Ultrasound Examination Research Articles

A sarcopenia prediction model based on the calf maximum muscle circumference measured by ultrasound

Abstract Background The correlation between calf circumference（CC）and sarcopenia has been demonstrated, but the correlation between calf maximum muscle circumference (CMMC) measured by ultrasound and sarcopenia has not been reported. We aims to construct a predictive model for sarcopenia based on CMMC in hospitalized older patients. Methods This was a retrospective controlled study of patients > 60 years of age hospitalized in the geriatric department of Hunan Provincial People’s Hospital. The patients were thoroughly evaluated by questionnaires, laboratory, and ultrasound examinations, including measuring muscle thickness and calf muscle maximum circumference using ultrasound. Patients were categorized into sarcopenia and non-sarcopenia groups according to the consensus for diagnosis of sarcopenia recommended by the Asian Working Group on Sarcopenia 2019 (AWGS2). Independent predictors of sarcopenia were identified by univariate and multivariate logistic regression analyses, and a predictive model was developed and simplified. The prediction performance of the models was assessed using sensitivity, specificity, and area under the curve (AUC) and compared with independent predictors. Results We found that patient age, albumin level (ALB), brachioradialis muscle thickness (BRMT), gastrocnemius lateral head muscle thickness (Glh MT), and calf maximum muscle circumference (CMMC) were independent predictors of sarcopenia in hospitalized older patients. The prediction model was established and simplified to Logistic P = -4.5 + 1.4 × age + 1.3 × ALB + 1.6 × BR MT + 3.7 × CMMC + 1.8 × Glh MT, and the best cut-off value of the model was 0.485. The sensitivity, specificity, and AUC of the model were 0.884 (0.807–0.962), 0.837 (0.762–0.911), and 0.927 (0.890–0.963), respectively. The kappa coefficient between this model and the diagnostic criteria recommended by AWGS2 was 0.709. Conclusion We constructed a sarcopenia prediction model with five variables: age, ALB level, BR MT, Glh MT, and CMMC. The model could quickly predict sarcopenia in older hospitalized patients.

Association of alcohol consumption and rotator cuff retear: a case control matched cohort study

Abstract Background Failure of healing or retear after surgical repair of the rotator cuff tendons are still a problem and can cause ongoing shoulder pain and dysfunction. Compromised microcirculation as seen in regular alcohol consumption may lead to poor healing. Purpose To compare the clinical outcomes and tendon integrity of patients after rotator cuff repair with and without regular alcohol intake. Study design Case control matched cohort study; Level of evidence, 3. Methods Patients who underwent arthroscopic rotator cuff repair (ARCR), had regular alcohol intake (according to world health organization (WHO) definition of harmful alcohol consumption) and were at least 2 years postoperative were included, and matched according to age, sex, involved tendon, and tear size with patients who underwent ARCR without regular alcohol intake. Patient-reported outcome (PRO) scores were collected at final follow-up including the Constant Murley Score (CMS), Western Ontario Rotator Cuff Score (WORC), Simple Shoulder Test (SST), and visual analog scale (VAS). Tendon integrity (maintained continuity: yes/no = full thickness) was assessed by ultrasound examination at final follow-up. Complications and revision surgeries are reported. Results Twenty-two patients (versus twenty-two matched—controls) were available for follow-up. There were two female (9%) and twenty male (91%) patients with a mean age of 66.6 years (standard deviation, 36–85 years). The mean follow-up was 4 years (standard deviation, 2–5 years) in the alcohol group and 5 years (standard deviation, 2–10 years) in the non-alcohol group. No differences in mean PRO scores between alcohol and non-alcohol groups were seen except VAS (0.5 (standard deviation, 0–5) vs. 1.6 (standard deviation, 0–8), (P = 0.049*) respectively). Intact tendon insertion was seen in 77% (17/22) for the alcohol group and 100% (22/22) for non-alcohol group, (P = 0.021*). One patient underwent revision surgery (5%) in the alcohol group due to a retear, no further peri- or postoperative complications were noticed. Conclusion Patients with torn rotator cuff tendons benefited similarly from ARCR independently of their alcohol use concerning clinical presentation. However, significantly higher retear rates were recorded in the alcohol group.

Leiomyosarcomas of the inferior vena cava: diagnostic features on contrast-enhanced CT, ultrasonography and MRI

PurposeTo evaluate clinical presentation and imaging characteristics of leiomyosarcomas of the inferior vena cava (IVC LMS) using contrast-enhanced CT (CECT), ultrasonography (US), magnetic resonance imaging (MRI), and to identify features that facilitate early and accurate pre-operative diagnosis.Materials and methodsOur study enrolled 21 patients with pathologically confirmed IVC LMS from October 2015 to June 2022. All participants underwent CECT, and additionally, 12 participants had US examinations and 3 had MRI. Images were independently reviewed by two experienced radiologists. The clinical presentations and diagnostic characteristics were recorded.ResultsThe study involved 16 female and 5 male patients, with an average age of 55 ± 11 years (ranging from 34 to 80 years). Common clinical symptoms included abdominal pain, back pain, leg discomfort, abdominal distension, jaundice, and the presence of an abdominal mass. On CT scans, a large, lobulated, heterogeneous mass with progressive enhancement was typically seen in 13 of the 21 patients (61.9%). Ultrasonography revealed that IVC LMS typically presented as a lobulated, heterogeneous, hypoechoic mass. Color Doppler imaging evaluated lumen obstruction in 8 of the 12 patients (66.7%), and high velocity flow signals were detected by Pulsed wave Doppler in 4 of the 12 patients (33.3%). On MRI, IVC LMS presented as a heterogeneous mass that exhibited intermediate intensity on T1-weighted images, slightly high intensity on T2-weighted images and high intensity on diffusion-weighted images.ConclusionSeveral diagnostic characteristics on CECT, US and MRI could aid in the diagnosis of IVC LMS. The detection of a heterogeneous mass with progressive enhancement along the inferior vena cava on CECT was strongly indicative of IVC LMS. Both CT and US are effective in accurately indicating the location of the tumor within the IVC.

Navigating diagnostic challenges: case reports on differentiating uterine fibroids from leiomyosarcoma through imaging and clinical evaluation.

Differentiating between uterine fibroids and leiomyosarcoma poses significant challenges, particularly in cases of atypical fibroid degeneration. Accurate diagnosis is crucial for appropriate treatment and patient outcomes. We present two case reports to illustrate the complexities involved in distinguishing these conditions. Both cases involved patients with similar clinical presentations and imaging findings. The diagnostic process included trans-abdominal and trans-vaginal ultrasound, CT scans, and histopathological examination. In Case 1, the patient presented with worsening abdominal pain and imaging revealed multiple myomas. Histological examination confirmed benign fibroids following surgery. Case 2 involved a patient with an abdominal mass and CT findings suggestive of a fibroid. However, ultrasound characteristics raised suspicion of malignancy, and subsequent histopathological analysis confirmed leiomyosarcoma. These case reports underscore the importance of combining clinical evaluation with advanced imaging techniques for accurate differentiation between uterine fibroids and leiomyosarcoma. While ultrasound plays a critical role, its effectiveness is enhanced by the experience of the sonographer and the integration of other diagnostic modalities. Future multicenter studies should focus on refining these diagnostic approaches to improve accuracy and patient outcomes.

Implementation of prehospital point-of-care ultrasound using a novel continuous feedback approach in a UK helicopter emergency medical service.

There has been increased use of prehospital point-of-care ultrasound (PoCUS) by helicopter emergency medical services (HEMS) in recent years. Lack of governance structure and evidence of benefit have been described as major barriers to its implementation. This paper describes a novel approach to implementation of prehospital PoCUS and clinical governance framework in a UK HEMS. A retrospective database review was undertaken at London's Air Ambulance (LAA) from 1st September 2021 to 31st March 2023. All patients who had PoCUS examination were included. Scans were archived in a cloud-based server and reviewed weekly by expert clinicians. They were graded in adequacy, agreement between reviewer and clinician was recorded and fed back to the clinicians allowing continuous feedback learning. In-hospital diagnosis was sought for patients having the full Pump, Pleura and Pouring blood (PPPB) protocol. Cohen's Kappa (ƙ) was calculated for inter-rater reliability. Sensitivity and specificity analysis was performed using 2 × 2 tables. LAA attended 3,068 missions. Our reviewers identified 701 PoCUS scanning encounters and 628 were included in the final analysis. Clinicians performed 420 scans for pneumothorax, 308 for free fluid and 305 pericardial effusions respectively. Majority of the population were male (85%) who sustained traumatic (93.5%) thoracic injuries (65%). Paramedics performed 29% of the scans. Reviewers deemed 83% of the scans of adequate quality. Inter-rater reliability between clinicians and reviewers was 0.6 for pericardial effusion, 0.67 for pneumothorax and 0.71 for free fluid respectively. A full PPPB protocol was performed in 52 patients out of which 46 were included. The sensitivity and specificity of PPPB protocol for diagnosis life-threatening injuries was 0.5 and 0.9 respectively. Introduction of prehospital PoCUS in a HEM service utilizing high quality training, user-friendly workflow and image archiving system, robust governance framework and continuous feedback may be feasible allowing high quality ultrasound examinations. The bespoke PPPB protocol in prehospital may improve diagnosis of life-threatening injuries.

Sonographic Diagnosis of Anterior Nutcracker Phenomenon and its Prevalence in Nigerian Males with Varicoceles

Abstract Background: The nutcracker phenomenon (NCP) is a rare and often unrecognised cause of varicocele, haematuria, and chronic pelvic pain due to the left renal vein (LRV) compression between the aorta and the superior mesenteric artery (anterior nutcracker). Its varied clinical manifestations make the diagnosis difficult and usually delayed. A high index of clinical suspicion, with appropriate imaging studies is crucial for the diagnosis. Objectives: We used a colour Doppler ultrasound scan to investigate the anatomic and haemodynamic properties of testicular and renal venous drainage. The emphasis was to determine the presence or absence of NCP, its possible effects on varicocele formation and severity, and its relationship with the body mass index (BMI) of the subjects. Materials and Methods: We carried out Doppler scrotal and upper abdominal ultrasound examinations of 100 subjects with male infertility and clinical varicoceles (group A), and 100 controls with male infertility but without varicoceles (group B). The mean peak velocity (PV) and the anteroposterior (AP) diameters of different segments of the renal veins, as well as the diameters of the testicular veins of the subjects in the two groups were measured and compared. The ratios of the PV and the diameters between the hilar portion and the aorto-mesenteric portion of the LRV were also calculated and compared. A PV ratio or anteroposterior diameter ratio between the two portions greater or equal to 5.0 was considered diagnostic of NCP. The diagnosis of varicocele was confirmed by visualising a dilated pampiniform plexus vein measuring greater than 2 mm in diameter using an ultrasound scan. Results: Six out of 100 subjects in group A had diameter and PV ratios (≥5.0) in the LRV that suggested the presence of NCP, and all participants in group B had neither diameter nor PV ratio suggestive of NCP. The prevalence of NCP seen within the varicocele group in this study was statistically significant (P = 0.038). Five (83.3%) of the six subjects in the NCP-associated varicocele subgroup had microscopic haematuria, orthostatic proteinuria, or both; these qualified them for the diagnosis of nutcracker syndrome (NCS), A significantly lower mean BMI (P = 0.004) was noted among the NCP-associated varicocele subgroup compared to those without NCP. Conclusion: Our findings indicate that the NCP is a significant finding in patients with varicoceles in our environment, and it is more common with lower BMI.

Age-optimized cut-off values for pubofemoral distances in screening for hip dysplasia.

To establish cut-off values for lateral pubofemoral distance (PFD) measurements for detecting hip dysplasia in early (four days) and standard care (six weeks) screening for developmental dysplasia of the hip (DDH). All newborns, during a one-year period (October 2021 to October 2022), were offered a PFD ultrasound (US) examination in addition to the existing screening programme for DDH. Newborns who were referred for standard care hip US, suspected for DDH, received a secondary PFD US examination in conjunction with the standard care Graf/Harcke hip US examination. Receiver operating characteristic curves and empirically optimal cut-off values were calculated with a true positive defined as a Graf type ≥ IIc hip. We included 2,735 newborns, of whom 758 received both early PFD hip US and standard care Graf/Harcke hip US. For early (four days) PFD screening, the optimal cut-off point was calculated to be 6.2 mm (95% CI 4.7 to 7.7) producing a sensitivity of 80% (95% CI 55% to 100%) and a specificity of 87% (86% to 89%). For PFD screening performed at standard care (six weeks) hip US, the optimal cut-off point was calculated to be 5.6 mm (95% CI 4.9 to 6.3) producing a sensitivity of 100% (95% CI 100% to 100%) and a specificity of 96% (95% CI 95% to 97%). PFD US screening produces a high degree of both sensitivity and specificity for detecting DDH. Age-specific cut-off values should be used to heighten the accuracy of PFD US screening.

A prediction nomogram for residual after negative pressure aspiration for endogenic cesarean scar ectopic pregnancy: a retrospective study

BackgroundWe aimed to establish a predictive nomogram to evaluate the incidence of residual tissue in patients with endogenic cesarean scar ectopic pregnancy after negative pressure aspiration.MethodsThis retrospective study included patients treated in the gynecology department of our institution from May 2017 to August 2023 who underwent negative pressure suction treatment, ultrasound examinations before and after treatment, and received telephone follow-up for at least 6 months. A total of 899 patients met the inclusion criteria and were divided into a training cohort (629 patients, 70%) and a validation cohort (270 patients, 30%). Independent predictive factors were established using multivariate logistic regression. The resulting nomogram was validated using 1,000 bootstrap resampling, and calibration curves were plotted. Receiver operating characteristic (ROC) analysis was performed to calculate the area under the curve, sensitivity, specificity, and other metrics to assess its discriminative performance. Clinical decision curves were constructed to evaluate clinical applicability and quantify the net benefit within a range of threshold probabilities. The model was externally validated in the validation cohort.ResultsPredictive factors included in the nomogram included age (hazard ratio [HR]: 1.220, 95% confidence interval [CI]: 1.135—1.316), BMI (HR: 0.890, 95% CI: 0.796—0.986), intraoperative major hemorrhage (HR: 4.457, 95% CI: 1.610—12.292), maximum diameter of the gestational sac (HR: 1.572, 95% CI: 1.295, 1.914), and thickness of the remaining muscle layer of the lower uterine segment (HR: 1.572, 95% CI: 0.014, 0.430). The ROC curve of the resulting nomogram showed similar area under the curve values for the training (0.809, 95% CI: 0.751—0.867) and validation cohorts (0.814, 95% CI: 0.739, 0.888). The Hosmer–Lemeshow test indicated good model fit (P = 0.861), and the calibration curve was close to the ideal diagonal line. Decision curve analysis demonstrated good net benefit, and external validation confirmed its reliability.ConclusionsThe model may aid in individual clinical decision-making, allowing clinicians to perform immediate postoperative assessments for patients with endogenous ectopic pregnancy in cesarean section scars treated with negative pressure suction, identify high-risk subpopulations, and select appropriate supplementary treatment in advance, making it particularly suitable for low-income areas and resource-limited primary hospitals.

Prenatal Diagnostics Using Deep Learning: A Dual Approach to Plane Localization and Cerebellum Segmentation in Ultrasound Images.

The fetal ultrasound examination is the significant task of mid-term pregnancy inspection and the accurate localization as well as the segmentation of the cerebellum is crucial for clinical diagnosis. This research focuses on developing deep learning techniques for prenatal prediction of neurodevelopmental disorders using 5th-month ultrasound brain images. The study introduces two specialized convolutional neural network (CNN) architectures: the differential CNN for plane localization and the dual CNN for cerebellum segmentation which are critical for accurate diagnostics during prenatal care. The differential CNN incorporates six different convolutional operators to capture diverse features for precise localization of specific planes within images. The dual CNN architecture integrates both the original image and complementary information such as feature maps, to enhance segmentation accuracy for the cerebellum. The models are trained on annotated datasets of ultrasound images, validated, and tested on separate datasets. The effectiveness of the proposed CNN architectures is determined by performing the specific tasks of plane localization and cerebellum segmentation, respectively. The proposed models achieved high performances of 98.6% and 0.956% from accuracy and dice coefficient (DSC) compared to existing approaches in medical image analysis. The findings of this study have significant implications for the prenatal prediction of neurodevelopmental disorders, offering a promising advancement in prenatal care and early diagnostics. The custom CNN architectures tailored to the specific tasks of plane localization and cerebellum segmentation highlight the importance of task-specific model design in medical imaging. While the study acknowledges certain limitations and challenges, the power of deep learning is analyzed for marking the benefit of healthcare and neurodevelopmental disorder prediction during pregnancy.

Ultrasound diagnosis and surgical treatment of rare lumbar renal hernia in a domestic cat (Felis catus)

AbstractLumbar hernias are infrequent occurrences in human surgical practices, with sparse reports in veterinary literature. This paper presents a rare case of lumbar renal hernia. A 4‐month‐old mixed‐breed domestic cat was evaluated, showing increased volume just behind the 13th rib, which was reducible, rounded and painless. A targeted ultrasound examination revealed the protrusion of the left kidney into the subcutaneous tissue and an abdominal wall defect measuring approximately 2.7 cm. The patient underwent surgical intervention to correct the abdominal musculature defect by suturing the defect's edges. After 130 days of operation, the patient was discharged with no signs of recurrence. This report contributes to the limited number of cases of lumbar renal hernia described in the literature and seeks to assist the scientific community in managing similar cases of lumbar renal hernias.

Radiomics analysis of ultrasound images to discriminate between benign and malignant adnexal masses with solid morphology on ultrasound.

The primary aim was to identify radiomics ultrasound features that can distinguish between benign and malignant adnexal masses with solid ultrasound morphology, and between primary malignant (including borderline and primary invasive) and metastatic solid ovarian masses, and to develop ultrasound-based machine learning models that include radiomics features to discriminate between benign and malignant solid adnexal masses. The secondary aim was to compare the discrimination performance of our newly developed radiomics models with that of the Assessment of Different NEoplasias in the adneXa (ADNEX) model and that of subjective assessment by an experienced ultrasound examiner. This was a retrospective, observational single-center study conducted at Fondazione Policlinico Universitario A. Gemelli IRCC, in Rome, Italy. Included were patients with a histological diagnosis of an adnexal tumor with solid morphology according to International Ovarian Tumor Analysis (IOTA) terminology at preoperative ultrasound examination performed in 2014-2020, who were managed with surgery. The patient cohort was split randomly into training and validation sets at a ratio of 70:30 and with the same proportion of benign and malignant tumors in the two subsets, with malignant tumors including borderline, primary invasive and metastatic tumors. We extracted 68 radiomics features, belonging to two different families: intensity-based statistical features and textural features. Models to predict malignancy were built based on a random forest classifier, fine-tuned using 5-fold cross-validation over the training set, and tested on the held-out validation set. The variables used in model-building were patient age and radiomics features that were statistically significantly different between benign and malignant adnexal masses and assessed as not redundant based on the Pearson correlation coefficient. We evaluated the discriminative ability of the models and compared it to that of the ADNEX model and that of subjective assessment by an experienced ultrasound examiner using the area under the receiver-operating-characteristics curve (AUC) and classification performance by calculating sensitivity and specificity. In total, 326 patients were included and 775 preoperative ultrasound images were analyzed. Of the 68 radiomics features extracted, 52 differed statistically significantly between benign and malignant tumors in the training set, and 18 uncorrelated features were selected for inclusion in model-building. The same 52 radiomics features differed significantly between benign, primary malignant and metastatic tumors. However, thevalues of the features manifested overlapped between primary malignant and metastatic tumors and did not differ significantly between them. In the validation set, 25/98 tumors (25.5%) were benign and 73/98 (74.5%) were malignant (6 borderline, 57 primary invasive, 10 metastatic). In the validation set, a model including only radiomics features had an AUC of 0.80, sensitivity of 0.78 and specificity of 0.76 at an optimal cut-off for risk of malignancy of 68%, based on Youden's index. The corresponding results for a model including age and radiomics features were AUC of 0.79, sensitivity of 0.86 and specificity of 0.56 (cut-off 60%, based on Youden's index), while those of the ADNEX model were AUC of 0.88, sensitivity of 0.99 and specificity of 0.64 (at a 20% risk-of-malignancy cut-off). Subjective assessment had a sensitivity of 0.99 and specificity of 0.72. Our radiomics model had moderate discriminative ability on internal validation and the addition of age to this model did not improve its performance. Even though our radiomics models had discriminative ability inferior to that of the ADNEX model, our results are sufficiently promising to justify continued development of radiomics analysis of ultrasound images of adnexal masses. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Correlation between antenatal and postnatal coiling index and its role in prediction of perinatal outcome: A prospective cohort study

Background: The umbilical cord has pivotal role in the development, well-being, and survival of fetus and is vulnerable to kinking, torsion, and compression affecting perinatal outcome adversely. Aims and Objectives: This study was aimed to correlate the umbilical cord index measured antenatally using ultrasonography with that of the umbilical cord index measured postnatally and the association of this index with adverse fetal outcomes. Materials and Methods: This prospective cohort study was conducted on 124 antenatal cases of age group 18–35 years with term gestation with singleton pregnancy that attendant the outpatients department and indoor of Department of Obstetrics and Gynecology, Nehru Hospital B.R.D. Medical College, Gorakhpur over a period of 1 year (2019–2020). After detailed history, examination, and required antenatal care investigations, Ultrasonographic examination was done and antenatal umbilical coiling index (UCI) was calculated. The cases were followed up till delivery and postnatal UCI was also calculated and fetomaternal outcome was noted. Statistical analysis: Appropriate tests were applied where ever necessary. Results: The mean age was 25.71±4.30 years. The risk of preeclampsia, fetal growth restriction, oligohydramnios was significantly high with antenatal and postnatal hypocoiling (P<0.001) whereas the risk of gestational diabetes mellitus was significantly associated with antenatal and postnatal hypercoiling. The risk of low birth weight, preterm, low APGAR, neonatal intensive care unit admission and perinatal mortality were significantly high with postnatal hypocoiling (P<0.0001). Conclusion: The present study concludes that abnormal UCI was associated with adverse perinatal outcomes. Quantification of degree of abnormal coiling in antepartum period is important.

Neglected Zone VII Extensor Tendons Reconstruction with a Palmaris Longus Tendon Autograft

Background: This study reported a case of zone VII multiple neglected extensor tendons reconstruction with a palmaris longus tendon autograft in a 15-year-old boy 3 months after the initial trauma. Case presentations: Preoperative examinations revealed complete damage of the extensor carpi radialis longus (ECRL), extensor carpi radialis brevis (ECRB), abductor pollicis longus (APL), and partial injury of the extensor pollicis brevis (EPB). The extensor tendons were reconstructed with a palmaris longus tendon autograft combined with graft tunnel reconstruction within the scar at the level of the damaged retinaculum. After the surgical treatment, short immobilization and early rehabilitation were applied, providing passive sliding of the reconstructed tendon supplemented with actively mediated extension. Results: Despite the neglectful nature of the injury, surgical treatment and early postoperative rehabilitation resulted in an excellent functional outcome. At the follow-up visit, 6 months postoperative, the patient presented a full range of motion of the radiocarpal joint and thumb without any limitations on hand function. Conclusions: (1) Palmaris longus tendon autograft is a viable option for the treatment of multiple zone VII extensor tendon damage. (2) The combination of early passive motion and actively mediated extension provides tendon gliding and results in good functional outcomes for a hand with zone VII extensor tendon injury. (3) Ultrasound examination can evaluate early results and detect complications, mainly tendon/graft adhesions, after extensor tendon reconstruction surgery.

Clinical utility of ultrasonography in pediatric and adolescent gynecology: retrospective review of 1313 ultrasound examinations.

Ultrasound is the first-line imaging modality of the pelvis in the pediatric and adolescent gynecology (PAG) population. Ultrasound findings in pre- and postpubertal PAG patients differ from those in adults. Diagnostic models for adnexal pathology have not been validated in this cohort. The primary aim of this study was to evaluate normative findings and the incidence of pathology in this cohort. The secondary aim was to assess the performance of expert opinion alone, as well as using retrospective application of the International Ovarian Tumor Analysis (IOTA) simple rules (SRs) and benign descriptors (BDs) in those found to have an adnexal mass. This was a retrospective review of pelvic ultrasound examinations performed in patients < 18 years of age from January 2017 to July 2021 in one expert center in the UK. Analysis was performed on three age groups: neonatal (aged < 1 year), premenarchal (aged ≥ 1 year) and postmenarchal. The study was locally approved as an audit (GRM_082). Expert review of images of ovarian masses was performed using retrospective application of the IOTA-SRs and IOTA-BDs. In total, data on 1429 pelvic ultrasound examinations were retrieved, of which 116 were excluded, resulting in the inclusion of 1313 ultrasound images (1145 patients). The median age at the first ultrasound scan was 2 days after birth in the neonatal group (n = 20), 8.8 years in the premenarchal group (n = 124) and 16.1 years in the postmenarchal group (n = 961). The status of menarche was unknown in a further 40 patients. Normative ultrasound findings were in keeping with those in the existing literature. Uterine anomalies were seen in 14 (1.2%) patients. Endometrial pathology was rare, with five cases of gestational trophoblastic disease. The most frequent indication for ultrasound scan for each group were a known medical condition in neonates (n = 11 (55.0%)), suspected precocious puberty in premenarchal girls (n = 38 (30.6%)) and abnormal vaginal bleeding in postmenarchal girls (n = 504 (52.4%)). Polycystic ovarian appearances were described in 150 (15.6%) postmenarchal girls. Adnexal pathology was identified in 102 (8.9%) participants on initial ultrasound: four neonates, three premenarchal and 95 postmenarchal patients. Benign cystadenomas and hemorrhagic cysts were the most common adnexal mass type in all groups. Final outcomes were available for 79/95 masses in the postmenarchal group, none of which were malignant. The IOTA-SRs, IOTA-BDs, expert opinion and standard ultrasound reporting could characterize as benign 96.2%, 87.3%, 98.7% and 77.2% of the masses, respectively, all with a specificity of 100%. Eleven patients underwent 12 surgeries overall (three oophorectomies, six cystectomies and three cyst aspirations), with 11 out of 12 masses classified as benign based on retrospective expert assessment. Ultrasound is effective for assessment of the female pelvis in the PAG population. Adnexal masses are common, but few require surgical intervention and most resolve expectantly. The IOTA-BDs and IOTA-SRs maintain their performance in this population. Larger studies are required for the prospective validation of diagnostic models which may aid a fertility-sparing approach to care. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Image-Guided Robotic Surgery for Sentinel Lymph Node Status Assessment in Uterine Cancers Using Ultrasound Drop-in Probe: Surgical Technique in 10 Steps.

Recent guidelines recommend the sentinel lymph node (SLN) technique in uterine cancers, as it is associated with lower perioperative complications.1 Image-guided surgery can address some limitations of SLN procedures, such as low frozen-section accuracy and risk of empty packets,2-4 by providing real-time lymph node assessment.5,6 This video describes the surgical procedure of intraoperative robotic ultrasound examination for SLN assessment. The Arietta L43K (2-12MHz, Hitachi, Japan) drop-in robotic ultrasound probe was used to assist with SLN dissection. The procedure was performed on the da Vinci Xi platform. The probe, introduced through an accessory trocar, was manipulated by robotic instruments, providing real-time ultrasound imaging in split-view mode on the surgeon's console. Ultrasound images, captured by the surgeon under the guidance of an experienced ultrasound examiner, were analyzed both in vivo and ex vivo.7 RESULTS: The procedure involves ten steps, detailed as follows. (1) The procedure begins with the cervical injection of indocyanine green. (2) The pelvic retroperitoneum is opened to allow access to anatomical landmarks. (3) Using near-infrared imaging mode, the lymphatic pathways are highlighted, allowing for the identification of the SLN. (4) Once identified, the drop-in ultrasound probe is introduced. (5) The console is switched to split-view mode, enabling the surgeon to observe ultrasound images alongside the endoscopic view. (6) In vivo imaging is conducted. (7) Both images and videos of the lymph node are captured. (8) The SLN is subsequently dissected. (9) SLN specimens are safely extracted. (10) Ex vivo ultrasound assessment is performed to further evaluate their characteristics. Although its accuracy compared with histology as the gold standard is yet to be demonstrated, image-guided robotic lymph node ultrasound is a feasible and promising procedure for real-time SLN assessment. A prospective study is ongoing (R-LYNUS, NCT06621823) to clinically validate this technique.

Association of uterine fibroids with late miscarriage: multicenter cohort study.

To investigate the correlation between the number, location and size of uterine fibroids and the incidence of late miscarriage during pregnancy. This was a retrospective, multicenter cohort study of singleton pregnancies, with a live fetus at the first-trimester ultrasound examination, without known genetic anomalies or major fetal defects, from January 2012 to December 2022. We assessed the impact of fibroids and their characteristics, identified on ultrasound imaging at 11 + 0 to 13 + 6 weeks, on the risk of late miscarriage occurring at 11 + 0 to 21 + 6 weeks. Fibroid number, location and size were investigated, and adjusted odds ratios (aORs) with 95% CIs were calculated using multiple logistic regression and propensity score analysis via inverse probability of treatment weighting (IPTW) to minimize confounding. Singleton pregnancies without uterine fibroids comprised the control group. We further calculated the adjusted absolute risk (aAR) for the control group and the adjusted risk differences (aRD) for the study groups. In total, 31 355 singleton pregnancies were analyzed, of which 942 (3.0%) had uterine fibroids. Multiple logistic regression analysis showed that pregnancies with a single fibroid did not have higher odds for late miscarriage compared to those without fibroids (aOR, 1.2 (95% CI, 0.6-2.4)), but women with multiple fibroids did have higher odds of late miscarriage (aOR, 2.5 (95% CI, 1.0-6.2)). Similarly, multiple logistic regression analysis after IPTW did not find higher odds of late miscarriage in pregnancies with a single fibroid (aOR, 1.7 (95% CI, 0.9-3.0) and aRD, 0.7% (95% CI, -0.2 to 2.1%)) but revealed increased odds of late miscarriage in women with multiple fibroids (aOR, 2.9 (95% CI, 1.1-7.3) and aRD, 2.0% (95% CI, -0.6 to 9.7%)). Analysis of the location of single fibroids revealed that submucosal fibroids significantly increased the odds of late miscarriage by 4.7 times, while the presence of fibroids in other locations did not have a statistically significant association with late miscarriage. When we limited our study population to cases with submucosal and intramural fibroids, logistic regression showed no significant increase in the odds of miscarriage for a single fibroid (aOR, 1.8 (95% CI, 0.9-3.5) and aRD, 1.2% (95% CI, -0.1 to 3.1%)), but revealed significantly higher odds for multiple fibroids (aOR, 3.8 (95% CI, 1.4-10.6) and aRD, 5.1% (95% CI, 0.6-22.0%)) compared with controls. IPTW analysis found a 2.3-fold increase in the odds of late miscarriage for a single fibroid (aOR, 2.3 (95% CI, 1.2-4.2)) and an even larger increase in the odds of late miscarriage for multiple fibroids (aOR, 5.7 (95% CI, 2.2-15.1)). Uterine fibroids are associated with increased odds of late miscarriage, particularly when they are multiple and submucosal. © 2025 International Society of Ultrasound in Obstetrics and Gynecology.

The prospective sonographic assessment of the lower uterine segment after cesarean section and its clinical utility.

This study aims to investigate the sonographic features of the lower uterine segment (LUS) and their association with successful vaginal birth after a cesarean section (VBAC). This is a prospective observational cohort study of women who underwent a first cesarean section (CS). Inclusion criteria were age over 18years and open family planning. Women with a history of any additional uterine surgery, as well as a vertical or inverted T uterotomy during the CS were excluded. A pregestational transvaginal sonography, followed by serial transabdominal ultrasound examinations at the first, second, and third trimesters upon starting a new pregnancy were performed. Each intra-gestational examination involved measuring the LUS on a sagittal plane over a length of 3cm starting from the most inferior identifiable part of the myometrium behind a full bladder. Logistic regression was performed to test the association between measures of the LUS and successful vaginal birth after CS. 96 women with a follow-up pregnancy within 2years of the initial CS were included in the analysis. The pregestational RMT ratio was 62% and 38 (39%) women had a niche. The median thickness of the lower uterine segment was 8.34mm (5.57-9.77), 4.75mm (4.02-5.95), and 2.55mm (2.01-3.55) at the first, second and third trimester, respectively. 70 women attempted VBAC and the risk of unplanned repeat CS was 37.1%. One millimeter increase in LUS thickness in the first trimester increased the odds of VBAC by 50-120% depending on the used measure (p < 0.05). This association weakened with increasing gestational age and the p values increased above 0.05. There is a good chance of successful VBAC for women attempting it. The sonographic assessment of the lower uterine segment during pregnancy could be helpful in counseling these women, albeit it seems that performing ultrasound during the first trimester is more informative than second and third trimesters.

Intraoperative Frozen Section Biopsy for the Auxiliary Diagnosis of Transmural Intestinal Intermediate T-Cell Canine Lymphoma

Intestinal lymphoma is characterized by a malignant lymphoid neoplasm with multifactorial causes, variable clinical symptoms, and, in some cases, rapid progression. This article describes a case of intestinal lymphoma in a dog that had a history of diarrhea lasting two months, accompanied by episodes of hematochezia, which was treated using the CHOP 19 protocol. A seven-year-old male Golden Retriever presented to a veterinary clinic with clinical signs of diarrhea, prostration, and the presence of bloody feces, as reported by the owner. Initial examinations, including hematology, serum biochemistry, and imaging, revealed an abnormal structure in the intestinal region. Considering the circumstances, a surgical procedure was conducted with the aid of a trans-surgical frozen section biopsy. This biopsy aimed to verify the presence of the neoplasm, assess the suspected diagnosis, evaluate the viability of the surgical margins, and determine the possibility of expanding the surgical area. An enterectomy with enteroanastomosis and trans-surgical biopsy was performed, leading to an initial diagnosis of intestinal lymphoma. The tissue fragment was sent for immunohistochemistry, which ultimately confirmed the diagnosis of intestinal T-cell lymphoma. The patient underwent the CHOP protocol for 19 weeks, but during the maintenance phase, abdominal ultrasound examination findings indicated tumor recurrence. Despite being informed of the potential benefits of further chemotherapy, the owner opted not to continue treatment for the animal. Frozen section biopsy can help with diagnosis during surgery, avoiding more invasive procedures and the removal of lymph nodes, since in some cases, the systemic treatment of the disease is recommended.

Ultrasound-assisted middle thoracic epidural catheter placement utilizing the most dorsal sites of bilateral transverse process roots as anatomical landmarks: A cadaveric observational study and a clinical randomized controlled trial.

We developed an innovative method for ultrasound-assisted thoracic epidural catheter placement and assessed its potential to reduce procedural duration for trainees. A cadaveric observational study and a clinical randomized controlled trial. Sapporo Medical University Hospital. A total of 52 adult patients scheduled for thoracic or abdominal surgery and four cadavers. Patients were randomly assigned to either group receiving conventional palpation (conventional group) or combination of the ultrasound examination and conventional palpation (ultrasound group). The primary outcome was total procedure time (sum of skin marking time and needling time) by trainees. The secondary outcomes were (1) skin marking time, (2) needling time, (3) multiple skin punctures, (4) needle redirection, (5) complications, and (6) failed cases. Through dissection of four cadavers, the most dorsal site of the transverse process root was identifiable by ultrasound and the reliable indicator of the interlaminar space. We devised ultrasound-assisted middle thoracic epidural catheter placement utilizing the most dorsal sites of bilateral transverse process roots as anatomical landmarks. Trainees in the ultrasound group had significantly longer skin marking time and significantly shorter needling time than those in the conventional group (107 [87-158] vs 46s [34-54] s, p<0.001 and 197 [156-328] vs 341 [303-488] s, p=0.003). Consequently, there was no significant difference between the two groups in total procedure time (326 [263-467] s vs 391 [354-533] s, p=0.167). Moreover, the probability of trainee failure in epidural anesthesia was significantly lower in the ultrasound group (2/26 [17.7%] vs 10/26 [38.5%], p=0.019). Our novel technique for thoracic epidural catheter placement resulted in expedited needling and enhanced success rates among trainees, although there was no significant difference between total procedure time when using ultrasound guidance and that when using conventional palpation.

Predictors Of Antepartum Hemorrhage In Patients With Placenta Previa

Antepartum Hemorrhage (APH) is a significant complication in pregnancy that poses serious risks to both maternal and fetal health. Objective: To find the predictors of antepartum hemorrhage in patients with placenta previa among the local population of Pakistan. Methods: This cross-sectional study was conducted at PAF Hospital Mianwali from November 2023 to April 2024. A total of 208 patients were included in the analysis. Patients diagnosed with placenta previa confirmed through ultrasound examination were included in the study. Results: The mean age of the patients was 32.83 ± 4.56 years. Out of 208, there were 60 (28.8%) and nulliparous, 148 (71.2%) were multiparous. 85 (40.9%) had previous C-section and 30 (14.4%) were suffered from hypertension. 15 (7.2%) were diabetic and 180 (86.5%) were non-smokers. APH increased by 15% (Adjusted OR: 1.15, 95% CI: 1.05-1.26, p = 0.005). Furthermore, patients with a history of previous cesarean sections had over twice the odds of developing APH compared to those without this history (Adjusted OR: 2.12, 95% CI: 1.23-3.66, p = 0.007). Conclusions: This study concluded that advanced maternal age and a history of previous cesarean sections are significant predictors of antepartum hemorrhage in patients with placenta previa.