Search Results (98)

Background/Objectives: The Doppler perfusion index (DPI) quantifies the ratio of arterial to total hepatic blood flow and reflects hepatic hemodynamic balance. Its clinical applicability is limited by insufficient standardization and the absence of clearly defined physiological reference conditions. This study aimed to establish an upper physiological reference limit for the DPI and to assess its dependence on standardized physiological conditions in healthy adults. Methods: In this prospective study, 44 healthy adults underwent Doppler ultrasonography under standardized conditions (fasting/resting, post-exercise, postprandial). Volumetric blood flow was measured in the portal vein and via the proper hepatic artery and, where feasible, the common hepatic artery. The DPI was calculated as the ratio of arterial to total hepatic inflow. Nonparametric statistical methods were applied. Results: After exclusion of participants with non-standard hepatic arterial anatomy, 39 individuals were analyzed. The DPI varied across physiological conditions, reflecting changes in the relative contributions of arterial and portal venous inflow. Under fasting/resting conditions, values based on the proper hepatic artery showed low variability (mean 0.242 ± 0.057) and normal distribution (Shapiro–Wilk p = 0.625). The empirically derived 90th percentile was 0.30. Measurements based on the common hepatic artery were higher and more variable. Conclusions: The DPI is a physiologically dynamic parameter whose clinical use requires standardized measurement conditions. Under defined protocols, a value of approximately 0.30 may be considered an upper physiological reference limit. Standardization of acquisition and use of the proper hepatic artery enable reproducible and interpretable measurements. This provides a methodological basis for further clinical applications, including oncological contexts in which functional alterations of hepatic perfusion may be relevant. Full article

When assessing hip pain in athletes, it is important to focus on the extra-articular soft tissues that may clinically mimic joint pathology. One such extra-articular structure is the synovial bursa. Bursitis can clinically be misdiagnosed as joint-, tendon- or muscle-related pain. These pathological processes are a result of inflammation that is often secondary to acute trauma, overuse injuries, arthritis, or infection. Traumatic and overuse hip bursitis occur frequently in amateur and professional athletes and clinical presentation is often nonspecific. After clinical assessment, imaging plays an important role in diagnosis and in work-up of these lesions. Ultrasonography (US) is being increasingly used in the assessment of the hip because of the wide availability of US machines, the lower cost, and the unique real-time imaging capability which allows both static and dynamic evaluation as well as guidance of interventional procedures such as fluid aspiration and steroid injection. In order to obtain a correct diagnosis, an efficient US examination requires a thorough understanding of hip anatomy. In this setting, a structured approach based on identification of important US landmarks and compartmentalization of hip anatomy can significantly simplify the task. Sports physicians must be aware about the diagnostic and therapeutic possibilities offered by US in order to expedite rapid referral to a musculoskeletal specialist who can perform a point-of-care US examination of the hip by using a structured diagnostic approach. The purpose of this narrative review is to illustrate both the normal and pathological features of anterior and lateral hip compartments bursae using schematic diagrams and corresponding US images. We will concentrate on sport-related bursitis, of which we will discuss the etiology, clinic and principles of care management. Our aim is to promote the acquisition of these concepts in sports medicine in order to improve patient outcomes. Full article

Background: Hypermobile Ehlers–Danlos syndrome (hEDS), the most common EDS subtype, is characterized by chronic pain and joint laxity, yet no definitive causative genes or imaging-based diagnostic criteria have been established. This study investigated the genetic basis of hEDS using whole-exome sequencing (WES) and objectively evaluated ankle instability. Methods: We conducted an observational cohort study with a case–control comparison, including 22 patients and a three-generation Korean family (six individuals, four affected) diagnosed with hEDS by the 2017 criteria. WES was performed; ankle laxity was assessed by the anterior drawer test (ADT), stress ultrasonography, and stress radiography. Healthy young adults (n = 24, Beighton score < 5) from our previous study served as controls. Results: The hEDS cohort had a mean Beighton score of 8.5, with all participants reporting a family history of hypermobility and musculoskeletal complications. Family-based WES identified variants in CD44 (c.1516 + 1G > A), ITIH2 (c.783C > G), and ADAM21 (c.397C > T) in all affected individuals. In 22 unrelated patients, 114 variants in 103 candidate genes were identified; 17 patients harbored variants in genes from the same pathways as the family-derived causative genes. Compared with controls, the hEDS group showed significantly greater manual ADT grade, anterior talofibular ligament (ATFL) length at rest and under stress, dynamic ATFL change, anterior talar translation, and talar tilt. Conclusions: These findings provide molecular evidence that hEDS is a multifactorial disorder involving interconnected biological pathways, and confirm ankle instability as a clinically meaningful diagnostic feature. These complementary approaches may improve diagnostic accuracy and provide insights into the prognosis and therapeutic strategies for hEDS. Full article

A 14-year-old spayed female Maltese dog presented with hematuria, pollakiuria, decreased urine volume per voiding, and prolonged urination time, and was diagnosed with multifactorial urinary obstruction involving suspected trigonal neoplasia and extensive urolithiasis affecting the kidneys, ureters, bladder, and urethra. Diagnosis was based on serum biochemical analysis, radiography, and ultrasonography, which revealed diffuse urolithiasis, urethral involvement, and a trigonal mass consistent with a suspected neoplastic lesion. Due to the multifocal nature of obstruction, surgical management was considered impractical. The patient underwent urethral stent placement as a minimally invasive palliative intervention. Following the procedure, rapid restoration of urine flow was achieved, and significant improvement in renal parameters, including blood urea nitrogen and creatinine, was observed within 3 days. During follow-up, the stent remained well positioned without migration. Although transient deterioration, including hydronephrosis and increased renal parameters, was noted at day 52, subsequent improvement was observed by day 64, suggesting a dynamic course of obstruction. This case demonstrates that urethral stenting can be an effective treatment option for managing complex, multifactorial lower urinary tract obstruction in dogs, providing rapid clinical improvement and sustained urinary patency. However, progressive changes in the upper urinary tract may occur, emphasizing the importance of comprehensive evaluation and continuous monitoring. Full article

Background: Ultrasonographic assessment of the upper airway has emerged as a non-invasive method for evaluating obstructive sleep apnea (OSA), offering advantages including wide accessibility and absence of ionizing radiation. However, the diagnostic validity and standardized screening thresholds for ultrasonographic parameters remain unclear. Methods: A systematic literature search was conducted in PubMed, Scopus, and ScienceDirect from database inception to February 2026. Eligible studies enrolled adults with suspected OSA, used in-laboratory polysomnography (PSG) as the reference standard, and assessed upper-airway structures using ultrasonography. Studies reporting diagnostic performance metrics (sensitivity, specificity, AUC, or diagnostic thresholds) or quantitative associations with apnea–hypopnea index (AHI) were included. Risk of bias was assessed using QUADAS-2. Owing to methodological heterogeneity, findings were synthesized qualitatively. Results: Six studies (n = 473 participants) met the inclusion criteria. Evaluated parameters included tongue base thickness, lingual artery distance, lateral pharyngeal wall thickness, dynamic airway dimensional changes, and tongue stiffness. Three studies reported threshold-based diagnostic performance, although only one provided a complete diagnostic contingency table. Dynamic retropalatal percentage change demonstrated the highest diagnostic performance (AUC up to 0.989; sensitivity 97%; specificity 93.3%). Other studies demonstrated significant morphologic associations with OSA severity but lacked externally validated diagnostic thresholds. Conclusions: Ultrasonographic upper-airway assessment demonstrates promising structural and functional correlates of OSA. However, robust diagnostic accuracy evidence and standardized thresholds remain limited. Further prospective studies with standardized acquisition protocols and predefined diagnostic thresholds are required before ultrasound can be incorporated into routine OSA screening pathways. Full article

Background/Objectives: Shoulder involvement is common in rheumatoid arthritis (RA), yet periarticular pathology may remain subclinical. Musculoskeletal ultrasonography enables detection of early inflammatory and structural changes; however, data on asymptomatic shoulder involvement in RA are limited. This study aimed to evaluate ultrasonographic shoulder findings in asymptomatic RA patients, compare them with healthy controls, and assess their association with disease activity. Methods: This prospective case–control study included 31 patients with RA without shoulder pain and 33 asymptomatic healthy controls. Bilateral shoulder examinations were performed using standardized ultrasonographic protocols. Periarticular findings were assessed using the Ultrasound Shoulder Pathology Rating Scale (USPRS), and acromiohumeral distance (AHD) was measured. Disease activity was evaluated using the Disease Activity Score in 28 joints (DAS28). Group comparisons, correlation analyses, receiver operating characteristic (ROC) analysis, and multivariate logistic regression were performed. Results: There were no significant differences in demographic characteristics or comorbidities between groups. Biceps tendinopathy scores were significantly higher in RA patients than in healthy controls (1.0 ± 0.79 vs. 0.5 ± 0.56, p = 0.01), whereas other ultrasonographic parameters, including supraspinatus tendinopathy, dynamic impingement findings, AHD, and total USPRS score, did not differ significantly. DAS28 showed significant positive correlations with biceps tendinosis (r = 0.37, p < 0.05) and supraspinatus tendinosis (r = 0.36, p < 0.05). Total USPRS demonstrated acceptable discrimination for identifying moderate–high disease activity (AUC = 0.73). In multivariate analysis, DAS28 was independently associated with biceps tendinopathy (OR = 1.62, 95% CI: 1.05–2.49). Conclusions: Asymptomatic patients with RA exhibit a higher burden of biceps tendon involvement compared with healthy individuals, and subclinical shoulder ultrasonographic findings are associated with disease activity. Asymptomatic patients with RA demonstrated a significantly higher biceps tendinopathy score compared with healthy controls, whereas most other ultrasonographic parameters, including total USPRS score and AHD, did not differ significantly. These findings suggest that the long head of the biceps tendon may represent a relatively more sensitive site of subclinical periarticular involvement in RA; however, the overall ultrasonographic differences were limited and should be interpreted cautiously. Full article

Flexor hallucis longus (FHL) tendon injuries, although rare, severely affect foot stability and mobility, particularly in individuals engaging in repetitive push-off actions. This case study examines a 27-year-old male who underwent surgical repair for FHL tendon rupture, followed by a structured, multi-modal rehabilitation program integrating advanced therapeutic techniques. The 12-week program was divided into three distinct phases to ensure a structured and progressive recovery process. The Early Phase (Weeks 1–4) focused on pain and edema control through interventions such as massage, electrotherapy, kinesiotaping, and the use of peritendinous ultrasonography to monitor recovery progress. The Intermediate Phase (Weeks 5–8) aimed to enhance strength and flexibility by incorporating Proprioceptive Neuromuscular Facilitation (PNF), weight-bearing exercises, dynamic stretching, and the progressive integration of Graston massage techniques. Finally, the Advanced Phase (Weeks 9–12) prioritized functional recovery, utilizing balance training, load transfer exercises, agility drills, and Theragun applications to prepare the individual for a return to optimal physical performance. Significant improvements were observed, including pain reduction (VAS score reduced by X%), increased dorsiflexion flexibility (from X° to X°), and enhanced muscle strength (e.g., tibialis anterior strength increased by X%). Functional assessments, such as the Y Balance Test, revealed improved endurance and mobility. This case study highlights the benefits of integrating innovative techniques like Graston massage and Theragun within a structured, evidence-based rehabilitation program to optimize recovery post-FHL tendon surgery. Full article

Background: Ultrasonography (US) has emerged as a non-invasive method for anatomical and functional evaluation of upper airway structures in adult obstructive sleep apnea (OSA). However, its role in severity stratification, dynamic assessment, elastographic characterization, and therapeutic monitoring remain to be investigated. Background/Objectives: The goal herein is thus to systematically review and synthesize available evidence on US assessment in adults with OSA, including structural parameters, dynamic measurements, correlation with the apnea–hypopnea index (AHI), integration with artificial intelligence, and evaluation of myofunctional therapy outcomes. Methods: A PRISMA-compliant systematic review of 19 studies (2007–2025) was conducted, evaluating US in adult patients with polysomnography-diagnosed OSA. Observational, pilot, case–control, and exploratory studies were included. Risk of bias was assessed using the National Institutes of Health Quality Assessment Tool for observational studies. Due to methodological heterogeneity, a structured qualitative meta-analytic synthesis was performed. Results: The tongue base was the most frequently studied structure. Increased tongue thickness, area, and stiffness were consistently associated with higher AHI. Elastography revealed increased intrinsic rigidity in patients with OSA. Dynamic US correlated with drug-induced sleep endoscopy findings and hyoid displacement. Machine learning integration improved severity prediction. A single study evaluated anatomical changes following myofunctional therapy, representing a nascent research area. US may become a complementary, non-invasive tool for anatomical and functional assessment of upper airway structures in adult OSA. Conclusions: Further standardization of acquisition protocols and well-designed longitudinal studies are needed to clarify the clinical role of US in phenotyping and therapeutic monitoring. Full article

Background and Clinical Significance: Post-traumatic finger stiffness is frequently attributed to soft tissue adhesions; however, mechanical obstruction from occult osseous structures remains a rare but critical differential diagnosis in adults. Case Presentation: This report describes a 56-year-old female presenting with severe, refractory stiffness of the little finger eight months after a proximal phalanx fracture. Despite extensive conservative therapy, active and passive flexion at the proximal and distal interphalangeal joints remained locked in extension. While conventional radiographs demonstrated bony union, musculoskeletal ultrasonography (MSUS) revealed an occult protruding malunited fragment incarcerating the flexor tendons. Dynamic MSUS provided real-time evidence of mechanical impingement by demonstrating proximal muscle contraction without distal tendon excursion. Intraoperatively, initial soft tissue tenolysis failed to restore motion; further exploration guided by MSUS evidence successfully identified a sharp bone spike. Subsequent ostectomy resulted in immediate restoration of functional range of motion. This case underscores the limitations of static imaging in evaluating the dynamic gliding mechanism and highlights the valuable role of MSUS in identifying mechanical functional obstructions. Conclusions: Early sonographic evaluation should be considered for refractory post-traumatic stiffness to prevent prolonged, ineffective conservative care and to guide definitive surgical management. Full article

Radiation-associated soft tissue fibrosis represents a progressive structural remodeling process characterized by extracellular matrix accumulation, septal thickening, and reduced tissue compliance, which complicates reconstructive interventions. Reliable longitudinal experimental frameworks capable of non-invasive structural monitoring remain limited. This study aimed to develop and implement a standardized ultrasonographic protocol for the evaluation of bleomycin-induced subcutaneous fibrosis and to assess remodeling dynamics following autologous fat grafting in a rat model. Twenty-two adult female Wistar rats were included. Subcutaneous fibrosis was induced using submaximal bleomycin administration (1 mg/kg/day for three consecutive days). High-frequency ultrasonography (12 MHz) was performed at baseline (Day 0), post-bleomycin (Day 17), and post-lipofilling (Day 31). A predefined semi-quantitative 0–3 scoring system was applied to characterize global echogenicity, septal thickening, and architectural organization. At Day 17, all animals demonstrated structural alteration with a mean score of 2.15 ± 0.58. At Day 31, the mean score decreased to 1.50 ± 0.50, with complete disappearance of high-grade architectural disorganization (score 3). Focal hypoechoic areas consistent with graft integration were observed in 88.9% of animals without ultrasonographic signs of necrosis or fluid collection. This standardized imaging-based framework enables reproducible longitudinal monitoring of early-stage subcutaneous fibrotic remodeling and provides a non-invasive tool for evaluating regenerative interventions in translational soft tissue engineering research. Full article

Objectives: This scoping review synthesized the available evidence on bedside ultrasonography used to confirm short-term nasogastric tube (NGT) placement in adults. Methods: The review followed JBI Collaboration methodology. Searches were conducted in CINAHL, Embase, LILACS, PubMed, and Scopus, as well as in gray literature sources (Google Scholar and ProQuest Dissertation & Thesis Global). Primary studies and clinical guidelines addressing bedside ultrasonography for short-term NGT placement in adults (≥18 years) were eligible, with no limits on language or publication year. Data were extracted and narratively summarized with the I-AIM framework (Indication, Acquisition, Interpretation, and Decision-Making). Results: Twenty-nine studies met the inclusion criteria. Most were single-center observational studies performed in intensive care units or emergency departments. Ultrasound was primarily used for confirmation prior to enteral nutrition initiation, while gastric decompression was less frequently reported. Acquisition protocols varied, although supine positioning, convex abdominal probes, and linear cervical probes were most commonly described. The gastric antrum and esophagus were the principal anatomical landmarks, with interpretation based on direct tube visualization and dynamic fogging; color Doppler was occasionally used. Radiography remained the reference standard in most studies, and only a minority initiated feeding based solely on ultrasound findings. Reported facilitators included bedside feasibility, absence of radiation exposure, and timeliness. Barriers included operator dependency, limited visualization in patients with obesity or gas interposition, protocol heterogeneity, and the limited methodological robustness of available studies. Conclusions: Current evidence suggests that ultrasonography may represent a feasible, radiation-free bedside approach for confirmation of NGT placement. Evidence from selected studies suggests that, with structured training, healthcare professionals may achieve diagnostic accuracy in specific clinical settings, although further robust multicenter investigations are needed to confirm these findings. Full article

Background/Objectives: Medial meniscus extrusion (MME) is a quantitative marker of altered meniscal containment and load sharing. Although ultrasonography enables dynamic assessment under functional loading, it remains unclear whether generalized ligamentous hypermobility influences physiologic extrusion behavior in healthy knees. The aim of this study was to quantify load-dependent MME in healthy adults and to determine whether generalized hypermobility is associated with greater physiologic extrusion under progressive loading conditions. Methods: In this prospective observational study, 106 healthy adults aged 18–40 years were evaluated between October and December 2025. Generalized joint hypermobility was defined as a Beighton score ≥5. MME was measured by standardized ultrasonography on the dominant limb in three conditions: sitting (unloaded), bipedal stance, and unipedal stance. Patellar tendon shear-wave elastography (SWE) was recorded in kilopascals (kPa). Interobserver reliability was assessed in the first 25 participants using ICC (2,1). Group comparisons, multivariable linear regression for loading-related Δ-extrusion (Unipedal−Sitting and Bipedal−Sitting), and a linear mixed-effects model for repeated MME measures, including a Position × Hypermobility interaction, were performed. Results: Twenty-eight participants (26.4%) were classified as hypermobile. The hypermobile group showed significantly lower patellar tendon SWE than controls (23.8 ± 7.0 vs. 37.6 ± 9.7 kPa, p < 0.001). MME increased stepwise with loading in both groups and remained consistently higher in hypermobile participants across sitting, bipedal, and unipedal conditions (all p < 0.001). Loading-related extrusion was also greater in the hypermobile group for both Bipedal−Sitting (p = 0.037) and Unipedal−Sitting (p = 0.002). In multivariable regression, lower patellar tendon SWE independently predicted greater loading-related extrusion, whereas hypermobility status did not remain an independent predictor. In the mixed model, the Position × Hypermobility interaction was significant and was most pronounced during the unipedal stance. Conclusions: In healthy adults, medial meniscus extrusion increases stepwise from unloaded sitting to bipedal and unipedal weight bearing. Participants with generalized hypermobility demonstrated higher physiologic MME values and a more pronounced load-dependent pattern, particularly during unipedal stance. However, in adjusted analyses, lower patellar tendon stiffness on SWE, rather than hypermobility status itself, independently predicted greater loading-related extrusion. These findings support a contextual interpretation of ultrasound-based MME measurements in relation to loading condition and hypermobility phenotype. Full article

Background and Objectives: Rapid physiological decline in terminal cancer is frequently accompanied by accelerated skeletal muscle loss. Although bedside ultrasonography (US) is practical and feasible in palliative care settings, the prognostic relevance of short-term muscle change remains unclear. This study aimed to evaluate whether the rate of muscle loss over a 10-day period, assessed by serial ultrasound, is associated with survival duration in terminally ill cancer patients. Materials and Methods: This single-center retrospective cohort study included 87 inpatients with end-stage cancer who underwent bedside ultrasound measurements of the biceps brachii (BB) and rectus femoris (RF). Baseline US was performed within the first three days of admission, followed by a repeat assessment 10 days after baseline (day-10 follow-up ultrasound). Muscle thickness (MT) measurements were normalized by height squared (m²), and 10-day changes were calculated as delta (Δ) indices, defined as baseline minus day-10 values. Because the exposure of interest (Δ) can only be determined after completion of the day-10 assessment, survival timing analyses were anchored to this prespecified landmark. Survival duration was defined as the number of days from the day-10 follow-up ultrasound to death among patients who died within one year. Associations between muscle changes and survival duration were evaluated using correlation analyses and multivariable linear regression adjusted for age, sex, body mass index, Eastern Cooperative Oncology Group (ECOG) performance status, and nutritional risk. The primary analyses focused on survival timing among decedents. Results: Significant muscle loss was observed over the 10-day interval between baseline and 10 days after baseline. Among the 58 patients who died within one year, greater short-term biceps muscle loss, reflected by higher Δ BB muscle thickness index (Δ BB MT-I), was moderately associated with shorter survival duration (r = −0.437, p = 0.0006). In multivariable linear regression analysis, Δ BB MT-I remained independently associated with survival duration (β = −701.19; 95% CI: −1102 to −301; p = 0.0006), whereas RF muscle changes and baseline clinical variables were not statistically significant. Conclusions: Short-term biceps muscle loss assessed by serial ultrasound, as reflected by Δ BB MT-I, is associated with shorter survival duration in terminally ill cancer patients. These findings suggest that dynamic muscle changes, rather than single-time-point measurements, may provide clinically meaningful insight into short-term survival timing. Serial bedside muscle ultrasound may serve as a low-burden adjunct for prognostic communication in palliative care, although prospective time-to-event studies are required for validation. Full article

Background/Objectives: Ectopic pregnancy (EP) remains a major cause of maternal morbidity. This study aimed to describe the clinical, ultrasonographic and histopathological features of EP, including changes following methotrexate (MTX) therapy. Methods: A retrospective analysis was conducted on 60 patients diagnosed with EP between 2018 and 2024. Clinical characteristics, serum β-hCG (beta-human chorionic gonadotropin) dynamics, treatment type, site-specific ultrasonographic features, and histopathological aspects were evaluated. Results: Extrauterine EPs accounted for 63.3% of cases, predominantly tubal ectopic pregnancy (T-EP), while uterine ectopic pregnancy represented 33.3%, including cesarean scar pregnancy (CSP) in 20%. Heterotopic pregnancy was identified in 3.3%. T-EP most frequently required surgical management, whereas MTX was effective in selected T-EP and CSP cases, as demonstrated by a ≥ 15% decline in serum β-hCG levels at 7 days. Transvaginal ultrasonography (TVUS) enabled accurate site-specific localization of ectopic implantation. Histopathological evaluation confirmed ectopic implantation and MTX-related changes in treated cases. Conclusions: Integrating clinical findings, β-hCG dynamics, and targeted TVUS allows accurate diagnosis and individualized management of EP, with histopathology providing definitive confirmation and insight into treatment-related changes. Full article

Background/Objectives: Rheumatoid arthritis is an autoimmune disease that induces joint deformity and disability. There are great expectations for biomarkers that would predict the response to treatment. CHI3L1 and CHI3L2 are chitinase-like proteins (CLPs) which lack enzymatic activity. CHI3L1 is expressed by a variety of cells, while reports on CHI3L2 are limited. The aim of the current study is to evaluate gene and protein CHI3L1 and CHI3L2 expressions before and after treatment of patients with RA and to search for correlations with ultrasonography and conventional laboratory parameters. Methods: Twenty-four newly diagnosed RA patients (19 females and five males) were enrolled in the study. Fourteen patients were treated with tofacitinib (TOFA) and 10 patients with methotrexate (MTX) for twenty-four weeks. Conventional biochemical and immunological markers were examined at the start of the treatment and after the follow-up period. The activity of RA was assessed via the Disease Activity Score 28 (DAS28). Gene expression and protein analysis were performed. Results: Ultrasonographic and clinical laboratory parameters showed improvement after therapy in both groups. A decrease in plasma levels of CHI3L1 (p = 0.04 *) and CHI3L2 (p = 0.03 *) were found after treatment with TOFA. No changes in either protein level were detected after MTX therapy, nor were any differences discovered in the gene expression of CLPs after treatment with both therapeutics. Strong correlations between CRP, GUS7 and CLPs were also established. Conclusions: The similar dynamics of CLPs expression in naïve RA patients and their distinct interplay with disease-related parameters after therapy suggest that both proteins may display different functions in RA pathophysiology. Full article