Ultrasonography Imaging Research Articles

Self-conducted sonographic monitoring of the knee in patients with haemophilia-A feasibility study.

To evaluate whether patients with haemophilia (PwH) can be enabled to perform ultrasonography (US) of their knees without supervision according to the Haemophilia Early Arthropathy Detection with Ultrasound (HEAD-US) protocol and whether they would be able to recognize pathologies. Five PwH (mean age 29.6 years, range 20-48 years) were taught the use of a portable US device and the HEAD-US protocol. Subsequently, the patients performed US unsupervised at home three times a week for a total of 6 weeks with a reteaching after 2 weeks. All images were checked for mapping of the landmarks defined in the HEAD-US protocol by a radiologist. In a final test after the completion of the self-sonography period, participants were asked to identify scanning plane and potential pathology from US images of other PwH. On the images of the self-performed scans, 82.7% of the possible anatomic landmarks could be identified and 67.5% of the requested images were unobjectionable, depicting 100% of the required landmarks. There was a highly significant improvement in image quality following reteaching after 2 weeks (74.80±36.88% vs. 88.31±19.87%, p<.001). In the final test, the participants identified the right scanning plane in 85.0% and they correctly identified pathology in 90.0% of images. Appropriately trained PwH can perform the HEAD-US protocol of their knee with high quality and are capable to identify pathologic findings on these standardized images. Asynchronous tele-sonography could enable early therapy adjustment and thereby possibly reduce costs.

The predictive value of point-of-care ultrasonography versus magnetic resonance imaging in assessing medial meniscal tears in patients with acute knee injury.

Musculoskeletal ultrasound is increasingly used as the modality of choice in diagnosing many medical situations. The present study aimed to compare the accuracy of point-of-care ultrasonography (POCUS) and magnetic resonance imaging (MRI) to detect acute medial meniscus tears in knee. The prospective study was conducted on patients with suspected medial meniscus tears in knee. in the emergency department. In the absence of a knee fracture on x-ray, POCUS on the knee was performed. All patients underwent POCUS and MRI of the knee followed by arthroscopy. POCUS findings were then compared to MRI findings to diagnose medial meniscus tears. A final total of 157 patients with a mean age of 25.04±7.41 years was included. Out of 157 patients, 94 (59.9%) were male. Medial meniscus tears were detected in 89 patients (56.7%) using arthroscopy as the gold standard. The sensitivity, specificity, positive and negative predictive values, and accuracy of POCUS to detect medial meniscus tears were 88.8% (95% confidence interval [CI], 80.3%-94.5%), 89.7% (95% CI, 79.9%-95.8%), 91.9% (95% CI, 84.8%-95.8%), 85.9% (95% CI, 77.2%-91.7%), and 89.2% (95% CI, 83.3%-93.6%), respectively. The diagnostic accuracy of MRI to detect medial meniscus injury was 93.0% (95% CI, 87.8%- 96.4%). The present study demonstrated that POCUS is an accurate and reliable diagnostic tool alternative to MRI in detecting medial meniscal tears. POCUS had acceptable sensitivity, specificity, and accuracy in detecting meniscal injuries and could be performed as an effective immediate investigation to guide further modalities in patients with acute knee trauma.

Gallbladder fossa lymphangioma encasing the common bile duct: a case report and review of the literature

Introduction: Lymphangiomas are rare low-flow lymphatic vessel malformations mostly diagnosed in childhood. Among the abdominal lymphangiomas, the gallbladder lymphangioma is a rare presentation, and only a few cases have been reported till date, of which majority were cystic lymphangiomas. Case presentation: The authors present a case of a 48-year-old female with abdominal pain and normal physical examination and laboratory findings. On the performed imaging, a multiloculated cystic lesion, located in the gallbladder fossa, was found. The patient underwent open cholecystectomy, and surprisingly, the cyst extended to the common bile duct, which was separated cautiously. The cyst was resected, and the histopathological findings confirmed cystic lymphangioma. Conclusion: The cystic lymphangioma of the gallbladder can be asymptomatic, although most of the literature has reported abdominal pain. The diagnosis of lymphangioma is complicated, especially when intra-cystic hemorrhage happens. Ultrasonography, computed tomography, and magnetic resonance imaging are usually performed. The surgical excision of the cyst and the gallbladder is the treatment of choice. Although bile duct involvement is extremely rare, it should be considered during the surgery.

Mayer–Rokitansky–Küster–Hauser syndrome managed with McIndoe’s vaginoplasty: a case series and literature review

Introduction: Mayer–Rokitansky–Küster–Hauser (MRKH) syndrome is a congenital anomaly characterized by the absence of the uterus and the upper two-thirds of the vagina. It is a rare congenital anomaly with an incidence of 1 in 5000 female live births. Case series: The authors describe three cases of females presenting with primary amenorrhoea who were diagnosed with MRKH syndrome. The patients were managed with McIndoe’s vaginoplasty with neovagina creation with an amnion graft. Discussion: Management of MRKH syndrome involves vaginoplasty with neovagina creation. The approach to neovagina creation can be done surgically or non-surgically. Non-surgical creation of the vaginal cavity involves serial use of vaginal dilators, while there are several ways for surgical creation of neovagina. The modified Abbe-McIndoe procedure using amnion to create neovagina is a minimally invasive, rapid, and simple procedure with no risk of immune rejection because the amnion membrane lacks histocompatibility antigens. In addition, the graft is also readily available, storable, and inexpensive. Conclusion: Diagnosis of MRKH syndrome can be made when a young female with primary amenorrhoea and normal secondary sexual characteristics has agenesis of the uterus, and upper two-thirds of the vagina revealed on ultrasonography or magnetic resonance imaging. The patient can be offered treatment with vaginoplasty with neovagina creation.

Sonographic Signs of SARS-CoV-2 Placentitis. Association with Pregnancy Outcome.

Being associated with a systemic infection, SARS-CoV-2 affects multiple organs, including the placenta. SARS-CoV-2 placentitis is a new condition that shows the destructive effects of fibrin deposition in the perivillous area, chronic histiocytic intervillositis and trophoblast necrosis after the placenta is infected with SARS-CoV-2. Until now, there have been no published reports regarding the ultrasound signs of massive perivillous fibrin deposition and the recommended monitoring for these cases. Our aim was to analyze the sonographic appearance of the placenta in a series of SARS-CoV-2 infected pregnant women during their third trimester. In all cases included in the present study, we performed serial obstetrical ultrasounds every seven days until delivery, followed by histopathological examination of the placenta postpartum. In women with intrauterine growth restriction (IUGR), sonographic images of the placentas revealed that they matured faster within three weeks of receiving a COVID-19 diagnosis and reached a more rapid senescence. In all cases, there was a gradual increase in placental calcification from week to week, but only in pregnant women with a grade 3 placenta at the moment of inclusion in the study the deterioration was severe, leading to placental insufficiency and subsequently to IUGR. The cases who had an increased placental degree at the time of infection were associated with abnormally rapid placental aging. These aspects can be evaluated sonographically.

Validation of a deep-learning modular prototype to guide novices to acquire diagnostic ultrasound images from urinary system

ImportanceArtificial intelligence (AI) application in guiding the acquisition of ultrasonography images represents a pioneering field of research. A new developed hybrid deep-learning (DL) algorithm, trained on more than high quality 60.000 curated and labelled reference images (distilled from a set of more than 600.000 abdominal ultrasound images) from La Paz Hospital, can provide real-time prescriptive guidance for novice operators to obtain standard planes images of the target organs. ObjectiveThis study aims to evaluate the capability of novice users to acquire diagnostic-quality abdominal ultrasound images of the urinary system using the deep-learning (DL)-based guiding research prototype provided by GMV. DesignSetting, and Participants: This prospective diagnostic study was conducted within the facilities of an academic hospital. A cohort of 24 technically-oriented volunteers, lacking prior knowledge in anatomy or medicine and without experience in conducting ultrasound examinations, was recruited. After a brief training session focused on various organs, each pair of volunteers performed scans of each other's urinary system, exclusively guided by AI support. These scans were subsequently repeated by experienced sonographers using identical ultrasound equipment but without AI assistance. Four radiologists, each with decades of experience, independently and blindly assessed the quality of each acquisition. ResultsOver 90.6 % of the images scanned by volunteers were identified as valuable clinical picture, using only an AI-based guidance system. This is nearly comparable to the results achieved by experienced radiologists, who attained a 98.6 % success rate. ConclusionsThis deep-learning (DL) prototype enables novices lacking experience in ultrasonography to acquire diagnostic ultrasound images suitable for subsequent expert evaluation. The modular prototype works on a large range of ultrasound device models and vendors. This advancement has the potential to extend the application of ultrasound beyond traditional clinical environments, particularly in situations requiring immediate anatomical and functional interrogation, as well as in resource-limited settings.

Imaging features, classification and clinical features of intrahepatic congenital portosystemic shunts.

Congenital portosystemic shunts (CPSS) are a rare developmental anomaly diverting blood flow from the portal venous system and the liver to the systemic venous system. This case series examines the sonographic imaging findings, shunt classification, ultrasound shunt ratios, and outcomes in nine children (5 females, 4 males) admitted to our institution between 2015 and 2022 were included in this study. The shunts were initially categorized by the Parks classification and were followed by serial ultrasounds. Clinical presentation, clinical course, laboratory data, shunt ratios, and time to shunt closure were all followed on subsequent ultrasounds. The most common type of CPPS was the Type 3 shunt. In cases where shunt ratios were measured, the shunt ratio gradually decreased in tandem with decreasing ammonia levels until spontaneous closure was achieved. Predictors of lack of shunt closure included high shunt ratios and Type 4 shunts. Patients with CPPS can be followed with the shunt ratio calculation obtained from sonographic imaging, which may correlate to ammonia levels and indicate risk of hepatic encephalopathy as well as predict speed and timing of closure.

Sonographic imaging of the genicular nerves of the knee

Introduction: The genicular nerves are sensory nerves around the knee. With the improvements in ultrasound imaging resolution, these nerves can be identified sonographically. Topic description: Due to their small size, genicular nerves are often underappreciated and overlooked during routine sonographic imaging. Chronic pain associated with knee osteoarthritis, or postsurgical knee pain can be relieved by ultrasound-guided radiofrequency ablations or nerve blockades targeting the genicular nerves. Discussion: To sonographically image these nerves, or guide nerve blocks or ablations, knowledge of the sonographic anatomy, technique and normal appearances of the genicular nerves and their surrounding structures is required and is unpacked in this pictorial essay. Conclusion: Enhanced knowledge of the anatomy and a systematic approach to sonographically image and assess the genicular nerves of the knee can enhance the diagnosis of pathology, nerve injury or entrapment, and sonographic guidance of interventional procedures for pain relief.

Echotextural evaluation of ultrasonographic images of the uterus in non-pregnant and pregnant Awassi ewes using computer-assisted image analysis

The aim of this study is to determine how physiological changes occurring in the uterus during early pregnancy affect echotexture values by computer-assisted analysis of ultrasonographic images of the uterus in pregnant and non-pregnant ewes. It was also aimed to clarify the relationship between the echotextural parameters and progesterone (P4) hormone in this period. A total of 40 Awassi ewes were used in the study, as Group 1 (n=20) not pregnant ewes, and Group 2 (n=20) pregnant ewes. Transrectal ultrasonography was applied on days 4, 7, 10, 13, 15, 16, and 17 after natural mating and the uterus tissue images were recorded. Blood samples were taken for the measurement of progesterone hormone. Measurements were taken on the uterus ultrasonographic images of the mean grayness value (MGV), homogeneity (HOM), and contrast (CON). In the statistical analyses of the data, two-way repeated measures ANOVA were examined with variance analysis and the Pearson test. It was found a time-related significant difference in the echotexture parameters within the groups of the pregnant and non-pregnant ewes in respect of the MGV, HOM, and CON values (P<0.05). The MGV and HOM values in all the days when measurements were taken after natural mating were significantly higher in the non-pregnant ewes compared to the pregnant group (P<0.001). The CON value was significantly higher in the pregnant ewes than the non-pregnant ewes in all days of measurement after natural mating (P<0.001). A time-related statistically significant difference was determined in the serum P4 within the groups of pregnant and non-pregnant ewes (P<0.001) and it was higher in the pregnant ewes (P<0.001). A significant negative correlation was determined between P4 and MGV, and between P4 and HOM, and a significant positive correlation between P4 and CON. In conclusion, it was found a significant difference between the pregnant and non-pregnant ewes in respect of the echotextural evaluation of the uterus and the measurement of P4 hormone. In ewes farming, the early determination of pregnancy and early determination of ewes that are not pregnant gives the opportunity for repeat mating, and the evaluation of changes occurring in the uterus by computer-assisted image analysis can be used as an assistive method for providing additional nutrition in pregnant ewes.

Efficacy of real-time artificial intelligence-aid endoscopic ultrasonography diagnostic system in discriminating gastrointestinal stromal tumors and leiomyomas: a multicenter diagnostic study

Gastrointestinal stromal tumors (GISTs) represent the most prevalent type of subepithelial lesions (SELs) with malignant potential. Current imaging tools struggle to differentiate GISTs from leiomyomas. This study aimed to create and assess a real-time artificial intelligence (AI) system using endoscopic ultrasonography (EUS) images to differentiate between GISTs and leiomyomas. The AI system underwent development and evaluation using EUS images from 5 endoscopic centers in China between January 2020 and August 2023. EUS images of 1101 participants with SELs were retrospectively collected for AI system development. A cohort of 241 participants with SELs was recruited for external AI system evaluation. Another cohort of 59 participants with SELs was prospectively enrolled to assess the real-time clinical application of the AI system. The AI system's performance was compared to that of endoscopists. This study is registered with Chictr.org.cn, Number ChiCT2000035787. The AI system displayed an area under the curve (AUC) of 0.948 (95% CI: 0.921-0.969) for discriminating GISTs and leiomyomas. The AI system's accuracy (ACC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) reached 91.7% (95% CI 87.5%-94.6%), 90.3% (95% CI 83.4%-94.5%), 93.0% (95% CI 87.2%-96.3%), 91.9% (95% CI 85.3%-95.7%), and 91.5% (95% CI 85.5%-95.2%), respectively. Moreover, the AI system exhibited excellent performance in diagnosing ≤20mm SELs (ACC 93.5%, 95% CI 0.900-0.969). In a prospective real-time clinical application trial, the AI system achieved an AUC of 0.865 (95% CI 0.764-0.966) and 0.864 (95% CI 0.762-0.966) for GISTs and leiomyomas diagnosis, respectively, markedly surpassing endoscopists [AUC 0.698 (95% CI 0.562-0.834) for GISTs and AUC 0.695 (95% CI 0.546-0.825) for leiomyomas]. We successfully developed a real-time AI-assisted EUS diagnostic system. The incorporation of the real-time AI system during EUS examinations can assist endoscopists in rapidly and accurately differentiating various types of SELs in clinical practice, facilitating improved diagnostic and therapeutic decision-making. Science and Technology Commission Foundation of Shanghai Municipality, Science and Technology Commission Foundation of the Xuhui District, the Interdisciplinary Program of Shanghai Jiao Tong University and the Research Funds of Shanghai Sixth people's Hospital.

Methodology exploration and reproducibility evaluation of TAI and TSI for quantitative ultrasound assessment of hepatic steatosis

Background and aimNew quantitative ultrasound techniques can be used to quantify hepatic steatosis, including tissue attenuation imaging (TAI), tissue scatter -distribution imaging (TSI), and the hepatorenal index (HRI). However, the measurement norms and the effects of fasting on these measurements remain unclear. The present study performed a methodological exploration and investigated the reliability of these measurements. MethodsIn total, 103 participants were prospectively recruited for ultrasonography and magnetic resonance imaging (MRI) scans. For the TAI and TSI data, the upper (2 cm), middle (4 cm) and lower (6 cm) areas determined according to the depth of the region of interest from the liver capsule, were sampled three times. Correlation analyses were performed to compare the measurements of TAI, TSI, and HRI with the controlled attenuation parameter (CAP) or MRI-proton density fat fraction (MRI-PDFF). Intra- and inter-operator repeatability was assessed using intraclass correlation coefficients. The effects of fasting on these measurements were then compared. ResultsThe TAI and TSI measurements obtained from the upper and middle depths exhibited stronger correlations with the CAP measurements than those obtained from the lower depth. Specifically, the mean TAI had a significant positive correlation with MRI-PDFF (r = 0.753, P < 0.0001). TAI and TSI measurements exhibited excellent intra- (0.933 and 0.925, respectively) and inter- (0.896 and 0.766, respectively) examiner reliability. However, the correlation between HRI and CAP measurements was only 0.281, with no significant correlation with MRI-PDFF, and intra- and inter-examiner reproducibility of 0.458 and 0.343, respectively. Fasting did not affect these measurements. ConclusionsTAI and TSI measurements demonstrated good intra- and interobserver reliability and correlated well with CAP and MRI-PDFF measurements. However, in practice-based clinical applications, the sampling depth should be controlled within 2–4 cm of the hepatic capsule; no fasting is required before the examination.

Deep learning: Integrating artificial intelligence into the sonography curriculum

AbstractArtificial intelligence (AI) tools that enhance image acquisition, measurement, and interpretation are a valuable part of contemporary sonographic imaging systems, and emerging AI technology is forecast to feature more extensively in future systems. In this commentary, we draw upon contemporary literature and our experience in curriculum design to indicate how educators should approach integrating AI into the pre‐qualification sonography curriculum. This integration will promote understanding of and engagement with the technology to ensure that graduates are prepared for work with AI‐assisted systems. Knowledge of the technical and interpretive applications, the legal and ethical concerns, plus industry and accreditation body collaboration are proffered as important parts of an AI‐integrated training program.

Deep learning driven diagnosis of malignant soft tissue tumors based on dual-modal ultrasound images and clinical indexes

BackgroundSoft tissue tumors (STTs) are benign or malignant superficial neoplasms arising from soft tissues throughout the body with versatile pathological types. Although Ultrasonography (US) is one of the most common imaging tools to diagnose malignant STTs, it still has several drawbacks in STT diagnosis that need improving.ObjectivesThe study aims to establish this deep learning (DL) driven Artificial intelligence (AI) system for predicting malignant STTs based on US images and clinical indexes of the patients.MethodsWe retrospectively enrolled 271 malignant and 462 benign masses to build the AI system using 5-fold validation. A prospective dataset of 44 malignant masses and 101 benign masses was used to validate the accuracy of system. A multi-data fusion convolutional neural network, named ultrasound clinical soft tissue tumor net (UC-STTNet), was developed to combine gray scale and color Doppler US images and clinic features for malignant STTs diagnosis. Six radiologists (R1-R6) with three experience levels were invited for reader study.ResultsThe AI system achieved an area under receiver operating curve (AUC) value of 0.89 in the retrospective dataset. The diagnostic performance of the AI system was higher than that of one of the senior radiologists (AUC of AI vs R2: 0.89 vs. 0.84, p=0.022) and all of the intermediate and junior radiologists (AUC of AI vs R3, R4, R5, R6: 0.89 vs 0.75, 0.81, 0.80, 0.63; p &amp;lt;0.01). The AI system also achieved an AUC of 0.85 in the prospective dataset. With the assistance of the system, the diagnostic performances and inter-observer agreement of the radiologists was improved (AUC of R3, R5, R6: 0.75 to 0.83, 0.80 to 0.85, 0.63 to 0.69; p&amp;lt;0.01).ConclusionThe AI system could be a useful tool in diagnosing malignant STTs, and could also help radiologists improve diagnostic performance.

Deep-learning-based sampling position selection on color Doppler sonography images during renal artery ultrasound scanning

Accurate selection of sampling positions is critical in renal artery ultrasound examinations, and the potential of utilizing deep learning (DL) for assisting in this selection has not been previously evaluated. This study aimed to evaluate the effectiveness of DL object detection technology applied to color Doppler sonography (CDS) images in assisting sampling position selection. A total of 2004 patients who underwent renal artery ultrasound examinations were included in the study. CDS images from these patients were categorized into four groups based on the scanning position: abdominal aorta (AO), normal renal artery (NRA), renal artery stenosis (RAS), and intrarenal interlobular artery (IRA). Seven object detection models, including three two-stage models (Faster R-CNN, Cascade R-CNN, and Double Head R-CNN) and four one-stage models (RetinaNet, YOLOv3, FoveaBox, and Deformable DETR), were trained to predict the sampling position, and their predictive accuracies were compared. The Double Head R-CNN model exhibited significantly higher average accuracies on both parameter optimization and validation datasets (89.3 ± 0.6% and 88.5 ± 0.3%, respectively) compared to other methods. On clinical validation data, the predictive accuracies of the Double Head R-CNN model for all four types of images were significantly higher than those of the other methods. The DL object detection model shows promise in assisting inexperienced physicians in improving the accuracy of sampling position selection during renal artery ultrasound examinations.

A New Quantitative Tool for the Ultrasonographic Assessment of Tendons: A Reliability and Validity Study on the Patellar Tendon.

Ultrasound is widely used for tendon assessment due to its safety, affordability, and portability, but its subjective nature poses challenges. This study aimed to develop a new quantitative analysis tool based on artificial intelligence to identify statistical patterns of healthy and pathological tendons. Furthermore, we aimed to validate this new tool by comparing it to experts' subjective assessments. A pilot database including healthy controls and patients with patellar tendinopathy was constructed, involving 14 participants with asymptomatic (n = 7) and symptomatic (n = 7) patellar tendons. Ultrasonographic images were assessed twice, utilizing both the new quantitative tool and the subjective scoring method applied by an expert across five regions of interest. The database contained 61 variables per image. The robustness of the clinical and quantitative assessments was tested via reliability analyses. Lastly, the prediction accuracy of the quantitative features was tested via cross-validated generalized linear mixed-effects logistic regressions. These analyses showed high reliability for quantitative variables related to "Bone" and "Quality", with ICCs above 0.75. The ICCs for "Edges" and "Thickness" varied but mostly exceeded 0.75. The results of this study show that certain quantitative variables are capable of predicting an expert's subjective assessment with generally high cross-validated AUC scores. A new quantitative tool for the ultrasonographic assessment of the tendon was designed. This system is shown to be a reliable and valid method for evaluating the patellar tendon structure.

Ultrasonographic measurement of diaphragm muscle activity for assessment of respiratory function in horses

Ultrasonographic imaging of the diaphragm is a non-invasive alternative for respiratory function evaluation in horses. This study aimed to measure diaphragm thickness, thickening (change in thickness with contraction) and thickening fraction in healthy adult horses during tidal breathing and forced vital capacity. Correlation between body weight (≤400 kg and >400 kg) and diaphragm thickness was investigated. To that purpose, 20 adult horses, weight 409±50 kg, height 1.47±0.05 m, and age 16±6 years were included in the study. Diaphragm thickness was measured at end-inspiration and end-expiration using B-mode and M-mode. The transducer was placed in the 10th, 11th and 12th intercostal spaces of both hemithoraces. Measurements obtained at end inspiration using M-mode during forced vital capacity were greater than for tidal breathing for diaphragm thickness (P=0.006), diaphragm thickening (P<0.001) and thickening fraction (P<0.001). The same was found for thickening (P<0.001) and thickening fraction (P<0.001). Diaphragm thickness at end-inspiration was greater in horses weighing >400kg than those ≤400kg at the inspiration (0.93±0.2 cm and 0.74±0 0.02 cm, P<0.001) and at the end of expiration (0.77±0.02 cm and 0.63±0, 02 cm, P<0.001). There was no difference in thickening fraction between horses weighing ≤400kg and >400kg (tidal breathing: 18±2 % and 16±2 %, P=0.609; forced vital capacity: 39±6 % and 31±5 %, P=0.301). Diaphragm assessment in horses is possible using both B-mode and M-mode. Breathing workload has a positive correlation between breathing workload and diaphragm contraction. Due to the relationship demonstrated between diaphragm thickness and weight, it is recommended that diaphragm thickening fraction is used to compare diaphragm measurements between horses.

Ultrasonography screening of hepatic cystic echinococcosis in sheep flocks used for evaluating control progress in a remote mountain area of Hejing County, Xinjiang

BackgroundAlthough ultrasonography (US) has been widely used in the diagnosis of human diseases to monitor the progress of cystic echinococcosis (CE) control, the screening method for hepatic CE in sheep flocks requires adjustment. In this study, we used a US scanner to screen sheep flocks and evaluated the efficacy of dosing dogs once a year with praziquantel for 7 years from 2014 to 2021.MethodsAll sheep in the three flocks were screened using an ultrasound scanner in 2014 and compared with the prevalence of infection in 2021 in Bayinbuluke, Xinjiang, China. Sheep age was determined using incisor teeth. Cyst activity and calcification were determined using US images. The dogs were dewormed with praziquantel once a year to control echinococcosis in the community.ResultsThree flocks had 968 sheep in 2014, with 13.22%, 22.62%, 18.7%, 27.27%, 11.88%, and 6.3% of sheep aged 1, 2, 3, 4, 5, and ≥ 6 years old, respectively. US scanning revealed that the overall CE prevalence was 38.43% (372/968), with active cysts and calcified cysts present in 9.40% (91/968) and 29.02% (281/968) of the sheep, respectively. For the young sheep aged 1 and 2 years, the prevalence of active and calcified cysts was: 1.56% and 0.91%, and 10.94% and 18.72%, respectively. Approximately 15.15% and 16.52% of the 4- and 5-year-old sheep, respectively, harbored active cysts. There was no significant difference in the infection rates of sheep between 2014 and 2021 (P > 0.05).ConclusionsUS is a practical tool for the field screening of CE in sheep flocks. One-third of the sheep population in the flocks was 1–2 years old, and these sheep played a very limited role in CE transmission, as most of the cysts were calcified. Old sheep, especially culled aged sheep, play a key role in the transmission of CE. Dosing dogs once a year did not affect echinococcosis control.

Comparative Evaluation of Chest Ultrasonography and Computed Tomography as Predictors of Malignant Pleural Effusion: A Prospective Study.

Malignant pleural effusion (MPE) is a manifestation of advanced cancer that requires a prompt and accurate diagnosis. Ultrasonography (US) and computed tomography (CT) are valuable imaging techniques for evaluating pleural effusions; however, their relative predictive ability for a malignant origin remains debatable. This prospective study aimed to compare chest US with CT findings as predictors of malignancy in patients with undiagnosed exudative pleural effusion. Fifty-four adults with undiagnosed exudative pleural effusions underwent comprehensive clinical evaluation including chest US, CT, and histopathologic biopsy. Blinded radiologists evaluated the US and CT images for features suggestive of malignancy, based on predefined criteria. Diagnostic performance measures were calculated using histopathology as a reference standard. Of the 54 patients, 33 (61.1%) had MPEs confirmed on biopsy. No significant differences between US and CT were found in detecting parietal pleural abnormalities, lung lesions, chest wall invasion, or liver metastasis. US outperformed CT in identifying diaphragmatic pleural thickening ≥10 mm (33.3% vs. 6.1%, p < 0.001) and nodularity (45.5% vs. 3%, p < 0.001), whereas CT was superior for mediastinal thickening (48.5% vs. 15.2%, p = 0.002). For diagnosing MPE, diaphragmatic nodularity detected by US had 45.5% sensitivity and 100% specificity, whereas CT mediastinal thickening had 48.5% sensitivity and 90.5% specificity. Both US and CT demonstrate reasonable diagnostic performance for detecting MPE, with particular imaging findings favoring a malignant origin. US may be advantageous for evaluating diaphragmatic pleural involvement, whereas CT is more sensitive to mediastinal abnormalities.

Fatty Liver Index (FLI) is the best score to predict MASLD with 50% lower cut-off value in women than in men

BackgroundMetabolic dysfunction-associated steatotic liver disease (MASLD) is defined by the presence of hepatic steatosis, detected on ultrasonography (US) imaging or histology, and at least one of criteria for Metabolic Syndrome diagnosis. Simple non-invasive tests (NITs) have been proposed as an acceptable alternative when US and biopsy are not available or feasible but have not been validated for MASLD. In this observational study, we investigated the reliability of NITs for MASLD detection and whether sex-differences in screening methods should be considered.MethodsWe included 1069 individuals (48% males and 52% females) who underwent their first clinical examination for Metabolic Syndrome in the period between January 2015 and December 2022. Liver steatosis was detected through US and anthropometric and clinical parameters were recorded.ResultsLiver steatosis was detected in 648 patients and MASLD was diagnosed in 630 subjects (355 males; 275 females). Women with MASLD showed better metabolic profile and lower prevalence of Metabolic Syndrome criteria than men. Among NITs, Fatty Liver Index (FLI) showed the best ability for detection of MASLD, with a cut-off value of 44 (AUC = 0.82). When considering the two sexes for MASLD detection via FLI, despite no substantial differences regarding FLI correlations with metabolic biomarkers except for age, women showed marked lower FLI cut-off value (32; AUC = 0.80) than men (60; AUC = 0.80).ConclusionsIn this study, we found that FLI is the best non-invasive predictor of both liver steatosis and MASLD. The finding that in women FLI cut-off value for MASLD detection is 50% lower than in men suggests the need of a sex-specific personalized program of screening and prevention of dysmetabolism-related liver diseases, despite outwardly healthy biomarkers profile.

Radiological Imaging of the Lacrimal Gland in Sjogren’s Syndrome: A Systematic Review and Meta-Analysis

Purpose To critically appraise the evidence on the ability of the lacrimal gland ultrasonography (USG) or magnetic resonance imaging (MRI) to differentiate between Sjogren’s syndrome and non-Sjogren’s syndrome/healthy controls. Methods A systematic review and meta-analysis (based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines) of online literature search was performed using PubMed, Scopus, and Cochrane databases. Cohort studies comparing the imaging features of the lacrimal glands of Sjogren’s syndrome with a control group were included. Quantitative synthesis was performed using the RevMan (Version 5.4.1). Results Six studies used USG as an imaging technique, and three used MRI for the lacrimal gland imaging. The lacrimal gland affected with Sjogren’s syndrome shows glandular heterogeneity on USG and MRI. Heterogeneity on USG had 6.18 times higher odds of the lacrimal gland being involved with Sjogren’s syndrome (95% CI, 3.31–11.55). Gland hyperechogenicity cannot reliably differentiate the glandular involvement in Sjogren’s syndrome. There is insufficient data for analysis on the gland size, hypoechoic areas, fibrous bands, and increased lacrimal artery resistance in Sjogren’s syndrome patients. Of the three MRI-based studies, reduced apparent diffusion coefficient and heterogeneity were the characteristics of Sjogren’s syndrome. Clinical parameters such as dry eye symptomatology and Schirmer values had variable associations with USG or MRI parameters. Ultrasonography parameters were no different between dry eye versus no dry eye in Sjogren’s syndrome patients, whereas small-sized glands had low Schirmer on MRI-based studies. Conclusion Glandular heterogeneity on USG is significantly associated with lacrimal gland involvement in Sjogren’s syndrome patients. However, the role of radiology in predicting lacrimal gland involvement is unclear as the evidence is insufficient and heterogeneous.