Journal of Ultrasound最新文献

{"title":"Venous wash-out at contrast-enhanced ultrasound for the identification of hematologic splenic lesions: an exploratory real-world substudy.","authors":"Daniela Tirotta, Claudia Lena, Elisabetta Fabbri, Paolo Muratori","doi":"10.1007/s40477-026-01236-7","DOIUrl":"https://doi.org/10.1007/s40477-026-01236-7","url":null,"abstract":"<p><strong>Purpose: </strong>Splenic lesions are a relatively rare but clinically relevant finding in internal medicine practice, particularly when hematologic or lymphoproliferative disorders are suspected. The aim of this exploratory subanalysis was to evaluate the role of CEUS perfusion patterns, with particular attention to venous wash-out and its timing, in discriminating between hematologic and non-hematologic disease in a real-world Internal Medicine cohort.</p><p><strong>Methods: </strong>An exploratory retrospective subanalysis was conducted on patients included in the intervention arm of a multicenter Quality Improvement study evaluating a structured contrast-enhanced ultrasound (CEUS)-based diagnostic pathway in newly identified splenic lesions. Consecutive adult patients with newly detected splenic lesions identified on B-mode ultrasound who underwent CEUS as part of the initial diagnostic evaluation were included. CEUS perfusion patterns were qualitatively classified according to arterial wash-in, venous wash-out, and wash-out timing. The diagnostic reference standard consisted of histologic and/or cytologic examination when available, or integration of clinical, laboratory, and imaging follow-up data within 90 days. In patients without histologic confirmation, non-hematologic classification required clinical and laboratory stability or improvement, stability or resolution of the splenic lesion on follow-up imaging, identification of an alternative non-hematologic diagnosis when present, and absence of a hematologic diagnosis during the 90-day follow-up. In line with the parent study, one patient in the intervention-arm cohort did not receive a definitive lesion-specific etiologic diagnosis within 90 days; however, no patient remained indeterminate for the prespecified binary endpoint because classification as hematologic versus non-hematologic was possible in all cases. The study endpoint was binary diagnostic classification (hematologic vs non-hematologic).</p><p><strong>Results: </strong>Fifty patients were included, of whom 11 (22%) had a hematologic diagnosis and 39 (78%) had a non-hematologic diagnosis. In univariable analysis, multiple lesions, systemic symptoms, and especially venous wash-out were associated with hematologic diagnosis. Venous wash-out was present in 10/11 hematologic cases and in 3/39 non-hematologic cases. In hematologic cases, wash-out was almost always early (< 60 s), whereas in the few non-hematologic cases with wash-out it was late. In the exploratory multivariable model, venous wash-out was the only variable independently associated with hematologic diagnosis. Because of the small number of hematologic events, this association should be interpreted as statistically unstable and hypothesis-generating. Venous wash-out showed a sensitivity of 90.9%, specificity of 92.3%, positive predictive value of 76.9%, negative predictive value of 97.3%, and accuracy of 92.0%.</p><p><strong>Conclusion: </strong>In pati","PeriodicalId":51528,"journal":{"name":"Journal of Ultrasound","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shear-wave elastography combined with ultrasound BI-RADS improves diagnostic accuracy in breast lesion characterization: a prospective cross-sectional study.","authors":"Rinzing Ongmu Bhutia, Tsella Lachungpa, Mingma Sherpa, Barun Kumar Sharma, Shubham Gupta, Bimal Nepal","doi":"10.1007/s40477-026-01247-4","DOIUrl":"https://doi.org/10.1007/s40477-026-01247-4","url":null,"abstract":"<p><strong>Background: </strong>To compare BI-RADS and shear-wave elastography (SWE) for differentiating benign from malignant breast lesions and assess whether adding maximum elasticity (Emax) improves discrimination and biopsy decisions.</p><p><strong>Methods: </strong>In this diagnostic accuracy study (May 2023-August 2024), 87 adults with 93 breast lesions underwent B-mode BI-RADS and SWE (Emax, Emean, Emin). ROC analysis and logistic regression incorporating BI-RADS and Emax were performed. Patient-level bootstrap resampling with 2,000 iterations provided optimism correction.</p><p><strong>Results: </strong>Eleven lesions (11.8%) were malignant. Median Emax and Emean were higher in malignant lesions (200.1 vs 105.7 kPa, P = 0.003; 103.1 vs 70.7 kPa, P = 0.004). AUCs were 0.766 for BI-RADS, 0.774 for Emax, 0.767 for Emean, and 0.697 for Emin; pairwise differences were nonsignificant (all P ≥ 0.153). The model had an AUC of 0.853 (95% CI, 0.754-0.951) and optimism-corrected AUC of 0.844. AUC gain was 0.087 (0.016-0.158; P = 0.017), with corrected gain of 0.077. At a 2% risk threshold, sensitivity was 100%, but biopsy recommendations increased from 41 to 55. The BE1 rule reduced biopsy recommendations by six, avoiding five benign biopsies but missing one carcinoma.</p><p><strong>Conclusion: </strong>Adding Emax to BI-RADS improved discrimination, with the gain persisting after validation. However, only 11 lesions were malignant, yielding imprecise estimates. No operating point reduced biopsy recommendations without sacrificing sensitivity. The model and SWE cut-offs require external validation.</p><p><strong>Implication of practice: </strong>SWE may be used as an adjunct to BI-RADS for characterization, but Emax thresholds and the combined model should not yet guide biopsy downgrading. Larger prospective studies with external validation are needed before implementation.</p>","PeriodicalId":51528,"journal":{"name":"Journal of Ultrasound","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility of ultrasonography for articular cartilage assessment in knee osteoarthritis: a comparative study with clinical scores and magnetic resonance imaging.","authors":"Anupama Tandon, Mohammad Ahmad, Saloni Jain, Gopesh Mehrotra, K L Chakraborti, Aditya Nath Aggarwal","doi":"10.1007/s40477-026-01241-w","DOIUrl":"https://doi.org/10.1007/s40477-026-01241-w","url":null,"abstract":"<p><strong>Objective: </strong>To assess the utility of ultrasonography in evaluating femoral articular cartilage in knee osteoarthritis and to determine the relationship between sonographic cartilage abnormalities and clinical pain scores.</p><p><strong>Methods: </strong>A prospective study was conducted on 63 clinically diagnosed knee osteoarthritis patients (126 knees) and 30 age-matched controls (60 knees). All participants underwent clinical evaluation and ultrasonography by two reviewers. Cartilage thickness and morphological abnormalities were assessed using a semi-quantitative sonographic grading system. Pain severity was evaluated using the visual analogue scale (VAS), and the relationship between sonographic cartilage grade and clinical pain was statistically analysed. A subgroup of 18 knees also underwent MRI for exploratory comparison of cartilage grading.</p><p><strong>Results: </strong>Cartilage abnormalities were detected by USG in 97% of OA knees compared to 50% of controls (p < 0.001). Medial condyle cartilage was significantly thinner in osteoarthritis knees (1.48[95% CI 1.37-1.60] mm) than controls (1.74[95% CI 1.59-1.88] mm, p = 0.027). Interrater agreement was almost perfect (Quadratic weighted Cohen Kappa was 0.89[95% CI 0.93-0.97). Higher cartilage grades (≥ 2B) on USG had significantly higher VAS scores compared to low cartilage grade (< 2B) (p < 0.001). USG showed fair agreement (Quadratic weighted Kappa = 0.40[95% CI 0.9-0.72] in detection of all cartilage abnormalities with MRI, however it underestimated severity compared to MRI (≥ Grade 2B in 67% vs. 95%).</p><p><strong>Conclusion: </strong>Ultrasound is a reliable, accessible tool for detecting femoral cartilage changes in knee osteoarthritis, showing significant correlation with clinical symptoms. Its affordability, safety, and dynamic capabilities make it a valuable adjunct for initial assessment and monitoring in routine clinical practice.</p>","PeriodicalId":51528,"journal":{"name":"Journal of Ultrasound","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of renal resistive index with coronary artery calcification in patients with preserved renal function.","authors":"Tuğba Öztürk Taşkıran, Tuna Şahin, Mehmet Burak Çildağ, Ahmet Tanyeri","doi":"10.1007/s40477-026-01243-8","DOIUrl":"https://doi.org/10.1007/s40477-026-01243-8","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate whether renal resistive index (RRI) is independently associated with the presence of coronary artery calcification in patients with preserved renal function undergoing coronary computed tomography angiography (CCTA), and to explore its unadjusted associations with continuous coronary artery calcium score (CACS) and Coronary Artery Disease Reporting and Data System (CAD-RADS) categories.</p><p><strong>Methods: </strong>This prospective cross-sectional study included 120 patients with preserved renal function who underwent renal Doppler ultrasonography before CCTA. The primary outcome was the presence of coronary artery calcification, defined as a CACS > 0. Associations of RRI with continuous CACS and CAD-RADS categories were evaluated in exploratory, unadjusted analyses. Multivariable logistic regression evaluated the independent association between RRI and CACS > 0. A clinical model and the same model supplemented with RRI were compared using receiver operating characteristic analysis.</p><p><strong>Results: </strong>RRI was higher in patients with CACS > 0 than in those with CACS = 0 (0.697 ± 0.051 vs. 0.646 ± 0.054, p < 0.001) and correlated with CACS (r = 0.474, p < 0.001). RRI also differed across CAD-RADS categories (p < 0.001). After adjustment for age, sex, hypertension, diabetes mellitus, smoking, and dyslipidaemia, each 0.01-unit increase in RRI was independently associated with higher odds of CACS > 0 (adjusted OR 1.137, 95%CI 1.041-1.242; p=0.005). Adding RRI improved model fit (likelihood-ratio p=0.003) but did not significantly improve discrimination (AUC 0.782 vs. 0.819; DeLong p = 0.129).</p><p><strong>Conclusion: </strong>RRI was independently associated with the presence of coronary artery calcification in patients with preserved renal function. Associations with continuous CACS and CAD-RADS categories were exploratory and unadjusted.</p>","PeriodicalId":51528,"journal":{"name":"Journal of Ultrasound","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149197737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"fiLiver and spleen elastography-based prediction models for clinically significant portal hypertension and high-risk esophageal varices: a systematic review of conventional and machine-learning approaches.","authors":"Nisar Ahmed, P S V M Deepika, Reshabh Saini, Chetna Sharma","doi":"10.1007/s40477-026-01239-4","DOIUrl":"https://doi.org/10.1007/s40477-026-01239-4","url":null,"abstract":"<p><p>The presence of clinically significant portal hypertension (CSPH) and high-risk esophageal varices (HREV) are major predictors of decompensation and mortality in chronic liver disease. Liver and spleen elastography are validated noninvasive markers of portal pressure, and increasing numbers of studies have integrated elastography measurements with conventional statistical and machine-learning (ML) models to predict these outcomes. This systematic review identified, critically appraised and synthesized studies developing or validating prediction models incorporating liver and/or spleen elastography for predicting CSPH and/or HREV. A structured literature search identified studies developing or validating prediction models using transient elastography, shear-wave elastography or magnetic resonance elastography in adults with chronic liver disease. Risk of bias and applicability were assessed using PROBAST+AI. Owing to substantial heterogeneity in elastography modalities, prediction algorithms and outcome definitions, findings were synthesized narratively. Eleven studies published between 2015 and 2025 met the inclusion criteria. Three evaluated machine-learning algorithms using elastography as an input feature (LightGBM, logistic regression/XGBoost hybrid and artificial neural network), whereas eight used conventional cutoff or regression approaches. The best-performing model combined liver stiffness, spleen stiffness and fibrosis-4 within logistic regression and XGBoost, achieving AUROCs of 0.902-0.927 across three independent datasets for HREV and outperforming earlier liver-stiffness-only models. The two newest multicenter externally validated ML studies showed low risk of bias, whereas older, smaller single-center studies frequently demonstrated high or unclear risk, particularly within the analysis domain because external validation was lacking. ML-assisted models integrating liver and spleen elastography with laboratory parameters show promising performance, warranting further external validation before widespread clinical implementation.</p>","PeriodicalId":51528,"journal":{"name":"Journal of Ultrasound","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149197762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasonography after adult living donor liver transplantation: a review of vascular and biliary complications.","authors":"Xiang Chen, Min Sun, Yajing Yang, Shuai Yang, Xiaofeng Wu, Aihua Yao, Zhongming Tan, Yonghua Zhu, Chen Wu","doi":"10.1007/s40477-026-01237-6","DOIUrl":"https://doi.org/10.1007/s40477-026-01237-6","url":null,"abstract":"<p><p>Living donor liver transplantation expands access to transplantation but introduces vascular and biliary reconstructions that require specific ultrasound assessment. Ultrasonography provides repeatable bedside evaluation without ionizing radiation, allowing early recognition of impaired flow and comparison with the postoperative baseline. This review examines how graft type and reconstruction affect Doppler interpretation in adult recipients, particularly after modified right-lobe transplantation. It addresses arterial, portal venous, hepatic venous, and biliary complications, with attention to measurement technique, transient postoperative changes, and limitations of diagnostic thresholds. Contrast-enhanced ultrasonography helps resolve uncertain arterial patency and perfusion. Computed tomography, magnetic resonance cholangiopancreatography, and invasive studies are selected according to the suspected complication and need for treatment.</p>","PeriodicalId":51528,"journal":{"name":"Journal of Ultrasound","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149185792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Wireless versus cart-based ultrasound in musculoskeletal and superficial soft-tissue imaging: a prospective blinded cross-over study.","authors":"Gianluca Pistore, Marco M Maceroni, Eleonora D'Armiento, Piero Maceroni","doi":"10.1007/s40477-026-01210-3","DOIUrl":"https://doi.org/10.1007/s40477-026-01210-3","url":null,"abstract":"<p><strong>Aim: </strong>Wireless ultrasound probes are increasingly used in point-of-care settings, but their performance in musculoskeletal and superficial soft-tissue imaging remains incompletely defined. This study compared image quality and clinical-pragmatic performance of a wireless ultrasound probe with a high-end cart-based ultrasound system.</p><p><strong>Methods: </strong>This prospective blinded cross-over study included 41 musculoskeletal or superficial soft-tissue anatomical regions examined in routine clinical practice. Each region was assessed with both the Mindray Resona I9 Elite Edition cart-based system and the Mindray TE-Air e5M wireless probe. Device order was randomized. Images were acquired by one experienced operator, anonymized, coded, and reviewed offline by an experienced reviewer blinded to device type. Image quality, anatomical margin definition, tissue contrast, speckle noise, diagnostic confidence, interpretability, diagnosis possibility, pathological finding detection, clinical decision sufficiency, and the need for further imaging were assessed.</p><p><strong>Results: </strong>The cart-based system showed superior image quality. Median global image quality was 5 versus 3, anatomical margin definition 5 versus 3 and tissue contrast 5 versus 4. Diagnostic confidence was higher with the cart-based system, 97.95 ± 5.32 versus 69.10 ± 16.05. Clinical-pragmatic endpoints showed a less pronounced reduction: examination interpretability was 97.6% versus 90.2%, diagnosis was considered possible in 73.2% versus 61.0%, and images were sufficient for clinical decision-making in 70.7% versus 58.5%.</p><p><strong>Conclusions: </strong>The wireless probe provided lower image quality and confidence but retained clinically useful performance in selected cases. It should be considered complementary rather than a substitute for high-end cart-based ultrasound.</p>","PeriodicalId":51528,"journal":{"name":"Journal of Ultrasound","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149185761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Carotid stenosis reporting in Doppler ultrasound: why specifying NASCET or ECST criteria matters-an outpatient study.","authors":"Chiara Mozzini, Alder Casadei, Giuseppe Lucchini, Mauro Pagani","doi":"10.1007/s40477-026-01238-5","DOIUrl":"https://doi.org/10.1007/s40477-026-01238-5","url":null,"abstract":"<p><strong>Purpose: </strong>Carotid artery stenosis represents a major risk factor for ischemic stroke, and Doppler ultrasound is widely used as the first-line imaging modality for its assessment. The degree of stenosis is commonly expressed as a percentage and can be calculated according to different methods, most notably the North American Symptomatic Carotid Endarterectomy Trial (NASCET) and the European Carotid Surgery Trial (ECST) criteria. However, in routine clinical practice, the classification system used to determine the percentage of stenosis is not always specified in the ultrasound report. These methods consider different reference diameters, making values non-comparable and potentially misleading for clinical decisions.</p><p><strong>Methods: </strong>In this study, we reviewed 1,400 patients evaluated in the Doppler ultrasound outpatient clinic of Internal Medicine at Poma Hospital, Mantova, Italy. All examinations were performed during routine clinical activity over four years by a physician tutor of the Italian Society of Medical and Biological Ultrasonology (SIUMB). The patient population included individuals aged between 18 and 97 years.</p><p><strong>Results: </strong>During follow-up evaluations, it was frequently observed that previous ultrasound reports indicated a percentage of carotid stenosis without specifying whether NASCET or ECST criteria had been used.</p><p><strong>Conclusions: </strong>Our experience highlights the importance of clearly stating the classification system used for stenosis grading in carotid Doppler reports. Standardized reporting may improve longitudinal comparison of examinations, facilitate clinical decision-making, and enhance communication among healthcare professionals involved in the management of carotid artery disease.</p>","PeriodicalId":51528,"journal":{"name":"Journal of Ultrasound","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound findings across liver fibrosis stages defined by transient elastography in patients with chronic hepatitis B in Georgia.","authors":"Lela Inaishvili, Elene Gotsiridze, Lasha Gulbiani, Nikoloz Pruidze, Maia Butsashvili","doi":"10.1007/s40477-026-01242-9","DOIUrl":"https://doi.org/10.1007/s40477-026-01242-9","url":null,"abstract":"<p><strong>Purpose: </strong>Chronic hepatitis B (CHB) remains a major cause of chronic liver disease and may progress to liver fibrosis, cirrhosis, and hepatocellular carcinoma (HCC). This study aimed to evaluate conventional abdominal ultrasound (US) findings across liver fibrosis stages defined by transient elastography (TE) in patients with CHB.</p><p><strong>Methods: </strong>In this cross-sectional study, 232 adults with CHB were included. Conventional abdominal US and TE data were available for 231 patients. US findings were evaluated in relation to liver fibrosis stages defined by TE-derived liver stiffness measurements. Differences in liver stiffness according to US findings were assessed using the independent-samples t-test.</p><p><strong>Results: </strong>Patients with heterogeneous liver echotexture had significantly higher liver stiffness than those with normal liver echotexture (8.71 ± 6.89 vs. 5.65 ± 1.30 kPa; mean difference, 3.06 kPa; 95% CI 1.78-4.34 kPa; p < 0.001). Patients with splenomegaly had significantly higher liver stiffness than those without splenomegaly (17.31 ± 15.18 vs. 6.55 ± 2.82 kPa; mean difference, 10.77 kPa; 95% CI 2.00-19.54 kPa; p = 0.020). Among the 231 patients, 71.9% were classified as F0-F1, 21.6% as F2-F3, and 6.5% as F4. Four patients were diagnosed with HCC, including three with cirrhosis (F4) and one with F0-F1 fibrosis.</p><p><strong>Conclusions: </strong>Conventional abdominal US findings, particularly heterogeneous liver echotexture and splenomegaly, were associated with higher liver stiffness in patients with CHB. These findings support the complementary role of conventional abdominal US in the comprehensive non-invasive evaluation of patients with CHB.</p>","PeriodicalId":51528,"journal":{"name":"Journal of Ultrasound","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The diagnostic signature of diabetic enthesopathy: bilateral symmetry, serological silence, and ultrasound dominance.","authors":"Adel Ibrahim Azzam, Taha Ibrahim Aladrosy, Saad Ghanem, Ashraf Abdelsalam Moustafa, Hatem Saadeldin, Yazeed Mohammed AlZahrani, Hilal Rajeh AlZahrani, Afrah Abdulraheem Alshahrani, Abdulaziz Altowairqi, Abdullah Almalki","doi":"10.1007/s40477-026-01224-x","DOIUrl":"https://doi.org/10.1007/s40477-026-01224-x","url":null,"abstract":"<p><strong>Objective: </strong>To characterize the distinctive bilateral, serological, and radiographic phenotype of diabetic enthesopathy using standardized quantitative ultrasonography with validated cutoff thresholds.</p><p><strong>Methods: </strong>This cross-sectional extended analysis of a previously published cohort enrolled 60 patients with diabetes (17 T1DM, 43 T2DM). Five bilateral entheseal sites were evaluated using the Glasgow Ultrasound Enthesitis Scoring System (GUESS) methodology with validated thickness cutoffs (> 6.1 mm quadriceps, >4.0 mm patellar, >5.2 mm Achilles, >4.4 mm plantar fascia). Rheumatoid factor (RF), anti-CCP, erythrocyte sedimentation rate (ESR), serum uric acid, and inflammatory ratios (NLR, PLR) were assessed. Conventional hand, foot, and knee radiographs were reviewed. Multiple linear regression with bootstrap validation (2000 iterations) identified independent predictors of structural burden.</p><p><strong>Results: </strong>Mean total entheseal thickness was 4.82±0.50 mm. All sites demonstrated strong bilateral symmetry with excellent inter-side correlations (r=0.49-0.60, all p<0.001) and no significant paired differences. RF was positive in 5.0% and anti-CCP in 0%; inflammatory indices were normal, and serum uric acid showed neither a significant intergroup difference nor an independent association with entheseal thickness (hyperuricemia prevalence 13.3%). Ultrasound detected tendon thickening in 93.3%, enthesophytes in 78.3%, and bursitis in 60.0%, whereas radiography showed only degenerative changes with <5% entheseal-specific findings. Age was the sole independent predictor of mean thickness (β=+0.020; p=0.007). After adjustment, the T2DM coefficient was borderline non-significant (β=-0.467; p=0.056), indicating that the higher raw burden in T2DM is primarily explained by age rather than diabetes subtype.</p><p><strong>Conclusion: </strong>Diabetic enthesopathy exhibits a distinct \"metabolic-mechanical\" phenotype defined by striking bilateral symmetry, near-complete seronegativity, and ultrasound-dominant structural detection. The increased burden in T2DM is predominantly age-mediated, with a borderline independent effect warranting larger confirmatory studies. Musculoskeletal ultrasound should be prioritized in older diabetic patients for early detection of subclinical entheseal pathology, irrespective of diabetes type.</p>","PeriodicalId":51528,"journal":{"name":"Journal of Ultrasound","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149118131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}