OBJECTIVES:To evaluate whether a multiparametric approach combining grayscale ultrasound (2D-US), contrast-enhanced ultrasound (CEUS), and serum anti-thyroid peroxidase antibody (TPO-Ab) improves the differentiation of benign from malignant thyroid nodules (TNs) in patients with Hashimoto's thyroiditis (HT) and to assess the stability of the combined diagnostic model through internal validation. METHODS:This retrospective study enrolled 600 HT patients with 650 pathologically confirmed TNs. All patients underwent 2D-US; CEUS was performed in 475, TPO-Ab testing in 452, and shear wave elastography (SWE) in an exploratory subset of 88 patients. The primary combined diagnostic model was developed using logistic regression (LR) on the subset of patients with complete 2D-US, CEUS, and TPO-Ab data. Internal validation was performed via stratified 5-fold cross-validation. Six machine learning classifiers were additionally compared to assess model robustness. RESULTS:Among single modalities, 2D-US showed the highest cross-validated area under the curve (AUC) (LR: 0.831). CEUS and TPO-Ab alone yielded limited discrimination (AUC 0.671 and 0.621, respectively). The combined model integrating 2D-US, CEUS, and TPO-Ab achieved a cross-validated AUC of 0.849 with sensitivity of 77.3% and specificity of 77.8%, outperforming any single modality. Among the 6 classifiers evaluated, LR demonstrated the most stable performance and the best balance between sensitivity and specificity. CONCLUSION:Integrating multimodal ultrasound with serum TPO-Ab significantly improves the differentiation of TNs in HT, with the combined LR model demonstrating robust performance after internal validation. This multiparametric approach may serve as a supplementary tool for risk stratification in surgical candidates, but prospective external validation is required before clinical implementation.
Objectives To evaluate whether a multiparametric approach combining grayscale ultrasound (2D‐US), contrast‐enhanced ultrasound (CEUS), and serum anti‐thyroid peroxidase antibody (TPO‐Ab) improves the differentiation of benign from malignant thyroid nodules (TNs) in patients with Hashimoto's thyroiditis (HT) and to assess the stability of the combined diagnostic model through internal validation. Methods This retrospective study enrolled 600 HT patients with 650 pathologically confirmed TNs. All patients underwent 2D‐US; CEUS was performed in 475, TPO‐Ab testing in 452, and shear wave elastography (SWE) in an exploratory subset of 88 patients. The primary combined diagnostic model was developed using logistic regression (LR) on the subset of patients with complete 2D‐US, CEUS, and TPO‐Ab data. Internal validation was performed via stratified 5‐fold cross‐validation. Six machine learning classifiers were additionally compared to assess model robustness. Results Among single modalities, 2D‐US showed the highest cross‐validated area under the curve (AUC) (LR: 0.831). CEUS and TPO‐Ab alone yielded limited discrimination (AUC 0.671 and 0.621, respectively). The combined model integrating 2D‐US, CEUS, and TPO‐Ab achieved a cross‐validated AUC of 0.849 with sensitivity of 77.3% and specificity of 77.8%, outperforming any single modality. Among the 6 classifiers evaluated, LR demonstrated the most stable performance and the best balance between sensitivity and specificity. Conclusion Integrating multimodal ultrasound with serum TPO‐Ab significantly improves the differentiation of TNs in HT, with the combined LR model demonstrating robust performance after internal validation. This multiparametric approach may serve as a supplementary tool for risk stratification in surgical candidates, but prospective external validation is required before clinical implementation.
OBJECTIVES:To compare residual myometrial thickness and cesarean scar elastography findings following single- versus double-layer uterine closure in women undergoing primary cesarean delivery. METHODS:In this prospective comparative cohort study, 100 women undergoing primary cesarean delivery at Izmir City Hospital between November 2024 and February 2025 were included. Participants were allocated according to the operating surgeon's routine uterine closure technique into single-layer (n = 50) and double-layer (n = 50) groups. Maternal characteristics, perioperative outcomes, hemoglobin changes, postoperative pain scores, and the requirement for additional hemostatic sutures were recorded. At 6 weeks postpartum, residual myometrial thickness, endometrial thickness, and cesarean scar elastography were assessed by ultrasonography. Exploratory receiver operating characteristic (ROC) analysis was performed to evaluate the discriminatory performance of the imaging parameters. RESULTS:Baseline demographic and perioperative characteristics were comparable between groups. The single-layer group required more additional intraoperative hemostatic sutures than the double-layer group (p = .002). Perioperative hemoglobin decline, postoperative pain scores, operative duration, and hospital stay did not differ significantly (all p > .05). Residual myometrial thickness (5.7 versus 4.9 mm, p = .001), endometrial thickness (7.9 versus 6.4 mm, p = .042), and elastography scores (11.1 versus 8.2, p < .001) were significantly greater following double-layer closure. Elastography demonstrated the highest discriminatory performance in the exploratory ROC analysis (AUC = 0.827). CONCLUSION:Double-layer uterine closure was associated with greater residual myometrial thickness, higher cesarean scar elastography scores, and a reduced need for additional hemostatic sutures than single-layer closure. These findings indicate more favorable early postoperative scar characteristics; however, their clinical significance and implications for long-term reproductive and obstetric outcomes remain uncertain.
Objectives To compare residual myometrial thickness and cesarean scar elastography findings following single‐ versus double‐layer uterine closure in women undergoing primary cesarean delivery. Methods In this prospective comparative cohort study, 100 women undergoing primary cesarean delivery at Izmir City Hospital between November 2024 and February 2025 were included. Participants were allocated according to the operating surgeon's routine uterine closure technique into single‐layer ( n = 50) and double‐layer ( n = 50) groups. Maternal characteristics, perioperative outcomes, hemoglobin changes, postoperative pain scores, and the requirement for additional hemostatic sutures were recorded. At 6 weeks postpartum, residual myometrial thickness, endometrial thickness, and cesarean scar elastography were assessed by ultrasonography. Exploratory receiver operating characteristic (ROC) analysis was performed to evaluate the discriminatory performance of the imaging parameters. Results Baseline demographic and perioperative characteristics were comparable between groups. The single‐layer group required more additional intraoperative hemostatic sutures than the double‐layer group ( p = .002). Perioperative hemoglobin decline, postoperative pain scores, operative duration, and hospital stay did not differ significantly (all p > .05). Residual myometrial thickness (5.7 versus 4.9 mm, p = .001), endometrial thickness (7.9 versus 6.4 mm, p = .042), and elastography scores (11.1 versus 8.2, p < .001) were significantly greater following double‐layer closure. Elastography demonstrated the highest discriminatory performance in the exploratory ROC analysis (AUC = 0.827). Conclusion Double‐layer uterine closure was associated with greater residual myometrial thickness, higher cesarean scar elastography scores, and a reduced need for additional hemostatic sutures than single‐layer closure. These findings indicate more favorable early postoperative scar characteristics; however, their clinical significance and implications for long‐term reproductive and obstetric outcomes remain uncertain.
OBJECTIVES:To compare the performance of 3 fetal growth standards-Hadlock, the Asian standards of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD.a), and Hong Kong standards-in predicting small-for-gestational-age (SGA) infants and associated adverse pregnancy outcomes (APO) in a Southern Chinese population. METHODS:Retrospective multicenter cohort study of 2763 singleton pregnancies (28-40 weeks). Estimated fetal weight (EFW) was calculated using the Hadlock formula, and SGA was defined as EFW <10th percentile for gestational age and sex. Receiver operating characteristic curves were generated to assess the predictive capability of each growth standard. Multivariable logistic regression analyses were conducted to identify predictors of APO. RESULTS:NICHD.a standards showed the highest overall predictive performance for SGA infants (AUC = 0.801), similar to Hadlock standards (AUC = 0.801) and higher Hong Kong standards (AUC = 0.788). For APO, NICHD.a had higher sensitivity; Hong Kong had higher specificity. Independent APO predictors included maternal age, nulliparity, IVF-ET, and umbilical artery abnormality. CONCLUSIONS:NICHD.a fetal growth standards were more effective than both Hadlock and Hong Kong standards in predicting SGA infants and associated APO in this Southern Chinese cohort.
OBJECTIVES:To evaluate the feasibility, transferability, and implementation performance of the cardiovascular system sonographic evaluation algorithm (CASSEAL), a structured 3 × 3 sequential framework for second-trimester ultrasound assessment of the extended fetal cardiovascular system, in a multicenter screening setting. METHODS:This prospective multicenter observational study included unselected singleton and twin pregnancies examined between 18 and 22+6 weeks' gestation. After standardized training, operators completed an initial implementation phase (first 30 examinations) followed by a validation phase (≥50 additional examinations). The CASSEAL algorithm consists of sequential acquisition of 9 axial planes organized into infracardiac, cardiac, and supracardiac territories within a structured 3 × 3 framework. The primary outcome was complete visualization of all 9 views. Secondary outcomes included examination time, factors associated with incomplete visualization, and exploratory screening performance using absence of normality in ≥1 axial view as the screening criterion. RESULTS:A total of 1494 fetal examinations performed by 15 operators across 7 centers were analyzed. Complete visualization of all 9 views increased from 78% in the implementation phase to 84% in the validation phase (p = .01). Mean examination time decreased significantly after completion of the learning phase (8.0 ± 6.4 versus 5.8 ± 3.9 minutes; p < .001). In multivariable analysis, the validation phase independently reduced the likelihood of incomplete visualization (adjusted OR, 0.65; p < .01), whereas higher maternal body mass index (adjusted OR, 1.06 per kg/m2; p < .001) and anterior fetal spine position (adjusted OR, 3.95; p < .001) increased this risk. Thirty-six fetuses (2.4%) had confirmed cardiovascular anomalies, vascular variants, or relevant ultrasound markers. Exploratory screening performance estimates based on available prenatal and postnatal follow-up suggested high specificity and negative predictive value, although sensitivity estimates should be interpreted cautiously because systematic postnatal echocardiography was not available. CONCLUSIONS:The CASSEAL algorithm demonstrates high feasibility, a short learning curve, and robust multicenter reproducibility for structured second-trimester evaluation of the extended fetal cardiovascular system. The integrated 3 × 3 sequential framework may facilitate standardized assessment of supracardiac, cardiac, and infracardiac territories in routine multicenter screening practice.
OBJECTIVES:To assess biomechanical properties of the ulnar nerve and flexor carpi ulnaris (FCU) muscle in young healthy adults using ultrasound shear wave elastography (SWE). METHODS:Using an elbow brace to standardize 30° and 90° of elbow flexion, shear wave velocity (SWV, m/s) of the ulnar nerve in cubital canal and FCU were measured using 18-MHz linear array transducer. The difference in SWV of ulnar nerve and FCU between both sides, between 30° and 90° elbow flexion, and between non-compression and compression conditions were analyzed using paired t-tests. Inter- and intra-observer reliability was analyzed using intraclass correlation coefficients (ICC) and Bland-Altman analysis. RESULTS:The study included 12 men and 12 women (mean age 26 ± 2 years) who had no upper extremity pathologies. No significant differences in nerve SWV were observed between male and female participants or between left and right sides (p > .05). Ulnar nerve SWV increased significantly under compression at 30° and 90° elbow flexion (p < .001) compared to non-compression. SWV of FCU also increased with muscle contraction at 30° and 90° elbow flexion compared to muscle relaxation (p < .001). A moderate and positive correlation in SWV between ulnar nerve and FCU was observed at variable elbow angles and stress conditions (Spearman r = 0.64, p < .001). Intra- and inter-observer reliability for performing SWE was moderate to good (ICC >0.79). CONCLUSIONS:SWE is a feasible method for quantifying biomechanical properties of the ulnar nerve and FCU in young healthy adults under physiological conditions, demonstrating good inter- and intra-observer reliability and minimal measurement variability.
