Background: Undifferentiated arthritis is characterized by synovitis that does not meet the criteria for any specific rheumatic disease. However, a subset of chronic occult infectious arthritis, owing to atypical or overlapping clinical features, is often misclassified as undifferentiated oligoarthritis, potentially leading to diagnostic delays and suboptimal management. This study aimed to compare the clinical, laboratory, and imaging characteristics of these two types of oligoarthritis and to evaluate potential discriminatory markers. Methods: Patients older than 16 years with synovitis involving ≤2 joints at Beijing Jishuitan Hospital from September 2023 to December 2024 were included. Ultrasound-guided joint aspiration or synovial biopsy samples were analyzed by culture and next-generation sequencing, classifying patients as pathogen-positive or -negative. Clinical, laboratory, and imaging data (ultrasound, MRI, CT, X-ray) were compared, and multivariable logistic regression and ROC analyses were performed to identify predictors of infectious arthritis. Results: A total of 57 patients were included, with 20 (35.1%) categorized as pathogen-positive and 37 (64.9%) as pathogen-negative. The mean age was 41.7 ± 14.3 years, and 61.4% of the patients were female, with no significant demographic differences between groups. Monoarthritis was more common in pathogen-positive patients, accounting for 95% of cases (p = 0.02). Although the distribution of affected joints was similar between groups, ultrasound revealed a significantly higher bone erosion grade in pathogen-positive patients (p = 0.02), and CT/X-ray demonstrated articular surface destruction in 58.8% of infectious cases compared to 6.2% in pathogen-negative cases (p < 0.001). Serum albumin levels were significantly lower in the pathogen-negative group (20.7 ± 8.5 g/L vs. 41.1 ± 3.9 g/L, p < 0.001). ROC analysis determined that an albumin threshold >35.4 g/L predicted microbiological positivity with 100% sensitivity and 69.7% specificity. Multivariable logistic regression identified normal serum albumin levels, severe ultrasound-detected bone erosion, and imaging evidence of joint surface destruction as significant predictors of chronic occult infectious arthritis. Conclusions: Our findings suggest that, despite overlapping clinical and laboratory features, serum albumin levels, severe bone erosion on ultrasound and articular surface destruction on CT/X-ray may help differentiate chronic occult infectious arthritis from undifferentiated oligoarthritis. Further studies with larger cohorts are needed to confirm these preliminary results.

Objective: Closed or open reduction and spica casting are common treatments for children aged 6 to 18 months, as well as infants aged 0 to 6 months whose harness treatment for developmental dysplasia of the hip (DDH) was unsuccessful. The study aimed to quantify the distance between the femoral head and the acetabulum after closed or open reduction and evaluate the dynamic docking progression of the femoral head using serial hip medical ultrasound. Methods: We retrospectively reviewed the medical records and hip medial ultrasound images of a consecutive series of patients with DDH who underwent spica casting after reduction and compared images obtained immediately after reduction and at follow-up. The first cast (stage I) was maintained for 2 to 3 months and scheduled for outpatient repeat ultrasound in 4 to 8 weeks. Then the second cast was placed (stage II), lasting for another 2 to 3 months. The triradiate cartilage-femoral head distance (TFD) was measured in the acetabulum coronal mid-sectional plane. The Wilcoxon signed-rank test was used to compare the TFD values. Results: This study included 49 patients. All patients underwent hip medial ultrasound 0 to 3 days after stage I (time 1) and 4 to 8 weeks (time 2) postoperatively, with 24 patients reviewed again 0 to 7 days after stage II. The TFD values in time 1 and time 2 were 6.0 (5.0, 9.0) mm and 5.0 (3.6, 7.0) mm, respectively. There was a statistically significant difference between times 1 and 2 regarding TFD values in 49 close-reduction hips (6.0 vs 5.0 mm, P < 0.001). Similar findings were also observed in 13 open-reduction hips (6.0 vs 5.0 mm, P = 0.023). Conclusions: Hip medial ultrasonography during the period of cast immobilization after reduction in children with DDH can objectively and quantitatively show the dynamic change of the distance between the femoral head and the acetabulum, and can be used to assess reduction of the hip and progression of femoral head docking.

Aim: The aim was to review several aspects of work using ultrasound in diagnosing developmental dysplasia of the hip and analyze the application status of the Graf technique in Beijing over 15 years. Methods: First, data on the promotion and development of the Graf technique in Beijing over the past 15 years were retrospectively analyzed. Second, data on hip ultrasound (US) screening and the effect of consecutive brace therapy were collected and analyzed. Infants were divided into subgroups according to Graf type, age at initiation of treatment, sex, and affected side. Results: The ultrasound detection rate of developmental dysplasia of the hip (DDH) was high at Beijing Jishuitan Hospital. The total detection rate of type IIa, IIb, IIc, D, III and IV (abbreviated as: types IIa and worse) was 4.58%, and that of type IIb, IIc, D, III and IV (abbreviated as: types IIb and worse) was 1.40%. Clinicians should pay attention to DDH, and early treatment is important; therefore, it is recommended that infants and young children undergo DDH ultrasound screening as soon as possible. Our research shows that when the α angle was more than 43°, the efficacy of brace therapy was 95.95%. Conclusions: It was confirmed that the Graf technique has greater practicality and accuracy. The Graf technique, as an important means for the early screening of DDH, has been widely recognized around the world, and it is recommended to be widely used in China to preserve future health in as many children as possible.

发育性髋关节发育不良(DDH)是髋臼发育不良、髋关节半脱位及髋关节脱位等一系列病理变化的统称,早期诊断和治疗DDH具有重要临床意义.超声是影像学诊断DDH的首选方法,可全面观察髋关节结构,有助于临床评估DDH分型、制定治疗方案及评估预后.本文介绍超声用于DDH研究进展.

女性患儿,4岁,发现左侧手指背伸受限9月余,无外伤史,无相关家族史.专科查体:左手各指背伸活动均明显受限,屈曲活动良好,末梢血运、皮肤感觉均未见明显异常,左腕关节屈伸活动无受限,左前臂未触及明显肿物,无压痛,皮肤颜色无改变.超声:左前臂桡神经深支局部梭形增粗,约2.3 cm× 0.8 cm×0.3 cm,边界欠清;神经束结构不清,可见不均质低回声(图1A、1B),并探及少量血流信号(图1C);考虑神经源性肿瘤.行左前臂桡神经深支肿瘤切除+腓神经移植术,术中见左侧桡神经深支内长约3.0 cm梭形肿瘤,位于主干至分叉处.病理:光镜下肿瘤细胞以同心圆状排列并包绕退变的轴突及施万细胞,形成"洋葱皮"样结构(图1D);诊断为神经内神经束膜瘤(intraneural perineurioma,IP).

OBJECTIVESThis study aimed to investigate the combined use of ultrasonography and clinical features for the differentiation of malignant peripheral nerve sheath tumors (MPNST) from benign peripheral nerve sheath tumors (BPNST) and to compare the efficacy of ultrasonography with that of magnetic resonance imaging (MRI).METHODSThis retrospective study included 28 MPNSTs and a control group of 57 BPNSTs. All patients underwent an ultrasound scan using the Logiq E9 (GE Health Care, Milwaukee, WI) or EPIQ7 equipment (Philips Medical System, Bothell, WA). A 3.0-T MRI machine (Ingenia; Philips Healthcare, Best, the Netherlands) was used for scanning, and conventional MRI was performed on different regions based on the patient's clinical situation. The following variables were evaluated: palpable mass, pain, nerve symptoms, maximum diameter, location, shape, boundary, encapsulation, echogenicity, echo homogeneity, presence of a cystic component, calcification, target sign, posterior echo, and intertumoral vascularity of the tumors. The diagnostic efficacy of ultrasonography and clinical factors was compared with that of MRI. Independent factors for predicting MPNST versus BPNST were also assessed.RESULTSThe parameters of location, shape, boundary, encapsulation, and vascularity were significantly different between MPNSTs and BPNSTs. Multiple logistic regression analysis showed that shape, boundary, and vascularity were independent predictors of MPNSTs. The sensitivity, specificity, and Youden index of the three clinical and ultrasound factors (shape, boundary, and vascularity) were 0.89, 0.81, and 0.69, respectively, whereas those of MRI were 0.71, 0.89, and 0.61, respectively. No significant differences in the area under the curve (AUC) of the three combined clinical and ultrasound factors and those of MRI were found (P > .05).CONCLUSIONSMRI was useful in the differential diagnosis between MPNSTs and BPNSTs. However, the combination of clinical and ultrasound diagnoses can achieve the same effect as MRI, including shape, boundary, and vasculature.

Takayasu arteritis (TA) is a common autoimmune disease in the clinical setting. However, vertebral artery aneurysms caused by TA are rarely reported. We herein describe a 28-year-old man with multiple vertebral artery aneurysms and carotid artery aneurysms caused by TA, which showed typical wall thickening and lumen dilation with a "string of beads" appearance by Doppler ultrasound and radiology. Previous studies have shown that most TA-associated vertebral artery lesions are stenosis, occlusion, and dissection of the intracranial part of the artery. In this case, TA mainly affected the cervical segment of the vertebral artery (the intracranial segment was not obviously involved), and the main manifestations were aneurysms and occlusion. This case provides more information for further understanding of TA-associated vertebral artery lesions.

Abstract Background Neuromuscular choristomas (NMCs), are extremely rare developmental lesions that, have been previously established associated with recurrent fibromatosis after surgery, leading to several operations or even amputation. However, reports on the ultrasound imaging features and clinical conditions of NMCs are rare. The purpose of this study is to describe the ultrasound features and clinical analysis of NMCs to provide suggestions to identify the optimal management strategy. Methods From September 2020 to September 2021, 7 patients with a confirmed diagnosis of NMC who underwent ultrasound examination in our department were enrolled in our study. Physical examinations were performed to detect motor deficits, sensory deficits, neuropathic pain, limb undergrowth, muscular atrophy, cavus foot and bone dysplasia. Ultrasound imaging was performed and investigated both in affected nerves and neuromuscular choristomas associated desmoid-type fibromatosis (NMC-DTF). All patients had a definite history and regular follow-up. The clinical course, physical examinations, ultrasound features and pathologic results of NMC patients were analyzed. Results Seven patients with an average age of 7.0 ± 7.2 years (range: 2–22 years) were enrolled in our study. The affected nerves included the sciatic nerve (6 cases) and the brachial plexus (1 case). Six patients (85.7%) presented with limb undergrowth, 6 (85.7%) with muscular atrophy, and 5 (71.4%) with cavus foot deformity. Based on ultrasound findings, all the visibly affected nerve segments presented with hypoechoic and fusiform enlargement with intraneural skeletal muscle elements. Five patients (71.4%) had NMC-DTFs at the site of the affected nerve. All NMC-DTFs were shown as hypoechoic solid lesions adjacent to the nerve and were well circumscribed. In the subset of the surgery group, all 5 patients presented with progression to NMC-DTFs at the site of the NMCs. No fibromatosis was detected in the other two nonsurgical patients. Conclusions Understanding the typical ultrasound features and clinically associated conditions would support the early diagnosis of this rare disease. When a potential diagnosis is determined, an invasive procedure such as biopsy or resection might not be a good choice given the frequent occurrence of complications such as aggressive recurrence.

患儿女，8个月，因双下肢不等长行双侧髋关节超声检查，检查见双侧髋关节骨性臼顶及软骨臼顶覆盖良好，骨性髋臼上缘锐利，股骨头大小正常，位于髋臼窝内；右髋关节Y形软骨内可见数个强回声团，较大者约0.6 cm×0.3 cm(图1)，后方伴声影，彩色多普勒血流显像未测及明显异常血流信号；左侧髋关节回声及结构未见异常。超声提示右侧髋关节Y形软骨内多发强回声团。双侧髋关节X线检查示：右侧髋关节骨骺较对侧增厚，内伴钙化(图2)。双侧髋关节MRI检查见：右侧髋关节Y形软骨内多发骨化灶(图3)，余双髋关节骨端髓内未见异常信号灶。临床诊断为：半肢骨骺异样增殖症(dysplasia epiphysealis hemimelic，DEH)。

Objective:To explore the high-frequency ultrasonographic and clinical features of superficial intravascular tumors.Methods:Thirteen superficial intravascular tumor patients who underwent ultrasound examination form Beijing Jishuitan Hospital during 2016-2020 were retrospectively analyzed. The location, anatomic blood vessels, shape, size, boundary, internal echo, blood flow and clinical characteristics of the tumors were analyzed.Results:Among the 13 cases, most of the tumors were oval like or long strip, and a few were round like. All 11 cases of primary intravascular tumors showed hypoechoic mass; 2 cases of intravascular metastasis or recurrence showed solid hypoechoic with hyperechoic mass. Arterial blood flow spectrum was detected in 12 cases. Two patients with glomus tumor showed typical tenderness at the fixed point. Two patients had a history of bone tumors in the upper or lower extremities.Conclusions:High frequency ultrasound can clearly recognize the location of the superficial intravascular tumors, describe the morphological characteristics and sonographic features of the tumor, then help to make a more accurate qualitative diagnosis.

BACKGROUND:Graf's method is currently the most commonly used ultrasound-based technique for the diagnosis of developmental dysplasia of the hip (DDH). However, the efficiency and accuracy of diagnosis are highly affected by the sonographers' qualification and the time and effort expended, which has a significant intra- and inter-observer variability.METHODS:Aiming to minimize the manual intervention in the diagnosis process, we developed a deep learning-based computer-aided framework for the DDH diagnosis, which can perform fully automated standard plane detection and angle measurement for Graf type I and type II hips. The proposed framework is composed of three modules: an anatomical structure detection module, a standard plane scoring module, and an angle measurement module. This framework can be applied to two common clinical scenarios. The first is the static mode, measurement and classification are performed directly based on the given standard plane. The second is the dynamic mode, where a standard plane from ultrasound video is first determined, and measurement and classification are then completed. To the best of our knowledge, our proposed framework is the first CAD method that can automatically perform the entire measurement process of Graf's method.RESULTS:In our experiments, 1051 US images and 289 US videos of Graf type I and type II hips were used to evaluate the performance of the proposed framework. In static mode, the mean absolute error of α, β angles are 1.71° and 2.40°, and the classification accuracy is 94.71%. In dynamic mode, the mean absolute error of α, β angles are 1.97° and 2.53°, the classification accuracy is 89.51%, and the running speed is 31 fps.CONCLUSIONS:Experimental results demonstrate that our fully automated framework can accurately perform standard plane detection and angle measurement of an infant's hip at a fast speed, showing great potential for clinical application.

目的 探讨对胎儿胆囊腔内结石样回声的超声特点,并在后续产前及产后复查中对胎儿或新生儿胆囊腔内异常回声情况进行随访,讨论超声检查在此类疾病诊断中的意义和价值.方法 选取2014年1月至2020年12月于北京积水潭医院进行常规产前超声检查并发现胎儿胆囊结石样回声的孕妇共12例,总结分析胎儿胆囊内结石样回声的声像图特征及胆囊内结石样回声随孕周变化的特点,并对孕妇情况进行分析.产后随访胆囊结石样回声的存在与消退情况.结果 12例胎儿胆囊腔内结石样回声的声像图表现为单发点状强回声1例(8.3％),多发点状强回声9例(75.0％),细密中强回声2例(16.7％).4例于孕晚期超声复查自行消失,7例产后超声复查均消失,1例随访至出生后3年7个月仍未消失.12例胎儿胆囊内异常强回声除1例在孕中期(孕25周)发现,其余均于孕晚期(孕33周及以后)发现.结论 超声可用于探查胎儿胆囊腔内结石样回声,进而做出胎儿胆囊结石或胆泥淤积的初步诊断,为妇产科、儿科等临床科室提供直接、可靠的超声诊断依据.

患者男,9岁,因扭伤左示指后,疼痛不缓解来我院就诊.专科检查:左手桡侧可见片状暗红色色斑,左示指近节压痛明显,可触及包块.超声所见:左示指近节指骨骨皮质膨胀,变薄,范围约2.3 cm×1.2 cm×0.6 cm,髓腔内呈低回声,紧贴指骨可见管腔样结构,并延伸至髓腔内,见图1a,内可见丰富血流信号,可探及低阻动脉频谱.超声提示:左示指近节指骨血管瘤可能.

患者女,67岁,因"右下肢包块渐大半年"就诊我院骨肿瘤科,无疼痛无活动受限等不适.超声所见:右大腿内侧肌层见实性低回声肿物,大小约16.2 cm×8.7 cm×5.8 cm,形态欠规则,边界不清,与肌纹理相延续,内回声不均,可见肌纹理样及腱膜回声,突破深筋膜侵犯皮下脂肪,见图1,可见丰富血流信号,并测得高速动脉频谱.右腹股沟多发肿大淋巴结,大者约3.4 cm×1.2 cm,血流较丰富,超声提示:右大腿肌层实性肿物并右腹股沟淋巴结肿大,考虑恶性病变,不除外淋巴瘤软组织侵犯.

Objectives The objectives were to identify the key features of malignant and benign peripheral nerve sheath tumors (PNSTs) and determine a strategy for differentiating them using sonography. Methods Forty‐six malignant peripheral nerve sheath tumors (MPNSTs) and 83 benign peripheral nerve sheath tumors (BPNSTs) confirmed by pathology from April 2010 to July 2021 were included. The general data and grayscale and color Doppler ultrasonic manifestations were compared between the two groups. We used single factor, multifactor, and area under the receiver operating characteristic (ROC) curve analyses to extract significant malignant risk factors and then established a scoring system with these factors. Results The significant variables identified in univariate analysis ( P < .05) were maximum diameter, location, shape, boundary, encapsulation, echogenicity, texture pattern, calcification, entering or exiting nerve, and vascularity. Shape, boundary and vascularity were significant risk factors, and a scoring system was established. The area under the ROC curve (0.925) confirmed the usefulness of the scoring system for differentiating MPNSTs and BPNSTs. Conclusions Ultrasonography is an effective method for differentiating MPNSTs from BPNSTs.

目的 评价超声鉴别诊断儿童四肢长骨嗜酸性肉芽肿(EGB)与骨髓炎的价值.方法 纳入经病理证实的EGB(EGB组)和骨髓炎(骨髓炎组)患儿各37例,观察组间超声表现差异.采用二元logistic回归分析,根据超声表现建立联合鉴别诊断方程;绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评价各超声表现及联合诊断方程鉴别EGB与骨髓炎的效能.结果 EGB组与骨髓炎组病灶周围软组织改变差异无统计学意义(P＞0.05);组间骨质破坏伴回声、骨膜反应及病灶血流信号表现差异均有统计学意义(P均＜0.05).二元logistic回归联合诊断方程为:Y=-1.061X骨质破坏伴回声+2.371×骨膜反应+1.995×病灶血流丰富.以骨质破坏伴回声、骨膜反应及病灶血流丰富鉴别EGB与骨髓炎的AUC分别为0.518、0.702及0.689;以联合诊断方程进行鉴别的AUC为0.766,高于单一超声表现(P均＜0.05),截断值为0.568时,鉴别诊断敏感度为97.31％,特异度为59.54％.结论 超声可鉴别儿童四肢长骨EGB与骨髓炎;联合应用各超声表现可提高鉴别诊断效能.

患儿男,6岁,5个月前家属发现患儿左手掌包块,未就诊,1个月后包块逐渐增大;既往无特殊病史.查体:左手掌第二掌骨掌侧触及3.0cm×2.0cm×1.0cm包块,质软,活动度尚可,局部无明显红肿及压痛,手指活动未见明显受限.实验室检查未见明显异常.左手掌超声:左手掌骨远端紧贴示指指屈肌腱见3.20 cm×1.32 cm×1.01 cm低回声肿物,形态欠规则,边界清,局部似见包膜,内部回声不均,可见条片状高回声及小灶性无回声(图1A),后方指屈肌腱略受压,周边及内部探及少许血流信号(图1B);考虑为滑膜来源腱鞘巨细胞瘤可能.行左掌肿物切除术,术中见肿物呈白色,包膜完整,与示指指屈腱粘连,实质内局灶呈胶冻样.术后病理:光镜下肿瘤细胞呈短梭形或星形,未见明显异型性,间质呈显著黏液变(图1C);诊断:(左手第二掌骨)关节旁黏液瘤(juxta-articular myxoma,JAM).

目的 探讨超声筛查发育性髋关节发育不良(DDH)应用“婴儿髋关节超声检查固定床架”的实用性.方法 对100例婴幼儿筛查DDH,按Graf法检查标准,甲、乙两组不同水平医师在使用床架的方式下,乙组同时在无床架的方式下,分别对同一婴儿进行检查,以甲组测值为金标准,以200髋a角及检查时间为评价指标,将乙组测值及检查时间分别与甲组对比分析.结果 配对样本t检验差异无统计学意义(P＞0.05);差值Biand-Altman分析,甲乙有床架测值组之间的一致性优于无床架组;有床架组检查时间少于无床架组.结论 使用床架进行超声筛查DDH,提高了测量的准确度,检查时间缩短,实用性强.

患者男,14岁,左上臂近端间断疼痛7年加重1个月就诊.查体:左上臂近端稍肿胀,触及质硬包块,按压时钝痛. 超声所见:左肱骨上段外侧骨膜抬高,骨皮质破损,骨膜下可见实性低回声肿物,大小约7.5cm×1.5 cm×0.8 cm,边界清,回声欠均,周围可见少量血流信号.超声提示:左肱骨上段外侧骨膜抬高,骨膜下实性低回声肿物.术后病理诊断为骨膜软骨瘤.镜下所见:肿瘤性软骨分叶状生长,局灶侵袭周围硬化骨,少部分肿瘤性软骨细胞较丰富,有轻微异型性.