Purpose:The lumbar plexus, formed by the anterior rami of T12/L1 to L4/L5, provides the main neural supply to the lower abdominal wall, groin, and anterior-medial thigh. Its principal peripheral branches (the iliohypogastric, ilioinguinal, genitofemoral, lateral femoral cutaneous, femoral, and obturator nerves) are clinically relevant targets for invasive diagnostic and therapeutic procedures, including nerve blocks and neuromodulatory techniques. This manual aims to describe how to visualize these six main lumbar plexus branches using ultrasound guidance. Materials and methods:For each nerve, this guide summarizes its typical anatomical course, key clinical considerations related to neuropathy or iatrogenic injury, the most relevant anatomical landmarks, recommended transducer positioning, and characteristic sonographic appearance. The text is complemented by illustrations of probe placement, schematic depictions of nerve pathways, and representative ultrasound images. Results:This manual provides a structured ultrasound-based approach for identifying the main lumbar plexus branches in the lower abdominal wall, groin, and thigh. It details the anatomical and sonographic features that facilitate nerve recognition and supports precise probe positioning and needle guidance when these nerves are targeted in clinical practice. Conclusions:Ultrasound guidance is encouraged when performing procedures involving lumbar plexus branches, as it may improve procedural accuracy and patient safety by enabling precise needle placement while reducing the risk of injury to adjacent non-target structures. This manual offers a practical anatomical and sonographic reference for clinicians performing ultrasound-guided interventions in this region.
Purpose To develop and validate an end-to-end interactive software that integrates lung ultrasound radiomics and machine learning for the objective assessment of pediatric pneumonia severity at the point of care. Materials and methods This retrospective study included a dataset of lung ultrasound images from 293 pediatric patients (157 with mild pneumonia and 136 with severe pneumonia). A total of 104 radiomics features were extracted from clinician-delineated regions of interest. Feature selection was performed using Least Absolute Shrinkage and Selection Operator regression, and 10 machine learning algorithms were constructed and evaluated. The optimal model was interpreted using SHapley Additive exPlanations. The finalized classifier was integrated into an interactive software platform that guides users from image upload to severity prediction. Results The Light Gradient Boosting Machine classifier, which forms the core of the software, demonstrated superior performance on the independent test set, achieving an accuracy of 89.8%, a sensitivity of 91.7%, a specificity of 88.6%, and an area under the curve of 90.1%. SHapley Additive exPlanation analysis identified and ranked the contribution of key predictive features, with morphological characteristics being the most influential. Conclusions We present an end-to-end interactive software that successfully leverages lung ultrasound radiomics and machine learning to provide an objective, accurate, and rapid assessment of pediatric pneumonia severity. This tool has significant potential to standardize diagnosis and support clinical decision-making in real-world settings.
Purpose This study aimed to assess the feasibility of dynamic contrast-enhanced ultrasound with Sonazoid, its correlation with disease activity, its ability to differentiate between remission/mild activity and moderate/severe activity, and if a region of interest including the mucosa and submucosa was different compared to one encompassing the entire wall. Materials and methods We prospectively studied 48 patients with Crohn's disease who underwent colonoscopy and dynamic contrast-enhanced ultrasound with Sonazoid from 2015 to 2019. We compared the local simple endoscopic score for Crohn's disease in the most affected area with parameters from Vuebox, including peak enhancement, wash-in and wash-out area under the curves, wash-in and wash-out rates, and wash-in perfusion index. Region of interest-1 (ROI-1) included all wall layers, and region of interest-2 (ROI-2) included the mucosa and submucosa. Linear data and normalised data were used. Technical failure or a quality of fit value of<80% was considered a failed examination. Results The feasibility of the dynamic contrast-enhanced ultrasound examination was 73%. No significant findings were noted in the linear data ( p >0.05). In the normalised data in both ROI-1 and ROI-2, the local simple endoscopic score for Crohn's disease correlated significantly with peak enhancement ( r =0.38 and r =0.35), wash-in rate ( r =0.34 and r =0.34), and wash-in perfusion index ( r =0.40 and r =0.37) and with wash-in area under the curve ( r =0.36) in ROI-2. In patients with moderate/severe disease peak enhancement, wash-in area under the curve, wash-out area under the curve, wash-in rate, and wash-in perfusion index were significantly higher in both region of interests ( p <0.05). All parameters were significantly different in ROI-1 and ROI-2 ( p <0.05). Conclusions Dynamic contrast-enhanced ultrasound parameters can differentiate between remission/mild and moderate/severe activity in Crohn's disease, but the method has relatively low feasibility.
Purpose The aim of this study was to assess bowel wall thickness using B-mode ultrasound (US) and perfusion measurement by DCE-US in patients with a food allergy (FA) compared to healthy controls (HCs) and patients with active Crohn's disease (CD). Materials and Methods Bowel wall thickness and perfusion were assessed in FA patients as well as in HCs on a potato rice diet (PRD) and after a provocation diet (PD). Additionally, patients with active CD were examined for further comparison.Results A total of 48 individuals (20 with FAs, 20 with CD, and 8 HCs) were included. There was no significant difference between the HCs and patients with FAs regarding the thickness of the terminal ileum (1.8mm vs. 2.2mm; p=0.46) and the sigmoid colon (2.1mm vs. 2.1mm; p=1) on a PRD. After a PD, the median value was significantly lower in the terminal ileum for HCs compared to patients with FAs (1.6 mm vs. 2.3 mm; p=0.03). In CD patients, the thickness of the terminal ileum was far more pronounced (median thickness 6 mm) compared to HCs and patients with FAs (p<0.001). There was no statistically significant difference for all tested DCE-US parameters in the terminal ileum between the HCs and patients with FAs on either PRD or PD. However, DCE-US perfusion parameters (PE, WiAUC, WiR, WiPi, and WoR) were significantly higher in patients with CD compared to HCs and patients with FAs on a PD. Conclusion Assessment of wall thickening of the terminal ileum using US and perfusion measurements via DCE-US appears to be insufficient for distinguishing between HCs and patients with FAs. However, US and DCE-US could be helpful in differentiating patients with CD from those with FAs.
Purpose:To investigate the potential correlation of dynamic contrast-enhanced ultrasound (DCE-US) with angiogenesis activity of renal cell carcinoma (RCC). Materials and Methods:Patients with surgery resection and histopathologically proven RCC lesions were included. B-mode ultrasound (BMUS) and contrast-enhanced ultrasound (CEUS) were performed one week before surgery. SonoVue was injected as the contrast agent. VueBox (Bracco, Italy) was used for the quantitative analysis. According to the histopathological and immunohistochemical results, patients were classified into two groups: active angiogenesis and inactive angiogenesis. Time intensity curves (TICs) and quantitative parameters were compared between two groups. Results:From July 2023 to November 2023, a total of 50 patients (13 females and 37 males, mean age 61.1±11.1 years) were included. The mean size of the lesions was 39.4±2.7 mm. Patients were classified into the active angiogenesis group (n=30) and the inactive angiogenesis group (n=20). On BMUS, 68.0% (34/50) of RCCs were visualized as hypoechoic lesions with ill-defined borders and irregular shapes (P>0.05). During cortical phase of CEUS, 72.6% (23/30) of RCCs with active angiogenesis were visualized with hyperenhancement (P=0.027). Only 30.0% (9/30) of RCCs with active angiogenesis showed hypo-enhancement in the parenchymal phase (P>0.05). Compared to the inactive angiogenesis group, TICs of the active angiogenesis group revealed faster and greater enhancement in the cortical phase, slower decline during the parenchymal phase, and an increased area under the curve. Among quantitative parameters, the active angiogenesis group showed the higher ratio of wash-in rate and wash-in perfusion index (P<0.05). Conclusion:DCE-US analysis has potential value in predicting angiogenesis activity in RCC lesions.
Purpose:This study aimed to measure the precise distance from the lowest boundary of a rectal tumor to the anal verge (DTAV) in patients with rectal cancer. Materials and Methods:A retrospective analysis was performed on clinical data from 70 rectal cancer patients. DTAV measurements were collected using transrectal biplane ultrasound, MRI, and colonoscopy. Results:The difference in DTAV measurements between the mean DTAV value obtained by ultrasound (US mean ) and colonoscopy exhibited a difference of 0.22 cm. In contrast, the difference between US mean and MRI was 0.48 cm, while the difference between MRI and colonoscopy was -0.26 cm. The ICC for DTAV measurements demonstrated excellent agreement, with values of 0.948 between US mean and MRI, 0.942 between US mean and colonoscopy, and 0.943 between MRI and colonoscopy. The minimum DTAV value obtained by ultrasound (US min ) was 5.05 cm, the middle DTAV value obtained by ultrasound (US mid ) was 5.10 cm, and the maximum DTAV value obtained by ultrasound (US max ) was 5.30 cm. Notably, the median values of the differences in DTAV measurements between US max and US min , US max and US mid , as well as US mid and US min , were 0.2 cm, 0.1 cm, and 0.1 cm, respectively. Furthermore, the consistency of DTAV measurements between US min and US mid , US max and US mid , as well as US min and US max was excellent, with all ICC values reaching 0.999. Additionally, the radiologist's reassessment of MRI DTAV data showed excellent consistency with the original results, with an ICC value of 0.985. Conclusion:Transrectal biplane ultrasound utilizing EFOV imaging technology exhibited both accuracy and reproducibility for measuring DTAV. This approach provided a highly efficient and practical clinical tool for DTAV measurement.
Purpose:Little is known about the benefit and interpretation of fetomaternal Doppler sonography in GDM for the prediction of an adverse perinatal outcome (APO). The aim of this study was to examine the performance of fetomaternal Doppler for APO prediction in pregnancies with GDM at term. Materials and Methods:This is a retrospective cohort study of singleton, non-anomalous fetuses of women with GDM, who primarily had a vaginal delivery attempt. Study inclusion also required no other major fetomaternal abnormalities that make placental dysfunction likely. Data on fetomaternal Doppler sonography including umbilical artery pulsatility index (PI), middle cerebral artery (MCA) PI, cerebroplacental ratio (CPR), mean uterine artery PI, cerebro-placental-uterine ratio (CPUR) was collected from 37+0 weeks on. Multivariate logistic regression analyses were performed using maternal characteristics, neonatal characteristics, and Doppler ultrasound parameters as independent variables with CAPO as a binary outcome. Results:A total of n=88 cases were included. Nulliparity (p=0.032) and CPUR (p=0.052) were independent predictors of CAPO. However, CPUR had borderline significance. All other Doppler indices were not independent predictors of CAPO. The ability of CPUR alone (AUC=0.65, 95% CI 0.51 to 0.80) to discriminate between GDM pregnancies with and without CAPO was poor. Conclusion:This study shows that there is no significant clinical relationship between fetomaternal Doppler indices and CAPO among pregnancies with GDM. This raises the question regarding the extent to which fetomaternal Doppler indices, which reflect placental function, can be helpful for CAPO prediction in GDM pregnancies.
Purpose:Native X-ray, magnetic resonance imaging (MRI), and computed tomography (CT) are standard methods for determining head-neck offset (HNO) in femoro-acetabular impingement (FAI). Our hypothesis was that sonography-assisted determination of the offset in CAM deformity of the hip is a cheap, radiation-free, and reliable alternative to conventional alpha-angle determination. Methods:Patients with hip pain and suspected CAM impingement who underwent anterior-longitudinal hip sonography according to DEGUM standard procedures and MRI were included in this single-center study between January 2015 and December 2019. Offset was determined three times on MRI and sonography by two independent investigators. Results:285 patients were screened and 110 patients (49 females, 61 males) met the inclusion criteria. The mean age at the time of investigation of 54 left and 56 right hip joints was 54.2 years. 1320 measurements were performed. No significant difference in HNO determination between MRI (6.11 mm+/-2.37) and sonography (5.93 mm+/-2.20) could be identified. The mean difference was 0.32 mm+/-0.32 mm (p>0.05) with a maximum deviation of 2.08 mm (outlier). Conclusion:Sonography-assisted determination of head-neck offset is a reliable and reproducible method and is not inferior to determination with MRI. Sonography can be used initially as an alternative or additional tool for the qualitative determination of CAM deformity of the hip joint.
Background Ultrasound (US) surveillance for transjugular intrahepatic portosystemic shunt (TIPS) dysfunction has yet to be standardized, as clear-cut criteria have not been conventionally defined. This study evaluated the role of US-based parameters in detecting hemodynamic TIPS dysfunction (HD). Methods We included consecutive patients treated with TIPS. All patients were scheduled within the first six weeks after the procedure for TIPS revision, comprised of a Doppler US exam and invasive hemodynamic reassessment. Clinical TIPS dysfunction (CD) was defined as symptom recurrence, while HD was defined by a portal pressure gradient (PPG) >= 12 mmHg. The predictive capabilities of Doppler US for predicting TIPS dysfunction were tested against the hemodynamic gold standard. Results 86 patients were included. Secondary prophylaxis of variceal bleeding was the main indication for TIPS in 72 patients (83.7%), while 27 (31.4 %) had refractory ascites. HD occurred in 37 cases (43 %), of which 25 patients (67.5 %) had no CD. Patients with HD had a significantly lower portal vein velocity (PVV): 35 (20-45) cm/s vs. 40.5 (35-50) cm/s, p = 0.02. Compared to the immediate post-TIPS assessment, the patients without HD had a Delta PVV of 6.08 +/- 19.8 cm/s vs. a decrease of -8.2 +/- 20.2 cm/s in HD (p = 0.04). Using a cut-off value of 40.5 cm/s, PVV had an AUROC of 0.705 for predicting HD, while the addition of Delta PVV (cut-off 9.5 cm/s) improved the AUROC to 0.78. Conclusion Despite adequate symptom control, a considerable percentage of patients have a post-TIPS PPG >= 12 mmHg. The dynamic assessment of PVV and its temporal dynamics can reliably predict TIPS dysfunction.
Purpose To detect sonographic abnormalities of the supratentorial structures of the brain - future cavum septum pellucidum, cavum velum interpositum, third ventricle, ganglionic eminence and thalamus/hypothalamus - in fetuses with a crown-rump length of 45-84 mm in high-risk pregnancies. Materials and Methods This study presents the retrospective analysis of transvaginally recorded 3D volumes of the fetal brain of 64 fetuses whose mothers consulted our ambulatory department for fetomaternal medicine for organic and/or genetic changes of their fetuses at GW 12-14. For this study we selected fetuses with 3D volume blocks of the fetal brain at best sonographic quality enabling detailed analysis and measurement of the supratentorial brain structures to correlate the results with the results of genetic analysis, ultrasound controls in later weeks of pregnancy, and fetal outcome. Results Of 44 fetuses with genetic changes and 20 fetuses with syndromic changes, structural brain changes were found in 27 fetuses, analyzed by correlating the brain structures with the recently published structures of the brain at gestational week 12-14 in early pregnancy, presenting new details of early pathological brain development - migration disorders, milder variants of holoprosencephaly (lobar, MIH), corpus callosum agenesis, for the first time in early pregnancy. Conclusion Supratentorial defects of the brain can be detected and analyzed in GW 12-14 in detail by direct analysis of sonopathology and visualization of pathological measurements using transvaginal 3D sonography in high quality.
Purpose We analyzed which contrast-enhanced ultrasound (CEUS) parameters are associated with reduced kidney function in the early postoperative period and are prognostic for kidney function six months after transplantation. Materials and Methods This prospective observational study included 74 patients in whom quantitative CEUS analysis and Doppler ultrasound were performed early after kidney transplantation (10±6 days). For each region of interest (ROI) the time-to-peak intensity (TTP) and the respective delta between ROIs within interlobar artery, cortex, and medulla were compared. Results were correlated with kidney function at the time of imaging and six months later. Results Patients with an eGFR<30 ml/min at the time of investigation had significantly slower cortical enhancement with a longer cortical TTP (cTTP: 16.1±0.9 vs. 11.7±0.7 sec, p<0.001), as well as a significant delay between the arterial and cortical phases (c-a), as shown in longer ∆TTP (c-a): 8.2±0.9 vs. 4.2 ± 0.5 sec, p<0.001. There was a significant negative correlation between cTTP and eGFR with a correlation coefficient of -0.37 (p<0.001), as well as between ∆TTP (c-a) and eGFR with a correlation coefficient of -0.40 (p<0.001). Reduced kidney function after 6 months correlated significantly with the findings of the initial CEUS examination (p=0.005, correlation coefficient -0.39). Conclusion CEUS revealed significant differences in temporal enhancement dynamics in patients with reduced kidney function after transplantation. Quantitative CEUS might therefore be able to depict graft function regarding microvascular damage and be of prognostic value regarding long-term renal outcomes.
Purpose A 4-step lung ultrasound (LUS) score has been previously used to quantify lung density. We compared 2 versions of this scoring system for distinguishing severe from moderate loss of aeration in ARDS: coalescence-based score (cLUS) vs. quantitative-based score (qLUS - >50% pleura occupied by artefacts). Materials and Methods We compared qLUS and cLUS to lung density measured by quantitative CT scan in 12 standard thoracic regions. A simplified approach (1 scan per region) was compared to an extensive one (regional score computed as the mean of all relevant intercostal space scores). Results We examined 13 conditions in 7 ARDS patients (7 at PEEP 5, 6 at PEEP 15 cmH2O-156 regions, 398 clips). Switching from cLUS to qLUS resulted in a change in interpretation in 117 clips (29.4%, 1-point reduction) and in 41.7% of the regions (64 decreases (range 0.2-1), 1 increase (0.2 points)). Regional qLUS showed very strong correlation with lung density (rs=0.85), higher than cLUS (rs=0.79; p=0.010). The agreement with CT classification in well aerated, poorly aerated, and not aerated tissue was moderate for cLUS (agreement 65.4%; Cohen's K coefficient 0.475 (95%CI 0.391-0.547); p<0.0001) and substantial for qLUS (agreement 81.4%; Cohen's K coefficient 0.701 (95%CI 0.653-0.765), p<0.0001). The agreement between single spot and extensive approaches was almost perfect (cLUS: agreement 89.1%, Cohen's kappa coefficient 0.840 (95%CI 0.811-0.911), p<0.0001; qLUS: agreement 86.5%, Cohen's kappa coefficient 0.819 (95%CI 0.761-0.848), p<0.0001). Conclusion A LUS score based on the percentage of occupied pleura performs better than a coalescence-based approach for quantifying lung density. A simplified approach performs as well as an extensive one.
Reliable and reproducible measurement methods have been established, and reference values are used in almost all scientific disciplines. Knowledge of reference values is crucial to distinguish physiological from pathological processes and, therefore, subsequently, for the clinical management of patients. Image storage and documentation of measurements and normal findings should be part of quality assurance in imaging. This paper aims to review the published literature and provide current knowledge of sonographic measurements and reference values of the pancreas. Moreover, the role of clinical influencing factors such as age, gender, constitution, and ethnicity is also analyzed.
The history of the emerging elastographic technique is presented. Ultrasound imaging of elasticity and tissue strain has gained clinical acceptance as an established technique useful in routine daily clinical practice.
