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Background/Objectives: Algorithms for quantifying liver fat content based on the ultrasound attenuation coefficient (AC) are currently available; however, little is known about whether their accuracy increases by applying quality criteria such as the interquartile range-to-median ratio (IQR/M) or whether the median or average AC value should be used. Methods: AC measurements were performed with the Aplio i800 ultrasound system using the attenuation imaging (ATI) algorithm (Canon Medical Systems, Otawara, Tochigi, Japan). Magnetic resonance imaging proton density fat fraction (MRI-PDFF) was the reference standard. The diagnostic performance of the AC median value of 5 measurements (AC-M) was compared to that of AC average value (AC-A) of 5 or 3 acquisitions and different levels of IQR/M for median values or standard deviation/average (SD/A) for average values were also analyzed. Concordance between AC-5M, AC-5A, and AC3A was evaluated with concordance correlation coefficient (CCC). Results: A total of 182 individuals (94 females; mean age, 51.2y [SD: 15]) were evaluated. A total of 77 (42.3%) individuals had S0 steatosis (MRI-PDFF < 6%), 75 (41.2%) S1 (MRI-PDFF 6–17%), 10 (5.5%) S2 (MRI-PDFF 17.1–22%), and 20 (11%) S3 (MRI-PDFF ≥ 22.1%). Concordance of AC-5A and AC-3A with AC-5M was excellent (CCC: 0.99 and 0.96, respectively). The correlation with MRI-PDFF was almost perfect. Diagnostic accuracy of AC-5M, AC-5A, and AC3A was not significantly affected by different levels of IQR/M or SD/A. Conclusions: The accuracy of AC in quantifying liver fat content was not affected by reducing the number of acquisitions (from five to three), by using the mean instead of the median, or by reducing the IQR/M or SD/A to ≤5%. [ABSTRACT FROM AUTHOR]

Objectives: To assess whether meal or water intake may affect the measurement of the ultrasound (US) attenuation coefficient (AC) imaging, a parameter that is directly related to liver fat content. Methods: The study was performed in two centers (Italy and USA). AC was obtained using the ATI algorithm implemented in the Aplio i‐series US systems (Canon Medical Systems, Japan) by one operator at each center. Measurements were performed at baseline and 5, 15, 30, 45 minutes after drinking 500 mL of water (group 1), or 30, 45, 60, 90, 120 minutes after eating a meal of about 600 kcal (group 2). Multilevel generalized estimating equations for repeated measures were used for the statistical analysis to consider the clustered nature of the data. Results: Twenty‐six individuals were enrolled: 11 (10 females; age, 43.7 ± 12.5 years) in Italy and 15 (10 females; age, 60.7 ± 6.3 years) in USA. At B‐mode US, 10 (38.5%) had liver steatosis. The baseline AC values, in decibel/centimeter/megahertz, were 0.64 (0.12) in group 1 and 0.66 (0.13) in group 2. There was not any significant difference in AC values at every time‐point after water or meal intake either in group 1 or group 2. This result did not change including sex, age, and skin‐to‐liver capsule into the models. Conclusions: The measurement of the AC, which is a biomarker of liver steatosis, does not require a fasting state and drinking water does not affect the result. [ABSTRACT FROM AUTHOR]

Purpose: It has been reported that the estimate of ultrasound attenuation coefficient (AC) is affected by depth of measurement, with linear decrease of values with depth. It is unknown whether backscatter coefficient (BSC) has similar behavior. Methods: This retrospective study was performed with Sequoia US system equipped with ultrasound derived fat fraction (UDFF) algorithm (Siemens Healthineers, Issaquah, WA, USA) that combines BSC with AC. UDFF was obtained positioning upper edge of the region of interest at 1.5,2,3,4,5 cm below liver capsule. BSC data were extracted from UDFF offline. A fractional polynomial regression, which selects the best model considering the polynomial development of the variables of interest, was used. Covariates included were age, sex, skin-to-liver-capsule distance, stiffness. Distance was included as linear factor or with a power ranging from − 2 to 3, and the best fitting model was chosen according to partial F test. Body mass index (BMI) was not included because of collinearity with skin-to-liver capsule distance. Results: 104 individuals (56 females; age: 57.9 ± 13.0 years; BMI: 29.0 ± 6.5 kg/m2; skin-to-liver-capsule distance: 2.3 ± 0.7 cm; liver stiffness: 7.5 ± 5.5 kiloPascal) were studied. Best fitting model for BSC included a combination of depth as linear factor and square root. BSC showed a decrease of − 13.98 dB/cm-steradian for each logarithmic increase of 1 cm depth (coefficient: − 13.98; 95% CI: − 21.016; − 5.379; p =.001). Skin-to-liver-capsule distance and stiffness also were independent predictors of BSC. Conclusions: The estimation of the BSC in the liver exhibits a depth dependence that significantly affects results. A standardized acquisition protocol is needed to compare results and reliably assess changes over time. [ABSTRACT FROM AUTHOR]

Ultrasonography is one of the key medical imaging modalities for evaluating breast lesions. For differentiating benign from malignant lesions, computer‐aided diagnosis (CAD) systems have greatly assisted radiologists by automatically segmenting and identifying features of lesions. Here, we present deep learning (DL)‐based methods to segment the lesions and then classify benign from malignant, utilizing both B‐mode and strain elastography (SE‐mode) images. We propose a weighted multimodal U‐Net (W‐MM‐U‐Net) model for segmenting lesions where optimum weight is assigned on different imaging modalities using a weighted‐skip connection method to emphasize its importance. We design a multimodal fusion framework (MFF) on cropped B‐mode and SE‐mode ultrasound (US) lesion images to classify benign and malignant lesions. The MFF consists of an integrated feature network (IFN) and a decision network (DN). Unlike other recent fusion methods, the proposed MFF method can simultaneously learn complementary information from convolutional neural networks (CNNs) trained using B‐mode and SE‐mode US images. The features from the CNNs are ensembled using the multimodal EmbraceNet model and DN classifies the images using those features. The experimental results (sensitivity of 100 ± 0.00% and specificity of 94.28 ± 7.00%) on the real‐world clinical data showed that the proposed method outperforms the existing single‐ and multimodal methods. The proposed method predicts seven benign patients as benign three times out of five trials and six malignant patients as malignant five out of five trials. The proposed method would potentially enhance the classification accuracy of radiologists for breast cancer detection in US images. [ABSTRACT FROM AUTHOR]

Objectives: The primary aim was to estimate the influence of various depths on ultrasound attenuation coefficient (AC) of multiple vendors in the liver. The secondary aim was to evaluate the impact of region of interest (ROI) size on AC measurements in a subset of participants. Methods: This Institutional Review Board (IRB)‐approved Health Insurance Portability and Accountability Act (HIPAA)‐compliant retrospective study was carried out in two centers using AC‐Canon and AC‐Philips algorithms and extracting AC‐Siemens values from ultrasound‐derived fat fraction algorithm. Measurements were performed positioning ROI upper edge (3 cm size) at 2, 3, 4, 5 cm from the liver capsule with AC‐Canon and AC‐Philips and at 1.5, 2, 3 cm with Siemens algorithm. In a subset of participants, measurements were obtained with 1 and 3 cm ROI size. Univariate and multivariate linear regression models and Lin's concordance correlation coefficient (CCC) were used for statistical analysis as appropriate. Results: Three different cohorts were studied. Sixty‐three participants (34 females; mean age: 51 ± 14 years) were studied with AC‐Canon, 60 (46 females; mean age: 57 ± 11 years) with AC‐Philips, and 50 (25 females; 61 ± 13 years) with AC‐Siemens. There was a decrease in AC values per 1 cm increase in depth in all. In multivariable analysis, the coefficient was −0.049 (−0.060; −0.038 P <.001) with AC‐Canon, −0.058 (−0.066; −0.049 P <.001) with AC‐Philips and −0.081 (−0.112; −0.050 P <.001) with AC‐Siemens. AC values with 1 cm ROI were significantly higher than those obtained with 3 cm ROI at all depths (P <.001) but the agreement between AC values obtained with different ROI size was excellent (CCC 0.82 [0.77–0.88]). Conclusions: There is depth dependence in AC measurement that affects results. A standardized protocol with fixed ROI's depth and size is needed. [ABSTRACT FROM AUTHOR]

Purpose: This study's primary aim was to assess factors affecting ultrasound attenuation coefficient (AC) measurement repeatability using the Canon ultrasound (US) system. The secondary aim was to evaluate whether similar results were obtained with other vendors' AC algorithms. Methods: This prospective study was performed at two centers from February to November 2022. AC was obtained using two US systems (Aplio i800 of Canon Medical Systems and Arietta 850 of Fujifilm). An algorithm combining AC and the backscatter coefficient was also used (Sequoia US System, Siemens Healthineers). To evaluate inter-observer concordance, AC was obtained by two expert operators using different transducer positions with regions of interest (ROIs) varying in terms of depth and size. Intra-observer concordance was evaluated on measurements performed intercostally, subcostally, and in the left liver lobe. Lin's concordance correlation coefficient was used. Results: Thirty-four participants (mean age, 49.4±15.1 years; 18 females) were studied. AC values progressively decreased with depth. The measurements in intercostal spaces on bestquality US images using a 3-cm ROI with its upper edge 2 cm below the liver capsule during breath-hold showed the highest intra-observer and inter-observer concordance (0.92 [95% confidence interval, 0.88 to 0.95] and 0.89 [0.82 to 0.96], respectively). Measurements in the left lobe showed the lowest intra-observer and inter-observer concordance (0.67 [0.43 to 0.90] and 0.58 [0.12 to 1.00], respectively). Intercostal space measurements also had the highest repeatability for the other two ultrasound systems. Conclusion: AC values obtained in intercostal spaces on best-quality images using a 3-cm ROI placed with its top 2 cm below the liver capsule were highly repeatable. [ABSTRACT FROM AUTHOR]

This letter to the editor discusses an article published in European Radiology about the use of quantitative ultrasound to diagnose and monitor fatty liver disease. The authors of the letter evaluate the effect of sex, transducer pressure, and patient positioning on estimating liver fat content using the LOGIQ E10 ultrasound system. They found that altering these factors can affect the accuracy of the measurements, and recommend following specific guidelines for standardized measurements. The authors caution that the results may be specific to the limitations of the LOGIQ E10 system and should not be generalized to other ultrasound systems. [Extracted from the article]

Purpose: To determine the natural history and necessity of long‐term follow‐up of renal masses that do not demonstrate enhancement on contrast‐enhanced ultrasound (CEUS). Methods: This retrospective single‐center study was approved by our local IRB and is HIPAA compliant. Exactly 405 patients with 620 non‐enhancing renal masses on CEUS from a previously reported study were followed for up to 10 years. Techniques and equipment are described in the original manuscript. Patient charts and imaging studies were reviewed for the change in features. There were 117 (18.6%) patients lost to follow‐up leading to 341 patients with 512 lesions. The lesion size, patient age, number of lesions per patient, and Bosniak class assigned at the initial examination was recorded. Results: Mean patient age was 66 ± 12.6 years (range 17–95 years). Average time of follow‐up was 58.9 ± 41.7 months (range 1–207 months). There was a mean of 1.5 ± 1.0 lesions per patient (range 1–7 lesions). Lesion size was 24.9 ± 18.2 mm (range 3–161 mm). There were 276 (53.9%) patients with >5‐year follow‐up and 78 (15.2%) patients with >10‐year follow‐up. The probability of change within 5 years was 0% (95% CI: 0–0.37 per 100PY) and 10 years 0% (95% CI: 0.0–0.18 per 100PY). Two lesions (0.4%) resolved by 60 months. Five lesions (1.0%) decreased in size. Four lesions (0.8%) increased in size >20% during the follow‐up period but remained benign on subsequent imaging. Conclusion: Any non‐enhancing renal mass on CEUS can be classified as benign. Access the CME test here and search by article title. [ABSTRACT FROM AUTHOR]

Atherosclerotic plaque in the carotid artery is the main cause of ischemic stroke, with a high incidence rate among people over 65 years. A timely and precise diagnosis can help to prevent the ischemic event and decide patient management, such as follow up, medical, or surgical treatment. Presently, diagnostic imaging techniques available include color-Doppler ultrasound, as a first evaluation technique, computed tomography angiography, which, however, uses ionizing radiation, magnetic resonance angiography, still not in widespread use, and cerebral angiography, which is an invasively procedure reserved for therapeutically purposes. Contrast-enhanced ultrasound is carving out an important and emerging role which can significantly improve the diagnostic accuracy of an ultrasound. Modern ultrasound technologies, still not universally utilized, are opening new horizons in the arterial pathologies research field. In this paper, the technical development of various carotid artery stenosis diagnostic imaging modalities and their impact on clinical efficacy is thoroughly reviewed. [ABSTRACT FROM AUTHOR]

The Urgent Need for FDA to Approve a Whole-Body Application of Ultrasound Contrast Agents To request CT or MR scan is, costly, and time consuming for the patient as well as subjects the patient to considerable more risk from the contrast agent than would exposure to an US contrast agent. UCAs have a very good safety record[[1]] having fewer adverse reactions than contrast agents for computed tomography (CT) and magnetic resonance imaging (MRI). CEUS is an excellent alternative; especially in patients who cannot receive a CT or MR contrast agents due to poor renal function or prior allergic reaction and, in some cases, more sensitive and specific. [Extracted from the article]

Despite its well-established benefits and a powerful body of scientific literature supporting the efficacy of contrast-enhanced ultrasound (CEUS), it has faced challenges in being fully adopted as a diagnostic and problem-solving tool within the USA. This effort, written by experts in performance of and interpretation of CEUS, acts as a roadmap, for those interested in expanding CEUS within their facility. CEUS benefits from a Champion who is knowledgeable and passionate about its performance and who is capable of transferring evidence-based enthusiasm to others. They must be willing to do the legwork required for the successful implementation of a CEUS program, including increasing referrals, expanding applications, and encouraging the inclusion of CEUS into current and established guidelines. The ability of CEUS to resolve a wide range of indeterminate results which come from CT and MR scan represents one of the most compelling arguments for the use of CEUS, decreasing down-stream testing, and reducing time to diagnosis. As utilization grows, the benefits of CEUS will become apparent to other healthcare teams. However, the ultimate beneficiary of improved CEUS utilization will be the patients themselves, who will have greater access to a safe, speedy, cost effective, reliable, and radiation-free diagnostic imaging tool. [ABSTRACT FROM AUTHOR]

Objectives: To compare the estimates of attenuation coefficient (AC) for liver fat quantification between 2 Ultrasound systems and to evaluate the quality measure of a pre‐released software. Methods: AC were obtained in 30 participants in this single‐center IRB‐approved, HIPAA compliant study. Images were obtained on the Philips Epiq Elite system using experimental software and the Canon Medical Systems Aplio i800 with released software. Five AC measurements were taken and the median and IQR/M were calculated. Region of interest placement was based on a confidence map. ROI was at the same depth and size for each system. The concordance was estimated using the Lin's concordance correlation coefficient (CCC), the r Pearson's correlation coefficient, the bias‐correction factor (Cb), and the Bland–Altman method. Results: The ACs varied from 0.45 to 1.0 dB/cm/MHz for the Philips system and 0.30 to 0.96 dB/cm/MHz for the Canon system. The CCC (95% CI) was 0.792 (0.666–0.918), Pearson's r was 0.839 with Cb of 0.944, and the mean difference was 0.03 (−0.101; 0.162) suggesting the 2 methods are considered to be in agreement. Based on a Philips confidence map to determine the best location for performing the measurements, a depth of 3.5 to 4.0 cm from the liver capsule was determined, which might be significantly different than that of the Canon system. Conclusions: Estimation of the AC of the 2 systems showed a high agreement, that is, a similar trend. Assessment of the placement of the measurement box based on the quality of the measurement might be different between the 2 systems. [ABSTRACT FROM AUTHOR]

Ocular ultrasound is an invaluable tool for the evaluation of the eye and orbit. However, the eye and orbit are potentially sensitive to the thermal and mechanical effects of ultrasound. When performing B‐mode imaging, dedicated ocular settings should be used. If these settings are not available, limiting the acoustic output to Food and Drug Administration (FDA) recommended maximum levels is strongly advised. Especially important is the acoustic output in spectral (pulsed) and color Doppler modes, which can exceed the FDA's maximum recommended levels for the eye. Adjusting settings to decrease acoustic output and limiting the time of the examination should be done when performing a Doppler examination. The acoustic output of shear wave elastography is significantly higher than FDA guidelines for the eye and should be considered experimental. [ABSTRACT FROM AUTHOR]

Objectives: AI-based algorithms for medical image analysis showed comparable performance to human image readers. However, in practice, diagnoses are made using multiple imaging modalities alongside other data sources. We determined the importance of this multi-modal information and compared the diagnostic performance of routine breast cancer diagnosis to breast ultrasound interpretations by humans or AI-based algorithms.Methods: Patients were recruited as part of a multicenter trial (NCT02638935). The trial enrolled 1288 women undergoing routine breast cancer diagnosis (multi-modal imaging, demographic, and clinical information). Three physicians specialized in ultrasound diagnosis performed a second read of all ultrasound images. We used data from 11 of 12 study sites to develop two machine learning (ML) algorithms using unimodal information (ultrasound features generated by the ultrasound experts) to classify breast masses which were validated on the remaining study site. The same ML algorithms were subsequently developed and validated on multi-modal information (clinical and demographic information plus ultrasound features). We assessed performance using area under the curve (AUC).Results: Of 1288 breast masses, 368 (28.6%) were histopathologically malignant. In the external validation set (n = 373), the performance of the two unimodal ultrasound ML algorithms (AUC 0.83 and 0.82) was commensurate with performance of the human ultrasound experts (AUC 0.82 to 0.84; p for all comparisons > 0.05). The multi-modal ultrasound ML algorithms performed significantly better (AUC 0.90 and 0.89) but were statistically inferior to routine breast cancer diagnosis (AUC 0.95, p for all comparisons ≤ 0.05).Conclusions: The performance of humans and AI-based algorithms improves with multi-modal information.Key Points: • The performance of humans and AI-based algorithms improves with multi-modal information. • Multimodal AI-based algorithms do not necessarily outperform expert humans. • Unimodal AI-based algorithms do not represent optimal performance to classify breast masses. [ABSTRACT FROM AUTHOR]

Objectives: The BI‐RADS classification provides a standardized way to describe ultrasound findings in breast cancer diagnostics. However, there is little information regarding which BI‐RADS descriptors are most strongly associated with malignancy, to better distinguish BI‐RADS 3 (follow‐up imaging) and 4 (diagnostic biopsy) breast masses. Methods: Patients were recruited as part of an international, multicenter trial (NCT02638935). The trial enrolled 1294 women (6 excluded) categorized as BI‐RADS 3 or 4 upon routine B‐mode ultrasound examination. Ultrasound images were evaluated by three expert physicians according to BI‐RADS. All patients underwent histopathological confirmation (reference standard). We performed univariate and multivariate analyses (chi‐square test, logistic regression, and Krippendorff's alpha). Results: Histopathologic evaluation showed malignancy in 368 of 1288 masses (28.6%). Upon performing multivariate analysis, the following descriptors were significantly associated with malignancy (P <.05): age ≥50 years (OR 8.99), non‐circumscribed indistinct (OR 4.05) and microlobulated margin (OR 2.95), nonparallel orientation (OR 2.69), and calcification (OR 2.64). A clinical decision rule informed by these results demonstrated a 97% sensitivity and missed fewer cancers compared to three physician experts (range of sensitivity 79–95%) and a previous decision rule (sensitivity 59%). Specificity was 44% versus 22–83%, respectively. The inter‐reader reliability of the BI‐RADS descriptors and of the final BI‐RADS score was fair‐moderate. Conclusions: A patient should undergo a diagnostic biopsy (BI‐RADS 4) instead of follow‐up imaging (BI‐RADS 3) if the patient is 50 years or older or exhibits at least one of the following features: calcification, nonparallel orientation of mass, non‐circumscribed margin, or posterior shadowing. Access the CME test here and search by article title. [ABSTRACT FROM AUTHOR]

Ultrasound is very effective in performing procedures and assessment of complications in peritoneal dialysis. The ultrasound examination can be applied for preoperative assessment, during the peritoneal catheter placement, for the detection and monitoring of infection, as well as for the evaluation of the catheter malfunction. Despite being not only a cost‐ and time‐saving technique but also a bedside procedure, ultrasonography remains an underrated clinical tool in the field of peritoneal dialysis. This publication wants to explain and reinforce the clinical utility of US in PD and to expand the diagnostic equipment for the clinician. [ABSTRACT FROM AUTHOR]

Purpose: To determine the indications for CEUS for renal mass evaluation. Methods: This retrospective, single-center, IRB-approved, HIPAA compliant study analyzed data from 303 consecutive patients scheduled for a renal CEUS to determine the indications for the examination. A chart review was performed from 05/01/2020 through 05/31/2021 on all patients who received a renal CEUS. The patient demographics were extracted as well as the motivating factor for ordering the examination. Results: From the 303 patients, 114 were referred because of an indeterminate mass seen on CT and 28 were referred for long-term follow-up of a mass defined as benign or malignant was identified on CT. 9 patients were referred for a CEUS follow-up due to an indeterminate mass on MRI and 6 patients were referred for long-term follow-up of a mass defined as benign or malignant on MRI. 34 patients were referred for follow-up for characterization of a lesion seen on unenhanced ultrasound. 48 patients and 21 patients were referred for long-term follow-up of a previously observed benign or malignant lesion, respectively, seen on CEUS. CEUS was ordered in 21 patients to follow-up a partial nephrectomy and 5 patients for follow-up of a thermal ablation. 7 patients were referred because of a clinical finding. Conclusion: The main reason for a renal CEUS referral is to characterize a mass which could not be characterized on CT or MRI. Another main indication is for long-term follow-up of lesions to decrease radiation dose. Referrals due to inability to receive CT or MRI contrast or renal insufficiency were minor indications. [ABSTRACT FROM AUTHOR]

Although accurate detection of breast cancer still poses significant challenges, deep learning (DL) can support more accurate image interpretation. In this study, we develop a highly robust DL model based on combined B-mode ultrasound (B-mode) and strain elastography ultrasound (SE) images for classifying benign and malignant breast tumors. This study retrospectively included 85 patients, including 42 with benign lesions and 43 with malignancies, all confirmed by biopsy. Two deep neural network models, AlexNet and ResNet, were separately trained on combined 205 B-mode and 205 SE images (80% for training and 20% for validation) from 67 patients with benign and malignant lesions. These two models were then configured to work as an ensemble using both image-wise and layer-wise and tested on a dataset of 56 images from the remaining 18 patients. The ensemble model captures the diverse features present in the B-mode and SE images and also combines semantic features from AlexNet and ResNet models to classify the benign from the malignant tumors. The experimental results demonstrate that the accuracy of the proposed ensemble model is 90%, which is better than the individual models and the model trained using B-mode or SE images alone. Moreover, some patients that were misclassified by the traditional methods were correctly classified by the proposed ensemble method. The proposed ensemble DL model will enable radiologists to achieve superior detection efficiency owing to enhance classification accuracy for breast cancers in ultrasound (US) images. [ABSTRACT FROM AUTHOR]

Indeterminate renal masses are a common clinical problem. CEUS has several advantages to characterize both cystic and solid renal masses including thin slice thickness, excellent background subtraction, and real-time imaging with a high frame rate. The ultrasound contrast agents are not nephrotoxic and can be used in patients with renal insufficiency and obstruction. The Bosniak classification has been developed for use in CT and MRI. A CEUS Bosniak classification has not yet been developed. This meta-analysis reviews the results of renal mass characterization using Lumason/Sonovue in characterizing renal solid and cystic masses. For complex cystic renal lesions (419 patients; 436 lesions), the pooled sensitivity and specificity of CEUS were 95% (95% CI: 91%, 99%) and 84% (95% CI: 77%, 90%) and for solid lesions (331 patients; 341 lesions), the pooled sensitivity and specificity of CEUS were 98% (95% CI: 95%, 100%) and 78% (95% CI: 68%, 88%), respectively. [ABSTRACT FROM AUTHOR]

Background: Concerns over gadolinium (Gd) retention encourage the use of lower Gd doses. However, lower Gd doses may compromise imaging performance. Higher relaxivity gadobenate may be suited to reduced dose protocols. Purpose: To compare 0.05 mmol/kg and 0.1 mmol/kg gadobenate in patients undergoing enhanced MRI of the central nervous system (CNS). Study Type: Retrospective, multicenter. Population: Three hundred and fifty‐two patients receiving 0.05 (n = 181) or 0.1 (n = 171) mmol/kg gadobenate. Field Strength/Sequences: 1.5 T and 3.0 T/precontrast and postcontrast T1‐weighted spin echo/fast spin echo (SE/FSE) and/or gradient echo/fast field echo (GRE/FFE); precontrast T2‐weighted FSE and T2‐FLAIR. Assessment: Images of patients with extra‐axial lesions at 1.5 T or any CNS lesion at 3.0 T were reviewed by three blinded, independent neuroradiologists for qualitative (lesion border delineation, internal morphology visualization, contrast enhancement; scores from 1 = poor to 4 = excellent) and quantitative (lesion‐to‐brain ratio [LBR], contrast‐to‐noise ratio [CNR]; SI measurements at regions‐of‐interest on lesion and normal parenchyma) enhancement measures. Noninferiority of 0.05 mmol/kg gadobenate was determined for each qualitative endpoint if the lower limit of the 95% confidence interval (CI) for the difference in precontrast + postcontrast means was above a noninferiority margin of −0.4. Statistical Tests: Student's t‐test for comparison of mean qualitative endpoint scores, Wilcoxon signed rank test for comparison of LBR and CNR values; Wilcoxon rank sum test for comparison of SI changes. Tests were significant for P < 0.05. Results: The mean change from precontrast to precontrast + postcontrast was significant for all endpoints. Readers 1, 2, and 3 evaluated 304, 225, and 249 lesions for 0.05 mmol/kg gadobenate, and 382, 309, and 298 lesions for 0.1 mmol/kg gadobenate. The lower limit of the 95% CI was above −0.4 for all comparisons. Significantly, higher LBR and CNR was observed with the higher dose. Data Conclusion: 0.05 mmol/kg gadobenate was noninferior to 0.1 mmol/kg gadobenate for lesion visualization. Evidence Level: 2 Technical Efficacy: Stage 3 [ABSTRACT FROM AUTHOR]

Purpose: To assess chronic liver disease (CLD) using multiparametric US in a private practice setting in a cohort of patients with increased skin-to-liver distance. Methods: 110 consecutive patients with increased skin-to-liver distance scheduled for US assessment of CLD were reviewed for study completion time, liver stiffness values (LS), attenuation imaging, and shear wave dispersion slope. The ROI was placed 2 cm below the liver capsule. The study included patients with NAFLD/NASH (68), hepatitis C (30), prior Fontan surgery (1), elevated liver function tests (5), alcohol abuse (3), hepatitis B (2), and primary biliary cirrhosis (1). IQR/M values were obtained. Comparison of less experienced sonographers (LES) and more experienced sonographers (MES) were evaluated through Student's t test for independent data. Pearson coefficient r of correlation among quantitative variables was calculated. Results: The mean time to perform the exam was 129.7 ± 62.1 s. There was a statistically significant difference between LES and MES. The mean IQR/M for LS was 12.3 ± 5.5% m/s. Overall, in a cohort of difficult patients, 4.5% of LS values were not reliable. Fat quantification using attenuation imaging had a mean value of 0.60 ± 0.15 dB/cm/MHz (range 0.35–0.98 cm/dB/MHz) with an IQR/M of 14.7 ± 9.2%. Less reliable measurements of steatosis were obtained in 4.5% of patients. The mean shear wave dispersion slope was 12.74 ± 4.05 (m/s)/kHz (range 7.7–27.5 (m/s)/kHz) with an IQR/M of 38.7 ± 20.2% (range 3–131%). 20.9% of patients had values suggestive of compensated advanced chronic liver disease (cACLD). Conclusion: Multiparametric US can provide assessment of CLD in less than 3 min in most patients and identify patients at risk for cACLD. [ABSTRACT FROM AUTHOR]

Purpose: The FUSION-X-US-II prototype was developed to combine 3D-automated breast ultrasound (ABUS) and digital breast tomosynthesis in a single device without decompressing the breast. We evaluated the technical function, feasibility of the examination workflow, image quality, breast tissue coverage and patient comfort of the ABUS device of the new prototype. Methods: In this prospective feasibility study, the FUSION-X-US-II prototype was used to perform ABUS in 30 healthy volunteers without history of breast cancer. The ABUS images of the prototype were interpreted by a physician with specialization in breast diagnostics. Any detected lesions were measured and classified using BI-RADS® scores. Image quality was rated subjectively by the physician and coverage of the breast was measured. Patient comfort was evaluated by a questionnaire after the examination. Results: One hundred and six scans were performed (61 × CC, 23 × ML, 22 × MLO) in 60 breasts. Image acquisition and processing by the prototype was fast and accurate. Breast coverage by ABUS was approximately 90.8%. Sixteen breast lesions (all benign, classified as BIRADS® 2) were identified. The examination was tolerated by all patients. Conclusion: The FUSION-X-US-II prototype allows a rapid ABUS scan with mostly high patient comfort. Technical developments resulted in an improvement of quality and coverage compared to previous prototype versions. The results are encouraging for a test of the prototype in a clinical setting in combination with tomosynthesis. [ABSTRACT FROM AUTHOR]

Breast elastography is a technique that has been available for over 20 years but has not been widely accepted in breast imaging. This is due to variations in technique, a steep learning curve, and differences in methodology between vendors. However, recent improvements in equipment have addressed many of these issues. Both strain elastography (SE) and 2D-shear wave imaging (2D-SWE) have been used to evaluate breast lesions and have shown improvement in characterizing breast lesions to varying degrees. SE is a relative technique that compares the stiffness of a lesion to other tissues in the field of view, while 2D-SWE provides a quantitative estimate of lesion stiffness based on shear wave speed. The optimal cut-off values for differentiating benign and malignant lesions are still being researched. Combining SE and 2D-SWE can overcome the limitations of each technique individually, making them complementary rather than competing techniques. [Extracted from the article]

In adults with chronic liver diseases, ultrasound and magnetic resonance shear wave elastography (SWE) can replace liver biopsy in several clinical scenarios. Several guidelines on the use of ultrasound SWE for the adult population have been published. However, the number of publications in the pediatric population is limited, and available guidelines on SWE do not specifically address pediatric chronic liver diseases. In this article, we review the literature on the use of SWE for pediatric chronic liver diseases and provide expert opinion on how to use SWE, both ultrasound and magnetic resonance techniques, in the pediatric population. [ABSTRACT FROM AUTHOR]

The diagnosis of prostate cancer (PCa) can be challenging due to the limited performance of current diagnostic tests, including PSA, digital rectal examination and transrectal conventional US. Multiparametric MRI has improved PCa diagnosis and is recommended prior to biopsy; however, mp-MRI does miss a substantial number of PCa. Advanced US modalities include transrectal prostate elastography and contrast-enhanced US, as well as improved B-mode, micro-US and micro-Doppler techniques. These techniques can be combined to define a novel US approach, multiparametric US (mp-US). Mp-US improves PCa diagnosis but is not sufficiently accurate to obviate the utility of mp-MRI. Mp-US using advanced techniques and mp-MRI provide complementary information which will become even more important in the era of focal therapy, where precise identification of PCa location is needed. [ABSTRACT FROM AUTHOR]

Contrast-enhanced ultrasound (CEUS) has become an established modality in various clinical indications for liver diseases. SonoVue®, a pure blood pure agent, and Sonazoid®, which exhibits an additional Kupffer phase, are contrast agents approved for liver imaging. This review discusses and compares the current clinical evidence for these two ultrasound contrast agents in the characterization and detection of focal liver lesions in the non-cirrhotic and cirrhotic liver, as well as for the use in interventional procedures such as liver biopsy guidance, and local ablation treatment monitoring. Reference is made to clinical studies which evaluated the accuracy of CEUS using a standard of reference, its safety, or to comparative studies of these two agents. [ABSTRACT FROM AUTHOR]

Objectives: There are conflicting results in the literature on the use of shear wave elastography of the kidney parenchyma to determine whether renal stiffness values are related to a disease process. This study was conducted to evaluate the raw data from 3 ultrasound systems and determine whether adequate displacement curves are obtained to accurately estimate shear wave speeds. Methods: Shear wave elastography was performed on 5 healthy volunteers with 3 ultrasound systems. The raw data were collected and evaluated for the shear wave propagation quality to determine whether accurate estimates of renal shear wave speeds could be determined. Results: Results from the 3 machines demonstrate that accurate shear wave displacement curves are not obtained with renal elastography on existing systems (as of June 2018). One vendor has recently released software that appears to acquire accurate shear wave displacements. Conclusions: Elastographic studies performed on the kidney to date are likely to be inaccurate. A new algorithm that appears to acquire accurate shear wave displacements in the kidney has been developed. Additional studies are needed to confirm that the new algorithm provides accurate clinical results. This study demonstrates that although the system provides a shear wave speed, it is important to confirm the accuracy of that number by evaluating the raw data. [ABSTRACT FROM AUTHOR]

The Journal of Ultrasound in Medicine (JUM) has made some changes as of January 1, 2024. The journal is now online-only, eliminating the printing and shipping of physical copies to reduce their carbon footprint. There have also been changes to the Deputy Editors, with Michael Blaivas stepping away and Keith R. Barron, Jr taking his place. Additionally, Jason Wagner has left his role as the General Abdominal Ultrasound Subspecialty Editor, and Gowthaman Gunabushanam has joined the editorial community to fill the vacancy. The journal receives over 1500 manuscripts yearly and is working to increase its Impact Factor. The transition to an online-only format will allow for faster publication of accepted articles. [Extracted from the article]

Breast elastography has been available for more than 15 years but is not widely incorporated into clinical practice. Many publications report extremely high accuracy for various breast elastographic techniques. However, results in the literature are extremely variable. This variability is most likely due to variations in technique, a relatively steep learning curve, and variability in methods between vendors. This article describes our protocol for performing breast elastography using both strain elastography and shear wave elastography, which produces high sensitivity and specificity. Additionally, we will describe the most commonly known false‐positive and false‐negative lesions as well as how to detect them. [ABSTRACT FROM AUTHOR]

Objectives: There is a significant learning curve in strain elastography. Uniform appropriate levels of stress must be applied for accurate elastograms. If the stress is not applied appropriately, inaccurate results will be obtained, particularly when strain ratios are being estimated. This paper describes a new technique which allows the real‐time visualization of the applied stress with a color‐coded stress map. The potential use of this map is discussed. Methods: Ten patients (5 breast, 5 thyroid) and phantoms were scanned using the stress map. The stress applied was varied and the resultant change in the strain image evaluated. Results: The stress map was able to document if appropriate stress was applied when performing strain elastography. When inappropriate stress was applied or physiological process effected the strain image the stress map demonstrated the areas of inaccurate measurements in the stress map. Conclusions: The display of a stress map that depicts the degree and uniformity of applied stress would be helpful both for training of the appropriate technique, for confirming that the elastogram is appropriate for evaluation, and that strain ratio estimates are accurate. [ABSTRACT FROM AUTHOR]

There are 3 methods of interpreting breast strain elastography: the elastographic–to–B‐mode length ratio (E/B), a 5‐point color scale (5P), and the strain ratio (SR). This meta‐analysis assessed which method is superior to the others. A systematic search of the medical literature was performed in July 2017. Studies were eligible for inclusion if they fulfilled the following criteria: (1) had biopsy‐proven or long‐term stability as the reference standard; (2) used either the E/B, 5P, or SR to interpret results; and (3) had at least 50 cases. A total of 220 records were retrieved; 60 full‐text articles were examined, and 46 were included in the meta‐analysis. Publication years ranged from 2007 and 2017. The quality of studies was generally high. The mean age of women was 48 years; 12,398 lesions (4242 malignant) were analyzed. For the 5P method, the sensitivity was 77%; specificity, 87%; positive likelihood ratio (LR), 5.3; and negative LR, 0.24. For the SR method, sensitivity was 87%; specificity, 81%; positive LR, 4.8; and negative LR, 0.16. For the E/B method, sensitivity was 96%; specificity, 88%; positive LR, 7.1; and negative LR, 0.03. Of the 3 methods, the E/B had the highest sensitivity, and the E/B and 5P had the highest specificity. With a negative LR of 0.03, the E/B method can downgrade lesions with a pretest probability of 50% to a 2% probability of malignancy. [ABSTRACT FROM AUTHOR]

Purpose: To determine the feasibility of a prototype device combining 3D-automated breast ultrasound (ABVS) and digital breast tomosynthesis in a single device to detect and characterize breast lesions.Methods: In this prospective feasibility study, the FUSION-X-US prototype was used to perform digital breast tomosynthesis and ABVS in 23 patients with an indication for tomosynthesis based on current guidelines after clinical examination and standard imaging. The ABVS and tomosynthesis images of the prototype were interpreted separately by two blinded experts. The study compares the detection and BI-RADS® scores of breast lesions using only the tomosynthesis and ABVS data from the FUSION-X-US prototype to the results of the complete diagnostic workup.Results: Image acquisition and processing by the prototype was fast and accurate, with some limitations in ultrasound coverage and image quality. In the diagnostic workup, 29 solid lesions (23 benign, including three cases with microcalcifications, and six malignant lesions) were identified. Using the prototype, all malignant lesions were detected and classified as malignant or suspicious by both investigators.Conclusion: Solid breast lesions can be localized accurately and fast by the Fusion-X-US system. Technical improvements of the ultrasound image quality and ultrasound coverage are needed to further study this new device.Key Points: The prototype combines tomosynthesis and automated 3D-ultrasound (ABVS) in one device. It allows accurate detection of malignant lesions, directly correlating tomosynthesis and ABVS data. The diagnostic evaluation of the prototype-acquired data was interpreter-independent. The prototype provides a time-efficient and technically reliable diagnostic procedure. The combination of tomosynthesis and ABVS is a promising diagnostic approach. [ABSTRACT FROM AUTHOR]

With the recent FDA approval for characterization of focal liver lesions (FLL) in both pediatric and adult patients using Lumason (sulfur hexafluoride microbubbles), increased use of ultrasound contrast for routine clinical use is expected. This agent has been available for many years in Europe and Asia, and a large body of literature is available regarding the sensitivity and specificity of this agent. In addition, a few studies have directly compared CEUS to CECT and CEMRI for the characterization of focal liver lesions. This paper reviews the literature to provide a background to investigators in the United States as to the accuracy of CEUS in the characterization of FLL. This paper reviews the literature regarding sulfur hexafluoride microbubbles (Lumason in the USA and Sonovue in the rest of the world) since it is the only FDA approved agent in the USA for characterization of FLL. The results of other ultrasound contrast agents which are not FDA approved for abdominal indications (approval for cardiac indications) most likely will have similar results. [ABSTRACT FROM AUTHOR]

Although contrast-enhanced ultrasound (CEUS) has become a widely utilized and accepted modality in much of the world, the associated contrast agents have only recently received approval in the United States. As with all radiological techniques, image artifacts are encountered in CEUS, some of which relate to commonly encountered ultrasound artifacts, while others are unique to this technique. Image artifacts must be recognized when performing and interpreting examinations to improve technique and diagnostic accuracy. In this article, we review artifacts that may be encountered in CEUS, and where possible discuss how to minimize them or mitigate their effect on image quality and interpretation. [ABSTRACT FROM AUTHOR]

Chronic liver disease is a substantial world-wide problem. Its major consequence is increasing deposition of fibrous tissue within the liver leading to the development of cirrhosis with its consequences of portal hypertension, hepatic insufficiency, and hepatocellular carcinoma. The stage of liver fibrosis is important to determine prognosis, surveillance, prioritize for treatment, and potential for reversibility. The process of fibrosis is dynamic and regression of fibrosis is possible with treatment of the underlying conditions. Previously, the only method of staging the degree of fibrosis was liver biopsy. The recent development of ultrasound elastography techniques allows a non-invasive method of estimating the degree of liver fibrosis. Transient elastography (TE) is a non-imaging elastographic technique, while point shear wave (p-SWE) and 2D-SWE combine imaging with elastography. The evidence at this time suggests that p-SWE is as accurate as but more reliable than TE, while 2D-SWE is more accurate than TE. This review discusses the background of chronic liver disease, the types of ultrasound elastography, how to perform an examination, and how to interpret the results. [ABSTRACT FROM AUTHOR]