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Appendicitis is a disease that refers to inflammation of the appendix caused by obstruction, or blockage, in the lumen of the appendix. We investigated that this disease can be detected early through medical imaging such as ultrasonography (USG). However, the role of ultrasound in these cases is still limited due to the low visualization rate of the visible appendix. Based on this, this research aims to develop an image extraction process using the Centerline method in the process of identifying appendicitis in ultrasound images. The development of the extraction process is presented in the performance of the centerline and boundary extraction (CBE) algorithm which can represent image objects as boundaries that limit and separate one area from other areas. The research dataset used was 2097 ultrasound images sourced from 90 patients at the West Sumatra Lung Hospital. Based on the tests that have been carried out, it has been proven that it can reduce the width of the image object iteratively until the object is represented as a center line or the thinnest representation. The performance of the CBE algorithm in the identification process is sufficient to provide accuracy results of 92%. These results can be a new extraction concept that can provide accuracy in the identification process. [ABSTRACT FROM AUTHOR]

Spondyloarthritis (SpA) is a prevalent genetic disorder that significantly impairs mobility, particularly in the spine, sacroiliac, and peripheral joints. Recent evidence highlights early involvement of the sternoclavicular joint in SpA, which may serve as an initial indicator. Diagnosis often relies on CT and MRI, neglecting ultrasound's potential in identifying SpA‐related sternoclavicular arthritis. This review focuses on the joint's anatomy, exploring ultrasound's diagnostic and therapeutic role in SpA‐related sternoclavicular arthritis, aiming to provide insights for future ultrasound applications in SpA management. [ABSTRACT FROM AUTHOR]

To evaluate the diagnostic value of ultrasound spectra of the middle cerebral artery (MCA) and umbilical artery (UA) blood flow in predicting adverse pregnancy outcomes.Data from 202 late singleton pregnancies (32–34 weeks gestation) were analyzed. Group A included 155 normal pregnancies, while Group B comprised 47 high-risk pregnancies. Color Doppler ultrasonography was used to measure and compare pulsatility index (PI), resistance index (RI), and end-systolic peak/end-diastolic peak (S/D) ratios of fetal MCA and UA between the groups.UA-related parameters (PI, RI, and S/D) were significantly higher in Group B compared to Group A, whereas MCA-related parameters (PI, RI, and S/D) were significantly lower in Group B than in Group A. In pregnancies with adverse outcomes, fetal UtA and UA-related parameters were elevated, while MCA parameters were decreased compared to those with favorable outcomes.Ultrasound spectra of MCA and UA blood flow provide valuable clinical information for assessing fetal intrauterine growth and predicting adverse pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Introduction: This study explored the clinical value and application of ultrasound contrast imaging technology in the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) TR4 benign and malignant thyroid nodules. Methods: We retrospectively analyzed data from the medical records of 40 patients who met the inclusion criteria between January 2020 and December 2023. Each patient was evaluated using the ACR TI-RADS classification and contrast-enhanced ultrasound (CEUS). The agreement between pathological outcomes and ultrasound indicators and the diagnostic value and significance of each parameter were assessed. Results: The diameters did not differ between benign and malignant nodules (P = 0.324). Ring enhancement was closely associated with benign thyroid nodules, with a negative predictive value of 100%. Homogeneous enhancement and enhancement intensity showed good diagnostic value for pathological results, with an area under the curve (AUC) > 0.8. This parameter showed a high diagnostic value for serial and parallel combinations of homogeneous enhancement and enhancement intensity, with a sensitivity of 77.8% and specificity of 85.7% for the serial combination and 100% and 71.4%, respectively. for the parallel combination. Conclusion: Among ACR TI-RADS TR4 nodules, diameter 1.0–1.5 cm was not significantly correlated with a benign or malignant nature. Nodules featuring ring enhancement with ring-enhancing features should be considered benign. Similarly, nodules showing no, homogeneous, or high enhancement with clear borders on CEUS imaging may be benign. However, nodules with uneven low enhancement or unclear borders may be malignant. Therefore, uneven and low enhancement on CEUS imaging may have a high diagnostic value for malignant nodules. Moreover, the combination of these features may have even higher specificity. [ABSTRACT FROM AUTHOR]

Intravenous leiomyomatosis (IVL), an abnormal growth pattern of uterine leiomyomas, is a rare tumor characterized by masses of smooth muscle cells appearing histologically benign and proliferating within the blood vessels but not invading the tissue. Currently, there have been limited reports of early cases of IVL, and the imaging characteristics of IVL remain uncertain, resulting in frequent misdiagnosis prior to surgery. The present study utilized a case of early IVL detected through conventional ultrasound and subsequently confirmed via contrast-enhanced ultrasound (CEUS) to further investigate ultrasound's diagnostic efficacy for early IVL detection. Here, a case of a 49-year-old woman was reported who presented with uterine leiomyoma and an echogenic mass in the left adnexal region on physical examination. Subsequent transvaginal CEUS examination revealed a left ovarian venous leiomyoma. The patient underwent resection of tumors in the uterus, bilateral ovaries, and left ovarian vein under general anesthesia. A venous plexus was identified above the left broad ligament close to the left ovary, and a myoma-like growth was detected in the posterior uterine wall during the operational procedure. Reports on pathology and immunohistochemistry verified leiomyomatosis with fatty metaplasia in the left broad ligament and uterine wall vein. The prognosis of patients with IVL is determined based on the appropriate surgical methods and the timely diagnosis of the condition. In this case, conventional ultrasound aided in the early identification of IVL, which was later verified by a CEUS examination, resulting in a successful surgical treatment. This example highlights the importance of ultrasound technology in diagnosing this uncommon condition and presents a new method for preoperative detection of IVL. [ABSTRACT FROM AUTHOR]

Background: Traditional methods of training in ultrasound technology make it difficult for postgraduate reproductive medicine students to rapidly develop into doctors who can perform clinical examinations independently. It is necessary to explore an efficient method for ultrasound training. The purpose of this study was to investigate whether the step-by-step (SBS) teaching improves the ultrasound diagnosis and clinical work level of reproductive medicine graduate students. Methods: A total of fifty postgraduate reproductive medicine students who participated in ultrasound room training were selected at random and divided into two groups: a traditional teaching control group and a stepwise teaching experimental group. A comparison was subsequently conducted between the two groups in terms of theoretical level, skill operation, comprehensive ability and teaching evaluation. Results: In terms of theory, skills, and comprehensive assessment, the experimental group exhibited superior performance compared to the control group (P < 0.05). The experimental group rated the instructors' teaching ability and methods significantly better than did the control group (P < 0.05). The experimental group's overall satisfaction with the training was better than that of the control group, but the difference was not statistically significant (P > 0.05). Conclusions: The stepped teaching model has the potential to facilitate the acquisition of clinical ultrasound detection and diagnostic techniques by postgraduate reproductive medicine students, thereby enhancing their overall competence and satisfaction with the teaching process. [ABSTRACT FROM AUTHOR]

Background Ovarian cancer is among the leading causes of gynecologic cancer-related death. Past ovarian cancer screening trials using combination of cancer antigen 125 testing and transvaginal ultrasound failed to yield statistically significant mortality reduction. Estimates of ovarian cancer sojourn time—that is, the period from when the cancer is first screen detectable until clinical detection—may inform future screening programs. Methods We modeled ovarian cancer progression as a continuous time Markov chain and estimated screening modality–specific sojourn time and sensitivity using a Bayesian approach. Model inputs were derived from the screening arms (multimodal and ultrasound) of the UK Collaborative Trial of Ovarian Cancer Screening and the Prostate, Lung, Colorectal and Ovarian cancer screening trials. We assessed the quality of our estimates by using the posterior predictive P value. We derived histology-specific sojourn times by adjusting the overall sojourn time based on the corresponding histology-specific survival from the Surveillance, Epidemiology, and End Results Program. Results The overall ovarian cancer sojourn time was 2.1 years (posterior predictive P value = .469) in the Prostate, Lung, Colorectal and Ovarian studies, with 65.7% screening sensitivity. The sojourn time was 2.0 years (posterior predictive P value = .532) in the United Kingdom Collaborative Trial of Ovarian Cancer Screening's multimodal screening arm and 2.4 years (posterior predictive P value = .640) in the ultrasound screening arm, with sensitivities of 93.2% and 64.5%, respectively. Stage-specific screening sensitivities in the Prostate, Lung, Colorectal and Ovarian studies were 39.1% and 82.9% for early-stage and advanced-stage disease, respectively. The histology-specific sojourn times ranged from 0.8 to 1.8 years for type II ovarian cancer and 2.9 to 6.6 years for type I ovarian cancer. Conclusions Annual screening is not effective for all ovarian cancer subtypes. Screening sensitivity for early-stage ovarian cancers is not sufficient for substantial mortality reduction. [ABSTRACT FROM AUTHOR]

Background and Purpose: Lateral elbow pain is quite common in everyday life. Lateral epicondylitis and radial tunnel syndrome are the most common causes of lateral elbow pain. The aim of this study was to evaluate the sensitivity and specificity of neuromuscular ultrasound examination in the diagnosis of lateral epicondylitis versus radial tunnel syndrome. Methods: This was a prospective double‐blinded pilot study of 68 elbows in 34 patients with lateral elbow pain. Patients underwent clinical examination and standardized neuromuscular ultrasound evaluation in the first 15 days after the initiation of symptoms. Statistical significance was set at p <.001. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Results: Sixty‐eight radial nerves were examined in 34 healthy controls (16 males; mean age 48.1 ± 8.2 years). Pain with palpation over the radial tunnel was found in 25 of 48 elbows (52.1%) compared to the pain over the lateral epicondyle found in 10 of 48 elbows (20.8%). Τhe sensitivity of palpation in differentiating radial tunnel syndrome from lateral epicondylitis was 75.7%, while the specificity was 50% (PPV 71.4%, NPV 51.5%). The sensitivity of neuromuscular ultrasound in differentiating radial tunnel syndrome from lateral epicondylitis was 92.6%, while the specificity was 80% (PPV 92.6%, NPV 80.0%). In most of the patients (25/31), fibrous bands anterior to the radio‐capitellar joint were responsible for the nerve entrapment. Conclusions: The present study highlights the importance of the neuromuscular ultrasound's diagnostic role in differentiating radial tunnel syndrome from lateral epicondylitis in the clinical scenario of lateral elbow pain. [ABSTRACT FROM AUTHOR]

Background: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder, and although the diagnosis is primarily based on clinical criteria, ENMG, as the "gold standard", does not always show detectable changes. Therefore, our study suggests that alterations in echogenicity and heterogeneity of the phrenic nerve (PN) may serve as potential additional diagnostic tools for ALS. Methods: Our study included 32 patients in the ALS group and 64 individuals in the control group. Each participant underwent an interview and completed questionnaires to collect clinical and demographic data, including age, gender, height, body mass index (BMI), hip and waist circumference, duration of illness, ALS-FRS-R score, comorbidities, and medication use. Ultrasound examinations of the PN were performed by two authors using a high-resolution "Philips EPIQ 7" ultrasound machine equipped with a linear 4–18 MHz transducer. The ALS group participants underwent PN sonography and conduction examinations, arterial blood gas (ABG) analysis, respiratory function tests (RFT), and electroneuromyography (ENMG). Results: The study demonstrated that the phrenic nerve is significantly smaller on both sides in patients with ALS compared to the control group (p < 0.01). Changes in the homogeneity and echogenicity of the PN were also observed on both sides. On the right side, 43.8% of the nerves showed heterogeneity, 40.6% were isoechoic, and 21.9% were hyperechoic. On the left side, 59.4% of the nerves exhibited heterogeneity, 34.4% were isoechoic, and 28.1% were hyperechoic. Moreover, sonography on both sides showed significant correlation with ALS-FRS-R, COMPASS-31, and ENMG results. Conclusions: Our study highlights the importance of phrenic nerve ultrasound as a promising supplementary diagnostic tool for ALS. The significant differences in phrenic nerve size, echogenicity, and homogeneity between patients with ALS and the control group demonstrate that ultrasound imaging can detect morphological changes in the phrenic nerve. Incorporating phrenic nerve ultrasound into routine diagnostic protocols could improve early detection, enhance disease monitoring, and offer a more comprehensive understanding of the neurodegenerative processes in ALS. [ABSTRACT FROM AUTHOR]

Objective: To determine the diagnostic accuracy of Ultrasound (US) and 99m-Tc Sestamibi scan in patients with primary hyperparathyroidism (PHPT) for the localization of parathyroid adenoma before surgery keeping Parathyroid histopathology as reference standard Method: This three years retrospective study was performed in the Department of Endocrinology, Hayatabad Medical Complex, Peshawar. Patients with PHPT who underwent parathyroidectomy from July 2019 to June 2022 were included in the study. Information relating to localization studies prior to surgical management like US and 99m-Tc Sestamibi scan was documented. These imaging findings were subsequently compared with the findings of parathyroid surgery and histopathology results which were taken as reference standard. Results: The sensitivity, positive predictive value (PPV) and overall accuracy of US for the preoperative localization of parathyroid adenoma was 77%, 95.7% and 75%, respectively. Whereas the sensitivity, PPV and accuracy of 99m-Tc Sestamibi scintigraphy was 89.5%, 95% and 86% respectively. Conclusion: Ultrasound despite its cost effectiveness has a lower sensitivity compared to 99m-Tc Sestamibi scintigraphy. Similarly, the sensitivity and overall accuracy of US and 99m-Tc Sestamibi scan when taken in combination is higher compared to either modality. It is thus recommended that the combination of these modalities should be employed to localize the adenomas accurately for surgery of the parathyroid gland for a better outcome. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the performance of ultrasound-based deep learning (DL) models in distinguishing breast phyllodes tumours (PTs) from fibroadenomas (FAs) and their clinical utility in assisting radiologists with varying diagnostic experiences. Methods: We retrospectively collected 1180 ultrasound images from 539 patients (247 PTs and 292 FAs). Five DL network models with different structures were trained and validated using nodule regions annotated by radiologists on breast ultrasound images. DL models were trained using the methods of transfer learning and 3-fold cross-validation. The model demonstrated the best evaluation index in the 3-fold cross-validation was selected for comparison with radiologists' diagnostic decisions. Two-round reader studies were conducted to investigate the value of DL model in assisting 6 radiologists with different levels of experience. Results: Upon testing, Xception model demonstrated the best diagnostic performance (area under the receiver-operating characteristic curve: 0.87; 95% CI, 0.81-0.92), outperforming all radiologists (all P < .05). Additionally, the DL model enhanced the diagnostic performance of radiologists. Accuracy demonstrated improvements of 4%, 4%, and 3% for senior, intermediate, and junior radiologists, respectively. Conclusions: The DL models showed superior predictive abilities compared to experienced radiologists in distinguishing breast PTs from FAs. Utilizing the model led to improved efficiency and diagnostic performance for radiologists with different levels of experience (6-25 years of work). Advances in knowledge: We developed and validated a DL model based on the largest available dataset to assist in diagnosing PTs. This model has the potential to allow radiologists to discriminate 2 types of breast tumours which are challenging to identify with precision and accuracy, and subsequently to make more informed decisions about surgical plans. [ABSTRACT FROM AUTHOR]

The aim of this meta-analysis was to assess the diagnostic performance of deep learning (DL) and ultrasound in breast cancer diagnosis. Additionally, we categorized the included studies into two subgroups: B-mode ultrasound diagnostic subgroup and multimodal ultrasound diagnostic subgroup, and compared the performance differences of DL algorithms in breast cancer diagnosis using only B-mode ultrasound or multimodal ultrasound. We conducted a comprehensive search for relevant studies published from January 01, 2017 to July 31, 2023 in the MEDLINE and EMBASE databases. The quality of the included studies was evaluated using the QUADAS-2 tool and radiomics quality scores (RQS). Meta-analysis was performed using R software. Inter-study heterogeneity was assessed by I^2 values and Q-test P-values, with sources of heterogeneity analyzed through a random effects model based on test results. Summary receiver operating characteristics (SROC) curves were used for meta-analysis across multiple trials, while combined sensitivity, specificity, and AUC were calculated to quantify prediction accuracy. Subgroup analysis and sensitivity analyses were also conducted to identify potential sources of study heterogeneity. Publication bias was assessed using the funnel plot method. (PROSPERO identifier: CRD42024545758). The 20 studies included a total of 14,955 cases, with 4197 cases used for model testing. Among these cases were 1582 breast cancer patients and 2615 benign or other breast lesions. The combined sensitivity, specificity, and AUC values across all studies were found to be 0.93, 0.90, and 0.732, respectively. In subgroup analysis, the multimodal subgroup demonstrated superior performance with combined sensitivity, specificity, and AUC values of 0.93, 0.88, and 0.787, respectively; whereas the combined sensitivity, specificity, and AUC value for the model B subgroup was at a level of 0.92, 0.91, and 0.642, respectively. The integration of DL with ultrasound demonstrates high accuracy in the adjunctive diagnosis of breast cancer, while the fusion of DL and multimodal breast ultrasound exhibits superior diagnostic efficacy compared to B-mode ultrasound alone. • The application of deep learning in the diagnosis of breast cancer is promising. • Deep learning-based computer-aided detection demonstrates high accuracy. • Multimodal breast ultrasound is expected to enhance the diagnostic accuracy. [ABSTRACT FROM AUTHOR]

The objective of this study was to investigate the subharmonic response of Lumason (also known as SonoVue; Bracco, Milan, Italy) to static and dynamic ambient pressures, with a direct comparison to Sonazoid (GE HealthCare, Oslo, Norway) and Definity (Lantheus Medical Imaging, MA, USA). The subharmonic responses of contrast agents can be exploited to perform subharmonic-aided pressure estimation. The subharmonic response of each ultrasound contrast agent was evaluated in both a static and dynamic tank using a commercially available Logiq E10 clinical ultrasound scanner (GE HealthCare) equipped with subharmonic imaging (SHI) and an acoustic power-optimization algorithm. A C1-6 curvilinear array that transmits at 2.5 MHz and receives at 1.25 MHz in SHI mode was used to acquire the subharmonic signals. Data was transferred offline into MATLAB (MathWorks) to perform linear regression analysis and statistical testing for significance of the slopes (i.e. , agent sensitivity). Sonazoid and Definity showed an inverse linear dependency between subharmonic signal and hydrostatic pressure at all pressure ranges (static and dynamic) tested, with maximum sensitivity under 50 mmHg in the static tank (−0.190 and −0.194 dB/mmHg for Sonazoid and Definity, respectively). Lumason exhibited a tri-phasic subharmonic behavior, beginning with a linear trend from 0 to 90 mmHg (sensitivity = 0.069 dB/mmHg), followed by a plateau from 100 to 130 mmHg, and an inverse linear trend from 140 to 200 mmHg (sensitivity = −0.137 dB/mmHg). The subharmonic response of Lumason is tri-phasic and differs from Sonazoid and Definity. Further investigation is needed to solidify understanding of the subharmonic behavior of Lumason to identify its usefulness for subharmonic-aided pressure estimation. [ABSTRACT FROM AUTHOR]

Objective: Although there is growing evidence that ultrasonography is superior to X-ray for rib fractures' detection, X-ray is still indicated as the most appropriate method. This has partially been attributed to a lack of studies using an appropriate reference modality. We aimed to compare the diagnostic accuracy of ultrasonography and X-ray in the detection of rib fractures, considering CT as the reference standard. Materials and methods: Within a 2.5-year period, all consecutive patients with clinically suspected rib fracture(s) following blunt chest trauma and available posteroanterior/anteroposterior X-ray and thoracic CT were prospectively studied and planned to undergo thoracic ultrasonography, by a single operator. All imaging examinations were evaluated for cortical rib fracture(s), and their location was recorded. The cartilaginous rib portions were not assessed. CTs and X-rays were evaluated retrospectively. Concomitant thoracic/extra-thoracic injuries were assessed on CT. Comparisons were performed with the Mann–Whitney U test and Fisher's exact test. Results: Fifty-nine patients (32 males, 27 females; mean age, 53.1 ± 16.6 years) were included. CT, ultrasonography, and X-ray (40 posteroanterior/19 anteroposterior views) diagnosed 136/122/42 rib fractures in 56/54/27 patients, respectively. Ultrasonography and X-ray had sensitivity of 100%/40% and specificity of 89.7%/30.9% for rib fractures' detection. Ultrasound accuracy was 94.9% compared to 35.4% for X-rays (P <.001) in detecting individual rib fractures. Most fractures involved the 4th–9th ribs. Upper rib fractures were most commonly overlooked on ultrasonography. Thoracic cage/spine fractures and haemothorax represented the most common concomitant injuries. Conclusion: Ultrasonography appeared to be superior to X-ray for the detection of rib fractures with regard to a reference CT. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 44-year-old female with persistent knee pain following a twisting injury, leading to the identification of a popliteal lipoma as the source of her discomfort. Topics discussed include the role of musculoskeletal ultrasound in diagnosing soft tissue lesions, the management of posttraumatic knee osteoarthritis, and the use of physical therapy techniques to address knee pain and dysfunction.

The use of artificial intelligence in diverse diagnosis areas has significantly increased in the past few years because of the advantages it represents in clinical routine. Among the diverse diagnostic techniques, the use of ultrasounds is often preferred because of their simplicity, low cost, non-invasiveness, and non-ionizing characteristic. However, obtaining an adequate number of patients and data for training and testing machine learning models is challenging. To overcome this limitation, a novel approach is proposed for simulating data produced by ultrasonic diagnostic devices. The implemented method was based on a clinical prototype for eye cataract diagnosis, although the method can be extended to other applications as well. The proposed model encompasses the electric-to-acoustic signal conversion in the ultrasonic transducer, the wave propagation through the biological medium, and the subsequent acoustic-to-electric signal conversion in the transducer. Electrical modelling of the transducer was performed using a two-port network approach, while the acoustic wave propagation was modelled by using the k-Wave MATLAB toolbox. It was verified that the holistic modelling approach enabled the generation of synthetic data augmentation, presenting high similarity with real data. [ABSTRACT FROM AUTHOR]

Background: Core musculature is important for efficiency during activities including running. Both abdominal muscle strength and endurance contribute to this efficiency. The purpose of this study is to determine what differences and relationships exist in abdominal muscle thickness, strength, and endurance among persons who are runners, active, and inactive. Hypothesis: Persons in the running group would show significantly greater abdominal muscle thickness, muscle strength, and muscle endurance compared with those in the nonrunning groups. Study Design: Quantitative cohort design. Level of Evidence: Level 2b. Methods: A total of 78 subjects aged 18 to 27 years were divided into 3 groups: runners, active, and inactive. Assessment included abdominal muscle thickness via diagnostic ultrasound (Mindray North America), strength using a static Isotrack dynamometer (JTech Medical), and abdominal muscle endurance using a side plank. Statistical analysis using analysis of variance, t tests, and Pearson's correlation coefficients and partial correlations was performed using SPSS Version 26 with a significance level of P < 0.05. Results: Significantly greater muscle thickness of internal obliques (IOs) at rest and during contraction was found in the running group compared with the active group, the active group compared with the inactive group, and the running group compared with the inactive group. There were no statistically significant differences in overall strength measured by dynamometry among the 3 groups. Plank time was significantly greater for the running group compared with the other 2 groups. Male participants were greater in all areas: strength, plank time as a measure of muscle endurance, and muscle thickness. Body mass index was significantly correlated with resting thickness, muscle endurance, and muscle strength. Conclusion: Persons who run, are active, and are inactive use their abdominal muscles differently. Runners have thicker IOs and better abdominal muscle endurance than the other 2 groups. Focusing on endurance training of the obliques may be beneficial for persons who run. Clinical Relevance: This research could contribute to developing core training programs to ensure runners target the correct abdominal muscles with the best type of training. [ABSTRACT FROM AUTHOR]

Objective: This study aims to assess the diagnostic performance of Sonazoid-contrast-enhanced ultrasound (CEUS) in identifying definitive HCC within hepatic nodules in cirrhotic patients, comparing the KLCA-NCC 2022 and APASL 2017 diagnostic guidelines. Materials and methods: This retrospective study analyzed cirrhotic patients who underwent Sonazoid-CEUS for liver lesion evaluation between October 2019 and October 2023. HCC diagnosis was based on the KLCA-NCC 2022 and APASL 2017 guidelines. Inter-reader agreement on CEUS imaging features and the diagnostic accuracy of the guidelines were evaluated. Sensitivity and specificity comparisons were made using McNemar's test. Results: Among 400 patients with 432 lesions, CEUS showed excellent inter-reader consistency in detecting arterial phase hyperenhancement and Kupffer defects. The KLCA-NCC 2022 criteria notably enhanced sensitivity to 96.2%, with specificity and accuracy of 93.8% and 95.8%, respectively. APASL 2017 achieved the highest sensitivity at 97.8%, although specificity dropped to 46.9%, resulting in an accuracy of 90.3%. The KLCA-NCC 2022 guidelines demonstrated significantly higher specificity than APASL 2017 (p < 0.001), while APASL 2017 exhibited the highest sensitivity at 97.8%. Notably, the KLCA-NCC 2022 guidelines also demonstrated an impressive positive predictive value of 98.9%. Conclusion: Sonazoid-enhanced CEUS, particularly when applied using the KLCA-NCC 2022 guidelines, is an effective diagnostic tool for HCC. Critical relevance statement: Perfluorobutane CEUS, particularly in accordance with the KLCA-NCC 2022 guidelines, emerges as a valuable adjunct for diagnosing HCC in cirrhotic patients. It demonstrates superior positive predictive value and specificity compared to APASL 2017, underscoring its potential as an effective diagnostic tool. Key Points: Contrast-enhanced (CE)US using Sonazoid with KLCA-NCC 2022 guidelines is highly effective for HCC diagnosis. KLCA-NCC 2022 criteria showed high accuracy, 96.2% sensitivity, and 98.9% PPV. CEUS demonstrated excellent inter-reader consistency in detecting arterial phase hyperenhancement and Kupffer defects. [ABSTRACT FROM AUTHOR]

Background: Point-of-care ultrasound (POCUS) has gained popularity as a bedside diagnostic imaging modality. In obstetrical populations, particularly in acute care settings, POCUS serves as a valuable complement to clinical assessment. Despite its many applications, only a few have been defined and validated in the obstetric population. This scoping review aims to delineate literature on the diagnostic applications of POCUS in obstetric anesthesia and critical care. Methods: This review will adhere to the Joanna Briggs Institute methodology for scoping reviews, as updated by Arksey and O'Malley and in stages elaborated by Levac et al. Relevant literature will be identified using Medical Subject Headings (MeSH), keyword, and proximity searches and combined using Boolean operators in PubMed, Embase, and Web of Science from January 1, 2000, to the present. Two independent reviewers will screen literature against predefined eligibility criteria in abstract and full-text forms. A third reviewer will be consulted if consensus cannot be reached. Data extraction will be systematic, focusing on pre-specified variables aligned with the review's aims. Descriptive statistical and thematic analysis will follow data extraction, with findings presented in graphical and tabular forms. The reporting will follow Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR). Conclusion: This review will present the scope of the current literature on diagnostic POCUS in obstetric anesthesia and critical care, highlighting both strengths and gaps in existing knowledge. The insights gained will support future research, knowledge synthesis, and development of educational programs. The findings will be disseminated through peer-reviewed journal publications, conferences, and social media platforms. Systematic review registration: Not applicable. [ABSTRACT FROM AUTHOR]

Background: Medical imaging is an integral part of healthcare. Globalization has resulted in increased mobilization of migrants to new host nations. The association between migration status and utilization of medical imaging is unknown. Methods and findings: A retrospective population-based matched cohort study was conducted in Ontario, Canada from April 1, 1995 to December 31, 2016. A total of 1,848,222 migrants were matched 1:1 to nonmigrants in the year of migration on age, sex, and geography. Utilization of computed tomography (CT), magnetic resonance imaging (MRI), radiography, and ultrasonography was determined. Rate differences per 1,000 person-years comparing migrants to nonmigrants were calculated. Relative rates were calculated using a recurrent event framework, adjusting for age, sex, and time-varying socioeconomic status, comorbidity score, and access to a primary care provider. Estimates were stratified by migration age: children and adolescents (≤19 years), young adults (20 to 39), adults (40 to 59), and older adults (≥60). Utilization rates of CT, MRI, and radiography were lower for migrants across all age groups compared with Ontario nonmigrants. Increasing age at migration was associated with larger differences in utilization rates. Older adult migrants had the largest gap in imaging utilization. The longer the time since migration, the larger the gap in medical imaging use. In multivariable analysis, the relative rate of imaging was approximately 20% to 30% lower for migrants: ranging from 0.77 to 0.88 for CT and 0.72 to 0.80 for MRI imaging across age groups. Radiography relative rates ranged from 0.84 to 0.90. All migrant age groups, except older adults, had higher rates of ultrasonography. The indication for imaging was not captured, thus it was not possible to determine if the imaging was necessary. Conclusions: Migrants utilized less CT, MRI, and radiography but more ultrasonography. Older adult migrants used the least amount of imaging compared with nonmigrants. Future research should evaluate whether lower utilization is due to barriers in healthcare access or health-seeking behaviors within a universal healthcare system. Author summary: Why was this study done?: Globalization has led to an increasing number of migrants who must navigate a new healthcare system in the countries they migrate to. Migrants have been shown to use specific health services, such as cancer screening or general practitioner use, at a lower rate than those born in the host country. Limited studies have been performed which have evaluated the longitudinal usage patterns of medical imaging of migrants compared with nonmigrants. What did the researchers do and find?: A retrospective cohort study of 1,848,222 migrants to Ontario, Canada were matched to an equal number of nonmigrants and evaluated for the utilization rates of computerized tomography, magnetic resonance imaging, radiography, and ultrasonography medical imaging. Usage rates of medical imaging were 20% to 30% lower in migrants compared with nonmigrants. A longer time since migration resulted in larger disparities in imaging use, with the largest age-related differences in utilization patterns observed in older migrants. What do these findings mean?: Large disparities in the utilization of medical imaging within this universal healthcare system exist which warrants further investigation to uncover mechanisms of action. These data may be used by healthcare policymakers and practitioners in regions where migration plays a significant role in its population. [ABSTRACT FROM AUTHOR]

AbstractPlant-based food consumption has increased substantially owing to its positive effects on human and global health. However, ensuring the quality and safety of plant-based foods remains a challenge. Diagnostic ultrasonic technology is widely used for rapid and nondestructive determination owing to its ability to penetrate optically opaque materials, strong directivity, rapid detection capabilities, low equipment costs, and ease of operation. This review provides a comprehensive understanding of diagnostic ultrasonic technology by summarizing the principles of food characterization, factors that influence detection accuracy and methods to mitigate their impact, composition of ultrasonic machine systems, and application of diagnostic ultrasound for monitoring plant-based foods. The detection principle of ultrasonic technology is based on empirical equations that establish a relationship between the ultrasonic and physicochemical indicators of food. To improve the detection accuracy, a compensation mechanism for the temperature and pressure should be established, measurement distances should be set in the far-field region, and liquid samples should be degassed. Furthermore, the sample platform design and the choice of detection mode depend on the nature of the food. Combining ultrasonic technology with machine learning techniques presents promising prospects for real-time process monitoring in the food and beverage industries. [ABSTRACT FROM AUTHOR]

The Ian Donald International School of Ultrasound bears testament to globalization in its most successful and worthwhile form. The school was founded in Dubrovnik in 1981. Since then, the growth has been meteoric and now consists of 126 branches throughout the world. The reason for this success has been the tireless and selfless efforts of the world’s leading authorities in ultrasound who are willing to dedicate their valuable time without reimbursement to teach sonologists and sonographers throughout the world. The teachers put national, religious, political, and other parochial considerations aside as they strive to improve the care of all women and fetal patients. Our politicians in all of the myriad countries represented in the school have much to learn from the purity of spirit that exists throughout the international family of Ian Donald schools. We believe that Ian Donald is smiling down from heaven at the School that bears his name. It is not overstating the fact to say that Donald’s innovation has changed the thinking of our age. The magnitude of this step alone is incalculable. Indeed, diagnostic ultrasound, more than any other modern technique, has made manifest that the fetus is an individual virtually from conception. [ABSTRACT FROM AUTHOR]

Background: Crohn's disease (CD) is a complex systemic entity, characterized by the progressive and relapsing inflammatory involvement of any part of the gastrointestinal tract. Its clinical pattern may be categorized as penetrating, stricturing or non-penetrating non-stricturing. Methods: In this paper, we performed a database search (Pubmed, MEDLINE, Mendeley) using combinations of the queries "crohn", "stricture" and "elastography" up to 19 June 2024 to summarize current knowledge regarding the diagnostic utility of ultrasound (US) and magnetic resonance (MR) elastography techniques in the evaluation of stricturing CD by means of an assessment of the transmural intestinal fibrosis. We decided to include papers published since 1 January 2017 for further evaluation (n = 24). Results: Despite growing collective and original data regarding numerous applications of mostly ultrasound elastography (quantification of fibrosis, distinguishing inflammatory from predominantly fibrotic strictures, assessment of treatment response, predicting disease progression) constantly emerging, to date, we are still lacking a uniformization in both cut-off values and principles of measurements, i.e., reference tissue in strain elastography (mesenteric fat, abdominal muscles, unaffected bowel segment), units, not to mention subtle differences in technical background of SWE techniques utilized by different vendors. All these factors imply that ultrasound elastography techniques are hardly translatable throughout different medical centers and practitioners, largely depending on the local experience. Conclusions: Nonetheless, the existing medical evidence is promising, especially in terms of possible longitudinal comparative studies (follow-up) of patients in the course of the disease, which seems to be of particular interest in children (lack of radiation, less invasive contrast media) and terminal ileal disease (easily accessible). [ABSTRACT FROM AUTHOR]

Aim To investigate the value of ultrasound in the diagnosis of congenital internal carotid artery hypoplasia (CICAH). Methods Patients diagnosed with CICAH by ultrasound in Baotou Central Hospital, Inner Mongolia from July 2022 to December 2023 were retrospectively collected. The general data, ultrasound and imaging data of all patients were recorded. Results Among the 25 317 carotid artery ultrasonography subjects, 13 patients were diagnosed as CICAH. The ultrasonic detection rate of CICAH was 0. 051%. The 13 cases of CICAH included 11 cases of unilateral internal carotid artery hypoplasia and 2 cases of bilateral internal carotid artery hypoplasia. CT scan of carotid canal confirmed that all 13 cases of internal carotid artery hypoplasia were unilateral lesions, among which 2 cases of unilateral lesions were misdiagnosed as bilateral lesions by ultrasound, with a misdiagnosis rate of 15%. Taking carotid canal dysplasia as the gold standard, ROC curve was plotted to evaluate the diagnostic value of ultrasound in CICAH. The area under the curve (AUC) was 0. 941, and the optimal diagnostic threshold value of CICAH was 3. 2 mm, sensitivity was 100%, and specificity was 85%. The consistency test between ultrasonic examination and gold standard test method for CT scanning of carotid artery canal showed that Kappa value was 0. 846. Conclusion Ultrasound has a high diagnostic value in the diagnosis of CICAH, and can be used as the first choice of clinical examination. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the ultrasonic characteristics of endometrial polyps in breast cancer patients after anti-estrogen endocrine therapy. Methods: A total of 91 patients with endometrial polyps who had breast cancer surgery at Yantai Muping District Hospital of Traditional Chinese Medicine, Yantai, China between February 2021 and August 2023 were randomly assigned to study (n = 42) and control groups (n = 49) based on postsurgery anti-estrogen endocrine therapy. The study group received tamoxifen (20 mg orally once daily for 6 months). Control group did not receive any post-surgery anti-estrogen endocrine therapy. Ultrasound characteristics of the study and control groups were assessed and compared. Results: The study group exhibited significantly increased endometrial thickness compared to control group (p < 0.05). However, both maximum and mean polyp diameters were significantly larger in the study group (p < 0.05). Linear endometrial echoes predominated in treated patients, contrasting with predominantly uniform echoes in the control group. Visualization issues of the uterine cavity line were significantly more common in the study group, while control group experienced more deviation and unclear visualization. Also, the study group mostly presented with strip-shaped polyps, differing from the round or oval shapes prevalent in control group. Furthermore, there were significant variations in internal echo characteristics and blood flow parameters between the two groups (p < 0.05). Conclusion: Endometrial polyps caused by postoperative anti-estrogen endocrine therapy in patients with breast cancer have unique ultrasonic characteristics, good ultrasonic diagnostic effect and a high detection rate as long as it is detected early and treated on time. Further analyses are needed with a larger sample size to investigate the underlying mechanism involved in developing endometrial polyps. [ABSTRACT FROM AUTHOR]

Introduction: Thyroid disorders are common in Indian adult population. Current management guidelines from the American Thyroid Association (ATA) recommend diagnostic ultrasonography for all patients with thyroid nodules. However, suspicious and few overlapping characteristics of benign and malignant thyroid nodules makes FNAC unquestionable. Unwanted suspicion leads to excessive unnecessary biopsies and insufficient lower suspicion leads to under-diagnosis or missing of thyroid malignancies. Hence, making accurate decision of whether a nodule is potentially malignant or not is crucial. Aims and objectives: To study the USG features of thyroid lesions in patients with thyroid disorders and correlate these USG findings with FNAC in the diagnosis of thyroid lesions. Methods: The cross-sectional study was done for 18 months among patients of thyroid disorders coming to the Radio-diagnosis department of Muzaffarnagar Medical College for routine USG scan for thyroid lesions. A sample of 50 patients was taken among the age group of 10-75years who gave consent for FNAC and did not have any bleeding disorders. Sonographic evaluation of the thyroid gland was done by characterising its size, shape, echogenicity, vascularity and presence or absence of nodules. The respective nodules were assed for suspicious patterns and FNAC of the nodules was done to correlate the radiological with pathological diagnosis. Results: As per the study, with good sensitivity and specificity, radiological examination of thyroid lesions by USG showed significant correlation with pathological evaluation of thyroid lesions by FNAC examination. A strong positive correlation between the two diagnostic procedures was seen. The correlation was statistically significant, with a P < 0.05. Conclusion: Thyroid gland ultrasound is a non-invasive, cost-effective and patient compliant technique in assessing and diagnosing thyroid swellings which can be performed as the initial investigation before FNAC examination for quickly assessing thyroid nodules, their vascularity and identifying benign from malignant lesions. This would avoid unnecessary invasion and its related complications like puncturing an highly vascular nodule which could be determined on USG itself. [ABSTRACT FROM AUTHOR]

Introduction: Ultrasound (USG) is a safe and cost-effective first-line imaging technique for the diagnosis of acute appendicitis. The objective of this study was to assess the diagnostic efficacy of ultrasound by correlating its findings with histopathological results. Materials and Methods: This retrospective observational study was conducted at the Bharat Ratna Late Shri Atal Bihari Vajpayee Memorial Government Medical College in Rajnandgaon, Chhattisgarh, India, from January 2022 to January 2024. The study encompassed 208 cases of suspected acute appendicitis. Ultrasound scores were determined based on specific sonological criteria and these scores were subsequently compared to histopathological findings to evaluate diagnostic accuracy, sensitivity, and specificity. Results: Out of a total of 208 cases, 190 underwent comprehensive ultrasonographic assessment followed by histopathological examination. The study population was predominantly male, comprising 77.88% of the participants, with 33.17% of patients aged between 11 and 20 years. The retrocecal positioning of the appendix was identified as the most prevalent, occurring in 72.63% of cases. The USG demonstrated a sensitivity of 91.03%, a specificity of 87.37%, and an overall accuracy of 63.16% in the diagnosis of acute appendicitis. The kappa (κ) value was calculated to be 0.589, indicating a moderate level of agreement between the USG findings and the histopathological results. Furthermore, the study revealed variability in diagnostic accuracy contingent upon the ultrasound scoring system employed. Conclusion: Ultrasound is a valuable diagnostic tool for acute appendicitis. However, relatively low accuracy of the ultrasound scoring system indicates that, it should be utilized in conjunction with clinical judgment and, when appropriate, other diagnostic methods. [ABSTRACT FROM AUTHOR]

Purpose: There is a lack of knowledge concerning differences between females and males in the early stages after an acute Achilles tendon rupture. This article aims to explore the different factors affecting early function after an Achilles tendon rupture with a validated test battery that includes functional tests, clinical measurements and patient‐reported outcome at a 3‐month follow‐up analysis of a larger prospective study. Methods: This study was part of the DUSTAR‐study (Diagnostic UltraSonography for the choice of Treatment of acute Achilles tendon Rupture) where the main aim was to evaluate if an acute ultrasonography could determine which patients, with an Achilles tendon rupture, should be treated surgically or nonsurgically. At the 3‐month follow‐up, the results between males and females were compared. Results: One hundred and twenty‐seven patients were included at the 3‐month follow‐up; of these, 102 (80%) were males and 25 (20%) were females. Amongst the females, 11 (44%) were able to perform a single leg heel‐rise compared to 48 (47%) of the males; however, the difference was not statistically significant. There was no difference between the sexes in the frequency of completing a single‐leg heel‐rise at 3 months after injury; however, there were statistically significant differences between the groups when comparing Limb Symmetry Index (LSI) of heel‐rise height and heel‐rise work. The females had a median heel‐rise height LSI/median heel‐rise work LSI of 45%/14% compared to males who reached a level of 57%/23% (p = 0.006/p = 0.010). At the 3‐month follow‐up, the median (range) Achilles tendon Total Rupture Score (ATRS) reported by females was 28.5 (8–51), which had a nonsignificant difference compared to males who reported a median (range) ATRS of 30 (1–86). Conclusion: The risk of reduced heel‐rise height and worse heel‐rise work 3 months after an acute Achilles tendon rupture increases by being a female. Through this knowledge, we highlighted the importance of an individualised treatment for acute Achilles tendon ruptures with better outcome for both males and females. Level of Evidence: Level II. [ABSTRACT FROM AUTHOR]

Quality assessment of ultrasound medical systems is a demanding task due to the high number of parameters to quantify their performance: in the present study, a Kiviat diagram-based integrated approach was proposed to effectively combine the contribution of some experimental parameters and quantify the overall performance of pulsed wave Doppler (PWD) systems for clinical applications. Four test parameters were defined and assessed through custom-written measurement methods based on image analysis, implemented in the MATLAB environment, and applied to spectral images of a flow phantom, i.e., average maximum velocity sensitivity (AMVS), velocity measurements accuracy (VeMeA), lowest detectable signal (LDS), and the velocity profile discrepancy index (VPDI). The parameters above were scaled in a standard range to represent the four vertices of a Kiviat plot, whose area was considered the overall quality index of the ultrasound system in PWD mode. Five brand-new ultrasound diagnostic systems, equipped with linear array probes, were tested in two different working conditions using a commercial flow phantom as a reference. The promising results confirm the robustness of AMVS, VeMeA, and LDS parameters while suggesting further investigations on the VPDI. [ABSTRACT FROM AUTHOR]

To take advantage of ultrasonic-based non-destructive testing (NDT) and data-driven intelligent defect diagnosis, the current study proposes a feature tensor classifier based on multi-source ultrasonic fusion, to enhance the defect diagnosis adaptability and reliability for gas-insulated switchgear (GIS) basin insulator. First, multi-source ultrasonic signals are acquired by finite element modelling (FEM), describing the healthy states of the GIS basin insulator completely. Second, time of flight (Tof)-featured tensors are expressed by wavelet transform (WT), and used to create the datasets. Third, a deep learning-based feature tensor classifier is proposed, and concerned training, validation, and testing processes are carried out. Finally, the effectiveness of feature tensor extraction is evaluated, and the anti-noise performance of the Tof-featured tensor classifier is verified. The main contributions indicate that the Tof-featured tensor classifier can realise excellent diagnosis performance, the average accuracy is, respectively, 90.53%, 99.75%, and 100% in training, validation, and testing sets, while the signal tensor classifier has poor performance. In addition, three other noised datasets are applied, and the result shows that the anti-noise performance of the Tof-featured tensor classifier is feasible, when SNR is greater than 1 dB. [ABSTRACT FROM AUTHOR]

Objectives: To transform the standardized descriptions of the ultrasound characteristics of endometrial and intrauterine lesions devised by the International Endometrial Tumor Analysis (IETA) group into a practical scoring method and to investigate whether application of this method enhances the diagnostic accuracy of ultrasound radiologists with different levels of experience in detecting malignancy compared with subjective assessment. Methods: This was a retrospective study of 855 patients with endometrial and/or intrauterine lesions, who were divided into a training (n = 600) and a validation (n = 255) set. Ultrasound radiologists with varying levels of experience (expert, intermediate and junior) evaluated all lesions by subjective assessment and according to IETA rules. Using IETA rules, the experts identified signs of malignancy in the training set, assigned scores for each indicator and validated the scoring method in the validation set. The intermediate‐level and junior ultrasound radiologists reassessed the malignancy of the lesions using the IETA scoring method and compared their classifications with those made previously by subjective assessment. Postsurgical pathological evaluation was used as the reference standard. Results: Using subjective assessment, the experts demonstrated the highest level of diagnostic accuracy, with a sensitivity of 85.0%, specificity of 94.3% and an area under the receiver‐operating‐characteristics curve (AUC) of 0.897. Applying the IETA scoring method (comprising eight ultrasound characteristics that contributed to the total score) with a threshold of > 25 points for the diagnosis of malignancy achieved a sensitivity of 84.7%, specificity of 94.7% and AUC of 0.9533 in the training set, with similar performance in the validation set, when performed by experts. Using the IETA scoring method, both junior and intermediate ultrasound radiologists showed improvement in sensitivity (from 55.5% to 74.8% and from 70.2% to 77.1%, respectively), specificity (from 88.4% to 91.5% and from 87.4% to 92.2%, respectively) and AUC (from 0.704 to 0.827 and from 0.793 to 0.841, respectively) for diagnosing malignant lesions. Conclusions: The IETA scoring method exhibits high diagnostic efficacy for malignant endometrial and intrauterine lesions. This method compensates for the lack of experience among junior and intermediate‐level ultrasound radiologists, enhancing their diagnostic skill to a level nearing that of experienced senior ultrasound radiologists. Further research is essential to validate the practicality of implementing this method and to confirm its clinical value. © 2024 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Introduction: Our objective was to determine whether the educational game SonoQz can improve diagnostic performance in ultrasound assessment of ovarian tumors. Material and Methods: The SonoQz mobile application was developed as an educational tool for medical doctors to practice ultrasound assessment, based on still images of ovarian tumors. The game comprises images from 324 ovarian tumors, examined by an ultrasound expert prior to surgery. A training phase, where the participants assessed at least 200 cases in the SonoQz app, was preceded by a pretraining test, and followed by a posttraining test. Two equal tests (A and B), each consisting of 20 cases, were used as pre‐ and posttraining tests. Half the users took test A first, B second, and the remaining took the tests in the opposite order. Users were asked to classify the tumors (1) according to International Ovarian Tumor Analysis (IOTA) Simple Rules, (2) as benign or malignant, and (3) suggest a specific histological diagnosis. Logistic mixed models with fixed effects for pre‐ and posttraining tests, and crossed random effects for participants and cases, were used to determine any improvement in test scores, sensitivity, and specificity. Results: Fifty‐eight doctors from 19 medical centers participated. Comparing the pre‐ and posttraining test, the median of correctly classified cases, in Simple Rules assessment increased from 72% to 83%, p < 0.001; in classifying the lesion as benign or malignant tumors from 86% to 95%, p < 0.001; and in making a specific diagnosis from 43% to 63%, p < 0.001. When classifying tumors as benign or malignant, at an unchanged level of sensitivity (98% vs. 97%, p = 0.157), the specificity increased from 70% to 89%, p < 0.001. Conclusions: Our results indicate that the educational game SonoQz is an effective tool that may improve diagnostic performance in assessing ovarian tumors, specifically by reducing the number of false positives while maintaining high sensitivity. [ABSTRACT FROM AUTHOR]

• Adnexal masses need thorough pre-op evaluation. A two-step strategy using ADNEX enhances stratification and communication. To evaluate and compare diagnostic performance of ultrasound-based reporting systems IOTA SR, ADNEX, GIRADS, ORADS for discrimination between benign and malignant adnexal masses. A prospective observational study in a tertiary care hospital's Obstetrics and Gynaecology department evaluated pre-operative ultrasound imaging for adnexal masses in 80 cases, comparing various reporting systems' sensitivity and specificity against histopathology as gold standard using STATA version 17.0 for data analysis. Among the 80 masses, 55 % (44/80) were confirmed as benign on histopathology, while 45 % were identified as malignant. The sensitivity and specificity of SR was 100 % (95 %CI: 90.0–100) and 97.1 % (95 %CI: 84.7–99.9) respectively. Eleven masses (13.8 %) were inconclusive, reducing specificity to 75 % (95 %CI:59.7–86.8). In ADNEX optimal cut-off for risk of malignancy was 34.1 % with sensitivity of 86.1 % (95 % CI: 70.5–95.3) and specificity of 90.9 % (95 % CI: 78.3–97.5). Considering GIRADS 4–5 and risk threshold of ≥10 % (ORADS 4–5) as predictors of malignancy sensitivity was 100 % (95 %CI: 90.3–100) and specificity was 70.5 % (95 %CI: 54.8–83.2) for GIRADS and ORADS. All reporting systems were comparable (p = 0.7). ADNEX identified 72.7 % (8/11) of inconclusive cases, outperforming GIRADS/ORADS which correctly classified 27.2 % (3/11) cases. When applied to misclassified GIRADS/ORADS 4–5 category, ADNEX demonstrated superior performance by correctly classifying 76.9 % (10/13) masses, while SR achieved correct classification in only 38.5 % (5/13) masses. All classification systems showed comparable accuracy in malignancy risk identification on imaging. GIRADS/ORADS tended to overestimate malignancy risk. The present study recommends a two-step strategy, leveraging higher specificity of ADNEX model for improved stratification of adnexal masses. [ABSTRACT FROM AUTHOR]

Introduction: Cancer rates are rising in low- and middle-income countries. While point-of- care ultrasound is now available globally and could serve to mitigate against this rise, its use in diagnosing cancers is inconsistent in lower-resourced healthcare contexts. This proof-of-concept study investigates the feasibility of an ultrasound training concept in a low-resource setting. It evaluates whether this educational concept led to improved knowledge and application of ultrasound diagnostics, cancer screening and staging and patient care. Material and methods: The curriculum was developed through expert exchange and is based on the World Health Organisation's Manual of Diagnostic Ultrasound. It consisted of two didactic components: an on-site training phase across 5 days for a total of 24 hours, and a digital follow-up phase involving the meeting of a bi-weekly tumor board online. The learning objectives of the on-site training were normal imaging and recognition of common pathologies of the abdominal organs, vessels, lymph nodes, female breasts and lungs. The virtual tumour boards met to discuss cases and ultrasound findings, thus aiding continuing professional development after the training sessions had concluded. The face-to-face course component was accompanied by tests given before and after training as well as an evaluation sheet (Likert-scale with 1 = 'completely/very good' and 7 'not at all/very poor'). Results: Of 20 participants from a rural hospital in Tanzania, a total of 16 were included in the analysis (clinical officers n = 6; medical officers n = 10). A significant increase in knowledge (p < 0.01) was measured both in the subjective self-assessment and in the theoretical competence tests. In multivariate linear regression, the status 'medical officers yes' (β = 5.4; p = 0.04) had a significant influence on theory test results at T2. During the 24 virtual tumour board meetings, 28 cases were discussed and a continuous improvement in image acquisition quality was observed. Conclusion: The ultrasound education concept comes with a sustainable increase in clinical competence and improved oncological ultrasound screening locally. There is potential for the transfer of the concept to other locations, which can be explored in the future. [ABSTRACT FROM AUTHOR]

Introduction: The Baveno criteria for assessing advanced liver fibrosis were mainly determined by transient elastography (TE), and its pathology-based validation studies in two-dimensional shear wave elastography (2D-SWE) remain limited. We aimed to validate the Baveno criteria through use of 2D-SWE. Method: Consecutive patients who underwent liver biopsies for various benign liver diseases were prospectively recruited. Liver stiffness measurement (LSM) was simultaneously evaluated by TE and 2D-SWE. The optimal cutoff value to predict advanced liver fibrosis was determined by the Youden Index, and the diagnostic performance was estimated using area under the receiver operating characteristic (AUROC) analysis. Results: A total of 101 patients were enrolled having a median age of 55.0 (IQR: 46.0–63.5) years, with 53 (52.48%) of them being male. Using <9 and >14 kPa as the optimal dual cutoffs, the AUROC values in TE and 2D-SWE were 0.92 (95% CI: 0.83–0.97) and 0.93 (95% CI: 0.84–0.98), respectively (p = 0.61). The sensitivity and specificity of LSM by TE/2D-SWE achieved rates of 94.44%/94.44% and 86.00%/88.00%, respectively. However, using the Baveno criteria, the AUROC values in TE and 2D-SWE could remain achieving 0.91 (95% CI: 0.82–0.97) and 0.93 (95% CI: 0.84–0.98), respectively (p = 0.36). The sensitivity and specificity in TE/2D-SWE were 88.24%/88.24% and 86.79%/90.57%, respectively. Conclusion: This study establishes the compatibility of the Baveno dual cutoff criteria with 2D-SWE, positioning it as an easily used criteria in clinical practice and research. [ABSTRACT FROM AUTHOR]

At the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2023 annual meeting, members were updated on a number of ongoing activities during the key project update session. These activities included the Axial Involvement in Psoriatic Arthritis (AXIS) cohort, the Axial Psoriatic Arthritis Molecular and Clinical Characterization study, the Diagnostic Ultrasound Enthesitis Tool (DUET) study, the Sex- and Gender-Based Analysis of the Effectiveness of Advanced Therapies in Psoriatic Arthritis (SAGE-PsA) study, the Health Initiatives in Psoriasis and Psoriatic Arthritis Consortium European States (HIPPOCRATES), the GRAPPA slide library, and the GRAPPA treatment recommendations. [ABSTRACT FROM AUTHOR]

The sensitivity of ultrasound (US) to detect, characterize, and monitor the relevant pathologies of psoriatic arthritis (PsA), including synovitis, enthesitis, tenosynovitis, and dactylitis, has made it an attractive tool for informing clinical decisions. The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) US working group ran 2 sessions during the annual GRAPPA meeting held in July 2023 in Dublin, Ireland. During the first workshop, the group presented 2 topics, followed by a live demonstration and a group discussion. The 2 topics were (1) an overview of the Diagnostic Ultrasound Enthesitis Tool (DUET) enthesitis scoring methodology, and (2) small hand-held probes—will the promise deliver? The live demonstration that followed compared the performance of 2 hand-held US (HHUS) devices vs a console US machine in patients with PsA, and the interactive group discussion considered gaps in the literature and future research suggestions relating to HHUS and its application in psoriatic disease. During the second session, the US working group provided further updates regarding the GRAPPA US studies currently underway or recently completed. [ABSTRACT FROM AUTHOR]

Muscle ultrasound quantification is a valuable complementary diagnostic tool for diabetic peripheral neuropathy (DPN), enhancing physicians' diagnostic capabilities. Quantitative assessment is generally regarded as more reliable and sensitive than visual evaluation, which often necessitates specialized expertise. This work develops a computer-aided diagnostic (CAD) system based on muscle ultrasound that integrates the bag of features (BOF) and an ensemble subspace k-nearest neighbor (KNN) algorithm for DPN detection. The BOF creates a histogram of visual word occurrences to represent the muscle ultrasound images and trains an ensemble classifier through cross-validation, determining optimal parameters to improve classification accuracy for the ensemble diagnosis system. The dataset includes ultrasound images of six muscles from 53 subjects, consisting of 27 control and 26 patient cases. An empirical analysis was conducted for each binary classifier based on muscle type to select the best vocabulary tree properties or K values for BOF. The result indicates that ensemble subspace KNN classification, based on the bag of features, achieved an accuracy of 97.23%. CAD systems can effectively diagnose muscle pathology, thereby addressing limitations and identifying issues in individuals with diabetes. This research underscores muscle ultrasound as a promising diagnostic tool to aid physicians in making accurate diagnoses, streamlining workflow, and uncovering muscle-related complications in DPN patients. [ABSTRACT FROM AUTHOR]

To explore the differences between SonoVue and Sonazoid contrast-enhanced ultrasound (CEUS) in evaluating enhancement features of renal masses and determine the diagnostic value of CEUS in clear cell renal cell carcinoma (ccRCC). A total of 57 eligible patients were enrolled and divided into the ccRCC, papillary renal cell carcinoma (pRCC), non-ccRCC and non-pRCC malignancy groups, and benign mass groups based on their postsurgical histopathologic diagnosis. The enhancement features of renal masses following SonoVue and Sonazoid CEUS in each group were analyzed. Diagnostic efficiencies of SonoVue and Sonazoid CEUS for ccRCC and non-ccRCC were determined. There were no significant differences in the enhancement features of renal masses with SonoVue and Sonazoid imaging in the four groups (p >.05). Both SonoVue CEUS and Sonazoid CEUS showed good diagnostic performance for the differential diagnosis of ccRCC and non-ccRCC, with sensitivities of 88.6% and 85.7%, specificities of 76.5% and 88.2%, accuracies of 84.6% and 86.5%, positive predictive values of 88.6% and 93.8%, and negative predictive values of 76.5% and 75%, respectively. There were no statistically significant differences in any of the diagnostic performance indices between the two methods (p >.05). The CEUS features of SonoVue and Sonazoid in evaluating renal masses were similar in the vascular phase. Both SonoVue and Sonazoid CEUS showed good diagnostic performance for the differential diagnosis of ccRCC and non-ccRCC. [ABSTRACT FROM AUTHOR]

Background and objective: Extrathyroidal extension (ETE) is the term used to describe the growth of the primary thyroid tumor beyond the thyroid capsule. ETE is a critical prognostic marker for thyroid tumors, necessitating accurate preoperative assessment. This study aims to evaluate the diagnostic performance of computed tomography (CT)-based grading for ETE and tracheal invasion (TI) for preoperative prediction in patients with differentiated papillary thyroid carcinoma (PTC) and compare the diagnostic accuracy with ultrasound (US). Materials and methods: This retrospective study was approved by our institutional review board. Preoperative US and CT were performed for 83 patients who underwent surgery for PTC between 1 January 2010 and 31 December 2020. The US and CT features of ETE and TI of each case were retrospectively and independently investigated by two radiologists. The diagnostic performances of US and CT, including their specificity, sensitivity, positive predictive value (PPV), and negative predictive value (NPV) for ETE, and their accuracy in predicting ETE and TI were analyzed. As per the grading for ETE on USG and CT, lesions were graded into three grades and Mahajan grading was also devised on CT to predict the TI and graded into four grades. Results: The accuracy and specificity of CT are relatively good for identifying tumor infiltration into the adjacent structures and range from 82% to 87% and 95% to 98%, respectively. It, however, has a low sensitivity, between 14.3% and 77.78%, when compared to US, which suggests that in case of any doubt regarding CT evidence of tumor infiltration into surrounding structures, additional clinical examination must be performed. CT showed better sensitivity (78%) and specificity (75%) in detecting TI compared to previous studies. The diagnostic accuracy of CT Mahajan grading was 91.5% with p <0.005 in the prediction of TI. Conclusion: Preoperative US should be regarded as a first-line imaging modality for predicting minimal ETE, and CT should be additionally performed for the evaluation of maximal ETE. The specificity and PPV of CT are higher than those of US in detecting overall ETE and TI of PTC. The US- and CT-based grading systems have the potential to optimize preoperative surgical planning. [ABSTRACT FROM AUTHOR]

Background: Several studies have advocated the use of ultrasound to diagnose distal forearm fractures in children. However, there is limited data on the diagnostic accuracy of ultrasound for distal forearm fractures when conducted by pediatric surgeons or trainees who manage orthopedic injuries in children. The objective of this study was to determine the diagnostic accuracy of point-of-care ultrasound (POCUS) for pediatric distal forearm fractures when conducted by pediatric surgeons and trainees after minimal training. Methods: This diagnostic study was conducted in a tertiary hospital emergency department in Germany. Participants were children and adolescents under 15 years of age who presented to the emergency department with an acute, suspected, isolated distal forearm fracture requiring imaging. Pediatric surgeons and trainees, after minimal training for sonographic fracture diagnosis, performed 6-view distal forearm POCUS on each participant prior to X-ray imaging. All data was retrospectively collected from the hospital's routine digital patient files. The primary outcome was the diagnostic accuracy of POCUS compared to X-ray as the reference standard. Results: From February to June 2021, 146 children under 15 met all inclusion and exclusion criteria, and 106 data sets were available for analysis. Regarding the presence of a fracture, X-ray and Wrist-POCUS showed the same result in 99.1%, with 83/106 (78.3%) fractures detected in both modalities and one suspected buckle fracture on POCUS not confirmed in the radiographs. Wrist-POCUS had a sensitivity of 100% (95% CI [0.956, 1]) and a specificity of 95.8% (95% CI [0.789, 0.999]) compared to radiographs. In 6 cases, there were minor differences regarding a concomitant ulnar buckle. The amount of prior ultrasound training had no influence on the accuracy of Wrist-POCUS for diagnosing distal forearm fractures. All fractures were reliably diagnosed even when captured POCUS images did not meet all quality criteria. Conclusion: Pediatric surgeons and trainees, after minimal training in POCUS, had excellent diagnostic accuracy for distal forearm fractures in children and adolescents using POCUS compared to X-ray. [ABSTRACT FROM AUTHOR]

Skeletal muscle index measurement via dual-energy X-ray absorptiometry or bioelectrical impedance analysis is used to evaluate muscle mass when diagnosing sarcopenia. However, inherent challenges exist with these methods. We previously focused on muscle mass evaluation in the quadriceps femoris by using computed tomography (CT). In this observational study, we utilized a new ultrasound device with a wide field of view that can obtain CT-like images and investigated its usefulness. Reproducibility was investigated by calculating the intra- and inter-examiner intraclass correlation coefficient (ICC) by using three examiners and performing five measurements in 12 participants. In 123 participants (48 men, 75 women, mean age 78.2 ± 8.1 years), we investigated the correlation between the quadriceps cross-sectional area measured with supine ultrasound and CT images as well as between supine and sitting ultrasound images. Unadjusted, age-adjusted, and age–sex-adjusted correlations were calculated. Reproducibility was excellent (intra-examiner ICC[1,1]: 0.978, 0.987, and 0.994; inter-examiner ICC[2,1]: 0.993). The unadjusted, age-adjusted, and age–sex-adjusted correlations between the quadriceps cross-sectional area measured using supine ultrasound and CT were 0.949, 0.940, and 0.894, respectively. For sitting ultrasound, the corresponding values were 0.958, 0.953, and 0.912, respectively. Correlations between the supine and sitting ultrasound measurements were also good, with corresponding values of 0.952, 0.945, and 0.904, respectively. The tested ultrasound device showed excellent measurement reproducibility and had good correlations with CT images. Further studies with an increased numbers of clinical cases and additional evaluations should allow the device to become a screening tool for diagnosing sarcopenia. [ABSTRACT FROM AUTHOR]

This review article describes the roles of ultrasound in assessing thoracic and abdominal infectious diseases, mainly bacterial and parasitic ones that affect farm animals, including cattle, camels, sheep, and goats. Ultrasonography is a non-invasive imaging technique used to diagnose infectious diseases affecting the cardiovascular, respiratory, digestive, urinary, and hepatobiliary systems. In cases of thoracic and abdominal infections, ultrasound typically reveals abnormalities in echogenicity and echotexture, the presence of unusual artifacts, and mass formation exerting pressure on surrounding structures. Inflammatory and degenerative changes within the viscera can be identified ultrasonographically by comparing the echogenicity of affected areas with that of the surrounding normal parenchyma, such as in fascioliasis. Bacterial and parasitic infections often result in capsular mass lesions with anechoic contents, as observed in hydatid cysts and cysticercosis, or varying echogenic contents, as observed in liver abscesses. Effusions within the pericardium, pleura, and peritoneum are common ultrasonographic findings in infectious thoracic and abdominal diseases. However, these effusions’ echogenicity does not always allow for clear differentiation between transudates and exudates. The routine use of ultrasonography in the evaluation of the chest and abdomen in affected or suspected ruminants is highly beneficial for detection, guiding therapeutic decisions, assessing prognosis, and aiding in the eradication of highly contagious diseases that cause significant economic losses. [ABSTRACT FROM AUTHOR]

Objective: To investigate the diagnostic value of ultrasound elastography combined with aspartate aminotransferase to platelet ratio index (APRI), international normalized ratio/platelet ratio (INPR), and four-factor-based liver fibrosis index (FIB-4) for liver fibrosis in patients with autoimmune hepatitis (AIH). Methods: 120 AIH patients who were admitted to our hospital from January 2021 to December 2022 underwent liver biopsy and the patients were divided into significant liver fibrosis group (F2-F4, n=74) and non-significant liver fibrosis group (F0-F1, n=46) according to the Metavir evaluation system, the baseline data, ultrasound elastography shear wave velocity (SWV), FIB-4, APRI and INPR were compared between the two groups. Logistic regression was used to analyze the influencing factors of significant liver fibrosis in AIH patients. The diagnostic value of SWV combined with APRI, INPR and FIB-4 for significant liver fibrosis in AIH patients were evaluated by receiver operating characteristic (ROC) curve. Results: The biopsy results of 120 AIH patients showed that: there were 15 cases (12.50%) in F0 stage, there were 31 cases (25.83%) in F1 stage, there were 35 cases (29.17%) in F2 stage, there were 27 cases (22.50%) in F3 stage, there were 12 cases (10.00%) in F4 stage. Compared with non-significant liver fibrosis group, the INR, SWV, APRI, INPR and FIB-4 values of the patients in the significant liver fibrosis group increased, and the PLT level decreased, with statistically significant differences (P<0.05). Logistic regression analysis showed that, elevated INPR, APRI, FIB-4 and SWV were risk factors for significant liver fibrosis in AIH (P<0.05). The results of ROC curve showed that, the AUC of APRI, INPR, FIB-4 and SWV in diagnosing the degree of liver fibrosis in AIH patients was>0.700, and the combination of the four items had the highest diagnostic efficiency. Conclusion: Ultrasound electrography parameters SWV combined with APRI, INPR and FIB-4 have high diagnostic value for significant liver fibrosis in AIH patients. [ABSTRACT FROM AUTHOR]

Piezoelectric composites have received widespread attentions in the fields of biomedicine and in vitro wearable devices due to their ability to convert mechanical forces into charge signals. The preparation of piezoelectric composites with complex structures through 3D printing technology can not only effectively improve their piezoelectric output, but also enable their customized therapeutic applications. This paper first introduces the types of piezoelectric composites and reviews the 3D printing technology commonly used in their preparation, analyzing the advantages and disadvantages of each 3D printing technology. Then, the state‐of‐the‐art of the biomedical applications of piezoelectric composites, including drug sustained‐release, wound healing promotion, bone tissue cells growth promoting, neurorehabilitation stimulating, ultrasonic diagnosis, and in vivo biosensing and in vitro wearable sensing, are emphasized. Finally, the main factors affecting the applications of 3D printed piezoelectric composites are outlooked, and an in‐depth discussion on the challenges toward 3D printed piezoelectric composites are analyzed. This review is believed to provide some fundamental knowledge of 3D printed piezoelectric composites. [ABSTRACT FROM AUTHOR]

The article discusses the use of transvaginal ultrasound (TVUS) for diagnosing endometriosis. It suggests that a simplified protocol focusing on specific anatomical structures can provide an efficient and accessible method for initial assessment. The authors argue for wider availability of TVUS in community imaging facilities to reduce diagnostic delay and improve quality of life for those with endometriosis. They also emphasize the importance of early diagnosis and propose incorporating endometriosis assessment into routine gynecological ultrasound examinations. However, they caution that a negative scan result does not rule out the possibility of endometriosis and further investigations may be needed. [Extracted from the article]

Background and Aim. Ectopia cordis is a rare congenital anomaly characterized by the heart being located partially or completely outside of the thoracic cavity. Thoracic ectopia cordis is an even rarer form of this anomaly, with only a few reported cases in the literature. The aim of this study was to present the clinical and radiological findings of a patient with thoracic ectopia cordis and discuss the management and outcomes of this rare anomaly. Methods. A 17‐week‐old female neonate with a history of prenatal diagnosis of congenital heart anomaly was admitted to Ayatollah Mousavi Hospital in Zanjan, Iran. For the diagnosis of thoracic ectopia, cordis fetal echocardiography and ultrasonography were performed. Moreover, the noninvasive prenatal testing (NIPT) genetic test performed in the 10th week of pregnancy was evaluated. Results. The neonate was diagnosed with thoracic ectopia cordis, with the heart located outside the thoracic cavity and covered by a thin membrane. The Z scores of the analyzed maternal venous blood chromosomes were between +6 and −6, and all chromosomes had a low risk in terms of the risk of birth defects. The results of this study revealed that genetic test analysis is not enough to diagnose and predict congenital anomalies and defects. Furthermore, the findings showed that the fetus's mother continued to take folic acid after the first 3 months of pregnancy. This can be one of the risk factors involved in causing this heart defect. Conclusion. One of the important results of this study was that the diagnostic findings of ultrasound were normal, but the findings of echocardiography were reported as abnormal. This shows that fetal echocardiography is better than ultrasound imaging in diagnosing ectopia cordis. In addition, it is recommended that pregnant women should avoid taking folic acid after the first trimester of pregnancy. [ABSTRACT FROM AUTHOR]

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]