Introduction:Thyroid nodules affect more than 60% of the population, approximately 5% being malignant. The British Thyroid Association U-classification guides ultrasound risk stratification across the United Kingdom but is subject to inter-observer variability. Artificial intelligence decision support tools may offer more standardised assessment, yet no peer-reviewed study has validated S-Detect, a computer-aided diagnosis tool integrated into Samsung ultrasound systems, against the British Thyroid Association framework. This study compares S-Detect with experienced ultrasound operators using histology as the reference standard. Methods:This retrospective pilot diagnostic accuracy study assessed 32 thyroid nodules (September 2023 to August 2024). S-Detect served as the index test applied retrospectively on a Samsung RS85 Prestige platform; prospectively assigned U-scores were the comparator and surgical histology the reference standard. A secondary analysis varied Doppler input across all four options in the 11 malignancies misclassified by S-Detect to test whether Doppler selection contributed to misclassification. Results:Operators achieved superior balanced performance (sensitivity: 78.9%, specificity: 84.6%, accuracy: 81.3%, and area under the curve: 0.870) compared with S-Detect (42.1%, 100%, 65.6%, area under the curve: 0.729), which under-classified 58% of malignancies. Inter-method agreement was slight (κ = 0.175), with significant directional discordance (McNemar p = 0.008). Doppler manipulation produced substantial variability: 81.8% of misclassified cases showed U-score change attributable solely to Doppler selection, with peripheral patterns yielding zero correct malignancy classifications. Conclusion:Operators achieved superior diagnostic performance. S-Detect's high false-negative rate appears largely driven by over-reliance on Doppler. Its clinical utility is limited within this single-centre study. Future iterations excluding Doppler would likely achieve substantially improved sensitivity.
Papillary endothelial hyperplasia, or Masson's tumour, is a benign, reactive endothelial proliferation classified as intravascular, mixed or extravascular, with the extravascular subtype arising as a reactive process at a site of vascular injury. Genitourinary presentations are rare and predominantly intravascular; extravascular disease at the penoscrotal junction is exceptionally rare and can mimic soft-tissue sarcoma due to its hypervascular, avidly enhancing appearance. We report a case of penoscrotal extravascular papillary endothelial hyperplasia and describe, to our knowledge, the first documented contrast-enhanced ultrasound features of this entity. A man in his sixties presented with a 4-week history of a small, non-tender lump at the left penoscrotal junction, with no reported history of local trauma. Grey-scale ultrasound demonstrated a well-defined, hypoechoic lesion abutting the tunica albuginea, with internal vascularity on colour Doppler. Contrast-enhanced ultrasound showed marked hypervascularity with rapid, avid, and persisting enhancement during the arterial and late venous phases, together with a large, serpiginous vein in close proximity to the lesion and appearing mildly compressed by the mass - a distinctive vascular morphology not previously described in papillary endothelial hyperplasia at any site. Magnetic resonance imaging confirmed a well-defined, uniformly enhancing nodule, with an adjacent peripheral vessel of indeterminate arterial or venous nature. Given residual diagnostic uncertainty, staging computed tomography excluded metastatic disease before surgical excision. Histopathology confirmed extravascular papillary endothelial hyperplasia, most likely reactive, possibly arising at a site of previously unrecognised local trauma. This case highlights a novel contrast-enhanced ultrasound appearance in extravascular papillary endothelial hyperplasia that may aid diagnostic confidence and support multimodality triage of indeterminate penoscrotal masses.
Aims:Musculoskeletal ultrasonography is an accessible imaging modality with potential utility in knee osteoarthritis. This study aims to compare the sonographic features of knee osteoarthritis with standing radiographic grading and to assess the association with pain severity. Methods:In this cross-sectional study, patients with knee osteoarthritis underwent knee ultrasonography and standing anteroposterior and lateral radiographs. Radiographs were independently assessed by a blinded reviewer and graded using the Kellgren-Lawrence system. Kellgren-Lawrence grades 1-2 were classified as mild osteoarthritis and grades 3-4 as moderate to severe osteoarthritis. Sonographic findings were compared with radiographic grades, and the association with pain severity measured by the visual analogue scale (VAS) was evaluated. Results:Sonographic measurements of medial femoral osteophytes, suprapatellar effusion, Baker's cyst, and medial meniscal protrusion significantly correlated to radiographic osteoarthritis severity (p ⩽ 0.05). A composite score derived from these four variables demonstrated acceptable diagnostic performance (Youden index: 0.61). This composite score significantly correlated to VAS pain scores (p = 0.003), whereas VAS was not significantly associated with the Kellgren-Lawrence grade. Conclusion:Ultrasonography may serve as a valuable adjunct or alternative to plain radiography for estimating knee osteoarthritis severity and its clinical impact. Further well-designed studies are warranted to confirm these findings.
Objectives:This study primarily examined sex differences in ultrasound-derived hamstring muscle quality in physically active prepubertal children and secondarily evaluated the effects of region of interest selection and measurement site on these indices. Methods:Twenty-six prepubertal children (9-11 years, 13 girls) underwent quantitative ultrasound assessment of the semitendinosus and biceps femoris at five measurement sites along the femur. Mean uncorrected echo intensity, corrected echo intensity, echovariation, and texture features were extracted from longitudinal ultrasound images using two region of interest approaches: maximal and standardised rectangular region of interest. Results:Linear mixed-effects models indicated that girls exhibited higher corrected echo intensity and homogeneity and lower contrast and correlation values in the semitendinosus (p < .05), while no sex differences were found in the biceps femoris (p > .05). Region of interest size affected the values of corrected echo intensity, echovariation, and correlation, with higher values observed in maximal region of interest, without altering group-level findings (p > .05). Corrected echo intensity was greater in the biceps femoris than the semitendinosus. Corrected echo intensity varied across the measurement sites, showing higher values at the proximal and proximal-middle locations (p < .05). Conclusions:Region of interest size, sex, muscle, and measurement site influence muscle quality parameters in prepubertal children. Site- and muscle-specific differences underscore the need for standardised assessment protocols.
Aim:Shear wave elastography is commonly used to evaluate muscle stiffness and thickness. This study aimed to evaluate the stiffness and thickness of the sternocleidomastoid muscle in patients diagnosed with head and neck cancer undergoing neck dissection (removal of lymph nodes). Materials and methods:Ten subjects with head and neck cancer were recruited. Two radiographers performed ultrasound and shear wave elastography scans to evaluate muscle stiffness and thickness in the sternocleidomastoid muscle pre-surgery, at 6 weeks, and at 6 months post-surgery. Results:The cohort had a mean age of 56.8 (±8.22) years, with equal numbers of males and females. Half had unilateral surgery (four left and one right), while the other half had bilateral surgery. One patient had the entire sternocleidomastoid muscle resected (participant HN2). Comparing all time points from pre-surgery to 6 weeks and 6 months, there was no significant change in sternocleidomastoid muscle thickness (pre-surgery to 6 weeks: 0.11 ± 2.45 cm; t = 0.18, p = 0.86; pre-surgery to 6 months: 0.36 ± 2.08 cm; t = -0.64, p = 0.53; 6 weeks to 6 months: 0.47 ± 1.53 cm; t = -1.15, p = 0.26). From pre-surgery to 6 weeks and 6 months, there was no statistically significant change in shear wave elastography readings (pre-surgery to 6 weeks: 3.62 ± 7.45 kPa; t = -1.82, p = 0.08; pre-surgery to 6 months: 3.33 ± 11.2 kPa; t = 1.11, p = 0.28). However, from 6 weeks to 6 months, the shear wave elastography values increased significantly by 6.95 ± 6.48 kPa (t = 4.01, p < 0.001). Conclusion:This preliminary exploratory study demonstrates the feasibility of longitudinal shear wave elastography assessment in this cohort and identifies an increase in sternocleidomastoid muscle stiffness between 6 weeks and 6 months, which warrants further investigation in larger, stratified studies with functional correlation.
Background:Doppler ultrasound is a widely used non-invasive imaging modality for evaluating venous thoracic outlet syndrome (vTOS), a condition marked by subclavian vein compression that can lead to complications such as thrombosis and pulmonary embolism. Despite recommendations from the American College of Radiology (ACR) supporting its use as a screening tool for vTOS, the available evidence derives mostly from small, non-randomised studies. Methods:We performed a systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses of Diagnostic Test Accuracy (PRISMA-DTA) guidelines. Diagnostic accuracy measures such as sensitivity, specificity, likelihood ratios (LRs), diagnostic odds ratio (DOR), and area under the curve (AUC) were pooled using a bivariate random-effects model. We also assessed heterogeneity, threshold effect, and publication bias. The review protocol was prospectively registered in the PROSPERO under registration number CRD42024621782. Results:Five studies with 293 patients were included. The pooled sensitivity and specificity were 91.4% (95% CI: 83.5-95.7; I² = 25.4%) and 91.1% (95% CI: 63.8-98.3; I² = 82.0%), respectively. The AUC was 0.919 (95% CI: 0.80-0.94), and the DOR was 54.1 (95% CI: 13.6-215.5; I² = 57%). The positive LR (LR+) and negative LR (LR-) were 10.3 (95% CI: 2.15-49.6) and 0.10 (95% CI: 0.06-0.2), respectively, indicating strong diagnostic performance. Sensitivity heterogeneity was resolved (I² = 0%) after excluding one outlier study, yielding a revised pooled sensitivity of 88.6% (95% CI: 81.0%-93.1%). Deeks' funnel plot asymmetry test showed no evidence of publication bias (p = 0.60). Fagan's nomogram showed that a positive test increased the post-test probability from 25% to 77%, while a negative test reduced it to 3%. LR scatterplots confirmed high diagnostic utility. Conclusion:Doppler ultrasound shows high accuracy and is a valuable first-line tool for the initial assessment of vTOS in symptomatic patients. Its non-invasiveness and bedside use make it ideal for early triage. However, broader clinical implementation requires standardised scanning protocols, training to reduce interobserver variability, and harmonisation of diagnostic criteria across centres to ensure reproducibility and reliability.
Introduction:Arterial tortuosity syndrome is a rare connective tissue disorder characterised by a distinct combination of cardiovascular manifestations, which include the tortuosity and elongation of large- and medium-sized arteries. In addition, the condition is associated with various connective tissue abnormalities, including facial dysmorphism, skin laxity, hernias, premature ageing, chest wall and spine deformities, and hypermobile joints. Arterial tortuosity syndrome is attributed to mutations in the SLC2A10 gene, which plays a critical role in extracellular matrix synthesis, an essential component that maintains the structural integrity of vascular and connective tissues. Case report:We present a case of a 21-year-old lady at 40 + 5 weeks of gestation, whose fetus on antenatal sonography showed an extremely tortuous and dilated aorta, and dilated main pulmonary artery and its main branches. The fetal neurosonogram showed prominence and septations in both the lateral cerebral ventricles and a diagnosis of arterial tortuosity syndrome with intraventricular septae secondary to hemorrhage was suspected. At birth, the female neonate exhibited abnormal facial features, lax skin, structural talipes, and hypermobility of joints. The antenatal diagnosis of arterial tortuosity syndrome was confirmed by typical postnatal physical characteristics and computed tomography angiography, which showed the extent of vascular involvement. However, genetic analysis could not be done to further support the diagnosis. Conclusion:A comprehensive understanding of the typical imaging features, physical characteristics, and genetic factors associated with arterial tortuosity syndrome can enhance understanding of the broader implications of this pathology across vascular and other connective tissue biology. Such an understanding may lead to improvements in the diagnosis and management of the condition.
Background:Renal recovery after acute kidney injury is a clinical outcome that influences prognosis in critically ill patients. The renal resistive index was measured by Doppler ultrasound and has been proposed as a potential predictor of renal recovery; however, its prognostic value remains inconsistent. Methods:This prospective study included acute kidney injury patients admitted to the intensive care unit at Cho Ray Hospital from November 2021 to July 2022. Renal resistive index was measured by Doppler ultrasound at intensive care unit admission, after 24 hours, and after 48 hours. Renal recovery was assessed on days 2 and 7 and at hospital discharge. Results:Among 95 patients with acute kidney injury, renal recovery occurred in 16.8% at day 2, 37.9% at day 7, and 47.4% at hospital discharge. Renal resistive index measured at day 2 (renal resistive index 2) was significantly higher in the non-recovery group than in the recovery group (0.755 ± 0.071 vs. 0.692 ± 0.091; p = 0.001). Both renal resistive index 2 and its percentage change (% renal resistive index 2) demonstrated moderate discriminative ability for predicting renal recovery at day 7. In multivariable analysis, acute kidney injury stage 3, cumulative fluid balance >5%, renal resistive index 2 >0.722, and a reduction in percentage renal resistive index 2 <5% were independently associated with impaired renal recovery at day 7. Conclusion:Renal resistive index on day 2 and its dynamic changes were associated with renal recovery in critically ill patients with acute kidney injury. Repeated renal resistive index assessment may provide complementary prognostic information when integrated with clinical factors. Further multicentre studies are needed to validate its clinical utility and to combine the renal resistive index with clinical and biochemical parameters.
Introduction:Fetal measurement audit is important in order to improve and maintain accuracy. The aim of this study was to model the potential outcomes of audits of different numbers of images and measurements, and explore the implications with respect to the improvement and maintenance of standards. Methods:The outcomes of image and estimated fetal weight audits of 3, 10, 25 and 100 patients were modelled using statistical techniques, namely the binomial distribution for images scored as pass/fail and sample size methods for fetal weight estimates. Scored images were modelled for pass rates of 45%, 60%, 75% and 90%. The difference between mean fetal weight errors that would be significant (p < 0.05) was calculated. Results:The 95% confidence interval on modelled pass rates ranged from ±32% to ±56% for 3 images, ±18% to ±31% for 10 images, ±11% to ±19% for 25 images and ±6% to ±10% for 100 images. The differences between mean fetal weight errors that would be significant were 16.8% (3 samples), 9.2% (10 samples), 5.8% (25 samples) and 2.9% (100 samples). Conclusion:The results of small audits lack precision; if not interpreted carefully, they may result in inappropriate targeting of interventions. Guidance is provided on careful interpretation and management of results to ensure that remedial training and support is appropriately targeted.
Introduction: Caesarean scar ectopic pregnancy (CSEP) is a potentially serious complication of caesarean section (C-section) which consists of the implantation of the gestational sac (GS) in the hysterotomy scar. All women with a history of C-section are at risk for CSEP. Early diagnosis and treatment are critical to avoid maternal morbidity and mortality. There is overlap in the sonographic appearance of CSEP, low-lying normal pregnancy, cervical ectopic pregnancy and miscarriage in progress. In 2022, a standardised sonographic evaluation and reporting system for CSEP in the first trimester was published to raise awareness of this entity. We aim to provide a practical guide to the sonographer by outlining the pertinent obstetric history, imaging findings and differential diagnoses in these patients. Case Report: We report three cases of CSEP, diagnosed by ultrasonography in the first trimester. We also report three different conditions that may mimic CSEP. We include the clinical details, sonographic findings and patient outcomes. Discussion: The incidence of CSEP is suspected to be under-recognised and thus underreported. CSEP presents a substantial risk for severe maternal complications including uterine rupture, severe hemorrhage and placenta accreta spectrum disorders. This is complicated by challenges in securing an early diagnosis. When a first-trimester ultrasound reveals a GS in the lower third of the uterus, the sonographer must consider the differential diagnoses herein. Conclusion: We will present the recommended criteria using cases demonstrating the sonographic findings. Raising awareness of the four key sonographic markers of CSEP may improve sonographer detection rates, thus facilitating better patient management.
Ovarian torsion is a surgical emergency in which twisting of the ovarian vascular pedicle leads to ischaemia. Although an uncommon diagnosis in prepubescent girls, prompt recognition of this condition is essential in order to prevent ovarian necrosis, which can have long-term consequences in terms of fertility. Transabdominal ultrasound is the recommended imaging modality for diagnosing ovarian torsion; however, given the limited availability of paediatric-trained sonographers, patients may not obtain the necessary imaging in a timely manner. Point-of-care ultrasound performed by emergency department personnel has emerged as a useful adjunct to clinical examination and one that can help expedite specialist involvement. We describe two cases of prepubescent ovarian torsion presenting to our Paediatric Emergency Department, where point-of-care ultrasound played a key role in diagnosis and expediting definitive surgical management.
Purpose:This study aimed to evaluate the effects of dietary composition, physical activity, and body mass index on gallbladder recovery time following food consumption and to identify alternative scan preparation strategies for patients unable to fast before abdominal ultrasound. Methods:A quasi-experimental study involving 26 participants was conducted using four ultrasound sessions under different conditions: consumption of each dietary item with and without moderate physical activity. Gallbladder wall thickness and volume were measured hourly following standardised ultrasound protocols. Measurement reliability was assessed using the intraclass correlation coefficient on 30 randomly selected scans reviewed by two independent observers. Results:Recovery time significantly varied among meal types (χ²(2) = 18.42, p < .001), with wholemeal bread yielding the fastest and yogurt the slowest recovery. Physical activity significantly enhanced wall recovery (p = 0.002) but did not affect volume (p = 0.317). Body mass index showed no significant effect. Moderate and excellent intraclass correlation coefficients were achieved for gallbladder wall thickness (0.52) and volume (0.88), respectively. Conclusion:Wholemeal bread and postprandial physical activity serve as effective alternatives for ultrasound preparation when assessing gallbladder wall recovery. These findings promote patient-specific ultrasound protocols to improve diagnostic efficiency and comfort.
Objective:To evaluate the diagnostic performance of cystic artery colour Doppler ultrasound indices in differentiating acute from chronic cholecystitis and to assess their added value over clinical and grayscale findings. Methods:In this prospective study, 101 adults with clinically suspected cholecystitis underwent ultrasound before cholecystectomy. Grayscale features and colour Doppler measurements of cystic and hepatic artery peak systolic velocity and resistive index were recorded; histopathology was the reference standard. Logistic regression models using clinical and grayscale variables alone and then with cystic artery peak systolic velocity were evaluated with receiver operating characteristic analysis. Results:In total, 33 patients had acute and 68 had chronic cholecystitis. Acute cholecystitis showed more abnormal grayscale features, including increased gallbladder size, wall thickening and pericholecystic change. Cystic artery peak systolic velocity was higher in acute than chronic disease (40.8 ± 14.9 vs 26.1 ± 15.5 cm/s; p < 0.001), as was hepatic artery peak systolic velocity (74.0 ± 24.4 vs 60.2 ± 22.4 cm/s; p = 0.006), whereas resistive index did not differ meaningfully. Cystic artery peak systolic velocity showed fair discrimination (area under the curve 0.78; cut-off 31.5 cm/s; sensitivity 0.91; specificity 0.71); hepatic artery peak systolic velocity performed more modestly (area under the curve 0.67). Adding cystic artery peak systolic velocity to a grayscale-only model produced negligible improvement in overall performance. Conclusion:Cystic artery peak systolic velocity is a useful adjunct for distinguishing acute from chronic cholecystitis when grayscale findings are equivocal, whereas resistive index adds little diagnostic value. Routine Doppler assessment is unlikely to change decisions when grayscale ultrasound is definitive.
Three-dimensional prenatal ultrasound scans of a baby's facial features have become increasingly popular among parents in both private and clinical settings. Ultrasound practitioners often draw on their experience to identify factors that influence image quality when discussing scan outcomes with parents. This study aims to identify the maternal, fetal and technical factors that may affect the quality of three-dimensional souvenir face images during ultrasound scan. A retrospective quality review study was performed with data from a single-centre research study, including ultrasound videos of the fetal growth scans, three-dimensional facial ultrasound acquisitions and post-processing steps. A total of 342 three-dimensional surface-rendered images were attempted from 41 singleton pregnancy subjects, average gestational age 26.69 weeks, range: 21-30. The retrospective image quality for all images was assessed by two observers. Univariable ordinal regression test was used to investigate the associations between demographic/technical factors and the best image quality acheiveable. Of the 41 pregnancies, three-dimensional acquisition time was an average of 03:07 (mm:ss), (range: 01:22-5:31). In total, 49% of women had at least one good or moderate quality image, and 51% women had a poor quality or failed three-dimensional scan as the best quality possible. Image quality was associated with placenta site, explaining 18% of the variation (p < 0.05). We found a maternal-fetal factor which has a high impact on three-dimensional image quality of the prenatal face but nonetheless, sonographer skill, training and other technical factors may be employed to minimise the impact of detrimental factors.
Case Presentations: Four patients underwent close follow-up after prenatal diagnosis of congenital portosystemic shunt, identified via ultrasound during the early third trimester. Among these cases, three were associated with fetal growth restriction, and one presented with bilateral talipes. Fetal hemodynamics were largely normal, except for one case with moderate biventricular hypertrophy. Induction of labor was performed in two cases for pre-eclampsia and in one case for severe fetal growth restriction. The fourth case underwent a repeat caesarean section at 37 + 6 weeks. All newborns demonstrated good adaptation to extrauterine life, remained asymptomatic, and were clinically and hemodynamically stable. Spontaneous closure of the fistulas occurred without the need for surgical intervention. Discussion: Congenital portosystemic shunt is associated with a wide spectrum of postnatal outcomes, ranging from spontaneous closure to complications such as cardiac overload, metabolic disturbances, and pulmonary hypertension. Prenatal recognition allows appropriate postnatal surveillance and early detection of complications. In this series, all shunts were intrahepatic and closed spontaneously within the first year of life, with favorable clinical outcomes. Conclusion: Early detection of congenital portosystemic shunt through prenatal screening can lead to improved postnatal outcomes and prognosis. Prenatal Doppler ultrasound can identify congenital portosystemic shunt when careful attention is paid to hepatic vascular anatomy. Prenatal diagnosis of congenital portosystemic shunt is essential for optimising postnatal management.
Introduction:Artery flow-mediated dilation (FMD) is a non-invasive method for assessing vascular endothelial function and cardiovascular disease risk. Flow-mediated dilation is calculated as the percentage increase in arterial diameter following a post-ischemic increase in blood flow through ultrasound analysis. Manual extraction of flow-mediated dilation scores is time-consuming, operator-dependent, and prone to variability. Automated software solutions for processing ultrasound data could enhance efficiency, accuracy, standardisation, and scalability for clinical and research applications, especially when distributed as free, open-source tools accessible even to non-coders. However, no current software tools reporting these features are available for automatic flow-mediated dilation extraction. Methods:We developed aFMD Master, a free, open-source software tool with an intuitive graphical interface designed for non-coders. The software is compatible with most of the videos from different ultrasound scanners, extracts arterial diameters, and outputs PDF reports and Excel datasheets with flow-mediated dilation scores. Validation was conducted by comparing software outputs with manually obtained data from 115 participants, using scatter plots, Bland-Altman analysis, and other appropriate statistical metrics. Results:Strong correlation between the software and manual methods was obtained (R² = 0.97, p < 0.01). The Bland-Altman analysis showed minimal bias (-0.0015%), with 95% limits of agreement between -0.28% and 0.28%. The software showed high accuracy, minimal bias, and low variability, with negligible impact of errors, reflecting strong precision, consistency, and reliability. Conclusions:Validation showed excellent agreement with manual analysis, confirming accuracy, low bias, and consistency. The aFMD Master offers an accessible and reliable solution for automated flow-mediated dilation analysis, showcasing significant potential for research and clinical applications.
