Ultrasound Assessment Research Articles

In vivo photoacoustic and ultrafast ultrasound doppler assessment of vascularity for potential thyroid cancer diagnosis: A comprehensive review

In vivo photoacoustic and ultrafast ultrasound doppler assessment of vascularity for potential thyroid cancer diagnosis: A comprehensive review

Ultrasound assessment of bladder and motor function in fetuses with open spina bifida: cohort study.

Open spina bifida (OSB) is associated with lower limb and bladder dysfunction. We documented bladder function and lower limb motor function on ultrasound throughout gestation in a cohort of fetuses with OSB. The association of the prenatal findings with postnatal dysfunction was investigated, along with the impact of talipes on pre- and postnatal motor function. A prospective cross-sectional cohort study was performed including all fetuses with isolated OSB, which were assessed at the University Hospitals Leuven between July 2015 and December 2019. The anatomical level of the lesion was determined on three-dimensional ultrasound. Bladder volumes were also measured on three-dimensional ultrasound and filling-voiding changes (flow) were calculated and compared to gestational-age-matched control fetuses imaged for this study (matched 1:1). The fetal motor function level was determined on ultrasound based on joint movement of the hip, knee, ankle and toes. Postnatal bladder function was assessed by questionnaire and cystography at 1 year of age. The predictive ability of prenatal anatomical and functional levels for postnatal lower limb function was assessed. Lastly, the presence of talipes was assessed as a prognostic factor. We included 122 examinations from 69 OSB fetuses. Bladder volumes were smaller in fetuses with OSB compared to controls and the difference increased with advancing gestational age. There was no association of bladder volume and urinary flow with the level of the lesion, nor was there a measurable effect of prenatal surgery on fetal bladder volume. Postnatal urinary reflux was more likely in children with a smaller bladder volume and lower urinary flow rate at 24 weeks' gestation. Lower limb motor dysfunction was more frequent at higher gestational ages. In-utero motor function was a better predictor of postnatal motor function than the anatomical level of the lesion in fetuses that underwent surgery. Fetuses with talipes performed four levels worse postnatally compared to fetuses without talipes, despite a similar anatomical level of the lesion. In OSB, prior to fetal surgery, bladder volume and urinary flow are already abnormal from early in gestation, independent of the level of the lesion, and may be predictive of postnatal urinary reflux. Motor function impairment can be demonstrated prenatally and is a better predictor of postnatal motor dysfunction than the prenatal anatomical level of the lesion. The presence of talipes adversely impacts postnatal motor function. © 2025 International Society of Ultrasound in Obstetrics and Gynecology.

Application of an AI-Based Model for Non-Invasive Sonographic Assessment for Injection Laryngoplasty.

Hyaluronic acid (HA) can be degraded over time. However, the persistence of the effects after injection laryngoplasty (IL) for unilateral vocal fold paralysis (UVFP) has been observed. The relation between HA residue and clinical voice outcomes is undetermined. We aimed to develop a non-invasive method with clinical applicability for objective evaluation of the temporal change in HA volume using artificial intelligence-based ultrasonographic assessment. Furthermore, the volume outcome and its relation to voice outcomes were investigated. A prospective cohort study. A voice clinic at a tertiary medical center. Adult patients who underwent HA IL for UVFP were recruited. The Voice Handicap Index-10 questionnaire, the grade, roughness, breathiness, asthenia, strainscale, and the normalized glottal gap were evaluated before IL. Patients received ultrasonography for the identification of HA and estimation of volume based on Temporal Convolutional Segmentation Network, and also voice outcome assessments at 2 weeks, and 2 and 6 months after IL. Contours of HA were well-described, and volumes were estimated accordingly. Clinical voice outcomes were significantly improved postoperatively and remained stationary. Contrarily, residual HA volume decreased significantly across time points (1.21 ± 0.53 at 2 weeks, 0.63 ± 0.35 at 2 months, P < .001; 0.32 ± 0.25 at 6 months, P < .001). Simple linear regression showed no significant relationship between the remaining volume at 2 months and patient age or duration of symptoms (P = .67). Volume change of injected HA over time was estimated non-invasively. The prolonged voice improvement, longer than HA longevity, was demonstrated objectively. The knowledge on HA longevity and duration of benefit provides perspectives beneficial to counseling patients and future treatment planning.

Ultrasound Assessment of Venous and Pulmonary Congestion in Left Ventricular Assist Devices Patients.

A significant number of (left ventricular assist device) LVAD patients (pts) have hemodynamic-related adverse events requiring right heart catheterization (RHC). Venous and lung ultrasound is an established method for evaluating congestion in heart failure pts. This study aimed to investigate the role of these ultrasound parameters in the hemodynamic assessment of LVAD pts. RHC and complete echocardiography were performed on 50 consecutive LVAD pts, 12 of whom were the validation cohort. Pts were stratified based on right atrial pressure (RAP) ≥ 7 mmHg and pulmonary capillary wedge pressure (PCWP) > 15 mmHg. The median LVAD follow-up time was 400 (209-900) days. Baseline characteristics were similar between high vs. normal RAP groups, except for NYHA class and renal function in the former group. High vs. normal PCWP showed a greater NYHA class and a furosemide dose. All hemodynamic parameters were significantly different in the high RAP group except for cardiac output (CO) and cardiac index (CI). In contrast, in the high PCWP group, no differences in CO, CI, and pulmonary vascular resistances were apparent. The most accurate non-invasive variable for detecting high RAP was renal venous stasis index (RVSI), receiver-operating characteristic curves for areas under the curve (AUC), 0.78 (95% CI, 0.62-0.93). Estimated left atrial pressure (LAP-eRAP) was the most accurate non-invasive value to discriminate high PCWP (AUC 0.85 95% CI 0.73-0.98). This study found a good correlation between RAP, PWCP, and non-invasive parameters, such as RVSI and LAP-eRAP, suggesting the importance of peripheral venous ultrasound in LVAD patients.

Technical Aspects of Transcutaneous Laryngeal Ultrasonography: A Review.

Technical Aspects of Transcutaneous Laryngeal Ultrasonography: A Review.

Exploring hand function in newly diagnosed primary Sjögren's syndrome: Clinical, radiographic, and ultrasonographic insights.

Exploring hand function in newly diagnosed primary Sjögren's syndrome: Clinical, radiographic, and ultrasonographic insights.

Ultrasound and magnetic resonance imaging (MRI) assessment of piezogenic papules: A report of three cases.

Piezogenic papules (PP) are protrusions of fat that form within the subcutaneous tissue, which are typically found on the heels. We herein describe the ultrasound (US) presentation (topography, echogenicity, shape, dynamic reducibility, and power Doppler activity) and magnetic resonance imaging features (topography, signal, and shape) of PP in three female patients who were referred to our institution for evaluation of soft tissue nodules of the heel. Then, we discuss the anatomy of the heel fat pad and its implication in the pathophysiology of PP. Because PP consist of herniations of subcutaneous fat from deep macrochambers to superficial microchambers through focal defects in the fibroconjunctive capsule of the heel fat pad, dynamic US can demonstrate the reducibility of PP under probe compression and therefore allows easy differentiation from other soft tissue tumors.

Multimodal ultrasound assessment for monitoring keloid severity and treatment response

The current understanding and a standardized assessment or treatment guidelines for keloids are not fully established, highlighting the need for an objective method to gauge keloid severity and treatment outcomes. This study investigated the clinical utility of multimodal ultrasound, integrating Shear Wave Elastography (SWE) and Angio planewave ultrasensitive imaging (AP), to assess keloid severity and treatment responses in 58 keloids across 31 patients. Keloids were categorized into mild, moderate, and severe based on Vancouver Scar Scale (VSS) scores. The results revealed significant differences in keloid thickness, elasticity parameters, and blood flow levels among severity groups, with the AP technique demonstrated superior sensitivity in detecting keloid microcirculation. Additionally, the study evaluated the therapeutic response to Strontium-90 Yttrium-90 isotope applicator treatment in 28 keloids, categorizing them into 13 good responders and 15 poor responders based on improvements observed in their VSS scores. Good responders demonstrated marked improvements post-treatment, including significant flattening of the keloids, decreased stiffness, and normalization of blood flow levels. In contrast, poor responders exhibited minimal changes in keloid thickness, stiffness, and blood flow signals following treatment. These findings underscore the effectiveness of multimodal ultrasound in evaluating treatment responses in keloid management. In conclusion, multimodal ultrasound, focusing on SWE and AP modalities, offers a promising tool for comprehensive assessment, with potential to enhance keloid evaluation and track treatment responses across varying therapeutic interventions, thereby facilitating optimized clinical management and guiding personalized treatment. The study was successfully registered on ClinicalTrials.gov on 12/09/2023, with the Identifier NCT06034587.

Ultrasound assessment of the effect of patient position and body shape on peri-operative renal transplant cortical resistive indices and perfusion.

Multiple factors impact kidney perfusion peri-operatively. The aim of this study was to evaluate the effect of patient position and size on renal transplant perfusion. Consecutive adult recipients of 123 single renal grafts were studied. Renal artery velocity, renal vein velocity and cortical resistive indices were measured in supine, oblique and decubitus positions on post-operative days 1, 3, 7 and 30, and standing on days 7 and 30. Positional resistive indices were significantly lower than the supine resistive indices except in the day 1 oblique scan. Greater reductions in resistive indices occurred in grafts with higher supine cortical resistive indices, higher renal vein velocities and greater change in renal vein velocities. Renal artery velocities, renal vein velocities and resistive indices progressively decreased with greater positional change. Although renal vein velocities correlated poorly with resistive indices in individual patients, mean resistive indices correlated well (r 2 = 0.73) with mean renal vein velocities for scans in different positions and on different days, and less so with mean renal artery velocities (r 2 = 0.37). Supine abdominal girth and change in girth with position were more strongly associated with larger changes in supine resistive indices than recipient weight, body mass index or peri-operative weight gain. Peri-operative renal transplant resistive indices, renal artery velocities and renal vein velocities improve with patient positional change due to reduced compression of the graft and renal vein, with implications for post-operative ultrasound scanning protocols, documentation and reporting. Peri-operative patient position, especially for at-risk grafts, is a modifiable risk factor for poorer graft outcomes. Patients should be nursed in the decubitus position rather than supine. Abdominal girth is more relevant to pre-operative patient assessment than weight or body mass index.

Prevalence of musculoskeletal disorders in patients referred for suspected deep vein thrombosis: insights from a rheumatologist-led clinic.

To assess the frequency of deep vein thrombosis (DVT) and alternative diagnoses in patients with suspected DVT when evaluated by a rheumatologist. Secondly, to describe the distribution of different diagnoses across three Wells score categories (low, moderate, and high). This is an observational study of patients evaluated at a DVT Clinic for suspected DVT, with a rheumatologist-supervised evaluation, performing ultrasound scans on the affected limbs and assessing their results. The obtained diagnoses were noted along with the initial Wells scores performed by the rheumatologist. 649 patients were included. DVT was confirmed in 119/649 (18.3%) cases, with musculoskeletal (MSK) disorders, particularly arthritis and knee-related conditions, being the most common alternative diagnoses (166/649, 25.6%). 288/649 (44.4%) patients did not receive a definitive diagnosis. Higher Wells scores were more common in confirmed DVT cases, while patients with MSK disorders generally had lower Wells scores, likely due to clinical assessments that identified alternative diagnoses early. MSK disorders frequently present with symptoms mimicking DVT, underscoring the value of rheumatologist-led evaluations in suspected DVT cases. Further research is needed to refine diagnostic approaches for patients with DVT-like symptoms, particularly regarding the role of MSK expertise in both physical and ultrasound assessments.

The Value of Clinical Variables and the Potential of Longitudinal Ultrasound Carotid Plaque Assessment in Major Adverse Cardiovascular Event Prediction After Uncomplicated Acute Coronary Syndrome

Due to the routine use of endovascular revascularization and improved medical therapy, the majority of acute coronary syndrome (ACS) cases now have an uncomplicated course. However, in spite of the currently accepted secondary prevention standards, the residual risk of remote major adverse cardiovascular events (MACEs) after ACS remains high. Ultrasound carotid/subclavian atherosclerotic plaque assessment may represent an alternative approach to estimate the MACE risk after ACS and to control the quality of secondary prevention. Aim: To find the most important clinical predictors of MACEs in contemporary patients with predominantly uncomplicated ACS treated according to the Guidelines, and to study the potential of the longitudinal assessment of quantitative and qualitative ultrasound carotid/subclavian atherosclerotic plaque characteristics for MACE prediction after ACS. Methods: Patients with ACS, obstructive coronary artery disease (CAD) confirmed by coronary angiography, and carotid/subclavian atherosclerotic plaque (AP) who underwent interventional treatment were prospectively enrolled. The exclusion criteria were as follows: death or significant bleeding at the time of index hospitalization; left ventricular ejection fraction (EF) &lt;30%; and statin intolerance. The clinical variables potentially affecting cardiovascular prognosis after ACS as well as the quantitative and qualitative AP characteristics at baseline and 6 months after the index hospitalization were studied as potential MACE predictors. Results: A total of 411 primary patients with predominantly uncomplicated ACS were included; AP was detected in 343 of them (83%). The follow-up period duration was 450 [269; 634] days. MACEs occurred in 38 patients (11.8%): seven—cardiac death, twenty-five—unstable angina/acute myocardial infarction, and six—acute ischemic stroke. In multivariate regression analyses, the most important baseline predictors of MACEs were diabetes (HR 2.22, 95% CI 1.08–4.57); the decrease in EF by every 5% from 60% (HR 1.22, 95% CI 1.03–1.46); the Charlson comorbidity index (HR 1.24, 95% CI 1.05–1.48); the non-prescription of beta-blockers at discharge (HR 3.24, 95% CI 1.32–7.97); and a baseline standardized AP gray scale median (GSM) &lt; 81 (HR 2.06, 95% CI 1.02–4.19). Among the predictors assessed at 6 months, after adjustment for other variables, only ≥ 3 uncorrected risk factors and standardized AP GSM &lt; 81 (cut-off value) at 6 months were significant (HR 3.11, 95% CI 1.17–8.25 and HR 3.77, 95% CI 1.43–9.92, respectively) (for all HRs above, all p-values &lt; 0.05; HR and 95% CI values varied minimally across regression models). The baseline quantitative carotid/subclavian AP characteristics and their 6-month longitudinal changes were not associated with MACEs. All predictors retained significance after the internal validation of the models, and models based on the baseline predictors also demonstrated good calibration; the latter were used to create MACE risk calculators. Conclusions: In typical contemporary patients with uncomplicated interventionally treated ACS, diabetes, decreased EF, Charlson comorbidity index, non-prescription of beta-blockers at discharge, and three or more uncontrolled risk factors after 6 months were the most important clinical predictors of MACEs. We also demonstrated that a lower value of AP GSM reflecting the plaque vulnerability, measured at baseline and after 6 months, was associated with an increased MACE risk; this effect was independent of clinical predictors and risk factor control. According to our knowledge, this is the first demonstration of the independent role of longitudinal carotid/subclavian AP GSM assessment in MACE prediction after ACS.

Evaluation of Long-COVID Syndrome in a Cohort of Patients with Endometriosis or Adenomyosis

Background: Long-COVID is characterized by the persistency of COVID-19 symptoms beyond 12 weeks, and it is probably consequent to immune dysregulation induced by SARS-CoV-2 infection. Immune dysregulation is associated with and probably involved in the pathogenesis of chronic gynecological conditions like endometriosis and adenomyosis. This study evaluated whether the presence of endometriosis or adenomyosis increases the risk of long-COVID, i.e., the persistence of COVID-19 symptoms beyond 12 weeks since infection. Methods: This retrospective observational study was performed at the outpatient service for endometriosis and chronic pelvic pain, at a university hospital. The diagnosis of endometriosis/adenomyosis was primarily based on clinical symptoms and ultrasonography assessment. Data regarding infection, vaccination, symptoms associated with SARS-CoV-2 infection, and their persistence for a minimum of 12 weeks were collected. Results: This study included 247 women, 149 controls without and 98 cases with endometriosis/adenomyosis. Among these, 194 (116 controls and 78 cases) had suffered from SARS-CoV-2 infection. Rates of infection and vaccination were similar in the two groups. The distribution of the SARS-CoV-2 vaccine was uniform across the two cohorts. COVID-19 patients with endometriosis or adenomyosis exhibited a higher prevalence (p &lt; 0.001) of dyspnea and chest pain. The prevalence of long-COVID beyond 12 weeks was higher in cases than controls (42% vs. 12%; p &lt; 0.001) with chest pain (p &lt; 0.001) and ageusia (p &lt; 0.05), forming the most representative symptoms. Conclusions: Symptoms of long-COVID are more frequent in women with than without endometriosis/adenomyosis.

Development of LncRNA Biomarkers in Extracellular Vesicle of Amniotic Fluid Associated with Antenatal Hydronephrosis

Background: Antenatal hydronephrosis (ANH) is the most common congenital renal and urinary tract anomaly, and parenchymal damage and renal fibrosis due to pathological hydronephrosis are the main causes of end-stage renal disease in children and chronic kidney disease in adults. At present, there is no validated biomarker for ANH, and diagnostic criteria other than prenatal ultrasonography (US) assessment are lacking. Therefore, we assessed to determine if biomarkers extracted from amniotic fluid small extracellular vesicles (sEVs) might be used as ANH diagnosis. Methods: With congenital ureteropelvic junction obstruction (UPJO) as the ultimate diagnosis, 10 pregnant women with Grade III-IV ANH and 10 normal pregnant women were recruited. The sEVs were extracted from amniotic fluid supernatant of all samples. Transcriptomic sequencing of sEVs in the discovery cohort identified the differential expression profiles for ANH. The known differentially expressed lncRNAs (DE-lncRNAs) were assessed by qRT–PCR in the validation cohort. Results: We explored the global RNA expression in sEVs from amniotic fluid. The differential expression profiles of both mRNAs and lncRNAs were related to fetal kidney development. Six known DE-lncRNAs were identified for ANH, and three of those with high expression were verified in more ANH samples. In particular, the upregulated LINC02863 and its target genes were associated with renal development and morphogenesis. The four predicted novel lncRNAs in high expression were also related to mesenchymal morphogenesis and the STAT3 signaling pathway and may play roles in ANH. Conclusions: We identified differentially expressed RNAs of all species in the sEVs from amniotic fluid, and the validated known DE-lncRNAs might serve as promising diagnostic biomarkers for ANH.

Construction of a nomogram prediction model for the pathological complete response after neoadjuvant chemotherapy in breast cancer: a study based on ultrasound and clinicopathological features.

To explore the application value of ultrasound in evaluating the efficacy of neoadjuvant chemotherapy (NAC) for breast cancer and construct a nomogram prediction model for pathological complete response (pCR) following different cycles of NAC based on ultrasound and clinicopathological features, and further investigate the optimal prediction cycle. A total of 249 breast cancer patients who received NAC were recruited. Ultrasound assessment was performed before NAC and after two cycles of NAC (NAC2), four cycles of NAC (NAC4), and six cycles of NAC (NAC6). All patients underwent surgical resection after NAC6 and the samples were sent for histopathological and immunohistochemical examination. Clinical efficacy was determined according to the Response Evaluation Criteria in Solid Tumors (RECIST). Pathological efficacy was determined according to the Miller-Payne evaluation system (MP); grade 5 was classified as pCR group, while Grades 1-4 were classified as the non-pCR group (npCR). The patients were randomly divided into the training set and the validation set at a ratio of 7:3. The ultrasound and clinicopathological features of the training set were compared, and a nomogram prediction model was constructed based on these features. Finally, the ROC curve, calibration curve, and DCA were used for verification. Among the 249 patients, 71 (28.5%) achieved pCR, whereas the remaining 178 (71.5%) exhibited npCR. The maximum tumor diameter measured by ultrasound after NAC6 was 1.20 (0.70, 2.10) cm, which was significantly positively correlated with the maximum tumor diameter measured by pathology after surgical resection (r=0.626, P<0.05). In the training set, multivariate logistic regression analysis revealed that tumor size, posterior echo, RECIST evaluation, and PR status were significantly correlated with pCR after NAC2, NAC4, and NAC6 (P<0.05). These indicators were incorporated into static and dynamic nomogram models, demonstrating high predictive performance, calibration, and clinical value in both the training and validation sets. Regardless of the cycle of NAC, patients with a small tumor, no posterior shadow, a valid RECIST, and a negative PR were more likely to achieve pCR. Evaluation after NAC2 can provide early predictive value in clinical practice.

Effectiveness of Etanercept Biosimilar Initiating for Etanercept-Naive Patients, Using Ultrasound, Clinical, and Biomarker Assessments in Outcomes of Real-World Therapy (ENPORT-NGSK Study): An Interventional, Multicenter, Open-Label, Single-Arm Clinical Trial.

Background/Objectives: This study aimed to investigate the effectiveness of etanercept biosimilar 1 under real-world clinical conditions in patients with rheumatoid arthritis (RA), using not only clinical evaluation but also musculoskeletal ultrasound (MSUS). Methods: This multicenter, interventional, open-label, single-arm clinical trial conducted a 24-week follow-up. Patients with RA with moderate to high disease activity received weekly subcutaneous injections of etanercept biosimilar 1 at 50 mg/dose for 24 weeks. The effectiveness was evaluated with clinical indices and MSUS. Results: Twenty-three patients were evaluated during the study period. The primary endpoint involves a change in the Global OMERACT-EULAR Synovitis Score by MSUS in bilateral second-fifth metacarpophalangeal joints from baseline, demonstrating median (IQR) values of 0 (-4, 1), including 4 (1, 9.8) and 2 (0, 5) at baseline and 24 weeks, respectively. The clinical endpoints exhibited a good treatment response, with 15 (68%) and 18 (86%) patients achieving low disease activity or remission at 12 weeks and 24 weeks, respectively. Additionally, MSUS scores improved at both 12 and 24 weeks compared to baseline. The patients who achieved power doppler remission (total power doppler score = 0) at 24 weeks demonstrated a shorter disease duration and no previous use of biological disease-modifying antirheumatic drugs compared to those with no power doppler remission. Conclusions: Etanercept biosimilar 1 exhibited significant improvements not only in clinical indices but also in MSUS assessment, indicating its effectiveness at the structural level.

Ultrasound assessment of the association between left atrial remodeling and fibrosis in patients with valvular atrial fibrillation: a clinical investigation

BackgroundAdvanced heart failure in patients with valvular atrial fibrillation (VAF) poses a significant threat to human health. Noninvasive assessment of left atrial remodeling in various pathological conditions is instrumental in guiding clinical treatment decisions, evaluating efficacy, and predicting prognosis.MethodsThe study enrolled 63 patients diagnosed with mitral stenosis (MS), among whom 44 presented concomitant atrial fibrillation (AF) and 19 had sinus rhythm. Left atrial volume and functional parameters were evaluated using real-time three-dimensional echocardiography (RT-3DE) and two-dimensional speckle tracking imaging (2D-STI) techniques, while left atrial stiffness index (LASI) was calculated accordingly. During surgery, left atrial myocardial specimens were obtained to determine the CVF through histopathological evaluation, reflecting the extent of left atrial myocardial fibrosis. Comparative analysis was conducted between the AF group and the control group regarding left atrial volume, functional parameters, LASI, as well as their correlation with CVF.Results(1) Patients with MS combined with AF exhibit larger left atrial volume, decreased strain at all stages, reduced function, and increased stiffness of the left atrium compared to patients in sinus rhythm. (2) LASI was positively correlated with CVF in both the control and AF groups, exhibiting the highest correlation coefficient (p < 0.05).ConclusionThe application of RT-3DE, 2D-STI, and LASI enables effective evaluation of left atrial structure and function changes in patients with VAF. LASI provides a more accurate indication of the extent of myocardial fibrosis.Clinical trial numberNot applicable.

Long-Term Outcomes of Transvaginal Sacrospinous Ligament Suture Rectopexy.

Obstructed defecation syndrome (ODS) is characterized by a combination of straining, incomplete evacuation, and the use of digital manipulation with defecation. Transvaginal sacrospinous ligament suture rectopexy has been shown to effectively improve obstructed defecation symptoms caused by rectal partial prolapse and lack of support during first year postoperatively. This study aimed to investigate the long-term clinical and anatomical outcomes of this novel and minimally invasive surgery. This longitudinal prospective cohort study was performed at a tertiary, university-affiliated pelvic health clinic. Women who underwent transvaginal sacrospinous rectopexy for treatment of ODS and for whom time since their surgery was at least 12 months were eligible for inclusion. Patients were contacted via telephone and were offered to come for an in-person evaluation, including symptom assessment (ODS symptoms, PFDI-20 and PGI-I questionnaires), POP-Q evaluation, and 3D dynamic ultrasound for assessment of rectal hypermobility. Clinical success was defined as not having any ODS symptoms (straining, incomplete emptying, or need to splint) in over 50% of bowel movements. Anatomical success was defined as not having rectal prolapse and compression ratio on ultrasound assessment of less than 50%. A total of 135 patients were eligible for inclusion, out of which 65 patients, averaging 63.3 ± 13.3 years in age and 27.1 ± 5.6 in body mass index (BMI), were recruited. Median follow-up time was 29 months. Subjective failure was noted in 18 patients (28.1%) who experienced symptoms in more than 50% of bowel movements. Anatomical failure, defined as having a compression ratio of more than 50% or rectal prolapse, was noted in seven patients (12.7%). Three patients failed treatment with a recurrence of rectal prolapse and two patients underwent ventral mesh rectopexy within 1 year after surgery. Ultrasound measurements revealed that compression ratio significantly reduced from 52.9% ± 24.7 to 17.7% ± 12.3 (p < 0.001), indicating substantial anatomical improvements during the follow-up period. In conclusion, this study indicates that transvaginal sacrospinous ligament rectopexy is a safe, feasible, and minimally invasive effective alternative for treating ODS.

Identification of Novel Biomarkers for Malignant Thyroid Nodules: A Preliminary Study Based on Ultrasound Omics.

The identification of thyroid nodules primarily relies on the ultrasound physician's assessment of nodule morphology and other visually identifiable features. Ultrasound omics technology can reveal additional features that are not visible to the naked eye, which may assist in the evaluation of malignant thyroid nodules. This study aims to explore novel markers for malignant thyroid nodules using ultrasound omics and machine learning (ML) techniques. A total of 1056 thyroid nodules with confirmed pathology were included, comprising 469 malignant and 587 benign cases. Traditional ultrasound features, such as "aspect ratio," "shape," "margins," "blood flow signal," and "calcification pattern," were recorded. Regions of interest (ROIs) were drawn for each ultrasound image, and features were extracted using the Python-based pyRadiomics tool. The Least Absolute Shrinkage and Selection Operator (Lasso) algorithm and correlation analysis were applied to select relevant features. Data were divided into training and testing sets at an 80:20 ratio. Various ML algorithms were employed to construct the models, and SHapley Additive exPlanations (SHAP) was used to assess feature importance. A total of 104 ultrasonic omics features were extracted from each image, and seven ultrasonic omics markers for thyroid malignant nodules were identified. The model developed using the random forest (RF) algorithm performed best on the test set, achieving accuracy, sensitivity, specificity, and area under the receiver operating characteristic (ROC) curve (AUC) values of 89.6%, 90.2%, 89.2%, and 89.7%, respectively. However, when the seven ultrasonic omics markers were excluded from the ML features, the model performance decreased to 83.5%, 80.4%, 85.8%, and 83.1%. SHAP analysis indicated that all seven markers were significant features. These novel ultrasonic omics markers may improve the accuracy of thyroid nodule diagnosis, and further research is needed to confirm their clinical utility.

The Levator Plate Architecture Is Altered in Women with Fecal Incontinence.

This study aimed to assess the architecture of the levator plate and anal complex in women with fecal incontinence using 3-dimensional endoanal ultrasound (EAUS). A retrospective cohort study reviewed EAUS examinations performed on women with fecal incontinence. The anal complex and levator plate architecture were examined and compared to a control group of women without fecal incontinence. The anal canal was divided into 6 different areas, and the visibility of specific structures was recorded. Measurements of the external anal sphincter (EAS) length, levator plate length, and the distance between the EAS and the levator plate were taken. The study included 31 patients with fecal incontinence and 30 nulliparous controls. Significant differences were observed in the anal complex anatomy between the 2 groups. The fecal incontinence group had a higher prevalence of abnormal levator plate anatomy (84%) than the control group (3%). The EAS size was significantly smaller in the fecal incontinent group (16 versus 18 mm, P = .04), and there was a shorter distance between the EAS and the levator plate (22 versus 28 mm, P = .001). Women with fecal incontinence exhibited significant changes in the anatomy of the anal canal, particularly in caudad structures of the anal sphincter complex. Additionally, a shorter distance between the levator plate and the EAS was observed in fecal incontinent patients. Sonographic assessment adds much to the evaluation of defecatory disorders.

Prevalence of abnormal common femoral vein pulsatility on Doppler ultrasound in patients undergoing cardiac surgery and its association with adverse events: a prospective cohort study.

Doppler ultrasound assessment of common femoral vein (CFV) flow could represent a simple, fast, and noninvasive technique to identify right ventricular dysfunction and venous congestion in patients undergoing cardiac surgery. Our primary objective was to determine the prevalence of abnormal CFV flow pulsatility before cardiac surgery. Secondary objectives included investigating its association with postoperative outcomes. We conducted a single-centre prospective cohort study and recruited adult patients undergoing cardiac surgery with cardiopulmonary bypass. We performed pulsed-wave Doppler ultrasound assessments of CFV flow at four timepoints: before surgery, after induction of anesthesia, immediately after surgery, and on postoperative day 1. When the Doppler profile showed cardiophasic variations in velocities, abnormal pulsatility was defined as a CFV pulsatility fraction ≥ 100%. Outcomes included postoperative complications, duration of postoperative support, and the cumulative time of persistent organ dysfunction after surgery (TPOD). Among the 150 patients included, 30 (20%) presented abnormal CFV pulsatility (pulsatility fraction [PF] ≥ 100%) before surgery. Preoperative abnormal CFV pulsatility was associated with a higher proportion of postoperative acute kidney injury (35% vs 16%; P = 0.02), major complications (21% vs 7%; P = 0.02), and a longer duration of TPOD (median [interquartile range]; 24 [9-56] hr vs 5 [3-19] hr; P < 0.001). After adjusting for the European System for Cardiac Operative Risk Evaluation II, the association between PF ≥ 100% before surgery and TPOD remained statistically significant (β = 0.72; 95% confidence interval, 0.21 to 1.23; P = 0.01). An abnormal CFV Doppler was associated with higher right atrial pressure and tricuspid regurgitation. Abnormal CFV flow pulsatility occurred in 20% of patients before cardiac surgery and was associated with a higher rate of major postoperative complications, longer durations of postoperative support and care, and a longer cumulative time of persistent organ dysfunction after surgery. ClinicalTrials.gov ( NCT05038267 ); first submitted 28 August 2021.