What’s new in Ultrasonography – December 2020

3 years ago


Abdominal Imaging



Accuracy of contrast-enhanced ultrasound liver imaging reporting and data system: a systematic review and meta-analysis

Son JH, Choi SH, Kim SY, Lee SJ, Park SH, Kim KW, Won HJ, Shin YM, Kim PN.

Hepatol Int. 2020 Nov 10.


Background: Results vary considerably in the literature on the performance of contrast-enhanced ultrasound (CEUS) using the Liver Imaging Reporting and Data System (LI-RADS) in patients that are at risk for hepatocellular carcinoma (HCC).
What is the diagnostic performance of CEUS LI-RADS in patients at risk for HCC?
Inclusion criteria:
8 (of 105) studies were included which had a summary of sensitivity and specificity for LR-5 observations (a total of 5428 observations).
Design: Meta-analysis using the QUADAS-2 tool to assess study quality and a bivariate random-effects model to analyze sensitivity and specificity.
The summarized sensitivity of CEUS for LR-5 lesions was 73% with a 95% confidence interval (CI) of 65-79%. The specificity was 95% with a CI of 91-97%. There was significant study heterogeneity which was associated with the number of cases of HCC (P≤0.05).
Conclusions and remarks:
The grouped specificity of CEUS in detecting LR-5 lesions is strong at 95%.


Primary Research

Evaluation of the Graft Kidney in the Early Postoperative Period

Goyal A, Hemachandran N, Kumar A, Sharma R, Shamim SA, Bansal VK, Das CJ, Kandasamy D, Agarwal SK, Dinda AK, Seenu V.

J Ultrasound Med. 2020 Nov 12.


Background: Parenchymal complications in transplanted kidneys, such as rejection and acute tubular necrosis (ATN), are not uncommon and early recognition is critical. Ultrasound contrast does not have the same potential nephrotoxicity as CT/MRI based contrasts.
Is ultrasound effective in the diagnosis of early renal transplant abnormalities?
Location: New Delhi, India
Patients and Inclusion criteria:
105 patients who had a transplanted kidney during the study period. 7 were excluded due to vascular and urologic complications.
Design: Prospective design using color Doppler, shear-wave elastography (SWE), CEUS, and renal scintigraphy to evaluate the post transplanted kidneys 3-10 days after surgery. The parameters were analyzed on a time-intensity curve.
19/105 (18.1%) patients developed parenchymal graft dysfunction. There was a significant difference in the peak systolic velocity of the interpolar artery compared to the control (higher in acute rejection, lower in ATN) (P<0.001). Time to peak ratios using CEUS was also significantly different between the control and dysfunction groups (p<0.05). Other parameters, including SWE and resistive indices were not significantly different.
Conclusions and remarks:
CEUS and peak systolic velocities of the interpolar renal artery may be useful for the assessment of graft dysfunction.


Primary Research

Contrast-Enhanced Ultrasound Versus Doppler Ultrasound for Detection of Early Vascular Complications of Pancreas Grafts

Swensson J, Hill D, Tirkes T, Fridell J, Patel A.

AJR Am J Roentgenol. 2020 Nov;215(5):1093-1097.


Background: Vascular complications can occur early in the course following pancreatic transplantation (similar to renal transplants) and may present as stenosis/thrombosis or breakdown of the vascular anastomosis.
How does CEUS compare to Doppler US in the assessment of post-transplant pancreatic vascular complications.
Location: Indianapolis, Indiana, USA
Patients and Inclusion criteria:
34 patients with CEUS and Doppler US following pancreatic transplantation were included in the analysis. 28 patients without repeat surgical exploration were used for the control group.
Design: Retrospective analysis with the vasculature scored as either normal or abnormal by two blinded radiologists on the basis of CEUS or Doppler.
The interobserver agreement was higher in CEUS (k=0.54) than Doppler US (k = 0.28)

Contrast enhanced US (CEUS)Color Doppler US
Reader 1Reader 2Reader 1Reader 2
Negative predictive value97%97%94%91%

Conclusions and remarks: CEUS may be helpful to assess for early vascular complications following pancreatic transplantation. It may exceed the performance of Doppler in ruling out these vascular abnormalities.


Comparative analysis of ultrasound and MRI in the diagnosis of placenta accreta spectrum

Barzilay E, Brandt B, Gilboa Y, Kassif E, Achiron R, Raviv-Zilka L, Katorza E.

Matern Fetal Neonatal Med. 2020 Nov 12


Background: Although ultrasound is the most frequently used modality to diagnose placenta accreta, there has been conflicting evidence that MRI may have added benefit.
How does MRI compare to ultrasound in the diagnosis of placenta accreta spectrum?
Location: Israel
Patients and Inclusion criteria:
23 cases in which placenta accreta spectrum was diagnosed at the time of cesarean delivery. The patients also had a pre-delivery MRI and US to evaluate for placenta accreta.
Design: Retrospective prospective study comparing the sensitivity and specificity of US and MRI for the diagnosis of placenta accreta. Prospective US diagnosis was based on previously published structured reporting. Post analysis receiver operator curves were used to assess MRI utility.
The sensitivity and specificity for the diagnosis of placenta accreta spectrum were 0.96 and 0.6 for ultrasound, while MRI was 0.83 and 0.4, respectively. When using a post analysis of MRI simulating a structured reporting scenario, the sensitivity increased to 0.96 while the specificity was 0.6.
Conclusions and remarks:
Although US has superior diagnostic performance for placenta acreta spectrum, a structured reporting system could improve MRI’s utility.


Primary Research

Accuracy of Transvaginal Ultrasound Compared to Cystoscopy in the Diagnosis of Bladder Endometriosis Nodules

Ros C, de Guirior C, Rius M, Escura S, Martínez‐Zamora MÁ, Gracia M, Peri L, Franco A, Carmona F.

J Ultrasound Med. 2020 Oct 21.


Background: The bladder is the most common urinary tract location involved in deep infiltrative endometriosis. Cystoscopy is the gold standard for diagnosis, but is invasive.
Can ultrasound predict cytoscopic results in the diagnosis of bladder endometriosis?
Location: Barcelona, Spain
Patients and Inclusion criteria:
22 patients with bladder endometriosis seen on a transvaginal ultrasound (TVUS) who had an accompanying cytoscopy.
Design: Retrospective study comparing the initial ultrasound examination in comparison to the findings at the time of cystoscopy.
Among the 22 patients, 9 had partial detrusor involvement and a normal cystoscopy. Meanwhile 13 patients had complete transmural detrusor muscle infiltration with all cases visible by cystoscopy. Ultrasound in both of these groups had a 100% positive predictive value. 20/22 patients also met criteria otherwise for adenomyosis and/or endometriosis on ultrasound.
Conclusions and remarks:
TVUS in bladder endometriosis appears to predict cystoscopic findings with a 100% positive predictive value for detrusor muscle involvement.



Ultrasound-based liver elastography: current results and future perspectives

Fang C, Sidhu PS.

Abdom Radiol (NY). 2020 Nov.



An open-access review article that covers the current practice of ultrasound liver elastography, particularly in the analysis of hepatic fibrosis. Both strain elastography and shear-wave elastography are discussed along with their clinical utility. The techniques and interpretation are all discussed with reference to various diseases, including non-alcoholic fatty liver disease. Finally, future directions are briefly touched upon with an emphasis on artificial intelligence analysis.


Musculoskeletal Imaging



Optimal Choice of Ultrasound-Based Measurements for the Diagnosis of Ulnar Neuropathy at the Elbow: A Meta-Analysis of 1961 Examinations

Haj-Mirzaian A, Hafezi-Nejad N, Grande FD, Endo Y, Nwawka OK, Miller TT, Carrino JA.

AJR Am J Roentgenol. 2020 Nov.


Background: Ulnar neuropathy can arise at the cubital tunnel of the elbow from compression or stretching of the nerve. Ultrasound can be used for diagnosis by demonstrating edema or nerve thickening.
What is the optimal technique to measure the ulnar nerve with ultrasound in the assessment of ulnar neuropathy?
Patients and Inclusion criteria:
19 studies with 1961 examinations had adequate measurements of the ulnar nerve on ultrasound and were thus included.
Design: Metanalysis calculating the sensitivity, specificity, and diagnostic odds ratio of measurements performed at the medial epicondyle. Nerve ratios compares the nerve measurements at different levels but varied between studies.
Measurements for ulnar neuropathy:

  • Highest specificity (89%): Nerve ratios
  • Highest sensitivity (80%): Cross-sectional area (CSA) measurements of the nerve at the medial epicondyle with a cutoff of 10-10.5 mm2.
  • A higher diagnostic performance was seen with CSA when measuring at the medial epicondyle (area under the curve of 0.931 on ROC analysis).
  • Every 1-mm2 increase in CSA was associated with a 36% increase in the diagnostic odds ratio.

Conclusions and remarks: The diagnosis of ulnar neuropathy can be maximized by using nerve ratios and the cross-sectional area of the nerve at the medial epicondyle.


Neuro Imaging


Primary Research

High-resolution ultrasound imaging compared to magnetic resonance imaging for temporomandibular joint disorders: An in vivo study

Talmaceanu D, Lenghel LM, Bolog N, Buduru S, Leucuta D, Rotar H.

Eur J Radiol. 2020 Nov.


Background: Disorders of the temporomandibular joints (TMJ), which include the disc and muscles, are most frequently assessed with MRI. However, ultrasound is a more accessible modality.
How does high-resolution ultrasound compare to MRI in the evaluation of TMJ disorders?
Location: Romania
Patients and Inclusion criteria:
50 patients with suspected TMJ disorders were enrolled.
Design: Prospective design with both an US and MRI performed on each TMJ within 1-7 days of clinical evaluation. The sensitivity, specificity, and diagnostic accuracy were calculated for US based on MRI findings.

TMJ Disc displacementsTMJ Degenerative Changes
US frequency13 MHz20 MHz13 MHz20 MHz
Positive predictive value90%90%70%70%
Negative predictive value66%69%88%88%

Conclusions and remarks: High-resolution US may be effective in diagnosing TMJ disorders. The specificity is particularly high, although the sensitivity is often lacking compared to MRI.

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