Ultrasonography Imaging Research Articles

Lameness and swelling of the metatarsus in a Saluki - Could it be an arteriovenous fistula?

A 12-year-old Saluki was presented with acute lameness and plantar swelling of the right metatarsus following an episode of free running. Radiographs showed soft tissue swelling only, the involved bone and joint structures were unremarkable. The lesion recurred several months later. Ultrasonographic imaging of the lesion revealed a well-vascularized cavernous structure. Subsequent surgical removal and histopathological examination of the structure raised the initial suspicion of an arteriovenous fistula, which was then confirmed histologically following a second surgical removal of another recurrence. The purpose of this case report is to illustrate the potential complexity of what initially appears to be a simple lameness. At the same time, attention is focused on the possibility that arteriovenous fistulas may tend to recur.

Using texture analysis of ultrasonography images of neck lymph nodes to differentiate metastasis to non-metastasis in oral maxillary gingival squamous cell carcinoma

ObjectTo differentiate between metastatic neck nodes and non-metastatic neck nodes in oral maxillary gingival squamous cell carcinoma, textural analysis of these lymph nodes in ultrasound images was performed in this study. MethodsTwenty five metastatic neck nodes and 28 non-metastatic neck nodes were enrolled in this study. Seventy eight texture characteristics were retrieved from the US images using the LIFEx software.The Mann Whitney U test was measurably utilized to survey on the off chance that there was a measurably noteworthy distinction within the textural characteristics between metastatic neck nodes and non-metastatic neck nodes. The capacity of the surface highlights to recognize between metastatic neck nodes and non-metastatic neck nodes was illustrated utilizing the Receiver Operating Characteristic analysis curves (ROC). Youden's J statistic was used to determine the cut-off positions in each ROC curve that maximized sensitivity and specificity. ResultsZone size non uniformity (ZSNU) highlight appeared the foremost noteworthy contrast between these nodes (p < 0.001).Strength had Area Under the Curve (AUC) of 0.811, specificity of 0.821 and sensitivity of 0.8, when measured at the cutoff value of 896.344. ConclusionsOur results come about uncovered that quality highlight may be the finest surface highlight to distinguish from non-metastatic neck nodes and to anticipate metastatic neck nodes in oral maxillary gingival squamous cell carcinoma.

Development and Validation of an Explainable Machine Learning Model for Identification of Hyper-Functioning Parathyroid Glands from High-Frequency Ultrasonographic Images

ObjectiveTo develop and validate a machine learning (ML) model based on high-frequency ultrasound (HFUS) images with the aim to identify the functional status of parathyroid glands (PTGs) in secondary hyper-parathyroidism (SHPT) patients. MethodsThis retrospective study enrolled 60 SHPT patients (27 female, 33 male; mean age: 51.2 years) with 184 PTGs detected from February 2016 to June 2022. All enrollments underwent single-photon emission computed tomography/computed tomography and contrast-enhanced ultrasound examinations. The PTGs were randomly divided into training (n = 147) and testing datasets (n = 37). Four effective ML classifiers were used and combined models incorporating multi-modal HFUS visual signs and radiomics features was constructed based on the optimal classifier. Model performance was compared in terms of discrimination, calibration and clinical utility. The Shapley additive explanation method was used to explain and visualize the main predictors of the optimal model. ResultsThis model, using a random forest classifier algorithm, outperformed other classifiers. Based on optimal classifier features, the model constructed from ultrasound visual and ML features achieved a favorable performance in the prediction of hyper-functioning PTGs. Compared with the traditional visual model, the ultrasound-based ML model achieved significant (p = 0.03) improvement (area under the curve: 0.859 vs. 0.629) and higher sensitivity (100.0% vs. 94.1%) and accuracy (86.5% vs. 67.6%). Among the predictors attributed to model development, large size and high echogenic heterogeneity of PTGs in ultrasonographic images were more often associated with high risk of hyper-functioning PTGs. ConclusionThe ultrasound-based ML model for identifying hyper-functioning PTGs in SHPT patients showed good performance and interpretability using high-frequency ultrasonographic images, which may facilitate clinical management.

Effectiveness of microvascular flow imaging for radiofrequency ablation in recurrent thyroid cancer: comparison with power Doppler imaging.

To compare microvascular flow imaging (MVFI) and power Doppler ultrasonography imaging (PDUS) for detecting intratumoral vascularity in recurrent thyroid cancer both before and after radiofrequency ablation (RFA). This retrospective study included 80 patients (age, 57 ± 12 years; 54 women) with 110 recurrent tumors who underwent RFA between January 2021 and June 2023. A total of 151 PDUS and MVFI image sets were analyzed (85 pre-RFA, 66 post-RFA). Two readers assessed vascularity on the images using a four-point scale with a 2-week interval between PDUS and MVFI to estimate inter-reader agreement. Intra-reader agreement was determined by reinterpreting images in reverse order (MVFI-PDUS) after a 1-month gap. Additionally, diagnostic performance for identifying viable tumors after RFA was assessed in 44 lesions using thyroid-protocol CT as a reference standard. MVFI demonstrated higher vascular grades than PDUS, both before (reader 1: 3.04 ± 1.15 vs. 1.93 ± 1.07, p < 0.001; reader 2: 3.20 ± 0.96 vs. 2.12 ± 1.07, p < 0.001) and after RFA (reader 1: 2.44 ± 1.28 vs. 1.67 ± 1.06, p < 0.001; reader 2: 2.62 ± 1.23 vs. 1.83 ± 0.99, p < 0.001). Inter-reader agreement was substantial (κ = 0.743) and intra-reader agreement was almost perfect (κ = 0.840). MVFI showed higher sensitivity (81.5%-88.9%) and accuracy (84.1%-86.4%) than PDUS (sensitivity: 51.9%, p < 0.01; accuracy: 63.6-70.5%, p < 0.04), without sacrificing specificity. MVFI was superior to PDUS for assessing intratumoral vascularity and showed good inter- and intra-reader agreement, highlighting its clinical value for assessing pre-RFA vascularity and accurately identifying post-RFA viable tumors in recurrent thyroid cancer. Microvascular flow imaging (MVFI) is superior to power-Doppler US for assessing intratumoral vascularity; therefore, MVFI can be a valuable tool for assessing vascularity before radiofrequency ablation (RFA) and for identifying viable tumors after RFA in patients with recurrent thyroid cancer. The value of microvascular flow imaging (MVFI) for evaluating intratumoral vascularity is unexplored. MVFI demonstrated higher vascular grades than power Doppler US before and after ablation. Microvascular flow imaging showed higher sensitivity and accuracy than power Doppler US without sacrificing specificity.

Concurrent radiological and ultrasonographical findings in the forelimb proximal sesamoid bones and adjacent suspensory ligament branches in yearling and 2-year-old Thoroughbred sales horses.

Changes in the proximal sesamoid bones (sesamoids) and the insertional region of the adjacent suspensory ligament branch (branch) are of particular importance in young Thoroughbreds sold at public auction. Little is known about the prevalence of concurrent ultrasonographical branch change, relative to the various grades of radiological sesamoid appearance. To examine the existence of concurrent radiological and ultrasonographical findings in individual sesamoid-branch units in sales horses; to determine whether there are any radiological findings that are consistently accompanied by a particular degree of insertional branch change, and to provide practical recommendations as to when suspensory branch ultrasonography may be warranted in a sales environment. Prospective cohort study using an enrolled sample. Horses were enrolled with consignor permission from a large Thoroughbred yearling sale and five 2-year-old Thoroughbred sales the following year. Data from the radiological evaluation of forelimb sesamoids and the ultrasonographical examination of the adjacent forelimb suspensory branches were described. A total of 2204 yearling forelimb sesamoid-branch units and 1336 2-year-old forelimb sesamoid-branch units were included, from 551 sales yearlings and 334 sales 2-year-olds. The proportion of yearling sesamoids with grade ≤1 vascular channels that had adjacent grade ≥2 fibrillar branch change was 1.2%. The same proportion for 2-year-olds was 3.8%, with medial forelimb sesamoids with grade 1 vascular channels overrepresented in 2-year-olds in this category. In yearlings, 31% of sesamoids with grade 2 vascular channels had adjacent grade ≥2 fibrillar branch change and 59% of sesamoids with grade 3 vascular channels had adjacent grade ≥2 fibrillar branch change. In 2-year-olds, 47% of sesamoids with grade 2 vascular channels had adjacent grade ≥2 fibrillar branch change and 67% of sesamoids with grade 3 vascular channels had the same. Only one yearling sesamoid and one 2-year-old sesamoid with radiological abaxial concavity had grade ≥2 fibrillar branch change. Hindlimbs were not included. Clinical examinations were not performed and the status of any past or present inflammatory process at the sesamoid-branch enthesis could not be inferred from radiographs and ultrasonographic images alone. The existence and prevalence of concurrent radiological and ultrasonographical findings in the proximal sesamoid bones and adjacent suspensory ligament branches in yearling and 2-year-old Thoroughbred sales horses has been established. General recommendations have been made for selective branch ultrasonography on the basis of radiological sesamoid appearance. The results support a separate aetiology for radiological sesamoid abaxial concavity that does not primarily involve the suspensory branch insertion.

Endobronchial Ultrasound-Based Support Vector Machine Model for Differentiating between Benign and Malignant Mediastinal and Hilar Lymph Nodes

Introduction: The aim of the study was to establish an ultrasonographic radiomics machine learning model based on endobronchial ultrasound (EBUS) to assist in diagnosing benign and malignant mediastinal and hilar lymph nodes (LNs). Methods: The clinical and ultrasonographic image data of 197 patients were retrospectively analyzed. The radiomics features extracted by EBUS-based radiomics were analyzed by the least absolute shrinkage and selection operator. Then, we used a support vector machine (SVM) algorithm to establish an EBUS-based radiomics model. A total of 205 lesions were randomly divided into training (n = 143) and validation (n = 62) groups. The diagnostic efficiency was evaluated by receiver operating characteristic (ROC) curve analysis. Results: A total of 13 stable radiomics features with non-zero coefficients were selected. The SVM model exhibited promising performance in both groups. In the training group, the SVM model achieved an ROC area under the curve (AUC) of 0.892 (95% CI: 0.885–0.899), with an accuracy of 85.3%, sensitivity of 93.2%, and specificity of 79.8%. In the validation group, the SVM model had an ROC AUC of 0.906 (95% CI: 0.890–0.923), an accuracy of 74.2%, a sensitivity of 70.3%, and a specificity of 74.1%. Conclusion: The EBUS-based radiomics model can be used to differentiate mediastinal and hilar benign and malignant LNs. The SVM model demonstrated excellent potential as a diagnostic tool in clinical practice.

The impact of V-flow on preoperative diagnosis of thyroid tumors: individually and as part of multimodal sonographic imaging.

V-flow is a dynamic ultrasound technique that visualizes perfusion patterns by displaying dynamic arrows that change in response to the flow of erythrocytes. Furthermore, it provides quantitative values for the maximum and mean velocity of blood flow as well as a percentage value for turbulence. The aim was to enhance the preoperative diagnostic accuracy of thyroid lesions by combining V-flow with established ultrasound modes.B-mode, CCDS, elastography, CEUS, and V-flow were performed on 101 patients. After the ultrasound examination, every nodule was confirmed as benign or malignant via histopathology. The Kruskal-Wallis test, ROC curve, and binary logistic regression were used for the statistical analysis.93 benign regressive thyroid nodules and 8 carcinomas were included in this study. The average mean velocity value for benign lesions was measured at 19.5 cm/s and at 10.7 cm/s for malignant lesions (p = 0.039). The average turbulence percentage was 26.1% for benign nodules and 46.7% for carcinomas (p = 0.016). Carcinomas exhibited a slower and more turbulent perfusion pattern compared to benign tumors. A V-flow-centered system achieves a sensitivity of 100.0% and a specificity of 84.9% in predicting malignancy. This system could have reduced the number of unnecessary thyroid surgeries for benign lesions in our patient group by 70%.The capillary perfusion of thyroid nodules represents a significant indicator of its status. By analyzing the velocity and turbulence level of microvascular blood flow, V-flow offers promising prospects for accurately distinguishing between benign and malignant thyroid lesions. When integrated into a comprehensive multimodal sonographic imaging approach, V-flow further enhances diagnostic accuracy. · V-flow allows for qualitative and quantitative analysis of microvascular perfusion. · Malignant tumors are associated with slower and more turbulent microvascular hemodynamics. · Combining V-flow with other ultrasound modes eases the diagnosis of thyroid carcinomas. · Brandenstein MK, Zhang L, Scharf G et al. The impact of V-flow on preoperative diagnosis of thyroid tumors: individually and as part of multimodal sonographic imaging. Fortschr Röntgenstr 2024; DOI 10.1055/a-2350-0107.

Primary leiomyosarcoma of epididymis: a case report

BackgroundLeiomyosarcoma is a tumor that can develop in any organ that contains smooth muscles. Although leiomyosarcoma is common, its epididymal localization is quite rare.Case presentationA 79-year-old male Chinese Han patient presented with mild pain in the right groin and scrotum for 3 years concomitant with right scrotal swelling. Ultrasonography and magnetic resonance imaging of the scrotum showed a irregular and heterogeneous mass that was extratesticular. Right high orchiectomy was performed, and pathological examination of the resected specimen confirmed the diagnosis of leiomyosarcoma of the epididymis with surgical margins clear of tumor.ConclusionEpididymal leiomyosarcoma is rare and difficult to diagnose preoperatively. The final diagnosis of epididymal leiomyosarcoma requires histologic examination. Resection must be extensive and complete. The effect of chemotherapy and radiation on the epididymal leiomyosarcoma remains unclear. Recurrence is common, so follow-up is necessary.

Diagnosing Solid Lesions in the Pancreas With Multimodal Artificial Intelligence

Diagnosing solid lesions in the pancreas via endoscopic ultrasonographic (EUS) images is challenging. Artificial intelligence (AI) has the potential to help with such diagnosis, but existing AI models focus solely on a single modality. To advance the clinical diagnosis of solid lesions in the pancreas through developing a multimodal AI model integrating both clinical information and EUS images. In this randomized crossover trial conducted from January 1 to June 30, 2023, from 4 centers across China, 12 endoscopists of varying levels of expertise were randomly assigned to diagnose solid lesions in the pancreas with or without AI assistance. Endoscopic ultrasonographic images and clinical information of 439 patients from 1 institution who had solid lesions in the pancreas between January 1, 2014, and December 31, 2022, were collected to train and validate the joint-AI model, while 189 patients from 3 external institutions were used to evaluate the robustness and generalizability of the model. Conventional or AI-assisted diagnosis of solid lesions in the pancreas. In the retrospective dataset, the performance of the joint-AI model was evaluated internally and externally. In the prospective dataset, diagnostic performance of the endoscopists with or without the AI assistance was compared. The retrospective dataset included 628 patients (400 men [63.7%]; mean [SD] age, 57.7 [27.4] years) who underwent EUS procedures. A total of 130 patients (81 men [62.3%]; mean [SD] age, 58.4 [11.7] years) were prospectively recruited for the crossover trial. The area under the curve of the joint-AI model ranged from 0.996 (95% CI, 0.993-0.998) in the internal test dataset to 0.955 (95% CI, 0.940-0.968), 0.924 (95% CI, 0.888-0.955), and 0.976 (95% CI, 0.942-0.995) in the 3 external test datasets, respectively. The diagnostic accuracy of novice endoscopists was significantly enhanced with AI assistance (0.69 [95% CI, 0.61-0.76] vs 0.90 [95% CI, 0.83-0.94]; P < .001), and the supplementary interpretability information alleviated the skepticism of the experienced endoscopists. In this randomized crossover trial of diagnosing solid lesions in the pancreas with or without AI assistance, the joint-AI model demonstrated positive human-AI interaction, which suggested its potential to facilitate a clinical diagnosis. Nevertheless, future randomized clinical trials are warranted. ClinicalTrials.gov Identifier: NCT05476978.

Few incidentally found interesting foreign objects in human body: a case series

Foreign bodies are objects that do not typically belong in the human body but can be ingested, inserted, or entered due to injuries. This article presents various cases and examples of foreign bodies, including objects swallowed, objects inserted into the rectum, vagina, urethra, ear, and nose, or due to injuries caused by falls, puncture wounds, and gunshot wounds. Foreign bodies can be difficult to detect, particularly if they are not inherently radio-opaque, and may be overlooked by patients who cannot provide an adequate history. These foreign bodies may cause harm to the patient. Interpretation is done on radiographs, computed tomography (CT), Ultrasonography (USG), and magnetic resonance imaging (MRI) studies. Most foreign objects pass through the gastrointestinal tract without problem; sharp and elongated objects can cause significant injury, and even if they only partially perforate the bowel wall, they can produce chronic inflammatory processes that produce symptoms months or years later. Hence, searching for foreign bodies should be done throughout the gastrointestinal tract, particularly in children and people with mental illness who are more likely to swallow multiple items more than once. Although rare, various materials can be left behind in the body of a patient after surgery, including large and small wire sutures, surgical drains, and retained sponges, which can cause potential complications and foreign body reactions. This article highlights the importance of being aware of the presence of foreign bodies in clinical practice, and a thorough search should be carried out using different modalities, especially CT. Great suspicion and early diagnosis of foreign bodies can avoid potential complications and morbidity. In general, it provides information on the diagnosis and treatment of various types of foreign bodies.

Effectiveness of ultrasonography in the diagnosis of temporomandibular joint disorders: A systematic review and meta-analysis.

Temporomandibular disorders (TMDs) pose diagnostic challenges, and selecting appropriate imaging modalities is crucial for accurate assessment. This study aimed to compare the diagnostic accuracy and efficacy of ultrasonography (US) and magnetic resonance imaging (MRI) in identifying TMDs. A comprehensive meta-analysis was conducted, including studies that compared US and MRI for TMJ disorder assessments. Fixed-effects models were utilized to calculate pooled odds ratios (ORs) and relative risks (RRs) with 95% confidence intervals (CIs). Heterogeneity was assessed using the chi-squared test and I2 statistic. Newcastle-Ottawa scale was used to assess the methodological quality of the studies included. Six studies were included, involving a total of 281 participants. The meta-analysis demonstrated that MRI was statistically somewhat better than US in identifying TMJ disorders. The summary OR was 0.64 (95% CI: 0.46-0.90), and the summary RR was 0.80 (95% CI: 0.68-0.95). Heterogeneity among the studies was low (χ2 = 2.73, df = 5, p = .74; I2 = 0%). Demographic variables revealed variations in sample size, gender ratio and mean age across the studies. This meta-analysis provides evidence that MRI may be more effective than US in diagnosing TMDs. However, the study is limited by the small number of included studies and variations in demographic variables and study designs. Future research with larger samples and standardised protocols is essential to confirm and strengthen these findings. Understanding the diagnostic accuracy of MRI and US for TMJ disorders will aid clinicians in making informed decisions for effective TMJ disorder assessments and patient management.

Parallel comparison of ocular metrics in non-human primates with high myopia by LS900, ultrasonography and MRI-based 3D reconstruction

We investigate the ocular dimensions and shape by using Lenstar900 (LS900), A-scan ultrasonography, and Magnetic Resonance Imaging (MRI) in highly myopic Macaca fascicularis. The ocular dimensions data of LS900, A-scan ultrasonography and MRI was assessed from 8 eyes (4 adult male cynomolgus macaque) with extremely high myopia (≤-1000DS) and compared by means of coefficients of concordance and 95% limits of agreement. Multiple regression analysis was performed to explore the associations between ocular biometry, volume, refraction and inter-instrument discrepancies. Test-retest reliability of three measurements of ocular parameters at two time points was almost equal (intraclass correlation = 0.831 to 1.000). The parallel-forms reliability of three measurements was strong for vitreous chamber depth (VCD) (coefficient of concordance = 0.919 to 0.981), moderate for axial length (AL) (coefficient of concordance = 0.486 to 0.981), and weak for anterior chamber depth (ACD) (coefficient of concordance = 0.267 to 0.621) and lens thickness (LT) (coefficient of concordance = 0.035 to 0.631). The LS900 and MRI systematically underestimated the ACD and LT comparing to A-scan ultrasonography (P < 0.05). Notably, the average AL on LS900 displayed a significant correlation with those on MRI (r = 0.978, P < 0.001) and A-scan ultrasonography (r = 0.990, P < 0.001). Almost 4/5 eyeballs were prolate. The mean eyeball volume positively correlated with AL (r = 0.782, P = 0.022), the width (r = 0.945, P = 0.000), and the length (r = 0.782, P = 0.022) of eyeball, while negatively correlated with SER (r = −0.901, P = 0.000). In conclusion, there was a high inter-instrument concordance for VCD with LS900, A-scan ultrasonography and MRI, while ACD and LT were underestimated with LS900 compared to A-scan ultrasonography, and the LS900 and A-scan ultrasonography could reliably measure the AL. MRI further revealed an equatorial globe shape in extremely myopic non-human primates.

Ultrasound imaging of bowel obstruction in infants and children.

We review the etiologies of bowel obstruction in infants and children that can be identified on ultrasound (US) including perforated appendicitis, intussusception, foreign body ingestion, colonic volvulus, intra-abdominal mass lesions, internal hernia, and stricturing inflammatory bowel disease. US can potentially identify the cause of bowel obstruction in these age groups, without the need for additional cross-sectional imaging, and can aid in patient management including interventional and surgical planning. Hence, it is important to be familiar with the sonographic imaging findings of bowel obstruction in infants and children.

Long-term outcomes of radiofrequency ablation for intrathoracic goiter up to 5 years: evaluated by computed tomography/magnetic resonance imaging and ultrasound

Objectives This study evaluated the long-term efficacy and safety of radiofrequency ablation (RFA) for intrathoracic goiter (ITG) over a follow-up period exceeding six months. Methods From 2017 to 2022, 22 patients (6 males, 16 females) with 24 ITGs treated with RFA at a single medical center were evaluated. All patients underwent ultrasonography (US), computed tomography (CT), or magnetic resonance imaging (MRI) before RFA. Follow-up CT/MRI was performed six months after the initial RFA and then every 6–12 months. The primary outcomes measured were the degree of extension, goiter volume, volume reduction rate (VRR), tracheal deviation, and tracheal lumen. Additionally, we assessed the outcomes of single-session RFA (n = 16) vs. multiple sessions (n = 8) on goiters and explored the correlation between ITG volume measurements obtained using ultrasonography and CT/MRI. Results The median follow-up period was 12 months (interquartile range: 6–36.8 months). At the last follow-up, the nodule volume measured by CT/MRI had significantly decreased (76.2 vs. 24.6 mL; p < 0.05), with a VRR of 64.6%. Patients who underwent multiple RFA sessions showed a significantly higher VRR than the single-session patients (63.8 vs. 80.1%, p < 0.05). The intraclass correlation between goiter volumes measured using US and CT/MRI was moderate. Conclusion This study affirms the long-term efficacy and safety of RFA for ITG, providing an alternative treatment for nonsurgical candidates. Multiple RFA sessions may be beneficial for achieving better volume reduction. Sole reliance on ultrasonography is inadequate; therefore, integrating CT/MRI is essential for accurate pre-RFA and follow-up assessments.

Magnetic resonance imaging of fetal vascular malformations.

Vascular anomalies develop during fetal life and can be detected on prenatal ultrasonography and fetal magnetic resonance imaging. Diagnosis of lymphatic, venous, and arteriovenous malformations, as well as congenital hemangiomas and other congenital vascular tumors, may be challenging. The benign vascular anomalies may be difficult to differentiate from malignancies with a similar appearance. In this manuscript, we present a succinct overview of the congenital vascular anomalies that may present in fetal or neonatal life.

Developing a device for simultaneously investigating pivoting neuromuscular control and muscle properties toward a multi-axis rehabilitation.

Understanding the pivoting neuromuscular control of the lower limb and its associated muscle properties is critical for developing diagnostic and rehabilitation tools. However, to the best of our knowledge, a device that can evaluate these factors simultaneously remains lacking. To address this gap, a device that can investigate pivoting neuromuscular control and associated muscle properties was developed in this study. The proposed device consisted of a pivoting mechanism and height-adjustable chair with a brace interface. The device can control a footplate at various speeds to facilitate pivoting stretching and quantify neuromuscular control. Time-synchronized ultrasonographic images can be acquired simultaneously to quantify muscle properties during both active and passive pivoting movements. The muscle displacement, fascicle length/displacement, pennation angle, pivoting stiffness, and pivoting instability were investigated using the proposed device. Further, the feasibility of the device was demonstrated through a cross-sectional study with healthy subjects. The proposed device successfully quantified changes in muscle displacement during passive and active pivoting movements, pivoting stiffness during passive movements, and neuromuscular control during active movements. Therefore, the proposed device is expected to be used as a research and therapeutic tool for improving pivoting neuromuscular control and muscle functions and investigating the underlying mechanisms associated between muscle properties and joint movement in the transverse plane.

P-402 Comparison of uterine contractions in artificial hormone treatment versus aromatase inhibitor stimulated frozen embryo transfer cycles

Abstract Study question does uterine contractions differ between aromatase inhibitor stimulated (AIS) or artificial hormone treatment (AHT) Frozen Embryo transfer (FET) cycles Summary answer uterine contraction activity did not show any difference between artificial hormone treatment and aromatase inhibitor stimulated FET cycles What is known already FET cycles are prepared by different protocols. aromatase inhibitor stimulated (AIS) or artificial hormone treatment (AHT) protocols are two common protocols among others. These protocols have different cycle dynamics and might differ in pregnancy rates and different effects on perinatal outcomes. Although embryo related factors are most important for implantation endometrial receptivity and therefore uterine contractions might have a role in implantation. English literature provides scarce data on uterine contractions and pregnancy outcomes. Presence of prominent contractions were related to poor pregnancy outcomes in some studies whereas other few studies failed to show any effect in this sense Study design, size, duration this study is an observational cohort study of successive frozen embryo transfer (FET) cycles of eligible patients between 1st of july 2023 to 31th of October 2023 in a tertiary university hospital in vitro fertilization clinic with ultrasonographic video recordings at transfer day. During study period of four months, 147 out of 265 consecutive FET cycles were included in this study and study is approved by local ethical committee of the affiliated university (KA23/388). Participants/materials, setting, methods Total study group was composed of 99 artificial hormone treatment cycles and 48 aromatase inhibitor stimulated FET cycles after exclusion of patients with uterine congenital malformations, uterine fibroids,adenomyosis patients and patient with previous uterine surgery. Implantation rates, pregnancy rates and clinical pregnancy rates were recorded. Transvaginal ultrasonographic sagittal uterine video image recordings were obtained at transfer day one hour before embryo transfer. Recordings were reviewed by two researchers and uterine contractions were documented by agreement. Main results and the role of chance This is the first study comparing different FET cycles and uterine contraction activities. Patient characteristics were similar between two groups. Artificial hormone treatment and aromatase inhibitor stimulated cycle groups showed similar endometrial thicknesses (11.47±1.92 and 11.24±1.02, respectively p = 0.42) and top quality embryo transfer rates (22.6 % and 26.8% p = 0.82). Although AIH group showed a statistically insignificant advantage, clinical and ongoing pregnancy rates were similar between protocols (supplementary data). Uterine peristaltic activity was not statistically different between aromataze inhibitor stimulated and artificial hormone treatment FET cycle (1.54±1.75 versus 1.63±2.15 p = 0.81 recpectively). Furthermore uterine persistalsizm were similar in pregnant and non-pregnant patients /1.52±2.07 vs 1.72±1.93 p = 0.57). However as far as Aromatase inhibitor stimulated FET cycles were considered; pregnant patients had less uterine peristaltic activity when compared ton non-pregnant patient (45.7% and 15.4%, respectively p = 0.054 ) although this difference was at the border of statistical significance. Limitations, reasons for caution This is an observational study of relatively short duration with limited number of patients. Our study in AIS cycles have a tendency to fewer contractions in cycles ended up in pregnancy. Larger series of FET cycles might prove differences in uterine contraction frequencies and pregnancy outcomes in AIS FET cycles. Wider implications of the findings Our study supported new information on uterine contractility in different FET cycles protocols. Further large scale studies might provide new insights to uterine factor and its role in implantation as far as uterine contraactions are concerned. Trial registration number (KA23/388) local ethic committee approval

Ovarian _ Reporting and Data System (O_RADS) Classification of Ovarian Lesions on Ultrasound Basis

Abstract Background Ovarian lesions present a special diagnostic challenge when imaging findings cannot be categorized into benign or malignant pathology. Ultrasonography (US), Computed Tomography (CT), and Magnetic Resonance Imaging (MRI) are currently used to evaluate ovarian tumors. Aim of the Work The aim of this work is to determine the efficacy of the classification of ovarian lesions on an ultrasound basis. Patients and Methods This was a prospective observational study conducted on 30 females with ovarian lesions at the Radiology Department of Ain Shams University Hospitals for 6 months from February to august 2022. Results The benign lesions of O-RADS 1, O-RADS 2, O-RADS 3, O-RADS 4, and O-RADS 5 represented 5.3%, 63.2%, 15.8%, 10.5% and 5.3% respectively. The malignant lesions of O-RADS 5, O- RADS 4 represented 81.8%, and 18.2%, respectively. There was a highly statistically significant difference between benign and malignant lesions in terms of the O-RADS score (P &amp;lt; 0.001). In order to assess the diagnostic performance of the O-RADS score to discriminate malignant from benign lesions, a ROC curve analysis was performed. O-RADS score (AUC of 0.959) showed a sensitivity of 100%, a specificity of 84.21%, PPV of 78.6%, and NPV of 100%, with the optimal cutoff value for predicting malignancy was &amp;gt;O-RADS 3. Conclusion The current study concluded the following: Ultrasonography is definitely an important non- invasive tool and is helpful in diagnosing most cases of ovarian lesions. O-RADS system has good sensitivity and moderate specificity for classifying ovarian lesions.

Pancreatic Cancer Surveillance and Survival of High-Risk Individuals

Pancreatic ductal adenocarcinoma (PDAC) is a deadly disease with increasing incidence. The majority of PDACs are incurable at presentation, but population-based screening is not recommended. Surveillance of high-risk individuals for PDAC may lead to early detection, but the survival benefit is unproven. To compare the survival of patients with surveillance-detected PDAC with US national data. This comparative cohort study was conducted in multiple US academic medical centers participating in the Cancer of the Pancreas Screening program, which screens high-risk individuals with a familial or genetic predisposition for PDAC. The comparison cohort comprised patients with PDAC matched for age, sex, and year of diagnosis from the Surveillance, Epidemiology, and End Results (SEER) program. The Cancer of the Pancreas Screening program originated in 1998, and data collection was done through 2021. The data analysis was performed from April 29, 2022, through April 10, 2023. Endoscopic ultrasonography or magnetic resonance imaging performed annually and standard-of-care surgical and/or oncologic treatment. Stage of PDAC at diagnosis, overall survival (OS), and PDAC mortality were compared using descriptive statistics and conditional logistic regression, Cox proportional hazards regression, and competing risk regression models. Sensitivity analyses and adjustment for lead-time bias were also conducted. A total of 26 high-risk individuals (mean [SD] age at diagnosis, 65.8 [9.5] years; 15 female [57.7%]) with PDAC were compared with 1504 SEER control patients with PDAC (mean [SD] age at diagnosis, 66.8 [7.9] years; 771 female [51.3%]). The median primary tumor diameter of the 26 high-risk individuals was smaller than in the control patients (2.5 [range, 0.6-5.0] vs 3.6 [range, 0.2-8.0] cm, respectively; P < .001). The high-risk individuals were more likely to be diagnosed with a lower stage (stage I, 10 [38.5%]; stage II, 8 [30.8%]) than matched control patients (stage I, 155 [10.3%]; stage II, 377 [25.1%]; P < .001). The PDAC mortality rate at 5 years was lower for high-risk individuals than control patients (43% vs 86%; hazard ratio, 3.58; 95% CI, 2.01-6.39; P < .001), and high-risk individuals lived longer than matched control patients (median OS, 61.7 [range, 1.9-147.3] vs 8.0 [range, 1.0-131.0] months; 5-year OS rate, 50% [95% CI, 32%-80%] vs 9% [95% CI, 7%-11%]). These findings suggest that surveillance of high-risk individuals may lead to detection of smaller, lower-stage PDACs and improved survival.

Sonographic Measurement and Sex Variability of Portal Vein in a Sample of Sudanese Adults

&amp;lt;i&amp;gt;Background: &amp;lt;/i&amp;gt;Measurements of the normal portal venous dimension in a species population is so crucial. portal vein can be measured by several methods for assessing different parameters, Computed topography (CT) and sonographic imaging are common examples. The diagnosis of portal hypertension depends on the transverse portal vein diameter (normal diameter from 6-15 mm). The aim of this study is to assess the portal vein diameter and correlate the diameter with age, sex, weight, height and BMI in Sudanese populations. &amp;lt;i&amp;gt;Methodology: &amp;lt;/i&amp;gt;This was a descriptive cross-sectional study that included a sample of Sudanese adults who were requested to have routine abdominal sonographic scanning due to reasons not related to liver or portal vein problems. The study was carried out at the Radiology Department of Qatar Alnada Hospital, Umbadda, Khartoum, Sudan 2022. &amp;lt;i&amp;gt;Results:&amp;lt;/i&amp;gt; In this study, 376 participants were included of which more than half were females (56.1%, n=211), while 165 (43.9%) were males. The mean age of the participants was 38.12 + 15.57 years. The mean portal vein diameter was 10.79 + 1.27 millimeters. From this study the portal vein diameter varied with age (p value = 0.000), weight (p value = 0.002), height (p value = 0.000) and sex (p value = 0.000). It is not related to BMI (p value = 0.3). &amp;lt;i&amp;gt;Conclusion: &amp;lt;/i&amp;gt;This study revealed that the portal vein diameter has positive correlation with age, sex, height, and weight of the person and has no correlation with the BMI.