PURPOSE: To assess whether intrapartum ultrasound parameters can predict obstetric anal sphincter injury (OASI) in forceps deliveries. METHODS: This retrospective cohort study included women undergoing forceps delivery f...PURPOSE: To assess whether intrapartum ultrasound parameters can predict obstetric anal sphincter injury (OASI) in forceps deliveries. METHODS: This retrospective cohort study included women undergoing forceps delivery for live, singleton, term cephalic pregnancies at Showa Medical University Hospital, between April 2021 and September 2024. Ultrasound was performed immediately before forceps application to evaluate angle of progression (AoP), head direction (HD), transperineal ultrasound (TUS) station, and midline angle (MLA) at rest and during pushing. Delta (Δ) values were calculated as differences between pushing and resting. OASI was diagnosed clinically and via transanal ultrasound. Parameters were compared between women with and without OASI. The Benjamini-Hochberg procedure corrected for multiple testing, with significance below < 0.05. RESULTS: Among 256 women, 23 (8.9%) developed OASI. Maternal, labor, and neonatal characteristics were similar between groups. Several intrapartum ultrasound parameters were significantly associated with OASI: TUS station during pushing (median 3.2 and 4.2, p = 0.002, q = 0.012), ΔTUS station (1.1 and 1.6, p = 0.006, q = 0.042), HD at rest (28° and 38°, p < 0.0001 q < 0.001), HD during pushing (32° and 50°, p < 0.0001, q < 0.001), and ΔHD (3.2° and 10°, p = 0.0005, q = 0.004). HD during pushing showed the best predictive performance (AUC = 0.871), with an optimal cutoff of 36° (sensitivity 0.69, specificity 0.90). CONCLUSION: Intrapartum ultrasound, particularly HD during pushing, is a valuable predictor of OASI in forceps deliveries. A cut-off value of 36° may identify women at higher risk and improve forceps delivery safety.
PURPOSE: While meso/dextrocardia, a cardiac axis abnormality, is associated with various complications and a poor prognosis, few studies have been reported. We aimed to identify and review patients at our hospital who ha...PURPOSE: While meso/dextrocardia, a cardiac axis abnormality, is associated with various complications and a poor prognosis, few studies have been reported. We aimed to identify and review patients at our hospital who had been diagnosed with fetal meso/dextrocardia. METHODS: The medical records of 29 patients diagnosed with fetal meso/dextrocardia between April 1, 2014 and March 31, 2024 were reviewed. RESULTS: We identified eight cases of mesocardia and 21 cases of dextrocardia (17 dextropositions and four dextroversions). Right lung hypoplasia (including 3q trisomy, esophageal bronchopleural fistula, and left pulmonary artery sling) was identified in three cases. Five cases of persistent left superior vena cava (PLSVC) were identified [isolated PLSVC (n = 2), VACTERL association (n = 1), trisomy 13 (n = 2)]. Dextroposition was linked to congenital pulmonary airway malformation (eight cases), left pulmonary sequestration (one case), congenital diaphragmatic hernia (six cases), right lung hypoplasia (one case), and VACTERL association with right lung aplasia and esophageal atresia (one case). Dextroversion was associated with asplenia syndrome (two cases), single-ventricle (one case), and Temple syndrome with PLSVC and bilateral hypoplastic pulmonary arteries (one case). Among 29 newborns, six (20.7%) died during the early neonatal period and seven (24.1%) required postnatal multidisciplinary treatment, highlighting a poor prognosis in many cases. CONCLUSION: While some patients, such as those with isolated PLSVC, had favorable outcomes, several cases involved severe complications requiring intensive perinatal management. When fetal meso/dextrocardia is detected, it is critical to evaluate fetal anomalies comprehensively and not limit assessment to the heart and lungs.
Uemura K, Saita M, Wagatsuma K
… +4 more, Iwamoto W, Morikawa D, Saigo Y, Naito T
J Med Ultrason (2001)
· 2026 Apr · PMID 41136763
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PURPOSE: Determining peak height velocity age (PHVA) is crucial for understanding child growth and development and preventing injuries. Previous studies have used anthropometric measurements or X-ray evaluation to predic...PURPOSE: Determining peak height velocity age (PHVA) is crucial for understanding child growth and development and preventing injuries. Previous studies have used anthropometric measurements or X-ray evaluation to predict the timing of PHV, whereas ultrasound provides a radiation-free and portable alternative. This study aimed to predict the years to PHV by assessing multiple secondary ossification centers using ultrasound. METHODS: A total of 12 sites across eight bones were evaluated using ultrasound in 181 children aged 6-12 years between June and December 2019. Height data were tracked from school entry until December 2022, with PHVA calculated using AUXAL software. Multivariable regression analysis was performed using bone maturity as the explanatory variable and the difference between ultrasound measurement age and PHVA as the dependent variable. RESULTS: A total of 159 participants were included in the final analysis. The hook of the hamate, calcaneus plantar thickness, plantar sesamoid, and tibial tuberosity were identified as significant variables for PHV prediction. The prediction equation was: Years to PHV = 1.206 + (0.562 × calcaneus plantar thickness) - (1.120 × plantar sesamoid) - (0.675 × tibial tuberosity) + (0.229 × hook of the hamate). This model achieved an adjusted R of 0.782. CONCLUSION: Ultrasound evaluation of multiple secondary ossification centers may provide a valuable method for predicting years to PHV.
Hashiguchi N, Fujiwara Y, Sato N
… +5 more, Matsumoto A, Murakami Y, Kotaka S, Ota R, Adachi N
J Med Ultrason (2001)
· 2026 Apr · PMID 41108466
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PURPOSE: Conventional posterior ultrasound-guided selective cervical nerve root block (SNRB) often fails to deliver injectate reliably into the neural foramen, while fluoroscopic guidance involves radiation exposure and...PURPOSE: Conventional posterior ultrasound-guided selective cervical nerve root block (SNRB) often fails to deliver injectate reliably into the neural foramen, while fluoroscopic guidance involves radiation exposure and specialized equipment. We developed a novel anterior compression lateral (ACL) ultrasound-guided approach to provide radiation-free, real-time visualization with improved intraforaminal delivery. This study compared ACL with conventional ultrasound (US) and fluoroscopy (FL) in terms of needle placement accuracy and injectate distribution. METHODS: This retrospective single-center cohort study measured needle tip distance from the lateral mass on anteroposterior radiographs. Contrast distribution was classified as foraminal, junctional, or extraforaminal on radiographs and confirmed with axial CT in the US and ACL subgroups. Craniocaudal spread distance was also quantified. RESULTS: A total of 114 patients with cervical radiculopathy underwent SNRB using FL (n = 56), US (n = 25), or ACL (n = 33). Radiographic intraforaminal distribution occurred in 76.8% of FL, 72.7% of ACL, and 16.0% of US injections (P < 0.0001). Needle tips in US and ACL were positioned more lateral than FL (mean offsets 4.3 ± 6.8 mm and 2.5 ± 3.9 mm vs - 3.5 ± 2.6 mm, respectively). Injectate spread was greater with US (30.8 ± 9.6 mm) and ACL (25.9 ± 15.1 mm) than FL (15.9 ± 10.7 mm) (P < 0.0001). On CT, ACL achieved higher intraforaminal contrast than US (72.7% vs 16.0%, P < 0.0001). No major complications occurred. CONCLUSION: The ACL ultrasound-guided approach delivers intraforaminal injectate with accuracy comparable to fluoroscopy while eliminating radiation exposure. It outperforms conventional posterior ultrasound in targeting consistency and offers a precise, accessible option for outpatient cervical SNRB.
Omodani T, Khadavi M, Takatsume Y
… +1 more, Lavigne A
J Med Ultrason (2001)
· 2026 Apr · PMID 41102505
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PURPOSE: To describe a novel, minimally invasive, ultrasound-guided Achilles tendon repair technique using a knotless barbed suture and to assess its feasibility in a cadaveric model. METHODS: A midportion Achilles tendo...PURPOSE: To describe a novel, minimally invasive, ultrasound-guided Achilles tendon repair technique using a knotless barbed suture and to assess its feasibility in a cadaveric model. METHODS: A midportion Achilles tendon rupture was simulated in a Thiel-embalmed cadaver. The tendon was repaired percutaneously under ultrasound guidance using a 0.6-mm USP 1 knotless barbed suture mounted on a 19-gauge, 3.5-inch curved needle. The needle was advanced intratendinously under continuous ultrasound guidance. Tendon reapproximation was assessed with ultrasound and confirmed by anatomical dissection. The resting plantar flexion angle was measured before and after the repair. RESULTS: The Achilles tendon repair technique resulted in successful reapproximation of the tendon ends with anatomic alignment. Post-repair ultrasound and dissection confirmed accurate intratendinous suture placement and full tendon continuity. The resting plantar flexion angle increased from 23° to 50° after the repair. CONCLUSION: This is the first report of an ultrasound-guided Achilles tendon repair using a knotless barbed suture. The technique appears feasible in a cadaveric model and may represent a promising minimally invasive option for patients requiring improved tendon approximation. Its office-based approach may reduce surgical risks associated with conventional repair and tendon elongation seen with conservative treatment. Further biomechanical and clinical studies are warranted to evaluate its safety, durability, and functional outcomes.
J Med Ultrason (2001)
· 2026 Jan · PMID 41094315
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PURPOSE: Minimum variance (MV) beamforming was introduced in ultrasound imaging to improve image quality. It solves a minimization problem where the closed-form solution imposes huge computational load due to the matrix...PURPOSE: Minimum variance (MV) beamforming was introduced in ultrasound imaging to improve image quality. It solves a minimization problem where the closed-form solution imposes huge computational load due to the matrix inversion requirement. The MV problem can be iteratively solved to avoid this requirement. METHODS: This paper shows that the weight vector at the first iteration is proportional to the covariance matrix elements. It is proposed that this proportionality be considered as a constraint in the main MV problem. Inspired by the idea of the exact line search method, solving the proposed constrained MV (CMV) problem leads to an adaptive beamforming with considerably lower computational load. As an interesting point, the unknown coefficients can be directly calculated through entries of a covariance matrix by a simple operation. RESULT: The proposed method was investigated on several simulation and experimental data sets. It was found that it required 93% fewer flops than the MV method, which represents a dramatic computational gain. CONCLUSION: This study showed how only two features, the mean and trace of the covariance matrix, are enough to achieve adaptive beamforming. The proposed beamformer provides approximately the same resolution as the MV method.
PURPOSE: The infrapatellar fat pad (IFP) is a source of pain in patients with knee osteoarthritis (OA). Changes in pressure due to knee joint movement may increase IFP stiffness and potentially cause pain. This study aim...PURPOSE: The infrapatellar fat pad (IFP) is a source of pain in patients with knee osteoarthritis (OA). Changes in pressure due to knee joint movement may increase IFP stiffness and potentially cause pain. This study aimed to investigate changes in IFP stiffness during knee flexion in knee OA patients. METHODS: Sixteen patients with knee OA and 14 healthy elderly controls participated in this study. IFP stiffness was measured with the patient in the supine position at maximum knee extension, 45°, 90°, and maximum flexion using ultrasound elastography. Stiffness was measured at the superficial layer of the IFP, located beneath the patellar tendon. Additionally, the knee pain score for knee OA patients was assessed using the numeric rating scale and the Intermittent and Constant Osteoarthritis Pain (ICOAP). RESULTS: Two-way analysis of variance showed a significant main effect for group and joint angle, as well as an interaction effect. IFP stiffness increased with knee flexion. Knee OA patients exhibited significantly higher IFP stiffness at both maximum knee extension and flexion than the control group. A significant correlation was found between IFP stiffness in knee OA patients at 45°, 90°, and maximum knee flexion and ICOAP intermittent pain. CONCLUSION: These results suggest that knee movement affects IFP stiffness, with increased stiffness observed in knee OA patients. Increased stiffness in OA patients may contribute to knee pain, particularly at mid-to-deep flexion angles.
J Med Ultrason (2001)
· 2025 Oct · PMID 41062892
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PURPOSE: Dynamic stretching (DS), characterized by repeated movements through the joint range of motion via antagonist muscle contraction, is thought to reduce muscle stiffness through mechanisms such as reciprocal inhib...PURPOSE: Dynamic stretching (DS), characterized by repeated movements through the joint range of motion via antagonist muscle contraction, is thought to reduce muscle stiffness through mechanisms such as reciprocal inhibition. However, whether DS effectively decreases muscle stiffness remains unclear. This study aimed to investigate the acute effects of DS on triceps surae muscle stiffness using shear wave elastography. METHODS: Sixteen healthy young adults performed both 120-s DS and control (no stretching) tasks. Shear wave velocities of the medial gastrocnemius (MG), lateral gastrocnemius (LG), and soleus (SOL) muscles were measured as indicators of muscle stiffness before and after DS. RESULTS: Our findings indicated that DS significantly reduced the shear wave velocity in the MG. However, no significant changes were observed in the shear wave velocities of the LG and SOL. CONCLUSION: DS effectively decreased MG stiffness, with no observed effects in the LG or SOL. These findings highlight inter-muscular variability in response to DS and suggest that DS may be particularly beneficial for targeting stiffness in the MG of the triceps surae muscles.
PURPOSE: This study aimed to evaluate the predictive value of transvaginal three-dimensional (3D) ultrasound imaging parameters for anti-Müllerian hormone (AMH) levels in women of reproductive age. METHODS: A retrospecti...PURPOSE: This study aimed to evaluate the predictive value of transvaginal three-dimensional (3D) ultrasound imaging parameters for anti-Müllerian hormone (AMH) levels in women of reproductive age. METHODS: A retrospective study was conducted on 492 patients who underwent ovarian reserve function assessments at Hangzhou Traditional Chinese Medicine Hospital. The patients were randomly divided into a training set (n = 420) and a validation set (n = 72). All participants underwent transvaginal 3D ultrasound to measure antral follicle count (AFC), ovarian volume (OV), peak systolic flow velocity (PSV), and resistance index (RI). Morning fasting venous blood samples were collected for AMH level measurement. Pearson correlation analysis was used to assess the relationships between age, AFC, OV, PSV, RI, and AMH. Multiple linear regression analysis was used to construct a unified regression model and a grouped regression model. The performance of the models was evaluated by comparing the root mean squared error (RMSE) and mean absolute error (MAE) between predicted and actual values. RESULTS: AMH showed a strong negative correlation with age and a positive correlation with OV, AFC, and PSV. AMH was significantly correlated with AFC and OV (r = 0.844 and 0.759, respectively; both P < 0.05), but only weakly correlated with PSV (r = 0.176, P < 0.05). The RMSE and MAE of the grouped regression prediction model were lower than those of the unified regression model. CONCLUSION: The grouped regression AMH prediction model developed through multiple linear regression analysis demonstrated favorable performance, enabling accurate individualized prediction of AMH levels, thereby assisting clinicians in evaluating the fertility potential of women of reproductive age.
Hayashi M, Sugimoto K, Kakegawa T
… +7 more, Takahashi H, Takeuchi H, Araki Y, Saito K, Nakayama R, Sakamaki K, Itoi T
J Med Ultrason (2001)
· 2026 Jan · PMID 41062889
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PURPOSE: To compare the performance of attenuation coefficient (AC) and sound speed (SS) for evaluating liver steatosis in participants who underwent liver fat quantification using magnetic resonance imaging (MRI)-derive...PURPOSE: To compare the performance of attenuation coefficient (AC) and sound speed (SS) for evaluating liver steatosis in participants who underwent liver fat quantification using magnetic resonance imaging (MRI)-derived proton density fat fraction (PDFF). METHODS: Participants with chronic liver disease who underwent both MRI-PDFF (reference standard) and multiparametric ultrasound (US) measurements (such as for AC and SS) were retrospectively enrolled. The associations between the clinical variables and US markers were determined using multivariate linear regression. The diagnostic performance of US markers for detecting steatosis grades was evaluated using the area under the receiver operating characteristic curve (AUC). RESULTS: Fifty-three participants were included. Patients with metabolic dysfunction-associated steatotic liver disease were predominant (34 out of 53, 53.2%). Multivariate regression analysis revealed significant associations of AC with PDFF (regression coefficient: 0.05, p = 0.003) and body mass index (regression coefficient: 0.0094, p = 0.01). SS was also significantly associated with PDFF (regression coefficient: -12.20, P = 0.03) and body mass index (regression coefficient: -3.08, p = 0.01). The AUCs for AC and SS were 0.88 (95% CI: 0.79-0.97) and 0.70 (95% CI: 0.55-0.84), respectively, for identifying participants with steatosis grade S1 or higher. The performance of detecting steatosis grade S1 or higher was improved and more balanced when AC was ≥0.54 dB/cm/MHz and SS was ≤1536 m/s; the sensitivity and specificity were 72% and 86%, respectively. CONCLUSION: SS was associated with PDFF and demonstrated fair diagnostic performance in identifying steatosis grade S1 or higher. The combined use of AC and SS may improve the detection of hepatic steatosis.
Nagasaki S, Kotaki H, Shimabukuro M
… +3 more, Sakuma J, Takano M, Nakata M
J Med Ultrason (2001)
· 2026 Jan · PMID 41045418
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PURPOSE: Criteria for diagnosing fetal growth restriction (FGR) vary globally. The Japanese criterion is estimated fetal weight (EFW) below - 1.5 standard deviations, without distinctions based on gestational age or seve...PURPOSE: Criteria for diagnosing fetal growth restriction (FGR) vary globally. The Japanese criterion is estimated fetal weight (EFW) below - 1.5 standard deviations, without distinctions based on gestational age or severity. However, some international diagnostic criteria classify FGR using gestational age, Doppler assessments, and growth. While the Japanese criterion is simple and easy to apply, including EFW, gestational age at diagnosis, growth, and Doppler findings can provide a more comprehensive assessment of fetoplacental function. The aims of this study were: [1] to reclassify small fetuses on the Japanese criterion into early FGR, late FGR, or small for gestational age (SGA) groups by applying Doppler-inclusive diagnostic criteria, and [2] compare the perinatal outcomes. METHODS: In this retrospective study, FGR diagnosed based on the Japanese criterion between 2017 and 2021 at our hospital were reclassified into early FGR, late FGR, or SGA by applying Doppler-inclusive criteria. Cases not classified as early or late FGR were categorized as SGA. Perinatal, maternal, and neonatal outcomes were analyzed across all groups. RESULTS: Overall, 184 growth-restricted fetuses based on the Japanese criterion-160 cases (42 early FGR, 51 late FGR, and 67 SGA)-were enrolled after excluding 24 cases of fetal malformation. Gestational age at delivery, mode of delivery, and maternal and neonatal complications differed significantly among the groups. The early FGR group showed a significantly higher incidence of preterm birth, emergent Cesarean section, and severe maternal or neonatal complications. CONCLUSIONS: FGR with Doppler-inclusive criteria can be better for practical use providing high relevance to perinatal outcome.
PURPOSE: Shear wave velocity (Vs) measurements can be unstable in individuals with obesity or with a skin-capsule distance (SCD) of ≥ 20 mm. However, instability of Vs has also been observed in cases where SCD is not mar...PURPOSE: Shear wave velocity (Vs) measurements can be unstable in individuals with obesity or with a skin-capsule distance (SCD) of ≥ 20 mm. However, instability of Vs has also been observed in cases where SCD is not markedly increased; therefore, the present study aimed to investigate the factors contributing to reduced VsN (net amount of effective shear wave velocity), an index that reflects the reliability of individual Vs measurements. METHODS: In total, 317 individuals who underwent community-based health screening were included in this study. We investigated the relationship between VsN and physical findings, laboratory data, SCD, and structure of the SCD (single vs. multilayered) to identify factors associated with decreased VsN. RESULTS: Multiple regression analysis revealed that body fat percentage (β = - 0.135, p = 0.011), SCD (β = - 0.347, p < 0.0001), and the structure of the SC region (β = - 0.295, p < 0.0001) were independently associated with decreased VsN. In cases where the SCD exceeded 20 mm, the VsN within the SCD was significantly lower in the multilayer structural type [52 (28-75)] than in the single-layer structural type [95 (77-99)] (p = 0.004). Furthermore, even when the SCD was 20 mm or less, the VsN within the SCD was significantly lower in the multilayer structure type [80 (68-89)] than in the single-layer structure type [99 (92-100)] (p < 0.0001). CONCLUSION: The results show that, in addition to SCD thickness, its internal structure reduces the VsN and contributes to Vs measurement instability.
Hirooka M, Miyake T, Yano R
… +8 more, Nakamura Y, Okazaki Y, Shimamoto T, Watanabe T, Yoshida O, Tokumoto Y, Abe M, Hiasa Y
J Med Ultrason (2001)
· 2026 Jan · PMID 41014474
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PURPOSE: To evaluate the technical feasibility and performance of automatic image-based registration (IBR) for liver fusion imaging and to identify clinical and anatomical factors affecting registration success. MATERIAL...PURPOSE: To evaluate the technical feasibility and performance of automatic image-based registration (IBR) for liver fusion imaging and to identify clinical and anatomical factors affecting registration success. MATERIALS AND METHODS: This prospective study included 84 patients undergoing liver fusion imaging using an ultrasound system with IBR. Three operators with 5, 10, and 25 years of experience (junior, intermediate, and senior), respectively, independently performed IBR. Fusion time and registration error were recorded. Fusion success was defined both globally (success by all or at least one operator) and individually (registration error < 10 mm). Clinical and anatomical factors were assessed. Predictors of failure were identified using multivariable logistic regression with Firth's correction. RESULTS: IBR was successful in all three operators in 86.9% of cases and by at least one operator in 96.4%. The most experienced operator achieved significantly shorter fusion times (median: 15.0 s) and smaller fusion errors (median: 6.0 mm) compared to the less experienced operators. Operator-specific success rates defined as registration error < 10 mm were 45.2%, 60.7%, and 79.8%, respectively (p < 0.001). Subcutaneous tissue depth was the only independent predictor of fusion failure in both multivariable models (OR = 1.13 for all failed, p = 0.033; OR = 0.88 for partial success, p = 0.012). Other clinical factors were not statistically significant. CONCLUSION: IBR is a highly feasible method that reduces operator dependency in liver fusion imaging compared to conventional methods, though registration accuracy still varies with operator experience. CLINICAL IMPACT: IBR enables consistent and simplified fusion imaging regardless of operator experience. Its broad applicability may support safer and more efficient ultrasound-guided interventions, especially in resource-limited or time-sensitive settings.
Zhang YQ, Wang X, Liu LN
… +7 more, Hu XY, Lu Q, Zhou BY, Xia HS, Han H, Xu HX, Zhao CK
J Med Ultrason (2001)
· 2026 Jan · PMID 40999259
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PURPOSE: To investigate the value of dynamic contrast-enhanced ultrasound (DCE-US) analysis using the Liver Imaging Reporting and Data System (LI-RADS) to improve the diagnosis of hepatocellular carcinoma (HCC). METHODS:...PURPOSE: To investigate the value of dynamic contrast-enhanced ultrasound (DCE-US) analysis using the Liver Imaging Reporting and Data System (LI-RADS) to improve the diagnosis of hepatocellular carcinoma (HCC). METHODS: This multicenter study retrospectively enrolled consecutive high-risk patients for HCC who underwent contrast-enhanced ultrasound (CEUS) between December 2022 and June 2023. Quantitative CEUS analysis was performed using VueBox to obtain diagnostic parameters for HCC. These parameters were used as auxiliary indicators to reassign the LI-RADS categories. The reference standard was pathologic confirmation or composite criteria. The diagnostic performance of LI-RADS with and without quantitative DCE-US parameters was assessed. RESULTS: 269 patients (median age, 61 years [interquartile range, 52-69]; 206 men, 63 women) with 269 focal liver lesions (FLLs) (median size, 40 mm [interquartile range, 25-62 mm]) were included. Among the 269 FLLs, 227 were HCC, 31 non-HCC malignancies, and 11 benign lesions. DCE-US analysis showed HCC had higher rise time (RT) and fall time (FT) at the lesion margin than non-HCC malignancies (both P < 0.05) but lower RT and FT than benign lesions (both P < 0.05). RT at the lesion margin (range 17.48 s-21.16 s) serves as an auxiliary indicator for HCC diagnosis. Compared to CEUS LI-RADS, the revised LR-5 improved sensitivity (61.7 vs. 52.8%, P < 0.001) without a significant decrease in specificity (76.2 vs. 83.3%, P = 0.25) for diagnosing HCC. CONCLUSION: DCE-US quantitative analysis improved the sensitivity for HCC diagnosis without affecting specificity, thereby optimizing the diagnostic performance of CEUS LI-RADS.
Miyamoto N, Hirokawa M, Higuchi M
… +6 more, Oshita M, Kawakami M, Yamaoka H, Fujishima M, Miyauchi A, Akamizu T
J Med Ultrason (2001)
· 2026 Jan · PMID 40973915
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PURPOSE: Extranodal extension (ENE) of metastatic carcinoma in patients with papillary thyroid carcinoma (PTC) has been associated with an increased risk of recurrent disease, persistent disease, and disease-specific mor...PURPOSE: Extranodal extension (ENE) of metastatic carcinoma in patients with papillary thyroid carcinoma (PTC) has been associated with an increased risk of recurrent disease, persistent disease, and disease-specific mortality; however, ultrasound findings suggestive of ENE have not been well established. In this study, we aimed to identify ultrasound findings suggestive of microscopic ENE and validate them histologically. METHODS: We retrospectively examined the ultrasound and histological findings of 21 PTC patients with microscopic ENE and 46 without ENE. RESULTS: Node matting, irregular shapes, ill-defined jagged border, and perinodal hyperechoic rims were observed in 38.1%, 57.1%, 42.9%, and 57.1% of lymph nodes with ENE, respectively, and the frequencies were significantly higher than those without ENE, with p values less than 0.05, 0.0005, 0.0001, and 0.0001, respectively. The sensitivity and specificity of cases with any one of irregular shapes, ill-defined jagged border, and perinodal hyperechoic rims were 81.0% and 82.6%, respectively. Histologically, node matting, irregular shape, ill-defined jagged border, and a perinodal hyperechoic rim correspond to adhesion between lymph nodes, extensive invasion, minimal invasion, and invasion into adipose tissue, respectively. CONCLUSIONS: We would argue that any irregular shape, ill-defined jagged border, and perinodal hyperechoic rim can be accepted as findings indicative of microscopic ENE.