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The effectiveness of ultrasonography (USG) in liver cancer screening is partly constrained by the operator's expertise. We aimed to develop and evaluate an AI-assisted system for detecting and classifying focal liver lesions (FLLs) from USG images. This retrospective study incorporated 26,288 USG images from 5444 patients to train YOLOv5 model for FLLs detection and classification of seven different types of FLLs, including hepatocellular carcinoma (HCC), cholangiocarcinoma (CCA), focal fatty infiltration, focal fatty sparing (FFS), cyst, hemangioma, and regenerative nodules. AI model performance was assessed for detection and diagnosis of the FLLs on a per-image and per-lesion basis. The AI achieved an overall FLLs detection rate of 84.8% (95%CI:83.3–86.4), with consistent performance for FLLs ≤ 1 cm and > 1 cm. It also exhibited sensitivity and specificity for distinguishing malignant FLLs from other benign FLLs at 97.0% (95%CI:95. 9–98.2) and 97.0% (95%CI:95.9–98.1), respectively. Among specific FLL types, CCA detection rate was at 92.2% (95%CI:88.0–96.4), followed by FFS at 89.7% (95%CI:87.1–92.3), and HCC at 82.3% (95%CI:77.1–87.5). The specificities and NPVs for regenerative nodules were 100% and 99.9% (95%CI:99.8–100.0), respectively. Our AI model can potentially assist physicians in FLLs detection and diagnosis during USG examinations. Further external validation is needed for clinical application. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study is to present novel diagnostic ultrasonography (USG)-based classification of inflammatory granulomatous mastitis (IGM) and to assess and compare dosage responses of locoregional steroid therapy. Methods: From January 2017 through March 2023, total of 230 biopsy-proven IGM patients were reclassified (grades I, II, and III) according to USG-based morphological features. The injection applications were grouped in Group1 (40 mg/mL between years 2017 and 2019) versus Group2 (80 mg/mL between years 2019 and 2023), and effectiveness was analysed for each grade in between groups. Results: The mean age was 31 years old (range: 19-60) with median follow-up period of 7 months. The most common clinical presentation was breast mass accompanying draining skin sinuses of the affected skin and hypoechogenic mass with tubular extensions was the most prevalent feature on USG examination. As per USG-based features, 79 (34.3%) patients were redefined as grade I, 64 (27.8%) as grade II, and 87 (37.8%) as grade III. All patients underwent locoregional steroid injection only. The average number of treatments in the first group was 6 (±3 SD) with an effective dose of 40 mg/mL in the first group, and 4 (±2 SD) with an effective dose of 80 mg/mL in the second group. The generalized linear mixed model was used to investigate effects between groups (P < .05). Conclusions: High-dose steroid treatment was effective in burnout lesions (grades II and III), and it was found to be statistically significant in lowering number of treatments irrespective of grade. Advances in knowledge: This novel classification could be a convenient tool in terms of common language between radiologists and clinicians. In addition, our study is a pioneer in comparing steroid dosage with no relapse in IGM patients. [ABSTRACT FROM AUTHOR]

BACKGROUND: Chronic kidney disease (CKD) is a major public health problem, so it is particularly important to quantitatively assess and intervene in the degree of early renal damage in CKD. OBJECTIVE: The objective of the research is to establish reference values for kidney elasticity by using real-time shear wave elastography (RT-SWE) technology to quantify Young's modulus values in the renal cortex of normal adults. The intention is to provide a foundation for evaluating renal function and structural changes in patients with CKD. Furthermore, this research investigates the role of RT-SWE in the early detection of renal fibrosis in CKD, providing insights into its diagnostic value for detecting pathological changes at an early stage. METHODS: Between August 2019 and December 2021, we collected a sample of 100 healthy people (55 men with an average age of 43.5 ± 15.2 years and 45 women with an average age of 41.6 ± 19.8 years) for medical evaluations at our hospital's Department of Ultrasound Medicine. In addition, 97 individuals with CKD1-3 stage were considered. Following the removal of contraindications and relevant confounding variables, we included a final cohort of 80 individuals in the research (45 men and 35 females, with an average age of 39.1 ± 19.2 years). The RENAL mode was selected and a convex array probe S6-1 operating at a frequency of 3.5–5.5 MHz was used in the research, which made use of the French Supersonic AixPlorer ultrasonic diagnostic instrument. Renal RT-SWE elastography was performed after conventional two-dimensional and color Doppler ultrasonography. The study used RT-SWE technology to assess the mean Young's modulus of the cortex in healthy individuals (Emean), with data analysis and comparisons based on age and gender. Furthermore, the Emean values of CKD stage 1–3 patients were determined, and analyses were performed about 24-hour urine protein quantitative (24hUTP), serum creatinine concentration (SCr), and renal biopsy pathology, specifically the degree of interstitial fibrosis. RESULTS: Healthy group: a) The average kPa values of the left kidney (4.2 ± 2.3), right kidney (4.3 + 2.5) kPa, both kidneys' average kPa values (4.3 ± 2.4) kPa, and the average kPa values of the left and right kidneys do not differ statistically (p = 0.986). b) There was no difference in the kPa values of healthy male and female kidneys (4.4 + 2.1 and 4.2 + 2.6, respectively. c) There was no difference in the renal kPa values of healthy adults aged 50 (4.4 ± 2.8) kPa and renal kPa of the 50-year-old population (4.2 + 2.1) kPa (p = 0.041). Case group: a) the group of patients with CKD1-3 stage and the group did not vary in their Emean values (both p < 0.05); b) There is a difference between CKD stages 1, 2, and 3 (p < 0.05), however, there is still no difference in the pyEmean value corrected for patient age between patients in stages 1 and 2 (p > 0.05). CONCLUSION: The study reveals no significant differences in the Emean value of bilateral kidneys in normal people and no differences in the elasticity value of kidneys and gender. However, age-based differences were statistically significant. pyEmean may be useful for comparing CKD stage 1, 2, and 3 patients, and RT-SWE can assess early renal damage. [ABSTRACT FROM AUTHOR]

Background: Lichenoid vulvar dermatoses (LVD) are inflammatory diseases primarily affecting the vulva and anus. This study aims to evaluate the skin changes in patients with LVD using high‐frequency ultrasound. Methods: Forty‐five patients with LVD, who attended Henan Provincial People's Hospital from November 2021 to March 2024, were selected. According to the pathological conclusions, patients were divided into two groups: the vulvar lichen sclerosus (VLS) group (n = 24) and the vulvar lichen simplex chronicus (VLSC) group (n = 21). Thirty age‐ and BMI‐matched healthy women were selected as the control group. We assessed the epidermal thickness, subepidermal low echogenic band (SLEB) thickness, dermal thickness, and vascular index (VI) among the three groups. Receiver operating characteristic curve (ROC) analysis was performed to determine the diagnostic efficacy of these ultrasound parameters for LVD. Binary logistic regression was used to investigate risk factors influencing LVD pathology in VLS patients. Results: Epidermal thickness, SLEB thickness, dermal thickness, and VI were increased in the VLS and VLSC groups compared to the control group (p < 0.05). There were no statistically significant differences in ultrasound parameters between the VLS and VLSC groups (p > 0.05). The ROC curves showed that the area under the curve (AUC) value for the dermis (AUC = 0.882) was the largest for VLS, and VI (AUC = 0.917), it was the largest for VLSC. Binary logistic regression indicated that having an allergic disease was a risk factor for VLS between VLS and VLSC groups (OR = 6.797, p = 0.028). Conclusion: High‐frequency ultrasound can detect thickening of the skin and increasing VI in patients with LVD, which can be helpful in the evaluation and management of LVD. [ABSTRACT FROM AUTHOR]

Background: Ultrasound is an attractive modality for the confirmation of sternal fractures in patients with trauma because of its easy, quick, and accurate nature, as well as its increased availability for focused assessment with sonography for trauma at the bedside. We aimed to confirm the diagnostic value of ultrasonography for sternal fractures in patients with trauma, anterior chest wall pain, and tenderness. Methods: This retrospective observational study included patients visiting a single regional trauma center from March 2022 to February 2023, diagnosed with sternal fractures via chest CT and bone scans, who underwent sternal ultrasound. Results: Twenty-six patients were divided into two groups: those with sternal fractures diagnosed with an initial chest CT scan (n = 19) and those without fractures (n = 7). Using ultrasound, 23 patients (88.5%) were diagnosed with sternal fractures. In the initial CT scan (+) group, all 19 patients (100%) were diagnosed using ultrasound. In the initial CT scan (−) group, four (57.1%) of the seven patients were diagnosed using ultrasound. In the initial CT scan (+) group, 14 (73.7%) of the 19 patients underwent bone scans and all 14/14 (100%) were diagnosed with sternal fractures. In the initial CT scan (−) group, seven (100%) patients underwent bone scans, and all were diagnosed with sternal fractures. Conclusions: Ultrasound is useful for the diagnosis of sternal fractures, with sensitivity of 88.5%. Therefore, in patients with blunt trauma experiencing anterior chest wall pain and tenderness, sternal ultrasonography might be helpful in diagnosing sternal fractures as an adjunct to chest CT and bone scans. [ABSTRACT FROM AUTHOR]

This study aims to enhance breast cancer detection accuracy through an AI-driven ultrasound tool, Vis-BUS, developed by Barreleye Inc., Seoul, South Korea. Vis-BUS incorporates Lesion Detection AI (LD-AI) and Lesion Analysis AI (LA-AI), along with a Cancer Probability Score (CPS), to differentiate between benign and malignant breast lesions. A retrospective analysis was conducted on 258 breast ultrasound examinations to evaluate Vis-BUS's performance. The primary methods included the application of LD-AI and LA-AI to b-mode ultrasound images and the generation of CPS for each lesion. Diagnostic accuracy was assessed using metrics such as the Area Under the Receiver Operating Characteristic curve (AUROC) and the Area Under the Precision-Recall curve (AUPRC). The study found that Vis-BUS achieved high diagnostic accuracy, with an AUROC of 0.964 and an AUPRC of 0.967, indicating its effectiveness in distinguishing between benign and malignant lesions. Logistic regression analysis identified that 'Fatty' lesion density had an extremely high odds ratio (OR) of 27.7781, suggesting potential convergence issues. The 'Unknown' density category had an OR of 0.3185, indicating a lower likelihood of correct classification. Medium and large lesion sizes were associated with lower likelihoods of correct classification, with ORs of 0.7891 and 0.8014, respectively. The presence of microcalcifications showed an OR of 1.360. Among Breast Imaging-Reporting and Data System categories, category C5 had a significantly higher OR of 10.173, reflecting a higher likelihood of correct classification. Vis-BUS significantly improves diagnostic precision and supports clinical decision-making in breast cancer screening. However, further refinement is needed in areas like lesion density characterization and calcification detection to optimize its performance. [ABSTRACT FROM AUTHOR]

Ultrasound (US) is recommended for HCC surveillance in high-risk patients but has limited performance in detecting early-stage HCC. We aimed to compare the diagnostic performance of biannual US and annual non-contrast abbreviated magnetic resonance imaging (NC-AMRI) as HCC surveillance modalities in high-risk patients. This prospective, multicenter cohort study enrolled participants with an estimated annual risk of HCC greater than 5% between October 2015 and April 2017. Participants underwent six rounds of HCC surveillance at 6-month intervals, with both US and NC-AMRI at rounds 1, 3, and 5, and only US at rounds 2, 4, and 6. The sensitivity, diagnostic yield (DY), and false referral rate (FRR) for HCC detection by US and NC-AMRI were compared. In total, 208 participants underwent 980 US and 516 NC-AMRI examinations during 30 months of follow-up. Among them, 34 HCCs were diagnosed in 31 participants, with 20 (64.5%) classified as very early-stage and 11 (35.5%) as early-stage HCC. The sensitivity of annual NC-AMRI (71.0%, 22/31) was marginally higher than that of biannual US (45.2%, 14/31; p = 0.077). NC-AMRI showed a significantly higher DY than US (4.26% vs. 1.43%, p <0.001), with a similar FRR (2.91% vs. 3.06%, p = 0.885). A simulation of alternating US and NC-AMRI at 6-month intervals yielded a sensitivity of 83.9% (26/31), significantly exceeding that of biannual US (p = 0.006). Annual NC-AMRI showed a marginally higher sensitivity than biannual US for HCC detection in high-risk patients. The DY of annual NC-AMRI was significantly higher than that of biannual US, without increasing the FRR. Thus, alternating US and NC-AMRI at 6-month intervals could be an optimal surveillance strategy for high-risk patients. Current guidelines permit the use of magnetic resonance imaging (MRI) as a surveillance tool for hepatocellular carcinoma in patients in whom ultrasonography (US) is inadequate. However, the specific indications, imaging sequences, and intervals for MRI surveillance remain unclear. In our study, we found that annual non-contrast abbreviated MRI exhibited marginally higher sensitivity and significantly better diagnostic yield than biannual US in patients at high risk of hepatocellular carcinoma. Alternating US and non-contrast abbreviated MRI at 6-month intervals led to significantly improved sensitivity compared to biannual US, making it a potentially optimal surveillance strategy for high-risk patients. NCT02551250 [Display omitted] • Biannual US showed suboptimal performance for early-stage HCC detection. • Annual NC-AMRI had significantly higher diagnostic yield than biannual US, without increasing the false referral rate. • Alternating biannual US and NC-AMRI had significantly higher sensitivity than biannual US. [ABSTRACT FROM AUTHOR]

The present study aimed to explore the effect of ultrasound-stimulated microbubble cavitation (USMC) on drug concentration and therapeutic efficacy of oral gefitinib in treating subcutaneously transplanted SKOV3 ovarian cancer tumors in nude mice. The present study employed the VINNO70 ultrasonic diagnostic and treatment integrated machine for USMC therapy. Firstly, the mechanical index was set at 0.25, and the therapeutic efficacy of USMC treatment was assessed at intervals of 5, 10 and 20 min. Briefly, 72 nude mice were randomized into the following four groups (n=18/group): Control group, USMC5 min group, USMC10 min group and USMC20 min group, and the therapeutic response to USMC treatment was evaluated by comparing pre-and post-intervention effects. Additionally, the combined therapeutic efficacy of USMC and gefitinib was investigated by randomly dividing 96 tumor-bearing mice into the following four groups (n=24/group): Control group, USMC group, gefitinib group and USMC + gefitinib group. Contrast-enhanced ultrasound, hematoxylin and eosin staining, western blotting, immunofluorescence staining, TUNEL staining, ELISA and liquid chromatography-mass spectrometry were performed in the present study. The results showed that USMC combined with gefitinib had the best treatment effect; the tumor inhibition rate was higher than that of gefitinib alone and the overall survival time was prolonged. In addition, the drug concentration in the tumor tissue obtained from the USMC + gefitinib group was revealed to be ~1.4 times higher than that detected in the group treated with gefitinib alone. The experimental results also confirmed that the strongest tumor inhibition rate and longest overall survival time was observed in the USMC + gefitinib group, followed by the gefitinib group and USMC group. STAT3 is an important signaling transducer and transcription factor, which, when phosphorylated, can lead to abnormal cell proliferation and malignant transformation. In addition, the upregulation of phosphorylated (p)-STAT3 is consider a reason for the poor efficacy of gefitinib in treating ovarian cancer. The present study revealed that ultrasound microbubble therapy could overcome this side effect. In conclusion, USMC improved the effects of oral gefitinib on subcutaneously transplanted SKOV3 ovarian cancer tumors in nude mice and increased drug penetration. In addition, USMC overcame the gefitinib-induced side effect of upregulated STAT3 phosphorylation and reduced the expression levels of p-STAT3 in the tumor. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the diagnostic performance of ultrasound guided attenuation parameter (UGAP) for evaluating liver fat content with different probe forces and body positions, in relation to sex, and compared with proton density fat fraction (PDFF). Methods: We prospectively enrolled a metabolic dysfunction-associated steatotic liver disease (MASLD) cohort that underwent UGAP and PDFF in the autumn of 2022. Mean UGAP values were obtained in supine and 30° left decubitus body position with normal 4 N and increased 30 N probe force. The diagnostic performance was evaluated by the area under the receiver operating characteristic curve (AUC). Results: Among 60 individuals (mean age 52.9 years, SD 12.9; 30 men), we found the best diagnostic performance with increased probe force in 30° left decubitus position (AUC 0.90; 95% CI 0.82–0.98) with a cut-off of 0.58 dB/cm/MHz. For men, the best performance was in supine (AUC 0.91; 95% CI 0.81–1.00) with a cut-off of 0.60 dB/cm/MHz, and for women, 30° left decubitus position (AUC 0.93; 95% CI 0.83–1.00), with a cut-off 0.56 dB/cm/MHz, and increased 30 N probe force for both genders. No difference was in the mean UGAP value when altering body position. UGAP showed good to excellent intra-reproducibility (Intra-class correlation 0.872; 95% CI 0.794–0.921). Conclusion: UGAP provides excellent diagnostic performance to detect liver fat content in metabolic dysfunction-associated steatotic liver diseases, with good to excellent intra-reproducibility. Regardless of sex, the highest diagnostic accuracy is achieved with increased probe force with men in supine and women in 30° left decubitus position, yielding different cut-offs. Clinical relevance statement: The ultrasound method ultrasound-guided attenuation parameter shows excellent diagnostic accuracy and performs with good to excellent reproducibility. There is a possibility to alter body position and increase probe pressure, and different performances for men and women should be considered for the highest accuracy. Key Points: • There is a possibility to alter body position when performing the ultrasound method ultrasound-guided attenuation parameter. • Increase probe pressure for the highest accuracy. • Different performances for men and women should be considered. [ABSTRACT FROM AUTHOR]

Phonon lasers, as mechanical analogues of optical lasers, are unique tools for not only fundamental studies of the emerging field of phononics but also diverse applications such as deep-ocean monitoring, force sensing, and biomedical ultrasonics. Recently, nonlinear phonon-lasing effects were observed in an opto-levitated micro-sphere, i.e., the spontaneous emerging of weak signals of high-order phonon harmonics in the phonon lasing regime. However, both the strengths and the quality factors of the emerging phonon harmonics are very poor, thus severely hindering their potential applications in making and utilizing nonlinear phonon-laser devices. Here we show that, by applying a single-colour electronic injection to this levitated system, giant enhancement can be achieved for all higher-order phonon harmonics, with more than 3 orders enhanced brightness and 5 orders narrowed linewidth. Such an electronically-enhanced phonon laser is also far more stable, with frequency stability extended from a dozen of minutes to over 1 h. More importantly, higher-order phonon correlations, as an essential lasing feature, are confirmed to be enhanced by the electronic injection as well, which as far as we know, has not been reported in previous works using this technique. This work, providing much stronger and better-quality signals of coherent phonon harmonics, is a key step towards controlling and utilizing nonlinear phonon lasers for applications such as phonon frequency combs, broadband phonon sensors, and ultrasonic bio-medical diagnosis. [ABSTRACT FROM AUTHOR]

Objectives: This systematic review and meta-analysis evaluates the combined accuracy of ultrasonic imaging in diagnosing soft tissue tumors and pseudotumors and identifies factors contributing to variability in its diagnostic accuracy. Methods: A literature search in significant databases used specific keywords and inclusion/exclusion criteria. Two authors independently performed cohort characterization and data analysis, with a third author resolving disagreements. A multivariate random effects model estimated pooled sensitivity, specificity, predictive values, and overall accuracy. Results: Ultrasound imaging demonstrated high pooled sensitivity and specificity, indicating effectiveness in identifying lesions. Variability in accuracy was attributed to factors such as tumor type and location, operator experience, and clinic location. Conclusions: Ultrasonic imaging is a reliable diagnostic tool for soft tissue tumors and pseudotumors, providing high sensitivity and specificity. However, variability in accuracy underscores the need to consider operator experience and tumor characteristics. Further research should explore the impact of technological advancements and include non-English studies to enhance understanding of ultrasound imaging's diagnostic validity. [ABSTRACT FROM AUTHOR]

Objective: To determine the diagnostic accuracy of thoracic ultrasound (TUS) for detecting interstitial lung disease (ILD) in rheumatoid arthritis (RA) with respiratory symptoms. Methods: Individuals with RA visiting rheumatologic outpatient clinics in the Region of Southern Denmark were systematically screened for dyspnea, cough, recurrent pneumonia, prior severe pneumonia, or a chest x‐ray indicating interstitial abnormalities. Eighty participants with a positive screening were consecutively included. Individuals were not eligible if they had a chest high‐resolution computed tomography (HRCT) less than 12 months ago or were already diagnosed with ILD. A blinded TUS expert evaluated TUS, and TUS was registered as positive for ILD if at least 10 B‐lines or bilateral thickened and fragmented pleura were present. The primary outcomes were TUS's sensitivity, specificity, and positive predictive value and negative predictive value. An ILD‐specialized thoracic radiologist assessed HRCT, followed by a multidisciplinary team discussion, which was the reference standard. The accepted window of HRCT was less than 30 days after TUS was performed. Results: A total of 77 participants received HRCT less than 30 days after TUS, and 23 (30%) were diagnosed with ILD. TUS had a sensitivity of 82.6% (95% confidence interval [CI] 61.2%–95.0%) and a specificity of 51.9% (95% CI 37.8%–65.7%), corresponding to a positive predictive value of 42.2% (95% CI 27.7%–57.8%) and a negative predictive value of 87.5% (95% CI 71.0%–96.5%). Conclusion: To our knowledge, this prospective study is the first to use respiratory symptoms in RA as inclusion criteria. Systematic screening for respiratory symptoms combined with TUS can reduce the diagnostic delay of ILD in RA. [ABSTRACT FROM AUTHOR]

Ultrasound is a readily available, non-invasive and low-cost screening for the identification of endometriosis lesions, but its diagnostic specificity strongly depends on the experience of the operator. For this reason, computer-aided diagnosis tools based on Artificial Intelligence techniques can provide significant help to the clinical staff, both in terms of workload reduction and in increasing the overall accuracy of this type of examination and its outcome. However, although these techniques are spreading rapidly in a variety of domains, their application to endometriosis is still very limited. To fill this gap, we propose and evaluate a novel multi-scale ensemble approach for the automatic segmentation of endometriosis lesions from transvaginal ultrasounds. The peculiarity of the method lies in its high discrimination capability, obtained by combining, in a fusion fashion, multiple Convolutional Neural Networks trained on data at different granularity. The experimental validation carried out shows that: (i) the proposed method allows to significantly improve the performance of the individual neural networks, even in the presence of a limited training set; (ii) with a Dice coefficient of 82%, it represents a valid solution to increase the diagnostic efficacy of the ultrasound examination against such a pathology. [ABSTRACT FROM AUTHOR]

Background: Endoscopic ultrasound (EUS) is a unique example of POCUS, which allows the gastroenterologist to discuss subepithelial pathology immediately after an endoscopy. The challenges that are encountered to create an acoustic interface by adding free water during the endoscopy may be curtailing the full utilization of EUS during endoscopic procedures. Eosinophilic esophagitis (EoE) is a progressive inflammatory condition whose morbidity is related to esophageal wall remodeling. However, in clinical practice, in clinical guidelines, and in many trials, EoE outcomes are based on esophageal eosinophilia and symptoms. Hence, a method to identify and quantitate the thickening of the esophageal wall, could contribute to the management of this disease. Results: A modification of the approach employed to perform EUS during bronchoscopy was developed. An EUS miniprobe was positioned inside of a water filled balloon sheath. This technique permitted rapid and reproducible images acquisition of the total esophageal wall and its sublayers (mucosa, and submucosa + submucosa, which permitted derivation of the muscle layer). The presented series describes the results from 22 consecutive EoE patients. A full set of measurements from both the mid and distal esophagus were achieved in all EoE patients in an average time of less than 10 minutes. Conclusions: This pilot study supports further investigations evaluating this economical, convenient, and safe technique to follow EoE patients. In addition, this approach could be potentially employed in all patients who are found to have subepithelial gastrointestinal pathology during routine endoscopic procedures. [ABSTRACT FROM AUTHOR]

Background: Although DBT is the standard initial imaging modality for women with focal breast symptoms, the importance of ultrasound has grown rapidly in the past decades. Therefore, the Breast UltraSound Trial (BUST) focused on assessing the diagnostic value of ultrasound and digital breast tomosynthesis (DBT) for the evaluation of breast symptoms by reversing the order of breast imaging; first performing ultrasound followed by DBT. This side-study of the BUST evaluates patients' perceptions of ultrasound and DBT in a reversed setting. Methods: After imaging, 1181/1276 BUST participants completed a survey consisting of open and closed questions regarding both exams (mean age 47.2, ±11.74). Additionally, a different subset of BUST participants (n = 29) participated in six focus group interviews 18–24 months after imaging to analyze their imaging experiences in depth. Results: A total of 55.3% of women reported reluctance to undergoing DBT, primarily due of pain, while the vast majority also find bilateral DBT reassuring (87.3%). Thematic analysis identified themes related to 1) imaging reluctance (pain/burden, result, and breast harm) and 2) ultrasound and DBT perceptions. Regarding the latter, the theme comfort underscores DBT as burdensome and painful, while ultrasound is largely perceived as non-burdensome. Ultrasound is also particularly valued for its interactive nature, as highlighted in the theme interaction. Perceived effectiveness reflects women's interest in bilateral breast evaluation with DBT and the visibility of lesions, while they express more uncertainty about the reliability of ultrasound. Emotional impact portrays DBT as reassuring for many women, whereas opinions on the reassurance provided by ultrasound are more diverse. Additional themes include costs, protocols and privacy. Conclusions: Ultrasound is highly tolerated, and particularly valued is the interaction with the radiologist. Nearly half of women express reluctance towards DBT; nevertheless, a large portion report feeling more confident after undergoing bilateral DBT, reassuring them of the absence of abnormalities. Understanding patients' perceptions of breast imaging examinations is of great value when optimizing diagnostic pathways. [ABSTRACT FROM AUTHOR]

Contrast-enhanced sonography (CEUS) is a very important diagnostic imaging tool in clinical settings. However, it is associated with possible artifacts, such as B-mode US-related artifacts. Sufficient knowledge of US physics and these artifacts is indispensable to avoid the misinterpretation of CEUS images. This review aims to explain the basic physics of CEUS and the associated artifacts and to provide some examples to avoid them. This review includes problems related to the frame rate, scanning modes, and various artifacts encountered in daily CEUS examinations. Artifacts in CEUS can be divided into two groups: (1) B-mode US-related artifacts, which form the background of the CEUS image, and (2) artifacts that are specifically related to the CEUS method. The former includes refraction, reflection, reverberation (multiple reflections), attenuation, mirror image, and range-ambiguity artifacts. In the former case, the knowledge of B-mode US is sufficient to read the displayed artifactual image. Thus, in this group, the most useful artifact avoidance strategy is to use the reference B-mode image, which allows for a simultaneous comparison between the CEUS and B-mode images. In the latter case, CEUS-specific artifacts include microbubble destruction artifacts, prolonged heterogeneous accumulation artifacts, and CEUS-related posterior echo enhancement; these require an understanding of the mechanism of their appearance in CEUS images for correct image interpretation. Thus, in this group, the most useful artifact avoidance strategy is to confirm the phenomenon's instability by changing the examination conditions, including the frequency, depth, and other parameters. [ABSTRACT FROM AUTHOR]

Background: Ehlers–Danlos syndrome (EDS), Marfan syndrome (MFS), and Loeys–Dietz syndrome (LDS) are connective tissue disorders frequently associated with vascular aneurysm formation, dissections, and subsequent major complications. Regular imaging surveillance is recommended for these conditions. However, no guidelines currently exist regarding imaging modality or surveillance intervals. Methods: This retrospective single-center observational study analyzed clinical and imaging data of patients attending an outpatient clinic for vascular connective tissue disorders between August 2008 and January 2024. Imaging (1424 data points in total) and clinical data were extracted from electronic health records. Analysis primarily included a comparison of vessel diameter progression across imaging modalities, with an additional review of the clinical history of vascular events. Results: In total, 19 patients with vascular connective tissue disorders (vCTDs) underwent consultations at our outpatient clinic. Nine (47.4%) patients experienced vascular events, while two (10.5%) passed away during the study period. Multimodal imaging surveillance revealed a tendency towards arterial diameter increase. Consistent ultrasound monitoring provided more reliable diameter progression data for the same arterial segment than a combination of imaging modalities. Temporal analysis indicated a tendency for the continuous growth of the abdominal aorta, the common and internal carotid artery, and the common femoral and popliteal artery. Conclusion: The study highlights the importance of standardized, modality-specific imaging protocols in monitoring patients with vCTDs. The variability in disease progression among these patients further complicates surveillance strategies, contemplating the need for individualized approaches. Further research and prospective multicenter studies are required to refine and improve monitoring protocols. [ABSTRACT FROM AUTHOR]

This article provides a detailed analysis of the clinical and gynecologic characteristics of ectopic pregnancy based on the anatomical site. The study utilized nationwide databases to examine patient encounters with ectopic pregnancy from 2016 to 2020. The fallopian tube was found to be the most common site for ectopic pregnancy, followed by the cervico-corpus, ovary, and abdomen. The study revealed an increase in ovarian ectopic pregnancy over the study period, while cervico-corpal ectopic pregnancy decreased. Patients with abdominal ectopic pregnancy were more likely to be obese and have comorbidities. The article emphasizes the importance of further research to understand the physiological effects of endometrial gestation on extra-endometrial gestation. [Extracted from the article]

The prevalence of osteoporosis is about one in three for women and one in five for men over the age of fifty, making it the most common bone disease worldwide. The disease is characterized by a reduction of the amount of volume percent of cortical bone, weakening the bone and increasing the likelihood of fractures. Modeling and numerical simulations can be used to better understand effects observed in measurements and thus the workings of human bones. Furthermore, they can be used to support the development of new diagnostic tools such as sonography. For this purpose, in previous contributions we developed a two‐scale bone model that considers mechanical, electric and magnetic effects. To connect the scales, we resorted to the finite element square method FE2${\text{FE}}^{2}$. For diagnostics, the main quantity of interest is the resulting magnetic field strength, which can be used to draw conclusions about the bone health. In this contribution, we investigate the influence of the used microstructure model in detail. We created different representative volume elements (RVEs), which are for example, randomly orientated, anisotropic, or differ in shape or mesh resolution. In addition, we consider the use of different shape functions in the finite element calculation. We compare our findings with previous results, which were obtained using only regular RVEs. We investigate the extent, to which the microscale results and the overall macroscale simulation results are affected by the choice of the RVE. [ABSTRACT FROM AUTHOR]

Background: Ultrasonography is not chosen as the common imaging modality to diagnose spinal cord diseases. The present report indicates good diagnostic efficacy of ultrasonography for identifying spinal cord compressed by subcutaneous mass when scanning through the defected vertebral laminae and spinous process. Case Description: A five-month-old female Holstein calf presented with progressive hindlimb paralysis following a surgical resection of a back mass conducted at 21 days of age. The mass was subsequently histopathologically diagnosed as a pulmonary choristoma. Alongside hindlimb paralysis, the calf developed a swollen back at the lumbar region where the mass was removed. This suggested regrowth of the resected mass, causing injury to the underlying spinal cord. Ultrasonography identified the subcutaneous involvement of the capsular mass, which had three anechoic cavities separated by the echogenic septal structures. The spinal cord could be ultrasonographically demonstrated as adjacent to the mass through the defected vertebral laminae and spinous process in the second and third lumbar vertebras. Ultrasound-guided centesis allowed the collection of purulent exudates in which Escherichia coli was isolated. Myelography and subsequent computed tomography (CT) revealed a partial blockage of the intradural flow of contrast media at the levels of the second and third lumbar vertebras, diagnosed as spina bifida on the CT images. When applying ultrasonography to the spinal cord within a saline pool soon after the subcutaneous abscess was successfully resected, the spinal cord was characterized by the interrupted and partly extended hyperechogenic line of the central canal within the echogenic parenchyma. The echotexture of the spinal cord showed damage due to compression from the subcutaneous abscess. The animal had a sub-optimal postoperative outcome, including limited improvement of the neurological signs. Conclusion: In the present case, combining ultrasonography, radiography (myelography), and CT was very effective for diagnosing spina bifida, with the subcutaneous abscess inducing spinal cord compression. Additionally, using intraoperative ultrasonographic scanning to evaluate the degree of spinal cord damage can contribute to predicting the postoperative outcome. [ABSTRACT FROM AUTHOR]

Objective: Ultrasonography (US) is a non-invasive, non-ionizing radiation modality which is highly successful at diagnosing meniscal pathologies. The aim of this study is to demonstrate the contribution of strain elastography (SE) to diagnosis by comparing SE and B-mode US findings of the meniscus with magnetic resonance imaging (MRI). Methods: A total of 22 patients (a total of 30 knees) who presented to the department of sports medicine with knee pain were included the study. All menisci of the 33 knees were evaluated by B-Mode US, SE, and MRI. The result of US, SE and MRI were compared each other. Pearson and Spearman correlation tests were used to evaluate the inter-technique correlation. Results: The US and MRI findings of medial meniscus anterior horn (MMAH), medial meniscus posterior horn (MMPH), lateral meniscus anterior horn(LMAH), lateral meniscus posterior horn(LMPH) were correlated (P < .001, P < .001, P = .002, P = .006). For the evaluation of MMAH and LMPH, the sensitivity of US was 100%, and the specificity was 87% and 80%, respectively. There was a negative correlation between strain ratio (SR) and both of US and MRI injury grades for MMAH, MMPH, and LMPH (r = -0.389 and r = -0.499 for MMAH; r = -0.045 and r = -0.441 for MMPH; r = -0.307 and r = -0.691 for LMPH, respectively). There was a negative correlation between SR and US injury grade for LMAH (r = -0.341). The SE elastogram and MRI findings were consistent for only MMAH (P = .044). Conclusion: Ultrasound elastography (USE) is an appropriate and valuable imaging technique that supports MRI and B-Mode US for the detection of meniscal injury. [ABSTRACT FROM AUTHOR]

Background Acute appendicitis is a common surgical emergency, and accurate imaging is crucial for diagnosis. This study aims to compare the diagnostic accuracy of ultrasound (US) and computed tomography (CT) imaging in adult patients presenting with symptoms suggestive of acute appendicitis. Methods A prospective study was conducted on 100 adult patients (50 males and 50 females) with a mean age of 35 years (range: 18-60 years). Each patient underwent both US and CT imaging. The diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of both imaging modalities were calculated and compared. Results Ultrasound imaging demonstrated a sensitivity of 75% (95% CI: 64%-84%), specificity of 85% (95% CI: 75%-92%), PPV of 81% (95% CI: 70%-89%), and NPV of 80% (95% CI: 70%-88%). CT imaging showed a sensitivity of 94% (95% CI: 86%-98%), specificity of 90% (95% CI: 81%-96%), PPV of 92% (95% CI: 84%-97%), and NPV of 93% (95% CI: 85%-98%). The accuracy of US was 79%, while CT achieved 92%. Comparative analysis revealed that CT imaging had significantly higher sensitivity (p<0.05) than ultrasound, with no significant difference in specificity (p>0.05). Conclusion CT imaging demonstrates superior diagnostic accuracy and sensitivity compared to ultrasound in diagnosing acute appendicitis in adults, though both modalities have comparable specificity. CT should be preferred for its higher diagnostic confidence, especially in equivocal cases. [ABSTRACT FROM AUTHOR]

Background Abdominal trauma is a significant cause of morbidity and mortality, necessitating accurate and timely diagnosis for effective management. Contrast-enhanced CT (CECT) is widely utilized for evaluating abdominal injuries, but its diagnostic efficacy compared to other modalities like ultrasonography (FAST) and clinical examination warrants further investigation.This prospective study evaluates the role of contrast-enhanced CT (CECT) in the assessment of abdominal trauma, comparing its diagnostic accuracy with ultrasonography (FAST) and clinical examination Methods A total of 100 patients with abdominal trauma were included in this study. Patient demographics, injury mechanisms, organ injuries detected by CECT, severity of injuries (based on the AAST Organ Injury Scale), presence of hemoperitoneum, diagnostic accuracy of CECT, interventions based on CECT findings, complications, mortality rates, length of hospital stay, and follow-up outcomes were analyzed. Results The study comprised 65 males and 35 females, with the majority aged between 18-30 years. Road Traffic Accidents (50%) were the most common injury mechanism. CECT detected liver injuries in 30%, spleen in 25%, kidney in 20%, pancreas and intestines in 10% each, and multiple organs in 5%. Severity distribution was as follows: Grade I (20%), Grade II (25%), Grade III (30%), Grade IV (15%), and Grade V (10%). Hemoperitoneum was present in 40% of patients. CECT showed high diagnostic accuracy with 95% sensitivity, 90% specificity, 92% PPV, and 93% NPV. In comparison, FAST had 70% sensitivity and 75% specificity, while clinical examination had 65% sensitivity and 80% specificity. Interventions based on CECT findings included non-operative management (70%), surgical intervention (25%), and endovascular procedures (5%). Complications included infections (5%), re-bleeding (3%), and organ failure (2%). Mortality was 4%, predominantly due to severe multi-organ injury. The mean hospital stay was 10 days. At 3-month follow-up, 80% of patients had fully recovered, 15% had partial recovery, and 5% had long-term complications. Conclusion CECT is a highly sensitive and specific imaging modality for evaluating abdominal trauma, providing critical information for clinical management and significantly influencing patient outcomes. [ABSTRACT FROM AUTHOR]

This article discusses a case study of a 25-year-old woman with a large renal angiomyolipoma (AML) associated with lymphangioleiomyomatosis (LAM). The patient presented with gastrointestinal symptoms and was initially misdiagnosed with leiomyosarcoma. After further evaluation, the mass was determined to be a benign AML. The patient underwent embolization followed by a partial nephrectomy, and her renal function was preserved. The article highlights the challenges in diagnosing and managing large AMLs and emphasizes the importance of regular surveillance for AMLs associated with LAM. [Extracted from the article]

Periventricular leukomalacia (PVL) is a common brain injury in premature infants, and epilepsy remains a significant complication. One concerning electroencephalographic (EEG) pattern found is developmental and/or epileptic encephalopathy with spike-and-wave activation in sleep (DEE-SWAS). This pattern is associated with persistent neuropsychological and motor deficits, even without a diagnosis of epilepsy. The purpose of this study is to identify the relationships between various PVL grades and EEG patterns in this population on follow-up visits, especially the occurrence of DEE-SWAS pattern on EEG. This is a retrospective study of <36 weeks gestational age newborns who were followed in the neurodevelopmental clinic at Corewell Health East/Corewell Health Children's Hospital in Royal Oak, Michigan, between 2020 and 2022. Patients' demographics along with prematurity complications, diagnostic head ultrasound (HUS), and EEG studies were reviewed and graded. EEG studies are usually ordered when seizures were suspected. A total of 155 newborns met the inclusion criteria. Twenty-six patients had PVL. Nine patients had grade 2 to 3 PVL based on HUS review. EEG was performed on 15 patients with PVL at a mean age of 22 months. More severe PVL grades were significantly associated with worse EEG patterns (P = 0.005). Five patients had DEE-SWAS pattern on EEG, all of whom had grade 2 or 3 PVL. Epilepsy was eventually diagnosed in three infants with PVL. EEG can help identify important abnormal electrographic patterns in premature infants with PVL early in life; this might give a window of opportunity to intervene early and improve long-term developmental outcomes in this population. [ABSTRACT FROM AUTHOR]

Medical image registration has become pivotal in recent years with the integration of various imaging modalities like X-ray, ultrasound, MRI, and CT scans, enabling comprehensive analysis and diagnosis of biological structures. This paper provides a comprehensive review of registration techniques for medical images, with an in-depth focus on 2D-2D image registration methods. While 3D registration is briefly touched upon, the primary emphasis remains on 2D techniques and their applications. This review covers registration techniques for diverse modalities, including unimodal, multimodal, interpatient, and intra-patient. The paper explores the challenges encountered in medical image registration, including geometric distortion, differences in image properties, outliers, and optimization convergence, and discusses their impact on registration accuracy and reliability. Strategies for addressing these challenges are highlighted, emphasizing the need for continual innovation and refinement of techniques to enhance the accuracy and reliability of medical image registration systems. The paper concludes by emphasizing the importance of accurate medical image registration in improving diagnosis. [ABSTRACT FROM AUTHOR]

It was previously believed that atherosclerotic (AS) plaque starts to develop from the intima and that intraplaque vasa vasorum (VV) hyperplasia promotes adventitial VV (AVV) hyperplasia. However, recent studies have shown that arterial AVV hyperplasia precedes early intimal thickening, suggesting its possible role as an initiating factor of AS. To provide further insight into this process, in this study, we examine the evolution of AAV and VV development in a preclinical model of early AS with longitudinal ultrasound imaging. Models of early AS were established. Duplex ultrasound scanning and contrast-enhanced ultrasound were performed for diagnosis. Pearson correlation tests were used to analyze the relationships between AVV hyperplasia and VV hyperplasia, or between AVV hyperplasia and intima-media thickness (IMT). During 0–12 wk of high-fat feeding, AVV gradually increased and intima-media thickened gradually in the observation area; in the 2nd wk of high-fat feeding, the observation area showed obvious AVV proliferation; at the 4th wk, the intima-media membrane became thicker; at the 12th wk, early plaque formation and intraplaque VV proliferation were observed. There was a strong positive correlation between AVV proliferation and IMT thickening and a strong negative correlation between AVV proliferation and the change rate of vessel diameter. This study demonstrated that AVV proliferation in the arteries occurred earlier than IMT thickening and was positively correlated with IMT. At present, the indicators of ultrasonic diagnosis of AS, such as IMT, Intraplaque VV, Echo property, all appear in the advanced stage of AS. The AVV may be an innovative diagnostic target for the early stage of AS plaque. [ABSTRACT FROM AUTHOR]

Ultrasound speckle tracking enables in vivo measurement of soft tissue deformation or strain, providing a non-invasive diagnostic tool to quantify tissue health. However, adoption into new fields is challenging since algorithms need to be tuned with gold-standard reference data that are expensive or impractical to acquire. Here, we present a novel optimization approach that only requires repeated measurements, which can be acquired for new applications where reference data might not be readily available or difficult to get hold of. Soft tissue motion was captured using ultrasound for the medial collateral ligament (MCL) of three quasi-statically loaded porcine stifle joints, and medial ligamentous structures of a dynamically loaded human cadaveric knee joint. Using a training subset, custom speckle tracking algorithms were created for the porcine and human ligaments using surrogate optimization, which aimed to maximize repeatability by minimizing the normalized standard deviation of calculated strain maps for repeat measurements. An unseen test subset was then used to validate the tuned algorithms by comparing the ultrasound strains to digital image correlation (DIC) surface strains (porcine specimens) and length change values of the optically tracked ligament attachments (human specimens). After 1500 iterations, the optimization routine based on the porcine and human training data converged to similar values of normalized standard deviations of repeat strain maps (porcine: 0.19, human: 0.26). Ultrasound strains calculated for the independent test sets using the tuned algorithms closely matched the DIC measurements for the porcine quasi-static measurements (R > 0.99, RMSE < 0.59%) and the length change between the tracked ligament attachments for the dynamic human dataset (RMSE < 6.28%). Furthermore, strains in the medial ligamentous structures of the human specimen during flexion showed a strong correlation with anterior/posterior position on the ligaments (R > 0.91). Adjusting ultrasound speckle tracking algorithms using an optimization routine based on repeatability led to robust and reliable results with low RMSE for the medial ligamentous structures of the knee. This tool may be equally beneficial in other soft-tissue displacement or strain measurement applications and can assist in the development of novel ultrasonic diagnostic tools to assess soft tissue biomechanics. [ABSTRACT FROM AUTHOR]

Objectives: Extrapulmonary sequestration (EPS) within the diaphragm (ID‐EPS) is rare and requires additional procedures such as incision or detachment of the diaphragm from the lesion for diagnosis. This study aimed to describe the imaging findings and evaluate the diagnostic accuracy of ultrasonography and computed tomography (CT) for ID‐EPS. Material and Methods: Split diaphragm sign, shape of lesion edge, drainage vein into intra‐abdomen on ultrasound and CT, and lesion characteristics on ultrasound were compared between patients with ID‐EPS and with above‐diaphragm EPS (AD‐EPS) using Fisher's exact test. Results: Three and nine patients were diagnosed with ID‐EPS and AD‐EPS, respectively. Significant differences were observed between the two groups in the split diaphragm sign on ultrasound (presence/absence in patients with ID‐EPS vs AD‐EPS, 2/1 vs 0/9, P =.046), shape of lesion edge on ultrasound/CT (round/beak in patients with ID‐EPS vs AD‐EPS, 3/0 vs 0/9, P =.005 on both CT and ultrasound), lesion characteristics on ultrasound (presence/absence of cystic area within lesion in patients with ID‐EPS vs AD‐EPS, 0/3 vs 7/2, P =.046), and the drainage vein into the abdomen on CT (presence/absence in patients with ID‐EPS vs AD‐EPS; 2/1 vs 0/9, P =.046). No drainage veins were visualized in the abdomen on ultrasonography and no significant differences in the presence/absence of the split‐diagram sign on CT (presence/absence in patients with ID‐EPS vs AD‐EPS and ID‐EPS; 0/3 vs 0/9, P >.999; 1/2 vs 0/9, P =.250) were observed between the two groups. Conclusion: A combination of postnatal ultrasonography and CT was useful in predicting EPS located within the diaphragm. Access the CME test here and search by article title. [ABSTRACT FROM AUTHOR]

Individuals at high risk of developing pancreatic ductal adenocarcinoma are eligible for surveillance within research programs. These programs employ periodic imaging in the form of magnetic resonance imaging/magnetic resonance cholangiopancreatography or endoscopic ultrasound for the detection of early cancer or high-grade precursor lesions. This narrative review discusses the role of endoscopic ultrasound within these surveillance programs. It details its overall strengths and limitations, yield, burden on patients, and how it compares to magnetic resonance imaging. Finally, recommendations are given when and how to incorporate endoscopic ultrasound in the surveillance of high-risk individuals. [ABSTRACT FROM AUTHOR]

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Background and Aims: Six-monthly ultrasound surveillance for hepatocellular carcinoma (HCC) is recommended in patients with cirrhosis. Surveillance enhances early detection and improves survival. Yet, despite clear benefits, uptake remains low. We aim to identify and explore ways to overcome patient-related barriers to HCC surveillance with the aim of producing invitations for surveillance. Methods: Using the COM-B model of behaviour and a co-design process, we collaborated with patients, liver health charities and advocacy groups, to identify patient-related barriers to attending HCC surveillance. We performed qualitative thematic analysis of co-production workshops on HCC surveillance to develop information leaflets and surveillance invitations. Results: Twenty-eight participants attended five workshops. Fear of a serious diagnosis and stigma from healthcare professionals were highlighted as main patient-related barriers to attending surveillance appointments. Co-design was used to develop informative, user-friendly, non-judgemental invitations and information regarding HCC surveillance relevant to populations with cirrhosis. Conclusion: We identified potential patient barriers to surveillance uptake and developed patient facing material that directly addressed these barriers to be trialled in the clinic. Targeting patient-specific barriers may increase uptake of surveillance and therefore enhance early diagnosis. Plain Language Summary: Ultrasound surveillance for hepatocellular carcinoma (HCC) is recommended for those with chronic liver disease, but surveillance uptake remains low. Fear and concern about stigma from healthcare professionals are widespread and act as barriers to surveillance attendance. Through a co-design process, we designed invitations to surveillance alongside informational material, aiming to address the self-reported barriers and motivators to surveillance attendance. [ABSTRACT FROM AUTHOR]

Liver fibrosis is a reparative response triggered by liver injury. Non‐invasive assessment and staging of liver fibrosis in patients with chronic liver disease are of paramount importance, as treatment strategies and prognoses depend significantly on the degree of fibrosis. Although liver fibrosis has traditionally been staged through invasive liver biopsy, this method is prone to sampling errors, particularly when biopsy sizes are inadequate. Consequently, there is an urgent clinical need for an alternative to biopsy, one that ensures precise, sensitive, and non‐invasive diagnosis and staging of liver fibrosis. Non‐invasive imaging assessments have assumed a pivotal role in clinical practice, enjoying growing popularity and acceptance due to their potential for diagnosing, staging, and monitoring liver fibrosis. In this comprehensive review, we first delved into the current landscape of non‐invasive imaging technologies, assessing their accuracy and the transformative impact they have had on the diagnosis and management of liver fibrosis in both clinical practice and animal models. Additionally, we provided an in‐depth exploration of recent advancements in ultrasound imaging, computed tomography imaging, magnetic resonance imaging, nuclear medicine imaging, radiomics, and artificial intelligence within the field of liver fibrosis research. We summarized the key concepts, advantages, limitations, and diagnostic performance of each technique. Finally, we discussed the challenges associated with clinical implementation and offer our perspective on advancing the field, hoping to provide alternative directions for the future research. [ABSTRACT FROM AUTHOR]

Background: Acute appendicitis is the most common surgical emergency in Ethiopian clinical practice. Although a multitude of scoring systems have been used in clinical practice, none have been universally validated. The purpose of this study was to validate the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scoring system in the Ethiopian context. Methods: A total of 315 consecutive patients who presented with a presumptive diagnosis of acute appendicitis and were planned to undergo appendectomy were studied. All the studied patients had diagnostic sonography and underwent the RIPASA scoring system. The sensitivity, specificity, positive predictive value, and negative predictive value of RIPASA and ultrasound results with intraoperative gross examinations. Results: The mean age of the participants was 27.4 ± 11.5 years, with a male-to-female ratio of 1.6:1. The concordance between ultrasound and RIPASA for the diagnosis of acute appendicitis was 93.6%. The sensitivity, specificity, positive predictive value, and negative predictive value of RIPASA were 96.2%, 30.8%, 93.9%, and 42.1%, respectively. Similarly, the sensitivity, specificity, positive predictive value, and negative predictive value of ultrasound were 95.3%, 27.8%, 95.6%, and 26.3%, respectively. White cell count and RIPASA scores were weakly correlated with intraoperative stages of acute appendicitis, r(313) = 0.18, p = 0.001, and r(313) = 0.129, p = 0.022, respectively. The rate of a negative appendectomy was 6%. Conclusion: RIPASA and ultrasound had equivalent performance in the diagnosis of acute appendicitis. In both cases, the rate of negative appendectomy was low enough to validate RIPASA for clinical practice in low-income institutions where sonographic diagnosis by a conventionally trained radiologist is not available. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Determine if a longitudinal point-of-care ultrasonography (POCUS) elective for medical students is effective in improving POCUS knowledge. METHODS: We share the format of our longitudinal POCUS elective for medical students. To evaluate the efficacy of our longitudinal elective, we compare the difference between pre-elective and post-elective scores on a POCUS test using a paired t-test with threshold of statistical significance of p ≤.05. We also share the results of a post-elective survey evaluating the effectiveness and quality of the longitudinal POCUS elective. RESULTS: Pretest mean score was 56.3% (σ = 13.6), while posttest mean score was 73.3% (σ = 9.4), with an average score improvement of 17.0% (95% CI 9.9-24.0%, p <.0001). All students strongly or moderately agreed that they would recommend the elective to future medical students, that they were more confident with their POCUS skills after completing the elective, that the time commitment of the elective was appropriate, and that they felt they had the time to fit the elective into their schedule as a medical school student. Most students (56.7%) strongly or moderately agreed that the knowledge gained from the POCUS elective had helped them in their clinical rotations. CONCLUSIONS: Our longitudinal POCUS curriculum subjectively and objectively improves medical students' POCUS knowledge while remaining accessible to students. We share our unique longitudinal POCUS elective curriculum, the format of which and its benefits are transferable to other medical schools. Through this, we hope to provide others with ideas on how they may implement a longitudinal POCUS elective. [ABSTRACT FROM AUTHOR]

Introduction: This paper was to assess the diagnostic performance and clinical value of three-dimensional ultrasonography (3DUS), three-dimensional ultrasonography power Doppler (3DPD), and 3DUS combined with 3DPD in ovarian cancer (OC). Methods: The study was registered with PROSPERO (CRD 42023405765). PubMed and Web of Science were searched from inception to 25 January 2022, and reference lists of potentially eligible studies were also manually searched. Patient and study characteristics were extracted by two independent reviewers. Any discrepancies were addressed through discussion. The sensitivity, specificity, positive and negative likelihood ratio (PLR and NLR, respectively), and the area under the receiver operating characteristic curve (AUC) were pooled separately. Results: We retrieved 2,566 studies, of which 18 were finally enrolled, with 2,548 cases. The pooled sensitivity, specificity, PLR, NLR, and AUC for 3DUS were 0.89 (95% CI: 0.85-0.93), 0.93 (95% CI: 0.88-0.96), 13.1 (95% CI: 7.3-23.4), 0.11 (95% CI: 0.08-0.16), and 0.90 (95% CI: 0.87-0.93), respectively. The pooled sensitivity, specificity, PLR, NLR, and AUC for 3DPD were 0.90 (95% CI: 0.80-0.95), 0.85 (95% CI: 0.71-0.92), 5.8 (95% CI: 3.0-11.2), 0.12 (95% CI: 0.06-0.24), and 0.94 (95% CI: 0.91-0.96), respectively. The pooled sensitivity, specificity, PLR, NLR, and AUC for 3DUS combined with 3DPD were 0.99 (95% CI: 0.73-1.00), 0.95 (95% CI: 0.85-0.99), 21.9 (95% CI: 6.1-78.9), 0.01 (95% CI: 0.00-0.37), and 0.99 (95% CI: 0.98-1.00), respectively. Conclusions: 3DUS, 3DPD, and 3DUS combined with 3DPD are promising diagnostic tools for OC, alongside elevated sensitivity and specificity. However, the combination of 3DUS and 3DPD techniques has higher diagnostic efficiency. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD 42023405765. [ABSTRACT FROM AUTHOR]

Mechanical ventilation injures not only the lungs but also the diaphragm, resulting in dysfunction associated with poor outcomes. Diaphragm ultrasonography is a noninvasive, cost-effective, and reproducible diagnostic method used to monitor the condition and function of the diaphragm. With advances in ultrasound technology and the expansion of its clinical applications, diaphragm ultrasonography has become increasingly important as a tool to visualize and quantify diaphragmatic morphology and function across multiple medical specialties, including pulmonology, critical care, and rehabilitation medicine. This comprehensive review aims to provide an in-depth analysis of the role and limitations of ultrasonography in assessing the diaphragm, especially among critically ill patients. Furthermore, we discuss a recently published expert consensus and provide a perspective for the future. [ABSTRACT FROM AUTHOR]

Background: The diagnosis of ICU-acquired weakness (ICUAW) may be delayed due to the complexity of critically ill patients. This study aimed to investigate the value of ultrasound measurements of rectus femoris cross-sectional area (RFCSA) in predicting ICUAW in patients undergoing invasive mechanical ventilation. Methods: This was a prospective cohort study of patients undergoing mechanical ventilation for at least 48 h. RFCSA was measured using ultrasound in patients upon ICU admission and followed until discharge. Using the Medical Research Council score as the gold standard, we evaluated the diagnostic value of ultrasound measurements in predicting ICUAW. Kaplan–Meier curves were constructed to evaluate and compare the length of ICU stay and duration of invasive mechanical ventilation between patients with and without ICUAW. Results: Among the 76 patients, 34 (44.7%) were diagnosed with ICUAW using the Medical Research Council score as the gold standard. The RFCSA atrophy rate between day 1 and day 3 was significantly higher in the ICUAW group (7.9 ± 2.8% vs. 4.3 ± 2.1%, p < 0.001). By utilizing a cutoff point of 6.9%, we discovered that the RFCSA atrophy rate exhibited excellent diagnostic accuracy in predicting ICUAW, with a sensitivity of 76.5% and specificity of 92.9%. In ICUAW patients diagnosed based on an RFCSA atrophy rate, the proportion of patients with an ICU stay longer than 14 days was 42.9%, which was significantly higher compared to 22.9% in the non-ICUAW group (HR: 1.768; 95% CI 1.128–2.772; p = 0.006). Similarly, the proportion of patients continuing mechanical ventilation at 14 days was 28.6% versus 4.2% between the two groups (HR: 1.988; 95% CI 1.266–3.120; p < 0.001). Conclusion: Ultrasound measurements of RFCSA provide a reliable method for diagnosing ICUAW and indicating prognosis in patients undergoing invasive mechanical ventilation. [ABSTRACT FROM AUTHOR]

This document provides a concise summary of three different texts or documents related to the use of transcranial ultrasound for precise and non-invasive interventions in deep brain circuits. The first text discusses the development of an ultrasound-based approach that compensates for the attenuation of ultrasound by the human skull, allowing for effective nerve stimulation and drug release. The second text explores the use of safe nanoparticles to deliver a neuromodulatory drug, demonstrating its effectiveness in ex-vivo skulls and human subjects. The third text is a list of references for further reading on the topic, covering various aspects of ultrasound in neuromodulation and drug delivery. These summaries provide library patrons with an overview of the research in this field, allowing them to decide if they want to explore the underlying texts further. [Extracted from the article]

Objective: To determine the diagnostic accuracy of ultrasound in the detecting malignant thyroid nodule keeping histopathology as a gold standard. Methodology: In the current study a total of 164 patients were included. A detail history, routine hospital investigations and physical examination for the included patients were performed. Patients were subjected to ultrasound in Radiology department where the ultrasound was done by the senior resident under the supervision of expert radiologist having more than 7 years of experience. The nodules were reported according to ACR TI-RADS. Then the patients were referred to ENT department where the incisional biopsy were performed and the specimen was sent to hospital laboratory for the diagnosis of malignant thyroid nodule. All the histopathological examinations were done by expert histopathologist having more than 7 years of experience. Results: In this study total 164 patients were included and mean age was 34 years with SD ± 7.318. Male patients were 62(38%) while 102(62%) patients were female. Ultrasound had sensitivity 96.58%, specificity 83.33%, positive predictive value 76.65%, negative predictive value 97.72% and the diagnostic accuracy was 88.12%. Conclusion: Our study concludes that ultrasound had sensitivity 96.58%, specificity 83.33%, positive predictive value 76.65%, negative predictive value 97.72% and the diagnostic accuracy was 88.12% in the detecting malignant thyroid nodule keeping histopathology as a gold standard. [ABSTRACT FROM AUTHOR]

This study investigates gender differences in core muscle morphology among elite alpine skiers using ultrasonography, highlighting significant disparities that could influence training and injury prevention strategies. Methods: A cross-sectional design was employed, examining ultrasound imaging (USI) in 22 elite skiers (11 male, 11 female) to assess the thickness of the external oblique (EO), internal oblique (IO), transversus abdominis (TrAb), and rectus abdominis (RA) muscles. Results: Significant differences were noted, with male skiers displaying greater muscle thickness, particularly in the right IO and RA and left IO, EO, TrAb, and RA. Conclusions: These findings suggest that male and female skiers may require different training approaches to optimize performance and reduce injury risks. This research contributes to a deeper understanding of the physical demands on elite skiers and underscores the need for gender-specific training regimens to enhance athletic outcomes and prevent injuries. [ABSTRACT FROM AUTHOR]

Background: We developed an artificial intelligence (AI)-based endoscopic ultrasonography (EUS) system for diagnosing the invasion depth of early gastric cancer (EGC), and we evaluated the performance of this system. Methods: A total of 8280 EUS images from 559 EGC cases were collected from 11 institutions. Within this dataset, 3451 images (285 cases) from one institution were used as a development dataset. The AI model consisted of segmentation and classification steps, followed by the CycleGAN method to bridge differences in EUS images captured by different equipment. AI model performance was evaluated using an internal validation dataset collected from the same institution as the development dataset (1726 images, 135 cases). External validation was conducted using images collected from the other 10 institutions (3103 images, 139 cases). Results: The area under the curve (AUC) of the AI model in the internal validation dataset was 0.870 (95% CI: 0.796–0.944). Regarding diagnostic performance, the accuracy/sensitivity/specificity values of the AI model, experts (n = 6), and nonexperts (n = 8) were 82.2/63.4/90.4%, 81.9/66.3/88.7%, and 68.3/60.9/71.5%, respectively. The AUC of the AI model in the external validation dataset was 0.815 (95% CI: 0.743–0.886). The accuracy/sensitivity/specificity values of the AI model (74.1/73.1/75.0%) and the real-time diagnoses of experts (75.5/79.1/72.2%) in the external validation dataset were comparable. Conclusions: Our AI model demonstrated a diagnostic performance equivalent to that of experts. [ABSTRACT FROM AUTHOR]

Diagnostic ultrasound visualization was initially developed and introduced as a more benign alternative to X-rays and is today established as a harmless routine procedure and tool for risk management, but as this article shows, it took several decades to overcome the popular notion that ultrasound itself was a high-risk technology, a potentially deadly weapon. Swedish newspaper material provides a window into internationally circulated narratives portraying ultrasound as both a frightening and promising phenomenon. These ideas also constituted an important context for risk assessment during the early adoption and development of obstetrical ultrasound imaging, as shown by the case of Lund, Sweden, where the still-experimental technology was first imported from Scotland in the early 1960s. The article repositions ultrasound in the history of risk and risk management in modern societies and also sheds new light on the history of ultrasound visualization by situating it in a broader context of media culture. [ABSTRACT FROM AUTHOR]

Background: The rupture and detachment of unstable plaques in the carotid artery can cause embolism in the cerebral artery, leading to acute cerebrovascular events. Intraplaque neovascularization (IPN) is a very important contributor to carotid plaque instability, and its evolution plays a key role in determining the outcome of vulnerable plaques. Ultrasound techniques, represented by contrast-enhanced ultrasound (CEUS) and superb microvascular imaging (SMI), are reported to be non-invasive, rapid, and effective techniques for the semi-quantitative or quantitative evaluation for IPN. Although ultrasound techniques have been widely applied in the detection of carotid plaque stability, it has been limited owing to the lack of unified IPN quantitative standards. Summary: This review summarizes the application and semi-quantitative/quantitative diagnostic standards of ultrasound techniques in evaluating IPN and looks forward to the prospects of the future research. With the development of novel techniques like artificial intelligence, ultrasound will offer appropriate selections for achieving more accuracy diagnosis. Key Messages: A large number of studies have used CEUS and SMI to detect IPN and perform semi-quantitative grading to predict the occurrence of diseases such as stroke and to accurately assess drug efficacy based on rating changes. These studies have made great progress at this stage, but more accurate and intelligent quantitative imaging methods should become the future development goal. [ABSTRACT FROM AUTHOR]

• Accurate non-invasive tools for early MASLD diagnosis are needed. • An AI-based US algorithm was developed to calculate hepatorenal index (HRI). • AI significantly improves HRI's diagnostic performance for mild liver steatosis. Steatotic liver disease is the most frequent chronic liver disease worldwide. Ultrasonography (US) is commonly employed for the assessment and diagnosis. Few information is available on the possible use of artificial intelligence (AI) to ameliorate the diagnostic accuracy of ultrasonography. An AI-based algorithm was developed using a dataset of US images. We prospectively enrolled 134 patients for algorithm validation. Patients underwent abdominal US and Proton Density Fat Fraction MRI scans (MRI-PDFF), assumed as reference technique. The hepatorenal index was manually calculated (HRIM) by 4 operators. An automatic hepatorenal index (HRIA) was obtained by the algorithm. The accuracy of HRIA to discriminate steatosis grades was evaluated by ROC analysis using MRI-PDFF cut-offs. Overweight was 40 % of subjects (BMI 26.4 kg/cm2). The median HRIA was 1.11 (IQR 0.32) and the average of 4 manually calculated HRIM was 1.08 (IQR 0.26), with a 15 % inter-operator variability. Both HRIA (R = 0.79, P < 0.0001) and HRIM (R = 0.69, P < 0.0001) significantly correlated with liver fat percentage (MRI-PDFF). According to MRI-PDFF, 32 % of enrolled subjects had steatosis. Discrimination capacity by AUC between patient with steatosis and patient without steatosis was better for HRIA than HRIM (AUC: 0.87 vs. 0.82, respectively). ROC analysis showed an AUC = 0.98 for HRIA with 1.64 cut-off in distinguishing between mild and moderate/severe groups. The use of AI improves accuracy and speed of ultrasonography in the diagnosis of liver steatosis. Further studies should evaluate the routine use of this technique in the management of liver steatosis at high cardio-metabolic risk. [Display omitted] [ABSTRACT FROM AUTHOR]

Summary: Background: Obesity impacts the diagnostic accuracy of shear wave elastography (SWE). A deep abdominal ultrasound transducer (DAX) capable of point (pSWE) and two‐dimensional (2D)‐SWE has recently been introduced to address this issue. Methods: We performed a prospective study in a cohort of mostly patients with obesity undergoing liver biopsy with a high prevalence of metabolic dysfunction‐associate steatotic liver disease (MASLD). Liver stiffness measurement (LSM) was measured using vibration‐controlled transient elastography (VCTE), as well as pSWE and 2D SWE on the standard (5C1) and the DAX transducers. Results: We included 129 patients with paired LSM and liver biopsy: median age 44.0 years, 82 (63.6%) women, median BMI: 43.2 kg/m2. Histologic fibrosis stages: F0: N = 55 (42.6%), F1: N = 14 (10.9%), F2: N = 50 (38.8%), F3: N = 2 (1.6%), F4: N = 8 (6.2%). VCTE‐LSM failed (N = 13) or were unreliable (IQR/median ≤30% in ≥7.1 kPa, N = 14) in 20.9% of patients. The Pearson correlation of reliable VCTE‐LSM with both pSWE and 2D SWE was strong (all >0.78). The diagnostic accuracy for all LSM techniques was poor for significant fibrosis (≥F2, AUC: 0.54–0.63); however, it was good to excellent for advanced fibrosis (≥F3, AUC: 0.87–0.99) and cirrhosis (F4, AUC: 0.86–1.00). In intention‐to‐diagnose analysis, pSWE on DAX was significantly superior to VCTE‐LSM. Conclusions: pSWE‐ and 2D‐SWE enable the non‐invasive identification of advanced fibrosis and cirrhosis in patients with obese MASLD. The use of the DAX transducer for acoustic radiation force imaging (ARFI)‐LSM avoids technical failures in an obese population and subsequently offers advantages over VCTE‐LSM for the evaluation of fibrosis in an obese MASLD population at risk for fibrosis. [ABSTRACT FROM AUTHOR]

The occurrence and development of developmental dysplasia of the hip (DDH) are related to a variety of factors, which have been reported in the literature, but the literature does not mention factors related to the severity of DDH. The purpose of this study is to analyze the related factors of the occurrence and severity of DDH in combination with the Graf ultrasonic diagnostic classification. This study was a monocentric retrospective study describing the factors associated with DDH in a large hospital of northwest China. A total of 3046 infants (6092 hips) within 6 months after birth using the Graf method were admitted to our department between 2014 and 2018. We analyzed data of DDH. After reviewing medical charts and diagnostic examination results, we assessed whether factors such as ethnicity, gender, gestational age, birth weight, diagnosis age, maternal age, mode of delivery, fetal presentation, amniotic fluid volume and birth order, had any effect on development of hip. ① Analysis showed that DDH mostly occurs in female and left hip joint, related to intrauterine fetal presentation, amniotic fluid volume, gestational age, mode of delivery, prenatal weight, and diagnosis age after birth, and the occurrence of DDH is also related to maternal age (All P＜0.05). Ethnicity and first born showed have no obvious correlation with DDH incidence (p = 0.718, 0.147, respectively). ② The strongest correlation was found with amniotic fluid, followed by birth weight. ③ The severity of DDH was correlated with ethnicity, births, prenatal weight, gestational age, diagnosis age and maternal age (All P＜0.05, respectively). ④ There were significant differences in treatment methods, duration and prognosis among different types of DDH. The occurrence and development of DDH are related to a variety of factors. Ultrasound examination can provide an early assessment of the hip development status of infants and may play an important role in establishing an early clinical diagnosis treatment and monitoring and prognosis. [ABSTRACT FROM AUTHOR]

Objective: To investigate the value of the sonographic identification of deep infiltrating endometriosis (DIE) in women presenting with complaints suggestive of DIE. Sonography findings were correlated with subsequent surgical exploration, and histologic verification. Methods: A retrospective observational case series was investigated to document the ability of the use of sonography to accurately detect the presence of deep infiltrating endometriosis. The clinical observations were performed consistent with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) recommendations for observational studies. Recognizing the real‐world office setting for this may introduce the importance of the practical clinical aspects of diagnostic procedures in general. Results: Three‐dimensional transvaginal sonography was able to accurately identify deep invasive endometriosis in 92% of the 100 women subjectively complaining of the associated symptoms of endometriosis, who underwent sonography, surgical exploration, and pathologic analysis. Additional sonographic evidence of pelvic pathology was found during the course of this investigation, perhaps complementing other means for diagnosing endometriosis. Conclusion: Three‐dimensional transvaginal sonography is a diagnostic tool that can effectively identify deep infiltrating endometriosis, which may otherwise go undetected and untreated. These findings should encourage the use of sonography for the detection of this subtype of endometriosis. Synopsis: A series of cases is described of sonographically detected deep infiltrating endometriosis with three‐dimensional transvaginal sonography, which were all surgically explored and histologically examined. [ABSTRACT FROM AUTHOR]

To determine (a) the accuracy of ultrasound in detecting brachial plexus pathology and (b) outline the advantages and limitations of ultrasound compared to MRI for imaging the brachial plexus. cases with clinically suspected brachial plexus pathology were evaluated first by ultrasound, followed by MRI. Patients with prior brachial plexus imaging were excluded. The final diagnosis was based on a combination of ultrasound, MRI, clinical follow-up, and surgical findings. The accuracy of the ultrasound was assessed by comparing the ultrasound and the final diagnoses. The mean clinical follow-up time following ultrasound was 1.8 ± 1.4 years. Ninety-two (64%) of the 143 cases had normal brachial plexus ultrasound and MRI examinations. Fifty-one (36%) of 143 cases had brachial plexus pathology on MRI, comprising post-radiation fibrosis (n=25, 49%), nerve sheath tumor (n=11, 21%), traumatic injury (n=7, 14%), inflammatory polyneuropathy (n=4, 8%), malignant infiltration (n=2, 4%), desmoid fibromatosis (n=1,2%), and neuralgic amyotrophy (n=1, 2%). Overall diagnostic accuracy of ultrasound for brachial plexus pathology was 98% (140/143), with three discordant cases (neuralgic amyotrophy n=1, inflammatory neuropathy n=1, postradiation fibrosis n=1) regarded as normal on ultrasound assessment. Sensitivity, specificity, and positive and negative predictive value of ultrasound for identifying brachial plexus pathology were 94%, 100%, 100%, and 97%, respectively. Ultrasound identifies brachial plexus pathology with high accuracy and specificity, showing comparable diagnostic efficacy to MRI. Ultrasound can serve as an effective first-line imaging investigation for suspected brachial plexus pathology. • Almost two-thirds of brachial plexus examinations are normal on both US and MRI. • The US has high accuracy for identifying brachial plexus pathology. • US is an efficient investigation for suspected brachial plexus pathology. [ABSTRACT FROM AUTHOR]

Thoracic ultrasound (TUS) is a tool that has become increasingly essential in the daily practice of thoracic medicine. Driven by the need to assess patients during the COVID-19 pandemic, there has been an increase in the use of point-of-care TUS, which has demonstrated several benefits, either as a complement to clinical decisionmaking for diagnosis or as a real-time guide for procedures, whether as a predictor or measure of treatment response. Here, we present a review of TUS, based on the most recent scientific evidence, from equipment and techniques to the fundamentals of pulmonary ultrasound, describing normal and pathological findings, as well as focusing on the management of lung disease and guidance for invasive thoracic procedures at the bedside. Finally, we highlight areas of perspective and potential lines of research to maintain interest in this valuable tool, in order to improve the diagnostic process and expand the treatment arsenal. [ABSTRACT FROM AUTHOR]