Ultraschall in Der Medizin最新文献

{"title":"The carotid-subclavian artery index (CSAI) in the fetal aortic arch with classical branching and brachiobicephalic trunk in a midtrimester low risk population.","authors":"Manuela Tavares de Sousa, Fatima Crispi, Olga Gomez, Bettina Hergert, Kurt Hecher","doi":"10.1055/a-2922-1435","DOIUrl":"https://doi.org/10.1055/a-2922-1435","url":null,"abstract":"<p><p>Purpose The carotid-subclavian artery index (CSAI) has shown high sensitivity and specificity for diagnosing coarctation of the aorta (CoA) in fetuses and neonates. We investigated whether variations in aortic arch (AA) branching without CoA affect CSAI by comparing fetuses with the classical pattern to those with a brachiobicephalic trunk (BBCT), the most frequent variant. Material and Methods In this prospective cohort study of 335 low-risk singleton pregnancies (19 - 22 weeks of gestation), standardized fetal echocardiography was used to assess AA branching in a sagittal view. Two blinded observers classified branching patterns and calculated CSAI. Results Adequate image quality was obtained in 262/335 (78.2%). 194/262 (74%) fetuses showed a classical pattern and 66 (25.2%) a branching variant. Furthermore, two fetuses (0.8%) due to disagreement on branching pattern. 50/66 (76.8%) fetuses with isolated BBCT were compared with 194 cases with classical AA branching pattern. 16 other variants were excluded. Interobserver agreement showed an intraclass correlation coefficient (ICC) of 0.87 (95%CI: 0.89-0.95). Mean CSAI was significantly lower in BBCT (0.71 ± 0.14) than in classical branching (1.46 ± 0.37; P < 0.001). None required cardiac intervention within two years. Conclusions Targeted fetal echocardiography showed a lower CSAI in cases with BBCT than in classical branching pattern. Future studies are warranted to assess the diagnostic impact of our findings in the setting of suspected CoA. Zielsetzung: Der Carotis-Subclavian-Artery-Index (CSAI) wird in der Diagnostik der Aortenisthmusstenose (CoA) eingesetzt. Wir untersuchten, ob der CSAI bei Feten mit Varianten der Aortenabgänge eine Rolle spielt und verglichen diesen mit Werten bei Aortenbögen mit klassischen Abgängen. Material und Methoden: In dieser prospektiven Kohortenstudie wurden 335 Einlingsschwangerschaften mit niedrigem Risiko zwischen der 19. und 22. Schwangerschaftswoche mittels standardisierter fetaler Echokardiografie untersucht. Der Aortenbogen wurde in sagittaler Ebene dargestellt. Zwei voneinander unabhängige Untersuchende beurteilten verblindet das Abgangsmuster und berechneten den CSAIErgebnisse: Eine ausreichende Bildqualität konnte bei 262 von 335 Fällen (78,2 %) erzielt werden. 194/262 (74 %) Feten zeigten ein klassisches Abgangsmuster, 66 (25,2 %) eine Variante. Bei zwei Feten (0,8 %) bestand Uneinigkeit über das Abgangsmuster. 50/66 (76,8 %) Feten mit isoliertem BBCT wurden mit den 194 Fällen mit klassischem Abgang verglichen; 16 weitere Varianten wurden ausgeschlossen. Die Interobserver-Übereinstimmung zeigte einen Intraklassen-Korrelationskoeffizienten (ICC) von 0,87 (95 %-KI: 0,89-0,95). Der mittlere CSAI war bei BBCT signifikant niedriger (0,71 ± 0,14) als bei klassischem Abgang (1,46 ± 0,37; p < 0,001). Kein Kind benötigte innerhalb von zwei Jahren eine kardiale Intervention. Schlussfolgerung: Die gezielte fetale Echokardiografie zeigte einen signifikant ni","PeriodicalId":49400,"journal":{"name":"Ultraschall in Der Medizin","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148581064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and Clinical Validation of an Automated Artificial Intelligence System for Bowel Wall Thickness Assessment in Adult Inflammatory Bowel Diseases.","authors":"Giovanni Maconi, Davide Giuseppe Cassella, Gabriele Natalello, Antonella Marra, Giovanni Cataletti, Pradeep Kumar Anand","doi":"10.1055/a-2870-0924","DOIUrl":"10.1055/a-2870-0924","url":null,"abstract":"<p><strong>Purpose: </strong>Intestinal ultrasound (IUS) is used to assess and monitor inflammatory bowel disease (IBD). Bowel wall thickness (BWT) is its key marker, but accurate measurement is operator-dependent and requires expertise. Artificial intelligence (AI) may reduce variability and support IUS implementation. We developed and validated an AI model to detect bowel wall layers and measure BWT.</p><p><strong>Materials and methods: </strong>We developed a deep learning system (BowelAssist, BA) based on a pretrained convolutional neural network. A dataset of 9000 images (711 patients, 421 IBD) was used for training (80%), validation (10%), and testing (10%). Ground-truth annotations of bowel wall layers for 3000 segments were provided by an expert sonographer. External validation was performed live in 35 patients (67 bowel segments), with additional blinded evaluation by a trained operator in 19 (30 segments). BA performance, including BWT measurement, wall-layer recognition, and intra- and inter-observer agreement, was compared with manual measurements using Pearson's correlation and Bland-Altman analysis.</p><p><strong>Results: </strong>BA analysis was feasible in 94.7% of measurements. It showed excellent agreement with manual BWT measurements (r=0.88 for cross-sectional and r=0.77 for longitudinal scans), and low mean absolute errors (<0.45mm). The sensitivity and specificity for detecting pathological BWT were 83.6% and 95.7%, respectively. The intra-observer reproducibility of BA measurements was >0.90 and the inter-observer reproducibility between expert and trained operators was 0.53 for cross-sectional and 0.57 for longitudinal scans. Stratification recognition showed sensitivity of 90.1% and specificity of 83.8%.</p><p><strong>Conclusion: </strong>An AI-based model provides accurate, reproducible assessment of BWT supporting its integration into clinical and research workflows for objective evaluation of IBD activity.</p>","PeriodicalId":49400,"journal":{"name":"Ultraschall in Der Medizin","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serial Ultrasound Findings After Microwave Ablation for Benign Breast Lesions.","authors":"Qian Cai, Ya-Ru Zhang, Ping Liang, Xiao-Ling Yu, Zhiyu Han, Jianping Dou, Jie Yu","doi":"10.1055/a-2742-1683","DOIUrl":"https://doi.org/10.1055/a-2742-1683","url":null,"abstract":"<p><strong>Purpose: </strong>Post-ablation ultrasound findings after microwave ablation (MWA) for benign breast lesions (BBLs) can mimic malignancy, leading to diagnostic confusion. This study aimed to characterize the longitudinal evolution of sonographic features after MWA and identify factors associated with malignant-like echogenic patterns (MEPs).</p><p><strong>Materials and method: </strong>This retrospective study included female patients with BBLs who underwent ultrasound-guided percutaneous MWA between August 2015 and October 2022. Ultrasound features were documented at baseline and at 1-6 months, 1 year, 2 years, and 3 years post-ablation. Independent predictors of MEPs were identified using multivariable logistic regression with Firth's penalized likelihood, and an XGBoost model was constructed to predict MEPs and evaluate feature importance.</p><p><strong>Results: </strong>A total of 314 patients (mean age: 38 ± 12 years) with 549 BBLs (1.5 cm (IQR, 0.6-4.0 cm)) were included. At 1-6 months, 85.8% of lesions showed benign evolution patterns (BEPs), 12.0% presented as concentric circular echogenicity (CCE) lesions, and 2.2% as nodular uneven low echogenicity (NULE, classified as MEP) lesions. By 3 years, 75.8% of BEP lesions progressed to complete absorption, while 54.5% of CCE lesions and 83.3% of NULE lesions persisted as MEPs. Independent predictors of MEPs included NULE at 1-6 months, CCE, adjacency to the pectoralis muscle, fibroglandular background, Doppler flow, irregular shape, and heterogeneous echogenicity.</p><p><strong>Conclusion: </strong>Although MEPs may mimic malignancy, histology confirmed their benign nature. Recognizing these evolving sonographic changes can improve diagnostic confidence and reduce unnecessary interventions.</p>","PeriodicalId":49400,"journal":{"name":"Ultraschall in Der Medizin","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148340845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Guidance Imaging Modality Influences Pulsed-Wave Doppler Measurements: Comparative Evaluation of B-mode, Power Doppler, CCDS, MVI, and B-Flow.","authors":"Christian Jacke, Christine Angermund, Berthold Stegemann, Emilia Stegemann","doi":"10.1055/a-2885-2749","DOIUrl":"https://doi.org/10.1055/a-2885-2749","url":null,"abstract":"<p><strong>Purpose: </strong>Pulsed-wave (pw) Doppler is widely used for quantitative blood flow assessment, but its accuracy depends on the guidance imaging modality used to position the sample volume. Modern ultrasound systems provide several guidance modes - B-mode, color-coded duplex sonography (CCDS), power Doppler, B-flow, and microvascular imaging (MVI) - the influence of which on pw-Doppler measurements has not yet been systematically evaluated.</p><p><strong>Materials and methods: </strong>In this prospective paired-methods study, pw-Doppler flow of the brachial artery was measured in 454 adults while simultaneously using four guidance imaging modalities (CCDS, power Doppler, B-Flow, MVI). B-mode pw-Doppler measurements were interspersed as a reference. Differences in measured flow were analyzed using Bland-Altman statistics, analysis of variance, and linear mixed-effects models.</p><p><strong>Results: </strong>CCDS, power Doppler, and B-flow produced pw-Doppler flow values closely matching the interpolated B-mode reference (bias < 6 mL/min). In contrast, MVI consistently underestimated flow (bias 50-60 mL/min, p < 0.001) and showed an additional flow-dependent bias. Bland-Altman analyses demonstrated markedly wider limits of agreement for MVI. No patient-related factors explained these deviations.</p><p><strong>Conclusion: </strong>Guidance imaging modality significantly affects pw-Doppler flow measurements. MVI introduces systematic, flow-dependent underestimation, whereas CCDS, power Doppler, and B-flow yield consistent results. MVI should not be used when accurate pw-Doppler quantification is required.</p>","PeriodicalId":49400,"journal":{"name":"Ultraschall in Der Medizin","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148273575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic value of inguinal ultrasound for predicting histological lymph node status in vulvar cancer.","authors":"Steffi Hartmann, Nicolas Wenk, Ellen Mann, Toralf Reimer, Sarah Fröhlich, Anne Urban, Manja Woelter, Gesche Schultek, Bernd Gerber","doi":"10.1055/a-2830-7606","DOIUrl":"10.1055/a-2830-7606","url":null,"abstract":"<p><strong>Purpose: </strong>As part of the pretherapeutic diagnostic workup for vulvar cancer, the inguinal lymph node status should be assessed. The diagnostic value of structured inguinal sonography for predicting the histological lymph node status in patients with vulvar cancer should be determined.</p><p><strong>Materials and methods: </strong>All patients diagnosed with vulvar cancer and scheduled for surgical removal of inguinal lymph nodes were included in the prospective unicentric cohort study from March 2023 to May 2025. Preoperatively, inguinal ultrasound was performed according to the Vulvar International Tumor Analysis (VITA) protocol. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were determined. These were compared with the retrospectively collected results of an inguinal ultrasound examination, which was not performed according to the VITA protocol, in patients who had undergone surgery between January 2016 and February 2023.</p><p><strong>Results: </strong>Lymph node sonography performed according to the VITA protocol, followed by inguinofemoral surgery, was conducted in 74 groins. Lymph node metastases could be identified with a sensitivity of 64.3%, a specificity of 78.3%, a PPV of 40.9%, and an NPV of 90.4%. In 92 groin surgeries in patients without application of the VITA protocol, a sensitivity of 56.3%, a specificity of 89.5%, a PPV of 52.9%, and an NPV of 90.7% were determined, which did not differ significantly from the VITA cohort (p > 0.05).</p><p><strong>Conclusion: </strong>Overall, even after the introduction of a structured examination protocol specifically designed for vulvar cancer, inguinofemoral sonography did not demonstrate higher accuracy in determining the histological lymph node status.</p>","PeriodicalId":49400,"journal":{"name":"Ultraschall in Der Medizin","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147391427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is there a slippery slope? - Data on 22 years of medically indicated terminations of pregnancy from a tertiary obstetric center in Germany.","authors":"Emilia Brinkman, Mareike Möllers, Daniela Willy, Kathleen Marie Oberste, Ralf Schmitz, Johannes Steinhard, Moritz Fabian Danzer, Kathrin Oelmeier","doi":"10.1055/a-2875-5116","DOIUrl":"https://doi.org/10.1055/a-2875-5116","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the impact of changes in legislation regarding termination of pregnancy (TOP) and new diagnostic procedures such as non-invasive prenatal testing (NIPT) on timing and diagnoses of medically indicated TOPs at a tertiary obstetric center during a 22-year period.</p><p><strong>Materials and methods: </strong>This retrospective study was conducted at the Department of Obstetrics and Gynecology of a tertiary obstetric center between 2002 and 2023. Data on TOP was extracted from the electronic patient files. Cases were divided into subgroups according to legislative changes as well as groups before and after the introduction of NIPT. Descriptive statistics were computed and Mann-Whitney-U and Kruskal-Wallis tests were conducted to compare the non-normally distributed variables among subgroups.</p><p><strong>Results: </strong>1726 cases of TOP were included in this study. Altogether, there was no noticeable change in diagnoses for TOP over the 22-year study period. We observed a noticeable increase in gestational age at the time of TOP which remained, however, below fetal viability. Towards the end of the study period, there was a noticeable increase in TOP requiring feticide.</p><p><strong>Conclusion: </strong>Neither changes in TOP legislation nor the introduction of NIPT resulted in a steep increase in TOP for certain diagnoses. The increase in gestational age as well as the increasing number of feticides can most likely be attributed to multiple factors beyond changes in legislation and diagnostic procedures.</p>","PeriodicalId":49400,"journal":{"name":"Ultraschall in Der Medizin","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148228906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unusual Treatment of Small Bowel Ileus via Ultrasound-Guided Transabdominal Puncture.","authors":"Julia Greiner, Hendrik Ueberschaer","doi":"10.1055/a-2835-5434","DOIUrl":"https://doi.org/10.1055/a-2835-5434","url":null,"abstract":"","PeriodicalId":49400,"journal":{"name":"Ultraschall in Der Medizin","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148228876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The \"Falx Flash\" sign as an indicator of accurate midsagittal plane alignment for fetal CNS and NT assessment in first-trimester ultrasound.","authors":"Jochen Ritgen, Florian Recker, Marit Kolsch, Jan Weichert, Jan Degenhardt","doi":"10.1055/a-2808-0761","DOIUrl":"10.1055/a-2808-0761","url":null,"abstract":"<p><strong>Purpose: </strong>Obtaining a true mid-sagittal plane (MSP) and further Fetal Medicine Foundation (FMF) criteria is essential for accurate first-trimester ultrasound screening. The \"Falx Flash\" sign, a homogeneous echo extending from the thalamus to the cranium, has been proposed as a useful marker. This study investigates the association between the Falx Flash sign and additional key central nervous system structures.</p><p><strong>Materials and methods: </strong>We conducted a retrospective analysis of 185 first-trimester ultrasound examinations performed between 11+0 and 13+6 weeks of gestation. Images were reviewed for the presence of the Falx Flash sign and fulfillment of the FMF criteria, including visualization of the nasal bone, brainstem, fourth ventricle, cisterna magna, thalamus delineation, and absence of zygomatic bone. Statistical comparisons between the Falx Flash sign-positive and negative groups were made using chi-square or Fisher's exact tests.</p><p><strong>Results: </strong>The Falx Flash sign was present in 70% of cases. Its presence was strongly associated with improved visualization of midline structures: nasal bone (100% vs. 80%, p<0.0001), brainstem (97.7% vs. 76.4%, p<0.0001), fourth ventricle (96.2% vs. 72.7%, p<0.0001), cisterna magna (93.8% vs. 76.4%, p=0.0006), and thalamus delineation (98.5% vs. 49.1%, p<0.0001). Absence of the zygomatic bone was significantly more common with a positive Falx Flash sign (76.2% vs. 16.4%, p<0.0001). There was no significant difference in fetal position, magnification, or caliper placement.</p><p><strong>Conclusion: </strong>The Falx Flash sign is a reliable real-time marker of the achievement of a true MSP, which is critical for correct NT measurement. Incorporating Falx Flash sign assessment into routine scanning protocols could improve anatomical visualization, enhance early anomaly detection, and reduce false-positive findings in first-trimester screening.</p>","PeriodicalId":49400,"journal":{"name":"Ultraschall in Der Medizin","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146151164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac Multifrequency Time-harmonic Elastography: In Silico Validation and In Vivo Application.","authors":"Stefan Klemmer Chandía, Brunhilde Wellge, Gina Barzen, Hossein Aghamiry, Chiara Manini, Marcel Bauer, Matthias Ivantsits, Lars Walczak, Katrin Hahn, Anja Hennemuth, Sebastian Spethmann, Heiko Tzschätzsch, Ingolf Sack, Tom Meyer","doi":"10.1055/a-2852-6188","DOIUrl":"10.1055/a-2852-6188","url":null,"abstract":"<p><strong>Purpose: </strong>To introduce and validate optimized multifrequency cardiac time-harmonic elastography (THE) with portable drivers and multiple-heartbeat acquisitions for detecting abnormal diastolic stiffness using in silico testing and investigating participants with confirmed cardiac wild-type transthyretin amyloidosis (ATTRwt), a model disease for myocardial stiffness, compared to healthy controls.</p><p><strong>Materials and methods: </strong>Cardiac THE was performed using continuous vibrations of 60, 70, and 80 Hz induced by a portable driver. Shear wave speed (SWS) maps, as a proxy for myocardial stiffness, were acquired over 4 seconds in a parasternal long axis view. Cardiac ultrasound simulations with CT-data-based anatomies were used for in silico validation and parameter optimization. Diagnostic performance was assessed using the area under the ROC curve (AUC) with 95% confidence interval (95%-CI).</p><p><strong>Results: </strong>Healthy controls (N=10; median age: 32 years [range: 27-56]; five men) and participants with ATTRwt (N=11; median age: 83 years [range: 64-86]; ten men) were investigated, resulting in accurate amyloidosis detection (AUC: 1.00; 95%-CI: 0.94-1.00). In-silico-estimated SWS agreed with ground-truth values (r²=0.94; median error: 5.6% [range: -26.2-19.7]) across various stiffnesses [range: 1.3-4.0 m s^-1] and thicknesses [range: 10-20 mm]. A trend towards underestimation was only observed in the unlikely scenario of thin and very stiff septa.</p><p><strong>Conclusion: </strong>For the first time, the accuracy of cardiac THE was quantified both in silico and in vivo, specifically in a cohort including patients with ATTRwt. Multifrequency shear waves induced by portable drivers and encoded in standard ultrasound provide a rapid, low-cost echocardiographic contrast that aids the detection of cardiomyopathies such as amyloidosis.</p>","PeriodicalId":49400,"journal":{"name":"Ultraschall in Der Medizin","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147647221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early postpartum sonographic evaluation of cesarean scar following vaginal birth after cesarean section: a prospective cohort study.","authors":"Nadine Ashkar Majadla, Amal Orabi, Inshirah Sgayer, Lior Lowenstein, Nadir Ghanem, Marwan Odeh","doi":"10.1055/a-2859-0130","DOIUrl":"https://doi.org/10.1055/a-2859-0130","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate cesarean scar morphology following vaginal birth after cesarean section (VBAC) and to examine associations of scar parameters with labor and clinical parameters.</p><p><strong>Materials and methods: </strong>In a prospective cohort study at a single tertiary center, women who had undergone one prior low-transverse cesarean section and delivered vaginally underwent two transvaginal ultrasound examinations: one immediately after delivery and one 24-48 hours postpartum. Scar depth and width, adjacent myometrial thickness (AMT), and residual myometrial thickness (RMT) were measured. Correlations with clinical and labor variables were analyzed.</p><p><strong>Results: </strong>50 women were included. The mean maternal age was 30.7 ± 4.8 years and the mean BMI was 30.3 ± 4.4 kg/m². 41 women completed both examinations. Between the two ultrasound examinations, the mean scar depth and width decreased (15.8 ± 6.7 mm vs. 13.1 ± 4.1 mm; p = 0.009 and 16.8 ± 9.6 mm vs. 12.2 ± 5.8 mm; p = 0.007, respectively), while the AMT and RMT remained unchanged (p > 0.7). Non-spontaneous labor onset was associated with deeper scars (p = 0.027), and spontaneous rupture of membranes correlated with a greater RMT (p = 0.041). Women with a BMI ≥30 kg/m² had a thinner AMT and RMT (p = 0.022 and 0.025, respectively) and more frequent labor augmentation (p = 0.006). No uterine ruptures or major maternal and neonatal complications occurred.</p><p><strong>Conclusion: </strong>Immediate postpartum ultrasound after VBAC elucidated early remodeling of the previous cesarean scar. Non-spontaneous labor onset and a higher BMI were associated with a less favorable scar morphology, though without adverse short-term maternal or neonatal outcomes.</p>","PeriodicalId":49400,"journal":{"name":"Ultraschall in Der Medizin","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148177107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}