AimAim of the study was to differentiate solid liver lesions according to their microvascularization. Therefore, we analyzed perfusion using time intensity curves (TIC) measured during contrast-enhanced intraoperative ultrasound (CE-IOUS).Material and MethodsData of 40 patients who underwent hepatic surgery with the diagnosis of hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (CCC), or liver metastases (LM) were retrospectively collected. CE-IOUS was performed using a linear multifrequency T-probe connected to a high-resolution device. Digital Imaging and Communications in Medicine (DICOM) loops were recorded, and TIC were analyzed for time to peak (TTP) and area under the curve (AUC) in tumor center, margin and reference tissue.ResultsAnalyses of the tumor center revealed significant higher AUC in HCC lesions than in CCC (p = 0.0310). HCC patients also showed longer TTP in reference tissue compared to CCC (p = 0.0251). Within the HCC cohort, TTP was shorter at tumor margins compared to reference tissue (p = 0.0420). For LM, AUC measured at tumor margins was higher than in center and reference tissue (pcenter-margin = 0.0266, pmargin-reference = 0.0064).ConclusionTIC analysis of solid liver lesions during CE-IOUS revealed significant differences in their microvascularization, improving, intraoperative differentiation. Artificial intelligence tools may enhance IOUS in the future by standardization and motion compensation.

The rheological properties of blood are influenced by red blood cell (RBC) mechanics and cell-cell aggregates, which yield important clinical information; however, measurement of rheological parameters is often not possible at phlebotomy-sites. We investigated the effect of short-term storage on the stability of RBC aggregation and deformability. Blood was obtained from apparently healthy volunteers and anticoagulated with lithium heparin or ethylenediaminetetraacetic acid (EDTA). Samples were stored either at ambient (22 °C) or cold (4 °C) temperature for up to 48 h. Aggregation and deformability were measured utilising light transmission and laser backscatter methods, and laser diffractometry, respectively. EDTA significantly lowered aggregation when compared with heparin-anticoagulated blood. During ambient temperature storage, EDTA preserved baseline RBC aggregation for up to 4 h, while lithium heparin-anticoagulated blood showed significant changes within 1 h. Deformability was altered after 8 h of storage, irrespective of anticoagulant. Cold storage extended stability most effectively in EDTA. It remains that EDTA should be the anticoagulant of choice to preserve blood physical properties. Even short-term storage of blood has a remarkable impact on physical properties; when unavoidable, however, EDTA blood should be stored at 4 °C for same day testing without negative effect.

BackgroundSteatosis hepatis is of outstanding clinical importance. The aim of this study was to apply the new parametric method "Ultrasound Derived Fat Fraction" (UDFF) to monitor changes of liver fat in obese patients undergoing weight loss measures.MethodsIn 53 obese patients BMI, absolute body fat, waist circumference and UDFF were measured before and after a three-month weight loss intervention. UDFF measurements were performed using a Siemens ultrasound system (DAX, 1.0-3.5 Mz). We analysed the correlation of change in BMI (≥-1 vs < -1), body fat (≥-2 kg vs < -2 kg) and waist circumference (≥-10 cm vs < -10 cm) with the change in UDFF (≥-30% vs < -30%) (significance level: p < 0.0167).ResultsAt baseline, mean BMI was 39.2 (range: 29.8-63.6), body fat 51.3 kg (range: 29.9-111.7), waist circumference 120.2 cm (range: 95-164) and UDFF 26% (range: 7-41%). 54.7% of patients lost at least 2 kg of body fat. These patients were significantly more likely to have a reduction in UDFF of at least 30% (≥2 kg fat: 58.6% vs. < 2 kg fat: 20.8%; p = 0.011). For BMI and waist circumference changes no significant correlation with UDFF was observed.ConclusionThis study underlines that UDFF could be a promising, non-invasive tool to monitor changes in liver fat.

ObjectiveTo explore the preoperative predictive efficacy of multimodal ultrasound based on microflow imaging(MFI) in Glypican-3(GPC-3) in hepatocellular carcinoma(HCC).MethodsThe general data and ultrasonographic data of patients with HCC confirmed by histopathology and hepatectomy from January 2019 to June 2023 were analyzed retrospectively. According to the gold standard of postoperative pathology, the patients were divided into GPC-3 positive group and GPC-3 negative group. Through analyze the correlation between multimodal ultrasound features and GPC-3, to determine the independent predictors of GPC-3, and to further analyze the preoperative predictive efficiency of Two-dimensional ultrasound(2D-US), contrast-enhanced ultrasound(CEUS) and microflow imaging(MFI) for GPC-3 of HCC.ResultsA total of 102 patients were enrolled in this study, including 60 GPC-3 positive patients(58.8%) and 42 GPC-3 negative patients(41.2%). Through univariate and multivariate analysis, it was found that there were significant differences in diameter(95%CI: 1.080-7.741, P = 0.034), start washout time(95%CI: 0.105-0.694, P = 0.007) and CEUS-MFI(95%CI: 1.180-4.553, P = 0.015) between the two groups, which were independent predictors of GPC-3 positive occurrence. The prediction efficiency of multimodal ultrasound combined with GPC-3 for HCC is better than that of single mode(P<0.05).ConclusionThe feasibility of multimodal ultrasound in predicting GPC-3 of HCC before operation is confirmed.

ObjectivesThis study investigated haemorheological alterations in patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE).MethodsA total of 136 individuals were enrolled, comprising 52 healthy controls, 51 RA patients, and 33 SLE patients. Blood samples were collected at the University of Health Sciences Sultan Abdulhamid Han Training and Research Hospital in Istanbul, Türkiye. Whole blood and plasma viscosity, along with red blood cell (RBC) deformability and aggregation, were analysed using a Brookfield viscometer and a laser-assisted optical rotational cell analyser (LORRCA).ResultsRBC deformability was reduced in both patient groups compared to controls (EImax: RA 0.645, SLE 0.642, control 0.648), while RBC aggregation was markedly increased (AI: RA 75.66, SLE 74.73, control 65.5) (p < 0.05). Plasma and whole blood viscosity were also elevated in RA and SLE groups, with the highest values observed in SLE patients (PV: RA 1.43, SLE 1.48, control 1.31).ConclusionsRA and SLE patients show notable impairments in haemorheological parameters. Evaluating RBC deformability, aggregation, and plasma viscosity may help clarify disease mechanisms and guide therapeutic strategies to mitigate vascular complications and tissue damage in autoimmune disorders.

ObjectiveCervical tuberculous lymphadenitis (CTBL) and cervical lymph node metastasis (CLNM) share similar imaging characteristics, making differentiation challenging. This study aims to evaluate the clinical utility of a multimodal radiomics model combining grayscale ultrasound (GUS), elastography ultrasound (EUS), and contrast-enhanced ultrasound (CEUS) for distinguishing CTBL from CLNM.MethodsA high-quality dataset comprising 203 cases of CTBL was used to train and test the radiomics models. The performance of single-modal (GUS, EUS, CEUS) and combined models was compared using AUC, sensitivity, specificity, and accuracy metrics. An independent test set of 45 cases was included for validation.ResultsThe combined GUS + EUS + CEUS model outperformed single-modal models, achieving AUCs of 0.894, 0.832, and 0.919 in the training, validation, and test sets, respectively. Its diagnostic performance was comparable to a clinical model in validation and test sets, demonstrating superior generalizability and robustness. Wavelet features accounted for all selected features, enhancing the model's discrimination ability.ConclusionsThe integration of three ultrasound modalities captures multidimensional imaging features, reducing reliance on subjective interpretation. This multimodal radiomics approach provides a standardized diagnostic tool with significant clinical potential, particularly for less experienced physicians. Further validation with diverse datasets is needed to confirm its utility.

PurposeTo explore the ultrasound features and the diagnostic values of CEUS LI-RADS and World Federation for Ultrasound in Medicine (WFUMB) - European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) criteria in serum biomarker negative hepatocellular carcinoma (HCC) and colorectal cancer liver metastasis (CRLM).MethodsA total of 161 patients with pathologically diagnosed alpha-fetoprotein (AFP)-negative HCC and carcinoembryonic antigen (CEA)-negative CRLM were retrospectively enrolled, including 101 HCC patients and 60 CRLM patients. The clinical characteristics and ultrasound characteristics of all cases were analyzed and lesions were categorized via two criteria.ResultsThe rate of HBV infection in HCC patients was higher than CRLM patients (P < 0.001). For the liver parenchyma, the rate of liver cirrhosis and liver steatosis in HCC patients were both higher than CRLM patients (P < 0.001 and P = 0.048, respectively). On CEUS, HCC lesions depicted higher rate of arterial phase hyperenhancement (APHE), mild washout and later wash-out onset, while rim-hyperenhancement, marked washout and earlier wash-out onset were more frequently observed in CRLM lesions. For diagnosing HCC, the sensitivity, specificity and accuracy of CEUS LR-5 were 55.4%, 93.3% and 69.6%, respectively, and of WFUMB-EFSUMB criteria were 87.1%, 73.3% and 82.0%, respectively. For diagnosing CRLM, the sensitivity, specificity and accuracy of CEUS LR-M were 100.0%, 63.4% and 77.0%, respectively, and of WFUMB-EFSUMB criteria were 76.7%, 94.1% and 87.6%, respectively.ConclusionIn patients with serum biomarker negative HCC and CRLM, both CEUS LI-RADS and WFUMB-EFSUMB criteria have each advantages and have high application value.

The occurrence of Raynaud's phenomenon in patients with multiple sclerosis (MS) is infrequently documented in the literature. Some cases have been attributed to interferon-β therapy, while others have emerged in MS patients who sub-sequently developed Raynaud's phenomenon and/or systemic sclerosis. The association between microangiopathic damage and both Raynaud's phenomenon and systemic sclerosis is well-established, leading to the adoption of nailfold video-capillaroscopy (NVC) as a non invasive diagnostic tool for the initial clinical assessment of these conditions. We present a case study of a 42-year-old female patient with Raynaud's phenomenon in MS. The patient underwent NVC in 2023 showing microvascular impairment and after one year and Natalizumab treatment she repeated NVC evaluation with significant improvement in previous microangiopathic changes. A comprehensive literature review regarding the relationship between MS and Raynaud's phenomenon was conducted using electronic databases (PUBMED, UpToDate, Google Scholar, ResearchGate), along with manual searches for relevant articles published up to December 2024. This case highlights the potential utility of NVC in the ongoing evaluation of microangiopathic damage in MS patients exhibiting Raynaud's phenomenon. By elucidating the overlap between these conditions, NVC may serve as a valuable tool in the clinical management of affected individuals.