Contrast-enhanced Ultrasound Research Articles

Contrast-Enhanced Ultrasound of Mouse Models of Hindlimb Ischemia Reveals Persistent Perfusion Deficits and Distinctive Muscle Perfusion Patterns

ObjectiveMouse models of hindlimb ischemia (HLI) are used to study peripheral arterial disease and evaluate novel therapies. Contrast-enhanced ultrasound (CEUS) is a noninvasive perfusion measurement technique that is increasingly being employed in these models. The objective of this study was to evaluate two models of severe HLI by CEUS to characterize perfusion recovery and muscle perfusion patterns. MethodsMice undergoing double femoral artery ligation were measured by CEUS and laser Doppler perfusion imaging (LDPI) at baseline and 1–150 d postsurgery. A second group undergoing femoral artery ligation and excision was measured 1–28 d postsurgery. ResultsBy LDPI, both surgeries showed robust perfusion recovery by 14 d postsurgery. However, by CEUS only a ∼40% perfusion recovery plateau was reached in either group. These results are consistent with our previous work, employing a less severe single femoral artery ligation, that showed perfusion in the ischemic limb does not return to normal by 150 d postsurgery. Cluster analysis of muscle perfusion patterns indicated 3–5 different patterns at day 1 postsurgery. The double ligation model yielded significantly less variable perfusion patterns, suggesting that it can provide more reproducible results. ConclusionContrary to LDPI, perfusion as measured by CEUS never fully recovers after hindlimb surgery, even when followed 28–150 d postsurgery. Individual mice can manifest different patterns of muscle perfusion to the same surgery, but these patterns are conserved within and between different surgical techniques. These results may have significant implications for the evaluation of novel therapeutics to treat PAD in mice.

Contrast-enhanced ultrasound for rare testicular tuberculosis

Testicular tuberculosis is a rare form of genital tuberculosis. Ultrasound is a crucial tool for evaluating male genital disorders. Contrast-enhanced ultrasonography (CEUS), which provides real-time monitoring of microvascular hemodynamics, provides rich information about microcirculation, helping distinguish testicular tuberculosis from other testicular conditions such as tumors and inflammation. This study reports on a rare case of testicular tuberculosis diagnosed through CEUS. A 31-year-old male patient presented with two months of persistent right scrotal pain and swelling. Conventional scrotal ultrasound showed an enlarged right testicle with heterogeneous echogenicity and abundant color Doppler blood flow signals. CEUS demonstrated rapid contrast agent filling in the right testicle, followed by the appearance of several irregular regions, indicating perfusion deficits in these areas. Histopathological confirmation through ultrasound-guided biopsy revealed granulomatous inflammation with caseous necrosis, which is consistent with the diagnosis of testicular tuberculosis. As a real-time monitoring technique for microvascular hemodynamics, CEUS provides valuable microcirculatory information that enhances diagnostic accuracy and enables the formulation of appropriate treatment plans for testicular tuberculosis versus other testicular pathologies.

The treatment response evaluation through the combination of contrast-enhanced ultrasound and squamous cell carcinoma antigen in cervical cancer.

The evaluation of the treatment response after concurrent chemotherapy and radiotherapy (CCRT) for locally advanced cervical cancer is closely related to the formulation of treatment strategies. Magnetic resonance imaging (MRI) is a recommended method for efficacy evaluation; however, a unified consensus has not yet been reached on its use, and it has its limitations. This study aimed to evaluate the diagnostic value of a combination of contrast-enhanced ultrasound (CEUS) parameters and the squamous cell carcinoma antigen (SCC-Ag) to establish another efficient and feasible examination method. The data of 94 patients with cervical cancer who underwent transvaginal contrast-enhanced ultrasound (TV-CEUS) from October 2020 to March 2023 were retrospectively collected. Based on the inclusion and exclusion criteria, 70 patients diagnosed with cervical squamous cell carcinoma (SCC) who underwent CCRT were selected for inclusion in the study. The patients were divided into the residual disease (RD) group (comprising 26 patients) and the complete response (CR) group (comprising 44 patients) according to the diagnostic standard. Data on the grayscale echogenicity, color Doppler flow imaging (CDFI), CEUS parameters, and the SCC-Ag of all the patients were collected by two experienced radiologists. Inter-observer reliability was assessed using the intraclass correlation coefficient (ICC). Receiver operating characteristic (ROC) curves were created based on the non-parametric U-test or t-test results for the two groups. Delong's test was used to compare the area under the curve (AUC) between different ROC curves. A subgroup analysis was conducted based on the patient's age, tumor diameter, and disease stage. The ICCs between the two observers ranged from 0.915 and 0.947. Hypervascular hyper-enhancement in the arterial phase, hypo-enhancement in the venous phase, and the SCC-Ag differed significantly between the RD and CR groups (P<0.05). The AUC of the ROC curve combining these indicators was 0.890 [95% confidence interval (CI): 0.792-0.989], which was higher than the AUC of any indicator alone (P<0.05). The subgroup analysis showed that the AUCs of the patients aged ≥53 and <53 years were 0.922 (95% CI: 0.816-1.00) and 0.896 (95% CI: 0.782-1.00), respectively, those of the patients with stage II, III, and IV were 0.881 (95% CI: 0.732-1.00), 0.955 (95% CI: 0.894-1.00), and 1.000 (95% CI: 1.00-1.00), respectively, and those of the patients with a tumor diameter ≤10 mm, 10 mm < tumor diameter (post) <20 mm, and tumor diameter (post) ≥20 mm were 0.976 (95% CI: 0.910-1.00), 0.883 (95% CI: 0.763-1.00), and 1.00 (95% CI: 1.00-1.00) respectively. Transvaginal ultrasound (TVUS), TV-CEUS, and the SCC-Ag can be used in combination to evaluate the patient response to CCRT in locally advanced cervical SCC. This integrated approach enhanced the accuracy of the diagnosis of residual lesions and may be helpful in treatment plan optimization.

Contrast-Enhanced Ultrasound-Based Radiomics for the Prediction of Axillary Lymph Nodes Status in Breast Cancer.

Breast cancer is the leading cause of cancer-related deaths in the female population. Axillary lymph nodes (ALN) are a group of the most common metastatic sites of breast cancer. Timely assessment of ALN status is of paramount clinical importance for medical decision making. To utilize contrast-enhanced ultrasound (CEUS)-based radiomics models for noninvasive pretreatment prediction of ALN status. Clinical data and pretreatment CEUS images of primary breast tumors were retrospectively studied to build radiomics signatures for pretreatment prediction of nodal status between May 2015 and July 2021. The cases were divided into the training cohorts and test cohorts in a 9:1 ratio. The mRMR approach and stepwise forward logistic regression technique were used for feature selection, followed by the multivariate logistic regression technique for building radiomics signatures in the training cohort. The confusion matrix and receiver operating characteristic (ROC) analysis were used for accessing the prediction efficacy of the radiomics models. The radiomics models, which consist of six features, achieved predictive accuracy with the area under the ROC curve (AUC) of 0.713 in the test set for predicting lymph node metastasis. The CEUS-based radiomics is promising to be developed as a reliable noninvasive tool for predicting ALN status.

A combined model based on radiomics features of Sonazoid contrast-enhanced ultrasound in the Kupffer phase for the diagnosis of well-differentiated hepatocellular carcinoma and atypical focal liver lesions: a prospective, multicenter study.

The objective of this study was to develop a combined model based on radiomics features of Sonazoid contrast-enhanced ultrasound (CEUS) during the Kupffer phase and to evaluate its value in differentiating well-differentiated hepatocellular carcinoma (w-HCC) from atypical benign focal liver lesions (FLLs). A total of 116 patients with preoperatively Sonazoid-CEUS confirmed w-HCC or benign FLL were selected from a prospective multiple study on the clinical application of Sonazoid in FLLs conducted from August 2020 to March 2021. According to the randomization principle, the patients were divided into a training cohort and a test cohort in a 7:3 ratio. Seventy-nine patients were used for establishing and training the radiomics model and combined model. In comparison, 37 patients were used for validating and comparing the performance of the models. The diagnostic efficacy of the models for w-HCC and atypical benign FLLs was evaluated using ROCs curves and decision curves. A combined model nomogram was created to assess its value in reducing unnecessary biopsies. Among the patients, there were 55 cases of w-HCC and 61 cases of atypical benign FLLs, including 28 cases of early liver abscess, 16 cases of atypical hepatic hemangioma, 8 cases of hepatocellular dysplastic nodules (DN), and 9 cases of focal nodular hyperplasia (FNH). The radiomics model and combined model we established had AUCs of 0.905 and 0.951, respectively, in the training cohort, and the AUCs of the two models in the test cohort were 0.826 and 0.912, respectively. The combined model outperformed the radiomics feature model significantly. Decision curve analysis demonstrated that the combined model achieved a higher net benefit within a specific threshold probability range (0.25 to 1.00). A nomogram of the combined model was developed. The combined model based on the radiomics features of Sonazoid-CEUS in the Kupffer phase showed satisfactory performance in diagnosing w-HCC and atypical benign FLLs. It can assist clinicians in timely detecting malignant FLLs and reducing unnecessary biopsies for benign diseases.

Machine learning model based on dynamic contrast-enhanced ultrasound assisting LI-RADS diagnosis of HCC: A multicenter diagnostic study

BackgroundTo enhance the accuracy of hepatocellular carcinoma (HCC) diagnosis using contrast-enhanced (CE) US, the American College of Radiology developed the CEUS Liver Imaging Reporting and Data System (LI-RADS). However, the system still exhibits limitations in distinguishing between HCC and non-HCC lesions. PurposeTo investigate the viability of employing machine learning methods based on quantitative parameters of contrast-enhanced ultrasound for distinguishing HCC within LR-M nodules. Materials and methodsThis retrospective analysis was conducted on pre-treatment CEUS data from liver nodule patients across multiple centers between January 2013 and June 2022. Quantitative analysis was performed using CEUS images, and the machine learning diagnostic models based on quantitative parameters were utilized for the classification diagnosis of LR-M nodules. The performance of the model was assessed using the area under the receiver operating characteristic curve (AUC) and compared with the performance of four radiologists. ResultsThe training and internal testing datasets comprised 168 patients (median age, 53 years [IQR, 18 years]), while the external testing datasets from two other centers included 110 patients (median age, 54 years [IQR, 16 years]). In the internal independent test set, the top-performing Random Forest model achieved an AUC of 0.796 (95%CI: 0.729–0.853) for diagnosing HCC. This model exhibited a sensitivity of 0.752 (95%CI: 0.750–0.755) and a specificity of 0.761 (95%CI: 0.758–0.764), outperforming junior radiologists who achieved an AUC of 0.619 (95%CI: 0.543–0.691, p < .01) with sensitivity and specificity of 0.716 (95%CI: 0.713–0.718) and 0.522 (95%CI: 0.519–0.526), respectively. ConclusionSignificant differences in contrast-enhanced ultrasound quantitative parameters are observed between HCC and non-HCC lesions. Machine learning models leveraging these parameters effectively distinguish HCC categorized as LR-M, offering a valuable adjunct for the accurate classification of liver nodules within the CEUS LI-RADS framework.

Global Research of the Use of Contrast-Enhanced Ultrasound in Cancer Diagnostic Process: A Bibliometric Analysis and Future Perspective

Pendahuluan: Contrast-enhanced ultrasound (CEUS) dapat digunakan untuk membedakan beberapa jenis tumor ganas. Namun, analisis bibliometrik yang merangkum tren penelitian global dengan topik CEUS untuk mendiagnosis kanker masih terbatas. Penelitian ini bertujuan untuk mengamati tren perkembangan CEUS dalam mendiagnosis kanker dan mengusulkan penelitian di masa depan. Metode: Analisis bibliometrik dilakukan terhadap data publikasi yang diambil dari database Scopus dengan pencarian kata kunci tertentu. Pencarian data diselesaikan dalam waktu satu hari (1 Juni 2024) untuk menghindari kemungkinan bias akibat mekanisme pembaruan database Scopus secara berkala. Data dibatasi untuk publikasi berupa artikel yang diterbitkan sejak awal publikasi hingga tahun 2023. Data-data berupa profil bibliografi, tren tahunan, dan hotspot penelitian dianalisis dan divisualisasikan menggunakan VOSviewer. Hasil: Sejak tahun 1994, terdapat peningkatan keluaran publikasi tahunan dari 2605 dokumen yang teridentifikasi dengan tingkat pertumbuhan rata-rata sebesar 2,35%. Tiga negara yang paling produktif terhadap penelitian topik ini yaitu Tiongkok (50,67%), Jepang (10,17%), dan Amerika Serikat (9,21%). “Ultrasound in Medicine and Biology” menerbitkan artikel terbanyak yang berkaitan dengan topik ini. Penelitian di bidang kedokteran (medicine) paling banyak diminati, diikuti penelitian di bidang biokimia, genetika, dan biologi molekuler (biochemistry, genetics and molecular biology). Sebanyak 4032 kata kunci diklasifikasikan ke dalam delapan kelompok termasuk contrast-enhanced ultrasound, breast cancer, hepatocellular carcinoma, diagnosis, liver, contrast media, metastasis, dan sonazoid. Kesimpulan: Studi bibliometrik ini menunjukkan tren global CEUS dalam bidang diagnosis keganasan. Selain biayanya yang rendah dan keunggulan tanpa radiasi, CEUS merupakan modalitas diagnostik yang menjanjikan untuk membedakan lesi ganas. Penelitian pada topik ini masih dapat dikembangkan pada berbagai lokasi dan jenis keganasan.

Contrast-Enhanced Ultrasound (CEUS) and Ultra-Microangiography (UMA) in Critically Ill Children with Acute Kidney Injury.

Acute kidney injury (AKI) is an acute condition of impaired kidney function with decreased glomerular filtration rate, which results in dysregulation in volume, electrolyte, and acid-base equilibrium. AKI can be a life-threatening condition and can also lead to chronic kidney disease. It is important to diagnose AKI early in the course of the disease or to predict its development, as this can influence therapeutic decisions, outcome, and, consequently, the prognosis. In clinical practice, an elevated serum creatinine concentration remains the most common laboratory indicator for diagnosing AKI. However, due to the delay in its rise, creatinine levels are often insensitive and inaccurate for early diagnosis. Novel biomarkers of kidney tubular injury and the renal angina index have shown promise in predicting AKI earlier and more accurately. Contrast-enhanced ultrasonography (CEUS) and ultra-microangiography (UMA) are radiological methods that can quantify renal microperfusion and may be able to predict the development of AKI. They have not yet been used for quantifying renal perfusion in children with risk factors for developing AKI. Further research is needed to compare these sonographic techniques with the renal angina index and emerging kidney injury biomarkers for predicting acute kidney injury (AKI) in both children and adults.

Contrast-enhanced ultrasound appearance of adrenal hemorrhage after orthotopic liver transplantation: a retrospective study.

This study aimed to identify the incidence of adrenal hemorrhage (AH) after OLT and to summarize the ultrasound (US) and contrast-enhanced ultrasound (CEUS) characteristics. Patients with adrenal lesions after OLT at our hospital were retrospectively reviewed between January 2010 and November 2023. The reference diagnosis was defined on the basis of surgical data, computed tomography scans, and magnetic resonance imaging with at least 12 months of follow-up. The incidence of AH and the US and CEUS characteristics after OLT were analyzed and compared with those of adrenal metastases. A total of 23 patients (1.2%) with AH and 7 patients (0.35%) with suprarenal metastases were assessed. Compared with metastases, hematomas had more inhomogeneous echotextures (57% vs. 0.00%, P = 0.010), hypoechoic or mixed-echoic patterns (96% vs. 71%, P = 0.022), and anechoic areas (52% vs. 0.00%, P = 0.024), and their echotextures varied more over time (65% vs. 0.14%, P = 0.031). CEUS was performed on 12 patients with AH and 2 patients with metastases. A "jet-like" contrast superflux was observed in one actively bleeding hematoma, whereas no enhancement was observed in any static hematoma (100%). However, adrenal metastases had a contrast-enhanced appearance in the early arterial phase, followed by fast washout in the late phase (100%), and the difference was statistically significant (P < 0.001). The sonographic characteristics of AH after OLT vary over time. CEUS is recommended when adrenal lesions are detected, as CEUS can differentiate AH from metastases.

The application value of two-dimensional ultrasound combined with contrast-enhanced ultrasound in the differential diagnosis of benign, borderline, and malignant ovarian epithelial tumors

ObjectiveThe aim of this study was to explore the clinical application value of two-dimensional ultrasound (2D-US) combined with contrast-enhanced ultrasonography (CEUS) in the differential diagnosis of benign, borderline ovarian tumors (BOTs), and malignant ovarian epithelial tumors (OETs).MethodsThe clinical data of 108 patients who underwent surgery for pathologically confirmed of OETs at Peking University People’s Hospital between December 2018 and November 2023 were retrospectively studied. The diagnostic value of 2D-US combined with CEUS for diagnosing OETs was analyzed using chi-square tests, receiver operating characteristic (ROC) curves, and random forest models.ResultsAmong the 108 cases of OETs, 23 were benign, 34 were BOTs, and 51 were malignant. Chi-square tests confirmed that the perfusion pattern of the contrast agent plays an important role in the differential diagnosis of OETs. Compared with those in the benign group, the BOTs were not significantly different in terms of perfusion phase and enhancement intensity, but the regression time of the BOTs was earlier (P < 0.05). Compared with the BOTs, the malignant tumors group showed earlier perfusion and higher enhancement intensity, with no significant difference in regression time. The ROC curve results indicated that the combined diagnostic efficiency of 2D-US and CEUS in distinguishing OETs was significantly higher than that of a single diagnostic technique in terms of sensitivity, specificity, accuracy, and AUC. The random forest model results revealed that among the various parameters used in the differential diagnosis of OETs, the perfusion pattern was the most significant factor.Conclusion2D-US combined with CEUS helps improve the differential diagnostic efficiency for benign, BOTs, and malignant OETs.

The value of contrast-enhanced ultrasonography in predicting stroke occurrence: A prospective study

ObjectivesThis study aimed to investigate the association between contrast-enhanced ultrasound-detected (CEUS) perfusion patterns of carotid plaque and the occurrence of stroke. Materials and methodsThis prospective observational study finally enrolled 256 patients (151 of them having undergone CEUS) from 7851 patients who underwent carotid artery ultrasound from May 2019 to December 2019 with the endpoint being the occurrence of stroke. The risk factors and carotid ultrasound fetures was obtained from those patients. Analyze the relationship between these variables and stoke occurrence. ResultsPatients in the recurrent stroke group and those in the no-recurrent stroke group were statistically different in stenosis rate, plaque echo, fibrous cap integrity, calcification of fibrous cap, hypoechoic area within the plaque, and the pattern of neovascularization perfusion from plaque surface to plaque interior (P < 0.05). Upon adjusting for variables, in all subjects, Cox regression analysis showed that symptoms experienced within the past 6 months (RR = 2.486, 95 % CI: 1.282–4.821), moderate-to-severe carotid stenosis (RR = 2.407, 95 % CI: 1.480–4.593), calcification of fibrous cap (RR = 1.599, 95 % CI: 0.727–3.516) and patchy hypoechoic areas within plaque (RR = 2.486, 95 % CI: 1.107–5.578)independently predicted stroke occurrence across all subjects.; Among subjects underwent CEUS, Cox regression analysis demonstrated that moderate-to-severe carotid artery stenosis (RR = 2.105, 95 % CI: 1.425–4.510) and microbubbles entering the interior of the plaque from its surface (RR = 2.323, 95 % CI: 1.175–4. 594) were independent predictors of stroke occurrence. ConclusionsThe neovascularization perfusion pattern from the plaque surface to its interior serves as an independent predictor of stroke occurrence, thereby potentially enhancing clinical decision-making.

Intentionally unilateral prostatic artery embolization: Patient selection, technique and potential benefits.

Prostatic artery embolization (PAE) is a promising but also technically demanding interventional radiologic treatment for symptomatic benign prostatic hyperplasia. Many technical challenges in PAE are associated with the complex anatomy of prostatic arteries (PAs) and with the systematic attempts to catheterize the PAs of both pelvic sides. Long procedure times and high radiation doses are often the result of these attempts and are considered significant disadvantages of PAE. The authors hypothesized that, in selected patients, these disadvantages could be mitigated by intentionally embolizing PAs of only one pelvic side. To describe the authors' approach for intentionally unilateral PAE (IU-PAE) and its potential benefits. This was a single-center retrospective study of patients treated with IU-PAE during a period of 2 years. IU-PAE was applied in patients with opacification of more than half of the contralateral prostatic lobe after angiography of the ipsilateral PA (subgroup A), or with markedly asymmetric prostatic enlargement, with the dominant prostatic lobe occupying at least two thirds of the entire gland (subgroup B). All patients treated with IU-PAE also fulfilled at least one of the following criteria: Severe tortuosity or severe atheromatosis of the pelvic arteries, non-visualization, or visualization of a tiny (< 1 mm) contralateral PA on preprocedural computed tomographic angiography. Intraprocedural contrast-enhanced ultrasonography (iCEUS) was applied to monitor prostatic infarction. IU-PAE patients were compared to a control group treated with bilateral PAE. IU-PAE was performed in a total 13 patients (subgroup A, n = 7; subgroup B, n = 6). Dose-area product, fluoroscopy time and operation time in the IU-PAE group (9767.8 μGy∙m2, 30.3 minutes, 64.0 minutes, respectively) were significantly shorter (45.4%, 35.9%, 45.8% respectively, P < 0.01) compared to the control group. Clinical and imaging outcomes did not differ significantly between the IU-PAE group and the control group. In the 2 clinical failures of IU-PAE (both in subgroup A), the extent of prostatic infarction (demonstrated by iCEUS) was significantly smaller compared to the rest of the IU-PAE group. In selected patients, IU-PAE is associated with comparable outcomes, but with lower radiation exposure and a shorter procedure compared to bilateral PAE. iCEUS could facilitate patient selection for IU-PAE.

Comparison of the value of ultrasound-guided fine needle aspiration biopsy and contrast-enhanced ultrasound in different sizes of thyroid nodules.

The purpose of this study was to evaluate the diagnostic value of ultrasound-guided fine needle aspiration biopsy (US-FNAB) and contrast-enhanced ultrasound (CEUS) in the presence of thyroid nodules of different sizes. We retrospectively analyzed 110 patients with surgically operated unimodular thyroid nodules in Yichang City Central Hospital from July 1, 2021, to April 1, 2023, all of whom underwent conventional thyroid ultrasound, CEUS, and US-FNAB, and all of whom were classified according to the size of nodules into <0.5, 0.5 to 1, and ≥1 cm groups. The diagnostic accuracy, sensitivity, and specificity of the 2 methods for benign and malignant nodules were calculated. Among 110 thyroid nodules, 102 were malignant nodules and 8 were benign nodules. In patients with nodule diameters <1 cm the sensitivity of US-FNAB and CEUS was 87.02% and 93.89%, respectively, and the specificity was 100.00% and 66.67%, with an accuracy of 87.31% and 93.28%, respectively. In patients with nodule diameter <0.5 cm, the sensitivities of US-FNAB and CEUS were 74.29% and 100.00%, respectively, and the differences were statistically significant (P < 0.05); in patients with nodule diameter 0.5 to 1 cm, the sensitivities of US-FNAB and CEUS were 79.59% and 95.92%, respectively, and the differences were statistically significant (P < 0.05); among patients with nodule diameters ≥1 cm, the sensitivities of US-FNAB and CEUS were 88.89% and 77.78%, respectively, with no statistically significant difference (P > 0.05). For thyroid nodules ≤1 cm in diameter, the sensitivity of CEUS examination was higher than that of US-FNAB; and CEUS still has good diagnostic accuracy in the diagnosis of benign and malignant thyroid nodules <0.5 cm, CEUS is recommended for thyroid nodules diagnosed negatively by US-FNAB with a diameter of <1 cm; and CEUS should be preferred for thyroid nodules with a diameter of <0.5 cm. CEUS should be preferred for thyroid nodules <0.5 cm in diameter.

Imaging features of hepatic angiosarcoma: retrospective analysis of two centers

PurposeIdentifying primary hepatic angiosarcoma (PHA) preoperatively is challenging, often relying on postoperative pathology. Invasive biopsy increases bleeding risk, emphasizing the importance of early PHA diagnosis through imaging. However, comprehensive summaries of ultrasound, abdominal computed tomography (CT), magnetic resonance imaging (MRI), and whole- body positron emission tomography-CT (PET-CT) in this context are lacking. This study aimed to investigate the comprehensive imaging characteristics of PHA.Patients and methodsImaging data were collected from 7 patients diagnosed with PHA via pathology between January 2000 and December 2019 in two provincial grade III hospitals. All patients underwent routine color ultrasound examinations before surgery, with 3 patients receiving contrast-enhanced ultrasound (CEUS).CT scans, both plain and enhanced, were performed on 5 patients, and whole-body PET-CT examinations were conducted on 2 patients.ResultsAmong the 7 patients with PHA, 4 presented with a single solid intrahepatic mass (2 of which were large), 1 with a single exophytic macroblock type, 1 with a mixed type featuring multiple masses and nodules, and 1 with a multiple nodule type. Conventional ultrasound of PHA showed uneven echoes within the tumor, potentially accompanied by septal zone echoes, and a blood flow grade of 0-I. CEUS displayed early-stage circular high enhancement, a central non-enhancement area, and a "vascular sign" around the tumor. CT scans revealed low-density shadows in the plain scan stage, high peripheral ring enhancement, and punctate nodular enhancement in the arterial phase, with varying intensities and the presence of a "vascular sign." During the portal vein stage, the interior of the tumor was consistently unfilled and exhibited structural disorder. PET-CT showed low-density lesions in the liver and low fluorodeoxyglucose metabolism.ConclusionsImaging diagnosis plays a crucial role in PHA diagnosis. When liver tumor imaging matches the above characteristics, consider PHA.

Polymeric antibubbles with strong ultrasound imaging capabilities.

Antibubbles are liquid droplets encapsulated by a gas film that have recently been explored for on-demand ultrasound-triggered drug release. However, their ultrasound imaging capabilities are limited by their stiff shells stabilized with silica nanoparticles. Here, we develop polymeric antibubbles that generate greater ultrasound contrast than silica-based antibubbles, while showing better stability than conventional polymeric microbubbles.

Ultrasound-based Radiomics Analysis for Assessing Risk Factors Associated With Early Recurrence Following Surgical Resection of Hepatocellular Carcinoma

ObjectiveThe aim of this study was to explore the value of ultrasound-based radiomics analysis for early recurrence (ER) after surgical resection of hepatocellular carcinoma (HCC). MethodsThis retrospective study included 127 patients who underwent primary surgical resection for HCC between October 2019 and November 2021. The patients were subsequently divided into training and validation sets (7:3 ratio). All patients received preoperative routine ultrasound and contrast-enhanced ultrasound (CEUS), with postoperative pathological confirmation of HCC. Radiomics features were extracted from maximum section of two-dimensional ultrasound image. The least absolute shrinkage and selection operation (LASSO) logistic regression algorithm with 10-fold cross-validation was employed to establish ultrasonic radiomics features. Logistic regression modeling was employed to build models based on clinical and ultrasonic features (model 1, clinical-ultrasonic model), radiomics signature (model 2, ultrasonic radiomics model), and the combination (model 3, clinical-ultrasonic-radiomics model). Then a nomogram model was established to predict the risk of ER, and the application value of nomogram through internal verification was evaluated. ResultsModel 3 showed optimal diagnostic performance in both training set (AUC=0.907) and validation set (AUC=0.925), followed by the model 1 in training set (AUC=0.846) and validation set (AUC=0.855), both above two models performed better than model 2 in training set (AUC=0.751) and validation set (AUC=0.702) (p<0.05). In training set and validation set of model 3, the sensitivity were 83.3%, 77.8%, the specificity ware 95.8%, 100.0% and the C-index were 0.791, 0.778. ConclusionThe preoperative clinical-ultrasonic-radiomics model is anticipated to be a reliable tool for predicting the ER of surgical resection of HCC.

Hydrogel System with Independent Tailoring of Mechanics, CT, and US Contrasts for Affordable Medical Phantoms.

Medical phantoms mimic aspects of procedures like computed tomography (CT), ultrasound (US) imaging, and surgical practices. However, the materials for current commercial phantoms are expensive and the fabrication with these is complex and lacks versatility. Therefore, existing material solutions are not suitable for creating patient-specific phantoms. We present a novel and cost-effective material system (utilizing ubiquitous sodium alginate hydrogel and coconut fat) with independently and accurately tailorable CT, US, and mechanical properties. By varying the concentration of alginate, cross-linker, and coconut fat, the radiological parameters and the elastic modulus were adjusted independently in a wide range. The independence was demonstrated by creating phantoms with features hidden in US, while visible in CT imaging and vice versa. This system is particularly beneficial in resource-scarce areas since the materials are cheap (<$ 1 USD/kg) and easy to obtain, offering realistic and versatile phantoms to practice surgeries and ultimately enhance patient care.

Ultrasound, contrast-enhanced ultrasound and pyelonephritis: A narrative review.

Acute pyelonephritis (APN) is a bacterial infection resulting in kidney inflammation, typically arising as a complication of an ascending urinary tract infection that ascends from the bladder to the kidneys. Clinical diagnosis is generally based on clinical and laboratory findings. Recent guidelines recommend not performing diagnostic imaging unless a complicated APN is suspected or the infection affects high-risk patients such as the elderly, immunocompromised individuals, or diabetics. Contrast-enhanced ultrasound (CEUS) is a valuable tool in both the diagnosis and follow-up of APN. It aids in distinguishing small simple nephritic involvement from abscess complications and monitoring their evolution over time during antibiotic therapy. Given its lack of ionizing radiation and nephrotoxicity, CEUS is a valid diagnostic modality for approaching and monitoring pyelonephritis, improving early identification and characterization of inflammatory lesions. This review aims to summarize the main evidence on the use of ultrasound and CEUS in the diagnosis of APN and its follow-up.

Contrast-enhanced ultrasound-guided percutaneous transhepatic cholangiodrainage is a safe and effective procedure for patients with malignant biliary obstruction and stage 3 chronic kidney disease

ObjectivesThis study aimed to validate the efficacy and safety of contrast-enhanced ultrasound-guided percutaneous transhepatic cholangiodrainage (CEUS-PTCD) as a biliary drainage procedure in patients with malignant biliary obstruction and stage 3 chronic kidney disease (CKD3). Materials and methodsBetween January 2019 and December 2023, 634 patients who underwent CEUS-PTCD were retrospectively enrolled in this study. During the procedure, imaging parameters such as the maximum diameter of the dilated bile duct, presence of ascites, detailed findings from CEUS, and clinical outcomes were meticulously recorded. Laboratory results, including serum bilirubin levels, liver function tests, and estimated glomerular filtration rate (eGFR), were evaluated in one day before and three days after procedure. The aforementioned parameters were compared using the paired-sample t test and the Wilcoxon test. ResultsA total of 66 (10.41 %) patients with malignant biliary obstruction and CKD3 were included in the final analysis (median age: 66, range: 30–89 years, 46 males and 20 females). Procedure records indicated that 23 patients (34.8 %) had a maximum biliary duct dilation diameter of ≤ 4 mm, while 5 patients (7.6 %) exhibited mild ascites. Additionally, 24 patients (36.4 %) had ultrasound contrast agent entry into both the biliary duct and bloodstream. All patients successfully achieved external bile drainage following CEUS-PTCD, with no significant complications observed during or after the intervention. Post-procedure, there was a statistically significant reduction in all previously elevated serum bilirubin and liver enzyme levels (P-values were less than 0.05). Furthermore, no statistically significant alterations in eGFR were observed prior to or following CEUS-PTCD across all patients (P = 0.295), including comparisons between groups with and without the ultrasound contrast agent into the bloodstream (P = 0.254). ConclusionCEUS-PTCD is a safe and effective biliary drainage procedure for patients with malignant biliary obstruction and CKD3.

Contrast-enhanced Ultrasound as a Method of Splenic Injury Assessment

Abstract Splenic injuries are common in abdominal trauma, as the spleen is one of the most often harmed organs. The treatment of splenic injuries underwent major changes during the past decades, shifting from a surgical approach to nonoperative management. This change of the proceedings results from a constantly growing awareness of the spleen’s crucial hematological and immunological function and was possible owing to the advances in radiological techniques. In a setting of high-energy trauma in hemodynamically stable patients, computed tomography (CT) remains the gold standard. Where ultrasonography (US) is of major importance is in cases of unstable patients undergone high-energy trauma or in patients after low-energy trauma. Nevertheless, baseline US’s sensitivity is not sufficient to detect splenic traumatic injuries; hence, a new method was developed involving ultrasound contrast agents (UCAs), called contrast-enhanced ultrasound (CEUS). In a low-energy trauma setting, it facilitates the diagnosis of abdominal lesions with a sensitivity close to that of CT, without the disadvantages of the latter. In addition, CEUS can be used in the follow-up of abdominal traumatic injuries. The fact that CEUS preserves CT’s sensitivity while not carrying the risk of radiation-induced cancer makes it feasible for children and pregnant women. This review aims to discuss the technical aspects of CEUS, the limitations, and possibilities regarding this modality, present the appearance of both a healthy and injured spleen, and compare CEUS’s effectiveness to that of CT through an analysis of retrievable studies.