The study aimed to evaluate the utility of 3D transrectal ultrasonography (3D-TRUS) for perianal Crohn's disease (pCD) activity stratification. Retrospectively enrolled Crohn's disease patients underwent both 3D-TRUS and magnetic resonance imaging (MRI) within 4 weeks between January 2021 and June 2023, excluding those with recent perianal surgery (≤ 4 weeks), suboptimal image quality, or lesions beyond detection range. 3D-TRUS examined parameters as follows: the number of fistulas, the length, diameter, echogenicity, color Doppler and internal openings of the main fistula, rectal wall thickness, gas in the fistula and collections. MRI was used as the reference standard. The least absolute shrinkage and selection operator regression was used to identify key ultrasound features for nomogram construction. Model performance in terms of accuracy, discrimination and clinical utility was evaluated by receiver operating characteristic curves, calibration curves and decision curve analysis, respectively. Our study included a total of 105 patients, with 49 classified as high activity (median age, 27 years [13-65 years]) and 56 as low activity (median age, 30 years [13-79 years]). A nomogram for identifying perianal CD activity was constructed, incorporating ultrasound characteristics including the number of fistulas, echogenicity and length of main fistula, collections, and gas in the fistula. The area under the curve of this model was 0.934 (95% CI: 0.883-0.988), and it exhibited good internal reliability and clinical net benefit. 3D-TRUS serves as a clinically valuable imaging method for assessing pCD activity, and the nomogram developed based on this modality demonstrates good diagnostic efficacy. Question The study explores the role of 3D transrectal ultrasonography(3D-TRUS) in evaluating perianal Crohn's disease (pCD) activity. Findings The nomogram model based on 3D-TRUS has good differentiation ability for pCD activity. Clinical relevance 3D-TRUS is a reliable tool for distinguishing disease activity of pCD and serves as a clinically valuable imaging modality, facilitating clinical management and follow-up.

Sjögren disease (SjD) is characterized by autoimmune lymphocytic infiltration of lacrimal and salivary glands, leading to dry eye and dry mouth. This study aimed to investigate the features and diagnostic value of lacrimal gland ultrasonography (LGUS) for distinguishing SjD from undifferentiated connective tissue diseases (UCTDs). This prospective cohort study enrolled 80 patients, including 46 with SjD and 34 with non-SjD UCTDs. All participants underwent LGUS, scored according to the OMERACT guidelines for greyscale and color Doppler systems, alongside salivary gland ultrasonography (SGUS) and objective dry eye tests. Diagnostic performance was assessed using receiver operating characteristic (ROC) analysis. The ocular surface evaluation including tear break-up time (BUT), Schirmer test (ST), ocular staining score (OSS), and LGUS greyscale score of patients with SjD showed significant differences as compared with non-SjD patients, while no difference was found in morphology and color Doppler ultrasound score between the two groups. The ROC of LGUS has an AUC of 0.70 (95% CI 0.579-0.810) compared to other CTD patients; the combined LGUS and SGUS model achieved an AUC of 0.76, while a multivariate nomogram incorporating LGUS, SGUS, Schirmer, and OSS yielded an AUC of 0.792 (95% CI 0.693-0.891). Besides, a significant correlation was found between the LGUS greyscale score and salivary gland involved, anti-SSA antibody, and the ocular surface parameters. LGUS is a non-invasive, cost-effective adjunct for early SjD diagnosis. It can be an additional tool integrated with SGUS and clinical tests, substantially improving diagnostic performance. Key Points • SjD patients showed significantly higher LGUS greyscale score than non-SjD UCTD patients. • LGUS may aid early SjD identification when used alongside ocular surface tests (Schirmer test and ocular staining score), with high specificity (82.4%). • LGUS greyscale score is significantly associated with anti-SSA antibody and parotid greyscale score on SGUS.

To explore the ultrasound findings, treatment strategies, and reproductive outcomes in patients with recurrent cesarean scar pregnancy (CSP), providing evidence for clinical management. We identified 1371 confirmed CSP from 1517 initially screened cases (2012-2022) through blinded image review. From 159 subsequent live births in this cohort, 27 recurrent CSP cases were matched 1:1 with CSP patients having normal subsequent pregnancies. Baseline characteristics and reproductive outcomes were collected via medical records and structured interviews. This study revealed the recurrent CSP group showed significantly higher rates of exogenous implantation pattern (33.3% versus 7.4%, OR = 1.96), rich vascularity on color Doppler (81.5% versus 40.7%, OR = 2.80), and embryonic cardiac activity detection (51.9% versus 18.5%, OR = 1.98) than the normal intrauterine pregnancy group after CSP (p < .05) during initial diagnosis. The most commonly used treatment at our hospital is trans-abdominal ultrasound-guided suction curettage, which effectively controls the condition and preserves fertility. However, during long-term follow-up, some patients still face the risks of recurrence infertility. Recurrent CSP presents characteristic sonographic features at initial diagnosis, among which an exogenous implantation pattern, rich vascular flow signals, and embryonic cardiac activity serve as relevant and significant indicators. Although transabdominal ultrasound-guided suction curettage is effective in managing the condition and preserving fertility, some patients still face long-term risks of recurrence and infertility.

Coverage of lower limb defects is a common challenge in reconstructive surgery. Flaps are often required, and perforator flaps are widely used. Preoperative mapping of perforators and donor site morbidity are key concerns. Traditional modalities used to locate perforators include computed tomographic angiography, magnetic resonance imaging and angiography, and handheld Doppler devices. With advancements in duplex ultrasound, minute details of the arterial system and its perforators can now be assessed preoperatively and utilised in surgical planning for lower limb reconstruction. A total of 17 patients with lower limb defects were reconstructed using pedicled perforator flaps guided by Colour Doppler Ultrasound (CDU). Fourteen patients were male and three were female. The mean age was 36±12.4 years (range: 13-57 years), and the mean follow-up period was six months. All defects were due to trauma. The average defect size was 33.6 cm² (range: 12-200 cm²). The choice of perforator flap was based on the best adjacent perforator identified using colour Doppler ultrasound. The mean perforator diameter was 1.4±0.2 mm (range: 1.1-1.8 mm), and the mean peak systolic blood flow velocity was 24.8±8.08 cm/s (range: 12-37 cm/s). The procedure was successful in 16 patients (94%). Colour Doppler ultrasound is a useful tool for identifying perforators for pedicled perforator flaps in lower limb reconstruction. Further studies with larger sample sizes are needed to establish linear correlations.

A physiological link between uterine perfusion and endocervical length reveals a novel interaction during early placentation.

This study identifies quantitative ultrasound predictors for the failure of ultrasound-guided suction curettage (USG-SC) in cesarean scar pregnancy (CSP) and develops a risk stratification model integrating residual myometrial thickness (RMT) and local vascularity (Adler grade). This retrospective cohort study included 415 patients with CSP who underwent primary USG-SC. Baseline morphological categorization adhered to the international Delphi consensus. Procedural failure was defined as hemorrhage (≥500 mL), requirement for secondary interventions, or incomplete evacuation. Preoperative sonographic parameters, primarily RMT and Adler vascularity grading, were evaluated. Multivariate logistic regression and receiver operating characteristic analyses were used to ascertain independent predictors and evaluate model performance. The overall failure rate was 13.7% (57/415). Compared to the successful group, the failed group presented with a significantly thinner RMT (1.6 ± 0.7 mm vs. 3.4 ± 1.2 mm; P < 0.001) and a higher prevalence of Adler grade 3 vascularity (P < 0.001). Multivariate analysis confirmed RMT as a significant independent protective factor (adjusted odds ratio [OR] = 0.21, 95% CI: 0.12-0.38) and Adler grade 3 vascularity as a significant risk factor (adjusted OR = 4.52, 95% CI: 1.85-11.04). The optimal RMT cut-off for predicting failure was determined to be 2.2 mm (area under the curve [AUC] = 0.912). The incorporation of RMT and Doppler vascularity into a combined algorithm yielded the highest predictive performance (AUC = 0.945). Integrating RMT with Color Doppler vascularity establishes a robust quantitative framework for surgical triage in cesarean scar pregnancy. Specifically, an RMT ≥2.2 mm accompanied by low-to-moderate vascularity (Adler grades 0-2) reliably identifies optimal candidates for primary USG-SC. This combined approach minimizes hemorrhagic morbidities while safely averting unnecessary prophylactic interventions.

Structured reporting of B-mode, color Doppler, and CEUS in testicular tumor assessment: a reader study with urologist ratings.

Facial burns often result in cicatricial eyelid retraction, causing corneal exposure, ulceration, and vision loss. Traditional reconstructive methods, such as full-thickness skin grafts or local flaps, frequently fail in extensive burns due to limited healthy tissue and a high risk of recurrent contracture. Achieving durable functional and aesthetic outcomes in such cases remains a major challenge. We report the use of bilateral free superficial circumflex iliac artery pure skin perforator (SCIA-PSP) flaps for upper eyelid reconstruction in a 50-year-old man with severe facial burns and recurrent bilateral upper eyelid retraction, leading to persistent lagophthalmos despite prior skin grafting. Preoperative color Doppler ultrasound was used to map SCIA perforators. Bilateral PSP flaps were elevated from the groin in the subdermal plane and transferred as free flaps to the eyelids, with microvascular end-to-end anastomoses to the supraorbital vessels. The postoperative course was uneventful, with no flap-related complications. At 52 months follow-up for the left eyelid and 31 months for the right, the patient achieved stable bilateral eyelid closure, resolution of lagophthalmos, excellent tissue pliability, and satisfactory aesthetic integration. The SCIA-PSP flap offers ultra-thin, vascularized tissue, effectively preventing recurrent contracture, and represents a reliable alternative in complex burn-related eyelid reconstruction.

Hepatic artery thrombosis (HAT) is a severe and potentially graft-threatening complication after liver transplantation, associated with biliary ischemia, graft failure, and high mortality. We report the case of a 43-year-old woman with primary sclerosing cholangitis who developed early HAT after orthotopic liver transplantation. An initial endovascular recanalization attempt was unsuccessful, and progressive ischemic cholangiopathy required liver color Doppler with aorto-hepatic arterial reconstruction. During follow-up, recurrent hepatic artery graft thrombosis was detected. Given the high surgical risk, an endovascular approach was undertaken. Successful intraluminal recanalization was achieved using percutaneous transluminal angioplasty and balloon-expandable stent placement, resulting in restoration of hepatic arterial flow. Follow-up imaging confirmed sustained graft patency and preserved liver perfusion. This case highlights the role of timely endovascular intervention as a viable graft-saving option in selected patientswith complex post-transplant HAT.

Purpose Cutaneous radiation syndrome (CRS) arises from high dose-ionizing radiation exposure and remains a major clinical challenge owing to limited effective therapies. This study investigated the time-dependent therapeutic potential of human umbilical cord blood-derived mesenchymal stem cells (hUCB-MSCs) for treating radiation-induced soft tissue injury in a Göttingen minipig model. Materials and methods Six minipigs were locally irradiated with 100 Gy gamma radiation on each thigh. Two animals served as irradiated group (IR group), whereas four received local intradermal hUCB-MSC injections five times, initiated at week 1 (early treatment; Group I) or week 7 (delayed treatment; Group II) post-irradiation. Serial ultrasonographic and color Doppler imaging were used to monitor changes in skin thickness, vascularity, and edema. Gross morphological and histopathological evaluations were conducted to assess wound progression and tissue repair. Results All irradiated minipigs developed severe radiation-induced skin burns. Ultrasonography detected skin thickening and vascular abnormalities at early time points, prior to the appearance of gross morphological changes, suggesting that vascular damage precedes visible lesions. Compared with IR group, both MSC-treated groups exhibited reduced ulcer formation, edema, and skin thickness, as confirmed by ultrasound and gross inspection. Early hUCB-MSC administration (Group I) markedly improved wound healing, reduced scab formation, and preserved tissue structure, whereas delayed treatment (Group II) showed limited recovery with persistent necrosis and thick scabbing. Conclusions Early administration of hUCB-MSCs combined with noninvasive ultrasonographic diagnosis effectively mitigates radiation-induced skin injury and promotes wound repair. Ultrasound-based monitoring combined with time-dependent MSC therapy may represent a promising strategy for the clinical management of severe CRS.

We report a case of a 22-year-old man with a lifelong uncorrected left intra-abdominal undescended testis presented with sudden severe left lower abdominal pain and vomiting. The initial evaluation at another hospital failed to recognize the absent testis and to perform a scrotal examination; he was treated for suspected intestinal obstruction. On transfer, physical examination revealed a small, empty left hemiscrotum and an impalpable left testis. Urgent color Doppler ultrasound of the left inguinal region showed a 3.1×2.8 cm left testis at the internal inguinal ring with heterogeneous echotexture and absent intratesticular blood flow. The findings were consistent with torsion of the undescended testis The patient underwent immediate laparoscopic exploration, left orchidectomy was performed. Histopathology confirmed hemorrhagic infarction and a congested epididymis; no malignancy was found. Serum tumor markers (AFP,b-hCG, LDH) were normal. This case highlights that undescended testicular torsion can present as an acute abdomen and be easily missed in adults. We emphasize the importance of routine genitourinary examination in young males with abdominal pain, the benefits of early orchiopexy for cryptorchidism, and the need for contralateral testis fixation to prevent future torsion. Journal of Surgical Sciences 2023;27(1): 23-27

Purpose To study the diagnostic role of contrast-enhanced ultrasound (CEUS) in terms of sensitivity, specificity, and its comparison with grey-scale ultrasound with colour Doppler in characterising malignant breast masses. Material and methods An observational study was done for duration of 18 months, including 64 adult females with breast masses. Patients underwent various investigations in the form of conventional ultrasound with colour Doppler and CEUS. Patients underwent surgery, and a histopathological examination was performed on a surgical specimen for confirmation of a benign or malignant lesion. Outcome measures were the proportion of benign and malignant lesions of the breast and the diagnostic accuracy of CEUS in characterising malignant lesions in the breast. Results On analysis, CEUS showed very good agreement with histopathological diagnosis with κ 0.967 (p &lt; 0.0001); while good agreement was found between histopathological diagnosis and diagnosis by B mode + colour Doppler with κ 0.772 (p &lt; 0.0001). CEUS demonstrated sensitivity of 100%, specificity of 96.15%, and AUC of 0.98, while diagnosis B mode + colour Doppler yielded sensitivity of 92.11%, specificity of 84.62%, and diagnostic accuracy of 89.06%. Conclusions CEUS was found to have a better diagnostic accuracy for differentiation of benign and malignant breast masses (using histopathology as a gold standard). The overall sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of CEUS was found to be 99%, 96%, 97.4%, 99%, and 98.4% respectively.

Objective To investigate the performance of colour Doppler lacrimal gland ultrasound (LGUS CD) for discriminating Sjögren’s disease (SjD) from non-SjD sicca patients under routine clinical practice conditions. Method Forty patients with clinically suspected SjD underwent ocular function tests [Schirmer’s test, ocular staining score (OSS)] and LGUS CD evaluation. Ultrasound images and videos were scored for both lacrimal glands using the Outcome Measures in Rheumatology (OMERACT) CD scoring system (range 0–3). Subsequently, a total score (range 0–6) was calculated for each patient. Sensitivity and specificity of LGUS CD and ocular function tests were calculated to predict SjD classification according to 2016 American College of Rheumatology/European Alliance of Associations for Rheumatology (ACR/EULAR) classification criteria. Construct validity of LGUS CD was assessed by determining Spearman’s correlation coefficients between LGUS CD, Schirmer’s test, and OSS. Results Twenty-three patients were classified with SjD and 17 as non-SjD sicca patients. LGUS CD sensitivity was 57% and specificity was 53% for prediction of classification according to 2016 ACR/EULAR classification criteria for SjD. Total LGUS CD score of both eyes and the individual LGUS CD score of the left and right eye did not differ significantly between SjD and non-SjD sicca patients. None of the ACR/EULAR classification criteria differed significantly between the groups with high and low LGUS CD scores. Poor correlations were determined between LGUS CD and ocular function tests (ρ = 0.028–0.187). Conclusion LGUS CD demonstrated similar characteristics in SjD and non-SjD sicca patients, suggesting limited discriminatory value. Refined ultrasonographic scoring systems are needed to improve differentiation between these patient groups.

BackgroundNeonatal priapism is a rare and typically benign condition characterized by a persistent penile erection unrelated to stimulation. Unlike priapism beyond the neonatal period, which is more frequently ischemic, most neonatal cases are non-ischemic and idiopathic, although associations with polycythemia have been reported.Case presentationWe report the case of a male neonate born at 37 + 3 weeks of gestation who developed painless priapism on the first day of life, persisting for approximately 48h. Clinical examination showed no penile discoloration or distress. Color Doppler ultrasound demonstrated preserved arterial and venous flow consistent with high-flow, non-ischemic priapism. A simple therapeutic phlebotomy was performed, resulting in complete detumescence within 24h and normalization of hematologic parameters. The infant remained clinically stable, and 3-month follow-up showed no recurrence or complications.ConclusionThis case highlights the importance of considering polycythemia in the etiological assessment of neonatal priapism and supports a conservative approach when vascular flow is preserved. Early recognition and appropriate management can lead to favorable outcomes without long-term sequelae.

Giant cell arteritis (GCA) is a systemic vasculitis that predominantly affects medium- and large-sized arteries. Delayed diagnosis may result in irreversible blindness or stroke. Temporal artery biopsy (TAB), historically regarded as the diagnostic gold standard, has limited sensitivity (40-70%) due to the segmental distribution of inflammatory lesions and risk of procedural complications and diagnostic delay. This systematic review aims to (1) compare the diagnostic accuracy of noninvasive imaging modalities with TAB, (2) assess the prognostic value of imaging findings, and (3) evaluate the implementation of imaging-first clinical pathways. In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement, PubMed and Embase were searched for high-impact studies (n = 36) addressing diagnostic accuracy, guideline updates, and the effectiveness of the fast-track clinic (FTC) model. Color Doppler ultrasound (CDUS) demonstrating the halo sign achieved a pooled sensitivity of 88-93%. Accordingly, the 2022 American College of Rheumatology (ACR)/European Alliance of Associations for Rheumatology (EULAR) classification criteria assign CDUS findings a diagnostic weight equivalent to those of a positive TAB. High-resolution magnetic resonance imaging (MRI) enables quantitative evaluation of cranial arterial wall thickening and contrast enhancement. 18F-fluorodeoxyglucose positron emission tomography/ computed tomography (18F-FDG PET/CT) is particularly useful for assessing systemic inflammatory burden and identifying large-vessel involvement associated with higher relapse risk, whereas CT angiography (CTA) delineates structural vascular damage. Implementation of FTC pathways reduces diagnostic latency to 24-72 hours and lowers the risk of permanent visual loss by 60-80%. Noninvasive, multimodal imaging has redefined the diagnostic paradigm of GCA. By enabling accurate diagnosis and risk stratification, it informs personalized management strategies. Future directions should emphasize standardized acquisition protocols and artificial intelligence-assisted analysis to reduce operator dependence and further enhance early detection.

Primary Sjogren's Syndrome (pSS) is characterized by earlier and more frequently involved in the lacrimal gland (LG). This study used lacrimal gland color doppler ultrasonography (LGCDUS) to explore changes in both structure and blood flow of LG in early-stage pSS patients. This is a retrospective case-control study which included 24 patients with pSS and 26 healthy controls. The size of LGs including major, minor and sagittal diameter and the hemodynamics of lacrimal artery including peak systolic velocity (PSV), end-diastolic velocities (EDV), and resistance index (RI), quantitatively analyzing and comparing were between the two groups based on LGCDUS. In the pSS group, correlation analysis was conducted among various parameters of LG and pSS. To evaluate the diagnostic efficacy of parameters of LG, the area under the receiver operating characteristic (ROC) curve was measured. The early-stage pSS patients showed significantly increased EDV, and decreased RI of LG (P < 0.0083, after Bonferroni correction). The LG sagittal diameter showed a significant positive correlation with C-reactive protein (CRP) (P < 0.00049, after Bonferroni correction). The LGCDUS parameters for diagnosis showed an area under the curve (AUC) of 0.764. This study observed that LGCDUS can detect damage, the systemic activity and ocular surface changes in early-stage pSS patients. Therefore, LGCDUS provides not only a new method for evaluating pathological changes and functions of LGs, but also a new and feasible technical means for diagnosing and management of pSS.

Retained unexploded ordnance (UXO) represents a rare, high‑stakes clinical entity in military trauma. Current Joint Trauma System Clinical Practice Guidelines explicitly advise against the use of diagnostic ultrasonography for UXO evaluation because of the theoretical risk of actuating piezoelectric fuzes via acoustoelectric coupling. This prohibition forces surgeons to rely on plain radiography, sacrificing real-time assessment of soft tissue and neurovascular structures. This study evaluates the validity of this theoretical risk by subjecting functional piezoelectric fuze components to diagnostic ultrasound energy under clinically extreme but realistic exposure conditions. In collaboration with the Naval Explosive Ordnance Disposal (EOD) Technology Division, we assessed the effect of ultrasound energy on seven configurations involving five electrically functional piezoelectric fuze assemblies (PZ‑11, VP‑7M, M69, M79, and VP‑16), including intact, damaged, and isolated crystal conditions. To detect potential actuation, fuzes were wired to a continuous monitoring oscilloscope with a preset safety threshold of 4 V, which is significantly lower than the standard 400 V firing requirement for military-grade fuzes. Imaging was performed using a Philips EPIQ 7 system equipped with C5-1 (1-5 MHz) and L12-5 (5-12 MHz) transducers. Testing conditions simulated maximum acoustic coupling: immersion in ultrasound transmission gel, direct probe contact with exposed piezoelectric elements, and a dynamic "hand-hold" model to introduce tissue harmonics and boney refraction. The system was operated at maximum gain settings across B-mode, color Doppler, and harmonic imaging modes. Across all tested frequencies (1-12 MHz) and standoff distances, no voltage generation exceeding the 4 V safety threshold was observed. The maximum recorded output remained consistently below the detection baseline (<1 V) for all fuze configurations, including unshielded piezoelectric elements. Although mechanical handling artifacts were observed, they were negligible compared to firing thresholds. Positive control testing via mechanical impact verified fuze functionality and oscilloscope sensitivity between all iterations. Diagnostic ultrasound did not induce sufficient voltage to actuate the internal piezoelectric crystal of the tested fuzes, likely because of significant acoustic impedance mismatch at the munition casing and mechanical damping of the internal crystal. Although current guidelines recommend only plain radiography, these findings suggest that the risk of acoustoelectric detonation is minimal. Diagnostic ultrasound may be considered a safe adjunct for surgical planning in retained UXO scenarios when applied with appropriate standoff techniques.

Introduction: The majority of babies have acceptable growth in the uterus. However, occasionally, fetal growth is influenced by factors other than maternal factors. Doppler ultrasound has been used to study the fetoplacental (umbilical) circulation since 1977 and used to study the uteroplacental (uterine) circulation and fetal circulation since 1980s. In this study, we aim to determine the predictive value of early color Doppler ultrasound for outcomes in low-risk pregnancies.Material and methods: This prospective cohort study included 176 nonselected low-risk pregnancies in the late second trimester who underwent uterine artery (UA) color Doppler ultrasound. Different ultrasound equipment’s was used, with a frequency of 5 MHz. The UA resistance index was used and compared with normal standards. Complicated pregnancies were excluded.Results: Of the 176 healthy pregnant cases studied, 47 (26.7%) had abnormal Resistance Index (RI) of the UA and were followed until the end of the pregnancy. The rate of intervention was high in this study group, as shown by the increased caesarean section rate of 114 (64.6%) compared to the vaginal deliveries of 59 (33.7%). The baby’s condition was normal in 169 (96%) after 2 years of follow-up, compared with only 7 (4%) who were unwell.Conclusion: The data suggest that Doppler evaluation in early low-risk pregnancies has a significant association with the detection of early-onset pre-eclampsia and intrauterine growth restriction. Thus, assessing low-risk pregnancies with early Doppler assessment may improve perinatal outcomes. The study supports the use of UA Doppler at least one time in low-risk pregnancies to discover and treat the cases of sudden and unknown causes of fetal growth restriction and loss.

Arteriogenic insufficiency (AI) is the most common vascular cause of erectile dysfunction (ED) and is traditionally diagnosed using semi-invasive papaverine-induced penile Doppler ultrasonography (P-PDUS). To evaluate the feasibility and diagnostic accuracy of the cavernosal artery ondulation index (CA-OI) measured during the flaccid penile phase for identifying AI in men with ED. This prospective study included 90 men with clinically confirmed ED (International Index of Erectile Function-5 ≤ 25) and suspected vascular etiology. Gray-scale and color Doppler ultrasonography were performed in the flaccid state to measure CA-OI. AI was diagnosed according to established P-PDUS criteria, and patients were classified into AI (n = 28) and non-AI (n = 62) groups. CA-OI values were compared between groups, and receiver operating characteristic curve analysis was used to evaluate diagnostic performance. The primary outcome was the diagnostic accuracy of flaccid-phase CA-OI for detecting AI. Patients with AI were significantly older than those without AI (59.8 ± 8.8 vs. 46.4 ± 13.5years, P < .001) and had a higher prevalence of diabetes mellitus (P < .001). Mean CA-OI values were significantly higher in the AI group (2.76 ± 0.28 vs. 2.33 ± 0.17, P < .001). Receiver operating characteristic analysis demonstrated excellent diagnostic performance, with an area under the curve of 0.906. A CA-OI cut-off value of 2.46 yielded 89.3% sensitivity and 79% specificity for identifying AI. Measurement of CA-OI in the flaccid phase offers a non-invasive and clinically practical approach for the initial screening of arteriogenic ED, potentially reducing the need for intracavernosal injection. The principal strength of this study is the first evaluation of CA-OI as a non-invasive diagnostic marker obtained during the flaccid penile phase; limitations include the single-center design and the use of P-PDUS rather than angiography as the reference standard. CA-OI measured during the flaccid penile phase is a highly accurate, non-invasive marker for AI in men with ED.

Anterior intercostal artery perforator (AICAP) flaps are valuable options for partial breast reconstruction, requiring reliable identification of dominant perforators for safe flap design. This study aimed to evaluate the agreement between preoperative high-frequency colour Doppler ultrasound (CDUS) findings and intraoperative anatomy of internal and lateral intercostal perforators, and to map their anatomical distribution. Sixty-four patients undergoing breast-conserving surgery were examined using high-frequency CDUS. The region from the midline to the mid-axillary line and from the fourth intercostal space to 4 cm below the inframammary fold was systematically scanned. Dominant perforators were measured, marked, and intraoperatively reassessed in 24 patients undergoing AICAP flap reconstruction. Vessel diameters, location, and additional perforators were recorded and spatial distribution was analysed. Preoperative CDUS identified lateral perforators as larger than internal (2.08mm vs. 1.61mm, p<0.01), confirmed intraoperatively (1.69mm vs. 1.10mm, p<0.01). Dominant perforators were located 3.63cm lateral to the patient's midline and 1.32cm inferior to the IMF (internal), and 0.53cm medial to the anterior axillary line and 0.95cm inferior to the IMF (lateral). In both internal and lateral regions, supplementary vessels were detected near the dominant perforators, contributing to increased perfusion security. High-frequency CDUS enables reproducible preoperative localisation of dominant IAICAP and LAICAP perforators and shows high agreement with intraoperative findings. Standardised ultrasound mapping may support structured flap planning and intraoperative orientation in oncoplastic breast reconstruction.