Ultrasound Unit Research Articles

Percutaneous radiofrequency ablation for stage B1 of modified Bolondi’s subclassification for intermediate-stage hepatocellular carcinoma

Abstract Background Hepatocellular carcinoma is considered the most common cause of hepatic focal lesions in Egypt. TACE is still the recommended treatment approach for patients in the intermediate stage. In the current research, we evaluated the safety and efficacy of percutaneous radiofrequency ablation (RFA) for a selected category in the intermediate stage (BCLC stage B). Methods This prospective study was conducted in the Department of Gastroenterology, Hepatology, Faculty of Medicine, Beni-Suef University between September 2022, and March 2024. In addition to AFP, Pelviabdominal ultrasound and computerized tomography (CT) were used for HCC diagnosis. According to the Child–Pugh score plus Milan and up-to-7 criteria, we used Modified Bolondi’s Subclassification (Kinki Criteria), to sub-classifies the BCLC B stage into B1/B2/B3 subcategories. Radiofrequency ablation was done in the interventional ultrasound unit. Treatment efficacy was assessed 6 months after tumor ablation. Results One hundred twenty participants were enrolled in our research trial, 72 (60%) were within the intermediate stage, and 48 (40%) had early-stage HCC. Most of our patients were males, 78 (65%). All the early-stage-HCC patients were Child–Pugh Score A (n = 48), while the intermediate-stage (BCLC B) group was classified in both Child–Pugh Score A (n = 59) and B (n = 16). Within the intermediate group (BCLC-stage B), All enrolled cases fell within category “B1” within the Kinki Criteria. Logistic regression analysis illustrated that the pre-treatment level of Platelet count and post-treatment level of AFP shows a statistically significant prediction effect on treatment response rate with p-value (0.028 and 0.007 respectively). Conclusion percutaneous radiofrequency ablation is considered an effective treatment option for the B1 subcategory according to Kinki Criteria for intermediate-stage HCC (BCLC-B1) but long-term follow-up is recommended.

Combining Ultrasonography and Endometrial Aspiration as a One-Stop Screening for Endometrial Neoplasia.

To assess the performance of simultaneous endometrial aspiration and sonohysterography to screen for endometrial cancer or hyperplasia in women aged 50 years or older. We conducted a prospective study from February 2014 to October 2020 at the ultrasound unit of a large urban academic medical center. The study included 1,635 women aged 50 years or older referred for endometrial evaluation, with follow-up through January 2021. Participants underwent saline infusion sonohysterography combined with ultrasound-guided endometrial aspiration. The primary outcome measured was a diagnosis of endometrial cancer or hyperplasia within 1 year from screening. The diagnostic accuracy of the combined evaluation method, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), was assessed. Of 1,170 women who completed the study protocol, 82 (7.0%) had endometrial cancer and 42 (3.6%) had endometrial hyperplasia. Of all patients who developed cancer during the follow-up period, 85.5% were diagnosed within 1 year after evaluation. The application of simultaneous endometrial aspiration and sonohysterography together demonstrated a sensitivity of 99.1%, specificity of 24.9%, PPV of 11.8%, and NPV of 99.6%. Using a theoretical sequential approach, assuming an endometrial aspiration is performed only in patients determined to be high risk by sonohysterography, demonstrated a sensitivity of 93.4%, specificity of 99.9%, PPV of 99.0%, and NPV of 99.3%. Simultaneous endometrial aspiration and sonohysterography is an effective one-stop outpatient screening tool for detecting endometrial cancer and hyperplasia in women aged 50 years or older. With the integration of two screening modalities into a single procedure, simultaneous endometrial aspiration and sonohysterography may overcome the limitations inherent in each of the currently recommended methods individually, potentially improving patient prognosis and streamlining the diagnostic process.

The Sonographic Characteristics of Isolated Fallopian Tube Torsion

ObjectiveIsolated fallopian tube torsion (IFTT) presents a challenging preoperative diagnosis. This study investigated the specific sonographic characteristics of IFTT and compared them to the characteristics of ovarian and adnexal torsion. DesignRetrospective cohort study. SettingTertiary level gynecological ultrasound unit.: 225 women operated for suspected isolated ovarian, fallopian tube or adnexal torsion (ovary and tube) were included. InterventionsElectronic medical records of patients diagnosed with torsion at our ultrasound unit from 2001 to 2018 were retrieved. Inclusion criteria were women operated for suspicion of isolated ovarian, fallopian tube or adnexal torsion (involving both ovary and tube), with a preoperative sonogram performed in our tertiary level gynecologic ultrasound unit. Patients operated after a sonographic examination in the emergency department were excluded. MeasurementsPatients were divided into 4 groups according to their laparoscopic diagnosis: IFTT, ovarian torsion, adnexal torsion or no torsion.The sonographic characteristics of the groups were compared and the diagnosis was confirmed according to laparoscopy findings. Main resultsIFTT was reported in 28/225 (12.4%) cases. Ovarian volume was significantly lower in IFTT (29.2 ± 44 cm3) compared to ovarian torsion (111 ± 143 cm3, p=.037). There were fewer cases of ovarian edema in IFTT compared to ovarian torsion (12/22 (54.5%) vs. 54/63 (85.7%) respectively, p=.001). IFTT was associated with paraovarian cyst significantly more often than with ovarian torsion (13/24 (54.2%) vs. 4/75 (5.3%), respectively; p=.003). There was no difference between whirlpool sign and location in all forms of torsion. The sensitivity, specificity, Positive predictive value and Negative predictive value for IFTT were 88.4%, 83.3%, 95.8% and 62% respectively. ConclusionIFTT has distinct sonographic characteristics, including normal ipsilateral ovary, paraovarian cyst, and whirlpool sign. Awareness of these features may improve the diagnosis of IFTT and promote faster and more efficient treatment. Further studies are needed to establish these characteristics.

Predictive capacity of fetal pancreatic circumference for gestational diabetes mellitus.

To assess the capacity of fetal pancreatic size, before standard blood glucose testing for screening and diagnosis, to predict maternal gestational diabetes mellitus (GDM). This was a retrospective cohort study of low-risk pregnant women recruited during routine second-trimester fetal anatomical screening at 20-25 weeks' gestation at two ultrasound units in Israel between 2017 and 2020. The predictive performance of fetal pancreatic circumference ≥ 80th and ≥ 90th centiles and glucose challenge test (GCT) was examined for the outcome of GDM. The independent-samples t-test was used to compare mean pancreatic circumference centile between pregnancies with GDM and those without GDM. Diagnostic performance was evaluated with 2 × 2 contingency tables and receiver-operating-characteristics (ROC) curves. Overall, 195 women were selected for statistical analysis. Twenty-four (12.3%) women were diagnosed subsequently with GDM. The mean ± SD fetal pancreatic circumference centile was significantly higher in the GDM group compared with the non-GDM group (82.4 ± 14.6 vs 62.8 ± 27.6; P < 0.001). The pancreatic circumference centile was correlated positively with the estimated fetal weight centile (Pearson's coefficient, 0.243; P = 0.001). The 80th centile cut-off for pancreatic circumference had the highest sensitivity (70.8%) and positive predictive value (23.3%) for future maternal GDM, with the best trade-off between sensitivity and specificity achieved at the 75th centile cut-off (sensitivity, 79%; specificity, 60%). The GCT had better specificity (90.2%) and negative predictive value (97.9%) compared with both cut-offs in pancreatic circumference. The area under the ROC curve was higher for pancreatic circumference compared with GCT (0.71 vs 0.64) and only the former was statistically significant (P = 0.001). Fetal pancreatic circumference has a higher positive predictive capacity compared with GCT. Measuring pancreatic circumference can identify pregnancies at high risk for maternal GDM, thereby promoting earlier diagnosis and treatment, decreasing the time period during which the fetus is exposed to high maternal glucose levels and improving infant outcome. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Temporal and external validation of the algorithm predicting first trimester outcome of a viable pregnancy.

Symptoms like vaginal bleeding or abdominal pain in early pregnancy can create anxiety about potential miscarriage. Previous studies have demonstrated ultrasonographic variables at the first trimester transvaginal scan (TVS) which can assist in predicting outcomes by 12 weeks gestation. To validate the miscarriage risk prediction model (MRP) in women who present with a viable intrauterine pregnancy (IUP) at the primary ultrasound. A multi-centre diagnostic study of 1490 patients was performed between 2011 and 2019 for retrospective external and 2017-2019 for prospective temporal validation. The reference standard was a viable pregnancy at 12 + 6 weeks. The MRP model is a multinomial logistic regression model based on maternal age, embryonic heart rate, logarithm (gestational sac volume/crown-rump length (CRL)) ratio, CRL and presence or absence of clots. Temporal validation data from 290 viable IUPs were collected: 225 were viable at the end of the first trimester, 31 had miscarried and 34 were lost to follow-up. External validation data from 1203 viable IUPs were collected at two other ultrasound units: 1062 were viable, 69 had miscarried and 72 were lost to follow-up. Temporal validation with a cut-off of 0.1 demonstrated: area under the curve (AUC) of 0.8 (0.7-0.9), sensitivity 66.7%, specificity 83.9%, positive predictive value (PPV) 35.7%, negative predictive value (NPV) 94.9%, positive likelihood ration (LR+) 4.1 and negative LR (LR-) 0.4. External validation demonstrated: AUC 0.7 (0.7-0.8), sensitivity 44.9%, specificity 90.4%, PPV 23.3%, NPV 96.2%, LR+ 4.6 and LR- 0.6 (0.4-0.7). The MRP model is not able to be used in real time for counselling, and management should be individualised.

Ultrasound-stimulated Microbubbles for Treatment of Pancreatic Cancer Cells with Radiation and Nanoparticles: In vitro Study.

This study aims to investigate the radiation enhancement effects of ultrasound-stimulated microbubbles (USMB) with X-rays and nanoparticles on pancreatic cancer cells in vitro. Sonazoid™ microbubbles were used for USMB treatment with a commercially available ultrasound unit. The characterization of the microbubbles before and after ultrasound exposure with different mechanical parameters was evaluated microscopically. Two pancreatic cancer cell lines, MIAPaCa-2 and PANC-1, were treated with different concentrations of microbubbles in combination with 150 kVp X-rays and hydrogen peroxide-modified titanium dioxide nanoparticles. Cell viability was evaluated using a water-soluble tetrazolium dye and a colony formation assay. In addition, intracellular reactive oxygen species (ROS) induced by the combined treatment were assessed. The number of burst microbubbles increased with ultrasound's higher mechanical index and the exposure time. A significant radiation enhancement effect with a significant increase in ROS levels was observed in MIAPaCa-2 cells treated with USMB and 6 Gy X-rays, whereas it was not significant in PANC-1 cells treated with the same. When a higher concentration of USMB was applied with X-rays, no radiation enhancement effects were observed in either cell line. Moreover, there was no radiation enhancement effect by USMB between cells treated with and without nanoparticles. The results indicate that USMB treatment can additively enhance the therapeutic efficacy of radiation therapy on pancreatic cancer cells, while the synergistic enhancement effects are likely to be cell type and microbubble concentration dependent. In addition, USMB did not improve the efficacy of nanoparticle-induced radiosensitization in the current setting.

The Pathognomonic ultrasonographic findings in fetus with COVID-19 infection

Aim: The main goal is to identify the pathognomonic sonographic signs for foetal SARS-CoV-2 infection and to determine whether or not transplacental SARS-CoV-2 transmission is possible. Patients and Methods: In total, 105 pregnant women with positive SARS-CoV-2 PCR swabs during the first trimester with mild or moderate infection without hospitalisation and/or oxygen support were included in this prospective comparative study, which was carried out at the ultrasound and foetal medicine unit of Ain Shams University Maternity Hospital from January 2021 to June 2023. The SARS-CoV-2 positive group was compared to the control group with inclusion and exclusion criteria. Results: In the COVID-19 group, pathognomonic ultrasonographic results were considerably more common. The COVID-19 group had a considerably higher frequency of placental calcifications and oligohydramnios. In the COVID-19 cohort, patients with positive pathognomonic ultrasonographic results had considerably higher BMIs. In the COVID-19 cohort, gestational age at infection, and BMI ≥30.0 kg/m2 were significant independent risk factors for the development of pathognomonic ultrasonographic abnormalities. Those in the control group who had positive pathognomonic ultrasonographic results were older and had higher rates of hypertension. Significant independent risk variables for the incidence of pathognomonic ultrasonographic findings in the control group included age ≥34.0 years and hypertension. Conclusion: There is no evidence of a teratogenic effect linked to maternal SARS-CoV-2 infection during the first few months of pregnancy. However, early pregnancy infection with COVID-19 is linked to pathognomonic ultrasonography findings of placental calcifications and oligohydramnios.

Role of Endoscopic Ultrasound in Diagnosis of Submucosal Lesions of Gastrointestinal Tract

The study aimed to understand the magnitude of submucosal lesions as part of the referral to the endoscopic ultrasound (EUS) unit in one year and know the percent of the different types and sites of submucosal lesions of GIT in Theodore Bilharz Research Institute as tertiary referral center draining Egyptian community. Within one year, all patients referred to the EUS unit at Theodore Bilharz Research Institute (TBRI) for assessment to assess the percent of submucosal lesions cases as part of the total referral and know the different types seen and their common sites as compared to the international literature. Patients diagnosed to have submucosal lesion will be subjected to; full clinical history, thorough physical examination, laboratory investigations, BUS for more characterization (site, size, location, echo pattern, etc.) and BUS-guided fine-needle aspiration (FNA) for histopathological examination. The work comprised 36 patients; 16 females and 20 males. Their ages ranged from 21 to 75 years. All patients had preliminary upper endoscopy or colonoscopy. According to the indication of upper preliminary endoscopy or colonoscopy, 12 (33.3%) were complaining of melena, 5 (13.8%) hematemesis, 1 (2.7%) bleeding per rectum, 7 (19.4%) upper abdominal pain, 2 (5.5%) dysphagia, finally, 8 (22.2%) vomiting. According to the site of the submucosal lesion, 24 (66.6%) were gastric, 6 (16.6%) esophageal, 4 (11.1%) duodenal, 1 gastro-esophageal (2.8%), and 1 (2.8%) rectal. 34 cases (94%) were covered by normal overlying mucosa while 2 cases (6%) had superficial ulcerations. It was concluded that EUS criteria, can be used without FNA and histopathologic examination to reduce the cost of differentiation between malignant and benign lesions. All homogenous lesions were benign. Lesion size of 4.5 cm is a cut off; &gt; 4.5 cm were malignant whereas &lt; 4.5 cm were benign. All submucosal lesions without areas of breakdown were benign. Those infiltrating all layers are malignant. EUS guided fine needle aspiration (FNA) and histopathological examination should be done for some submucosal masses to put a definite diagnosis. EUS with colored Doppler is necessary in differentiating cystic from vascular lesions.

The importance of ultrasound-guided biopsy: lesson from a case of liver metastasis from uveal melanoma

Melanoma is an extremely aggressive malignant neoplasm. Uveal melanoma is the most common primary intraocular malignancy in adults, representing 3–5% of all melanomas. Liver metastases can be clinically detected in 10–20% of patients with metastatic disease from cutaneous melanoma. However, while liver is typically not the first site of disease spread in cutaneous melanoma, ocular melanoma has been showed to primarily metastasize from the eye to the liver; indeed, liver metastases are detected in approximately 87% of patients with metastatic uveal melanoma. Therefore, liver metastasis can be challenging to identify in early stages, thus being essentially asymptomatic until the disease has advanced. Here we report the case of a patient who came to our ultrasound unit reporting a large liver mass. Both contrast-enhanced abdominal computed tomography and magnetic resonance imaging did not establish a definitive diagnosis. The final diagnosis was made only through an ultrasound-guided biopsy of the mass, thus revealing a uveal melanoma metastasis. This is followed by a review of the literature on imaging follow-up of patients with melanoma.

Value of Ultrasound Super-Resolution Imaging for the Assessment of Renal Microcirculation in Patients with Acute Kidney Injury: A Preliminary Study.

The present study aimed to explore the clinical applicability of ultrasound super-resolution imaging (US SRI) for assessing renal microcirculation in patients with acute kidney injury (AKI). A total of 62 patients with sepsis were enrolled in the present study-38 with AKI and 24 control patients-from whom renal ultrasounds and clinical data were obtained. SonoVue contrast (1.5 mL) was administered through the elbow vein and contrast-enhanced ultrasound (CEUS) images were obtained on a Mindray Resona A20 ultrasound unit for 2 min. The renal perfusion time-intensity curve (TIC) was analyzed and, after 15 min, additional images were obtained to create a microscopic blood flow map. Microvascular density (MVD) was calculated and its correlation with serum creatinine (Scr) levels was analyzed. There were significant differences in heart rate, Scr, blood urea nitrogen, urine volume at 24 h, and glomerular filtration rate between the two groups (p < 0.01), whereas other characteristics, such as renal morphology, did not differ significantly between the AKI group and control group (p > 0.05). The time to peak and mean transit times of the renal cortex in the AKI group were prolonged compared to those in the control group (p < 0.01), while the peak intensity and area under the TIC were lower than those in the control group (p < 0.05). The MVD of the renal cortex in the AKI group was lower than that in the control group (18.46 ± 5.90% vs. 44.93 ± 11.65%; p < 0.01) and the MVD in the AKI group showed a negative correlation with Scr (R = -0.84; p < 0.01). Based on the aforementioned results, US SRI can effectively assess renal microcirculation in patients with AKI and is a noninvasive technique for the diagnosis of AKI and quantitative evaluation of renal microcirculation.

Inline Monitoring of continous Ultrasonic Welding Processes of Thermoplastic Composites via a custom polyCMUT based Ultrasound Array

Ultrasonic welding (UW) of thermoplastic composites (TCs) is an emerging technology in the field of composite joining techniques in the aerospace sector. Through a mechanical oscillator, ultrasound at a frequency of 20kHz is induced into the material via a welding horn, where microscopic friction and damping effects melt the thermoplastic. Under further pressure the weld area cools down, permanently joining both parts together. Like all joining processes in the aerospace industry the resulting joints need to be tested for their quality and structural integrity. The traditional testing method using water-coupled ultrasound includes extra steps. This process could be considerably improved by assessing the quality of the weld directly after or even during the welding process, allowing for immediate rework or discard of the parts in question. Ultrasound is still the best solution for this quality assessment, being inexpensive, well understood, and able to create B-Mode images, allowing a look into the cross-section of the weld. However, there are several major problems: To increase the system complexity as little as possible it is necessary to attach the ultrasound unit next to the welding equipment, and as close to the welding horn and compactor as possible to save space and keep the end- effector manoeuvrable. This brings problems for classic piezoelectric ultrasonic arrays: The low welding frequency and its resonance modes reach into the lower resonance modes of the piezoelectric sensors leading to immense noise, hiding any potential echo from the welding zone. Classic piezoelectric crystals are also very brittle and can suffer damage from sustained exposure to this violent environment. The authors present a novel solution: a custom-made polymer-based capacitive micromachined ultrasonic transducer array (polyCMUT). polyCMUTs are tiny drums with two electrodes. One on the bottom and the other suspended over a cavity sandwiched between two layers of polymers. By applying a DC-bias an electrical field is created and the membrane is set under tension. If then an AC voltage is applied, the strength of the electric field decreases, allowing the membrane to snap back into its original position. If done at the resonance frequency of the membrane, a strong ultrasonic signal is created. To receive this signal the polyCMUT is charged with a DC-bias, allowing it to receive the echo of the transmitted signal by measuring the changing capacitance. Not only is the polymer robust and inexpensive to fabricate, the general architecture of CMUTs also allows a design where the first mode of resonance is the actual mode the CMUT is operating in. By designing for a resonance frequency over 5 MHz all noise from the initial welding process is ignored, leading to a working pulse echo imaging system. The array is then mounted onto a PEEK block attached to the compactor unit of the welding end-effector. This publication is intended to present initial results, the design process of the custom array and the tests leading there.

Ultrasound-guided percutaneous biopsy for focal liver lesions: Adverse events and diagnostic yield in a single-centre analysis.

Ultrasound-guided biopsy of focal liver lesions (FLL) is a well-established procedure with crucial impact on therapeutic decisions. The safety and accuracy depend on needle type, tumour location and comorbidities. Modern oncological concepts often require large tumour specimens which may increase the procedural risk. We retrospectively collected data from consecutively scheduled ultrasound-guided FLL biopsies performed in an interdisciplinary ultrasound unit at a university hospital from 2015-2020. We analysed complication rates, diagnostic accuracy, and patient outcome in a one-year period. Of 426 scheduled interventions, 339 were included: 322 primary biopsies (40% female, median age 65 years, median BMI 25.4 kg/m2) and 17 rebiopsies in cases with undetermined diagnosis. Indications comprised 309 (96%) cases with suspected malignant lesions. Important comorbidities were type 2 diabetes (n = 107, 33%) and cirrhosis (n = 64, 20%). A conclusive histopathological diagnosis was achieved in 270 (84%) cases with a weak association with lesion size (OR 1.12 per cm, 95%CI 0.99-1.27). Greater BMI (OR 0.60 per 10 BMI points, 95%CI 0.34-1.05) showed a trend towards an insufficient diagnosis. Relevant complications occurred in 8 (2.5%) cases (2 major; 1 life-threatening). Multiple passes showed a trend towards adverse events (OR 2.32 for > 1 pass, 95%CI 0.99-5.42). 93 (29%) patients died during a median follow-up of 171 days. Ultrasound-guided FLL biopsy is an efficient and safe diagnostic measure. The limitations of the procedure and its associated risks should be considered in patients with advanced malignancies.

Multiwavelength laser diode based portable photoacoustic and ultrasound imaging system for point of care applications.

Vascular diseases are a leading cause of death and disability worldwide. Despite having precursor conditions like peripheral arterial disease (PAD), they are often only diagnosed after the onset of stroke or heart attack. Low-cost, portable, noninvasive, point-of-care (POC), label-free assessment of deep vascular function benefits PAD diagnosis, especially in resource poor settings of the world. Doppler ultrasound-based blood flow measurements can diagnose PAD, albeit with limited sensitivity and specificity. To overcome this, here, we propose the first-of-its-kind dual-modality photoacoustic-and-ultrasound (PAUS) imaging system that integrates a multiwavelength pulsed laser diode (PLD) with a compact ultrasound data acquisition unit. The mesoscopic imaging depth of the portable PLD-PAUS system was validated using tissue phantoms, and its multispectral photoacoustic imaging capabilities were validated using an atherosclerosis-mimicking phantom. Furthermore, we demonstrated high-contrast volumetric in vivo photoacoustic imaging of rodent abdominal vasculature and quantified vessel reactivity due to hypercapnia stimulation. The multiparametric functional and molecular imaging capabilities of the PLD-PAUS system holds promise for POC applications.

A survey of the use of ultrasound by small animal veterinary clinicians.

This study aimed to determine the current use of ultrasound amongst small animal veterinarians. A total of 1216 small animal veterinary practitioners responded to an electronic survey that was administered through the Veterinary Information Network to all its members. Descriptive statistics were generated; limited inferential statistics were performed to examine specific relationships. Eighty-four percent of respondents had access to an ultrasound unit, and 86% of respondents reported using their unit multiple times per week. The most common uses were assistance with cystocentesis (93%) and abdominocentesis (71%), pregnancy diagnosis (69%), limited abdominal evaluation (63%), to aid in thoracocentesis (59%), and limited thoracic evaluation (52%). Eighty-nine percent of respondents received some formal training in ultrasound, most commonly from continuing education courses. Most respondents (52%) reported receiving ≤25h of training. Additionally, 88% of respondents believed it was either extremely or very important for there to be ultrasound training for veterinary students prior to graduation. Based on this survey, most small animal practitioners commonly use ultrasound for limited examinations, being most confident in the sonographic evaluation and centesis of the bladder and for the detection and centesis of effusion in a body cavity. With most respondents having ≤25h of training in ultrasound, typically obtained in postgraduate courses, an expansion in standardized basic ultrasound training within the veterinary curriculum may be warranted.

Obstetric imaging practice characteristics associated with prenatal detection of critical congenital heart disease in a rural US region over 20years.

To identify clinical practice characteristics associated with the frequency of prenatal critical congenital heart disease (CCHD) detection (i.e., the number of liveborn infants with postnatally confirmed CCHD identified on prenatal sonography) over 20years in a rural setting comprised of 11 primarily low-volume obstetric hospitals and the single tertiary academic hospital to which they refer. This was a retrospective cohort study of all patients in the referral region with an initial prenatal and/or postnatal diagnosis of CCHD from 01/01/2002 to 12/31/2021. The frequency of prenatal CCHD detection at the time of an obstetric ultrasound was reported, as was the change in detection over time. Critical congenital heart disease detection was assessed as a function of cardiac lesion type, practice setting, and practice characteristics. There were 271 cases with a confirmed postnatal CCHD diagnosis, of which 49% were identified prenatally. The majority of community practices each averaged <10 CCHD cases in total over the study period. Prenatal detection at the tertiary academic hospital's obstetric ultrasound unit was 64%, compared to 22% at the combined referring community practices (p<0.001), though CCHD detection improved over time in both settings. Professional accreditation by the American Institute of Ultrasound in Medicine, image interpretation by radiology or Maternal Fetal Medicine, and use of video clips of ventricular outflow tracts were associated with improved prenatal CCHD detection. Our data demonstrate the infrequency of CCHD cases at small-volume, rural hospitals and the substantial variation in prenatal CCHD detection across practice settings. Our methods allowed for the identification of practice characteristics associated with prenatal CCHD detection.

Use of a handheld real-time ultrasound unit in post-prostatectomy incontinence rehabilitation

Following surgery for prostate cancer, a 56-year- old man self-referred to a specialist pelvic health physiotherapist working in private practice. An assessment was performed, and a holistic treatment programme was implemented. The patient was an advanced clinical practitioner who concurrently employed real-time ultrasound as a biofeedback tool. This was part of a wider, physiotherapist-supervised programme of pelvic floor muscle training and overall rehabilitation. An early return to continence was achieved. While recognizing the limitations of the unique circumstances described, this case report discusses the possibilities that it raises with regard to: male pelvic health rehabilitation; the use of biofeedback tools; and access to information or adjuncts that might be usefully employed by physiotherapists working in this field.

Place Of First Trimester Ultrasound at The University Teaching Hospital of Bogodogo (UTH-B) in Burkina Faso

Objective: To describe the experience of the UTH-Bogodogo obstetrics and gynecology department in ultrasound determination of fetal sex in the first trimester of pregnancy. Patients and methods: This was a prospective descriptive study conducted over a 30-month period from February 1, 2021 to June 30, 2022 in the gynecological and obstetric ultrasound unit of the UTH-Bogodogo in Ouagadougou. The study sample consisted of 311 fetuses. The sample included all pregnant women who came for an obstetrical ultrasound scan in a non-emergency situation, whose gestational age was between the 11th and 14th week of amenorrhea, and who expressed a wish to know the fetal sex. The methods described by Mazza and Efrat were used to determine fetal sex. Patients were followed until delivery, after clinical verification of the sex of their newborns. Data were collected using an individual data collection form. Participation in the study was conditional on patients signing an informed consent form. Results: Fetal sex determination was possible in 280 of 311 fetuses, for a feasibility rate of 89.7%. In the remaining 31 cases, it was not possible to determine the fetal sex, as the position of the fetus did not allow a clear view of the genital bud. In terms of reliability, of the 238 fetuses monitored, fetal sex determination was correct in 204 fetuses, for a success rate of 85.7%. Accuracy was better when sex determination was performed after 12 weeks of amenorrhea. There was no significant difference in measurements between single and multiple fetuses. Conclusion: ultrasound determination of fetal sex at first birth could be an effective, simple, available and inexpensive option in developing countries.

PLACE OF FIRST TRIMESTER ULTRASOUND AT THE UNIVERSITY TEACHING HOSPITAL OF BOGODOGO (UTH-B) IN BURKINA FASO

AbstractObjective: To describe the experience of the UTH-Bogodogo obstetrics and gynecology department in ultrasound determination of fetal sex in the first trimester of pregnancy.Patients and methods: This was a prospective descriptive study conducted over a 30-month period from February 1, 2021 to June 30, 2022 in the gynecological and obstetric ultrasound unit of the UTH-Bogodogo in Ouagadougou. The study sample consisted of 311 fetuses. The sample included all pregnant women who came for an obstetrical ultrasound scan in a non-emergency situation, whose gestational age was between the 11th and 14th week of amenorrhea, and who expressed a wish to know the fetal sex. The methods described by Mazza and Efrat were used to determine fetal sex. Patients were followed until delivery, after clinical verification of the sex of their newborns. Data were collected using an individual data collection form. Participation in the study was conditional on patients signing an informed consent form.Results: Fetal sex determination was possible in 280 of 311 fetuses, for a feasibility rate of 89.7%. In the remaining 31 cases, it was not possible to determine the fetal sex, as the position of the fetus did not allow a clear view of the genital bud. In terms of reliability, of the 238 fetuses monitored, fetal sex determination was correct in 204 fetuses, for a success rate of 85.7%. Accuracy was better when sex determination was performed after 12 weeks of amenorrhea. There was no significant difference in measurements between single and multiple fetuses.Conclusion: ultrasound determination of fetal sex at first birth could be an effective, simple, available and inexpensive option in developing countries.

Using Fuzzy Mathematical Model in the Differential Diagnosis of Pancreatic Lesions Using Ultrasonography and Echographic Texture Analysis.

Malignant tumors of the pancreas are the fourth leading cause of cancer-related deaths. This is mainly because they are often diagnosed at a late stage. One of the challenges in diagnosing focal lesions in the pancreas is the difficulty in distinguishing them from other conditions due to the unique location and anatomy of the organ, as well as the similarity in their ultrasound characteristics. One of the most sensitive imaging modalities of the pancreas is endoscopic ultrasonography. However, clinicians recognize that EUS is a difficult and highly operator-dependent method, while its results are highly dependent on the experience of the investigator. Hybrid technologies based on artificial intelligence methods can improve the accuracy and objectify the results of endosonographic diagnostics. Endoscopic ultrasonography was performed on 272 patients with focal lesions of the pancreatobiliary zone, who had been treated in the surgical section of the Kursk Regional Clinical Hospital in 2014-2023. The study utilized an Olympus EVIS EXERA II video information endoscopic system, along with an EU-ME1 ultrasound unit equipped with GF UM160 and GF UC140P-AL5 echo endoscopes. Out of the focal formations in the pancreatobiliary zone, pancreatic cancer was detected in 109 patients, accounting for 40.1% of the cases. Additionally, 40 patients (14.7%) were diagnosed with local forms of chronic pancreatitis. The reference sonograms displayed distinguishable focal pancreatic pathologies, leading to the development of hybrid fuzzy mathematical decision-making rules at the South-West State University in Kursk, Russian Federation. This research resulted in the creation of a fuzzy hybrid model for the differential diagnosis of chronic focal pancreatitis and pancreatic cancer. Endoscopic ultrasonography, combined with hybrid fuzzy logic methodology, has made it possible to create a model for differentiating between chronic focal pancreatitis and pancreatic ductal adenocarcinoma. Statistical testing on control samples has shown that the diagnostic model, based on reference endosonograms of the echographic texture of pancreatic focal pathology, has a confidence level of 0.6 for the desired diagnosis. By incorporating additional information about the contours of focal formations obtained through endosonography, the reliability of the diagnosis can be increased to 0.9. This level of reliability is considered acceptable in clinical practice and allows for the use of the developed model, even with data that is not well-structured.

Fetal "gallstones" are still an unsolved mystery. Case series.

Echogenic content in the fetal gallbladder is rather an incidental finding during third-trimester ultrasonography. The etiology, clinical course, and prognosis of this condition are still unclear. We highlight the demographic, clinical and ultrasound characteristics of our patients with echogenic content in the fetal gallbladder. This is a retrospective single-center study conducted at the University of Medicine and Pharmacy Cluj-Napoca, Romania, between March 2022 and April 2023. All pregnant patients who were admitted to the hospital and had echogenic content in the fetal gallbladder detected by ultrasound were identified. The clinical and ultrasonography parameters were obtained from the databases of the ultrasound units and the medical records of the patients. Four patients were found to have echogenic content in the fetal gallbladder. The mean maternal age at diagnosis was 27.5 years (range 25-31). All patients had singleton pregnancies. The mean gestational age at diagnosis was 36.5 weeks (range 35-40). In all cases, the predominant aspect of echogenic content on ultrasound was multiple hyperechogenic foci; additionally, in one case, sludge was also observed. The mean maximal length of the hyperechogenic foci was 3.375 mm (range 1.6-5.4). All fetuses were delivered at full term, either vaginally or by cesarean section. The mean weight at birth was 3082.5 g (range 2800-3450). In all four cases, the EC disappeared spontaneously at birth. Neither of the four newborns displayed digestive symptoms or complications during the follow-up. The EC is still a medical mystery since little is known about its etiology and long-term outcome. Many cases are likely to be undetected until after birth; therefore, fetal gallbladder examination should be included in the US routine. The condition appears to be benign, and usually, it improves naturally after birth. Consecutively, asymptomatic newborns with EC can be managed through a wait-and-see approach.