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To assess the diagnostic performance of the modified LR‐M method of CEUS LI‐RADS version 2017 with nodules of different sizes. This retrospective study included consecutive patients with high risk for HCC who underwent CEUS between 2019 and 2021, demonstrating an LR‐M observed using CEUS LI‐RADS version 2017. Four modified LR‐M methods were used to evaluate nodules of different sizes. The diagnostic performances of the four modified LR‐M methods were assessed in LR‐M nodules of different sizes by the area under the receiver operating characteristic curve (AUC). The 261 patients with LR‐M observations included 166 HCCs and 95 non‐HCCs. A total of 133 nodules were <30 mm and defined as group A, 78 nodules were 30–50 mm in size and defined as group B, and 50 nodules were >50 mm and defined as group C. The AUCs between criterion I, II, III, and IV were not significantly different in all LR‐M nodules. The AUCs of the ROC curves between criterion I, II, III, and IV were not significantly different in group A. However, the AUC of criterion IV was significantly higher than that of criterion I and III in group B, and the AUCs of criterion I and criterion III were both not significant in group B; the AUC of criterion IV was not significant in group C. The modified LR‐M method could moderate the detection effectiveness in differentiating HCC from other lesions. According to tumor size, the selection of appropriate modified LR‐M diagnostic criteria could effectively improve the diagnostic performance of LR‐M.

To compare the on‐site diagnostic performance of contrast‐enhanced ultrasound (CEUS), computed tomography (CECT), and magnetic resonance imaging (CEMRI) for hepatocellular carcinoma (HCC) across diverse practice settings. Between May 2019 and April 2022, a total of 2085 patients with 2320 pathologically confirmed focal liver lesions (FLLs) were enrolled. Imaging reports were compared with results from pathology analysis. Diagnostic performance was analyzed in defined size, high‐risk factors for HCC, and hospital volume categories. Three images achieved similar diagnostic performance in classifying HCC from 16 types of FLLs, including HCC ≤2.0 cm. For HCC diagnosis at low‐volume hospitals and HCC with high‐risk factors, the accuracy and specificity of CEUS were comparable to CECT and CEMRI, while the sensitivity of CEUS (77.4 and 89.5%, respectively) was inferior to CEMRI (87.0 and 92.8%, respectively). The diagnostic accuracy of CEUS + CEMRI and CEUS + CECT increased by 7.8 and 6.2% for HCC ≤2.0 cm, 8.0 and 5.0% for HCC with high‐risk factors, and 7.4 and 5.5% for HCC at low‐volume hospitals, respectively, compared with CEMRI/CECT alone. Compared with CECT and CEMRI, CEUS provides adequate diagnostic performance in clinical first‐line applications at high‐volume hospitals. Moreover, a higher diagnostic performance for HCC is achieved by combining CEUS with CECT/CEMRI compared with any single imaging technique.

Byline: Dong. Xu, Minghua. Ge, Ankui. Yang, Ruochuan. Cheng, Hui. Sun, Hongcheng. Wang, Jianquan. Zhang, Zhigang. Cheng, Zeyu. Wu, Zhongmin. Wang, Bo. Zhai, Yin. Che, Lin. Chen, Liyu. Chen, Wen. [...]

Byline: Yehua. Shen, Chien-shan. Cheng, Peng. Wang, Xu. Zhu, Guangyan. Lei, Yong. Fang, Hailiang. Li, Weijun. Fan, Hongming. Pan, Zhe. Tang, Kuansheng. Ma, Xiaoguang. Li, Zhengyu. Lin, Yiping. Zhuang, Xin. [...]

Compared with two-dimensional shear-wave elastography, US molecular imaging with CD34-targeted microbubbles to view sinusoidal capillarization helped to provide better detection of early-stage and more accurate assessment of fibrosis regardless of inflammation.

A hepatocellular carcinoma (HCC) prediction score constructed from age, platelet count, and liver stiffness measurement at two-dimensional shear-wave elastography, or APS score, higher than 60 is predictive of higher risk of HCC development in patients with chronic hepatitis B.

A multiparametric US predictive model combining attenuation coefficient, alanine aminotransferase level, and international normalized ratio showed good ability to predict metabolic dysfunction–associated steatohepatitis in participants with metabolic dysfunction–associated fatty liver disease.

Liver allograft fibrosis (LAF) is a common challenge threatening patient survival after liver transplantation, making a potent imaging technique vital for clinical management. To date, ultrasound (US) elastography has been regarded as one of the most promising techniques for LAF monitoring. However, it is susceptible to inflammation and also insensitive to early-stage pathological changes, which affects its diagnostic accuracy of LAF. Herein, based on a thorough comparison with US elastography at multiple disease stages, VEGF receptor-2 (VEGFR2) targeted US molecular imaging (USMI) was validated to be highly potent for LAF early diagnosis and staging. The VEGFR2-targeted microbubbles (MBs) were fabricated as a specific probe for angiogenesis. Then, VEGFR2-targeted USMI and US elastography were compared in terms of evaluating the LAF progress in a rodent model. The quantitative USMI result displayed a much higher linear correlation with histological standards including the Metavir fibrosis score (R2= 0.77 vs. 0.35) and VEGFR2 semi-quantitative counting (R2= 0.78 vs. 0.49) than US elastography, which demonstrated a greatly improved diagnostic accuracy. The study not only revealed the mechanism of employing angiogenesis to describe LAF but also overcame the intrinsic limitations of US elastography, thus highlighting the potential of VEGFR2-targeted USMI as an effective monitoring tool for LAF surveilling.

Two-dimensional shear-wave elastography is valuable in predicting liver-related events in patients with well-compensated cirrhosis and chronic hepatitis B viral infection; its predictive accuracy is similar to that of transient elastography and superior to that of liver biopsy and serum markers of fibrosis tests.

In this study, we built a novel handheld array photoacoustic probe by integrating multiple optical components with a transrectal ultrasound (TRUS) transducer array. The optical components deliver laser energy and TRUS is used for photoacoustic signal detection. Compared to the previously reported probe, the new photoacoustic probe utilizes an optimized light illumination scheme to enhance the utilization-efficiency of the laser energy, thus improving the imaging sensitivity of the probe. In addition, the new probe is compact and easy to handle for clinicians. We validated the use of this photoacoustic probe for prostate cancer imaging through both phantom studies and in vivo canine model study, which mimics the prostate cancer conditions. The results showed that the probe is suitable for clinical use and can be used in the clinics for several potential clinical applications, including early diagnosis of prostate cancer, targeted image-guided biopsy, and image-guided intra-operative procedure.

ObjectiveWe aimed to evaluate the performance of the newly developed deep learning Radiomics of elastography (DLRE) for assessing liver fibrosis stages. DLRE adopts the radiomic strategy for quantitative analysis of the heterogeneity in two-dimensional shear wave elastography (2D-SWE) images.DesignA prospective multicentre study was conducted to assess its accuracy in patients with chronic hepatitis B, in comparison with 2D-SWE, aspartate transaminase-to-platelet ratio index and fibrosis index based on four factors, by using liver biopsy as the reference standard. Its accuracy and robustness were also investigated by applying different number of acquisitions and different training cohorts, respectively. Data of 654 potentially eligible patients were prospectively enrolled from 12 hospitals, and finally 398 patients with 1990 images were included. Analysis of receiver operating characteristic (ROC) curves was performed to calculate the optimal area under the ROC curve (AUC) for cirrhosis (F4), advanced fibrosis (≥F3) and significance fibrosis (≥F2).ResultsAUCs of DLRE were 0.97 for F4 (95% CI 0.94 to 0.99), 0.98 for ≥F3 (95% CI 0.96 to 1.00) and 0.85 (95% CI 0.81 to 0.89) for ≥F2, which were significantly better than other methods except 2D-SWE in ≥F2. Its diagnostic accuracy improved as more images (especially ≥3 images) were acquired from each individual. No significant variation of the performance was found if different training cohorts were applied.ConclusionDLRE shows the best overall performance in predicting liver fibrosis stages compared with 2D-SWE and biomarkers. It is valuable and practical for the non-invasive accurate diagnosis of liver fibrosis stages in HBV-infected patients.Trial registration numberNCT02313649; Post-results.

This prospective multicenter study confirmed that the performance of two-dimensional shear-wave elastography is superior to other noninvasive methods for noninvasive assessment of cirrhosis.

Compared with delayed ablation combined with systemic therapy, upfront ablation combined with systemic therapy extended disease-free survival in patients with few (three or fewer) and small (<3 cm) unresectable colorectal liver metastases.

This study reviewed the literature to directly evaluate the diagnostic performance of contrast‐enhanced ultrasonography (CEUS) versus contrast‐enhanced computed tomography (CECT) for assessing residual tumors of hepatocellular carcinoma treated with transarterial chemoembolization. PubMed, Embase, the Cochrane Library, and the China National Knowledge Infrastructure were searched through April 30, 2017. The pooled sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and summary receiver operating characteristic curve were calculated and compared to examine the diagnostic performance of CEUS versus CECT. A total of 11 studies, including 421 patients and 491 nodules were analyzed. The pooled diagnostic performances of CEUS versus CECT were as follows: (1) sensitivity (95% confidence interval), 0.97 (0.95–0.99) versus 0.72 (0.67–0.76); (2) specificity, 0.86 (0.74–0.94) versus 0.99 (0.95–1.00); (3) positive predictive value, 0.97 (0.95–0.99) versus 1.00 (0.98–1.00); (4) negative predictive value, 0.90 (0.83–0.95) versus 0.51 (0.44–0.58); (5) positive likelihood ratio, 7.79 (4.73–12.82) versus 12.50 (5.74–27.20); (6) negative likelihood ratio, 0.05 (0.03–0.09) versus 0.35 (0.26–0.48); (7) diagnostic odds ratio, 150.56 (57.03–397.49) versus 35.54 (14.89–84.83); and (8) area under the summary receiver operating characteristic curve, 0.9875 versus 0.9239. The sensitivity and negative predictive value of CEUS were significantly higher than those of CECT (both P< .001). The specificity and positive predictive value of CECT were significantly higher than those of CEUS (both P< .05). Contrast‐enhanced US, with better sensitivity and negative predictive value versus CECT, was an effective method for exclusion of residual tumors after transarterial chemoembolization. Contrast‐enhanced CT, with higher specificity than CEUS, is a valid approach for identifying residual tumors.

Photoacoustic technology in combination with molecular imaging is a highly effective method for accurately diagnosing brain glioma. For glioma detection at a deeper site, contrast agents with higher photoacoustic imaging sensitivity are needed. Herein, we report a MoS2–ICG hybrid with indocyanine green (ICG) conjugated to the surface of MoS2nanosheets. The hybrid significantly enhanced photoacoustic imaging sensitivity compared to MoS2nanosheets. This conjugation results in remarkably high optical absorbance across a broad near-infrared spectrum, redshifting of the ICG absorption peak and photothermal/photoacoustic conversion efficiency enhancement of ICG. A tumor mass of 3.5 mm beneath the mouse scalp was clearly visualized by using MoS2–ICG as a contrast agent for the in vivo photoacoustic imaging of orthotopic glioma, which is nearly twofold deeper than the tumors imaged in our previous report using MoS2nanosheet. Thus, combined with its good stability and high biocompatibility, the MoS2–ICG hybrid developed in this study has a great potential for high-efficiency tumor molecular imaging in translational medicine.

Among medical imaging modalities available in the clinic, ultrasonography is the most convenient, inexpensive, ionizing-radiation-free, and most common. Micrometer-size perfluorocarbon bubbles have been used as efficient contrast for intravascular ultrasonography, but they are too big for tumor penetration. Nanodroplets (250–1000 nm) encapsulating both perfluorocarbon and drug have been used as an ultrasound-triggered release drug delivery platform against cancer, but they are generally not useful as a tumor imaging agent. The present study aims to develop a type of pH-sensitive, polymersome-based, perfluorocarbon encapsulated ultrasonographic nanoprobe, capable of maintaining at 178 nm during circulation and increasing to 437 nm at the acidic tumor microenvironment. Its small size allowed efficient tumor uptake. At the tumor site, the nanoparticle swells, resulting in lowering of the vaporization threshold for the perfluorocarbon, efficient conversion of nanoprobes to echogenic nano/microbubbles for ultrasonic imaging, and eventual release of doxorubicin from the theranostic nanoprobe for deep tissue chemotherapy, triggered by irradiation with low-frequency ultrasound.

We developed a linear ultrasound array-based real-time photoacoustic imaging system with a compact coaxial excitation handheld photoacoustic imaging probe for guiding sentinel lymph node (SLN) needle biopsy. Compared with previous studies, our system and probe have the following advantages: (1) the imaging probe is quite compact and user-friendly; (2) laser illumination and ultrasonic detection are achieved coaxially, enabling high signal-to-noise ratio; and (3) GPU-based image reconstruction enables real-time imaging and displaying at a frame rate of 20 Hz. With the system and probe, clear visualization of the SLN at the depth of 2 cm (~human SLN depth) was demonstrated on a living rat. A fine needle was pushed towards the SLN based on the guidance of real-time photoacoustic imaging. The proposed photoacoustic imaging system and probe was shown to have great potential to be used in clinics for guiding SLN needle biopsy, which may reduce the high morbidity rate related to the current gold standard clinical SLN biopsy procedure.

Ultrasound contrast agents (UCA) represented by gas-filled microbubble, can provide simultaneous and co-localized enhancement on image contrast to help disease diagnosis by highlighting tissue borders. Nowadays, Some UCAs (e.g. Levovist®, Optison®, Definity®, and Sonovue®) are commercially available, and have been clinically utilized for enhanced ultrasonography in the US, Canada, Europe, Asia and so on. However, their large diameters (1~10 μm) mainly hinder more precise and deeper applications in the imaging of capillaryabundant organs or tissues (e.g. tumor), and undersized nanoscale UCAs also lack enough backscattering echo intensity to distinguish abnormal distribution of vessels. So novel shapes, structures and materials of nano-sized UCAs are constantly emerging for cancer ultrasonic imaging. Particularly, the cavitation effect of diagnostic ultrasound can accelerate effusion of loaded contents from UCAs, following cellular uptake. This will inevitably contribute to develop other potential applications of nano-sized UCAs towards cancer therapy and theranostics.

Anechoic carotid plaques on sonography have been used to predict future cardiovascular or cerebrovascular events. The purpose of this study was to investigate whether carotid plaque echogenicity could be assessed objectively by combining texture features extracted by MaZda software (Institute of Electronics, Technical University of Lodz, Lodz, Poland) and morphologic characteristics, which may provide a promising method for early prediction of acute cardiovascular disease. A total of 268 plaque images were collected from 136 volunteers and classified into 85 hyperechoic, 83 intermediate, and 100 anechoic plaques. About 300 texture features were extracted from histogram, absolute gradient, run‐length matrix, gray‐level co‐occurrence matrix, autoregressive model, and wavelet transform algorithms by MaZda. The morphologic characteristics, including degree of stenosis, maximum plaque intima‐media thickness, and maximum plaque length, were measured by B‐mode sonography. Statistically significant features were selected by analysis of covariance. The most discriminative features were obtained from statistically significant features by linear discriminant analysis. The K‐nearest neighbor classifier was used to classify plaque echogenicity based on statistically significant and most discriminative features. A total of 30 statistically significant features were selected among the plaques, and 2 most discriminative features were obtained from the statistically significant features. The classification accuracy rates for 3 types of plaques based on statistically significant and most discriminative features were 72.03% (κ= 0.571; P< .001) and 88.14% (κ= 0.820; P< .001), respectively. The receiver operating characteristic curve for identifying anechoic plaques showed an area under the curve of 0.918 when the most discriminative features were used to train the classifier. It is feasible to classify carotid plaque echogenicity by combining texture features extracted from sonograms by MaZda and morphologic characteristics.

Contrast-free ultrasensitive US microvessel imaging provided noninvasive in vivo imaging and quantification of hepatic microvessels in cirrhotic rat liver.

A novel perfluorooctyl bromide (PFOB)-loaded nanovesicle with a size of about 500 nm was prepared by self-assembly of an amphiphilic block copolymer, poly(ethylene oxide)-b-poly(d,l-lactic acid) (PEG-PDLLA), for blood pool ultrasound imaging. The excellent compatibility of PFOB with the hydrophobic PDLLA block makes PFOB uniformly distribute and integrate well within the nanovesicle shell. In theory, both the compressibility and shell density of the nanovesicle as ultrasound scatterers are enhanced, resulting in much higher echo intensity compared to the other PFOB nanoparticles. In vitroand in vivoimaging results illustrate that these polymeric nanovesicles with extremely low content of PFOB show quite a good contrast-enhancing effect even if highly diluted in blood. Therefore this PFOB-loaded polymeric nanovesicle is anticipated to be applicable as an ultrasound contrast agent for normal angiography and specific imaging of capillary-abundant organs or tissues (e.g.tumors).

Microbubbles (MBs) are gas-filled hollow microparticles. Under the ultrasound field, the difference of acoustic characteristics between gas and plasma in the blood vessel will cause strong impedance mismatch and echogenicity to enhance ultrasonic grey scale imaging. The linear or nonlinear resonance of MB shell in the ultrasound field would lead to repeated expansion-contraction till destruction. In this case, the pre-loaded drug in the MB shell will be released in an accelerated manner triggered by the ultrasound at a probe–given site. Sonoporation effect of the cell membrane would also help increase the uptake of substances into cells. This paper is dedicated to review recent developments on MBs, especially multifunctionalized MBs, as a potential drug/gene delivery microdevices for both diagnosis and therapy of malignant tumors.

More and more clean and safe drinking water will be needed due to the explosive population growth and water pollution, as well as peoples increasing demands for better life quality. In response to this problem, various kinds of drinking water treatment approaches have been developed over the past decade. As a result, diversified water purifiers with patents appeared on the market. This paper analyzes recent researches and developments of advanced drinking water treatment, and seeks to offer a scientific and technical overview of dramatic trend and useful information to researchers who work in this field. Potential methods and popular apparatuses with patents are discussed first, especially those novel processes using membranes. Compared with ozonation, electrolysis and photocatalysis process, membrane technology shows enormous application potential and bright development prospect in the field of advanced drinking water treatment. The advantages of novel membrane processes include extremely high quality of water, nature friendly, cost effectiveness and easy operation. Therefore, commercial point-of-use water purifiers with membrane module are becoming more popular on the market. With a view to the membrane fouling in water purifiers, progresses on available filtration media prior to membrane separation are also discussed, such as copper/zinc redox alloy (KDF) and activated carbon fiber (ACF). These typical filtration medias have played a dual role in both alleviating membrane fouling and enhancing water quality.

•Fusion imaging can accurately guide puncture and reduce thermal damage.•Sufficient ablation area for completely necrosis of the medium-sized HCCs.•Achieve good prognosis with lower LTP rate and good long-term survival.