rss_2.0Journal of Ultrasonography FeedSciendo RSS Feed for Journal of Ultrasonography of Ultrasonography Feed ultrasound-guided thoracentesis simulation using an optical see-through head-mounted display: a proof-of-concept study<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Aim</title><p>This study aimed to examine the feasibility and potential benefits of an optical see-through head-mounted display (OST-HMD) during real-time ultrasound-guided thoracentesis simulations.</p> </sec> <sec><title style='display:none'>Material and methods</title> <p>Six physicians performed a thoracentesis simulation using an OST-HMD and a wireless image transmission system. The time required, puncture needle visibility, pleural fluid collection success rate, and head movement during the procedure using a smart glass equipped with an inertial measurement unit were all recorded and compared with and without the HMD.</p> </sec> <sec><title style='display:none'>Results</title> <p>Study participants successfully extracted effusions in all procedures. The use of OST-HMD did not significantly affect the time of the procedure, but notably decreased the horizontal and vertical head movements during the procedure.</p> </sec> <sec><title style='display:none'>Conclusions</title> <p>The study demonstrated the feasibility of using an OST-HMD in a simulated real-time ultrasound-guided thoracentesis procedure and showed the potential of HMD in thoracentesis to improve ergonomics and accuracy. Further research is necessary to confirm these findings.</p> </sec> </abstract>ARTICLEtrue ultrasound (POCUS) to the rescue in VA-ECMO vascular abnormalities linked to pregnancy complications: color and power Doppler-assisted transvaginal ultrasound evaluation<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Aim</title> <p>Abnormal uterine vascular pattern can be observed during transvaginal ultrasound examination used for investigating post-abortion bleeding and secondary postpartum hemorrhage. The purpose of this series of cases was to evaluate almost all the rare causes of uterine vascular abnormalities linked to pregnancy complications, and determine how to arrive at the diagnosis to optimize patient management, which is crucial for preventing life-threatening massive vaginal bleeding.</p> </sec> <sec><title style='display:none'>Material and methods</title> <p>Retrospective observational case series study including 20 women with postpartum or post-abortion vaginal bleeding who were found to have an abnormal uterine vascular pattern during a transvaginal color duplex assessment.</p> </sec> <sec><title style='display:none'>Results</title> <p>The study yielded the following findings: 10 cases of enhanced myometrial vascularity, two cases of pseudoaneurysm in the uterine artery, one case of myometrial venous varix, one case of large uterine venous pseudoaneurysm, one case of uterine arteriovenous malformation, one case of retained placental polyp, one case of invasive vesicular mole, and three cases of subinvolution of the placental implantation site.</p> </sec> <sec><title style='display:none'>Conclusions</title> <p>Transvaginal color duplex ultrasound plays a crucial role in detecting uterine vascular abnormalities as a cause of post-abortion or secondary postpartum hemorrhage and can help differentiate the pathologies responsible for the abnormal vascular pattern, which is highly recommended to optimize patient management.</p> </sec> </abstract>ARTICLEtrue ultrasound-based evaluation of hemodynamic changes in the ophthalmic artery and central retinal artery in patients with type 1 diabetes mellitus without retinopathy and with mild non-proliferative retinopathy<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Aim</title> <p>Determination of blood flow parameters in the ophthalmic artery and central retinal artery using Doppler ultrasound in patients with type 1 diabetes mellitus without fundus signs of diabetic retinopathy and with mild non-proliferative retinopathy.</p> </sec> <sec><title style='display:none'>Material and methods</title> <p>To eliminate the impact of other systemic factors on vascular flow, the study enrolled a total of 80 patients with type 1 diabetes mellitus, aged between 18 and 45 years. The study participants did not have any diabetic complications or other systemic or ocular comorbidities. The control group comprised 81 healthy individuals within a similar age range. Color Doppler ultrasound examinations of the ophthalmic artery and central retinal artery were performed to evaluate selected blood flow parameters including peak systolic velocity, end-diastolic velocity, and resistance index.</p> </sec> <sec><title style='display:none'>Results</title> <p>Patients with type 1 diabetes mellitus exhibited statistically significant decrease in both systolic and end-diastolic velocities in the central retinal artery, accompanied by an elevation in resistance index, compared to the control group. The study revealed differences in blood flow parameters between the patients without fundus changes and those exhibiting mild non-proliferative retinopathy. Specifically, patients with retinopathy showed a significant decrease in both systolic velocity and end-diastolic velocity in the central retinal artery. No differences were observed for the same parameters in the ophthalmic artery. When analyzing the patients’ blood flow parameters in relation to the degree of diabetes control, as determined by glycated hemoglobin levels, a statistically significant reduction in systolic velocity was identified in both the ophthalmic and central retinal arteries in the group with poorly controlled diabetes.</p> </sec> <sec><title style='display:none'>Conclusions</title> <p>Examination of the orbital vessels using Doppler ultrasound in patients with type 1 diabetes mellitus holds promise as an effective method for early detection of vascular abnormalities.</p> </sec> </abstract>ARTICLEtrue assessment of the relationship between urethral hypermobility as measured by ultrasound and the symptoms of stress urinary incontinence in primiparous women 9–18 months postpartum<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Aim</title> <p>The aim of the study was to estimate the relationship between bladder neck hypermobility as assessed by ultrasound and the occurrence of stress urinary incontinence as measured with the UDI-6 questionnaire in primiparous women 9–18 months postpartum.</p> </sec> <sec><title style='display:none'>Materials and methods</title> <p>The study included 100 women 9–18 months after their first delivery, 19% of whom (study group) presented with urethral hypermobility. Ultrasound was used to determine the position and mobility of the bladder neck in order to assess the urethral hypermobility. A vector of ≥15 mm was defined as urethral hypermobility. Symptoms of stress urinary incontinence were assessed using question 3 of the UDI-6 questionnaire, in which the presence of symptoms was defined as a response rated from 1 to 4.</p> </sec> <sec><title style='display:none'>Results</title> <p>We demonstrated a statistically significant relationship between urethral hypermobility and the symptoms of stress urinary incontinence with a statistical significance level of <italic>p</italic> &lt;0.002.</p> </sec> <sec><title style='display:none'>Conclusions</title> <p>Stress urinary incontinence is a common disorder in women, the pathophysiology of which is not fully understood. It has adverse effects on the quality of life, perception of one’s own body and sexual function. Impairment of urethral fixation may play an important role in the pathophysiology of this common form of urinary incontinence. The study showed that urethral hypermobility, as assessed by ultrasound, contributes to stress urinary incontinence, as measured with the UDI-6 score. Although stress urinary incontinence is a multifactorial disorder influenced by anatomical changes and congenital anatomical features, it is easily diagnosed. Suburethral slings are an effective surgical technique; however, the incidence of postoperative voiding dysfunction or recurrent stress urinary incontinence is 10–20%. Therefore, an assessment of anatomical changes in stress urinary incontinence may help individualize the surgical strategy.</p> </sec> </abstract>ARTICLEtrue of the canal of Nuck: a rare differential diagnosis for an inguinal hernia<abstract> <title style='display:none'>Abstract</title> <p>Hydrocele of the canal of Nuck is a rare condition which is commonly misdiagnosed as an inguinal hernia due to the unfamiliarity of clinicians with this pathology. There are three different types of hydrocele of the canal of Nuck, with type 1 being the most common, typically presenting as a unilocular cystic lesion with no communication with the peritoneal cavity. We present a case of a two-month-old female patient with an enlarging inguinal swelling raising the suspicion for an inguinal hernia or lymphadenopathy, with sonographic imaging revealing a fluid collection in the canal of Nuck, suggestive of a hydrocele. Diagnostic radiology plays a crucial role in the initial diagnosis of a canal of Nuck hydrocele, and ultrasound is considered the modality of choice for early diagnosis differentiating it from other causes of inguinal swelling.</p> </abstract>ARTICLEtrue, follow-up, or discharge? An aid in sonographic decisions for the borderline centered neonatal/infantile hips<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Aim</title> <p>To investigate whether linear measurements or ratios on the Graf’s “standard plane” ultrasound images of the neonatal/infantile hip, can support the clinically important differentiation between type I and type II hips.</p> </sec> <sec><title style='display:none'>Material and methods</title> <p>A total of 60 Graf type II hips and 124 randomly selected Graf type I hips, matched to the gestational age at delivery, birth weight, delivery mode, and age at the time of the examination, were identified through our hip screening service, during a period of two years. The images were diagnostically suitable, following anatomical identification and usability check, according to Graf. Anatomical landmarks including the lower limb of the os ilium, the bony rim, the silhouette of the os ilium, the labrum and the femoral head’s borders, were used to determine the measurements and ratios which quantified their inter-relationships.</p> </sec> <sec><title style='display:none'>Results</title> <p>The indices which differed significantly between type I and type II hips included: (a) the width of the “bony roof” (cut-off value 5.91 mm, sensitivity: 75%, specificity: 70%), (b) the ratio of the width of the “bony roof” to the femoral head’s width (cut-off value 0.40, sensitivity 83%, specificity 71%), and (c) the ratio of the cartilaginous acetabular roof’s width (including the labrum), to the width of the femoral head (cut-off value 0.450, sensitivity 82%, specificity 67%).</p> </sec> <sec><title style='display:none'>Conclusions</title> <p>Newly introduced measurements and calculated ratios on “standard plane” ultrasound images can be used as additional indices in the differentiation between Graf’s types of “centered hips”, thus increasing the diagnostic certainty of the examiner in borderline cases and limiting unnecessary re-examinations or treatment.</p> </sec> </abstract>ARTICLEtrue realistic aortic dissection simulator as a potential training tool for point-of-care ultrasound<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Aim</title> <p>Simulators for aortic dissection diagnosis are limited by complex anatomy influencing the accuracy of point-of-care ultrasound for diagnosing aortic dissection. Therefore, this study aimed to create a healthy ascending aorta and class DeBakey, type II aortic dissection simulator as a potential point-of-care ultrasound training model.</p> </sec> <sec><title style='display:none'>Material and methods</title> <p>3D mould simulators were created based on computed tomography images of one healthy and one DeBakey type II aortic dissection patient. In the next step, two polyvinyl alcohol-based and two silicone-based simulators were synthesised.</p> </sec> <sec><title style='display:none'>Results</title> <p>The results of the scanning electron microscope assessment showed an aortic dissection simulator’s surface with disorganised surface texture and higher root mean square (RMS or Rq) value than the healthy model of polyvinyl alcohol (<italic>Rq<sub>AD</sub></italic> = 20.28 &gt; <italic>Rq<sub>AAo</sub></italic> = 10.26) and silicone (<italic>Rq<sub>AD</sub></italic> = 33.8 &gt; <italic>Rq<sub>AAo</sub></italic> = 23.07). The ultrasound assessment of diameter aortic dissection showed higher than the healthy ascending aorta in polyvinyl alcohol (<italic>d<sub>AD</sub></italic> = 28.2 mm &gt; <italic>d<sub>AAo</sub></italic> = 20.2 mm) and Si (<italic>d<sub>AD</sub></italic> = 31.0 mm &gt; <italic>d<sub>AAo</sub></italic> = 22.4 mm), while the wall thickness of aortic dissection showed thinner than the healthy aorta in polyvinyl alcohol, which is comparable with the actual aorta measurement. The intimal flap of aortic dissection was able to replicate and showed a false lumen in the ultrasound images. The flap was measured quantitatively, indicating that the intimal flap was hyperechoic.</p> </sec> <sec><title style='display:none'>Conclusions</title> <p>The simulators were able to replicate the surface morphology and echogenicity of the intimal flap, which is a linear hyperechoic area representing the separation of the aorta wall.</p> </sec> </abstract>ARTICLEtrue artery occlusion: a case study<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Aim of the study</title> <p>The aim of this case report is to evaluate carotid duplex and hemodynamic patterns in an asymptomatic male patient with innominate artery occlusion. Innominate artery occlusion is a rare clinical entity that can lead to a range of cerebrovascular symptoms, including arm claudication, subclavian steal syndrome, and stroke. The case report emphasizes key learning points in diagnosing innominate artery occlusion using imaging and physiological methods.</p> </sec> <sec><title style='display:none'>Case description</title> <p>A 64-year-old asymptomatic male patient with a history of carotid bruit, hypertension, coronary artery bypass grafting, aortic aneurysm, hyperlipidemia, mild aortic stenosis, long-term tobacco use, and a body mass index of 24 was referred for a carotid ultrasound.</p> </sec> <sec><title style='display:none'>Conclusions</title> <p>Innominate artery occlusion is a rare condition requiring a comprehensive assessment of collateralization before any intervention is attempted. Considering waveform features such as transient end-diastolic flow reversal and tardus parvus, along with brachial pressures and transcranial Doppler, can assist in evaluating the extent of disease.</p> </sec> </abstract>ARTICLEtrue role of gray-scale and shear-wave elastography in pediatric patients with undescended testes: a prospective controlled study<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Aim</title> <p>Ultrasound elastography is a simple non-invasive method for measuring tissue elasticity in relation to tissue fibrosis. The aim of this study was to compare echogenicity, volume and shear wave velocities of undescended vs normally descended testes.</p> </sec> <sec><title style='display:none'>Material and methods</title> <p>Sixty-six boys with undescended testes were included in this study. The median age range was 35.5 (10–118) months old. The cases included in this prospective study consisted of 66 patients with non-operated undescended testes, with 51 of them being affected unilaterally and 15 affected bilaterally, as diagnosed by physical examination. The control group consisted of 31 healthy boys without any particular health problems. This prospective study was performed by gray-scale ultrasonography and shear wave elastography in boys with undescended testes and healthy testes. The testicular volumes were established by ultrasound measurement, the echogenicity and shear wave elastography values were measured in boys with unilateral and bilateral undescended testes, and the results were compared with healthy boys’ testes and their contralateral testes. The stiffness values were recorded for speed (m/s) and elasticity (kPa), and the stiffness values of undescended testes were compared with the healthy control group.</p> </sec> <sec><title style='display:none'>Results</title> <p>Echogenicity values were lower in the bilateral undescended testes group than in the healthy group, and the healthy group’s echogenicity was normal (<italic>p</italic> &lt;0.001). The ROC curve was used to identify a cut-off shear wave elastography value for predicting decreased testicular echogenicity by using average shear wave elastography values. The area under the curve for the undescended testes was 0.78 (95% CI: 0.70–0.85, sensitivity 83.7%, specificity 68.7%, <italic>p</italic> &lt;0.001), with an average shear wave elastography value of 2.32 (m/s) for above the cut-off point indicates. This was found to be significantly associated with reduced echogenicity on gray-scale ultrasonography, suggesting that it may be correlated with fibrosis developing in patients with undescended testes.</p> </sec> <sec><title style='display:none'>Conclusion</title> <p>The study provides interesting findings in that it proposes an alternative non-invasive method for the assessment of testicular tissue in undescended testes. We used shear wave elastography to compare the stiffness of normal testes in both heathy patients and in the contralateral healthy testes of boys with undescended testes, with the values obtained for the undescended testes reflecting the level of fibrosis of the parenchyma. Another outcome of this study was observed in patients with unilateral undescended testes, where the normally descended testes showed increased shear wave elastography values, which could be an early indication of parenchymal change.</p> </sec> </abstract>ARTICLEtrue of Ovarian Malignancy Algorithm and Pelvic Mass Score for the prediction of malignant ovarian tumors: a prospective comparative study<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Aim</title> <p>Ovarian cancer is the seventh most common female cancer worldwide. Nevertheless, there is no available universal screening method for malignant ovarian masses. This study compares the value of the Risk of Ovarian Malignancy Algorithm (ROMA) and Pelvic Mass Score (PMS) scoring systems in the diagnosis of malignant ovarian masses.</p> </sec> <sec><title style='display:none'>Material and methods</title> <p>This prospective comparative study was conducted from March 2021 until April 2022. A total of 258 women diagnosed with ovarian mass and eligible for surgical intervention according to institutional guidelines were enrolled in the study. Ultrasound was performed for the assessment of masses, ascites and metastases, also color flow Doppler was done to measure the resistance index of the mass vasculature. Preoperative venous blood samples were collected to measure CA 125 and HE4. PMS and ROMA scoring systems were calculated for each patient. All women were subjected to a surgical intervention (according to applicable institutional guidelines), using either open or laparoscopic techniques. Histopathological examination of the removed specimens was done, and in line with the recognized gold standard, the results were compared with the pre-operative diagnosis of both scoring systems.</p> </sec> <sec><title style='display:none'>Results</title> <p>Both PMS and ROMA showed a high predictive probability for ovarian malignancies (AUC = 0.93, sensitivity = 83.3%, specificity = 90.37%; AUC = 0.91, sensitivity = 84.4%, specificity = 95.56%, respectively), yet no statistical significant difference was found between the two scoring systems (<italic>p</italic> = 0.353, 95% CI −0.025 to 0.070).</p> </sec> <sec><title style='display:none'>Conclusions</title> <p>Both PMS and ROMA seem to be promising scoring systems for discriminating benign from malignant ovarian masses, but more research is needed to determine the optimum diagnostic pathway, especially one yielding the least false-negative results.</p> </sec> </abstract>ARTICLEtrue of life-threatening bleeding complication from splenic venous ectasia by B-mode-, color Doppler- and contrast-enhanced ultrasound in a patient with ALL<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Aim of the study</title> <p>Spontaneous splenic rupture is a serious complication of pathologically altered spleen tissue, associated with a high mortality rate.</p> </sec> <sec><title style='display:none'>Case description</title> <p>We describe a spontaneous splenic rupture in a patient with acute lymphoblastic leukemia undergoing chemotherapy. Ultrasound revealed splenomegaly, and diffuse splenic acute lymphoblastic leukemia-infiltration was suspected. In addition, only color Doppler sonography and contrast-enhanced ultrasound diagnosed splenic vascular ectasias with a venous-flow-profile. During therapy, short-term sonographic follow-up examinations were able to reveal an increase in the size of venous ectasias and the associated increased risk of spontaneous splenic rupture. Based on these sonographic findings, immediate surgical splenectomy was performed in the spontaneous splenic rupture case and the patient survived.</p> </sec> <sec><title style='display:none'>Conclusions</title> <p>Ultrasound is an important diagnostic method in patients with newly diagnosed malignant hematological diseases to detect disease-related splenic pathologies. Short-term follow-up examinations of splenic vascular pathologies can detect size progression and a potential risk of spontaneous splenic rupture with life-threatening bleeding.</p> </sec> </abstract>ARTICLEtrue of intrahepatic cholangiocarcinoma with CEUS<abstract> <title style='display:none'>Abstract</title> <p>Intrahepatic cholangiocarcinoma (ICC) is a rare, heterogeneous, highly lethal tumor of the biliary tract. Due to the lack of effective treatments, an early identification of ICC is essential to achieve the best outcome in terms of therapy and prognosis aiming for a curative intent. ICC may arise on a normal liver or with an underlying liver disease, making the diagnosis more difficult and complex. Contrast-enhancement ultrasound (CEUS) is an accurate procedure able to detect ICC-specific contrast vascular pattern, and thus facilitating the correlation between radiological and histopathological findings with high specificity and sensitivity. CEUS has been shown to have a high diagnostic potential in the diagnosis of ICC thanks to the possibility of studying in real time the intralesional microcirculation and evaluating the precocity of the enhancement of the lesion during the arterial phase. All these features allow to differentiate the ICC from hepatocarcinoma (HCC) with high sensitivity and specificity. Furthermore, CEUS is a rapid, non-invasive, non-nephrotoxic or non-allergenic tool. The only limitations CEUS may have are related to the disease site and patient characteristics (obesity) and compliance, including the operator’s experience. A clinical evaluation of the patient, together with tumor markers and biochemical tests assessment, to differentiate ICC from HCC are highly suggested.</p> </abstract>ARTICLEtrue ultrasound in the evaluation of musculoskeletal infections<abstract> <title style='display:none'>Abstract</title> <p>Soft tissue and osseous musculoskeletal infections are common but can be difficult to diagnose clinically. Signs, symptoms, and physical examination findings may be nonspecific, and laboratory values can be inconclusive. The extent of disease may also be underestimated on physical examination. Soft tissue infections most commonly occur secondary to direct inoculation from broken skin and less frequently due to the seeding of the soft tissues from hematogenous spread, while osseous infections are more commonly due to hematogenous seeding. Infections may also be iatrogenic, following surgery or other procedural interventions. High-resolution ultrasound is an extremely useful imaging modality in the evaluation of musculoskeletal soft tissue and joint infections, and can occasionally be used to evaluate osseous infections as well. Ultrasound can aid in the early diagnosis of musculoskeletal infections, allowing for prompt treatment, decreased risk of complications, and treatment optimization. Ultrasound is sensitive and specific in evaluating soft tissue edema and hyperemia; soft tissue abscesses; joint, bursal and tendon sheath effusions/synovitis; and subperiosteal abscesses. This article describes the typical high-resolution grayscale as well as color and power Doppler ultrasound imaging findings of soft tissue infections including cellulitis, fasciitis, necrotizing deep soft tissue infection, pyomyositis, soft tissue abscess, infectious bursitis, and infectious tenosynovitis. Ultrasound findings of septic arthritis as well as osteomyelitis, such as subperiosteal spread of infection (subperiosteal abscess). are also reviewed. In addition, the use of ultrasound to guide fluid and tissue sampling is discussed.</p> </abstract>ARTICLEtrue role of high-resolution ultrasound and MRI in the evaluation of peripheral nerves in the lower extremity<abstract> <title style='display:none'>Abstract</title> <p>Lower extremity peripheral neuropathy is a commonly encountered neurologic disorder, which can lead to chronic pain, functional disability, and decreased quality of life for a patient. As diagnostic imaging modalities have improved, imaging has started to play an integral role in the detection and characterization of peripheral nerve abnormalities by non-invasively and accurately identifying abnormal nerves as well as potential causes of neuropathy, which ultimately leads to precise and timely treatment. Ultrasound, which has high spatial resolution and can quickly and comfortably characterize peripheral nerves in real time along with associated denervation muscle atrophy, and magnetic resonance neurography, which provides excellent contrast resolution between nerves and other tissues and between pathologic and normal segments of peripheral nerves, in addition to assessing reversible and irreversible muscle denervation changes, are the two mainstay imaging modalities used in peripheral nerve assessment. These two modalities are complimentary, and one may be more useful than the other depending on the nerve and location of pathology. Imaging must be interpreted in the context of available clinical information and other diagnostic studies, such as electrodiagnostic tests. Here, we offer a comprehensive overview of the role of high-resolution ultrasound and magnetic resonance neurography in the evaluation of the peripheral nerves of the lower extremity and their associated neuropathies.</p> </abstract>ARTICLEtrue on current concepts and advances in musculoskeletal ultrasound: Honoring my Teacher Dr. Ronald Adler value of high-resolution ultrasound and MRI in the evaluation of rheumatologic diseases<abstract> <title style='display:none'>Abstract</title> <p>Rheumatologic diseases are a widespread group of disorders affecting the joints, bones, and connective tissue, and leading to significant disability. Imaging is an indispensable component in diagnosing, assessing, monitoring, and managing these disorders, providing information about the structural and functional alterations occurring within the affected joints and tissues. This review article aims to compare the utility, specific clinical applications, advantages, and limitations of high-resolution ultrasound and magnetic resonance imaging in the context of rheumatologic diseases. It also provides insights into the imaging features of various types of inflammatory arthritis with clinical relevance and a focus on high-resolution ultrasound and magnetic resonance imaging. By understanding the comparative aspects of high-resolution ultrasound and magnetic resonance imaging, it is easier for the treating physicians to make informed decisions when selecting the optimal imaging modality for specific diagnostic purposes, effective treatment planning, and improve patient outcomes. The patterns of soft tissue and joint involvement; bony erosion and synovitis help in differentiating between various type of arthritis. Involvement of various small joints of the hands also gives an insight into the type of arthritis. We also briefly discuss the potential applications of emerging techniques, such as ultrasound elastography, contrast-enhanced ultrasound, and dual-energy CT, in the field of rheumatology.</p> </abstract>ARTICLEtrue of high-resolution ultrasound and magnetic resonance neurography in the evaluation of peripheral nerves in the upper extremity<abstract> <title style='display:none'>Abstract</title> <p>Upper extremity entrapment neuropathies are common conditions in which peripheral nerves are prone to injury at specific anatomical locations, particularly superficial regions or within fibro-osseous tunnels, resulting in pain and potential disability. Although neuropathy is primarily diagnosed clinically by physical examination and electrophysiology, imaging evaluation with ultrasound and magnetic resonance neurography are valuable complementary non-invasive and accurate tools for evaluation and can help define the site and cause of nerve dysfunction which ultimately leads to precise and timely treatment. Ultrasound, which has higher spatial resolution, can quickly and comfortably characterize the peripheral nerves in real time and can evaluate for denervation related muscle atrophy. Magnetic resonance imaging on the other hand provides excellent contrast resolution between the nerves and adjacent tissues, also between pathologic and normal segments of peripheral nerves. It can also assess the degree of muscle denervation and atrophy. As a prerequisite for nerve imaging, radiologists and sonographers should have a thorough knowledge of anatomy of the peripheral nerves and their superficial and deep branches, including variant anatomy, and the motor and sensory territories innervated by each nerve. The purpose of this illustrative article is to review the common neuropathy and nerve entrapment syndromes in the upper extremities focusing on ultrasound and magnetic resonance neurography imaging.</p> </abstract>ARTICLEtrue ultrasound: a technical and historical perspective<abstract> <title style='display:none'>Abstract</title> <p>During the past four decades, musculoskeletal ultrasound has become popular as an imaging modality due to its low cost, accessibility, and lack of ionizing radiation. The development of ultrasound technology was possible in large part due to concomitant advances in both solid-state electronics and signal processing. The invention of the transistor and digital computer in the late 1940s was integral in its development. Moore’s prediction that the number of microprocessors on a chip would grow exponentially, resulting in progressive miniaturization in chip design and therefore increased computational power, added to these capabilities. The development of musculoskeletal ultrasound has paralleled technical advances in diagnostic ultrasound. The appearance of a large variety of transducer capabilities and rapid image processing along with the ability to assess vascularity and tissue properties has expanded and continues to expand the role of musculoskeletal ultrasound. It should also be noted that these developments have in large part been due to a number of individuals who had the insight to see the potential applications of this developing technology to a host of relevant clinical musculoskeletal problems. Exquisite high-resolution images of both deep and small superficial musculoskeletal anatomy, assessment of vascularity on a capillary level and tissue mechanical properties can be obtained. Ultrasound has also been recognized as the method of choice to perform a large variety of interventional procedures. A brief review of these technical developments, the timeline over which these improvements occurred, and the impact on musculoskeletal ultrasound is presented below.</p> </abstract>ARTICLEtrue versus MRI in the evaluation of the thumb metacarpophalangeal joint<abstract> <title style='display:none'>Abstract</title> <p>An intricate and unique combination of ligamentous, fibrocartilaginous, and osseous structures stabilize the thumb metacarpophalangeal joint. Both ultrasound and high-resolution magnetic resonance imaging are extremely useful in evaluating these critical structures. This article reviews common injuries of the thumb metacarpophalangeal joint, while highlighting the merits, limitations, and pitfalls of the two imaging modalities. A clear appreciation of each method, paired with anatomic knowledge, will lend greater confidence and accuracy to diagnosing impactful injuries and guiding intervention.</p> </abstract>ARTICLEtrue