Acoustic Shadowing Research Articles

Seeing beyond skin deep: High-resolution ultrasound in dermatology-A comprehensive review and future prospects.

High-resolution ultrasound (HRUS), operating at frequencies of 20-25 MHz, is a non-invasive imaging tool that offers dermatologists the ability to visualize structures beneath the skin surface. The objective of this review is to present a comprehensive overview of HRUS applications, emphasising its utility in diagnosing, characterising and managing various dermatological conditions. We undertook a comprehensive literature review on the dermatological application of HRUS across Medline, Embase and Cochrane Library databases, while also incorporating our own clinical experience of over 16 years with the tool. In normal skin, the epidermis and dermis are hyperechoic, and the subcutaneous layer is hypoechoic. Basal cell carcinomas appear hypoechoic with irregular margins, while the presence of hyperechoic inclusion bodies suggests aggressive pathology. Squamous cell carcinomas pose challenges due to acoustic shadow artefacts from the thickened stratum corneum. Melanomas are homogenous hypoechoic lesions, with HRUS used to accurately predict Breslow thickness. HRUS provides dermatologists with a valuable adjunct to traditional clinical examination. Future advancement in image resolution and the standardisation of diagnostic parameters may further expand its utility.

Acoustic shadow zone of the guided wave in a variable thickness plate

This paper calculates the acoustic shadow zone of the guided wave in a variable thickness plate. The variable thickness plate has a wide range of applications in bridges, ships, etc., and the guided wave is often used for its nondestructive testing. The velocity gradient induced by thickness variations will deflect the guided wave towards lower phase velocities. Both frequency and thickness variation play crucial roles in determining the extent of path bending. In particular, the guided wave can undergo reverse propagation at the non-boundary of the plate. This curved propagation path results in an acoustic shadow zone, inaccessible to direct waves. This article calculates and experimentally verifies the curved propagation path of dispersive guided waves. Experiments show that the degree of propagation path bending increases with the increase of frequency in a certain frequency range. On the path that varies along the thickness, the experiment observes an acoustic shadow zone that accounts for nearly 25% of the total path. Additionally, a practical case study involving a guided wave with a curved path is presented. Consideration of the curved path improves the positioning accuracy, offering insights into damage location in variable thickness plates. This research on the propagation path and acoustic shadow zone contributes to advancing the understanding of guided wave propagation characteristics and enhancing their application in nondestructive testing for variable thickness structures.

What Is the Added Value of Carotid CEUS in the Characterization of Atherosclerotic Plaque?

Background and Objectives: Unstable atherosclerotic plaque in the arteries is one of the main risk factors for cerebral ischemia. Duplex ultrasound is a frequently used diagnostic method, but it has some limitations for microvascularization and neovascularization evaluation. The aim of this review was to evaluate the role of the new multiparametric US method-contrast-enhanced ultrasound (CEUS)-in atherosclerotic plaque instability verification. Materials and Methods: Original studies, reviews, and meta-analyses were included in this article. A total of 53 studies were retrieved; 29 were included in this study. Results: Carotid artery CEUS as a part of the multiparametric ultrasound method shows promising results and provides additional characteristics of soft- and high-risk atherosclerotic plaques; it can be advised in clinical practice for patients with carotid artery soft- and high-risk plaques. However, there are some limitations, such as extensive calcinosis with important acoustic shadows in carotid atherosclerotic plaque neovascularization diagnostics by CEUS. The added value of CEUS in the characterization of atherosclerotic plaque is that it indicates regions with high neovascularization and visualizes ulcerations on plaque surfaces, suggestive of increased instability risk.

A modified CEUS risk stratification model for adnexal masses with solid components: prospective multicenter study and risk adjustment.

To evaluate the additional advantages of integrating contrast-enhanced ultrasound (CEUS) into the Ovarian-Adnexal Reporting and Data System (O-RADS) ultrasound (US) for the characterization of adnexal lesions with solid components. This prospective multicenter study recruited women suspected of having adnexal lesions with solid components between September 2021 and December 2022. All patients scheduled for surgery underwent preoperative CEUS and US examinations. The lesions were categorized according to the O-RADS US system, and quantitative CEUS indexes were recorded. Pathological results served as the reference standard. Univariable and multivariable analyses were performed to identify risk factors for malignancy in adnexal lesions with solid components. Receiver operating characteristic (ROC) curve analysis was employed to assess diagnostic performance. A total of 180 lesions in 175 women were included in the study. Among these masses, 80 were malignant and 100 were benign. Multivariable analysis revealed that serum CA-125, the presence of acoustic shadowing, and peak intensity (PI) ratio (PImass/PIuterus) of solid components on CEUS were independently associated with adnexal malignancy. The modified CEUS risk stratification model demonstrated superior diagnostic value in assessing adnexal lesions with solid components compared to O-RADS US (AUC: 0.91 vs 0.78, p < 0.001) and exhibited comparable performance to the Assessment of Different NEoplasias in the adnexa (ADNEX) model (AUC 0.91 vs 0.86, p = 0.07). Our findings underscore the potential value of CEUS as an adjunctive tool for enhancing the precision of diagnostic evaluations of O-RADS US. The promising performance of the modified CEUS risk stratification model suggests its potential to mitigate unnecessary surgeries in the characterization of adnexal lesions with solid components. • The additional value of CEUS to O-RADS US in distinguishing between benign and malignant adnexal lesions with solid components requires further evaluation. • The modified CEUS risk stratification model displayed superior diagnostic value and specificity in characterizing adnexal lesions with solid components when compared to O-RADS US. • The inclusion of CEUS demonstrated potential in reducing the need for unnecessary surgeries in the characterization of adnexal lesions with solid components.

Bilateral Retinal Astrocytic Hamartoma in Patient with Retinitis Pigmentosa: A Case Report

Abstract&#x0D; Introduction : Retinal astrocytic hamartomas (RAH) are benign tumors derived from glial cells. It is usually asymptomatic and detected incidentally during screening patients with visual impairment. The variety of lesions in these tumors poses special challenges in their diagnosis and treatment. Modern imaging methods, including as spectral domain optical coherence tomography (OCT), have substantially increased knowledge of these lesions. The aim of this case report is to report a case of retinal astrocytic hamartoma with retinitis pigmentosa in a male patient.&#x0D; Case Illustration : A 22-year-old man presented with blurred vision with headache for 2 weeks accompanied by floaters, flashes of light and night blindness and the UCVA was 20/100 on both eyes. On fundoscopic examination, we found a well-defined multilobulated lesions with cystic impressions on optic nerve head, arteriolar attenuation, and bone spicule pigmentation in peripheral retina. Ultrasonography examination showed a hyperechoic mass with acoustic shadow on optic nerve head. Optical Coherence Tomography (OCT) showed hyper-reflective intraretinal mass with “moth-eaten pattern”. Electroretinogram's (ERG) patient showed reduction of a-wave and b-wave. Patient then referred to Low Vision and was given glasses.&#x0D; Discussion : Retinal Astrocytic Hamartoma (RAH) is a benign tumor of the astrocytes and found within the nerve fiber layer of the retina. It is associated with certain types of phakomatosis but also in Retinitis Pigmentosa. Retinitis Pigmentosa can cause visual impairment as illustrated in this case.&#x0D; Conclusion : Retinal astrocytic hamartomas of the optic nerve head have been described in patients with retinitis pigmentosa. The tumors can be found anywhere. A comprehensive evaluation and examination are required.

Calcified Sclero-Choroidal Choristomas in Mosaic RASopathies: A Description of a New Imaging Sign

PurposeTo evaluate the imaging and clinical features of unusual calcified lesions seen in the fundus of mosaic RASopathy patients. DesignSingle-center retrospective observational study. SubjectsTen eyes with calcified fundus lesions in 7 mosaic RASopathy patients. MethodsThe lesions were evaluated with fundus photography, oral fundus fluorescein angiography, B-scan ultrasonography, Magnetic Resonance Imaging (MRI), and Computed Tomography (CT) scan where available. Main Outcome MeasuresThe imaging characteristics of calcified fundus lesions were assessed. ResultsWe found seven patients with mosaic RASopathies, 5 males and 2 females (3 with Linear Sebaceous Nevus Syndrome, 3 with Oculoectodermal Syndrome, and 1 with Encephalocraniocutaneous Lipomatosis) with molecular confirmation in 5 cases, all 5 having KRAS-pathogenic variants. Calcified fundus lesions were identified in 10 eyes (bilateral in 3 patients), appearing as slightly elevated, creamy-yellow lesions around or adjacent to the optic nerve, extending supero-nasally; all but two of these lesions involved both the choroid and sclera, with two of them only involving the sclera at the time of examination. One case developed a choroidal neovascular membrane (CNV) necessitating intravitreal bevacizumab injections. All 7 patients had B-scan ultrasonography and the lesion appeared as a hyperechogenic area with an acoustic shadow posteriorly despite reduced gain. Five patients had MRI, and where fundus lesions were present, there was a focal defect in the sclero-choroidal layer. Four patients had a CT scan and all four showed calcifications affecting both the posteromedial sclero-choroid and adjacent medial rectus muscle. Two of these patients had normal eye movements, one had a unilateral fixed adducted eye and a vestigial fibrous medial rectus muscle seen in imaging and intraoperatively, and the fourth had marked exotropia with a right gaze deficit affecting both eyes. ConclusionsWe propose that the lesions seen in this cohort are calcified sclero-choroidal choristomas (CaSCCs) and should be suspected in mosaic RASopathies when creamy-yellow lesions are seen in the fundus. If identified, the possibility of choroidal neovascularization should be considered during follow-up. In all cases where a CT scan was performed, a novel sign of sclero-muscular calcification involving the medial rectus muscle was seen.

Integrating vascularity into the pattern classification of pilomatricomas on ultrasound provides a more competent approach for discriminative evaluation.

Pilomatricoma has various manifestations on color Doppler ultrasound, and a differential diagnosis is challenging. The objective of this study was to investigate which characteristics of skin lesions on color Doppler ultrasound are effective in distinguishing pilomatricoma from epidermoid cyst and dermatofibrosarcoma protuberans. Records of patients with pilomatricomas (n=63), epidermoid cysts (n=76), and dermatofibrosarcoma protuberans (n=19) who underwent color Doppler ultrasound evaluation and surgical excision were reviewed. The anatomical distribution and color Doppler ultrasound characteristics of these lesions were analyzed. The 63 pilomatricomas were categorized into five types based on their color Doppler ultrasound characteristics, and the roles of these five types in the differential diagnosis of the aforementioned diseases were studied. Pilomatricomas, epidermoid cysts, and dermatofibrosarcoma protuberans exhibited some similar characteristics. Dominantly markedly hyperechoic or hyperechoic appearance, posterior acoustic shadowing, and the presence of vascularity were the major characteristics of pilomatricomas. The pilomatricomas could be categorized into five types, with type II having a diagnostic performance of sensitivity of 65.08%, specificity of 98.95%, area under the receiver operating characteristic curve (AUC) of 0.743, positive predictive value of 97.62%, and negative predictive value of 81.03% for the diagnosis of the aforementioned skin diseases. A combination of dominantly markedly hyperechoic or hyperechoic appearance, posterior acoustic shadowing, and the presence of vascularity exhibits higher diagnostic performance for the differential diagnosis of pilomatricomas, epidermoid cysts, and dermatofibrosarcoma protuberans.

Evaluation of lesions requesting biopsy according to imaging findings in breast cancer patients who have undergone breast-conserving surgery

Aims: In patients undergoing breast-conserving surgery (BCS), the traditional follow-up imaging methods of the breast are mammography and ultrasonography. However, after BCS and radiotherapy, it becomes more difficult with imaging methods to detect the presence of recurrence or secondary focus due to the change of normal breast structure in patients. In this study, we aimed to investigate the sensitivity, specificity and malignancy prediction values of imaging methods in the follow-up of patients who underwent BCS. Methods: 421 patients diagnosed with breast cancer who underwent BCS were retrospectively analyzed. 63 patients with histopathology results, which were categorized as BI-RADS 4 or 5 according to imaging findings in their follow-up after BCS, were included in the study. The age of diagnosis, time taken for biopsy and mammography, ultrasonography and magnetic resonance imaging findings were recorded. Patients were divided into 2 groups (benign and malignant) according to the results of biopsy. According to the pathology results, sensitivity, specificity, positive and negative predictive values and diagnostic accuracy levels of radiological imaging findings were calculated. The significance of the difference between pathology groups in terms of mean age of diagnosis and biopsy time was evaluated by Mann-Whitney U test. Categorical variables were assessed by Yates test or Fisher's exact test. Results: Of the 63 patients, 49 (77.7%) were benign and 14 (23.3%) were malignant. There was a significant difference between the two groups in mass finding on mammography and posterior acoustic shadowing on US (p=0.011, p=0.049, respectively). Conclusion: MRI is the most sensitive imaging method in post-BCS follow-up and mammography is the most specificity imaging method. The finding with the highest positive predictive value for malignancy detection is the presence of mass on mammography and posterior acoustic shadow on ultrasonography.

Verification of the Morphofunctional Disorders Level of the Hepatorenal System during the Feline Tripelphosphate Urolithiasis

Introduction. The available information referring to the feline urolithiasis pathogenesis does not fully reflect the nature of changes taking place in the body, because it does not take into account the existing liver-kidney interrelationship. A systemic approach to studying this problem enables development of the targeted diagnostic strategies, increase of the subsequent therapeutic efficacy, as well as reduction of the possible clinical harm of polypragmasia. The aim of this article is to study the interrelationship between the nature of the hepatorenal system morphofunctional disorders and the level of metabolic processes in cats sick with struvite urolithiasis with the signs of cystolithiasis.Materials and Methods. The objects of the research were cats: the 1st experimental group consisted of the outbred female cats with tripelphosphate urolithiasis with signs of cystolithiasis, the 2nd experimental group — outbred castrated male cats with tripelphosphate urolithiasis with signs of cystolithiasis, the control group was mixed of the clinically healthy male and female animals. During the research, the results of the sick animals' clinical study, morphological and biochemical blood serum tests, hepatorenal system transabdominal ultrasonography were used, the urine macroscopic and biochemical examinations as well as urine sediment microscopy were carried out.Results. Against the background of hyperazotemia in sick animals (UREA — 14.70±1.30 mmol/L and 17.05±1.60 mmol/L; CREA — 173.90±6.06 μmol/L and 182.30±7.54 μmol/L; URIC ACID — 69.30±4.50 μmol/L and 73.48±4.83 μmol/L) and water-electrolyte metabolism disorder (Ca+2 — 2.89±0.05 mmol/L and 3.04±0.12 mmol/L; P+3 — 3.12±0.06 mmol/L and 3.20±0.09 mmol/L; iCa+2 — 1.39±0.03 mmol/L and 1.42±0.02 mmol/L; Cl- — 125.58±1.19 mmol/L and 129.90±1.06 mmol/L) there were observed: a disorder in the hepatobiliary system functioning due to elevation of the main hepatic transaminase activity (AST — 41.74±5.35 unit/L and 49.30±6.74 unit/L; ALT — 85.82±6.15 unit/L and 90.05±6.50 unit/L; ALКP — 45.61±3.10 unit/L and 48.16±2.86 unit/L; AAR — 0.49±0.03 and 0.54±0.02), elevation of total bilirubin level (BILT — 5,76±0,15 μmol/L and 6,08±0,24 μmol/L) and bilirubin direct (BILD — 1,40±0,03 μmol/L and 1,62±0,02 μmol/L), as well as elevation of the gamma-glutamyl transpeptidase (GGT — 6,67±1,01 unit/L and 7,90±0,90 unit/L) and lactate dehydrogenase (LDH — 215,47±10,30 unit/L and 219,04±9,27 unit/L) activity level. The acoustic shadowing of the hepatorenal system organs confirmed the signs of acute hepatitis against the background of cystolithiasis due to the existing anatomical relationship between kidneys and liver.Discussion and Conclusion. The results of the sick animals’ blood serum examination indicated the progression of the hematopoietic dysfunction during the tripelphosphate urolithiasis, which contributed to the development of the circulatory tissue hypoxia in the liver-kidney system. The development of the hyperazotemia contributed to the elevation of the main hepatic transaminase activity and building-up of the functional disorders in the hepato-biliary system of sick cats in response to the acute inflammatory process going on in the urogenital tract. The carbohydrate and lipid metabolism disorders indicated the liver metabolic activity disorder and its parenchymal damage on the background of urolithiasis. The electrolyte and water metabolism disorders, the development of the hyperproteinemia in test cats with the tripelphosphate urolithiasis contributed to the damage of the hepatorenal system organs due to development of the compensated metabolic acidosis and hyperchloremia.

Spatiotemporal Deep Learning-Based Cine Loop Quality Filter for Handheld Point-of-Care Echocardiography.

The reliability of automated image interpretation of point-of-care (POC) echocardiography scans depends on the quality of the acquired ultrasound data. This work reports on the development and validation of spatiotemporal deep learning models to assess the suitability of input ultrasound cine loops collected using a handheld echocardiography device for processing by an automated quantification algorithm (e.g. ejection fraction estimation). POC echocardiograms (n=885 DICOM cine loops from 175 patients) from two sites were collected using a handheld ultrasound device and annotated for image quality at the frame-level. Attributes of high-quality frames for left ventricular (LV) quantification included a temporally-stable LV, reasonable coverage of LV borders, and good contrast between the borders and chamber. Attributes of low-quality frames included temporal instability of the LV and/or imaging artifacts (e.g., lack of contrast, haze, reverberation, acoustic shadowing). Three different neural network architectures were investigated - (a) frame-level convolutional neural network (CNN) which operates on individual echo frames (VectorCNN), (b) single-stream sequence-level CNN which operates on a sequence of echo frames (VectorCNN+LSTM) and (c) two-stream sequence-level CNNs which operate on a sequence of echo and optical flow frames (VectorCNN+LSTM+Average, VectorCNN+LSTM+MinMax, and VectorCNN+LSTM+ConvPool). Evaluation on a sequestered test dataset containing 76 DICOM cine loops with 16,914 frames showed that VectorCNN+LSTM can effectively utilize both spatial and temporal information to regress the quality of an input frame (accuracy: 0.925, sensitivity = 0.860, specificity = 0.952), compared to the frame-level VectorCNN that only utilizes spatial information in that frame (accuracy: 0.903, sensitivity = 0.791, specificity = 0.949). Furthermore, an independent sample t-test indicated that the cine loops classified to be of adequate quality by the VectorCNN+LSTM model had a statistically significant lower bias in the automatically estimated EF (mean bias = - 3.73 ± 7.46 %, versus a clinically obtained reference EF) compared to the loops classified as inadequate (mean bias = -15.92 ± 12.17 %) (p = 0.007). Thus, cine loop stratification using the proposed spatiotemporal CNN model improves the reliability of automated point-of-care echocardiography image interpretation.

Características anatômicas e ultrassonográficas dos abscessos testiculares e microlitíase testicular: um estudo de caso de cinco carneiros cazaques

ABSTRACT Anatomical and ultrasonographic diagnostic work-up of testicular abscesses (n = 2) and testicular microlithiasis (n = 3) in Kazakh rams is described. For testicular abscesses, the localized symptoms include enlargement of the testicle and decreased elasticity, accompanied by varying degrees of pain and fever, abnormal behavior, walking or urinating with legs spread apart and accompanied by painful moans. Ultrasound findings: several hypoechoic or fluid dark areas with irregular morphology appear within the testicular parenchyma, with unclear borders with the surrounding normal tissues and uneven internal echogenicity. An autopsy revealed unilateral caseous necrosis with degeneration of all testicular tissues. Testicular microlithiasis does not present clinically and normal semen quality is not affected. Ultrasound findings: sparse, scattered, or dense punctate, pinpoint-like echogenic dots, some with comet tail signs and no acoustic shadow, are seen in the testicular parenchyma. The routine treatment for testicular abscesses is surgical drainage, but when degeneration and necrosis of testicular tissue occur, leading to severe systemic symptoms, the animal must be put down. Testicular microlithiasis is relatively rare and there are no effective treatments or interventions available, but it remains a potential contributor to testicular dysfunction and other secondary conditions.

Comparison of pre-mortem 2D-3D ultrasound examination to post-mortem micro-CT of carotid arteries - first experiences.

<p>A prerequisite for the treatment of carotid atherosclerosis is the accurate measurement of the stenosis, that is most commonly evaluated by duplex ultrasonography. In this study, we aimed to verify the reliability of 2D and 3D ultrasonography, comparing the data to results of post-mortem micro-CT examination.</p>. <p>Neurological patients with any life-threatening, presumably fatal neurological disease were enrolled. Ultrasound examinations were performed with a Philips Epiq 5G machine, using a VL13-5 broadband linear volume array transducer. Plaque length, diameter and vessel area reduction (stenosis) were calculated using the 2D images. Finally, the stenosis was reassessed using automatized, 3D application as well. After the death of the patient, autopsy was performed, during which the previously examined carotid artery was removed. The samples were examined with micro-CT. Similar to the ultrasound examination, plaque length, diameter and vessel area reduction (stenosis) were determined.</p>. <p>Ten vessels of seven patients were eligible for complex comparison. Plaque diameter and length measured by CT did not correlate with the ultrasound data. CT-measured axial plaque and vessel areas showed no correlation with ultrasound results either. While determining the strength of correlation between stenoses measured by the different modalities, significant correlation was found between the results measured by ultrasound (2D) and CT (Pearson r: 0.902, P&lt;0.001).</p>. <p>Three-dimensional ultrasound analysis is a spectacular method for examining carotid plaques, as it can assist in a more detailed evaluation of the plaque morphology and composition, thereby identifying plaques with a particularly high risk of stroke. Micro-CT is an excellent tool for the exact determination of calcified plaque areas, but ultrasound images are not suitable yet for such a precise examination due to acoustic shadowing and artifacts.</p>.

Fetal growth analysis from ultrasound videos based on different biometrics using optimal segmentation and hybrid classifier.

Birth defects and their associated deaths, high health and financial costs of maternal care and associated morbidity are major contributors to infant mortality. If permitted by law, prenatal diagnosis allows for intrauterine care, more complicated hospital deliveries, and termination of pregnancy. During pregnancy, a set of measurements is commonly used to monitor the fetal health, including fetal head circumference, crown-rump length, abdominal circumference, and femur length. Because of the intricate interactions between the biological tissues and the US waves mother and fetus, analyzing fetal US images from a specialized perspective is difficult. Artifacts include acoustic shadows, speckle noise, motion blur, and missing borders. The fetus moves quickly, body structures close, and the weeks of pregnancy vary greatly. In this work, we propose a fetal growth analysis through US image of head circumference biometry using optimal segmentation and hybrid classifier. First, we introduce a hybrid whale with oppositional fruit fly optimization (WOFF) algorithm for optimal segmentation of segment fetal head which improves the detection accuracy. Next, an improved U-Net design is utilized for the hidden feature (head circumference biometry) extraction which extracts features from the segmented extraction. Then, we design a modified Boosting arithmetic optimization (MBAO) algorithm for feature optimization to selects optimal best features among multiple features for the reduction of data dimensionality issues. Furthermore, a hybrid deep learning technique called bi-directional LSTM with convolutional neural network (B-LSTM-CNN) for fetal growth analysis to compute the fetus growth and health. Finally, we validate our proposed method through the open benchmark datasets are HC18 (Ultrasound image) and oxford university research archive (ORA-data) (Ultrasound video frames). We compared the simulation results of our proposed algorithm with the existing state-of-art techniques in terms of various metrics.

Categorization of fibroepithelial breast tumors according to ultrasound BI-RADS classification

Among breast masses, the most common are fibroadenomas (FA), which belongs to the group of a fibroepithelial tumors. Simple pericanalicular FA ordinarily shows the ultrasound signs of a benign mass. Long-standing pericanalicular FA and intracanalicular FA as they grow acquire some ultrasound features uncommon for benign lesions, which requires differential diagnosis with malignant breast masses. The group of fibroepithelial breast tumors also includes phyllodes tumors with frequency of malignant variants of 20–30%. Differential diagnosis of phyllodes tumor and fibroadenomas is difficult, due to the lack of the clear radiologic diagnostic criteria (incl. ultrasound). All breast masses that shows suspicious or atypical features should be selected for biopsy, with the use of BI-RADS classification for the biopsy need indication.Objective: to reveal the rules for fibroepithelial breast tumors categorization according to BI-RADS depending on the ultrasound features.Material and methods. A total of 86 breast masses in 79 women were assessed by ultrasound in B-mode and Color Doppler (CDI). Of these, 22 masses in 15 women showed the typical ultrasound pattern of FA up to 2.0 cm in size with no necessary of morphological evaluation (the average age of the patients was 24.2 ± 5.1 years). Surgery performed for 64 lesions ≥2.0 cm in size, postsurgery morphological examination revealed pericanalicular FA – 38, intracanalicular FA –19 and phyllodes tumors (benign) – 7.Results. The majority of atypical pericanalicular FA (84.2%) were categorized as BI-RADS 4а (a low risk of cancer), 94.7% of intracanalicular fibroadenomas and all phyllodes tumors – as BI-RADS 4b and BI-RADS 4c (а high risk of cancer). The identification of suspicious ultrasound signs led to an increase in the BI-RADS category with indications to the morphological evaluation of the mass.Conclusion. As the suspicious ultrasound signs in B-mode should be considered the irregular shape and borders, vertical orientation and inhomogeneous acoustic shadowing in the absence of macrocalcifications, in Color Doppler – diffuse or focal mass hypervascularity or abnormal vascular pattern. The atypical ultrasound pattern commonly presents in large breast fibroadenomas (&gt;3.0 cm in size), requires differential diagnosis with phyllodes tumors and breast cancer and indicates the need of morphological evaluation and categorizing them as not lower than BI-RADS4.

CHOROIDAL OSTEOMA IN AN INFANT

Purpose: To describe a case of choroidal osteoma with macular involvement in an infant that was treated with transpupillary thermotherapy. Methods: A case report. Results: An 11-month-old infant presented for retinopathy of prematurity follow up examination and was found to have a three disc-diameter round, orange, subretinal, slightly elevated lesion with well-defined margins in the superior macula of the left eye. B-scan ultrasonography showed a slightly elevated, highly reflective choroidal mass with acoustic shadowing. A diagnosis of choroidal osteoma was made. Six months later, repeat examination under anesthesia (EUA) showed the lesion to be increasing in size and encroaching on the fovea. Given demonstrated growth and the risk of central vision loss, the patient was treated with transpupillary thermotherapy (TTT). Subsequent EUAs, over a period of four months, have shown complete decalcification with no subsequent growth. Conclusion: Choroidal osteomas are benign lesions that can be sight threatening if located in the macula. TTT in this case resulted in complete regression of a sight threatening extrafoveal choroidal osteoma at four month follow up.

Prediction model of adnexal masses with complex ultrasound morphology.

Based on the ovarian-adnexal reporting and data system (O-RADS), we constructed a nomogram model to predict the malignancy potential of adnexal masses with sophisticated ultrasound morphology. In a multicenter retrospective study, a total of 430 subjects with masses were collected in the adnexal region through an electronic medical record system at the Fourth Hospital of Harbin Medical University during the period of January 2019-April 2023. A total of 157 subjects were included in the exception validation cohort from Harbin Medical University Tumor Hospital. The pathological tumor findings were invoked as the gold standard to classify the subjects into benign and malignant groups. All patients were randomly allocated to the validation set and training set in a ratio of 7:3. A stepwise regression analysis was utilized for filtering variables. Logistic regression was conducted to construct a nomogram prediction model, which was further validated in the training set. The forest plot, C-index, calibration curve, and clinical decision curve were utilized to verify the model and assess its accuracy and validity, which were further compared with existing adnexal lesion models (O-RADS US) and assessments of different types of neoplasia in the adnexa (ADNEX). Four predictors as independent risk factors for malignancy were followed in the preparation of the diagnostic model: O-RADS classification, HE4 level, acoustic shadow, and protrusion blood flow score (all p < 0.05). The model showed moderate predictive power in the training set with a C-index of 0.959 (95%CI: 0.940-0.977), 0.929 (95%CI: 0.884-0.974) in the validation set, and 0.892 (95%CI: 0.843-0.940) in the external validation set. It showed that the predicted consequences of the nomogram agreed well with the actual results of the calibration curve, and the novel nomogram was clinically beneficial in decision curve analysis. The risk of the nomogram of adnexal masses with complex ultrasound morphology contained four characteristics that showed a suitable predictive ability and provided better risk stratification. Its diagnostic performance significantly exceeded that of the ADNEX model and O-RADS US, and its screening performance was essentially equivalent to that of the ADNEX model and O-RADS US classification.

The Impact of Side-Scan Sonar Resolution and Acoustic Shadow Phenomenon on the Quality of Sonar Imagery and Data Interpretation Capabilities

Side-scan sonar is designed and used for a variety of survey work, in both military and civilian fields. These systems provide acoustic imageries that play a significant role in a variety of marine and inland applications. For this reason, it is extremely important that the recorded sonar image is characterized by high resolution, detail and sharpness. This article is mainly aimed at the demonstration of the impact of side-scan sonar resolution on the imaging quality. The article also presents the importance of acoustic shadow in the process of analyzing sonar data and identifying underwater objects. The real measurements were carried out using two independent survey systems: hull-mounted sonar and towed side-scan sonar. Six different shipwrecks lying in the Baltic Sea were selected as the objects of research. The results presented in the article also constitute evidence of how the sonar technology has changed over time. The survey findings show that by maintaining the appropriate operational conditions and meeting several requirements, it is possible to obtain photographic-quality sonar images, which may be crucial in the process of data interpretation and shipwreck identification.

Diffractors on a low screen: a valid alternative for conventional noise screens along multi lane motorways?

Diffractors are an innovative way of shielding noise from e.g. motorways by bending the propagation direction of sound waves upwards and hence creating an acoustic shadow area along the road. The bending upwards is done by the interaction of the road noise with a series of slits, all parallel to the road but with varying depths for varying resonance frequencies. This principle has been invented about 10 years ago and has since then been tested with temporary and permanent constructions. The slits can be integrated in the ground, but can also be put on a low (0,5 - 1 m) screen for enhancing the performance at short distance. The Belgian Road Research Centre has carried out several measurement campaigns at different diffractor set ups on low screens. The measurements were of the "Controlled Pass-By" type yielding consistent results. An overview is given of the findings since the first measurement, including the new results obtained along a ring road in the Dutch town of Amersfoort in 2022, where for the first time such a device was constructed along a 2 x 2 lane, showing the performance in case the noise source is at a larger distance from the diffractor.

Twinkle Artifact Observed During POCUS of a Human Myiasis Caused by the Dermatobia hominis Botfly

An 81-year-old man presented to urgent care for assessment of an area of erythema and tenderness on his right thigh after recent travel to Belize. Point of care ultrasound (POCUS) revealed a hyperechoic structure with acoustic shadowing in the subcutaneous tissue. Colour Doppler assessment of the structure produced a twinkle artifact. The structure was removed and pathology identified the object as a Dermatobia hominis larva (human botfly). The use of POCUS helped identify and localize the subcutaneous foreign body. The use of colour Doppler produced the twinkle artifact, which has not been previously reported as a finding produced during ultrasonographic assessment of botfly larvae.

Ultrasound imaging of onychopapilloma: Evaluation of 43 cases

IntroductionOnychopapilloma is a benign tumor presenting as an isolated benign warty distal matrix and bed lesion in association with longitudinal erythronychia for which no underlying cause can be identified. Diagnosis might be challenging due to other, more severe, causes of erythronychia. ObjectivesThis study aimed to investigate the clinical and sonographic features of onychopapilloma using high-frequency ultrasound. MethodsBetween February 2022 and May 2023, a cross-sectional study was conducted, involving 39 patients displaying clinical features suggestive of onychopapilloma. These patients were selected at random and underwent examination using high-frequency ultrasound. High-frequency ultrasound assessments of the nail unit were carried out using 33 MHz and 24 MHz high-frequency linear transducers. An experienced radiologist performed the ultrasound scans while participants assumed an orthostatic seated position. Subsequently, the collected ultrasound images were independently evaluated by two radiologists specializing in nail injuries, ensuring a blinded assessment. This evaluation aimed to provide comprehensive insights into the imaging characteristics of onychopapilloma. ResultsHigh-frequency ultrasound revealed oval or linear hyperechoic masses located in the middle of the nail plate, without vascularity or posterior acoustic shadowing. Nail plate irregularity, thickening, and nail bed indentation were observed in some cases. These findings demonstrate that high-frequency ultrasound can aid in the diagnosis and surgical planning of onychopapilloma, providing detailed visualization of the lesion and surrounding structures. ConclusionsThis imaging method could represent a potential tool to differentiate onychopapilloma from other nail conditions, especially malignant neoplasms. However, further research is needed to validate these findings and assess long-term outcomes.