Objectives To establish a reliable ultrasound (US) method of evaluating dynamic extrusion of lateral meniscus in healthy population, and to investigate the pattern of dynamic meniscus extrusion (ME) in lateral meniscus under loading conditions. Methods The lateral ME was examined via US method in unloaded, double‐leg standing, and single‐leg standing positions. Two different US measurement methods were compared to the magnetic resonance imaging (MRI) results to determine the optimal measurement methods. The US results obtained by different researchers were tested for interobserver consistency and the results obtained by the same researcher on two separate days were tested for intraobserver consistency. The patterns of dynamic extrusion were compared between medial and lateral sides. Results A total of healthy 44 volunteers were included in the study, with 86 knees assessed by US, and 25 knees evaluated by MRI. The US evaluation of dynamic lateral ME demonstrated excellent interobserver and intraobserver reliability. The US measurements using method A were consistent with the MRI results with no significant difference ( P = .861, intraclass correlation coefficient [ICC] = 0.868), while method B underestimated the lateral ME compared to MRI ( P = .001, ICC = 0.649). Lateral ME decreased slightly from unloaded (1.0 ± 0.8 mm) to single‐leg standing position (0.8 ± 0.8 mm), whereas medial ME increased significantly in both double‐leg and single‐leg standing positions (2.4 ± 0.7 mm, 2.6 ± 0.7 mm). Conclusion A novel US evaluation method of lateral ME was established with reliable and accurate results compared to the MRI. Lateral ME in healthy populations decreased slightly as the loadings increased, which was different from the pattern of dynamic extrusion in medial meniscus.

目的 评估实时超声引导下尺神经周围药物注射及去除病因治疗肘管综合征的临床价值.方法 回顾性分析行超声引导下单侧尺神经周围药物注射治疗肘管综合征的患者40例,其中男23例,女17例,年龄42～68岁,平均(56±10.5)岁.结合临床病史及超声检查,对其中12例类风湿性关节炎患者、5例肘管处腱鞘囊肿患者进行针对病因的治疗.采用门诊和电话方式随访,分别记录治疗前和治疗后的患者尺侧手指疼痛的疼痛视觉模拟评分(VAS),应用配对t检验比较治疗前和治疗后1周、1个月的VAS评分.结果 40例患者肘管处尺神经平均最大横截面积约9.2 mm2,其中12例类风湿患者可见肘关节滑膜增生挤压尺神经,5例患者可见肘管处腱鞘囊肿压迫尺神经.40例患者均成功进行超声引导下介入治疗.40例患者治疗前疼痛VAS评分(7.7±0.9)分,治疗后1周VAS评分(3.6±1.2)分,治疗后1个月VAS评分(3.1±1.1)分,与治疗前比较均明显降低并具有统计学意义(P＜0.05).结论 实时超声引导下尺神经周围药物注射及去除病因治疗肘管综合征是一种安全、有效的方法.

目的 研究分析原发性睾丸淋巴瘤的多模态超声声像图特征.方法 回顾性分析20例经病理证实的原发性睾丸淋巴瘤患者的声像图资料,包括灰阶超声、彩色多普勒超声、超声造影和弹性成像.结果 20例原发性睾丸淋巴瘤,其中19例为弥漫性大B细胞淋巴瘤,1例为成熟T细胞淋巴瘤.灰阶超声显示8例患者为弥漫型,表现为睾丸明显肿大伴回声弥漫性减低;12例患者为结节型,表现为睾丸实质内单个或多发低回声结节.彩色多普勒超声显示弥漫型和结节型病灶内均可见丰富的血流信号,为Ⅲ级血流.3例患者超声造影检查发现睾丸病灶平均灌注时间为5.7 s,睾丸病灶灌注强度高于正常睾丸实质.1例弥漫型患者行剪切波弹性成像,病变侧睾丸弹性值为17 kPa,而对侧正常睾丸弹性值为3.4 kPa.结论 原发性睾丸淋巴瘤的超声声像图具有一定的特征,充分应用多模态超声成像有助于原发性睾丸淋巴瘤的准确诊断.

OBJECTIVE:We developed an intelligent assistance system for shoulder ultrasound imaging, incorporating deep-learning algorithms to facilitate standard plane recognition and automatic tissue segmentation of the rotator cuff and its surrounding structures. We evaluated the system's performance using a dedicated data set of rotator cuff ultrasound images to assess its feasibility in clinical practice.METHODS:To fulfill the system's primary functions, we designed a standard plane recognition module based on the ResNet50 network and an automatic tissue segmentation module using the Mask R-CNN model. The modules were trained on carefully curated data sets. The standard plane recognition module automatically identifies a specific standard plane based on the ultrasound image characteristics. The automatic tissue segmentation module effectively delineates and segments anatomical structures within the identified standard plane.RESULTS:With the use of 59,265 shoulder joint ultrasound images, the standard plane recognition model achieved an impressive recognition accuracy of 94.9% in the test set, with an average precision rate of 96.4%, recall rate of 95.4% and F1 score of 95.9%. The automatic tissue segmentation model, tested on 1886 images, exhibited a commendable average intersection over union value of 96.2%, indicating robustness and accuracy. The model achieved mean intersection over union values exceeding 90.0% for all standard planes, indicating its effectiveness in precisely delineating the anatomical structures.CONCLUSION:Our shoulder joint musculoskeletal intelligence system swiftly and accurately identifies standard planes and performs automatic tissue segmentation.

目的 探讨超声在股直肌腱钙化性肌腱炎诊断中的应用价值.方法 回顾性分析35例因腹股沟区疼痛在我院行超声检查并诊断为股直肌钙化性肌腱炎的患者,观察股直肌腱的病变部位、厚度,内部回声、钙化灶形态、局部血流情况及有无其他并发症.结果 股直肌钙化性肌腱炎主要累及直头(91.4％),患侧股直肌腱较健侧多肿胀增厚(74.3％),腱体内结构紊乱(71.4％),回声减低(91.4％),局部血流信号增多(42.8％),腱体内钙化灶以Ⅱ型和Ⅲ型为主(65.7％),边缘不清(68.6％),在超声扫查过程中35例患者局部均有明显压痛.结论 超声能显示病变肌腱的形态和回声变化,动态观察钙化部位及其与周围组织的关系,可作为该病的理想影像检查方法.

Objective:Based on the research results of the national continuing medical education project "musculoskeletal ultrasound and new technology quality class" held by the Department of Ultrasound Diagnosis of Peking University Third Hospital, to explore and analyze the effect of basic and applied teaching method based on musculoskeletal ultrasound.Methods:Totally 109 participants attending the classes held on April 14-18, 2019 and on September 9-13, 2019 were selected as study objects, and the training effects of quality private classes were evaluated by questionnaires, operational tests and theoretical tests. SPSS 21.0 was used for t test. Results:The results showed that more than 80% of students were satisfied with the teaching content, teaching plan and teaching materials. Through the class training, the greatest gains of the students were that the operation ability [67 cases (30.7%)] and the theoretical level [53 cases (24.3%)] had been significantly improved. All 109 students passed the operation test. There were no statistical differences in the average scores of theoretical tests among the students with different professional titles, academic qualifications and whether they were from primary hospitals (75-80 points, P>0.05) . Conclusion:The musculoskeletal ultrasound quality private class can improve the students' operating ability and theoretical level in the musculoskeletal system. The class model can guarantee the teaching quality and provide a new direction for continuing medical education.

目的:探讨超声引导下选择性神经根脉冲射频联合药物治疗神经根型颈椎病的有效性及安全性.方法:回顾分析2017年1月至2020年6月北京大学第三医院疼痛科住院的46例神经根型颈椎病病人临床资料,均在超声引导下行颈椎神经根脉冲射频联合药物治疗,采用疼痛数字评分法(numerical rating scale,NRS)进行疼痛程度评分,并进行临床治疗效果评价以及记录并发症的发生情况.结果:41例病人可清晰显示C4～8神经根,5例病人通过射频治疗仪定位确认,46例病人均100％穿刺顺利,治疗前及术后1周、4周、12周、24周NRS评分分别为6.8±1.0、3.0±0.8、3.1±0.8、2.8±0.7、2.7±0.8,术后各时点NRS评分与术前相比较差异有统计学意义(P<0.01).术后1周、4周、12周、24周治疗的优良率分别为89.1％、80.4％、80.4％、76.1％.所有病人均无神经损伤等并发症.结论:超声引导下选择性颈椎神经根阻滞联合脉冲射频治疗神经根型颈椎病效果可靠,安全性高,无明显不良反应.

目的 探讨急诊超声在网球腿诊断中的应用价值.方法 回顾性分析因小腿损伤在我院行急诊超声检查的2 225例患者,观察小腿三头肌的损伤情况.结果 2 225例患者中,850例患者为单纯腓肠肌内侧头损伤;267例患者为腓肠肌内侧头损伤合并跟腱完全断裂;35例患者为腓肠肌内侧头损伤合并跟腱部分断裂;11例患者为腓肠肌外侧头损伤;15例患者为腓肠肌内、外侧头联合损伤;30例患者为比目鱼肌损伤;所有患者中有14例存在跖肌损伤;1 017例患者小腿三头肌未见异常.结论 急诊超声对网球腿的诊断准确度高,具有重要的临床意义.

患者女 , 25岁.双乳肿物就诊 ,超声检查:右乳低回声结节 (图1) ,大小约24 mm × 13 mm ,形态不规则 , CDFI :结节周边及内部可见血流信号;左乳低回声结节 ,大小约26 m m × 15 m m (图2 ) ,形态不规则 ,CDFI :结节内未见血流信号.结合超声检查结果行双乳肿物切除.术后病理 :根据免疫组化结果 ,双侧β-catenin (浆+ ) ,考虑为 (双侧) 韧带样纤维瘤病.

Objective To explore convenient and effective ultrasound scanning methods and skills for imaging the distal biceps tendon.Methods Totally 80 distal biceps tendons of 40 healthy volunteers were scanned and evaluated with high-frequency ultrasound using the direct and the indirect methods. The scanning time and the subjective comfort scores of each subject were recorded. The imaging clarity of the tendon and its insertion onto the radial tuberosity was evaluated.Results The scanning time of the indirect method was shorter than that of the direct method in all volunteers,male volunteers,and female volunteers,although the differences were not statistically significant(all P> 0.05). The mean scanning time was longer on the left side than on the right side regardless of the scanning method (all P> 0.05). The scanning time in women was significantly shorter than in men when the scan was performed by using indirect method on the left side (t=-2.33,P=0.025),direct method on the right side (t=-3.35,P=0.002),or indirect method on the right side (t=-2.67,P=0.011). However,the scanning time was not significantly different between women and men when using the direct method on the left side (t=-1.27,P=0.213). The subjective comfort score was not significantly different between direct and indirect methods in each group (all P>0.05). However,the subjective comfort score was higher on the right side than on the left side regardless of the methods used. In particular,the subjective comfort scores showed significant difference when using the direct method in all subjects (t=2.32,P=0.026),the indirect method in all subjects (t=3.08,P=0.004),and indirect method in females (t=2.52,P=0.021). The overall subjective comfort score of females was higher than that of males,and the difference was statistically significant when the direct method was used on the right side (t=2.33,P=0.025),although no significant difference was observed for the indirect method on the right side (t=2.00,P=0.053),direct method on the left side (t=0.34,P=0.739),and indirect method on the left side (t=-0.15,P=0.884). The clarity rates of the indirect method for the insertions were 100.0% and 95.0%,which were significantly higher than those of the direct method(right side:100.0% vs. 85.0%,P=0.026;left side:95.0% vs.60.0%,P=0.000). The clarity rates of the main trunk of the tendon showed no significant difference between direct and indirect methods on both sides (right side:100.0% vs.95.0%,P=0.494;left side:92.5% vs.87.5%,P=0.712).Conclusions When high-frequency ultrasound is applied for scanning the distal biceps tendon,the scanning time and the subjective comfort are similar when either the direct method or the indirect method is used. The indirect method has higher clarity in imaging the insertion and may be used as the preferred scanning method,whereas the direct method may serve as a supplementary method.

Objective To evaluate the safety and efficacy of ultrasound-guided selective posterior medial branch of lumbar nerve interventional therapy in the chronic low back pain patients.Methods 40 patients with chronic low back pain who received selective posterior medial branch of lumbar nerve interventional therapy in our hospital were reviewed.The radiofrequency needle under ultrasound guidance was inserted into the corresponding lumbar transverse process and the articular facet junction.The X-ray fluoroscopy was used to adjust the position of the needle, and the sensory test was performed.Using real-time ultrasonography to monitor the posterior medial branch of lumbar nerve drug block and radiofrequency ablation therapy.The VAS score before treatment and 1 month and 6 months after treatment were recorded respectively.Results The RF needles were successfully placed in the lumbar transverse process and the articular facet junction in all 40 patients, and can induce the corresponding sensory response.The VAS score were (8.9±0.9) in the 40 patients before treatment, and the VAS score 1 month and 6 months after treatment were (3.7±1.3) and (3.2±1.1), which were significantly decrease (P＜0.001).Conclusions Real-time ultrasoundguided selective posterior medial branch of lumbar nerve drug block and radiofrequency ablation in the treatment of chronic low back pain is a safe and effective technique.

探讨PBL教学法在北京大学第三医院超声科住院医师规范化培训中的应用,通过以临床问题为导向的教学方法,结合超声科住院医师规范化培训要求,以超声科临床诊断中的具体疾病作为典型病例,由浅入深设计PBL教学课题,充分发挥住院医师的自主能动性和独立探索问题的能力,培养超声科住院医师的临床诊断思维,从而提高住院医师规范化培训的教学质量.

目的 探讨肱二头肌远端肌腱厚度正常值及常见病变的超声表现.方法 应用高频超声获取50例健康志愿者的双侧共100条肱二头肌远端肌腱的系列长轴切面声像图,测量其厚度,分析其相关因素.回顾性分析15例肱二头肌远端肌腱疾病患者的声像图资料,观察其声像图表现.结果 高频超声可以清晰显示肱二头肌远端肌腱的走行和结构,正常肱二头肌远端肌腱的平均厚度为(3.51±0.45) mm,双侧肱二头肌远端肌腱的厚度均值差异均无统计学意义(P=0.504).男性肱二头肌远端肌腱平均厚度大于女性,且其厚度均值的差异存在统计学意义(P＜0.001).肱二头肌远端肌腱的厚度与身高、体质量有不同程度的相关性,且均呈正相关.不同的肱二头肌远端肌腱病变具有各自特征性的超声声像图表现,超声动态实时扫查有助于准确诊断及鉴别诊断.结论 高频超声是评估肱二头肌远端肌腱结构、诊断和鉴别肱二头肌远端肌腱病变的有效影像学工具,具有重要的临床应用价值.

在超声科进修医师肌骨超声教学中引入"专业学习共同体"这一新的教学方法,通过设置共同的学习目标,创建共享性实践操作和支持性专业指导,探讨"专业学习共同体"在超声科进修医师继续教育中的应用价值,以达到提高进修医师教学质量的目的,并以此推动进修医师继续教育的长远发展.

Objective To investigate the safety and efficacy of ultrasound-guided drug injection therapy for plantar fasciitis.Methods Thirty patients with plantar fasciitis who received ultrasound-guide drug injection therapy were reviewed.The thickness of plantar fascia and VAS score before and 1 month and 6 months after treatment were recorded respectively.Injection drugs were compound betamethasone and lidocaine hydrochloride mixture.Results 30 patients were completed ultrasound-guided drug injection therapy successfully,no obviously complications.Ultrasonography showed a thickening of the plantar fascia at the plantar calcaneal nodules,with an average thickness about (4.5 ±1.0) mm.The mean thickness of the 1 month and 6 months after treatment were (4.0±0.8) mm and (4.1±1.1)mm,which were statistically different from those before treatment(P＜0.001).The VAS score was (8.53±0.57) in the 30 patients before treatment,and the VAS score 1 month and 6 months after treatment were (2.36±0.55) and (3.53±0.62),which were significantly decrease(P＜0.001).Conclusions Ultrasound-guided drug injection therapy for plantar fasciitis is a safe and effective method.

Objective To investigate the safety and efficacy of fusion of real-time US with CT images guided selective lumbosacral nerve root injection.Methods Forty patients with lumbar radiculopathy who received guided injection therapy were reviewed.They were randomly divided into fusion-Imaging guidance group(20 cases)and single-US guidance group (20 cases).Needle positioning of two groups were identified by x-ray fluoroscopy.The total puncture time and fluoroscopy times were recorded respectively.Then the sequential therapies were performed by the pain physician.Results All forty patients were successfully completed puncture.In fusion imaging group,the total time of puncture was 13-18 min,the mean (15.7±1.4) min;fusion imaging time was 4-8 min,mean (6.9±1.3) min;registration error was 3.0-5 mm,average (4.1±0.61) mm;the distance of D was 1.2-2.2 cm,average (1.60± 0.25) cm and the number of x-ray fluoroscopy were 3-5 times,mean (3.9±0.8) times.In single-US group,the total time of puncture was 9-21 min,the mean (16.4±2.6) min and the number of x-ray fluoroscopy was 4-8 times,mean (6.1± 1.1) times.For x-ray fluoroscopy there was significant difference between two groups (t =6.914,P＜ 0.001).Conclusions Fusion imaging is safe and effective for selective nerve root injection therapy for lumbosacral radiculopathy patients.

Objective To discuss the effect of “practice teaching methods ” in musculoskeletal ultrasound diagnosis training process .Methods Thirty refresher doctors for a month with the method training .The effect training is evaluated by objective exam and questionnaire survey .Results Thirty refresher doctors received tests before and after the training .Test results showed that the accuracy after the training was significantly higher than that of before ( P<0.05 ) .Refresher doctors survey about satisfaction of the training method showed that whole satisfaction is 100%, in which 70%were very satisfied , 30%were satisfied .The self-assessment results for the improvement of the level of diagnosis musculoskeletal ultrasound showed that 45%doctors are very satisfied ,40%doctors are satis-fied, and 15%is not satisfied .Conclusions With the implementation of “teaching by practice” method, refresher doctors could master the knowledge of musculoskeletal anatomy as soon as possible , and have the ability to diagnose common musculoskeletal diseases independently .

To evaluate the diagnostic performance of contrast-enhanced ultrasound (CEUS) in differential diagnosis of inflammatory bowel disease (IBD) and colon cancer, we enrolled 51 patients with thickened bowel walls (13 with IBD and 38 with colon cancer). Ultrasound and CEUS were performed and both qualitative and quantitative features were analyzed. The intestinal wall stratification was preserved in 63.6% of the IBD group but in only 2.6% of the colon cancer group (p <0.01). On CEUS, disordered enhancement and heterogeneous enhancement were shown in only 9.1% and 0%, respectively, of the IBD group while in 94.7% and 78.9%, respectively, of the colon cancer group (p <0.01). For quantitative analysis, compared to IBD, colon cancer showed later enhancement and slower wash-out with less speed to reach peak intensity (p <0.05). In conclusion, CEUS may prove useful for the differential diagnosis of IBD and colon cancer, but more studies are required.

Foreign body (FB) removal represents a large part of the work in surgical practice.[1] However, FB removal may often be a surgical challenge because of the nonpalpated and close anatomical relationship of the FB to vital structures or due to patients with cicatricial diathesis.[2] Retained FBs may result in infection, chronic pain, structural injury, granuloma, and psychological distress, especially with late presentation (more than 1 week from the time of injury).[13] Between December 2011 and February 2016, 12 consecutive patients with retained FBs were examined at our department. They were 8 men and 4 women, aged 10–68 years (mean age, 42.7 years). Indications for ultrasound-guided FB removal were as follows: FB was retained in the soft tissue for various reasons; the FB was visible on ultrasound with an apparent safe-guided access;[2] the FB was located in the subcutaneous soft tissue a distance of <30 mm from the skin; and the patient did not want the FB to be surgically removed or patient was with cicatricial diathesis. The FBs included one cactus needle, one jujube thorn, a metal fragment, and one shard of glass, and the remaining eight were all wooden splinters. Small FBs were retained in the various areas of the body, including four fingers, two feet, two calves, one palm, one forearm, one back, and one ankle. The pretherapeutic duration was from 2 weeks to 1.5 years. Two patients underwent surgical exploration without the use of ultrasound examination to detect the FB before, and the outcome turned to be a failure. The remaining ten patients presented to our department complaining of a persistent FB sensation without previous treatment. The distance between the FBs and the skin was 8.8 mm (range: 3–23 mm). The largest diameter of FB was 11.9 mm (range: 4–25 mm). All FB removal procedures were performed under real-time ultrasound guidance by one radiologist with >10 years of experience in interventional radiology. The technique described below was used for all patients in the outpatient clinic. The area around the wound was sterilized and the probe was sheathed or sterilized. After careful ultrasound examination, the size of the FB and its exact location, depth, three-dimensional orientation, and relationship to other structures were recorded, and the skin was marked accordingly. A small incision (usually 2–3 mm) was made at the point of nearest long axis of the FB (skin marking). Through the incision, ophthalmologic forceps arrived at the tip of the FB in the same plane (long-axis view). Then, the probe turned to the short-axis view to show the relationship between the forceps and FB [Figure 1]. The arms of the forceps were then opened to grasp the FB and remove it. All the procedures were performed freehand by the same radiologist.Figure 1: A 10-year-old boy fell into a ditch 2 weeks before presenting at our hospital. Initially after the wooden splinter was removed, the wound healed. However, the patient still felt discomfort and received an ultrasound examination. (a) Transverse sonogram showing a foreign body (arrows) with posterior acoustic shadowing in the subcutaneous soft tissue layer. (b) After confirmation, the foreign body was removed under ultrasound guidance. The surgical forceps were inserted through the incision (crocodile forceps) and reached the foreign body in-plane.In 11/12 patients, the FBs were successfully removed under ultrasound guidance, and the procedure took from 15 to 30 min (mean, 21.6 min). There was only one failure to remove the FB, which was in a male with a wood thorn that had penetrated into the thenar muscles. The distance between the FB and the skin was 23 mm, which was deeper than those successful cases (mean: 7.5 mm, range: 3–16 mm). The patient was then referred to a surgeon and surgical exploration was successful. All patients were discharged on the same day of the procedure. The FB removal procedure was well tolerated by all patients. No procedural-related complications occurred. After a mean follow-up of 22.4 months (9–39 months), no patients had discomfort at the site where the FB was removed. In conclusion, the ultrasound-guided soft tissue FB removal is a safe and minimally invasive technique. It is worthwhile to promote the use of ultrasound-guided FB removal, even with late presentation. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship This work was supported by a grant from the Hospital Clinical Key Project of Peking University Third Hospital (No. 75502-02). Conflicts of interest There are no conflicts of interest.