Search Results (56)

Pelvic floor dysfunction (PFD) is one of the most significant postoperative consequences in gynecological surgery, leading to impaired bowel function, structural alteration, and reduced quality of life. The conventional technique using fluoroscopic defecography and perineal ultrasonography provides an incomplete assessment of multi-compartment defects and post-surgical changes. Magnetic resonance defecography (MRD) represents a valuable alternative imaging method in the assessment of PFD following gynecological surgery, increasing diagnostic accuracy and enabling personalized treatment planning. MRD achieves high-resolution multi-compartmental assessment of the pelvic floor in dynamic states. Particularly, it is able to detect postoperative complications such as mesh retraction, organ prolapse, and fistula formation, not visible to other modalities. This narrative review discusses the role of MRD in diagnosing PFD and its advantages in detecting functional and anatomical changes following gynecological surgery. This review also examined the ability of MRD to demonstrate surgical changes and its contribution to possible standardization in clinical practice. Full article

Background/Objectives: Carpal tunnel syndrome (CTS) is a common entrapment neuropathy. Traditional diagnostics like EMG and NCSs are invasive and do not visualize nerve morphology. This study aims to evaluate the diagnostic and prognostic value of high-resolution ultrasonography in patients with CTS using a standardized scanning protocol and to evaluate the relationship between sonographic findings and traditional electrodiagnostic results. Methods: In this observational study with both prospective and retrospective components, 31 subjects were included. Between November 2023 and June 2024, 11 symptomatic CTS patients were scheduled for surgical decompression and 14 healthy controls were prospectively enrolled. Additionally, six post-surgical CTS patients who had undergone decompression between 2016 and 2021 were retrospectively included for comparative analysis. All underwent clinical and ultrasonographic assessments of the median nerve at predefined anatomical landmarks. EMG was performed in the CTS groups. Ultrasound was repeated at 1, 3, and 6 months postoperatively to monitor morphological changes. Results: CTS patients had significantly increased the median nerve CSA compared to controls. Postoperative ultrasound showed progressive CSA reduction correlating with clinical improvement and EMG recovery. The CSA correlated moderately to strongly with distal motor latency. Conclusions: High-resolution ultrasound is a reliable, non-invasive tool for diagnosing and monitoring CTS. Standardized protocols are needed to support broader clinical adoption and establish it as a standalone diagnostic method. Full article

Background/Objectives: Chronic anal fissure, an anorectal condition, is characterized by internal anal sphincter fibers at the base of the fissure. The lifetime prevalence is 7–8%. Medical management and lifestyle modifications are the first-line treatments, whereas chemical or surgical internal anal sphincterectomy is an option for refractory cases. The aim of this study was to evaluate the impact of surgical anal canal length and sphincter pressure on postoperative symptom relief and continence outcomes. Methods: A total of 26 patients diagnosed with chronic anal fissures were selected for surgical treatment. Five patients voluntarily withdrew, leaving 21 cases for analysis. In patients undergoing open lateral internal sphincterotomy, anal canal length and sphincter pressure were assessed preoperatively and three months postoperatively using endoanal ultrasonography and high-resolution anal manometry. Results: Postoperatively, all patients experienced complete resolution of pain and bleeding. The expected decrease in resting pressure was not significantly associated with sex. A significant weight gain was observed postoperatively (p = 0.001). Although a significant decrease was observed in preoperative sphincter resting pressure and VAS scores, Wexner scores remained unchanged. Preoperatively and postoperatively, mean sphincter pressure was significantly lower in the spontaneous vaginal delivery group than that in the non-spontaneous vaginal delivery group (p < 0.05). Patients with short anal canal lengths had greater pressures reductions, though not statistically significant. Conclusions: Lateral internal sphincterotomy is an effective and safe treatment for chronic anal fistula when performed by experienced surgeons. Anal canal length may influence postoperative complications and surgical decisions. Larger studies are needed to confirm these findings. Full article

Background and Objectives: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder characterized by the degeneration of both upper and lower motor neurons, leading to the rapid decline of motor function. In recent years, dysfunction of the autonomic nervous system (ANS) has also been increasingly recognized as a contributing factor in various neurodegenerative diseases, including ALS. This study is the second publication from our ALS research cohort at Kaunas Clinics. Our previous work examined ultrasonographic changes in the phrenic nerve as a supplementary diagnostic approach for ALS. Materials and Methods: In the present study, we investigated ultrasonographic alterations of the vagus nerve within the same ALS cohort, aiming to explore correlations with ANS involvement. We performed high-resolution ultrasonography of the vagus nerve (VN), collected clinical data, conducted heart rate monitoring, and evaluated respiratory function. Results: We prospectively included 32 ALS patients meeting “Gold Coast” criteria and 64 age- and sex-matched control patients. The average onset of ALS was 57.97 ± 9.22 years, and the duration of the disease was15.41 ± 9.04 months. For ALS patients, we found significantly reduced vagus nerve cross-sectional area (CSA) at the level of the carotid artery bifurcation bilaterally compared to controls (right VN 1.86 ± 0.21 vs. 2.07 ± 0.18 mm², p < 0.001; left VN 1.69 ± 0.21 vs. 1.87 ± 0.21 mm², p < 0.001). Reduced values of the left VN positively correlated with the reduced values of FEV1% and sO₂. Conclusions: Our findings revealed a significant bilateral reduction in vagus nerve size in ALS patients compared to controls, suggesting that vagal atrophy may serve as a potential marker of autonomic dysfunction in ALS. Full article

Background: The superficial vessel system in the lower abdomen, including the superficial circumflex iliac artery (SCIA) and superficial inferior epigastric artery (SIEA), is widely used in reconstructive microsurgery. Preoperative ultrasonography, particularly ultra-high-frequency ultrasound (UHFUS), enhances surgical planning by providing high-resolution imaging. This study aimed to utilize UHFUS to examine the SCIA, SCIV, SIEA, and SIEV for reconstructive surgery planning. Methods: This prospective study included 25 patients undergoing free DIEP flap breast reconstruction. Patients with horizontal lower abdominal scars were excluded. Preoperative UHFUS, using a 48 MHz transducer, was performed to map and measure the superficial branch of SCIA (sSCIA), SCIV, SIEA, and SIEV. The vessel location, diameter, depth, and course were documented and analyzed. Results: Twenty-five female patients (50 hemiabdomens) aged 41 to 66 were included. The mean BMI was 21.6 kg/m² (range: 18.4–30.4 kg/m²). At the ASIS level, the mean diameter of the sSCIA, SIEA, SCIV, and SIEV were 0.76 mm, 0.63 mm, 1.72 mm, and 2.18 mm, respectively. A superior lateral pedicle course was observed in 98% of the sSCIA. All patients had at least one detectable superficial artery, with 96% showing detectable arteries on both sides of the lower abdomen. Conclusions: UHFUS effectively maps superficial vessels in the lower abdomen for reconstructive surgery. The SCIA and SCIV are reliably detectable, while the SIEA is less consistently identified. UHFUS enhances flap design by providing precise vessel localization and sizing, leading to safer and more efficient surgeries. Full article

Objectives: Hamstring strain injuries are common in elite athletes and affect return-to-sport timelines. Although magnetic resonance imaging (MRI) is the gold-standard method for assessing injury severity, ultrasonography (US) is a more accessible and cost-effective alternative. This study aimed to evaluate the agreement between US and MRI in the diagnosis of hamstring injuries and their prognostic value in predicting recovery. Methods: This retrospective study included elite athletes who sustained acute first-time hamstring strains and underwent both MRI and US within five days after injury. The injuries were classified according to location (muscle belly, musculotendinous junction, or tendon) and severity (modified Peetron’s classification). The agreement between the imaging findings and return-to-sports timelines was analyzed. Results: US demonstrated a 70% agreement with MRI in identifying injury locations, showing the highest concordance for muscle belly injuries (90%), followed by musculotendinous junction (80%) injuries, but a lower accuracy for tendon injuries (60%). Recovery times differed significantly by location and severity (p < 0.01), with tendon grade 3 injuries requiring the longest recovery (383 days) and muscle belly injuries requiring the shortest recovery (16 days). Musculotendinous junction grade 2, tendon grade 1, and tendon grade 2 injuries had similar recovery durations (57–65 days). Conclusions: High-resolution US is a reliable diagnostic tool for muscle belly and musculotendinous junction injuries. However, MRI remains essential for high-grade tendon injuries. US serves as the first-line imaging modality, with MRI reserved for cases that require a detailed prognostic assessment. These findings provide guidance for optimizing imaging strategies for hamstring injury management. Full article

Background/Objectives: Periodontitis is an inflammatory disease associated with many systemic disorders such as diabetes and cardiovascular disease. The aim was to evaluate the usefulness of the CDC/AAP and the EFP/AAP criteria to detect subclinical atherosclerosis in subjects with diabetes and severe periodontal disease. Methods: This was a cross-sectional study. Atheroma plaque was evaluated by high-resolution carotid and femoral ultrasonography. A dental examination protocol was implemented by a trained periodontist. A full-mouth periodontal clinical examination was carried out at six sites by automated computerized Florida Probe Periodontal Probing. Periodontal disease was defined by CDC/AAP and EFP/AAP criteria. Results: In total, 98 patients were included (60.2% women), of which 50% had diabetes. Subjects with diabetes showed a high prevalence of severe cases of periodontal disease. Both criteria were useful to detect the presence of atheroma plaque only in the presence of diabetes. However, the CDC/AAP criteria had higher correlation with atheroma plaques than EFP/AAP criteria (r = 0.522 vs. r = 0.369, p < 0.001). Conclusions: The CDC/AAP and the EFP/AAP criteria are a useful tool to identify subclinical atherosclerosis in subjects with severe periodontal disease and diabetes. These results show the potential role of the oral healthcare team in the dental office for the identification of subjects with diabetes at risk of developing cardiovascular disease. Full article

Injuries to the soleus muscle are often unrecognized, which increases the risk of complete tearing. Consequently, it results in the need for a long break in sports. This is mainly because the soleus muscle is complex, and the clinical signs of injury are difficult to capture, which can mimic Achilles tendinopathy and tennis player’s calves. This muscle has a complex connective tissue structure with three intramuscular tendons, which makes it challenging to interpret pathological muscle conditions. Injuries to the soleus muscle can be acute or chronic and are usually considered to be a minor discomfort by both the patient and the sports medicine physician, leading to a relatively quick return to sports activity with a high risk of re-injury. This narrative literature review aims to explore the diagnostic challenges and treatment failures associated with soleus muscle injuries, highlighting the critical lack of standardized protocols and a comprehensive understanding of the nuances of these injuries, which requires the collection of qualitative data from clinical case studies, quantitative data from imaging studies and rehabilitation outcomes, and expert opinion to formulate evidence-based guidelines to improve patient management. Calf muscle pain symptoms should not be ignored because the injury may become chronic, and the lack of treatment adequate to the actual cause of the pain increases the risk of the injury deepening, including complete rupture. High-resolution ultrasonography and magnetic resonance imaging are recommended methods for differentially diagnosing soleus muscle injury in conjunction with physical examination to make a precise and reliable diagnosis. A soleus muscle injury case report and a comprehensive proposal for conservative treatment supplement our literature review. Full article

Background: Carotid intima-media thickness (IMT) is a noninvasive surrogate marker of subclinical atherosclerosis and cardiovascular disease risk. This study explored IMT distribution across three carotid artery segments in a large cohort of healthy individuals and identified the key factors associated with increased IMT. Methods: This study utilized data from the Kangbuk Samsung Health Study, a cohort of South Korean adults aged ≥ 18 years who underwent comprehensive annual or biennial health examinations. The analysis included 86,351 healthy individuals, excluding those with known carotid disease. IMT was measured using high-resolution B-mode ultrasonography across the three segments: common carotid artery (CCA), carotid bulb, and internal carotid artery (ICA). An increased IMT was defined as a measurement of ≥1.5 mm in any segment. Multivariable linear regression analyses were conducted to identify independent predictors of increased IMT. Results: The study population had a mean age of 46.7 years and was predominantly male (69.7%). The prevalence of thickened IMT was the highest in the carotid bulb, followed by the ICA and CCA. IMT increased progressively with age and was higher in males across all segments, with the disparity becoming more pronounced after 65 years of age. The carotid bulb displayed the largest absolute IMT values, whereas the ICA exhibited a sharper age-related increment. Increased CCA IMT was strongly linked to hypertension (beta, 0.11; p < 0.001) and diabetes mellitus (beta, 0.12; p < 0.001). Both CCA and ICA IMT showed a weak but significant association with dyslipidemia (beta, 0.03; p < 0.001). Conclusions: The IMT distribution and its determinants vary across carotid segments. CCA is a robust marker of systemic vascular health, whereas the carotid bulb is the most sensitive marker for detecting early atherosclerotic changes. This study provides novel insights into segment-specific IMT patterns and their association with cardiovascular risk factors in a large, healthy Asian population. Full article

Dermatologic ultrasonography applications are rapidly growing in all skin fields. Thanks to very high spatial resolution, high-frequency and ultra-high-frequency ultrasound can evaluate smaller structures, allowing us to improve diagnosis accuracy and disease activity. Moreover, they can guide treatment, such as drug injection, and assess therapy efficacy and complications. In this narrative review, we evaluated high-frequency ultrasound and ultra-high-frequency ultrasound in infections, inflammatory dermatoses, metabolic and genetic disorders, specific cutaneous structure skin disorders, vascular and external-agent-associated disorders, neoplastic diseases, and aesthetics. Full article

Objective: The objective of this study was to assess the diagnostic efficacy of dynamic high-resolution ultrasonography (HRUS) in detecting anterior disc displacement with reduction (ADDWR) and anterior disc displacement without reduction (ADDWoR) in the temporomandibular joint (TMJ). Methods: A total of 144 TMJs was categorized into three groups according to the magnetic resonance imaging (MRI) findings, which served as the reference standard: the normal disc position (NDP) group, the ADDWR group, and the ADDWoR group. Static images of the TMJ in full opening and maximum intercuspal positions, along with dynamic sequences during jaw opening, were obtained utilizing a 14 MHz L-shaped linear array transducer. The diagnostic efficacy of dynamic HRUS for identifying ADDWR and ADDWoR was evaluated in terms of accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic odds ratio (DOR), and the Youden index. Results: According to the MRI findings, the NDP, ADDWR, and ADDWoR groups consisted of 42 (29.2%), 47 (32.6%), and 55 (38.2%) TMJs, respectively. HRUS data revealed 54 TMJs (37.5%) in the NDP group, 26 TMJs (18.1%) in the ADDWR group, and 64 TMJs (44.4%) in the ADDWoR group. With MRI as the reference standard, HRUS exhibited a diagnostic accuracy of 71.4%, sensitivity of 51.4%, and specificity of 91.4% for ADDWR. For the ADDWoR, HRUS attained a diagnostic accuracy of 86.5%, sensitivity of 90.0%, and specificity of 82.1%. Conclusions: With MRI serving as the reference standard, dynamic HRUS has high diagnostic value for ADDWoR, with better diagnostic accuracy than ADDWR. Ultrasonography has the potential to be used as a highly effective and non-invasive imaging modality for the early screening of ADD in future clinical practice. Full article

Background/Objectives: The prevalence of developmental hip dysplasia is estimated to be 0.1–2 per 1000 infants. Hip imaging by ultrasonography is considered to be the gold standard method for screening and detecting developmental dysplasia of the hip (DDH), as per the Graf categorization. The classification of hip differentiation into type 1 and type 2 is determined by the alpha angle, as assessed by the Graf classification. Type 1 hips are defined as those with an alpha angle exceeding 60 degrees, whilst type 2 hips are defined as those with measurements falling within the range of 50 to 59 degrees. Methods: The computerized patient card in our institution had a compilation of 208 hip photographs taken from 110 patients, with 98 of them being bilateral. The acquisition of these photos occurred from January 2020 to December 2020. A retrospective review was conducted on the ultrasound (US) scans, with a specific emphasis on the outcomes related to type 1 and type 2 hips. Results: There were 108 high-resolution US photos in the type 1 hip group and 100 high-resolution US images in the type 2 hip group. In terms of unilateral or bilateral cases, gender, or age, no statistically significant differences were seen between the two groups (p > 0.05). The FMD model exhibited a sensitivity of 86% and specificity of 70% in effectively predicting the presence of type 1 mature hips when the values surpassed 2.9 mm. The AUC (area under the curve) value achieved was 0.628. Conclusions: The process of diagnostic categorization may occasionally encounter challenges in accurately differentiating between type 1 and type 2 hip separation subsequent to a hip ultrasound examination. The findings of our analysis indicate that the assessment of the FMD is a highly successful method, demonstrating both high specificity and sensitivity in differentiating between various scenarios. Full article

Background: Thrombosis is the abnormal formation of blood clots within blood vessels; it results from an imbalance between fibrinolytic, pro-coagulant, and anticoagulant systems. Pediatric arterial thrombosis, especially related to catheter usage, is an emerging issue with limited evidence. This study evaluates the efficacy of enoxaparin in treating arterial thrombosis in pediatric patients at a single center. Methods: A retrospective single-center study included children under 14 years old diagnosed with catheter-related arterial thrombosis (CAT) and treated with low-molecular-weight heparin (LMWH) at King Abdulaziz Medical City between 2016 and 2021. Patients without follow-up at our institution or those using other anticoagulants were excluded. Data collected included age, sex, weight, catheter type, location and degree of thrombosis, ultrasonographic results, treatment duration, hemoglobin and platelet levels, and missed refills. Radiologic confirmation of CAT was required for inclusion. Results: This study included 111 children treated with enoxaparin for non-cerebral arterial thrombosis. The median age at diagnosis was 3 months, with 58% being male patients. Most cases (87%) involved cardiac catheterization, and all were confirmed using ultrasonography. Complete thrombus resolution was achieved in 90% of patients, partial resolution in 8.1%, and 1.8% had no resolution. The median duration of enoxaparin therapy was 20 days. Multivariate analysis indicated that higher age and lower body weight were associated with a higher risk of non-resolution. Indwelling catheters also posed a greater risk of non-resolution compared to cardiac catheters. Conclusions: Enoxaparin proved effective in treating catheter-related arterial thrombosis in children, with high resolution rates and few side effects. This study helps inform treatment strategies in pediatric thrombosis management and highlights the need for further research to refine treatment durations and address patient risk factors. Full article

(1) Background: Ocular emergencies account for 1.5–3% of emergency department (ED) visits and require urgent diagnosis to prevent serious complications. Ultrasonography is a crucial, non-invasive diagnostic tool for these conditions but traditionally lacks portability and integration with modern electronic smart devices. The purpose of this study was to assess the accuracy and performance of a new handheld ultrasound device in comparison to a conventional cart-based sonographic machine in patients attending to the ED for vitreo-retinal diseases. (2) Methods: three specialists in ophthalmology, with at least 4-year experience in vitreo-retinal diseases and eye ultrasound, evaluated images of 50 eyes with both portable and traditional ultrasound probes. Each specialist made the diagnosis based on the images captured with both probes and then rated their overall image quality and confidence of diagnosis with a five-point Likert scale. The concordance of diagnosis between the two probes was evaluated. (3) Results: The sample comprised 42 patients. Twenty (40%) healthy eyes and thirty eyes with the following vitreo-retinal interface conditions were examined: 12 retinal detachment (24%), 8 vitreous hemorrhage (16%), and 10 posterior vitreous detachment (20%). The overall accuracy of the two devices appeared to be comparable (70.7% vs. 69.3%). The Butterfly iQ+ probe showed similar sensitivity in retinal detachment diagnosis (91.7% vs. 94.4% of the Accutome B-scan Pro), while it showed poor performance in diagnosing posterior vitreous detachment (sensitivity = 27.2%); (4) Conclusions: The Butterfly iQ+ device demonstrated high sensitivity in the diagnosis of retinal detachment. Significant adjustments are still needed to improve the resolution of the vitreous body. Full article

Background: Primary cutaneous lymphoma (PCL) is a rare form of extranodal non-Hodgkin’s lymphoma characterized by malignant lymphocytes confined to the skin. Accurate diagnosis and staging are crucial for optimal management, yet radiological literature on imaging PCL remains limited. This study aims to delineate the imaging characteristics of PCLs using high and ultra-high frequency ultrasound (UHFUS) and proposes a classification system based on ultrasound findings. Methods: A cohort of 88 individuals with suspected PCL underwent high-resolution ultrasound (HRUS) and color Doppler examination of lesions. Lesions were categorized based on sonographic appearance, and subsequent histopathological assessment confirmed the diagnosis. Results: Ultrasound imaging revealed distinct patterns for primary cutaneous T-cell lymphomas (PCTCL) and primary cutaneous B-cell lymphomas (PCBCL), with characteristic features such as hypoechoic nodules, pseudonodular lesions, and dermal infiltration. Histopathological analysis confirmed the ultrasound findings, supporting the proposed classification system. Conclusions: Ultrasonography, particularly UHFUS, offers valuable insights into the imaging characteristics of primary cutaneous lymphomas, aiding the accurate diagnosis and assessment of treatment response. The proposed classification system based on ultrasound findings enhances the diagnostic approach to PCLs, and paves the way for improved patient care and management strategies. Full article