Abstract Background Non-alcoholic fatty liver disease (NAFLD) is one of the most common causes of elevated liver enzymes encountered in the practice of hepatology and an important predisposing factor for chronic liver disease. Fatty infiltration of the liver parenchyma occurs with variable degrees in NAFLD, ranging from simple hepatic steatosis up to cirrhosis, and hepatocellular carcinoma. Purpose The rationale behind the study is to evaluate and compare the hepatic hemodynamic indices measured by ultrasound and Color Doppler to the different quantified degrees of fibrosis and steatosis measured by transient elastography. Results In this cross-sectional study, twenty-eight females (70%) and twelve males (30%) with NAFLD were involved. Fatty liver severity was graded by sonography (sonography steatosis grade) and FibroScan® (S score), and liver fibrosis was graded through FibroScan® (F stage). Changes to the portal, hepatic, and splenic veins were evaluated by color Doppler. A significant association between sonography steatosis grade and F stages ( p < 0.001) was revealed. In addition, a significant association existed between the sonography steatosis grade and the S score ( p < 0.001). Among Color Doppler findings, there were statistically significant differences in mean portal vein resistivity index (RI) among the S score ( p = 0.007) and the sonography steatosis grades ( p = 0.005), and in mean splenic vein RI among the F stages ( p = 0.021) . Conclusion Color Doppler ultrasonography and hepatic transient elastography complement each other in understanding the degree of hepatic parenchymatous and hemodynamic changes, offering useful insights about the severity of the disease, which likely has valuable clinical implications in terms of treatment and follow-up.

Accurate preoperative mapping of skin-paddle perforators is vital for osteocutaneous fibula free flap (FFF) success. While hand-held Doppler (HHD) is widely used for its convenience, its performance compared to color Doppler ultrasound (CDU) in FFF planning remains uncertain. In this prospective study, 50 consecutive patients undergoing fibula free flap reconstruction after head and neck cancer resection were evaluated. Each patient underwent HHD and CDU mapping on the day before surgery. Perforator skin-surface location, anatomical type (septocutaneous vs. musculoseptocutaneous), peak systolic velocity, and source vessel (peroneal vs. posterior tibial) were recorded. Mapping marks were concealed between examinations. A total of 185 perforators were confirmed intraoperatively (mean 3.7 per limb). CDU identified 179 candidates, yielding 95% sensitivity, 92% specificity, and 94% accuracy. HHD detected 155 sites, achieving 59% sensitivity, 6% specificity, and 48% accuracy, with significantly more false positives and negatives (p < 0.001). Both overall and dominant perforators clustered in the fourth decile of the lower leg (counting from lateral malleolus to fibular head). Distal regions were dominated by septocutaneous vessels, while musculoseptocutaneous types were more common in proximal regions. Anatomical variants-perforators draining into posterior tibial instead of peroneal vessels-occurred in 8% of cases and were identified exclusively by CDU. CDU outperforms HHD for preoperative perforator mapping in osteocutaneous FFF, combining high spatial precision with reliable hemodynamic assessment and variant detection. Incorporation of CDU into routine surgical planning promises to enhance flap design accuracy and minimize intraoperative uncertainty.

Association between ureteral jet angle by color Doppler ultrasonography and the clinical outcomes of vesicoureteral reflux.

Papillary thyroid carcinoma (PTC) is the predominant type of malignant thyroid tumor, with its incidence steadily rising in recent years. Timely diagnosis and intervention are crucial for minimizing metastasis and improving survival rates. This study aims to investigate miR-485-3p's diagnostic potential for PTC and its role in malignant progression, offering a novel biomarker for PTC. This study enrolled 150 benign thyroid nodule (BTN) patients and 200 PTC patients. All participants underwent color Doppler ultrasound (CDUS) to measure relevant parameters (RI, PI, and PSV). Serum miR-485-3p levels were quantified using RT-qPCR. ROC analysis was conducted to estimate the diagnostic efficacy of CDUS parameters and miR-485-3p. Functional experiments were performed to investigate the role of miR-485-3p in PTC cells. Additionally, dual-luciferase reporter assays were utilized to validate the direct targeting relationship between miR-485-3p and GCNT4. Elevated CDUS parameters could differentiate between patients with PTC and BTN. Serum miR-485-3p levels were markedly enhanced in PTC patients. The combination of miR-485-3p and CDUS parameters demonstrated superior diagnostic performance for PTC (AUC = 0.926), with sensitivity and specificity of 0.870 and 0.847. Inhibition of miR-485-3p remarkably suppressed the proliferative, migratory, and invasive capacities of PTC cells. Furthermore, mechanistic investigations revealed that miR-485-3p directly regulates GCNT4 expression, thereby modulating the malignant behavior of PTC cells. Preliminary results indicate that the biomarker panel combining serum miR-485-3p levels with CDUS parameters shows diagnostic potential for PTC. Invitro experiments confirmed the potential of the miR-485-3p/GCNT4 axis in modulating the malignant behavior of PTC cells.

To characterize the multiparametric ultrasound (MPUS) features of testicular sarcoidosis, incorporating greyscale, color Doppler ultrasound (CDUS), contrast-enhanced ultrasound (CEUS), and strain elastography (SE), and to assess their collective diagnostic value. A retrospective review of our institutional ultrasound database identified patients with testicular lesions and a confirmed diagnosis of sarcoidosis (via histopathology or established clinical criteria) between May 2009 and June 2025. All patients underwent a standardized scrotal MPUS protocol. Lesion characteristics on greyscale, vascularity on CDUS and CEUS, and tissue stiffness on SE were systematically analyzed. Seventeen patients (mean age: 42.1 ± 12.4 years) were included. The MPUS pattern was consistent. On grayscale, all lesions were small, solid (mean largest diameter: 4.3 ± 1.8 mm), hypoechoic, and well-defined. Lesions were multifocal (76.5%) and bilateral (52.9%). CDUS showed absent (47.1%) or low (35.3%) internal vascularity. CEUS demonstrated no enhancement in 62.5% of lesions. SE indicated intermediate (53.3%) or soft (26.7%) tissue elasticity. Follow-up ultrasound demonstrated temporal stability in 76.5% of lesions. Testicular sarcoidosis exhibited a suggestive MPUS signature characterized by small, hypoechoic, solid, hypovascular, and stable lesions, often with soft or intermediate elasticity. Recognition of this pattern in the appropriate clinical context can strongly suggest this rare benign diagnosis, guiding conservative management and preventing unnecessary orchidectomy.

ABSTRACT Objectives Pediatric testicular torsion (TT) requires emergency surgical intervention to prevent testicular loss. This study aimed to examine clinical and laboratory parameters that predict intraoperative orchidectomy and testicular atrophy (TA) at one-year follow-up, with a focus on symptom duration and inflammatory biomarkers. Materials and methods A retrospective cohort study included 90 pediatric patients ( < 18 years) who underwent surgical exploration for TT. Clinical predictors included age, symptom duration, scrotal findings (pain, swelling, redness, high-riding testis), and preoperative preparation time. Laboratory parameters included leukocyte count, platelet count, mean platelet volume (MPV), and C-reactive protein (CRP). Testicular vascularization (normal vs. pathologic) was assessed preoperatively at presentation using color Doppler ultrasound (CDUS). Outcomes were orchiectomy or orchiopexy, and testicular atrophy (≥80% volume loss) at one-year follow-up. Multivariate logistic regression was used to identify independent predictors of testicular loss. Results Forty patients underwent orchidectomy, and 50 underwent orchidopexy. Among those treated with orchidopexy, TS at one-year follow-up was achieved in 36 patients (72%). Age and type of vascularization were significantly different between patients from the orchidectomy and orchidopexy groups. There was a notably larger number of patients experiencing scrotal redness, swelling, or hardness in the orchidectomy group in comparison to the orchidopexy group. CRP was significantly higher in the orchidectomy group (p = 0.002). Multiple logistic regression indicated considerably increased odds ratios of orchidectomy with symptom duration > 12 hours, younger age, longer preoperative preparation times, and elevated CRP. Conclusion Delayed presentation ( > 12 hours), younger age, elevated CRP, and longer preoperative preparation time were identified as the strongest predictors of orchidectomy and subsequent testicular atrophy. Symptom duration remained the most critical determinant of failed testicular salvage. These findings highlight the importance of timely recognition and prompt surgical management to optimize outcomes in pediatric testicular torsion.

To evaluate for the first time a combination of novel colour Doppler ultrasound (CDUS), greyscale (GSUS) and oscillometric indices of angiopathy in patients with autoinflammatory syndromes (AIS). Further, to explore the associations between these markers and patient- and disease-related characteristics, as well as traditional cardiovascular (CV) risk factors. CDUS was used to assess arterial compliance markers, such as resistance index, pulsatility index (PI) and flow-velocity integral (FVI) in the common carotid artery (CCA) of AIS patients and healthy controls. Additionally, GSUS was employed to measure carotid intima-media thickness (cIMT), detect plaques and quantify total calcification surface. Oscillometry was utilized to evaluate aortic stiffness by carotid-femoral pulse wave velocity (cfPWV). Thirty-one patients with AIS and 62-matched (1:2) healthy controls were recruited. AIS patients exhibited higher CCA-PI [1.89 (0.46) vs 1.59 (0.32), P = 0.024] and peak systolic velocity (80.15 vs 64.95 cm/s, P = 0.003), compared with controls. Moreover, AIS patients not receiving biologic therapy demonstrated significantly higher cfPWV [6.99 (1.71) vs 5.86 (0.81) m/s, P = 0.001]. cfPWV and cIMT were predicted by age (cfPWV: rho = 0.573, P < 0.001; cIMT: rho = 0.675, P = 0.002), systolic arterial pressure (SAP) (cfPWV: r = 0.464, P = 0.009; cIMT: rho = 0.514, P = 0.029) and lymphadenopathy (cfPWV: eta = 0.373, P = 0.039). PI associated with nicotine (rho = 0.691, P = 0.008) and FVI (inversely) with SAP (rho = -0.522, v0.026). In the first CV surrogate marker study in AIS combining oscillometry and arterial US, patients exhibited increased carotid pulsatility and altered flow dynamics vs controls. Aortic stiffness was lower in patients receiving biologics and mainly predicted by traditional CV factors and lymphadenopathy. Angiopathy markers may reveal significant vascular abnormalities in AIS patients, improving CV screening and risk classification.

Changes in intrarenal vascular indices after semi-rigid ureteroscopy in pediatric urolithiasis.

Testicular temperature gradient and vascular perfusion as predictors of semen quality in summer-stressed Murrah bulls.

Enhanced myometrial vascularity (EMV) is a common postpregnancy (ie, postpartum, postpregnancy termination, and postpregnancy loss) sonographic finding that represents involuting myometrial hypervascularity of the placental bed in the early puerperium and may persist if retained products of conception (RPOC) are present. On color Doppler US images, EMV is characterized by tortuous and dilated myometrial vessels with high-velocity and turbulent flow. These features can be easily mistaken for an arteriovenous malformation (AVM). However, despite sharing overlapping flow patterns, AVM and EMV are fundamentally distinct. AVMs are vascular congenital malformations, whereas EMV is a dynamic finding in the postpregnancy state related to persistent or involuting uteroplacental circulation. Most EMVs that come to medical attention regress spontaneously after expulsion of the associated RPOC. AVMs, on the other hand, are not associated with pregnancy, do not regress spontaneously, and are difficult to treat, often requiring repeated embolization sessions with liquid embolic agents. By becoming familiar with EMV, radiologists may better serve patients and referring clinicians with guidance for further investigation or treatment (when appropriate), thereby preventing unnecessary interventions, hysterectomies, or potential complications associated with such treatments. The authors clarify the definitions of EMV, AVM, and other pertinent terms, discuss the physiology of the uteroplacental circulation and postpregnancy EMV, address the pathogenesis of persistent EMV associated with RPOC, and provide an overview of the imaging features and management of EMV. ©The Author(s) 2026. Published by the Radiological Society of North America under a CC BY 4.0 license. Supplemental material is available for this article. See the invited commentary by Kirsch and Ponder in this issue.

Exploration of the Application of Multimodal Feature Analysis Based on Random Forest Algorithm Combining Ultrasound Elastography and Contrast-Enhanced Ultrasound in the Diagnosis of Ovarian Tumors.

Testicular torsion (TT) is an emergency condition that leads to disruption of testicular blood supply and risk of necrosis due to rotation of the spermatic cord. In this study, the effect of manual detorsion (MD) procedure performed in the emergency department on patient outcomes was analyzed. Forty-one patients who presented with acute scrotal pain or swelling between January 2009 and December 2019 were retrospectively analyzed. Color doppler ultrasonography (CDUS) was performed at presentation, and all patients underwent MD. Patients were grouped according to symptom duration (0–6 hours, 7–12 hours, ≥13 hours), and subsequent emergency or elective surgery was planned based on post-detorsion CDUS findings. The median age of the patients was 16 years (IQR: 13–27), the most common complaint was pain (92.68%), followed by swelling (7.32%). The right testicle was most commonly affected (51.22%). As the first intervention, 65.85% of the patients underwent surgery and 34.15% underwent manual intervention and elective surgery. MD is more effective in patients who present within the first 6 hours (63.64% but P = .056). In patients who underwent elective surgery after MD (within 1–14 days), no new TT developed and no orchiectomy was required. Of the patients who underwent orchiectomy, 5/6 were symptomatic for 13 hours or more. Approximately 2/3 of the patients presented to the emergency department within 12 hours after the onset of the first symptom. MD was most effective in patients presenting within the first 6 hours. Therefore, it should be emphasized more strongly that TT is an emergency requiring reperfusion just like acute stroke and acute coronary syndromes.

This study aims to assess the vertebral artery diameter and flow rates in patients with BPPV by using color Doppler ultrasonography. This cross-sectional study was carried out at ESIC Medical College and Hospital, Faridabad, from October 2022 to October 2023. During this period, all patients aged 21 to 60 years, who presented with dizziness triggered by postural variation were included. Detailed clinical history was taken, and systemic and ENT examinations were done. All patients underwent color Doppler ultrasound of the vertebral artery. This study included 40 patients. The most commonly affected age group was 51 to 60 years, with a mean age of 56 years. The type of BPPV was categorized as right posterior semicircular BPPV in 19 patients (47.5%), right lateral semicircular BPPV in 6 patients (15%), left posterior semicircular BPPV in 12 patients (30%), and left lateral semicircular BPPV in 3 patients (7.5%). On the BPPV-affected side, the vertebral artery diameter was lower by a mean of 0.07cm [95% CI (0.05, 0.09)], and peak systolic velocity of 9.9cm/s [95% CI (6.28, 13.49)]. In this study of 40 BPPV patients, VA parameters had small decreases on BPPV-affected side compared with non-affected side. Larger samples would be necessary to define these findings and any potential implications.

Background Testicular torsion is a time-sensitive urological emergency requiring prompt diagnosis and surgical intervention to prevent irreversible ischemia and testicular loss. International guidelines emphasize immediate surgical exploration in patients with high clinical suspicion rather than delaying intervention for confirmatory imaging. Delays are more common in rural hospitals due to limited resources and lack of urologists. Case Presentation A 13-year-old boy presented with sudden severe left scrotal pain. Physical examination revealed a hard, horizontally lying left testis with absent cremasteric reflex. The TWIST score was 6, indicating high risk of torsion. Color Doppler ultrasonography showed reduced perfusion. Surgical exploration was performed approximately 7 hours after admission, revealing intravaginal torsion exceeding 360° with non-viable testis. Left orchiectomy and right orchidopexy were performed. Postoperative recovery was uneventful. Discussion This case highlights the importance of early clinical diagnosis, utilization of the TWIST score, and prompt surgical management. Delayed intervention related to emergency department workload, operating room availability, and absence of on-site urologists contributed to testicular loss. Conclusion In rural hospitals without urologists, standardized triage using TWIST, early surgical referral, and consideration of manual detorsion are essential to reduce preventable orchiectomy.

Abstract Introduction The regurgitant volume (RVol) is used to decide which patient with mitral valve regurgitation (MR) needs to be referred to invasive therapeutic procedure. It is currently computed with the proximal isovelocity surface area (PISA, fig. 1a) method which uses a single velocity value at the aliasing point (fig. 1b). The RVol is then obtained by integrating all the PISA over time. This method used in the clinic with focused echocardiography is known to underestimate the RVol [1]. Ultrafast ultrasound color Doppler can map the flow field of interest at any point in the field of view with high temporal and spatial resolution. In this study, we investigated whether we can improve the precision of the RVol quantification with ultrafast ultrasound with respect to the clinical standard PISA method. Methods In a left heart phantom, different physiological RVols were delivered by a pulsatile pump through a regurgitant orifice. Data were acquired at 6000 frames/s by a conventional cardiac phased array probe (central frequency at 2.75MHz) emitting ultrafast diverging waves, connected to an ultrafast scanner. Power Doppler was first computed to select the area of the image with higher signal (fig. 1c). Color Doppler mapping (fig. 1d) was computed over the systolic phase. A point on the central line in the axis of the orifice was selected in in the convergence zone were the mean velocity was 0.25m/s on average. On this point, RVols were computed as the surface integral of the velocity through a planar disk at the input of the orifice and was integrated over the systolic phase (blue dotted line, fig. 1e) and with the PISA method at this same point (red point fig 1e). The accuracy of the 2 methods were compared by computing the difference in their mean absolute value and percentage. Results RVol estimation using planar disk method yielded statistically significant lower absolute values than the clinical standard PISA method (9±8ml vs 31±10 ml, p&amp;lt;0.001; 19±12% vs 73±11%, p&amp;lt;0.001) as depicted in fig. 2. Conclusion In conclusion, we could demonstrate a more accurate method to calculate the RVol using the velocity field mapping of ultrafast ultrasound in a MR model.Figure 1 FIgure 2

Dorsal vein thrombophlebitis, or penile Mondor disease, is a rare benign penile condition presenting with cord-like induration at the dorsum of the penis. This induration is caused by an isolated thrombosis of the dorsal superficial vein of the penis. As symptoms are not typical and many patients are asymptomatic, it is often underdiagnosed. Causes include trauma, infection, sexual activity, genital surgery, and cancer. Differential diagnosis includes Peyronie's disease and sclerosing lymphangitis, and diagnosis remains crucial as it facilitates the treatment plan and reassures the patient. Treatment consists of conservative measures, such as oral nonsteroidal anti-inflammatory medications (NSAIDs) and anticoagulation, and surgical management, with excision of the thrombosed vein. We present a case report of penile Mondor disease following circumcision, with the aim to provide educational ultrasound images of this rare entity. The patient, 32 years old, on the sixth postoperative day, developed a cord-like induration, along with pain, at the dorsum of the penis. Physical examination revealed a cord-like mass on the dorsal aspect of the penis. Penile triplex demonstrated a lack of endoluminal flow signals of the superficial dorsal veins, which were uncompressible. Triplex of the femoral and iliac veins showed no sign of thrombosis. Clinical presentation, along with imaging findings, facilitated the diagnosis of Mondor disease. The patient was treated conservatively with sexual abstinence and NSAIDs, and 6 weeks after the presentation, the patient was asymptomatic, without evidence of the disease in clinical examination.

Objectives: This study aimed to investigate the impact of scrotal pain on venous diameter and reflux duration in varicocele, and to assess the predictive value of ultrasonographic findings for varicocele grading. Methods: Fifty-two symptomatic patients with left-sided varicocele, presenting with infertility or scrotal pain, were prospectively evaluated. Grading was based on physical examination. Visual Analog Scale (VAS) scores, venous diameters, and reflux durations were measured using scrotal color Doppler ultrasonography (CDUS) both during active pain and after pain had markedly subsided or resolved. Results: After pain resolution, venous diameters significantly decreased in both resting and Valsalva states (p < 0.001). In grade-specific analysis, this reduction was significant only in grade II varicocele (rest: p = 0.004; Valsalva: p = 0.026). Reflux durations also significantly decreased after pain relief in all varicocele grades, both at rest and during Valsalva (p < 0.001 for all, except G3 Valsalva: p = 0.001). Ultrasonographic parameters during the pain-present state showed better discrimination for detecting grade I varicocele (AUC: 0.88), while the pain-free state provided better diagnostic accuracy for grade III varicocele (AUC: 0.69). Combining measurements from both conditions further improved predictive accuracy, especially for grade III varicocele (AUC: 0.77). Conclusions: Scrotal pain significantly influences scrotal CDUS findings in patients with varicocele, leading to measurable differences in venous diameter and reflux duration between pain-present and pain-free states. Therefore, consideration of symptom status when interpreting scrotal CDUS results may improve diagnostic accuracy and support more informed clinical decision-making.

Carpal tunnel syndrome is a common musculoskeletal disorder. In severe cases, it can lead to median nerve damage and loss of hand function. Occupational carpal tunnel syndrome, as a newly included disease in the category of occupational diseases, poses significant risks to the health of workers and has become a research hotspot in recent years. The diagnosis of this disease relies on clinical symptoms, neurological physical examination and related imaging tests. This article analyzes ultrasound examination techniques such as high-frequency ultrasonography, color Doppler ultrasonography, superb microvascular imaging combined with shear wave elastography, and high-frequency ultrasonography combined with grayscale technology, and conducts ultrasonography diagnosis and evaluation of lesions in the median nerve, transverse carpal ligament, etc., providing a scientific basis for the ultrasonography diagnosis of carpal tunnel syndrome.

The study was conducted at the Referral Veterinary Polyclinic (VGO-OPD), ICAR–Indian Veterinary Research Institute (IVRI), Izatnagar, Uttar Pradesh, India during 2023–2024 to determine whether Doppler-based uterine hemodynamic indices can objectively differentiate the vascular alterations associated with clinical metritis in early-postpartum buffaloes and to evaluate their normalization following therapeutic recovery. The study characterized uterine vascular dynamics in pluriparous buffaloes diagnosed with clinical metritis within 21 days postpartum using transrectal color and spectral Doppler ultrasonography. Ten affected animals were evaluated, and Doppler indices of the middle uterine artery viz. resistance index (RI), pulsatility index (PI), time-averaged maximum velocity (TMAX), arterial diameter, and blood flow volume (BFV) were recorded before and after therapeutic intervention consisting of ceftiofur, flunixin meglumine, uterine lavage, and supportive therapy. During the disease phase, RI and PI were significantly reduced (p&lt;0.05), while TMAX, BFV, and arterial diameter were significantly increased (p&lt;0.05), indicating uterine vasodilation and hyper perfusion associated with inflammation. All vascular parameters gradually returned toward baseline values following clinical recovery, reflecting restoration of vascular tone. Correlation analysis revealed a strong positive association between RI and PI (r=0.63, p&lt;0.05) and a negative association between RI and BFV (r=-0.45, p&lt;0.05), consistent with expected hemodynamic responses.

Aims: To characterize the ultrasonographic features of intrathyroidal ectopic thymus (IET) in pediatric patients and emphasize the role of ultrasound (US) in its accurate identification to prevent misdiagnosis. Methods: Eighty-four pediatric patients (aged 3–12 years) were referred for neck US due to cervical lymphadenopathy, during which incidental lesions in the thyroid gland were detected. These lesions, identified within normal thyroid parenchyma, were classified as IET. In such cases, color Doppler US (CDUS) was also performed without additional cost or workload. Results: Among 84 pediatric patients, all IET lesions appeared as solid nodules with smooth margins and no mass effect. Ten lesions were uniformly hypoechoic, while 74 showed scattered internal bright echoes. Lesions measured 4–12 mm and were predominantly fusiform (59.5%), followed by triangular and round shapes. IET was unilateral in most cases (88%), with a marked left-lobe predominance, and all lesions were localized to the mid-to-lower thyroid lobe. CDUS demonstrated reduced or normal vascularity without suspicious flow patterns. Follow-up imaging in 62 children showed stable findings, with gradual size reduction in 8 adolescents and complete regression in one child. Echogenicity (p=0.001), lesion shape (p=0.01), and location (p=0.03) were significantly associated with IET characteristics, supporting their diagnostic relevance. Conclusion:The presence of internal echogenicities and mid-to-lower lobe localization, especially in the left lobe, are key diagnostic indicators. IET is more prevalent than previously recognized. Recognition of its US features may prevent unnecessary interventions. Routine US monitoring is recommended, while further diagnostic procedures are generally unwarranted.