OBJECTIVE: Gonadotropin-releasing hormone (GnRH) stimulation testing is the gold standard for distinguishing central precocious puberty (CPP) from premature thelarche (PT). Due to the limitations of this test, previous s...OBJECTIVE: Gonadotropin-releasing hormone (GnRH) stimulation testing is the gold standard for distinguishing central precocious puberty (CPP) from premature thelarche (PT). Due to the limitations of this test, previous studies have elucidated the clinical and laboratory factors that predict CPP. This study explored the diagnostic importance of pelvic ultrasound in girls with CPP. METHOD: Between May 2023 and May 2024, 55 girls with suspected CPP underwent a GnRH stimulation test and pelvic ultrasonography (PU). Additionally, bone ages were evaluated using a left wrist x-ray. RESULT: The multivariate analysis found that basal luteinizing hormone (bLH) > 0.67 IU/L, basal follicle-stimulating hormone (FSH) > 3.5 IU/L, basal estradiol > 7.5 pg/mL, uterine volume > 2.6 cm3, and longitudinal uterine diameter >35 mm were significantly associated with a pubertal response at the GnRH test. The 2 groups had no difference in bone age and bLH/basal FSH values. Peak LH/FSH ratio had the best diagnostic performance, with an area under the curve of 0.956 (95% confidence interval, 0.864-0.993), a sensitivity of 81.82%, a specificity of 96.97%, a positive predictive value of 94.7%, and a negative predictive value of 88.9%. The optimal cutoff value was >0.59 for the LH/FSH ratio. CONCLUSIONS: Uterine long axis and uterine volume measurements are noninvasive data that help distinguish CPP from PT.
Lung ultrasound has become a standard practice in acute care as an adjunct to the physical exam, providing valuable insights to guide clinical decision making at the point of care. Lung ultrasound can rapidly uncover ana...Lung ultrasound has become a standard practice in acute care as an adjunct to the physical exam, providing valuable insights to guide clinical decision making at the point of care. Lung ultrasound can rapidly uncover anatomic detail, help resolve undifferentiated respiratory failure, and delineate equivocal findings on standard plain film without the need for transport to access additional diagnostic imaging. In the following review, basic concepts of lung ultrasound are reviewed including its role in detecting and assessing a variety of common problems.
Various thyroid diseases can lead to changes in the volume of the gland. Therefore, it is important to know the normal thyroid volume. The primary aim of this investigation was to establish normative values for thyroid g...Various thyroid diseases can lead to changes in the volume of the gland. Therefore, it is important to know the normal thyroid volume. The primary aim of this investigation was to establish normative values for thyroid gland volume using ultrasonography in children aged 0-18 years in Turkey.A retrospective analysis was conducted on thyroid ultrasound findings from 800 children (400 boys, 400 girls) between 2019 and 2020. Pediatric age groups were classified into 20 categories for children aged 0-18. Among these 20 groups, the initial 3 pertain to the 0-1 age range, encompassing infants aged 0-1 month, 1-6 months, and 6-12 months. Each age group consisted of 20 boys and 20 girls.The volume of each thyroid lobe was computed in milliliters using Brunn's formula, which involves multiplying the maximal anteroposterior diameter, mediolateral diameter, and craniocaudal diameter of the lobe by the correction factor 0.479.Data analysis employed the Statistical Package for the Social Sciences, SPSS version 24.0. All analyses were conducted at a 95% confidence interval, and significance was set at P < 0.05.Mean thyroid volumes of 800 children were determined for each age group. Thyroid volume exhibited a strong correlation with age. The Pearson correlation coefficient was 0.987 (P = 0.001).Given the scarcity of comprehensive studies in the literature focusing on thyroid volume in children aged 0-18 across various age groups, we believe that our findings for each age group can provide valuable insights for daily clinical practice.
Patients with Bethesda III/IV thyroid nodules may benefit from molecular testing in order to determine the likelihood of malignancy. The goal is to avoid unnecessary surgery for these often-benign nodules. The decision t...Patients with Bethesda III/IV thyroid nodules may benefit from molecular testing in order to determine the likelihood of malignancy. The goal is to avoid unnecessary surgery for these often-benign nodules. The decision to acquire samples for molecular testing is typically made after formal cytologic interpretation. This creates anxiety and inconvenience for patients who must return for a repeat biopsy. We explored the impact of routinely collecting "just-in-case" samples from each thyroid nodule. Thus, a minimum of 4 samples were acquired from each nodule: 2 for routine cytologic analysis and 2 for possible genomic sequencing. Nodules subsequently determined to be Bethesda III/IV, were further evaluated by sending the prospectively acquired aspirates for genomic sequencing. Over a 7-month period, there were 69 consecutive patients with ages ranging from 24 to 88 years. There were 16 males and 63 females. Six patients had 2 nodules sampled, yielding total of 75 nodules. Of the 75 nodules, 4 (5.3%) were Bethesda I, 37 (49.3%) Bethesda II, 30 (40%) Bethesda III, 0 (0%) Bethesda IV, 1 (1.3%) Bethesda V, and 3 (4%) Bethesda VI. Of the 30 Bethesda III, 18 (60%) were deemed benign (4% risk of malignancy) by genomic testing. Nine (30%) were deemed 50% or 75% suspicious for malignancy. Two (6.7%) yielded insufficient material for analysis and 1 (3.3%) analysis was canceled because of nonpayment. There were no patient complications. Just-in-case samples prevented call-back of 40% of sampled nodules and thus deemed worthwhile and efficient despite adding an estimated 10 minutes to overall procedure time.
In this study, 3D HD-live Flow was used to differentiate true and false knots. The study involved 9161 fetuses who underwent ultrasound during the 13th to 40th week of pregnancy. Among them, 38 cases of true knots of umb...In this study, 3D HD-live Flow was used to differentiate true and false knots. The study involved 9161 fetuses who underwent ultrasound during the 13th to 40th week of pregnancy. Among them, 38 cases of true knots of umbilical cord were found, with 24 cases correctly identified by 3D HD-live Flow, representing a detection rate of 63.2%. There were 19 cases of false knots of umbilical cord, with 13 cases correctly identified by 3D HD-live Flow, representing a detection rate of 68.4%.The detection rates of true knots of umbilical cord by 2D ultrasound and color Doppler ultrasound were significantly lower than that of 3D HD-live Flow (P < 0.05). However, there was no significant difference in detection rate between color Doppler ultrasound and 2D ultrasound (P > 0.05).This study demonstrates that 3D HD-live Flow is an effective imaging technique for distinguishing true and false knots of the umbilical cord in the prenatal period. It has the potential to improve the accuracy of diagnosis and provide valuable information for clinical management.
Ultrasonography is the gold standard for diagnosing acute epididymitis. However, it is not well understood if the simultaneous inflammation of the spermatic cord (funiculitis) is a helpful imaging finding in diagnosing a...Ultrasonography is the gold standard for diagnosing acute epididymitis. However, it is not well understood if the simultaneous inflammation of the spermatic cord (funiculitis) is a helpful imaging finding in diagnosing acute epididymitis. This study aimed to investigate the frequency of funiculitis in cases of epididymitis and determine its sensitivity and specificity. This retrospective study included 50 consecutive patients with acute epididymitis. Funiculitis was defined as increased echogenicity of the spermatic cord fat with mass-like cord thickening. All scrotal ultrasound examinations were reviewed for the size of the spermatic cord and surrounding fat, indistinct margins between the spermatic cord and epididymis, similar findings on the contralateral side, and scrotal wall thickening. Spermatic cord inflammation was present in 96% (48/50) of patients with acute epididymitis, significantly higher than in the asymptomatic side (18%, n = 9/50, P < 0.0001). The presence of funiculitis had a sensitivity of 95.9% (confidence interval [CI] 86-99.5%), a specificity of 81.6% (CI 68-91.2%), a positive predictive value of 83.9% (CI 71.7-93%), and a negative predictive value of 95.2% (CI 84-99%) for diagnosing acute epididymitis. The sonographic presence of funiculitis in the setting of acute scrotal pain is a sensitive marker for concomitant acute epididymitis.
Extrathyroidal masses in the anterolateral neck are frequently encountered in the adult population and may represent a diagnostic dilemma. These neck masses can result from a diverse array of pathologies including congen...Extrathyroidal masses in the anterolateral neck are frequently encountered in the adult population and may represent a diagnostic dilemma. These neck masses can result from a diverse array of pathologies including congenital, inflammatory, infectious, and neoplastic causes. Relevant medical history and physical examination are essential to complement the imaging findings. Ultrasound (US) plays an important role in the initial evaluation of neck masses due to its reliability, availability, safety and cost-effectiveness. It can confirm or exclude the presence of a mass and initially characterize it as solid or cystic. Sonographically assessing the relationship of a mass to adjacent cervical anatomy can facilitate a more targeted differential diagnosis. US also effectively guides fine needle aspirations and/or biopsies of accessible lesions. Multimodality imaging is reserved for problem-solving complex cases and presurgical planning. The anterolateral neck masses are categorized into midline/paramedian lesions, salivary gland pathologies, and other soft tissue lesions. Midline and paramedian lesions include thyroglossal duct pathologies, ectopic thyroid tissue, and parathyroid adenomas. Salivary gland pathologies include obstructive/inflammatory processes, benign and malignant neoplasms, and systemic diseases. This pictorial essay presents clinical features and sonographic characteristics of extrathyroidal masses in the anterolateral neck with a brief discussion of other imaging modalities.
Berry syndrome is a rare combination of cardiac malformations, which is characterized by the following malformations, including the aortopulmonary window, aortic right pulmonary origin, interrupted aortic arch or hypopla...Berry syndrome is a rare combination of cardiac malformations, which is characterized by the following malformations, including the aortopulmonary window, aortic right pulmonary origin, interrupted aortic arch or hypoplastic aortic arch or coarctation of the aorta, and an intact ventricular septum. There are few reviews on prenatal diagnosis of Berry syndrome by fetal echocardiography. We used sequential cross-sectional scanning from apex to bottom of the heart to find aortic right pulmonary origin, aortopulmonary window, and hypoplastic aortic arch. This process is like opening a Chinese scroll painting, and the picture gradually extends to reveal the whole picture. As far as we concerned, this is the first report of prenatal diagnosis with Berry syndrome through sequential cross-sectional scanning.
Effective presentations are crucial for disseminating knowledge and cultivating skilled learners. Cognitive load theory (CLT) offers a framework for optimizing instructional design by managing the mental effort required...Effective presentations are crucial for disseminating knowledge and cultivating skilled learners. Cognitive load theory (CLT) offers a framework for optimizing instructional design by managing the mental effort required for learning. This article explores principles from CLT with practical suggestions to create brain-friendly presentations, focusing on intrinsic, extraneous, and germane cognitive loads. Intrinsic load can be managed through pretraining, organizing topics from simple to complex, and segmenting topics. Extraneous load should be minimized through coherence, signaling, redundancy, and spatial/temporal contiguity principles to eliminate unnecessary cognitive burden. Germane load can be enhanced by incorporating personalization, contextualization, relevance, interactive elements, and variability to promote deeper engagement and schema construction. This article emphasizes applying CLT principles to aid the reader in translating theory into practice.
The purpose of this study is to investigate the diagnostic accuracy of a new noninvasive imaging technique, ultrasound-guided attenuation parameter (UGAP), in diagnosing hepatic steatosis. This single-center retrospectiv...The purpose of this study is to investigate the diagnostic accuracy of a new noninvasive imaging technique, ultrasound-guided attenuation parameter (UGAP), in diagnosing hepatic steatosis. This single-center retrospective study included 81 UGAP studies performed to guide therapy between July 2022 and June 2023 at a large academic medical center. Patients with either liver biopsy or Magnetic resonance-based proton-density fat fraction (MRI-PDFF) within 12 months of US-UGAP imaging, irrespective of order, were included. Patient demographics, body mass index, liver function tests, UGAP values, MRI-PDFF values, and liver biopsy results were obtained from a review of the medical records. Presence of steatosis was defined as PDFF >5.2% or >5% of hepatocytes with steatosis at pathology. Area under the ROC curve (AUROC) was used to measure UGAP accuracy for the detection of hepatic steatosis with statistical significance P < 0.05. There was a significant positive correlation between UGAP and MRI-PDFF (r = 0.463; P < 0.001; confidence interval [CI]: 0.220;0.651). The AUROC to differentiate absence of steatosis (n = 21) from presence of steatosis (n = 32) for UGAP with MRI as the gold standard was 0.760 (P < 0.001; CI: 0.623;0.867). A UGAP value >0.66 had 78% sensitivity and 67% specificity to identify steatosis presence on MRI-PDFF. The AUROC to differentiate absence of steatosis (n = 11) from presence of steatosis (n = 21) for UGAP with pathology as the gold standard was 0.894 (P < 0.001; CI: 0.734;0.974). A UGAP value >0.57 had 100% sensitivity and 64% specificity to identify steatosis presence at pathology. UGAP is an accurate measure for detecting the presence of hepatic steatosis and may be a noninvasive method for metabolic dysfunction-associated steatotic liver disease diagnosis and follow-up.
Incidental findings in diagnostic imaging are common, but follow-up recommendations often lack consistency. The Society of Radiologists in Ultrasound (SRU) issued guidelines in 2021 for managing incidentally detected gal...Incidental findings in diagnostic imaging are common, but follow-up recommendations often lack consistency. The Society of Radiologists in Ultrasound (SRU) issued guidelines in 2021 for managing incidentally detected gallbladder polyps, aiming to balance follow-up with avoiding overtreatment. There is variable adherence to these guidelines in radiology reports, however, which makes it difficult for the clinician to pursue appropriate follow-up for the patient. The purpose of this project is to test the feasibility of a Large Language Model (LLM)-based tool to incorporate SRU guidelines into radiology reports. Additionally, we propose a framework for closely integrating societal follow-up recommendations into radiology reports, using this tool as an example.Following institutional review board approval, we retrospectively reviewed gallbladder ultrasound examinations performed on adult ED patients in 2022. Data on patient demographics and radiology report content were collected. Using the 2021 SRU guidelines, we developed an interactive tool employing a retriever-augmented generator (RAG) and prompt engineering. A board-certified radiologist tested the accuracy, whereas a board-certified emergency medicine physician assessed the clarity and consistency of the recommendations.The interactive tool, GB-PRL, outperformed leading closed-source and open-source LLMs, achieving 100% accuracy in risk categorization and follow-up recommendations on hypothetical user queries (P < 0.001). The tool also showed superior accuracy compared to radiology reports on retrospective data (P = 0.04). Although GB-PRL demonstrated greater clarity and consistency, the improvement from the radiology reports was not statistically significant (P = 0.22). Further work is needed for prospective testing of GB-PRL before integrating it into clinical practice.
This retrospective study included 311 patients who had increased nuchal translucency (NT ≥3 mm) or nuchal septations (NSs) during the first trimester from January 2018 to December 2020. These patients were divided into 3...This retrospective study included 311 patients who had increased nuchal translucency (NT ≥3 mm) or nuchal septations (NSs) during the first trimester from January 2018 to December 2020. These patients were divided into 3 groups: (1) patients with NT thickness between 3 and 5 mm and without NS (NT 3-5 mm group, n = 131), (2) patients with NT thickness >5 mm and without NS (NT >5 mm group, n = 105), and (3) patients with NS (NS group, n = 75). The incidence of abnormal pregnancy outcomes was 92.0% in the NS group, which was significantly higher (both P's < 0.01) compared with that in the NT 3-5 mm group (57.3%) and NT >5 mm group (75.2%). Multivariate logistic regression analysis illustrated that the sonographic evidence of NS was associated with a higher risk of abnormal pregnancy outcomes compared with NT 3-5 mm (odds ratio [OR] = 8.552; 95% confidence interval [CI]: 3.411-21.441; P < 0.01) and NT >5 mm (odds ratio [OR] = 3.636; 95% CI: 1.391-9.524; P < 0.01). After NT measurement entered the multivariate logistic regression as a continuous confounder, patients with NS were still associated with a higher risk of composite abnormal outcomes compared with those without NS (odds ratio [OR] = 4.820; 95% CI: 1.877-12.380; P < 0.01). In conclusion, the presence of NS during the first trimester was significantly associated with a high risk of abnormal pregnancy outcomes.
Mucinous carcinomas are a rare type of invasive breast carcinoma characterized by large quantities of extracellular mucin on histopathological examination. These tumors can be easily missed or misdiagnosed. Due to large...Mucinous carcinomas are a rare type of invasive breast carcinoma characterized by large quantities of extracellular mucin on histopathological examination. These tumors can be easily missed or misdiagnosed. Due to large quantities of mucin, these tumors are presumed to be "soft" masses. This pilot study aims to evaluate the strain and shear wave elastography features of these tumors. Out of 485 referred patients with breast cancer between November 2022 and January 2023, 8 cases were diagnosed as mucinous carcinoma breast on histopathology. These were evaluated with strain and shear wave ultrasound elastography in addition to mammography and B-mode ultrasound. Tsukuba elasticity score, fat-to-lesion ratio (FLR), and distance ratios were calculated on strain elastography. Mean elasticity values as well as elasticity ratio were evaluated on shear wave elastography. On mammography, 3/8 masses were equal density, 2/8 were low density, 2/8 were high density, and 1/8 showed extensive calcifications. Microlobulated margins were seen in 6/8 masses, and the rest (2/8) showed circumscribed margins. On ultrasound, 4 masses appeared isoechoic, and the remaining 4 were hypoechoic. On strain elastography, 7/8 (87.5%) masses had Tsukuba elasticity scores of 4 and above; 6/8 had FLR >4.8 and 6/8 had distance ratios >1. The mean elasticity value on shear wave was 149.12 kPa, and the shear wave elasticity ratio was 8.9. Interestingly, despite the presence of large quantities of extracellular mucin in these tumors, mucinous tumors have elastography findings similar to solid malignant breast masses. Hence, elastography is a useful tool in detecting these often-benign-looking masses.
This study aimed to assess the effectiveness of intelligence-based computer-aided diagnosis (CAD) software in ultrasound (US) and its potential to improve the diagnostic performance of less experienced radiologists, as w...This study aimed to assess the effectiveness of intelligence-based computer-aided diagnosis (CAD) software in ultrasound (US) and its potential to improve the diagnostic performance of less experienced radiologists, as well as the agreement on Breast Imaging Reporting and Data System (BI-RADS) categories with the experienced radiologist. Images of 385 breast lesions in 351 female taken from January 2019 to December 2020 were included. Two less experienced radiologists independently reviewed US images with and without CAD assistance, recording final assessments using the BI-RADS category. The diagnostic performance of CAD and radiologists were calculated and compared. Kappa statistics were used to determine agreement between the experienced radiologist and the less experienced radiologists, based on BI-RADS category before and after using CAD software. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of CAD software were 95.5%, 71.5%, 81.3%, 69.8%, and 95.9%, respectively, and those were improved in junior radiologist and intermediate-level radiologist after the addition of CAD. Additionally, with the assistance of CAD, the area under the curve was improved for both the junior radiologist and radiologist (0.704 vs 0.847 and 0.876 vs 0.900, P = 0.009, 0.005), although it remained lower than the senior radiologist. The agreement of BI-RADS category between the less experienced and the experienced radiologists showed a significant improvement (P = 0.04, 0.000). The CAD on US could improve less experienced radiologists' diagnostic performance and agreement on BI-RADS categories, making it an effective decision-making tool in clinical practice.
Shear wave elastography (SWE) is an ultrasound method that effectively demonstrates liver fibrosis. This prospective study aimed to compare magnetic resonance imaging T2* and SWE results of the liver in children with tha...Shear wave elastography (SWE) is an ultrasound method that effectively demonstrates liver fibrosis. This prospective study aimed to compare magnetic resonance imaging T2* and SWE results of the liver in children with thalassemia major (TM). Patients with TM who had regular follow-ups were included. SWE was performed first, followed by MRI T2*. In addition, a healthy control group of the same age group, known to have no liver disease, was recruited. For these participants, only SWE was performed, and their results were compared with the SWE parameters of the TM patients. The study included 38 patients and 25 individuals who made up the control group. The groups with mild, moderate, and severe iron overload according to MRI T2* were compared in terms of SWE with parameters, and no statistically significant difference was found. However, when comparing the SWE parameters between the control group and patients, the median, average, and standard values were found to be statistically significantly higher in the patient group (P < 0.001, P < 0.001, P = 0.026). When comparing MRI T2* results, the median, average, and standard values were found to be statistically significantly higher in the patients with normal and mild iron overload (P < 0.001, P < 0.001, P = 0.033). SWE is an effective, more accessible, and easy-to-apply method for demonstrating early changes in the liver in pediatric patients with TM. This study serves as a guide for more comprehensive studies that may investigate the effect of SWE in this patient group.
Magnetic resonance imaging (MRI) may be time-consuming, expensive, or poorly tolerated by patients with liver lesions. This is a prospective clinical trial designed to evaluate if contrast-enhanced ultrasound (CEUS) can...Magnetic resonance imaging (MRI) may be time-consuming, expensive, or poorly tolerated by patients with liver lesions. This is a prospective clinical trial designed to evaluate if contrast-enhanced ultrasound (CEUS) can be used to differentiate focal nodular hyperplasia (FNH) from hepatocellular adenoma (HCA) with similar accuracy compared with hepatobiliary agent MRI.Institutional review board approval was obtained (1805450097), and the trial was registered with ClinicalTrials.gov (NCT03652636). From 2018 through 2023, 40 patients who had lesions consistent with FNH or HCA on HBA-MRI underwent 1-time prospective CEUS of up to 2 hepatic lesions. Sonographic images obtained before and after intravenous administration of 2 mL sulfur hexafluoride lipid-type A microspheres (Lumason) per lesion totaling 59 lesions (27 FNHs/32 HCAs). Two blinded radiologists provided a diagnosis of FNH or HCA.Thirty-eight female and 2 male patients (age 36.7 ± 9.9) were scanned. Radiologists provided diagnosis of FNH or HCA with respective sensitivity (66.7/64.0%), specificity (71.9/90.6%), and accuracy (69.5/78.0%). For 38 lesions greater than or equal to 2 cm in size (17 FNHs/21 HCAs), readers had sensitivity (70.6/84.2%), specificity (70.6/84.2%), and accuracy (81.5/86.8%). Interobserver agreement for all lesions was fair (κ = 0.34), whereas agreement for lesions 2 cm or larger was substantial (κ = 0.67).Contrast-enhanced ultrasound can differentiate FNH from HCA with accuracy approaching that of hepatobiliary agent MRI for lesions 2 cm or greater. Interobserver agreement is improved with larger lesions. CEUS may have utility as an alternate diagnostic tool for FNH/HCA, especially in patients who cannot or do not desire to undergo MRI.
Sonographic detection of mobile echogenic foci within the main portal vein and its branches or within the liver parenchyma extending along the portal triads to the periphery of the liver is an alarming finding that has b...Sonographic detection of mobile echogenic foci within the main portal vein and its branches or within the liver parenchyma extending along the portal triads to the periphery of the liver is an alarming finding that has been associated with portal venous gas in the setting of bowel ischemia. Ultrasound-enhancing agents (UEAs) have been widely utilized in abdominal ultrasound for evaluation of organ neoplasms and vascular patency as well as in echocardiography for the evaluation of cardiac function. The appearance of UEAs on abdominal ultrasound can resemble gas like that seen in the portal venous system and liver in patients with bowel ischemia; therefore, UEA residuals should always be a part of the differential diagnosis of echogenic foci when seen on abdominal ultrasounds with preceding recent UEA administration. In this observational study, we present a series of cases with suspected portal venous gas suspicious for bowel ischemia that turned out to be a result of residual or persistent UEA from the recent contrast-enhanced echocardiography. Discussion of this phenomenon and its potential explanation is provided.
Sonazoid is a new ultrasound contrast agent with unique Kupffer phase imaging advantages and high mechanical index stability. This paper introduces the basic theories and advantages of Sonazoid ultrasound. Then, the appl...Sonazoid is a new ultrasound contrast agent with unique Kupffer phase imaging advantages and high mechanical index stability. This paper introduces the basic theories and advantages of Sonazoid ultrasound. Then, the application and latest advances of Sonazoid in the diagnosis and treatment of liver diseases are reviewed in detail. In addition, the advantages and disadvantages of Sonazoid ultrasound and its future directions are discussed. Sonazoid is expected to become an important tool for clinical ultrasound diagnosis and treatment.