Ultrasound Assessment of Hip Subspine Bone Morphology Soft-tissue Correlates with Clinical Diagnosis of Impingement.

PURPOSE: To determine the ultrasound imaging manifestations associated with subspine impingement (SSI), including the osseous and soft-tissue injuries adjacent to anterior inferior iliac spine (AIIS) and to investigate the diagnostic value of ultrasound for SSI. METHODS: We retrospectively evaluated patients who attended the sports medicine department of our hospital and underwent arthroscopic treatment for femoroacetabular impingement (FAI) between September 2019 and October 2020, with preoperative hip joint ultrasound and computed tomography (CT) examination within 1 month before surgery. All of the FAI patients were divided into the SSI group and non-SSI group, according to the clinical and intraoperative findings. The preoperative ultrasound and CT findings were assessed. The sensitivity, specificity, and positive predictive value (PPV) of some indicators were calculated and compared. Multivariable logistic regression and receiver operating characteristic curve (ROC) were also used. RESULTS: A total of 71 hips were included, with a mean age of 35.4 ± 10.4 years, 56.3% were women. Of these, 40 hips had clinically confirmed SSI. The bone morphology type III, heterogeneous hypoecho in anterosuperior joint capsule and the direct head of rectus femoris (dRF) tendon adjacent to AIIS on the Standard Section of the dRF in ultrasound were associated with SSI. Among them, the heterogeneous hypoecho in the anterosuperior joint capsule had the best diagnostic value for the SSI (85.0% sensitivity, 58.1% specificity, AUC = 0.681). The AUC of the ultrasound composite indicators was 0.750. The AUC and PPV of CT low-lying AIIS for the SSI diagnosis was 0.733 and 71.7%, which could be improved when CT was combined with the ultrasound composite indicators with AUC = 0.831 and PPV = 85.7%. CONCLUSIONS: Bone morphology abnormalities and soft-tissue injuries adjacent to the AIIS through sonographic evaluation were associated with SSI. Ultrasound could be used as a feasible method to predict SSI. The diagnostic value for SSI could be improved when ultrasound is combined with CT. LEVEL OF EVIDENCE: Level IV, case series.

Development and Validation of a Prognostic Nomogram for Prognosis in Patients With Renal Artery Stenosis.

Background and Objective: Renal artery stenosis (RAS) is associated with an increased risk of renal function deterioration (RFD). Our previous study showed that renal cortical blood perfusion assessed by contrast-enhanced ultrasound (CEUS) was an important related factor for RFD in RAS patients. Based on several conventional related factors confirmed by previous studies, we aimed to establish and verify a CEUS+ scoring system to evaluate the risk of RFD at 1 year of follow-up in RAS patients. Methods: This study was a single-center retrospective study. A total of 497 elderly RAS patients (247 in the training group and 250 in the verification group) admitted to the Beijing Hospital from January 2016 to December 2019 were included. The baseline characteristics of the patients on admission (including general conditions, previous medical history, blood pressure, blood creatinine, RAS, and cortical blood perfusion in the affected kidney) and renal function [glomerular filtration rate (GFR)] at 1-year of follow-up were collected. We used the univariate and multivariate logistic regressions to establish a CEUS+ scoring system model, the receiver operating characteristic (ROC) curve and area under the curve (AUC) to evaluate prediction accuracy, and the decision curve analysis and nomogram to evaluate the clinical application value of CEUS+ scoring system model. Results: Among the 497 patients enrolled, 266 (53.5%) were men, with an average age of (51.7 ± 19.3) years. The baseline clinical-radiomic data of the training group and the verification group were similar (all p > 0.05). Multivariate logistic regression analysis results showed that age [Odds ratio (OR) = 1.937, 95% confidence interval (CI): 1.104-3.397), diabetes (OR = 1.402, 95% CI: 1.015-1.938), blood pressure (OR = 1.575, 95% CI: 1.138-2.182), RAS (OR = 1.771, 95% CI: 1.114-2.816), and area under ascending curve (AUCi) (OR = 2.131, 95% CI: 1.263-3.596) were related factors for the renal function deterioration after 1 year of follow-up (all p < 0.05). The AUC of the ROC curve of the CEUS+ scoring system model of the training group was 0.801, and the Youden index was 0.725 (specificity 0.768, sensitivity 0.813); the AUC of the ROC curve of the validation group was 0.853, Youden index was 0.718 (specificity 0.693, sensitivity 0.835). There was no significant difference in ROC curves between the two groups (D = 1.338, p = 0.325). In addition, the calibration charts of the training and verification groups showed that the calibration curve of the CEUS+ scoring system was close to the standard curve (p = 0.701, p = 0.823, both p > 0.10). Conclusion: The CEUS+ scoring system model is helpful in predicting the risk of worsening renal function in elderly RAS patients.

Quantitative and Qualitative Ultrasound Evaluation for the Diagnosis of an Anterosuperior Acetabular Labral Tear.

We investigated the diagnostic performance of qualitative and quantitative ultrasound criteria for anterosuperior acetabular labral tears (ALTs). In all, 118 people with ALTs (120 hips; case group) and 31 asymptomatic volunteers (42 hips; control group) at Peking University Third Hospital between August 2018 and November 2019 were consecutively included. The labral cleft, labral heterogeneous echogenicity, labral plump morphology, paralabral cyst and labral focal hyperechoic area were used as the qualitative criteria. The anterosuperior labral cross-section area (CSA) was measured as the quantitative criterion. The diagnostic utility of the quantitative and qualitative criteria were explored with magnetic resonance imaging as the diagnostic gold standard. Labral heterogeneous echogenicity was the most sensitive criterion for diagnosing ALTs (up to 80.00%), and the specificity of diagnosing ALTs with paralabral cysts, labral focal hyperechoic area and subcortical cysts of the femoral head and neck was as high as 90.48%-100%. The labral CSA in the case group was 0.27 cm2 (0.21-0.39 cm2), which was significantly larger compared with the control group (0.18 cm2 [0.14-0.23 cm2]; p < 0.001). The area under the receiver operating characteristic curve was 0.802 for diagnosing ALTs according to the labral CSA. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of the combined qualitative criteria for diagnosing ALTs were 90.00%, 71.43%, 90.00%, 71.43% and 85.19%, respectively. Labral heterogeneous echogenicity is a sensitive criterion for diagnosing ALTs, and paralabral cysts, labral focal hyperechoic, area and subcortical cysts of the femoral head and neck are specific criteria. The CSA of the anterosuperior acetabular labrum measured by ultrasound can be used as a quantitative criterion to diagnose ALTs. The combination of labral qualitative criteria provides higher sensitivity and accuracy in diagnosing ALTs.

Ultrasound and shear-wave elastography characteristics of the iliocapsularis muscle in pincer-type femoroacetabular impingement.

BACKGROUND: The iliocapsularis muscle is a structure of the anterior hip, which may play a key role in stabilizing the hip joint, but to our knowledge no studies exist describing ultrasound (US) and shear-wave characteristics of this muscle. OBJECTIVES: To investigate the anatomic dimensions and elasticity of the iliocapsularis muscle in patients with pincer-type femoroacetabular impingement (FAI) and normal hips using gray-scale US and shear-wave elastography (SWE). DESIGN: Case-control study. SETTING: Sports medicine and ultrasound department within a tertiary hospital. PARTICIPANTS: Thirty-three patients (33 hips) with pincer-type FAI and 37 healthy volunteers (37 hips). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: US parameters (anteroposterior diameter, transverse diameter and circumference) of the iliocapsularis muscle in patients with pincer-type FAI and volunteers. Shear-wave velocity and Young's modulus of the iliocapsularis muscle in patients with pincer-type FAI and volunteers in both neutral and external rotation positions. RESULTS: Significant differences were not observed in the anatomic dimensions of the iliocapsularis muscle between patients with pincer-type FAI and volunteers. The iliocapsularis muscle in patients with pincer-type FAI had significantly lower shear-wave velocity and Young's modulus than the volunteers (p < .05). The cutoff value of the maximum velocity in the external rotation position was 3.35 m/s, which separated pincer-type FAI patients from volunteers and revealed the highest accuracy with sensitivity, specificity, and accuracy of 78.8%, 48.6%, and 64.3%, respectively. CONCLUSION: The anatomic dimensions of the iliocapsularis muscle in pincer-type FAI patients and volunteers were similar; however, iliocapsularis stiffness in patients with pincer-type FAI was significantly lower than that of the volunteers. SWE can demonstrate altered muscle stiffness of the iliocapsularis muscle in pincer-type FAI patients, which might be used to help make clinical decisions.

Rationale and study design for one-stop assessment of renal artery stenosis and renal microvascular perfusion with contrast-enhanced ultrasound for patients with suspected renovascular hypertension.

BACKGROUND: Renal artery stenosis (RAS) is always associated with abnormalities in renal microvascular perfusion (RMP). However, few imaging methods can simultaneously evaluate the degree of luminal stenosis and RMP. Thus, this study will aim to evaluate the feasibility of using contrast-enhanced ultrasound (CEUS) for assessing both RAS and RMP to achieve a one-stop assessment of patients with suspected renovascular hypertension. METHODS: This will be a single-center diagnostic study with a sample size of 440. Patients with chronic kidney disease (CKD) and suspected of having resistant hypertension will be eligible. Patients with Stages 1-3 CKD will undergo CEUS and computed tomography (CT) angiography (CTA). Values obtained by CEUS and CTA for diagnosing low-grade (lumen reduced by <60%) and high-grade (lumen reduced by ≥60%) RAS will be compared. Moreover, all patients will also undergo radionuclide imaging. The diagnostic value for RAS will be assessed by the receiver operating characteristic curve, including the accuracy, sensitivity, specificity, positive predictive values, negative predictive values, and area under the ROC. Pearson correlation analysis will be performed to assess the association between CEUS findings for RMP and glomerular filtration rate measured by a radionuclide imaging method. CONCLUSION: The data gathered from this study will be used to evaluate the feasibility of expanding clinical applications of CEUS for evaluation of patients with suspected renovascular hypertension. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR1800016252; https://www.chictr.org.cn.

Incremental value of resting three-dimensional speckle-tracking echocardiography in detecting coronary artery disease.

The aim of the present study was to investigate the incremental value of resting three-dimensional speckle-tracking echocardiography (3D-STE) in the detection of early-stage left ventricular dysfunction in patients with coronary artery disease (CAD). A total of 110 patients suspected of having CAD were recruited. All patients underwent 3D-STE and coronary artery angiography (CAG). They were divided to a CAD group and a normal group according to the results of CAG. Using 3D-STE software, the peak values of longitudinal strain (LS), circumferential strain (CS), radial strain (RS) and area strain (AS) and the time to peak value of these strains (T-LS, T-CS, T-RS and T-AS) were measured. A receiver operator characteristic curve (ROC) was used to analyze the sensitivity of these strains for the diagnosis of CAD. ROC analysis indicated that T-LS and composite indices combining the peak strain value and time to peak of LS, CS and AS have diagnostic value for the early detection of CAD; the area under the curve (AUC) values were 0.667, 0.692, 0.621 and 0.672 respectively (P<0.005). The composite index of longitudinal strain demonstrated the highest diagnostic value for CAD with 62% sensitivity and 76% specificity. These results indicate that 3D-STE has incremental value for the diagnosis of CAD in patients at rest.