parameters of success of unilateral varicocele repair are the presence of normal-sized testes, high grade reflux, and large vein diameter.

Accuracy of Ultrasound Imaging Findings in Diagnosis of Adnexal Masses: A Cross-sectional Study

Introduction: Adnexal mass lesions are common among women of all age groups. Precise preoperative estimation of the benign or malignant nature of an adnexal mass is important to avoid additional surgical treatment. Sonography is the initial imaging study of choice in the evaluation of women with suspected adnexal masses. Assiut scoring model is a simpler model for differentiation of adnexal masses into benign and malignant using various ultrasonographic parameters. Aim: To assess the accuracy of ultrasound in differentiating benign from malignant adnexal masses using Assiut scoring model. Materials and Methods: This cross-sectional study was conducted in Department of Radiodiagnosis at Christian Medical College and hospital (tertiary care hospital), Ludhiana, Punjab, India, from November 2018 to January 2021. The study included 80 cases of adnexal masses. An Ultrasound (USG) diagnosis was made based on tumour volume, type of mass, papillary projections, septae and vessel location and Assiut score was obtained. Histopathological examination was carried out following surgery or biopsy. The diagnostic accuracy of USG (with histopathology as gold standard) was determined. Sensitivity, specificity, positive predictive value and negative predictive value of USG was assessed for predicting malignancy taking histopathology as gold standard. The p-value &lt;0.05 was considered statistically significant. Results: Most numbers of patients (33 patients, 41.25%) belonged to age group 21-30 years. Mean age of study subjects was 35.35±12.8 years. Majority (60, 75%) of patients were benign and 20 (25%) were malignant. The USG findings showed good agreement with histopathology (kappa=0.76, p-value&lt;0.0001). Sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) for correctly predicting malignant lesions being 90%, 90%, 75% and 96.43% respectively. Median Assiut score in malignant was significantly higher as compared to benign (9.95 vs 3.47, p-value&lt;0.0001). Characteristics such as central or septal vascularization, presence of thick septa, papillary projections, multilocularity and high tumour volume (especially above 500 mL) showed a significant association with malignancy (p-value&lt;0.0001). Conclusion: The USG based Assuit scoring model is a good tool in differentiating benign from malignant adnexal masses with high sensitivity and specificity.

Correlation between upper airway ultrasound and Cormack–Lehane grading during laryngoscopy – A prospective study

Background: Securing airway and adequate ventilation after induction of anesthesia is the utmost priority of anesthesiologists, failure of that can lead to hypoxic brain injury and death in a few minutes. Aims and Objectives: The aims of this study were to ascertain the role of ultrasonography in predicting difficult intubation by comparing different ultrasonographic parameters. Materials and Methods: One hundred patients posted for elective surgery under general anesthesia were studied. The study was carried out in two phases. The first phase – during the pre-anesthetic checkup, ultrasonographic measurements of Anterior neck soft-tissue thickness at the level of hyoid (ANS-Hyoid), anterior neck soft tissue thickness at the level of vocal cords (ANS-VC), pre-epiglottic space (Pre-E), distance from the epiglottis to the mid-point of the distance between the vocal cords (EVL), and the ratio of both (PES/EVL) was also done. In the second phase, Cormack–Lehane (CL) grade was noted during intubation. A Chi-square test was applied to correlate ultrasonographic parameters and CL grade. Sensitivity, specificity, an area under the receiver operating characteristic (ROC) curve, negative predictive value, and positive predictive value were calculated for various parameters. Results: In this study among the studied parameter, only ANS–VC was statistically significant in predicting difficult intubation (P&lt;0.0001). ANS-VC &gt;0.32 cm was 93.3% sensitive and 84.7% specific and had Area under the ROC curve of 85% in predicting CL grade 3 and 4 (difficult intubation). Conclusion: USG is a useful tool in predicting difficult intubation. ANS-VC &gt;0.32 cm is a highly sensitive and specific predictor of difficult intubation, while other USG parameters are not indicative of difficult intubation.

Correlation between the International Prostate Symptom Score and sonographic parameters in patients with symptomatic benign prostate enlargement

Correlation between the International Prostate Symptom Score and sonographic parameters in patients with symptomatic benign prostate enlargement