Search Results (140)

Wireless ultrasound (US) probes for point of care (POC) evaluation of horses presented for veterinary evaluation of colic have become widely available in recent years. The availability and performance of this technology mean POCUS is readily available to the equine practitioner and the technology is well suited to patient evaluation or serial monitoring in first opinion practice. In human health care and veterinary contexts, it has been suggested that there is a need for practitioners to better appreciate the value of POCUS for assessment of gastrointestinal structure and function. This study was conducted as a narrative review of the literature relating to the use of abdominal sonography in equine clinical practice, juxtaposed with recent publications on the use of POCUS in human health care settings and extended to include the authors’ experiences of POCUS in the evaluation of horses presenting with select abdominal conditions. Common sonographic views are described and representative images are presented to facilitate practitioner use of the technique. By distillation of the available literature and review of sonographic techniques our aim is to provide a resource for equine practitioners. Full article

The Focused Assessment with Sonography in Trauma (FAST) enables rapid point-of-care screening for internal hemorrhage by detecting free fluid, but its accuracy is highly operator-dependent and prone to missed diagnoses in emergency settings. While deep learning–based AI assistance can address these limitations, most existing models rely on computationally intensive networks, restricting deployment on resource-limited bedside devices. Thus, developing a lightweight architecture for free fluid detection is essential for clinical translation. We propose a lightweight model based on YOLOX, incorporating a dual-stream fusion (DSF) backbone to preserve spatial details while reducing computation, and a global fusion feedback (GFF) neck to enhance efficient multi-scale feature fusion. We also built a dedicated dataset using ultrasound images from rabbits with active liver hemorrhage to better mimic in vivo sonographic features of free fluid. Compared with mainstream detectors, our method achieves the lowest FLOPs and parameter count while maintaining superior precision, recall, and F1-score. Ablation studies validate that DSF improves accuracy and reduces complexity, and GFF further lowers computational costs with minimal performance tradeoff. The proposed approach enables fast, accurate free fluid detection on constrained bedside devices, advancing intelligent point-of-care trauma assessment. Full article

Background: The characterization of thyroid lesions is essential in clinical practice. Recent advances in imaging modalities, including nuclear imaging (NM), color Doppler ultrasonography, and sonography, have markedly improved the diagnostic accuracy for thyroid nodules. Objective: To assess thyroid diseases using Doppler ultrasound, nuclear scintigraphy, and sonography. Results: In this cross-sectional single-center study, 144 patients were examined to determine their thyroid structure and function using a multimodal imaging approach. Fine-needle aspiration cytology (FNAC) indicated that most thyroid nodules were benign (62.5%), with 37.5% being malignant. Doppler vascularity demonstrated a sensitivity of 70.4% and a specificity of 40% (AUC = 0.514) for malignancy detection, while scintigraphy uptake in hypofunctioning nodules (nodules with decreased radionuclide uptake) showed a sensitivity of 37% and a specificity of 54.4% (AUC = 0.388). Thyroxine hormone levels showed a sensitivity of 57.4% and a specificity of 45.6% (AUC = 0.503) for detecting malignant thyroid nodules. In multivariate logistic regression, increased Doppler vascularity remained an independent predictor of malignancy (OR = 2.39; 95% CI: 1.15–4.96; p = 0.019), whereas decreased scintigraphic uptake showed a borderline effect (OR = 1.82; p = 0.069); high T4 level and increased uptake were not significant predictors. The combined Doppler ultrasound, scintigraphy, and thyroxine level model yielded an AUC of 0.72 (95% CI: 0.63–0.81), markedly higher than any single parameter. At the optimal Youden threshold (0.43), the model achieved 79.6% sensitivity, 68.2% specificity, and 72.4% accuracy, highlighting the superior diagnostic performance of the integrated approach for pre-FNAC stratification of thyroid malignancies. There was a strong, significant linear association between thyroxine levels and thyroid scintigraphy uptake (p-value < 0.001). Most patients with normal thyroxine levels exhibited decreased uptake (66.1%), whereas a minority (6.5%) demonstrated elevated uptake levels. This study found a strong correlation between mixed-echogenicity nodules and thyroid scintigraphy uptake (p-value = 0.019). Mixed-echogenicity nodules were most often associated with reduced uptake (57.8%), and hypoechoic nodules often had normal uptake (57.1%). Conclusions: The complementary integration of color Doppler vascularity, Tc-99m thyroid scintigraphy, and serum thyroxine levels yields superior Doppler–scintigraphy uptake correlation, increases the overall diagnostic accuracy, and offers a practical, non-invasive algorithm for differentiating benign from malignant thyroid nodules prior to FNAC or surgery. Full article

Background/Objectives: Trauma management in emergency departments (EDs) requires rapid and reliable diagnostic tools. The Focused Assessment with Sonography in Trauma (FAST) is a bedside ultrasound examination used for the early detection of free fluid in the intraperitoneal cavity, pericardium, and pleural spaces. Expanding FAST use to trained emergency nurses may support timely bedside evaluation in high-demand settings. However, data on agreement with physicians remains limited. This study aimed to evaluate the inter-rater agreement between a trained emergency nurse and physicians in performing FAST and to explore the diagnostic accuracy of nurse-performed FAST compared with computed tomography (CT). Methods: A prospective pilot observational agreement study was conducted between October and December 2023 in the ED of a general hospital in Cyprus. FAST examinations were independently performed by a nurse trained in FAST and by physicians from the radiology department. Four anatomical areas were assessed: right upper quadrant (RUQ), left upper quadrant (LUQ), subxiphoid-pericardial area (SUPH), and suprapubic area (BLADDER). Findings were recorded independently to promote blinding. Diagnostic performance of nurse-performed FAST was explored in a subset of patients undergoing CT. Results: The sample included 68 trauma patients, of whom 58 underwent FAST by both the nurse and the radiologists and were included in the inter-rater agreement analysis. Fluid was detected in four patients (6.9%) in the RUQ area and in one patient (1.7%) in both the LUQ and SUPH regions, while no positive findings were recorded in the BLADDER area. Agreement in the RUQ area was 98.3% (Cohen’s kappa = 0.85, p < 0.001) while agreement was observed in all cases in the SUPH region (100%, Cohen’s kappa = 1.00, p < 0.001), although this finding was based on a single positive case. High observed agreement was also noted in LUQ (98.3%) and BLADDER regions; however, Cohen’s kappa could not be reliably estimated in these regions due to limited variability and the very small number of positive cases. In a subgroup of patients who underwent CT (n = 23), as well as in an additional Trauma Team subgroup (n = 10), diagnostic accuracy estimates were 100% for sensitivity and specificity; however, these estimates were based on a very small number of positive cases (only two positive cases in each subgroup) and were associated with wide confidence intervals. Conclusions: This pilot study suggests that, under specific training conditions, a trained emergency nurse may achieve a high level of agreement with physician assessments when performing FAST. The findings regarding diagnostic accuracy are preliminary and should be interpreted with caution due to the small sample size and low number of positive cases. Further studies with larger samples and multiple operators are required to confirm these findings and to evaluate their clinical implications. Future research is also needed to determine whether nurse-performed FAST may contribute to improved patient safety and emergency department workflow. Full article

Necrotizing (abscessing) lymphadenopathy is a clinically relevant condition with a broad differential diagnosis, including acute bacterial infections, mycobacterial disease, zoonoses, fungal and parasitic infections, autoimmune disorders, and malignancies with central necrosis. Early and reliable differentiation between these causes is important to avoid misdiagnosis and to guide appropriate therapy. This review summarizes the pathophysiological mechanisms, typical imaging features, and diagnostic value of contrast-enhanced ultrasound (CEUS) in necrotizing lymphadenopathy. Representative clinical vignettes illustrate the disease spectrum and correlate CEUS patterns with underlying pathology. The literature review was narrative and based on targeted searches of PubMed/MEDLINE and Google Scholar focusing on CEUS in necrotizing lymphadenopathy. A brief literature overview highlights current evidence, limitations, and research gaps. Conventional B-mode ultrasound (BMUS) and Doppler typically demonstrate enlarged hypoechoic or heterogeneous nodes with reduced central vascularity but lack specificity for necrosis. CEUS provides real-time visualization of nodal microvascular perfusion, which may support clearer differentiation between viable tissue and necrotic or abscess cavities. Common but non-specific CEUS patterns include central non-enhancement with a peripheral hyperemic rim in abscesses, irregular avascular cores in tuberculous lymphadenopathy, patchy non-enhancing areas in autoimmune conditions, and heterogeneous enhancement with ill-defined necrosis in malignant nodes. CEUS can support biopsy targeting, facilitate drainage procedures, and enable radiation-free follow-up. CEUS may offer diagnostic and interventional advantages in the evaluation of necrotizing lymphadenopathy, offering more consistent characterization of nodal necrosis compared with conventional sonography. While most evidence focuses on tuberculosis and malignancy, growing experience with zoonotic and autoimmune diseases suggests broader utility. Most currently available evidence derives from observational studies and small case series, highlighting the need for prospective multicenter validation. Standardization of CEUS criteria, integration into multiparametric ultrasound protocols, and multicenter validation are needed to establish CEUS as a routine component in the diagnostic work-up of necrotizing lymphadenopathy. Full article

Point-of-care ultrasound (POCUS) is portable and radiation-free, but its clinical reliability is constrained by operator-dependent image acquisition and the limited scalability of expert quality assurance (QA) review. As handheld devices proliferate faster than mentorship capacity, trainees increasingly rely on heterogeneous free open access medical education (FOAMed) resources that rarely provide real-time psychomotor feedback. We conducted a structured narrative review (MEDLINE, Embase, Scopus, and Web of Science; last searched on 23 February 2026), with searches performed by H.H. and independently checked by J.J.P. (both POCUS-trained clinicians). After screening, 31 studies were included. We synthesized evidence on artificial intelligence (AI) systems that support bedside image acquisition and automate QA. The primary synthesis centered on key prospective or comparative clinical evaluations of AI-guided acquisition across echocardiography, focused assessment with sonography in trauma, abdominal aortic aneurysm screening, and lung ultrasound, complemented by peer-reviewed studies of FOAMed appraisal tools and online resource quality. These evaluations suggest that real-time probe guidance, view recognition, anatomy labeling, and automated capture may enable novices, after brief training, to acquire diagnostically adequate images for narrowly defined tasks. Early reports of automated QA scoring and program-level triage for expert review suggest potential to reduce expert workload and shorten feedback cycles, but external validation, generalizability across devices and patient habitus, and patient-centered outcomes remain limited. Acquisition-focused AI may therefore serve as an upstream “digital mentor” to improve novice image acquisition. We propose a practical pathway that integrates curated FOAMed resources and simulation with AI-guided bedside acquisition and continuous QA governance for safe deployment. Full article

Sarcopenia is characterized by the progressive loss of muscle mass and function, and it represents a significant and prevalent condition in patients undergoing peritoneal dialysis (PD). However, limited research has been conducted to document techniques for the early detection of sarcopenia in adult PD patients. This review addresses the pathophysiology, prognostic implications, and various assessment techniques for sarcopenia, including creatinine kinetics, anthropometry, imaging techniques (computed tomography, magnetic resonance imaging, and ultrasound sonography), bioimpedance spectrometry, and the modified creatinine index. Each of these techniques presents unique strengths and limitations, necessitating careful consideration of the most appropriate assessment method based on specific clinical conditions. By synthesizing current knowledge, this review aims to evaluate the strengths and limitations of available muscle-assessment techniques and assist in the development of improved diagnostic strategies for sarcopenic adult PD patients. Full article

Transcranial sonography is one of the methods of examination used in atypical parkinsonian syndromes. The assessment is not indicated in the diagnostic criteria of entities in this group e.g., Progressive Supranuclear Palsy, Corticobasal Degeneration, Multiple System Atrophy and Dementia with Lewy Bodies. Atypical parkinsonisms are a group of diseases affected by diverse pathologies including alpha-synuclein or tau among others. Recently broader attention was brought to less common atypical parkinsonisms as Perry syndrome. Atypical parkinsonisms are related to poor response to levodopa treatment, rapid deterioration and unfavorable prognosis. Additionally, the entities often overlap in terms of clinical manifestation, especially in the early stages. Though atypical parkinsonisms are affected by the lack of possibility of obtaining definite in vivo diagnosis, growing interest is associated to supplementary evaluations including neuroimaging. Among these methods could be mentioned magnetic resonance imaging, positron emission tomography, single photon emission computed tomography and transcranial sonography. Transcranial sonography is associated with high accessibility and low cost. The goal of this paper is to highlight the strengths and weaknesses of transcranial sonography in the examination of atypical parkinsonisms. Full article

Background/Objectives: Posterior tarsal tunnel syndrome is a compressive neuropathy of the tibial nerve at the level of the ankle within the tarsal tunnel. However, there is no established gold standard for the diagnosis of tarsal tunnel syndrome to date. High-resolution ultrasound could add important value in this setting. But up to date, to the best of our knowledge, only six clinical studies have investigated the use of ultrasound for the diagnosis of tarsal tunnel syndrome, with partially conflicting results. Most authors identify nerve swelling at the level of anatomical compression as the key ultrasonographic criterion, whereas at least one study and some expert opinions instead emphasize nerve compression at the site of entrapment. Methods: We performed a retrospective observational study of high-resolution ultrasound of the tibial nerve in patients with typical clinical and electrophysiological characteristics of tarsal tunnel syndrome. Results: A cohort of 26 feet with clinically and electrophysiologically confirmed tarsal tunnel syndrome was collected. Nerve ultrasound demonstrated a moderate sensitivity of 65% for the detection of abnormalities of the tibial nerve when applying the commonly used cut-off of 11.8 mm² for the tibial nerve at the level of the tarsal tunnel entry or within the tarsal tunnel. In all but one of the cases classified as pathological on ultrasound, an increase in tibial nerve CSA in the tarsal tunnel was observed compared with the CSA measured 5–10 cm proximal to the tarsal tunnel entry (by a factor of 1.6 ± 0.53). A secondary cause was found in only 12% of the cases. But this study also suggests that ultrasound may remain unremarkable in approximately one third of patients with tarsal tunnel syndrome. Conclusions: Establishing the diagnosis of tarsal tunnel syndrome remains challenging. Our study supports the hypothesis proposed in previous publications that tarsal tunnel syndrome appears to be an exception among compression neuropathies on ultrasound: sonography demonstrates nerve swelling not proximal to the site of compression, but at the level of the anatomical compression. Further prospective data would be of substantial clinical relevance. Full article

Point-of-care ultrasonography (POCUS) has become an integral part of intensive and emergency care. Despite the widespread use and availability of multipurpose ultrasound devices, the regular assessment of intracranial circulatory conditions has not become a part of daily routine in multidisciplinary intensive care units. This brief narrative review aims to summarize the fundamental knowledge about the transcranial Doppler technique and the most significant clinical areas in which the method can provide valuable assistance in daily diagnostic and therapeutic decision-making. The authors searched the PubMed database for reviews, systematic reviews, and meta-analyses using the keywords “transcranial Doppler sonography; critical care; cerebral vasospasm; brain death diagnosis; non-invasive intracranial pressure monitoring”. We conclude that TCD is a simple, yet skilled, bedside method for assessing intracranial circulation. In everyday practice, it can be used to support clinical decision-making primarily in the areas of intracranial pressure monitoring, diagnosis and follow-up of cerebral vasospasm, and diagnosis of cerebral circulatory arrest. The study of cerebral hemodynamics should be an integral part of the increasingly widespread bedside ultrasound diagnostics in intensive care. Full article

Background: Although large-vessel vasculitis (LVV) can affect both the anterior and posterior intracranial circulation, routine neurosonographic follow-up, including transcranial duplex sonography, has not been established. We aimed to characterize patients with giant cell arteritis (GCA) and Takayasu arteritis (TAK) regarding the detection of progressive or new-onset inflammatory vessel changes by using neurosonography, and to assess the impact on medical or interventional treatment strategies. Methods: We retrospectively identified all patients with LVV treated at our neurological department between January 2015 and October 2025 with at least one neurosonographic follow-up examination. Baseline and follow-up sonographic data, clinical characteristics, medical therapy, and interventional treatments were analyzed. Results: In total, 21 LVV patients (GCA, n = 16; TAK, n = 5) underwent sonographic follow-up (GCA: median 28 (2–106) months, 4.5 (2–33) sonographic assessments; TAK: 75 (33–255) months, 14 (4–60) sonographic assessments). Isolated or combined, progressive or new-onset intra- and extracranial arterial disease was detected in seven of the 16 GCA patients (43.8%), of whom three (18.8%) presented with ischemic stroke. Medical treatment was adapted in four progressive cases. In two patients, additional interventional treatment was performed. Among TAK, two of five (40%) patients showed progressive sonographic changes, with one patient experiencing an ischemic stroke requiring endovascular treatment for progressive common carotid artery stenosis and one patient showing asymptomatic intracranial ICA involvement. Conclusions: Progressive and symptomatic involvement of intracranial carotid and vertebral arteries is a frequent finding in patients with LVV. These changes can be effectively detected through comprehensive neurosonographic follow-up, including transcranial ultrasound assessment. Full article

Background/Objectives: Currently, no non-invasive detection method for endometrial cancer (EC) is recommended in clinical practice worldwide. This study aimed to evaluate the clinical value of detecting DNA methylation of CDO1 and CELF4 (CDO1m/CELF4m) in exfoliated cervical cells for the detection of EC in women with suspected endometrial lesions. Methods: A total of 2164 patients scheduled for hysteroscopic surgery due to suspected endometrial lesions at the Obstetrics and Gynecology Hospital of Fudan University between July 2023 and May 2024 were prospectively enrolled. Preoperative exfoliated cervical cells were collected for dual-gene methylation testing. Clinical data and endometrial thickness measured by transvaginal sonography (TVS) were recorded. Hysteroscopic histopathological diagnosis served as the gold standard to evaluate the performance of methylation testing alone and in combination with TVS. Results: This study included 2164 patients, comprising 33 EC cases, 31 cases of endometrial intraepithelial neoplasia (EIN), and 2100 cases of non-endometrial lesions, with mean ages of 51.7 ± 6.4, 49.5 ± 8.9, and 44.7 ± 9.8 years, respectively (p < 0.001). For EC detection, CDO1m/CELF4m positivity showed a sensitivity of 93.94% (95% CI: 79.77–99.26%), specificity of 96.7% (95% CI: 95.92–97.47%), positive predictive value (PPV) of 31.0% (95% CI: 25.96–36.53%), and negative predictive value (NPV) of 99.90% (95% CI: 99.63–99.98%). For EIN detection, the sensitivity was 83.87%, specificity 97.95%, PPV 37.68%, and NPV 99.76%. Combining TVS with DNA methylation detection further improved the sensitivity and NPV for both EC and EIN detection. Conclusions: DNA methylation detection in exfoliated cervical cells demonstrates high sensitivity and specificity for EC detection. The combination with TVS further enhances sensitivity and NPV, offering a simple and non-invasive triage strategy for patients with suspected endometrial lesions. This study was registered in China Clinical Trial Registry (ChiCTR2200055991) on 30 January 2023. Full article

Background: High-frequency ultrasonography (US) is increasingly used to guide closed reduction in nasal bone fractures, but near-field resolution over the curved nasal dorsum depends critically on the acoustic coupling medium. We aimed to determine whether a semi-solid standoff gel pad (PAD) provides superior image contrast and signal stability compared with a liquid gel barrier (LGB) during intraoperative nasal bone fracture sonography. Methods: In this prospective, single-center, within-subject crossover study, 30 adults with isolated nasal bone fractures underwent intraoperative high-frequency US of the nasal dorsum under two coupling conditions differing only by the medium used: a 7 mm hydrogel standoff pad (PAD) and a custom-made 7 mm liquid gel barrier (LGB). All scans were acquired on the same platform using fixed B-mode presets (10 MHz, 4.0 cm depth, single focal zone at the cortex). Rectangular regions of interest (ROIs) were placed on the cortical interface (bone ROI) and adjacent soft tissue (soft-tissue ROI) at matched depth. For each subject and condition, contrast-to-noise ratio (CNR) and two signal-to-noise ratios (SNR_bone, SNR_soft) were derived from ROI gray-level statistics and compared using paired t-tests. Results: The PAD yielded a significantly higher CNR at the cortical interface compared to the LGB (3.46 ± 0.17 vs. 2.50 ± 0.19; mean paired difference 0.96, 95% CI 0.88–1.04; p < 0.0001). SNR_bone was also higher with PAD (4.31 ± 0.35 vs. 3.63 ± 0.34; difference 0.68, 95% CI 0.52–0.83; p < 0.0001). Using the soft-tissue ROI as the noise reference (SNR_soft), PAD again outperformed LGB (7.64 ± 0.73 vs. 6.68 ± 0.78; difference 0.96, 95% CI 0.59–1.33; p = 0.000012). Conclusions: Compared with a liquid gel barrier of similar thickness, a semi-solid standoff gel pad provides higher near-field CNR and SNR at the nasal cortical interface under standardized intraoperative conditions. These quantitative differences support the use of a gel pad as a practical coupling medium for real-time ultrasound guidance during closed reduction in nasal bone fractures, although the impact on clinical outcomes remains to be determined. Full article

Background/Objectives: Cerebral vasospasm (CV) is a serious complication of aneurysmal subarachnoid hemorrhage (aSAH). Carotid siphon calcification (CSC) has been associated with a reduced risk of CV. This study investigates the influence of CSC on the clinical and radiographic severity of CV and functional outcome of aSAH. Methods: A total of 475 patients with aSAH treated at the University Hospital Essen (2008–2016) were analyzed retrospectively. CSC was assessed using the Woodcock score. Study endpoints were the CV severity in digital subtraction angiography, presence of CV in transcranial Doppler (TCD) ultra-sonography, occurrence of delayed ischemic neurological deficit (DIND) and the functional outcome at 6 months measured with the modified Rankin scale. Results: CSC was confirmed as an independent predictor for the occurrence (aOR 0.76; 95% CI 0.60–0.97; p = 0.025) and severity (RC −0.14; 95% CI −0.24 to −0.04; p = 0.006) of angiographic CV and development of DIND (aOR 0.76; 95% CI 0.59–0.98; p = 0.034). Only the duration (in days: RC −0.43; 95% CI −0.77 to −0.10; p = 0.010) but not the presence (aOR 0.87; 95% CI 0.68 to 1.11; p = 0.265) and severity (cerebral blood flow, in cm/s: RC +1.57; 95% CI −7.45 to +10.58; p = 0.731) of TCD CV was associated with CSC. Finally, the increasing levels of CSC were related to poorer 6-month functional outcome (RC +0.12; 95% CI +0.05 to +0.18; p < 0.001). Conclusions: CSC appears to be protective against angiographic CV and DIND, but correlates with worse overall outcome, suggesting that atherosclerosis, represented by CSC, affects cerebrovascular regulation and overall prognosis. We suggest careful evaluation of primary imaging studies for markers of atherosclerosis to identify patients at risk for CV and patients with low risk for CV but still at high risk for poor outcome. Full article

Objective: Restless legs syndrome (RLS) is a highly prevalent neurological complication in end-stage renal disease (ESRD) patients. This study aimed to explore the transcranial sonography (TCS) characteristics of the substantia nigra (SN) and brainstem raphe (BR) in ESRD patients with and without RLS and to evaluate the diagnostic value of SN echogenicity for ESRD-related RLS. Methods: A total of 65 ESRD patients (45 with RLS [ESRD + RLS] and 20 without RLS [ESRD − RLS]) from the dialysis center and 30 age- and gender-matched healthy controls (NC) from the health management center were enrolled between January 2017 and December 2022. All participants underwent TCS to measure the bilateral SN echogenic area, and the total SN echogenic area (SNsA) was calculated. BR echogenicity was assessed using a semiquantitative scale. Receiver operating characteristic (ROC) curves were plotted to determine the optimal SNsA cutoff for diagnosing ESRD + RLS. Results: The SNsA in the ESRD + RLS group [0.15 (0.13–0.22) cm²] was significantly smaller than that in the ESRD − RLS group [0.27 (0.23–0.31) cm²] and the NC group [0.27 (0.22–0.30) cm²] (both p < 0.001). ROC curve analysis showed that SNsA had the highest diagnostic efficacy for ESRD + RLS, with an area under the curve (AUROC) of 0.823 (95% confidence interval [CI]: 0.722–0.924). At a cutoff of 0.22 cm², SNsA yielded a sensitivity of 85.0%, specificity of 73.3%, accuracy of 76.92%, positive predictive value (PPV) of 58.6%, and negative predictive value (NPV) of 91.7%. The prevalence of BR hypoechogenicity was significantly higher in ESRD + RLS (33.33%) and ESRD − RLS (35.00%) groups than in the NC group (10.00%) (both p < 0.05), but no difference was observed between the two ESRD subgroups (p > 0.05). No significant differences in third ventricle (TV) width or bilateral middle cerebral artery peak systolic velocity (MCA-PSV) were found among the three groups (all p > 0.05). Conclusions: ESRD + RLS patients exhibit significant SN hypoechogenicity compared with ESRD − RLS patients and healthy controls. SNsA with a cutoff of 0.22 cm² serves as a reliable imaging biomarker for diagnosing ESRD + RLS, and TCS is a valuable noninvasive tool to assist clinical decision-making in this population. Full article