The sentinel lymph node (SLN) concept hypothesizes that metastatic cancer cells will spread through the lymphatic system to the SLN being the first one in the lymphatic chain to receive the metastatic cells, indicating that if the SLN is free of cancer cells the rest of the lymphatic chain is also without metastatic disease. Diagnostic ultrasound imaging (US) has been used to evaluate lymph nodes (LN) to determine level of suspicion and to guide LN biopsies. However, conventional US cannot be used for lymphatic mapping, which requires administration of a tracer. This has been changed with the use of contrast-enhanced US (CEUS) to detect lymphatic channels and SLNs after subcutaneous injections of microbubble-based US contrast agents (UCAs). The aim of this review is to examine the clinical evidence on the role of subcutaneous injection of UCA, known as lymphosonography, to be used as preoperative identification of SLNs in patients with breast and other cancers.

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.

Internal carotid artery dissection (ICAD) is the result of a tear at the intimal layer of the internal carotid artery, which is a common cause of stroke in young and middle age patients. We present multimodal vascular ultrasound findings (include color Doppler flow, power Doppler flow, advanced dynamic flow, superb microvascular and contrast enhanced ultrasound imaging) of a 30-year-old female with ICAD and thrombus in false lumen. To our best knowledge, this is the first report that several superior vascular ultrasound imaging techniques have been used to evaluate ICAD.

Atherosclerosis (AS) is the main pathophysiological process behind CVD. Cardiovascular diseases caused by AS (such as stroke, coronary heart disease, etc.) are characterized by a high prevalence, high disability rate and high mortality, which greatly increase the burden on families and society. Thus, it is important to find AS as early as possible. When atherosclerosis occurs, the earliest sign of its structural and functional changes is arterial stiffness, and endothelial dysfunction is the key link. Arteriosclerosis is caused by the imbalance between collagen and elastin in the arteries. Elastin fibers gradually decrease, and stiffer collagen fibers increase, making the vessels less elastic. Endothelial dysfunction also affects the regulatory function of arterial vascular tension, and accelerates the remodeling of the vascular wall, to make blood vessels more rigid. Quantitative measurement of arterial stiffness and carotid intima-media thickness (CIMT) is an important tool for early detection of vascular lesions. At present, ultrasound technology including echo tracking (ET), wave intensity (WI), real-time shear wave elastography (SWE), ultrafast pulse wave velocity (ufPWV), shear wave dispersion (SWD), cardio-ankle vascular index (CAVI), arterial velocity pulse index and arterial pressure volume index (AVI and API) has the advantages of being noninvasive, real-time, economical and reproducible in the assessment of atherosclerosis, and is widely used in the early diagnosis of AS. Most importantly, the change in arterial hardness detected by traditional ultrasound technology precedes the change in intima-media thickness, suggesting that ultrasonic elasticity monitoring may be a more sensitive method of predicting AS and can find and prevent cardiovascular diseases earlier.

Contrast-enhanced ultrasound (CEUS) is an imaging modality that has achieved considerable relevance in various clinical settings including the assessment of renal disease. CEUS is performed by injecting microbubble-based ultrasound contrast agents (UCAs) that create signals to display the microvasculature, allowing quantitative and qualitative assessment of parenchymal perfusion and real-time visualization of the renal anatomy. In recent years, CEUS has been widely accepted and applied for the assessment of kidney perfusion and the characterization of indeterminate renal masses, primarily due to its diagnostic efficacy, availability, low cost, reproducibility, and absence of nephrotoxicity. CEUS provides a higher spatial and temporal resolution than other cross-sectional imaging, resulting in high sensitivity and specificity for its applications in a variety of renal conditions including cancer monitoring following ablation, detection of transplant complications, hypoperfusion, acute traumatic injury, renal artery stenosis, parenchymal infection, and kidney intervention guidance. Additionally, the continuous investigation and development of new technologies surrounding this imaging technique have shown encouraging preliminary results for the use of CEUS in the evaluation of molecular expression in several disease processes, the dynamic analysis of blood flow kinetics, and the implementation of super-resolution imaging systems. The purpose of this article is to provide an overview of the current and potential clinical applications of renal CEUS.

The cholinergic anti-inflammatory pathway is a neuro-immune regulatory pathway that mediates anti-inflammatory effects based on the vagus nerve, acetylcholine and α7 nicotinic acetylcholine receptors. In recent years, the effect of nerve stimulation by ultrasound has attracted much attention and has been widely studied. Ultrasound can stimulate the vagus nerve or spleen nerve and activate the cholinergic anti-inflammatory pathway, exerting anti-inflammatory and organ protection effects, which is expected to provide a new treatment for many inflammatory diseases. The purpose of this review is to introduce the composition, mechanisms and regulation methods of cholinergic anti-inflammatory pathway, and discuss its therapeutic implications.

The exploration of human brain function has always been a research hotspot in the field of neuroscience. The concept of a neurovascular unit suggests that cerebral microcirculation can be used as a reliable signal to reflect neural function. Accordingly, functional imaging techniques based on the neurovascular unit are very promising because of their ability to reveal neurovascular coupling and evaluate the functional rehabilitation of cerebrovascular diseases represented by stroke. In the present review, we first describe the role of the neurovascular unit in the injury and repair processes after stroke. We then briefly introduce the relative characteristics and advantages of representative neurovascular unit-based functional imaging. Finally, we summarized the value of these techniques in the evaluation of neural networks after stroke.

Objective: CT-based Bosniak classification system has been routinely used to assess complex renal cystic lesions and also been applied to contrast-enhanced magnetic resonance imaging (CEMRI) and contrast-enhanced ultrasound (CEUS). Besides, the 2019 new version incorporated MRI into the Bosniak system. However, the role of US in the Bosniak system has not been clearly established. The aim of this study was to compare the diagnostic ability of CEUS, CECT and CEMRI for renal cystic lesions based on the current Bosniak classification.

Methods: Related studies were searched in PubMed, EMBASE, and the Cochrane Library databases from January 1, 2010 to December 14, 2020. QUADAS-2 was used to assess the study quality. Meta-analysis was performed by “midas modules” of Stata SE 15.0 software. The bivariate mixed-effect model was used. The pooled sensitivity and specificity of these three modalities were calculated and compared. Meta-regression and subgroup analyses were conducted to reveal the source of heterogeneity.

Results: CEUS showed highest pooled sensitivity and specificity, which were 98% (95% CI: 91%, 100%) and 80% (95% CI: 64%, 90%) respectively. Pooled estimates of CEMRI were slightly lower than those of CECT with the sensitivity 85% (95% CI: 77%, 91%) versus 88% (95% CI: 77%, 94%) and specificity 71% (95% CI: 52%, 85%) versus 79% (95% CI: 70%, 86%), respectively.

Conclusions: Based on the current Bosniak classification, CEUS seemed superior to CECT and CEMRI for the diagnosis of complex renal cystic masses, and could serve as a valuable alternative for CECT and CEMRI.

This article provides a review of pathology, clinical features, imaging diagnosis and treatment of lipomatosis of nerve (LN), aiming to improve the comprehensive understanding of the disease and achieve early diagnosis and treatment. By searching for the relevant literature, we systematically summarized the pathology, clinical features, imaging diagnosis and treatment of LN in peripheral nerve. Lipomatosis of nerve is a rare benign tumor-like lesion in the peripheral nerve. LN can present primarily as painless neoplasm, macrodactyly, or neurological dysfunction. Magnetic resonance imaging and ultrasonography are commonly used imaging methods before operation, which can characterize and locate the scope of the disease. There are few ultrasonographic studies on LN of peripheral nerve, mostly in the form of case report or small sample analysis. Treatment of lipomatosis of nerve varies with clinical symptoms and lacks consensus. Although LN is benign lesion, it can be invasive, progressive, and recurrent. It is very important to understand the problems of neurological dysfunction caused by LN. More studies are needed to provide more detailed imaging information for clinicians and to achieve the effective treatment.

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.

Undifferentiated embryonal sarcoma of the liver (UESL) is an aggressive mesenchymal tumor, which presents a low incidence in adults. The low morbidity and atypical clinical manifestations conduce to difficulty in preoperative diagnosis. Imaging manifestations of this tumor is important for its identification. Contrast-enhanced ultrasound (CEUS) was a promising tool to characterize hepatic lesions and proved to have high diagnostic accuracy. The present study reported the CEUS characteristics of UESL in two adult patients, which exhibited peripheral rim hyper-enhancement along with progressively centripetal enhancement and large areas of perfusion defection. Sonographers should be fully aware of this rare disease for better differential diagnosis.

Uterine artery pseudoaneurysm is a rare complication associated with obstetric or gynecological procedures. We described a case report of a primigravid, underwent cesarean section who evolved with massive, intermittent vaginal bleeding requiring multiple blood transfusions. The diagnosis of uterine artery pseudoaneurysm was suspected on transvaginal Doppler ultrasound and confirmed on computed tomography angiography. Due to the patient's stability, age and undefined offspring, superselective uterine artery embolization was chosen for treatment and the procedure successfully performed.

Appendiceal mucocele is a rare disease. Sometimes it is discovered accidentally and sometimes it resembles acute appendicitis. The incidence is 0.2% to 0.7% of all appendectomies specimens. A case report of A 35-year female presented to the emergency room with a history of progressively increasing abdominal pain on and off for 3 months. Tenderness in the right lower quadrant of the abdomen was noted with a palpable mass in the right iliac fossa. An abdominal ultrasound examination was performed, and the patient was found to have an Appendicular mucocele-onion peel sign (sonographic layering within a cystic mass). The patient underwent surgery, and the diagnosis was confirmed by the histopathological report. If mucocele is treated incorrectly, pseudomyxoma peritonei which is characterized by a malignant process may develop. The term mucocele is widely used in diagnosing both benign and malignant lesions.

Thyroid metastatic tumors are a series of rare clinical disease with an incidence of approximately 1.4-3%, of which metastatic tumor from the digestive system is even rarer. Thyroid metastatic tumor from the digestive system is characterized by a rapid growth tumor with high invasiveness and poor prognosis. Ultrasound (US) and contrast-enhanced ultrasound (CEUS) could provide more information for making diagnosis, determining lesion range, and offering biopsy guidance. Ultrasound-guided core needle biopsy (CNB) should be used instead of fine needle aspiration (FNA) to confirm the pathological diagnosis. Here, we report two cases of thyroid metastatic tumor from the digestive system. By describing these cases, we aimed to assess the clinical value of conventional US and CEUS in the diagnosis and treatment of these 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.

Lymphoepithelioma-like cholangiocarcinoma (LEL-CC) is an intrahepatic cholangiocarcinoma with a prominent lymphoid infiltrate. According to previous reports, most LEL-CCs are a single lesion with a notably better prognosis compared to typical liver cancers. However, most literature reported pathological features and lacked imaging features, especially that of ultrasound. We report on a 74-year-old female with LEL-CC presented with headache and malaise for six months. We performed superficial ultrasonography, abdominal ultrasonography, hepatic contrast-enhanced ultrasound, positron emission tomography-computed tomography, and ultrasound-guided biopsy. We definitively diagnosed LEL-CC with multiple metastases in the liver, skeleton, and lymph nodes.

Pancreaticoduodenal pseudoaneurysm, accounting for only 2% of visceral aneurysms, is a rare but fatal clinical entity. It is a common complication associated with chronic pancreatitis. We here present a case of a 63-year-old Chinese man, who was diagnosed with pancreaticoduodenal pseudoaneurysm by ultrasound and CT. His past medical history was unremarkable, and no obvious cause of the disease could be found. The patient was treated successfully with endovascular embolization using microcoils with no clinical complications.

Objective: In the present study, we aimed to evaluate the diagnostic performance of superb microvascular imaging (SMI) for breast masses through a meta-analysis.

Methods: PubMed, EMBASE, Cochrane Library, and Web of Science Core Collection databases, as well as the most comprehensive Chinese academic databases in medicine, such as China Biology Medicine Disc, China National Knowledge Infrastructure, and Wanfang Database, were systematically searched. All included studies used histopathological results as the reference standard. To assess the diagnostic performance, we calculated the pooled sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR-), diagnostic odds ratio (DOR), and the area under the curve (AUC). In addition, a subgroup meta-regression analysis was performed to investigate the heterogeneity.

Results: Fourteen of 1,075 identified articles were included in the current review. The pooled sensitivity, specificity, LR+, LR-, and DOR for SMI were 0.85 (95% CI: 0.79-0.89), 0.80 (95% CI: 0.71-0.87), 4.3 (95% CI: 2.9-6.2), 0.19 (95% CI 0.14-0.26), and 22 (95% CI: 14-36), respectively. The AUC was 0.90 (0.87 - 0.92). Meta-regression showed that there were heterogeneities for sensitivity, but not for specificity.

Conclusions: SMI had good sensitivity, specificity, and excellent diagnostic value in distinguishing benign breast masses from malignant masses and could potentially help select suspicious breast masses for surgery.

The use of contrast-enhanced ultrasound (CEUS) has expanded over the past decade to include a variety of diagnostic and therapeutic applications. These include urgent clinical situations that require timely diagnosis and subsequent treatment. With the introduction of microbubble ultrasound contrast agents (UCAs), CEUS provides increased sensitivity and specificity over conventional ultrasound. Within the trauma setting, CEUS benefits include point of care imaging and an ability to monitor perfusion in real-time. Additionally, UCAs are non-nephrotoxic, and can be used when contrast enhanced CT is contraindicated. In this review, we discuss recent advancements of CEUS within trauma settings.

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.

Schwannoma in retroperitoneal region is quite rare. In this report, we presented such a rare case of a large size schwannoma in a 23-year-old man admitted with a complaint of mild pain in his right lower abdomen. The abdominal ultrasonography detected a round-shaped heterogeneous hypoechoic mass with a few blood flow signals at the retroperitoneal area inferior to the right kidney. The contrast-enhanced ultrasound demonstrated a well-demarcated hypoechoic mass with minor vascularization. Computed tomography (CT) diagnosed the retroperitoneal mass as a malignant neoplasm. After surgical resection, histopathologic examination revealed that the mass was a benign cellular schwannoma. Besides the rare case of schwannoma in retroperitoneal region, we believe that multimodal sonographic patterns are conducive to the preoperative diagnosis of retroperitoneal neurilemmoma.

The anomalous origin of the left main coronary artery from the right sinus of the Valsalva (ALCA) is rare, and varies significantly in congenital heart disease. Patients are usually asymptomatic, and in most cases, coronary abnormalities are discovered by chance at autopsy after coronary angiography or sudden cardiac death. As a routine physical examination procedure, echocardiography is particularly important for the rapid and sensitive diagnosis of ALCA. We report a case of ALCA using echocardiography. “Seagull sign” is a direct ALCA sign manifesting on the short axis section of the artery with two vessels coming from the right coronary sinus. Based on this case, we propose this specific ultrasound sign as a way to improve the diagnostic rate.

Ultrasound imaging has attracted great interest of researchers due to their application in cancer diagnosis and treatment. Ultrasound contrast agents, microbubbles and nanobubbles are widely explored as a multifunctional platform, not only carrying other contrast agents for multimodal imaging to complement the disadvantages of each imaging modality, but also carrying drug/gene for cancer theragnostic. In this article, the characteristics and differences of microbubbles and nanobubbles are briefly introduced and reviewed. Besides, the microbubbles and nanobubbles driven multimodal imaging and theragnostic of cancer are summarized.

Gas therapy is a new therapeutic method that has been developed in recent years and shows great clinical prospects for the treatment of tumours and cardiovascular, nerve, and immune system diseases. Therapeutic gases, including oxygen, hydrogen, nitric oxide, hydrogen sulfide, xenon, and other bioactive gases are involved in modulating cell signaling pathways and have important physiological functions with substantial therapeutic potential. However, their precise delivery remains a major challenge. Recently, researchers began to use ultrasound to trigger microbubbles that have encapsulated these gases for intravenous administration. This not only enhances the contrast of ultrasound imaging, but also precisely releases gases in the targeted area using ultrasound-targeted microbubble destruction. This article reviews the latest advances in the use of microbubbles to load therapeutic gases for the treatment of diseases.

Objective: This study aimed to compare the diagnostic performance of three-dimensional ultrasound (3D-US) and automated breast volume scanner (ABVS) for the characterization of benign and malignant breast lesions.
Methods: Ninety patients who underwent surgery and preoperative conventional ultrasound (US), 3D-US, and ABVS examinations were enrolled in this study. The image quality and adjacent structures of the lesions in the coronal plane were compared. The combination of US, 3D-US, and ABVS for retraction phenomenon of the lesion was compared and the diagnostic performance of each combination was analyzed.
Results: ABVS displayed better image quality and adjacent structures than 3D-US (P < 0.001). The area under the curve (AUC) was 0.913, 0.842, and 0.871 for US, 3D-US, and ABVS, respectively. The AUC of the retraction phenomenon of the lesion was 0.732 and 0.810 for 3D-US and ABVS, respectively. When they were combined, US+ABVS showed the highest AUC of 0.924. No significant difference of diagnostic performances was found among conventional US, US+3D-US, and US+ABVS(P > 0.05).
Conclusions: Compared with 3D-US, ABVS seems to be superior in showing the retraction phenomenon of breast lesions and in the characterization of breast lesions alone or in combination with conventional US. Although no significant difference was observed between them, both ABVS and 3D-US provided valuable information in the coronal plane and improved our confidence level in breast lesion characterization, especially when combined with the conventional US.

Ultrasound (US) technology, with major advances and new developments, has become an essential and first-line imaging modality for clinical diagnosis and interventional treatment. US imaging has evolved from one-dimensional, two-dimensional to three-dimensional display, and from static to real-time imaging, as well as from structural to functional imaging. Based on its portability and advanced digital imaging technique, US was first adopted by emergency medicine in the 1980s and gradually gained popularity among other specialists for clinical diagnosis and interventional treatment. Point-of-Care Ultrasound (POCUS) was then proposed as a new concept and developed for new uses, which greatly extended clinical US applications. Nowadays, artificial intelligence (AI), cloud computing, 5G network, robotics, and remote technologies are starting to be integrated into US equipment. US systems have gradually evolved to an intelligent terminal platform with powerful imaging and communication tools. In addition, specialized US machines tend to be more suitable and important to meet increasing demands and requirements by various clinical specialties and departments. In this article, we review current US technology and POCUS as new concepts and its future trends, as well as related technological developments and clinical applications.

The ultrasound contrast agents currently used in clinics are microbubbles with a large particle size and short circulation time, and their approved clinical applications are limited to endovascular diagnosis and therapy only. The development of ultrasound-responsive nanodroplets (NDs) provides a new approach for extravascular diagnosis and therapy, especially for molecular imaging and targeted therapy of tumors. The NDs with a nano-scaled particle size and a liquid core can maintain their shape and initial diameter during injection, enhancing their EPR effects and facilitating the accumulation of NDs at the tumor site. When exposed to ultrasound, NDs can vaporize and exhibit contrast enhancement at the sites of interest. In addition, the destruction of microbubbles can provide a driving force to facilitate the release of drugs or genes from the microbubbles into target cells, allowing the NDs to act as drug carriers. The development of ultrasound-responsive NDs has shown rapid progress in recent years, while a variety of NDs with excellent properties have been fabricated for targeted diagnosis and drug delivery. In this article, the development of ultrasound-responsive NDs was reviewed in terms of their structure, phase transition properties, and applications in targeted tumor diagnosis and therapy.

Thyroid carcinoma is the most common malignant tumor of the endocrine system. Nearly 90% of thyroid carcinomas are papillary type, of which many are thyroid papillary microcarcinoma (PTMC) with a maximum diameter≤1 cm. Highresolution ultrasound imaging plays an important role in evaluating PTMC and guiding biopsy for pathology as well as appropriate treatment. This review paper discusses the ultrasonography features of PTMC and explores the clinical value of ultrasonography with gene testing in the diagnosis and management of PTMC.

The study aims to review literatures on ultrasound-based radiomics, including ultrasound modalities, and discusses basic methods, applications, and limitations of ultrasound-based radiomics. The search strategy was conducted in form of “Radiomics [Title/Abstract] and Ultrasound [Title/Abstract]”in PubMed. The retrieved articles were initially screened via abstracts. Then, the main objectives, methods, and achievements of selected articles were summarized. Finally, twenty articles focused on malignancies of different organs, such as liver, rectum, breast, and thyroid were included into this review. The multiparametric features exhibited a superior diagnostic performance compared with a single modality. Ultrasound-based radiomics can assist radiologists to improve the accuracy of diagnosis, and it may promote the development of precision diagnosis and treatment of various types of cancer.

For symptomatic hypertrophic obstructive cardiomyopathy (HOCM), how to effectively relieve left ventricular outflow tract obstruction is of great significance. Relying on drugs and double-chamber pacing to reduce left ventricular outflow tract pressure gradient can alleviate symptoms. Methods to reduce the thickness of inter-ventricular septum include myocardial myectomy, percutaneous transluminal septal myocardial ablation, radiofrequency catheter ablation of ventricular tachycardia, and high-intensity focused ultrasound (HIFU) ablation of the ventricular septum that were performed on animal experiments to reduce inter-ventricular septal thickness, and showed significant therapeutic effects. Ultrasound-guided percutaneous intramyocardial septal ablation, as a less invasive and more effective treatment, exhibited great application prospects in reducing the pressure gradient of left ventricular outflow tract. This article reviews the research progress of several ventricular septal ablation techniques for the treatment of HOCM.

Telemedicine refers to a discipline in which medical personnel use modern communication technology, electronic technology, and computer technology to realize the remote collection, storage, processing, transmission, and inquiry of various medical information, so as to cross the barriers of time and space and provide medical services to a wider range of people With the rapid development of Internet technology, telemedicine is being used more widely in case consultation, imaging, ECG and pathology. The demand for remote echocardiography is increasingly strong and its potential applications becoming more extensive, however, the development of remote ultrasound imaging, especially remote echocardiography, is lagging behind due to the limitation of dynamic image codec, immature multi-channel information synchronization technology, and slow network transmission speeds. This article reviews the development status and application prospects of remote diagnosis and treatment of echocardiography at home and abroad.