The accuracy of prenatal ultrasound in recognizing fetal non‐duodenal small bowel dilation (ND‐SBD) due to obstructive conditions requiring neonatal surgery is not well established. We assessed the positive predictive value (PPV) of prenatal 2‐dimensional (2D) ultrasound measurement of the small bowel diameter for identifying fetuses with ND‐SBD who will require postnatal surgical intervention. We systematically searched PubMed, Embase, Web of Science, Scopus, and Cochrane with terms related to fetal bowel dilation and postnatal outcome. For each included study, we estimated the PPV of prenatal ultrasound in predicting the need for neonatal surgery among live‐born, evaluable newborns classified as having a prenatal diagnosis of ND‐SBD, and performed a Bayesian random‐effects meta‐analysis of proportions to estimate the pooled PPV across studies. We identified 10 manuscripts, comprising 390 fetuses with a prenatal diagnosis of ND‐SBD, of which 341 from 9 studies had data available for analysis. The observed PPV for postnatal surgery ranged from 8 to 82%, with a pooled estimate of 56% (90% credible interval (CrI) [44%, 67%]). Heterogeneity between studies was elevated, with an I 2 of 84.8% (90% CrI [68.3%, 92.4%]) and a wide 90% posterior predictive interval of 19–89%, indicating substantial variability in the PPV across populations. Most studies presented high or unclear risk of bias and applicability concerns based on QUADAS‐2 evaluation. 2D prenatal ultrasound evaluation of the fetal small intestine diameter has a moderate ability in predicting the need for postnatal surgery due to ND‐SBD conditions. The substantial between‐study heterogeneity and wide posterior predictive interval indicate considerable variation in the predictive value across populations and clinical settings, limiting the interpretation of the pooled PPV alone. Our findings highlight the need for prospective studies to better define the normal development of the fetal small intestine and identify prenatal ultrasound markers predicting non‐duodenal small bowel abnormalities.
Hair transplantation (HT) has become an important reconstructive option for selected patients with stable cicatricial alopecia. However, objective methods for assessing recipient‐site suitability before surgery remain limited. The objective of the study is to describe the structural and vascular ultrasound findings in patients with cicatricial alopecia undergoing preoperative evaluation for HT. This retrospective observational study included 22 patients with cicatricial alopecia evaluated with high‐frequency ultrasound (HFUS) and color Doppler between 2014 and 2025. Structural variables included dermal and subcutaneous thickness, follicular characteristics, and follicular diameter, while vascular assessment included Doppler patterns and peak systolic velocity. HFUS consistently demonstrated dermal thinning, reduced or absent subcutaneous adipose tissue, and decreased or absent follicular structures. Eleven patients underwent HT, of whom 4 required recipient‐site optimization with autologous fat grafting before follicular unit excision. All 4 demonstrated preoperative dermal thickness <3 mm and reduced or absent subcutaneous adipose tissue on ultrasound. At 12 months, graft survival exceeded 90% in 8 patients and was approximately 80% in 3 patients. Limitations: Retrospective design, limited sample size, and clinical heterogeneity. In conclusion, HFUS and color Doppler provide objective assessment of recipient‐site characteristics and may support preoperative planning by identifying patients who could benefit from recipient‐site optimization before HT.
OBJECTIVES To investigate the clinical, anatomical, and sonographic features of abdominal aortic pseudoaneurysms (AAP), evaluate the real-world diagnostic performance of color Doppler ultrasound for AAP in patients with abdominal aortic aneurysmal dilatation, and analyze factors associated with misdiagnosis. METHODS This single-center retrospective diagnostic accuracy study followed STARD 2015. We included 520 consecutive patients with abdominal aortic aneurysmal dilatation detected by color Doppler ultrasound between January 2018 and January 2025. Using surgical findings, computed tomography angiography, or magnetic resonance angiography as the reference standard, we analyzed AAP features, evaluated ultrasound diagnostic performance, and reviewed misdiagnosed cases. RESULTS A total of 393 patients were included, 25 (6.36%) were confirmed as AAP. Focal wall disruption most frequently occurred in the distal abdominal aorta (64.00%), predominantly on the left and posterior walls. Abdominal or back pain was the most common presenting symptom, with 76.00% of patients having elevated D-dimer levels. The characteristic sonographic findings of AAP were focal aortic wall disruption with a cystic lesion communicating with the aortic lumen. Ultrasound demonstrated 84.00% sensitivity (95% CI: 63.92-95.46), 100.00% specificity (95% CI: 99.00-100.00), and 98.98% overall accuracy (95% CI: 97.41-99.72). In all correctly diagnosed cases, the site of focal wall disruption was 100% concordant with the reference standard. Four cases (16.00%) were misdiagnosed as eccentric true abdominal aortic aneurysms. A retrospective imaging review revealed that these misdiagnoses may be associated with three imaging findings: broad focal wall disruption with absent neck, secondary loss of the typical pseudoaneurysmal to-and-fro flow signature, and coverage of the focal wall disruption by organized thrombus. CONCLUSIONS Color Doppler ultrasound demonstrates favorable diagnostic performance for AAP in real-world clinical practice and can serve as a reliable first-line non-invasive modality for early screening and diagnosis. Recognition of characteristic features and avoidance of common diagnostic pitfalls can further improve diagnostic accuracy.
OBJECTIVES To evaluate the interaction between previous Cesarean delivery and anterior placental location in persistent low-positioned placenta and the association between placental edge-to-internal-os distance and persistence among women with a low-lying placenta. METHODS This single-center retrospective cohort study included 1508 singleton pregnancies with a low-positioned placenta identified during routine mid-trimester fetal ultrasound between 2020 and 2024. Multivariable analysis was used to evaluate factors associated with persistence and the interaction between previous Cesarean delivery and anterior placental location. Among women with a low-lying placenta, the association between placental edge-to-internal-os distance and persistence was also assessed. RESULTS Previous Cesarean delivery and anterior placental location interacted significantly in relation to persistent low-positioned placenta (P for interaction = 0.003). The additive interaction risk difference was 20.0 percentage points (95% confidence interval [CI], 8.2-31.7). Placenta previa at the mid-trimester examination was associated with a higher risk of persistence than low-lying placenta (adjusted relative risk, 5.87; 95% CI, 4.95-6.96). Among women with a low-lying placenta, each 5-mm decrease in placental edge-to-internal-os distance was associated with a 63% higher risk of persistence (adjusted relative risk, 1.63; 95% CI, 1.45-1.83). CONCLUSIONS Previous Cesarean delivery and anterior placental location interacted significantly in relation to persistent low-positioned placenta, and women with both factors present may warrant closer attention during follow-up. Considering these factors together with the type of low-positioned placenta and placental edge-to-internal-os distance may help refine risk assessment and inform subsequent ultrasound follow-up and clinical management.
