Background Intraplaque neovascularization is a biomarker of vulnerable plaque. However, no data are available whether the increase in neovascularization within carotid plaques is a result of ischemia or an increase in adventitial vasa vasorum (VV).

Objective To evaluate the VV signal in carotid vulnerable plaques.

Methods Contrast-enhanced ultrasound (CEUS) examination was performed to examine changes in VV density in 47 patients with carotid plaque, and 21 patients received CT angiography (CTA) examination to assess the VV signal. In addition, a single-channel flow tissue model was fabricated for use in vitro studies to exclude pseudo-enhancement interferences in the distal wall of arteries by CEUS.

Results The intensities of adventitial VV behind carotid plaque were lower than that of adventitial VV at the same level adjacent to the plaque in both CEUS and CTA examinations (P < 0.05). In vitro study, the intensities of far wall increased as the microbubble concentration increased (P < 0.05). However, no significant differences of intensities of far wall were found between different thicknesses tubes at the concentration of microbubble concentrations of 0.3% and 0.5% (P ≥ 0.05).

Conclusion The formation of intraplaque neovascularization in carotid arteries is associated with the adventitial VV, and ischemia of VV may be a potential mechanism for intraplaque neovascularization.

Stroke is a critical condition marked by the death of brain cells due to inadequate blood flow, necessitating improved predictive models for stroke lesions. The accuracy and flexibility required to forecast and classify stroke lesions is lacking in current approaches, which compromise patient outcomes. To solve these issues, Bille-Viper-Segmentation with the Tandem-MU-Net Model is suggested as a solution for tissue damage detection problems. This study improves blood flow detection in stroke images by introducing the Bille-Viper-Segmentation method to overcome difficulties in recognizing tissue injury. This novel method effectively samples pixel data and analyzes fogging phases related to stroke lesions by utilizing a Deep Luxe Gauging Tree. Existing methods struggle with flexibility in varying conditions; thus, the Trans-Lucent-Rich Reprise Pattern recognition algorithm for precise identification of infected areas is introduced. Furthermore, the Focus View Algorithm is suggested, which incorporates features from infarcted regions to improve early detection of emerging lesions. Furthermore, the Tandem-MU-Net model is used to extract essential morphological features and categorize stroke types, including Hemorrhagic and Acute strokes, through an investigation of their neutral and ionic forms. The results show that the suggested model performs substantially better than existing methods, achieving an amazing accuracy rate of 75%, recall rate of 83%, F1 score of 98%, Dice score of 98%, and precision of 73%, all while operating effectively in a time frame of 250 seconds.

Objective Antenatal vaginal bleeding, particularly during the first trimester, is worrisome for obstetricians. The common causes are all types of abortions, including molar and ectopic pregnancies. The aim is to evaluate the obstetric causes of vaginal bleeding during the first trimester.

Methods The study population comprises 100 pregnant women with complaints of vaginal bleeding during their first trimester period. These patients were subjected to ultrasound examination to diagnose the causes of bleeding. Patients with 12 completed weeks of gestation and non-obstetrical causes of vaginal bleeding were excluded.

Results The study population of 18-34 years had complained of vaginal bleeding during their first trimester of pregnancy. Most 57% were in the age group of 20-24 years. Forty-two percent of the study population presented at ten weeks of amenorrhea. Out of 100 cases, the majority (58%) were diagnosed as threatened abortion, 31% cases were diagnosed as incomplete abortion, 4% cases were diagnosed as complete abortion, 2 (2%) cases each were diagnosed as ectopic gestation, inevitable and missed abortions, and 1 (1%) case diagnosed as Hydatidiform mole. Out of 100 patients, the gestational sac was seen in 75 (75%).

Conclusion Antenatal ultrasonography is helpful in accurate and early diagnosis of the causes of vaginal bleeding during the first trimester. This aids the obstetrician in selecting the best treatment planning and helps with prognosis prediction, establishing an accurate diagnosis in a few clinically misdiagnosed cases.

Objective Biliary atresia is a significant cause of neonatal pathological jaundice, demanding effective interventions such as the Kasai procedure to impede its advancement. Previous research highlights the potential of shear wave elastography for assessing liver fibrosis and the subsequent necessity for liver transplantation following Kasai procedure. This underlines the significance of our study in investigating shear wave elastography as a predictive tool for the success of Kasai procedure in biliary atresia patients.

Methods This retrospective case-control comparative study analyzed data from biliary atresia patients who underwent shear wave elastography ultrasound and the Kasai procedure at our center from 2020 to 2022. Successful Kasai outcomes formed the case group; unsuccessful, the control. We calculated the mean shear wave elastography values for each group and established a predictive Kasai success cut-off using SPSS for statistical analysis.

Results Twenty-one subjects, with 8 males and 13 females (median age: 82 days), were evaluated. Of the 21 subjects, 9 (42.9%) had successful Kasai outcomes, while 12 (57.1%) were unsuccessful. There are statistically different values between two groups, such as the shear wave elastography value (P = 0.001). The optimal cut-off point of shear wave elastography value to predict the success of Kasai procedure is 2.21 m/s or 14.4 kPa (sensitivity 88.9%, specificity 83.3%, accuracy 85.7%, PPV 87.65%, NPV 84.91%), with an AUC of 0.889 (95%CI = 0.75-1.00), OR = 10.50 (1.360-81.053).

Conclusion This study demonstrates shear wave elastography’s potential utility in predicting Kasai procedure success for biliary atresia patients, suggesting its role as a valuable prognostic tool.

Objective: This study aims to assess the performance of the Chat Generative Pre-Trained Transformer (ChatGPT), specifically versions GPT-3.5 and GPT-4, on ultrasonography board-style questions, and subsequently compare it with the performance of third-year radiology residents on the identical set of questions.
Methods: The study, conducted from May 19 to May 30, 2023, utilized a selection of 134 multiple-choice questions sourced from a commercial question bank for American Registry for Diagnostic Medical Sonography (ARDMS) examinations and imported into the ChatGPT model (encompassing GPT-3.5 and GPT-4 versions). ChatGPT’s responses were evaluated overall, by topic, and by GPT version. An identical question set was assigned to three third-year radiology residents, enabling a direct comparison of performances with ChatGPT.
Results: GPT-4 correctly responded to 82.1% of questions (110 of 134), significantly surpassing the performance of GPT-3.5 (P = 0.003), which correctly answered 66.4% of questions (89 of 134). Although GPT-3.5’s performance was statistically indistinguishable from the average performance of the radiology residents (66.7%, 89.3 of 134) (P = 0.969), there was a notable difference in the accuracy in question-answering accuracy between GPT-4 and the residents (P = 0.004).
Conclusions: ChatGPT demonstrated significant competency in responding to ultrasonography board-style questions, with the GPT-4 version markedly surpassing both its predecessor GPT-3.5 and the radiology residents.

Objectives: The incidence of chronic liver diseases in children is increasing worldwide due to congenital, metabolic, autoimmune and viral diseases. Currently, liver biopsy for fibrosis assessment is considered the gold standard. However, this procedure is invasive, may result in unavoidable complications and is prone to sampling errors. These limitations have led to an increasing demand for noninvasive methods for fibrosis screening. Artificial intelligence integration in ultrasound diagnosis of liver fibrosis has gained interest in clinical research. In the current study we used a cloud-based artificial intelligence platform utilizing transfer learning to evaluate the accuracy of B-mode ultrasound based AI model compared to pediatric radiologists in detection of liver fibrosis in a pediatric population.
Methods: For this IRB approved study, charts of 190 pediatric patients who were referred for liver biopsy and ultrasound were reviewed. On average 14 images of different liver areas were selected and a single image per decision was used for both radiologist and AI reads. A supervised machine learning model for image classification was developed using Google Vision AutoML (Google Inc., Mountain View, CA, USA). Data was divided for model development (80% of cases (154 cases) = 2324 images) and a model validation cohort for external testing (20% (36 cases) = 360 images). As a comparator, three blinded radiologists read the ultrasound images of the validation cohort and provided a binary diagnosis of fibrosis versus non fibrotic liver appearance. Tissue sampling was used as the reference standard for all cases.
Results: There were 99 and 91 patients in the biopsy proven fibrosis and non-fibrosis group, respectively. The model’s internal evaluation resulted in precision of 78.2%, recall of 78.5% and average precision of 87.7%. In the external validation cohort, three radiologists (Mean ± Standard Deviation) and Google AutoML (confidence interval (CI)) achieved a sensitivity of 42.04% ± 0.04 and 70.56% (63.32% to 77.10% CI), specificity of 50.18% ± 0.04 and 45.00% (37.59% to 52.58% CI), positive predictive value of 45.76% ± 0.01 and 56.19% (52.17% to 60.14% CI), negative predictive value of 46.39% ± 0.01 and 60.45% (53.65% to 66.86% CI) and accuracy of 46.11% ± 0.01 and 57.78% (52.49% to 62.94% CI). When evaluating agreement across multiple images from the same patient, intra-reader agreement was 77.2% for AutoML and 90.8%-92.5% for the 3 radiologists. The models' F1 scores for the development and validation cohort were 0.78 and 0.62, respectively.
Conclusions: Liver fibrosis assessment in children is challenging without biopsy. An ultrasound-based AI model showed high sensitivity compared to radiologists, albeit still without suitable diagnostic performance for clinical use.

Objective: Drug-induced liver injury (DILI) is one of the most challenging forms of liver disorder. We aimed to use ultrasound dual elastography, by combining strain and shear wave imaging, to noninvasively assess liver inflammation and injury severity of DILI.

Methods: 291 DILI patients were included in the prospective multicenter study and divided into training and validation cohorts. All patients received liver biopsy and dual elastography examination. Liver inflammation grading (G0-4) and fibrosis staging (F0-4) were considered as the gold standard of liver injury and G+F ≥ 5 was defined as severe liver injury. Indexes of dual elastography and serological indicators (DESI) were selected and analyzed with multivariable logistic regression to build DESI models for evaluating liver inflammation, and the C score model was built with the same method for diagnosing severe liver injury.

Results: Areas under the receiver operating characteristic curve (AUCs) of the DESI model to assess liver inflammation ≥ G2 were 0.887 and 0.868 in training and validation cohorts, respectively. AUCs of the DESI model in diagnosing ≥ G3 were 0.893 and 0.896 in the two cohorts, respectively. The C score accurately assessed severe liver injury with AUCs of 0.909 and 0.885 in two cohorts. Of the 87 patients with mild clinical severity, 10 (11.49%) had severe pathological injury, which could be identified by C score.

Conclusion: Dual elastography demonstrated high performance in diagnosing liver inflammation and identifying severe pathological liver injury of DILI, making up for the deficiency of serological indicators alone for evaluating DILI severity.

Objective: To evaluate accuracy and feasibility of a handheld ultrasound machine for measuring carotid artery intima-media thicknesses (CIMT) and hemodynamic parameters by different expertise levels of ultrasound operators.

Methods: The operators were divided into three groups based on the level of their medical expertise: ultrasound technician, sonographer, and nursing staff. Operators from each group measured the CIMT and hemodynamic parameters of 25 volunteers using both handheld ultrasound and a conventional ultrasound machine. The reliability and reproducibility of handheld ultrasound measurements of CIMT and hemodynamic parameters (peak systolic velocity (PSV), end-diastolic velocity (EDV)) in operators were analyzed.

Results: After a period of training, there was no statistically significant difference between the mean CIMT measured using handheld ultrasound among the three operators (0.45 ± 0.09 mm, 0.50 ± 0.07 mm, 0.46 ± 0.08 mm, P> 0.05, respectively), as well as PSV (83.30 ± 15.42 cm/s, 76.28 ± 13.26 cm/s, 81.12 ± 21.21 cm/s, P> 0.05, respectively) and EDV (21.04 ± 4.12 cm/s, 21.87 ± 5.05 cm/s, 20.17 ± 5.90 cm/s, respectively, P> 0.05). Furthermore, there was a good repeatability and consistent of handheld ultrasound device in measuring mean CIMT in the ultrasound technician and sonographer groups (r = 0.662, 0.691, respectively, P < 0.01).

Conclusions: Under the premise of proper training, handheld ultrasound systems are feasible for rapid and primary assessment of carotid artery by operators with different levels of expertise.

Objective: To explore the diagnostic value of real-time shear wave elastography (SWE) in hepatic hemangioma (ANGI) and hepatocellular carcinoma (HCC).

Methods: A total of 88 patients diagnosed with angiosarcoma (ANGI) or hepatocellular carcinoma (HCC) in our department from February 2019 to February 2020 were included in this study. These patients were assigned to two groups based on pathological diagnosis: the ANGI group (n = 42) and the HCC group (n = 46). All patients underwent SWE examination, and the clinical efficacy was analyzed by comparing the average value of Young's modulus of the two groups and plotting the receiver operator characteristic (ROC) curve.

Results: There was no significant difference in lesion diameter between ANGI and HCC patients (P > 0.05). The ANGI group exhibited a significantly higher average Young's modulus for both the lesions and the adjacent liver tissues compared to the HCC group (P < 0.001); The area under the curve (AUC) of the average value of Young’s modulus of the lesion to ANGI and HCC was 0.875 (95% CI = 0.795-0.955).

Conclusion: SWE demonstrates high diagnostic accuracy in distinguishing ANGI from HCC, providing valuable clinical evidence for differentiating between the two diseases.

Objective: To determine whether COVID-19 causes an increase in spleen dimensions in individuals with a recent history of COVID-19 infection.

Methods: This case-control study was conducted at the Radiology Department of the University of Lahore Teaching Hospital and Sehat Medical Complex, both in Lahore. The study sample comprised 384 individuals, selected using a convenience sampling technique. Participants included individuals of all age groups and both genders; however, those under 18 were excluded due to the potential for incomplete spleen maturation. Other exclusion criteria included a history of splenectomy, the presence of traumatic or non-traumatic splenic lesions, or any other splenic abnormalities. Data collection commenced after obtaining approval from the Research Ethics Committee at the University of Lahore. The Siemens Sonovista c3000 Grey Scale Ultrasound Machine was used, and the data were analyzed using SPSS version 24.

Results: In a study involving 384 participants, the mean age was 35.7 ± 6.14, ranging from 22 to 50 years. Of these, 296 (71.1%) were female, and 88 (22.9%) were male. Echogenicity varied, with 29 participants (7.6%) exhibiting heterogeneous echogenicity and 355 (92.4%) showing homogeneous echogenicity. Spleen margins were irregular in 67 participants (17.4%) and smooth in 317 participants (82.6%). Regarding the history of Covid-19, 188 participants (49%) tested negative, while 196 participants (51%) tested positive.

Conclusion: Patients with a history of COVID-19 exhibited a significant increase in spleen length, volume, and thickness.

Objective This study aimed to evaluate the development of atherosclerosis in ApoE-deficient dogs fed with a high-fat diet (HFD) using vascular duplex ultrasonography (VDU).

Methods Thirty beagle dogs were enrolled, including 10 wild-type, 16 heterozygous (ApoE^-/+), and four homozygous (ApoE^-/-) mutant dogs. The dogs were categorized into either the normal diet (ND) or HFD group. Plasma lipids levles were tested at baseline and then after feeding the dog a different diet for 6 months. The carotid arteries, abdominal aorta (AO) and iliac arteries were examined using VDU. Artery sections of the ApoE^-/- dogs were analyzed.

Results After HFD, lipids especially triglycerides, total cholesterol and low-density lipoprotein (LDL) in the wild type and ApoE^-/+ dogs were significantly increased. Both the intima-media thickness (IMT) of the common carotid artery (CCA) and AO in the wild type and ApoE^-/+ dogs significantly increased. In the ApoE^-/+ dogs, the mean percentages increases in CCA-IMT and AO-IMT after HFD were higher than those in the ND dogs. The mean values of CCA-IMT and AO-IMT in the ApoE^-/-dogs increased to 2-2.5 folds after HFD. Histological analysis confirmed that the carotid and iliac arteries had advanced atherosclerotic lesions in the ApoE^-/- dogs.

Conclusions HFD may accelerate the development of atherosclerosis in ApoE-deficient dogs, which is an optimal large-animal model of atherosclerosis.

ObjectiveThe objective of this study was to develop a sonographic technique using two-dimensional (2D) markers for detecting isolated fetal cleft palate (no cleft lip) and to evaluate the ability of 2D and three-dimensional (3D) sonography to image the normal and abnormal palate.

Methods Seventy-three fetuses with a high risk of cleft palate at 12-39 weeks of gestation were referred for specialist ultrasound. A detailed evaluation of the palate was performed through 2D ultrasound, which revealed the appearance of the palatine line in the sagittal plane; the palate and alveolar ridge in the coronal plane of the fetal face; the horizontal plate of the palatine bone in the axial maxillary plane; and the soft palate in the transverse plane of the cavum pharyngis. Subsequently, 3D ultrasound imaging of the palate was performed in all fetuses. Antenatal diagnoses were compared with postnatal findings or autopsy findings.

Results Visualization of 2D markers was accomplished in all fetuses, and 3D assessment was achieved in 97% of fetuses. Cleft palate was suspected in 16 cases (21.9%), among which 14 were suspected on the basis of both 2D and 3D evaluation, and two were suspected only on the basis of 3D evaluation. A normal palate was observed in 57 fetuses (78.1%). The mean gestational age was 27 weeks (range of 12 weeks to 39 weeks). All 16 fetuses with suspected cleft palate were confirmed by postnatal or autopsy findings, no false-positives were observed, and one case with a bifid uvula was missed among 57 fetuses with a presumed normal palate.

Conclusions The fetal palate can be evaluated with 2D markers and 3D sonography. The detection of isolated cleft palate is more sensitive when 2D markers are present in all four planes.

Objective Aimed to evaluate patients with essential hypertension (EH) using four-dimensional automatic left atrial quantification (4DLAQ) To assess the occurrence of EH.

Methods This study selected 80 patients with EH for the EH group and 36 healthy individuals for the control group. Various cardiac parameters, including left atrial diameter (LAD), interventricular septal thickness (IVST), left ventricular end-diastolic diameter (LVDD), left ventricular posterior wall thickness (LVPWT), early E-wave velocity of mitral valve diastole/mitral valve ring myocardial displacement velocity (E/e'), biplanar left ventricular ejection fraction (biplanLVEF), left atrial minimum volume (LAVmin), lateral left atrial maximum volume (LAVmax), left atrial presystolic volume (LAVpreA), left atrial ejection fraction obtained by two-dimensional echocardiography (LAEF), left atrial passive ejection fraction (LAPEF), left atrial active ejection fraction (LAAEF), left atrial reservoir longitudinal strain (LASr), left atrial catheter longitudinal strain (LAScd), left atrial systolic longitudinal strain (LASct), left atrial reservoir circular strain (LASr_c), left atrial catheter circular strain (LAScd_c), and left atrial systolic circular strain (LASct_c) were measured using 4DLAQ. Binary logistic regression was employed to analyze the effect of 4DLAQ strain parameters on EH. Receiver operating characteristic (ROC) curves were used to assess the predictive value of 4DLAQ strain parameters for EH.

Results Systolic blood pressure and diastolic blood pressure in the EH group were higher than those in the control group (P = 0.000 and 0.000, respectively). In the EH group, LAD, IVST, LVDD, LVPWT, E/e', LAVmin, LAVmax, and LAVpreA were significantly increased (P = 0.000, 0.000, 0.072, 0.000, 0.000, 0.001, 0.052, and 0.004, respectively), whereas biplanLVEF, LAEF, LAPEF, LAAEF, LASr, LAScd, LASct, LASr_c, LAScd_c, and LASct_c significantly decreased (P = 0.090, 0.000, 0.009, 0.064, 0.000, 0.000, 0.000, 0.000, 0.000, and 0.689, respectively). Bland-Altman plots were used to illustrate the relationship between variables and audience consensus. LASr and LAScd were identified as independent risk factors for EH. The area under the ROC curve (AUC) for LASr was 0.925, (95% confidence interval [CI] = 0.879-0.971) with a sensitivity of 80.00%, specificity of 94.44%, using a cut-off value of 20%. For LAScd, the AUC-ROC was 0.878 (95% CI = 0.818-0.939 with a sensitivity of 76.25%, specificity 86.11%, and using a critical value of -11%.

Conclusion LASr and LAScd exhibited superior predictive capabilities for EH, with LASr performing the best. This study fills a critical gap in left atrial research and holds significant clinical implications.

Objective To evaluate the feasibility and capability of UT in detecting musculoskeletal system lesions in the limbs and to explore its image quality.

Materials and Methods The Institutional Review Board has approved this prospective single-center study. This study included participants with various musculoskeletal and neurologic disorders in the limbs who provided written consent from October 2022 to April 2023. In addition to other radiological examinations (X-rays, CT, or MRI) and conventional handheld ultrasound scans requested by clinicians based on the conditions, each participant also underwent UT scanning using our developed limb ultrasound imaging system during the same period. Four radiologists and ultrasound physicians with more than five years of experience in musculoskeletal diagnostics analyzed the two-dimensional and three-dimensional images of the examination area.

Results Overall, 50 participants were evaluated (mean age, 36 years ± 18 [SD]; 26 males). The conditions included musculoskeletal tumors (n = 10), postoperative follow-up of musculoskeletal tumors (n = 20), peripheral nerve disorders in the limbs (n = 10) and postoperative pain in orthopedic surgery (n = 10). In all UT images, the region of interest was completely displayed, and internal structures such as muscles and nerves were clearly visible. Compared to conventional ultrasound images, the reconstructed three-dimensional images intuitively displayed the relationship between the lesions and surrounding tissues. Furthermore, UT did not exhibit metal artifacts when observing soft tissues around metallic implants, providing more comprehensive soft tissue information and more intuitive stereoscopic images.

Conclusion Clinical results of the UT system have demonstrated its feasibility as an automated and standardized imaging technique for musculoskeletal imaging, providing a new imaging modality for the diagnosis of musculoskeletal diseases in the human body.

Objective To investigate the effectiveness of SMI in evaluating hepatic IRI and detecting its therapy response.

Methods Thirty rats were randomly divided into sham (n = 12), IRI (n = 12), and andrographolide pretreatment (n = 6) groups. SMI, pathological, and biochemical examinations were conducted for the sham and IRI groups at 4 (n = 6) and 24 h (n = 6) after reperfusion, respectively. Two ultrasonologists measured the vascular index (VI). The interobserver agreement was evaluated using the intraclass correlation coefficient (ICC). The rat liver parameters, including Suzuki's score, alanine aminotransferase (ALT), and aspartate aminotransferase (AST), were obtained at different time steps in each group. For the andrographolide pretreatment group, data were obtained at 24 h after reperfusion to further verify the advantage of VI. Parameters were analyzed for correlations and compared between each group at 4 and 24 h.

Results The ICC between two ultrasonologists who measured the VI was 0.912 (95%CI: 0.889-0.940). Suzuki's score and VI were negatively correlated (r = -0.504, P = 0.012). Compared with the sham group, the IRI group showed a significant decrease in the VI at 4 and 24 h after reperfusion [(24.78 ± 3.23) versus (20.22 ± 2.55); (22.67 ± 1.36) versus (19.27 ± 2.23), P < 0.05)]. The VI in the andrographolide pretreatment group was higher than that in the IRI group [(21.90 ± 1.47) versus (19.27 ± 2.23), P <0.05].

Conclusions The VI on SMI can be used as a noninvasive and sensitive index to evaluate hepatic IRI and detect its therapeutic response.

Objective MicroRNAs (miRNAs) play important roles in various diseases’ development and progression. The aim of this study is to identify the differently expressed miRNAs (DEmiRNAs) and differently expressed genes (DEGs) between BPH and PCa.

Methods Selecting BPH and PCa tissues from GEO database (GSE118038 as test dataset; GSE30994 as validation dataset), we identified DEmiRNAs and DEGs between BPH and PCa using GEO2R online tool and “Deseq2” R package. We applied random forest method to select hub DEmiRNAs, combining age and BMI, to establish a nomogram model for BPH detection. Finally, GO and KEGG enrichment analyses were conducted to explore the underlying mechanisms and pathways of DEmiRNAs in BPH.

Results We found 26 DEmiRNAs between BPH and PCa, of which 21 DEmiRNAs were up-regulated and 5 DEmiRNAs were down-regulated. Via forest random method, we selected miR-636, miR-324-3p, miR-210-3p and miR-3615 as hub DEmiRNAs in BPH. Combing these four hub DEmiRNAs, age and BMI, we established a nomogram model to distinguish BPH from PCa. Through “miRWalk” online tool, we targeted 499 hub DEGs between BPH and PCa, and found most of genes enriched in muscle system process, muscle contraction, contractile fiber, myofibril, actin binding, passive transmembrane transporter activity, focal adhesion, axon guidance.

Conclusion Our results suggested that miR-636, miR-324-3p, miR-210-3p and miR-3615 might the hub DEmiRNAs between BPH and PCa, which may play a crucial role to distinguish BPH from PCa.

Objective A non-invasive assessment of the risk of benign and malignant follicular thyroid cancer is invaluable in the choice of treatment options. The extraction and fusion of multidimensional features from ultrasound images of follicular thyroid cancer is decisive in improving the accuracy of identifying benign and malignant thyroid cancer. This paper presents a non-invasive preoperative benign and malignant risk assessment system for follicular thyroid cancer, based on the proposed deep feature extraction and fusion of ultrasound images of follicular thyroid cancer.

Methods First, this study uses a convolution neural network (CNN) to obtain a global feature map of the image, and the fusion of global features cropped to local features to identify tumor images. Secondly, this tumour image is also extracted by googleNet and ResNet respectively to extract features and recognize the image. Finally, we employ an averaging algorithm to obtain the final recognition results.

Results The experimental results show that the method proposed in this study achieved 89.95% accuracy, 88.46% sensitivity, 91.30% specificity and an AUC value of 96.69% in the local dataset obtained from Peking University Shenzhen Hospital, all of which are far superior to other models.

Conclusion In this study, a non-invasive risk prediction system is proposed for ultrasound images of thyroid follicular tumours. We solve the problem of unbalanced sample distribution by means of an image enhancement algorithm. In order to obtain enough features to differentiate ultrasound images, a three-branched feature extraction network was designed in this study, and a balance of sensitivity and specificity is ensured by an averaging algorithm.

Objectives To measure the CSA of the HST musculature measured with ultrasonography in soccer players undergoing ACLR and compare limb differences with healthy controls.

Methods A case-control study was performed with patients after anterior cruciate ligament repair (ACLR) and healthy controls in which cross-sectional areas (CSA) obtained using a model TE7 ultrasound machine (MINDRAY ®, USA) in B mode (4.2 to 13 MHz) with a multifrequency linear array transducer (L12-4S). Three CSA images were taken of the semitendinosus muscle (ST) and the long head of the biceps femoris (BFlh), at a distance of 30% and 70% of the ischial tuberosity insertion. Mean differences between groups were analyzed using SPSS v.20 (IBM®, USA), and statistical analyses were performed using non-parametric techniques to determine differences between groups (Student's t-test) and Cohen's correlation coefficient to quantify effect size.

Results 14 ACLR operated 17 ± 5.4 months ago and 12 healthy controls (W = 6; M = 20M; 24.5 ± 3.92 years; BMI = 25.1 ± 2.32 kg/m²) were recruited. There were differences between groups in CSA-ST70 (Post-ACLR = 1.43 ± 1.029 cm² vs Control 2.65 ± 0.664 cm², T Student = -3.68, 95% CI [-Inf, -0.648], P < 0. 001, ES = -1.418), but not in CSA-ST30 (Post-ACLR = 8.42 ± 1.596 cm² vs Control 9.16 ± 0.945 cm², T Student = -1.535; 95% CI [-Inf, -0.0793], P = 0. 068, ES = -0.5607), CSA-BFlh30 (Post-ACLR = 8.79 ± 1.47 cm² vs Control 8.87 ± 2.312 cm², T Student = -0.123; 95% CI [-Inf, 1.1049], P = 0.452, ES = -0. 049) or CSA-BFlh70 (Post-ACLR = 6.91 ± 1.011 cm² vs Control 7.01 ± 1.453 cm², T Student = -0.214; 95% CI [-Inf, 0.6795], P = 0.416, ES = -0.0783).

Conclusion Ultrasound measurement of the CSA can be an image marker to identify muscle weakness or atrophy that predicts functional loss early.

Objective This cross-sectional study was designed considering disagreements on the normal range of Median Nerve Cross-Sectional Area (MNCSA) and its association with age.

Methods In this cross-sectional descriptive study, the upper limbs of 98 healthy subjects (46 men and 52 women) were assessed bilaterally by sonography, and MNCSA was measured at the distal wrist crease.

Results Mean MNCSA values for subjects older and younger than 40 were 11.25 mm² and 10.21 mm², respectively. The results showed that the MNCSA significantly increased after 40 years of age.

Conclusion According to the present study's findings, advances in age can increase the MNCSA and affect the diagnostic accuracy of MNCSA measurement in CTS diagnosis.

Objective The purpose of this study was to compare the diagnostic performance of virtual touch tissue quantification (VTTQ) combined with B-mode ultrasonograpgy (US), strain elastography (SE) combined with B-mode US and B-mode US alone in differentiating the properties of breast lesions.

Methods A retrospective database was queried for 283 healthy subjects and 100 consecutive patients with 130 breast lesions. All the cases were examined by B-mode US, VTTQ and SE. Histological diagnosis was used as the reference standard. The area under the receiver operating curve (AUC) values of each data set was compared.

Results Twenty-two lesions were determined as malignant and 108 as benign. The best cutoff point of VTTQ was 7.82 m/s. The AUC of B-mode US combined with VTTQ or SE was greater than that of B-mode US alone (0.913 or 0.918 vs. 0.797) (P = 0.007 and 0.012).

Conclusion Both VTTQ and SE could give help to B-mode US in distinguishing benign from malignant breast lesions about elastography values. There was no difference between them.

Objective VaveHealth is a company that developed an app-based POCUS (Point of Care Ultrasound) education platform. Our objective is to provide educators with insights into novel approaches to medical education by comparing the platform to PowerPoint-based education, the standard and current technique used to instruct medical students in the United States.

Methods We used a non-inferiority study to assess if the app-based platform was not less efficacious than the current standard of PowerPoint-based education. Thirty-three military medical students were provided with app-based or PowerPoint-based education for instructions on performing a focused assessment with sonography for trauma (FAST exam). Physicians evaluated each image and assigned a score from 1-5. The final scores were the average of all views. In addition, a two-sample t-test of the final scores and each view of the FAST was used to measure whether the VaveHealth platform was non-inferior to a PowerPoint-based model.

Results Overall, the VaveHealth group had lower average scores on each view and a lower average total score. There was no statistically significant difference in overall scores (VaveHealth = 7.65, PowerPoint = 9.04, P = 0.07). Subgroup analysis showed no statistically significant difference in student performance in the views of the splenorenal recess (VaveHealth score = 1.60, PowerPoint score = 1.65, P = 0.42), hepatorenal recess (VaveHealth score = 2.45, PowerPoint score = 3.00, P = 0.11), and suprapubic (VaveHealth score = 2.10, PowerPoint score = 2.46, P = 0.23) regions. In the subxiphoid region, students in the VaveHealth had a statistically significantly lower average score (VaveHealth score = 1.70, PowerPoint score = 2.08, P = 0.04).

Conclusion VaveHealth education is not a viable alternative to traditional PowerPoint education for POCUS training based on the lower raw scores and statistically significantly lower scores on one of the views of the FAST exam.

Objective: To compare the diagnostic sensitivity and consistency of ultrasound-guided attenuation parameter (UGAP) with B-mode ultrasound in nonalcoholic fatty liver disease (NAFLD) patients, and explored their correlation with clinical indicators.
Methods: Patients suspected of NAFLD from July to November 2021 were enrolled in this prospective study. After performing the B-mode ultrasound and UGAP examination, all patients were divided into four groups according to the grade of NAFLD obtained by two modalities, respectively. The diagnostic agreement of the two modalities were evaluated, and the diagnostic sensitivity was compared by the McNemar test. The correlation between clinical indicators and the attenuation coefficient (AC) of UGAP was analyzed by linear regression.
Results: The intraclass correlation coefficient of UGAP was 0.958 (95%CI: 0.943,0.970), while the kappa value of B-mode ultrasound grading was 0.799 (95%CI: 0.686, 0.912). The diagnostic sensitivity of UGAP was higher than that of B-mode ultrasound (99.0% vs. 32%, P < 0.001). BMI and TG can be distinguished in different grades of NAFLD diagnosed by B-mode ultrasound, while BMI, ALT, HDL, and Apo A can be distinguished in different grades of NAFLD diagnosed by UGAP. BMI (r = 0.502, P < 0.001), ALT (r = 0. 396, P < 0.001), TG (r = 0.418, P < 0.001), HDL (r = -0. 359, P < 0.001) and Apo A (r = -0.228, P = 0.020) were linearly correlated with the AC value of UGAP.
Conclusions: Compared with the B-mode ultrasound, UGAP had a higher sensitivity and consistency in diagnosing NAFLD, and correlated well with some laboratory indicators, which may be more valuable in screening and diagnosis of NAFLD.

Background and Purpose: Surgery of ultrasound-detected non-palpable breast lesions should be guided by ultrasound. Commonly radiologists localize the lesion under ultrasound preoperatively, which necessitates the availability of a localization device and may involve a substantial cost. We performed a study to prospectively assess the feasibility of ultrasound-guided localization without any special device.
Methods: Women with non-palpable benign breast masses were assigned to the “guide wire insertion” (GWI) or the “local coordinates and skin inking” (LOCSI) groups. In both groups, the tumor was marked as a shadow on the skin by the radiologist under ultrasound. In the GWI group, a guidewire was inserted, and in the LOCSI group, the local coordinates of the lesion relative to the skin and the nipple as well as its clockwise placement were reported.
Results: Overall, 29 cases were included in the study, 11 in the GWI and 18 in the LOCSI groups. In all cases, the specimen was correctly excised. The weights of the resected specimens were significantly higher with GWI; LOCSI prevented excessive tissue extraction. Clinicians reported LOCSI as “very easy” more frequently, and surgery took less time.
Conclusions: Overall, our study showed that LOCSI was feasible and can be a suitable method in areas with limited resources. We propose similar studies with a larger sample size, inclusion of malignant cases for margin assessment, and estimation of the cost-effectiveness of the technique.

Objective: Computed tomography (CT) imaging of the chest is an effective diagnostic tool assisting physicians in making a diagnosis. This study aimed to propose a new convolutional neural network for classifying the lung nodules of the patient through chest CT scan data to determine whether the patient has related disease genes.
Methods: We proposed a DenseNet-based neural network structure that uses multi-scale convolutional kernels to obtain features of different receptive fields, which are fed into a DenseNet containing four improved DenseBlocks, followed by a classification module to obtain the model output, i.e., whether a lung nodule contains a cancer gene. We conducted classification experiments on a CT scan dataset containing 465 training samples and 117 test samples.
Results: The results showed that DenseNet was better than ResNet in terms of classification, whereas ResNet was better than VGG, which was consistent with the findings of previous studies. However, because these models were more complex, they suffered from overfitting problems. Among all of the models used in this paper, our proposed network achieved the best results in terms of accuracy, F1 score, and sensitivity without an over fitting. The accuracy was 72.0%, sensitivity was 78%, and F1 score was 68%.
Conclusion: The proposed DenseNet neural network can improve and assist medical imaging diagnostic physicians in the initial diagnosis of lung nodules.

Objective: An observational cross-sectional study to assess sonographic splenomegaly quantitatively in thalassemia patients grouped with respect to transfusion given whole blood vs packed red cells.
Methods: A study was conducted among 330 patients equally divided into two groups, undergoing an abdominal ultrasound examination with a transducer frequency ranging from 3-5 MHz during the period December 2021 to August 2022. An independent t-test was applied to compare the splenic volume in thalassemia patients given whole blood transfusions versus packed red cells transfusions, and Cohen's d was used to indicate the standardized difference between two ultrasound splenic volume means.
Results: The mean splenic volume of the patients who received whole blood cells was 320.62 ± 219.05 cm³, which is greater than the patients who received packed red cells, whose mean was 60.72 ± 58.72 cm³, The splenomegaly was quantitatively assessed in six age groups ranging from 1 to 3 years, 4 to 6 years, 7 to 9 years, 10 to 12 years, 13 to 15 years, and 16-18 years and mean splenic volume in each age group was compared to those receiving whole blood or packed red cells transfusion. there is a statistically significant difference between both transfusion receiving groups, having a larger Cohen’s d size effect of 1.62.
Conclusion: Ultrasound is a reliable imaging modality for assessing splenic volume and linear parameters of the spleen with greater splenomegaly in thalassemia patients with whole blood transfusions than those with packed red cells when quantitatively assessed according to relevant age groups. Thalassemia patients should be transfused packed red cells to delay splenomegaly, that should be assessed sonographically.

Objective: To evaluate the real-time accuracy of cloud handheld ultrasound system using AI technology in screening carotid plaque.

Methods: 2627 ultrasound images of the carotid artery are collected using the cloud handheld system. Bounding boxes of carotid plaques are labeled by qualified sonographers, and the dataset is trained using a lightweight YOLOv3 model. An additional and separate 390 images are collected and tested using the evaluation metrics average recall (AR), average precision (AP), and frames per second (FPS) for quantifying classification performance and time consumption.

Results: We use a plaque grading definition with a thickness of 1.2-1.5 mm defined as small plaque, 1.5-3 mm as medium plaque, and more than 3 mm thick as large plaque. Our model achieves AP^IoU=0.50 with 96.5%, with AP^large is 79.9%, AP^medium is 90.7%, AP^small is 93.5%; AR^IoU=0.50 is 64.5%, where AR^large is 60.6%, AR^medium is 58.3%, AR^small is 70.8%, and FPS is 33.3.

Conclusion: We establish a framework for data set construction, model selection, training, and testing of carotid ultrasound images and verify the effectiveness of real-time AI technology in the automatic detection of carotid artery plaque.

Objective To predict sonographic features of malignancy in thyroid nodules by using convolutional neural networks (CNNs) ResNet50 model.

Methods A cohort of 461 patients having sonographic thyroid nodules with histology diagnosis were randomly split into training set (70%), validation set (15%) and testing set (15%). Labeled sonographic patterns of thyroid nodules were used to train CNNs ResNet50 in training set, where algorithm pipelines were used to explicitly delineate structures of interest using segmentation algorithms to measure predefined characteristics of these structures as to be predictive and to use these features to train models that predict the malignancy in thyroid nodules. The prognostic accuracy of ResNet50 model was evaluated on validation set and compared with the individual sonographic specialists in testing set. Accuracy, sensitivity, specificity, and efficiency of ResNet50 model was measured using receiver operating characteristic (ROC) curve.

Results Measurements showed the evaluation indexes of ResNet50 model were as follows: accuracy: 94.39%, sensitivity: 92.45%, specificity: 96.30%, efficiency: 96.08%, F1 value: 94.23%, and AUC: 93.40%. The prognostic accuracy and other indexes of ResNet50 model was not subordinate compared to sonographic specialists (P < 0.05).

Conclusion These results highlight the emerging role of deep learning techniques including CNNs in precision medicine and suggest an expanding utility for computational analysis of sonographic images in the future practice. This study showed a computational approach can be used for learning sonographic features of thyroid nodules using ResNet50 model to combine the power of adaptive machine learning and algorithms with traditional sonographic assessment.

Objectives To assess the clinical efficacy and safety of ultrasound-guided stellate ganglion block in the treatment of allergic rhinitis.

Methods Sixty patients with allergic rhinitis were selected as study subjects and were treated with stellate ganglion blocking. We observed the appearance and time of the patient's Horner syndrome, and compared the patient's clinical symptom scores before and after one month treatment, and calculated the clinical efficacy and overall effective rate.

Results After ultrasound-guided stellate ganglion blocking treatment, 97% of patients occurred Horner syndrome within 2 minutes. The scores of sneezing, runny nose, nasal itching, and nasal congestion significantly reduced at one month after treatment compared with those before treatment, in which there was statistically significant difference (P<0.05). The clinical efficacy rate also reached 96.7% after procedures. No serious complications occurred in this study.

Conclusions Ultrasound-guided stellate ganglion block can significantly improve the clinical symptoms and the life quality for patients with allergic rhinitis, and it is worthy of extensive clinical application.

Objective: To investigate the best combined method of S-Detect, a computer-aided diagnosis (CAD) system, with breast ultrasound (US) according to radiologists’ experience.

Methods: From March 2019 to June 2019, 259 breast masses in 255 women were included in this study. Ultrasonographic images of the target masses were prospectively analyzed by radiologists and CAD. Three combined methods, including method 1 [selective downgrading combination for Breast Imaging Reporting and Data System (BI-RADS) 4a lesions], method 2 (selective upgrading combination for BI-RADS 3 lesions) and method 3 (selective upgrading or downgrading combination for BI-RADS 3 or 4a lesions), were applied to interpret the CAD results. The sensitivity, specificity, the area under the receiver operating characteristic curve (AUC) of experienced or inexperienced radiologists before and after adding CAD results were compared using the histopathological results as a reference standard.

Results: In identifying breast malignancy, the AUC for CAD was similar to that of experienced radiologists (P= 0.410), but higher than that of inexperienced radiologists (P= 0.003). When combining CAD with experienced radiologists based on method 1 and combining CAD results with inexperienced radiologists based on method 3, the AUCs were significantly improved (P= 0.024 and 0.003, respectively) compared to US alone, with significantly increased specificity (P< 0.001 for both) and no significantly decreased sensitivity (P> 0.05 for both).

Conclusion: The combination of CAD system and conventional ultrasound can improve ultrasound diagnostic performance in determining breast malignancy. The method 1 and method 3 combinations are respectively recommended for experienced and inexperienced radiologists when CAD is combined with conventional breast ultrasound.

Objective: Heavy metal pollution has become one of the environmental contamination problems in today's world. Adsorption materials can effectively remove heavy metal ions from the water. There are some shortcomings for traditional adsorbents, such as difficult separation after adsorption, long separation time, and may cause secondary pollution in the environment without recycling. The aim of this study was to seek new materials with effective ways to absorb heavy metal ions in the water.

Methods: A new kind of adsorption material consisted of polylactic acid (PLA) microbubble and graphene oxide (GO) (i.e., PLA@GO microbubbles) was fabricated which can combine by electrostatic adsorption with the assistance of PAH. The influence of the initial concentration of heavy metal of lead ion, pH value, and absorption time on the adsorption effect of PLA@GO microbubbles was tested in this study.

Results: Graphene oxide modified on PLA microbubble has huge specific surface area and various functional groups, which can adsorb heavy metal ions in water. The resulting PLA@GO microbubble showed a homogeneous spherical structure with a size of 500-1.5 μm, which was suitable for its effective separation from water. The optimal dosage of PLA@GO microbubbles was 10 mg, the pH value of the solution was 5.0, and the adsorption time was 20 minutes which correlates to 75 mg/L of leadions.

Conclusion: The characteristics of the PLA@GO microbubbles showed a strong adsorption capacity, high adsorption efficiency, and a shorter balance time which provided an environment-friendly new material to remove heavy metal ions from water.

Objective: To evaluate and compare the diagnostic performance of B-mode ultrasound (B-mode US), strain elastography (SE), color Doppler ultrasound (color Doppler US) and the combination of these modalities in differentiation between fibroadenomas and phyllodes tumors.

Methods: This retrospective study included 220 breast lesions, between January 2016 and January 2018. B-mode US, strain elastography, and color Doppler US were realized to evaluate each lesion. The results of three modalities were compared between the B-mode US and the combination of B-mode US, elastography, and color Doppler US: sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating characteristic curve (AUC). The pathological findings were used as the reference standard.

Results: Among 220 breast masses, 189 of the lesions were fibroadenomas, 31 were phyllodes tumors. Addition of strain elastography and color Doppler US to B-mode US increased the specificity from 27.5% (95% confidence interval [CI]: 21.15%, 33.88%) to 95.24% (95% CI: 92.20%, 98.27%; P < 0.001); PPV from 16.46% (95% CI: 10.79%,22.14%) to 60.87% (95% CI: 40.92%, 80.82%; P < 0.001) and AUC from 0.584 (95% CI: 0.481, 0.687) to 0.886 (95% CI: 0.824, 0.948; P < 0.001).

Conclusion: The combination B-mode US, strain elastography and color Doppler US increase the diagnostic performance in distinguishing fibroadenomas from phyllodes tumors.

Objective: To investigate the accuracy of contrast-enhanced ultrasound (CEUS) in the diagnosis and localization of active needle-tract bleeding (ANTB) during thermal ablation for liver cancer.

Methods: Between June 2013 and December 2018, liver cancer patients with poor coagulation function or suspected needle-tract bleeding during ablation were enrolled in the study. Conventional US and CEUS were applied to detect ANTB and the bleeding sites, and sequentially abdominal paracentesis drainage (APD) was used as the gold standard for the diagnosis of ANTB. Thermal ablation guided by conventional US or CEUS was used to stop the bleeding.

Results: Among the 77 enrolled patients, 21 patients (27.3%, 21/77) had ANTB. In total, four (19.0%) and 21 (100%) cases of ANTB were diagnosed by colour Doppler US and CEUS, respectively. The sensitivity, specificity and accuracy of colour Doppler US for diagnosing ANTB were 19.0%, 100% and 77.6%, respectively. The sensitivity, specificity, and accuracy of CEUS for diagnosing ANTB were 100%, 100% and 100%, respectively. The sensitivity of CEUS to diagnose ANTB was significantly higher than that of colour Doppler US (P < 0.001). All cases of ANTB were arterial bleeding and were stopped by thermal ablation under the guidance of colour Doppler US or CEUS.

Conclusion: Compared to colour Doppler US, CEUS could detect ANTB with significantly higher sensitivity and accurately guide needle-tract ablation during thermal ablation of liver cancer.

Objective: Transient tachypnea of newborn (TTN) and respiratory distress syndrome (RDS) are the most common causes of respiratory distress among preterm neonates. The aim of this study was to evaluate the accuracy of lung ultrasonography (LUS) for diagnosing and differentiating TTN and RDS in preterm neonates.

Methods: This was a prospective single center study. From January 2020 to June 2021 a total of 114 preterm neonates who were admitted to neonatal intensive care unit (NICU) with symptoms of respiratory distress within 6 hours of birth were subjected to clinical examination, laboratory testing, chest x-ray (AP and lateral view’s) and LUS. Their clinical course was closely monitored. On the basis of final diagnosis made on day three of admission they were divided into two groups, 37 diagnosed with TTN and 61 with RDS. Patients diagnosed with other conditions including neonatal pneumonia, meconium aspiration syndrome etc. were excluded from analysis. LUS findings in RDS and TTN were analyzed and compared to each other.

Results: Pulmonary edema manifesting as alveolo-interstitial syndrome, double lung point and less commonly as white out lungs in absence of consolidation had a 100% sensitivity and specificity in diagnosing TTN. A combination of three signs of consolidation with air or fluid bronchograms, white out lungs and absent spared areas has a 100% sensitivity and specificity for diagnosing RDS. Double lung point was seen only in infants suffering from TTN while consolidation with air or fluid bronchograms was only seen in cases of RDS.

Conclusion: Lung ultrasound can accurately diagnose and reliably differentiate TTN and RDS in preterm neonates. Hence LUS can become an initial screening tool in NICU.

Objective: In this paper, we retrospectively analyzed the ultrasonographic features of paratesticular leiomyoma to help doctors correctly diagnose the disease before operation and guide surgical treatment.

Methods: From 2013 to 2020, 16 cases of paratesticular leiomyomas confirmed by pathology in our hospital were retrospectively analyzed. The retrospective analysis included the ultrasound and color Doppler flow imaging (CDFI) of paratesticular leiomyoma which were evaluated by two experienced radiologists based on the features of ultrasound images of lesions.

Results: All the 16 paratesticular leiomyoma presented as hypoechoic masses with a clear boundary and round shape. The echotexture of 6 large leiomyomas showed a typical vortex appearance. In the remaining 10 small leiomyomas, thin cord-like hyper-echogenic appearance was found. Color Doppler flow imaging showed that the blood flow signal within a large leiomyoma mass (n = 1) was significantly higher than that of surrounding testis while the blood flow signals of the smaller leiomyomas (n = 5) had significantly less flow signals compared with the testis. The remaining leiomyoma masses (n = 10) had similar flow signals to the testicular blood flow.

Conclusion: Sonography can be used to detect testicular tumors and to differentiate extratesticular from intratesticular masses. The ultrasound features of paratesticular leiomyoma included hypo- and hyperechoic mass, a round or typical vortex shape as well as various vascularity based on the size of the tumors.

Objective: The aim of this study was to identify features of follicular thyroid neoplasm by conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS) based on morphological and pathological correlations and make diagnostic strategy for predicting malignancy.

Methods: Conventional US and CEUS were performed in 21 follicular thyroid cancers (FTCs) and 35 follicular adenomas (FAs) that were pathologically approved. Sonographic features were retrospectively reviewed, and diagnostic performance were analyzed using pathology as reference standard.

Results: The most useful character in diagnosis of FTC by conventional US was round shape (OR=6.6), followed by absent of halo sign (Odds ratio, OR = 4.79) and calcification (OR = 3.875). Among all CEUS morphological and blow flow findings, incomplete rim enhancement pattern (OR = 19.2) and the presence of perfusion defects (OR = 5.454) were the most effective features to discriminate between FTC and FA. Based on the five discriminatory parameters, a diagnostic criterion was established to assess the risk of FTC. The sensitivity, specificity, positive predictive values (PPV), negative predictive values (NPV) and accuracy for predicting malignancy were 81.0 %, 80 %, 70.8 %, 87.5 % and 80.4%, respectively.

Conclusions: CEUS provided additional sonographic features which is helpful for predicting potentially malignancy of follicular thyroid neoplasm.

ObjectiveIntrathyroidal thymic carcinoma (ITTC) is a rare epithelial tumor of the thyroid gland. Since ITTC is rare, its imaging findings have not been well defined. In the present study, we studied the US appearance of ITTC by analyzing ten cases retrospectively.

Methods Patients were identified by searching the surgical pathology records at our hospital. There were three male and seven female patients ranging in age from 40 to 79 years. The ultrasound (US) features were evaluated, and the relevant clinical data were combined with the fine needle aspiration (FNA) results from previous publications.

Results The average length of the nodules was 48 mm. Of all ten nodules, half were located in the right lobe of the thyroid, and half were located in the left lobe, either immediately adjacent to the lower lobe or within the lower part of the thyroid lobe. All nodules manifested with a completely solid composition and heterogeneous hypoechoic echogenicity. Three nodules had striped hyperechogenicity within the nodule. All nodules had irregular margins. Seven had a horizontal shape, and three had a vertical shape. Four nodules manifested with mainly peripheral vascularity, two nodules showed mainly central vascularity, and three had mixed vascularity. The vascularity of one remaining nodule was unknown. Cervical lymph node metastasis was detected in two cases by US examination. According to previous literature, FNA cytology revealed atypical type of thyroid cancer, poorly differentiated carcinoma, or a high-grade malignant thyroid neoplasm without further definitive classification.

ConclusionA large cancer-like nodule located within the lower thyroid in middle-aged people, combined with an atypical type of thyroid cancer after FNA, indicated that ITTC should be considered.

Objective: To compare the etiologies and adverse outcomes of pregnancies with short fetal femur length (FL) categorized based on relative proportion and percentile placement.
Methods: Fetuses (n = 254) with short FL measured by ultrasound were classified into four groups: severe and disproportionate short FL (group A); severe and proportionate short FL (group B); mild and disproportionate short FL (group C); mild and proportionate short FL (group D). Etiologies and outcomes of pregnancies were compared between groups.
Results: A larger percentage of skeletal dysplasia occurred in group A (28.57%) than in the other three groups (group B: 1.85%; group C: 4.08%; group D: 0). Groups A and B also had higher rates (group A: 40.82%, group B:33.33%) of fetal growth restriction (FGR) than groups C and D (group C: 4.08%; group D:3.92%). No difference in chromosomal and genetic anomalies was detected among groups (P = 0.307); however, the rate of chromosomal and genetic testing in group A was higher than in group D (P = 0.001). Group A (57.14%) had a significantly lower rate of live birth than the other three groups, and group D (98.04%) had a higher live birth rate than groups B (87.04%) and C (83.67%). Considering only living fetuses, higher rates of preterm birth (P < 0.001), low birth weight (LBW) (P < 0.001), neonatal intensive care unit (NICU) admission or pediatric hospital referral (P = 0.004), Apgar score (1 min/5 min) ≤7 (P < 0.001) and fetal distress or neonatal asphyxia (P = 0.004) were found in group A compared to group D.
Conclusion: Fetuses with severe and disproportionate short FL should be flagged for possible skeletal dysplasia. Fetuses with severe short FL should be watched for FGR prenatally. Invasive prenatal tests are recommended for fetuses with severe and disproportionate FL but not recommended for those with mild and proportionate short FL. Outcomes of fetuses with severe and disproportionate short FL were worse than that of fetuses with mild and proportionate short FL.

Objective: To assess the viscoelasticity of the carotid artery using shear wave dispersion Imaging and to determine the relevant factors.
Methods: Ninety volunteers were recruited and divided into elder group and young group. Shear wave dispersion (SWD) imaging was applied to measure carotid viscoelasticity. The other arterial parameters, including arterial pulse wave velocity (PWV), inner diameter (CD), intima-medium thickness (CIMT), peak systolic velocity (PSV), mean flow velocity (MFV), and velocity time integral (VTI) of the common carotid artery (CCA) were also recorded by using ultrasound measurement.
Results: Measurements showed the SWD were lower, while CD, CIMT and PWV were higher in the elder group than those of young group. However, SWD was negatively correlated with VTI, and PSV respectively (r = -0.492 and -0.533, all P < 0.05). SWD was also positively correlated with MFV (r = 0.354, P < 0.05). In elder group, SWD was negatively correlated with PSV and PWV, respectively (r = -0.372 and -0.422, all P < 0.05) while in young group, SWD positively correlated with CD, CIMT and MFV (r = 0.531, 0.462 and 0.479 respectively, and all P < 0.05).
Conclusion: SWD imaging shown relationship with ultrasound parameters of carotid artery and has a potential for assessment of arterial viscoelasticity.

Objective: Imaging modalities for pancreatic intraductal papillary mucinous neoplasm (IPMN) often provide a large amount of information, and an adequate comparison of their diagnostic efficacies cannot be made by simply referring to the diagnostic accuracy rates. The aim of the study was to apply a novel scoring system to evaluate the pancreatic IPMN diagnostic efficacy of transabdominal ultrasound (TAUS), computed tomography (CT), and magnetic resonance imaging (MRI).

Methods: The clinical and diagnostic imaging data of 42 patients with pancreatic IPMN diagnosed at Fujian Medical University Union Hospital between January 2014 and November 2020 were retrospectively analyzed. We applied our scoring system for the quantitative, location, and qualitative diagnosis of each imaging modality, and the diagnostic efficacy was determined.

Results: The mean rank scores of quantitative diagnosis for MRI, CT, and TAUS were 53, 48.96, and 48.54, respectively (P = 0.267). The mean rank scores of location diagnosis for these three methods were 51.72, 49.58, and 48.97, respectively (P = 0.752). The mean rank scores of qualitative diagnosis for MRI, CT, and TAUS were 59.69, 41.08, and 51.18, respectively; the difference was statistically significant (P = 0.015).

Conclusions: The novel scoring system could comprehensively and accurately evaluate the diagnostic efficacy of TAUS, CT, and MRI for pancreatic IPMN. MRI had the highest quantitative, localization, qualitative, and comprehensive diagnostic efficacy.

Objective: To explore the feasibility of quantitative evaluation of cirrhosis by geometrical characteristics of hepatic capsule based on high-frequency ultrasound imaging.

Methods: Rabbits with models of cirrhosis were established and then were divided into four groups: control, 6-week, 12-week and 18-week groups. Two-dimensional high-frequency ultrasound images of hepatic capsule of all rabbits were collected to obtain hepatic capsual contours and key points refltected shapes of these contours (shape control points) which were approximated by the principle of vertical gradient maximization under the manual supervision. Subsequently, the number of continuous segments of the contour line, the mean value and variance of angles between adjacent seed points were extracted to evaluate the continuity and smoothness of the contour line of the hepatic capsule.

Results: With aggravating cirrhosis, the number of segments required to make the sum of lengths of continuous segments reach up to 80% of the total width of the imaging section was gradually increased. The differences between the control group and 18-week group (P = 0.025) as well as between 6-week group and 18-week group (P = 0.004) were statistically significant. Similarly, the mean value and variance of the angles were also gradually increased, and the differences between the control group and the 6-week (P = 0.015, P = 0.036), 12-week (P < 0.001, P = 0.002) and 18-week groups (P = 0.023, P < 0.001) were statistically significant. In addition, the difference in variance of angles between the 6-week group and 18-week group (P = 0.030) was statistically significant.

Conclusion: Sonographic analysis of geometrical characteristics of the hepatic capsule could be used to partially indicate the presence of early-stage cirrhosis, which could provide a quantitative method for non-invasive assessment of cirrhosis.