To investigate the role of pelvic ultrasound in monitoring therapeutic response and predicting long-term outcomes in girls with central precocious puberty (CPP) undergoing gonadotropin-releasing hormone agonist (GnRHa) therapy. In this retrospective study, 219 girls aged 6-8 years (69 with CPP and 150 age-matched controls) were enrolled between February 2018 and September 2021 at Wuzhong People's Hospital of Suzhou. Pelvic ultrasound was used to measure uterine and bilateral ovarian volume, follicle number ≥ 4 mm, and maximum follicle diameter. A total of 69 girls with precocious puberty were treated with GnRHa and followed up. The data of pelvic ultrasound, breast ultrasound, and bone age index were collected for 3, 6, and 12 months after treatment, and carry on the contrast analysis. A total of 252 girls, aged 6-8 years, who were diagnosed as CPP and treated with GnRHa at the same hospital, were randomly divided into two groups: Modeling Group (N = 176) and validation group (N = 76). According to the change of growth rate after 1 year treatment and other evaluation indexes, the patients were divided into two groups: the group with significant therapeutic effect and the group without significant therapeutic effect, to collect the related data of ultrasound measurement of uterus and ovary and to construct the prediction model of curative effect. The model was validated by validation group. The ultrasonic parameters of pelvic cavity in the treatment group were significantly different from those in the control group (p < 0.05). In the treatment group, there were significant differences in every stage before and after treatment except for 3 months (p < 0.05). To analyze the related data of pelvic ultrasound examination in the significant-response group and the group with no significant therapeutic effect, the established joint prediction equation of pelvic ultrasound related parameters: Logit (p) = 7.8696-0.4435 × (maximum follicle diameter)-0.2640 × (number of follicles ≥ 4 mm)-0.4425 × age. The joint prediction model equation yielded an AUC of 0.747 (95% CI: 0.672, 0.822). The results of the validation group were similar to those of the modeling group, with an AUC of 0.730 (95% CI: 0.610, 0.851). Ultrasound can dynamically evaluate the efficacy of GnRHa in the treatment of central precocious puberty. Pelvic ultrasound has significant predictive value in evaluating the efficacy of GnRHa therapy at the early diagnosis of central precocious puberty.
This case report describes a prenatal diagnosis of sirenomelia sequence at 12 weeks and 4 days of gestation using two-dimensional (2D) and three-dimensional (3D) ultrasound. The case highlights the importance of First Trimester ultrasound screening and the value of 3D ultrasound in early diagnosis. The etiology of this condition is discussed, with a focus on its potential association with embryonic layer development abnormalities. Ultimately, the patient opted for termination of pregnancy. This report provides valuable clinical experience in the early ultrasound diagnosis of sirenomelia sequence and discusses the importance of its ultrasound manifestations and clinical management.
We present a case of a very rare benign ovarian tumor, a sclerosing stromal tumor (SST). In addition, we performed a review of the literature to describe the spectrum of sonographic findings of this tumor. Our case was a 43 year-old woman, referred for pelvic endometriosis evaluation. Transvaginal ultrasound showed a solid tumor with a maximum diameter of 30 mm arising from external pole of the right ovary. Color Doppler assessment showed a moderate/abundant vascularity. A diagnosis of presumed ovarian surface serous borderline tumor was established. Surgery was performed with tumor removal. Definitive histological diagnosis was benign sclerosing stromal ovarian tumor. In the literature review, we identified 81 cases describing sonographic findings of this tumor. This spectrum was wide, with most tumors reported as purely solid or predominantly solid with cystic areas (86.7%) and few cases were reported as multilocular-solid, unilocular-solid, multilocular and unilocular. Echogenicity was heterogeneous in 96.9% of the cases. When vascularity was described, 61% of the cases had moderate/abundant vascularization. Calcification and shadowing were rare. Ascites was reported in 16.0% of the cases. In conclusion, the spectrum of findings of SSTs may vary, but most cases were solid tumors. Our case fits this pattern.
Ultrasound radiomics is gradually emerging as a powerful tool for improving the diagnosis and management of Hashimoto's thyroiditis (HT), effectively overcoming the limitations of conventional ultrasound, such as high interobserver variability and difficulties in evaluating nodule characteristics. This narrative review aims to systematically summarize the fundamental principles, algorithms, and clinical application progress of ultrasound radiomics in HT, focusing on its diagnostic value in early diagnosis of HT, assessment of inflammatory activity, differentiation of benign and malignant nodules, and prediction of lymph node metastasis. Meanwhile, this review analyzes the current challenges, including data heterogeneity and insufficient model interpretability. Future directions are also prospected, including the establishment of standardized databases and interpretable artificial intelligence models to support the precise diagnosis and treatment of HT.
Spiradenomas are rare adnexal neoplasms that clinically mimic other cutaneous entities, such as epidermoid cysts and basal cell carcinomas. Although ultrasound diagnosis of common cutaneous tumors has significantly evolved over the last decades, the sonographic presentations of spiradenomas have been scarcely described. This study includes a case report and systematic review of previously reported sonographic characteristics of spiradenomas. A comprehensive search of the Pubmed/MEDLINE database identified studies with histological confirmation and ultrasound characterization of spiradenomas. Eight articles, comprising seven case reports and one case series with eight cases, were included. Data on clinical, demographic and sonographic features were extracted and analyzed. On B-mode ultrasound, spiradenomas appeared as well-defined, multilobulated, heterogeneous, hypoechoic masses located within the dermis and/or hypodermis, with posterior acoustic enhancement. Color Doppler imaging showed increased intralesional vascularization without anarchic pattern. The identified features helped differentiate spiradenomas from similar conditions, potentially reducing misdiagnoses, and optimizing management.
To describe the longitudinal ultrasound features and clinical course of ovarian endometriomas in postmenopausal women, aiming to improve diagnostic accuracy and guide follow-up strategies. This retrospective observational study included postmenopausal women with at least one ovarian endometrioma identified by transvaginal ultrasound (TVUS) and monitored for a minimum of 24 months at the University of Rome Tor Vergata (2018-2023). All had a known premenopausal endometriosis detected by TVUS at our Unit. Clinical and ultrasound assessments were conducted at baseline and at 12 and 24 months, recording changes in TVUS characteristics and symptoms. Endometrioma size was classified using the #Enzian classification. Forty-one postmenopausal patients (mean age 53.5 ± 6.4 years) were included. A total of 45 endometriomas were analyzed, mostly unilocular (100%), with a typical "ground glass" echogenicity (75.6%) and classified as #Enzian O1 (82.2%) at the first postmenopausal scan. A significant early dimensional reduction occurred between pre- and postmenopause: the mean maximum diameter decreased from 29.0 ± 15.2 to 20.6 ± 9.7 mm (p = 0.002), and the mean diameter from 24.5 ± 13.1 to 17.9 ± 8.9 mm (p = 0.006), with continued decline at 12 and 24 months (p < 0.05). In contrast, morpho-structural changes emerged later during follow-up, with the proportion of cysts showing wall irregularities rising from 11.1% in premenopause to 38.6% at 24 months (p = 0.003). Vascularization remained minimal throughout. All serum epithelial tumor markers stayed within normal ranges, no suspicious or malignant transformations were observed, and pain symptoms remained stable during follow-up. Ovarian endometriomas in postmenopausal women exhibit a benign evolution, characterized by early dimensional regression and later structural remodeling without malignant features. Regular ultrasound surveillance remains essential to recognize benign morphologic changes, avoid unnecessary surgery, and promptly identify lesions requiring further evaluation.
Fetal tumors are extremely rare, but with more widespread ultrasound screening in pregnancy, the incidence of prenatal diagnosis is increasing. The perinatal tumor concept refers to the tumors diagnosed either prenatally or within the first month after birth. This is a case report of a fetal spinal malignant tumor. On prenatal ultrasound, a closed neural tube defect was suspected at first glance because of a paraspinal soft tissue mass connected to the spinal canal and tethered spinal cord at 22 weeks of gestation. Fetal magnetic resonance imaging performed at 30 weeks of gestation revealed a spinal cord mass extending from the coccyx to the thoracic vertebrae, with involvement of the paraspinal soft tissues and the abdominal cavity. Due to its poor prognosis, the pregnancy was terminated, and postnatal excisional biopsy and pathological examination made the final diagnosis of a malignant small round cell tumor.
Diagnosing tuberculosis (TB) in children is challenging because of nonspecific symptoms, low microbiological yield, and imaging limitations. Comprehensive point-of-care ultrasound (cPOCUS) may detect mediastinal lymphadenopathy, but evidence remains limited. We conducted a prospective observational study in four tertiary hospitals in Spain (May 2023-June 2024) enrolling children (0-18 years) with presumptive TB. All participants underwent chest X-ray (CXR) and cPOCUS; chest CT was performed when clinically indicated. cPOCUS assessed lung, mediastinal, and abdominal compartments using a standardized protocol. Images were independently reviewed by expert readers blinded to clinical data. Diagnostic performance was evaluated against a final TB classification based on clinical, immunological, microbiological, and conventional radiological findings, excluding cPOCUS. Twenty-seven children were included (median age 9.0 years), of whom 12 (44.4%) had TB disease. CT was performed in 14 (51.9%). Only 22.2% of cPOCUS examinations were complete. Mediastinal lymphadenopathy was the most frequent abnormality. cPOCUS detected abnormalities in 58.3%-63.6% of TB cases, particularly aortopulmonary window lymph nodes and small subpleural consolidations, with moderate sensitivity and high specificity (80.0%-86.7%). Inter-reader agreement was high (κ = 0.92). In this pilot prospective study, cPOCUS demonstrated limited diagnostic performance but high inter-reader reliability. These exploratory findings suggest that cPOCUS may complement standard imaging for selected abnormalities (particularly aortopulmonary window lymphadenopathy), but larger studies with optimized protocols are needed before broader clinical implementation.
To investigate the ultrasonographic features and clinical characteristics of TFE3-rearranged renal cell carcinoma (TFE3-rRCC) in adults. Ultrasound images and clinical records of 28 adult patients with TFE3-rRCC confirmed by immunohistochemical and fluorescence in situ hybridization were retrospectively analyzed. Patients (22 females, 6 males) were aged 19-70 years (mean age, 43.9 ± 15.8 years). The size of tumors ranged from 1.5 to 17.0 cm (mean diameter, 5.5 ± 3.5 cm). Seven patients (mean diameters, 9.7 ± 3.6 cm) had symptoms and 21 patients (mean diameters, 4.0 ± 2.0 cm) were asymptomatic. Most of the patients (20/28) had no metastasis and they haven't experienced recurrence. TFE3-rRCC presented as well-defined (26/28) lumps with regular shapes (27/28). Solid lumps (hyperechoic 15, isoechoic 8, hypoechoic 1) accounted for 85.7% (24/28). Cystic components (14/24), punctate or circular calcifications (8/24), and color Doppler signals (19/24) can be observed in the solid lumps. Few tumors (4/28) are cystic lumps with varying thickness internal septations (4/4), calcifications (4/4), irregular walls (2/4), and solid protrusions (2/4). Most of the TFE3-rRCC were hyperechoic or isoechoic lumps, often accompanied by cystic components and calcifications. Few cases were cystic masses with internal septations, calcifications, irregular wall, and solid protrusions. These features may have potential value in the diagnosis of TFE3-rRCC.
We retrospectively analyzed the clinical and imaging data of a patient with pathologically confirmed testicular Leydig cell tumor (LCT). During routine preconception screening 1 year ago, a right testicular mass was detected. The patient underwent multimodal ultrasound, including two-dimensional ultrasound, color Doppler flow imaging (CDFI), elastography, and Microvascular Flow Imaging (MVFI). A distinctive feature was the visualization of both peripheral annular vascularity and intralesional blood flow from MVFI. Postoperative histopathology and immunohistochemistry confirmed the diagnosis of LCT. We reviewed relevant literature on sonographic features of LCT and compared the findings with the multimodal ultrasound presentation in this case, aiming to provide insights for accurate diagnosis of LCT.
This case presents the diagnosis and management of a rare ectopic molar pregnancy. A 31-year-old woman developed intermittent vaginal bleeding after presumed induced abortion 6 months ago. Elevated serum level of 𝛽-HCG and multimodal imaging confirmed the diagnosis of parametrial molar pregnancy. The patient underwent laparoscopic surgery combined with chemotherapy and immunotherapy. She has maintained complete remission for 1 year with normal range of serum 𝛽-HCG. This case underscores the characteristic imaging features of ultrasound and magnetic resonance imaging of ectopic molar pregnancy. Familiarity with these specific signs may facilitate accurate preoperative diagnosis of this rare disease.
To investigate the correlation between two-dimensional speckle tracking echocardiography (2D-STE) measurements and the Gensini score in coronary artery disease (CAD) patients, to explore the relationship between left ventricular (LV) strain and the severity of CAD, and to determine the predictive value of LV strain for CAD severity. A total of 128 CAD patients and 32 healthy controls were included. The severity of CAD was represented by the Gensini score on the basis of coronary artery angiography (CAG) findings. All the subjects underwent echocardiography for routine measurement of standard echocardiographic parameters and 2D-STE strain parameters. We further divided all patients into three groups according to the tertiles of the Gensini score: the mild group, with a Gensini score ≤ 16 (43 cases); the moderate group, with a Gensini score > 16 and ≤ 50 (41 cases); and the severe group, with a Gensini score > 50 points (44 cases). The analyses revealed that global longitudinal strain (GLS), global circumferential strain (GCS), twist and torsion decreased significantly. Correlation analyses revealed positive correlations between GLS and GCS and the Gensini score (r = 0.741 and 0.562, respectively; p < 0.05). Whereas twist and torsion were negatively correlated with the Gensini score (r = -0.570 and -0.565, respectively; p < 0.05). The multiple stepwise regression analysis revealed that GLS and twist were independently associated with the Gensini score (all p < 0.001). Receiver operating characteristic (ROC) curve analysis of GLS and twist for predicting moderate to severe CAD yielded areas of 0.914 and 0.823, respectively, whereas that for the combination of the two parameters was 0.934. The optimal cut-off value for GLS was -18.85%. GLS and twist were independently correlated with the Gensini score. GLS showed greater discrimination, whereas the combination of GLS and twist yielded better performance in predicting CAD severity. Assessments of strain parameters appear to be feasible in the echocardiographic examination of CAD patients.
To evaluate the predictive value of ultrasound-assessed cervical volume for successful labor induction in late preterm and term pregnancies with an unfavorable cervix and to compare its performance with cervical length. This prospective study included 350 singleton pregnancies at ≥ 34 weeks of gestation undergoing labor induction with an unfavorable cervix. Cervical length and cervical volume were measured by transvaginal ultrasound prior to induction, with cervical volume calculated using a cylindrical geometric model. Successful induction was defined as vaginal delivery within 24 h. Receiver operating characteristic curve analysis and multivariable logistic regression were performed to assess predictive performance and identify independent predictors after adjustment for maternal age, body mass index, parity, and gestational age. Labor induction was successful in 222 patients (63.4%). The successful induction group had significantly higher Bishop scores, shorter cervical lengths, and smaller cervical volumes (all p < 0.001). Cervical volume showed a positive correlation with cervical length and a negative correlation with Bishop score. Cervical length ≤ 33 mm (AUC = 0.836) and cervical volume ≤ 29.8 cm3 (AUC = 0.798) predicted induction success, with comparable predictive performance. Both cervical length (aOR = 0.78, 95% CI: 0.73-0.84) and cervical volume (aOR = 0.93, 95% CI: 0.90-0.97) were independent predictors of successful induction, while multiparity was a strong positive predictor. Similar findings were observed in term and late preterm subgroups. Cervical volume is an independent predictor of labor induction success in late preterm and term pregnancies with an unfavorable cervix and demonstrates predictive performance comparable to cervical length.
Early skeletal growth represents a critical window for lifelong bone health and is influenced by genetic, nutritional, and environmental factors. However, the assessment of bone status during infancy remains challenging due to the limited feasibility of reference densitometric techniques for longitudinal use. Radiofrequency echographic multi-spectrometry (REMS) is an ultrasound-based technology validated for bone mineral density (BMD) assessment in adults, but its applicability to early infancy has not yet been established. This study aimed to explore a REMS-based approach for investigating femoral skeletal growth during early life. Eighty-two healthy term infants underwent femoral REMS examinations at 3 and 6 months of age. Unfiltered radiofrequency ultrasound signals were analyzed using a multivariate framework combining fast Fourier transform (FFT) spectral analysis with partial least squares (PLS) regression. Body weight was used as an indirect surrogate marker of skeletal growth, with spectral features serving as predictors. Average power spectra stratified according to PLS-inferred body weight demonstrated distinct spectral patterns between lower- and higher-weight infants. The PLS-based spectral model showed longitudinal consistency, preserving relative skeletal status across time points. These findings indicate that REMS-derived spectral features vary systematically with growth-related physiological changes during infancy. REMS-derived spectral characteristics appear to be sensitive to early skeletal growth processes in infancy. Although further studies incorporating direct bone outcomes are required to disentangle the relative contributions of body size and mineralization, this work provides foundational evidence supporting the feasibility of extending REMS technology to early life. REMS may represent a promising non-invasive and radiation-free approach for longitudinal investigation of skeletal development in pediatric populations.
Ultrasonography is routinely used after pediatric kidney transplantation, but the prevalence and longitudinal pattern, and prognostic value of abnormal findings are not well defined. We described the frequency and temporal trends of post-transplant ultrasound abnormalities in children and evaluated their association with graft outcomes. We retrospectively included patients (< 18 years) who underwent kidney transplantation at Children's Medical Center Hospital between 2018 and 2024. Sonographic features (parenchymal changes, peritransplant collections, urinary tract abnormalities, and Doppler indices) were recorded within six predefined follow-up windows. We used descriptive statistics and Kaplan-Meier survival curves stratified by the presence of any abnormal ultrasound finding at each window. Analyses were performed in R (version 4.3). Sixty-three patients (mean age 12.0 ± 3.9 years) were included. Abnormal findings were present in 43%-56% of scans across follow-up windows. Peritransplant collections (33.9%) and hematomas (24.6%) were common early findings, whereas hydronephrosis and increased echogenicity became more frequent over time. Resistive index elevation (> 0.8) was uncommon (< 3.5%). Three-year graft survival was 55.7%. Any abnormality on baseline ultrasound was associated with lower 36 month survival (40.9% vs. 73.1%, log-rank p = 0.025), while abnormalities detected at later windows were not associated with survival differences. Abnormal ultrasound findings were common after pediatric kidney transplantation, particularly in the early postoperative period. Baseline abnormalities were associated with poorer long-term graft survival, which may reflect perioperative complications or early allograft injury. This supports the clinical value of baseline ultrasound for early risk stratification and guiding the follow-up intensity.
Abdominal pain is a common complaint in pediatric patients with Group A streptococcal (GAS) pharyngitis. Etiology of abdominal pain from GAS infections are unknown. Point-of-care ultrasound (POCUS) is often used by pediatric emergency medicine physicians to evaluate children with abdominal pain. We describe 12 pediatric patients who presented to our Pediatric Emergency Department with symptoms suggestive of acute pharyngitis and abdominal pain, tested positive for GAS pharyngitis, and were found to have mesenteric lymphadenitis (mLAD) on POCUS. Findings on POCUS suggest that abdominal pain in GAS pharyngitis patients may be caused by mLAD. Further studies are warranted to validate this association.
Atypical fibrous histiocytoma (AFH) is an uncommon tumor in the neck, and there are limited reports on its ultrasound characteristics. We present a case report of an atypical fibrous histiocytoma in the neck of a 38-year-old woman, emphasizing the diagnostic challenges and differential diagnoses that should be considered when evaluating neck masses using ultrasound.
To investigate the diagnostic clues and genetic etiology of short-rib thoracic dysplasia (SRTD) in early pregnancy, we report a case of a fetus suspected of having SRTD based on ultrasound findings at 13 weeks of gestation. Prenatal genetic testing revealed a pathogenic variant in the DYNC2H1 gene, and post-abortion examination of the specimen along with X-ray findings confirmed the diagnosis as short-rib thoracic dysplasia 3 (SRTD3; OMIM #613091). Such cases are rarely reported in the early gestational period. The detection and subsequent confirmation in this case at 13 weeks demonstrate that the combination of early ultrasound screening and genetic testing can enable early detection and diagnosis of SRTD. This approach provides a basis for precise prenatal assessment and holds significant clinical importance for reducing birth defects.
Hepatocellular carcinoma (HCC) at the early stage frequently evades detection. Aberrant expression of miR-1233 has been reported in various malignancies, yet its level and potential clinical value in HCC remain unknown. This study evaluated miR-1233 expression and potential diagnostic performance in HCC patients. This prospective study enrolled 100 individuals with benign hepatic tumors and 120 cases with HCC. They all underwent dual-source CT imaging and were confirmed pathologically. The miR-1233 level was quantified by qRT-PCR. The multivariate logistic regression analysis was employed to identify the underlying risk factors of HCC. Pearson correlation analysis was carried out to assess the association of miR-1233 with alpha fetoprotein (AFP) or des-gamma-carboxy prothrombin (DCP). After statistical analysis in SPSS, ROC curves were generated for significantly different miR-1233, dual-CT parameters, and the combination to compare their diagnostic performance in distinguishing HCC patients. Serum miR-1233 was up-regulated in HCC patients. The expression pattern of miR-1233 showed positive correlation to AFP and DCP indicators. In ROC curve of miR-1233, AUC reached 0.821, with a sensitivity of 73.33% and specificity of 76.67%. Combined with the differential dual-CT parameters, the AUC reached 0.944, with both sensitivity and specificity exceeding 90%. Serum miR-1233 was significantly up-regulated in HCC patients. The diagnostic efficacy of miR-1233 combined with dual-source CT was superior to that of the single one in recognizing HCC individuals.
This study retrospectively analyzed the safety of sulfur hexafluoride microbubble contrast-enhanced ultrasound (CEUS) in 447 pediatric patients (median age 8 years 4 months) at a single center. Using weight-based dosing (≤ 0.03 mL/kg of SonoVue), the overall adverse event incidence was 1.6% (7/447). Events included nausea/vomiting, severe cough, headache, rash, and transient hypertension, all mild and transient with no serious outcomes. All seven events were classified as mild, and no serious adverse events (e.g., anaphylactic shock, laryngeal edema) occurred in this study. No significant differences were found across gender or age groups. With standardized procedure and monitoring, CEUS demonstrated a highly favorable safety profile as a valuable radiation-free imaging tool in pediatrics.