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Comparison of Sonographic Quantitative Assessment of Splenomegaly in Thalassemia Patients Receiving Whole Blood and Packed Red Cell Transfusions
Muhammad Arif Afridi, MS , Raham Bacha, PhD , Nadeem Ullah, BS , Syed Muhammad Yousaf Farooq, PhD , Malik Mairaj Khalid, BS , Imran Khan, BS , Ashfaq Ahmad, Mujahid Sher, PhD
Advanced Ultrasound in Diagnosis and Therapy    2023, 7 (3): 279-284.   DOI: 10.37015/AUDT.2023.220039
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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.

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Advances and Applications of Transperineal Ultrasound Imaging in Female Pelvic Floor Dysfunction
Shuangyu Wu, MM , Xinling Zhang, MD
Advanced Ultrasound in Diagnosis and Therapy    2023, 7 (3): 235-247.   DOI: 10.37015/AUDT.2023.220044
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Pelvic floor dysfunction (PFD) is a series of diseases with anatomical and/or functional abnormalities of the pelvic organs, which is common in women and can considerably interfere with their quality of life. Imaging is increasingly being used and can contribute towards better understanding, management, and prediction of long-term outcomes in women who suffer from PFD. Of the available techniques such as X-ray, computed tomography, magnetic resonance imaging, and ultrasound, the latter is generally superior for female pelvic floor imaging, especially in the form of transperineal imaging. This technique is safe, cost-effective, simple, widely available, and can provide an overview of the female pelvic floor. This review will outline the basic methodology, introduce recent researches in the field, and provide an overview of likely future utility of this technique in the evaluation of PFD.

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Ultrasonographic Identification of Muscle Atrophy in Hamstring Muscles after Anterior Cruciate Ligament Repair among Soccer Players: A Case-control Study
Sebastián Eustaquio Martín Pérez, MSc, Raúl Hernández García, PT, Alberto Brito Lorenzo, PT, Carlos Daniel Sabater Cruz, PT, Mario Herrera Pérez, PhD, Fidel Rodríguez Hernández, PhD, Kristin Briem, PhD, Isidro Miguel Martín Pérez, MD
Advanced Ultrasound in Diagnosis and Therapy    2023, 7 (4): 381-389.   DOI: 10.37015/AUDT.2023.230036
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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.

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Clinical Application of Ultrasound Tomography in Diagnosis of Musculoskeletal Diseases
Cong Wei, MD, Hui Zhang, PhD, Tao Ying, MD, Bing Hu, MD, Yini Chen, MD, Hongtao Li, MD, Qiude Zhang, PhD, Mingyue Ding, PhD, Jie Chen, MD, Ming Yuchi, PhD, Yuanyi Zheng, MD
Advanced Ultrasound in Diagnosis and Therapy    2024, 8 (1): 7-14.   DOI: 10.37015/AUDT.2024.230060
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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.

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Localization of Nonpalpable Breast Lumps by Ultrasound Local Coordinates and Skin Inking: A Randomized Controlled Trial
Leila Bayani, MD, Donya Goodarzi, BS, Reza Mardani, MD, Bita Eslami, PhD, Sadaf Alipour, MD
Advanced Ultrasound in Diagnosis and Therapy    2023, 7 (3): 267-271.   DOI: 10.37015/AUDT.2023.220033
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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.

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Clinical Application of Robot-assisted Teleultrasound
Keyan Li, MD, Faqin Lv, MD, Junlai Li, MD
Advanced Ultrasound in Diagnosis and Therapy    2023, 7 (3): 228-234.   DOI: 10.37015/AUDT.2023.230031
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With the development of network technology and intelligent robot technology, Robot-assisted teleultrasound has played an important role in clinical fields. The application of real-time remote ultrasound technology has made the ultrasonic diagnosis break through the limitation of time and space distance, and solved the problem of shortage of medical resources to a certain extent. This article introduces the development and application basis of robot-assisted teleultrasound, summarizes the clinical application status, and discusses the advantages and limitations of its current application. In addition, we discuss the value in application scenario, interventional therapy and intracavitary ultrasound in the future.

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Decreased Cerebral Flow Velocities from General Anesthesia are Not Associated with Cerebral Hyperperfusion Syndrome
Yumei Liu, MD, PhD, Yang Hua, MD, Yabing Wang, MD, PhD, Nan Zhang, MS, Ting Ma, MD, PhD, Yue Zhao, MS, Na Li, MS, Na Lei, MS, Ran Liu, MS
Advanced Ultrasound in Diagnosis and Therapy    2023, 7 (3): 248-253.   DOI: 10.37015/AUDT.2023.220032
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Objective: General anesthesia (GA) can decrease cerebral flow velocities and predispose patients to cerebral hyperperfusion syndrome (CHS) and other perioperative adverse events after carotid endarterectomy (CEA). The aim of this study was to investigate whether decreased pre-operative flow velocity is associated with an increased risk of CHS and perioperative cerebral infarct, and to further identify risk factors if there is any.
Methods: We retrospectively evaluated 920 consecutive patients who received CEA from 2010 to 2020 at a major academic hospital in China. Middle cerebral artery (MCA) blood flow velocities were measured before and after induction of the GA by transcranial Doppler (TCD). Patients were classified into two groups: the NORMAL group if flow velocity decreased<30% and the LOW group if flow velocity decreased ≥30%. The ultrasonographic diagnostic criterion of CHS was defined as the 100% increase in flow velocity by TCD from the baseline to post-CEA. The occurrence of CHS, perioperative cerebral infarction was compared between the two groups.
Results: 399 (43.4%) were classified as LOW measurement, and 521 (56.6%) patients were classified as NORMAL measurement. In the LOW group, there were more patients with diabetes, fewer patients with ipsilateral ICA severe stenosis and the opening of anterior/posterior communicating artery. Although the occurrence of CHS per ultrasonography criteria was higher in the LOW group (21.3% vs 15.7%, P = 0.03), the occurrence of CHS per clinical criteria (3.2%, vs 2.1%, P = 0.28) or the perioperative cerebral infarct between the two groups (5.8% vs 5.0%, P = 0.60) is equivalent.
Conclusion: Patients with decreased flow velocities post-GA were more likely to meet the ultrasonography criteria for CHS, but they are not at risk of developing clinical CHS or perioperative cerebral infarct.

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Lung Nodule Classification in CT Images Using Improved DenseNet
Xiuping Men, PhD, Vladimir Y. Mariano, PhD, Aihua Duan, PhD, Xiaoyan Shi, PhD
Advanced Ultrasound in Diagnosis and Therapy    2023, 7 (3): 272-278.   DOI: 10.37015/AUDT.2022.220018
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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.

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State-of-the-Art and Development Trend of Interventional Ultrasound in China
Yang Qi, MD, Dengsheng Sun, MD, Linyao Wang, MD, Jie Yu, MD, Ping Liang, MD
Advanced Ultrasound in Diagnosis and Therapy    2023, 7 (4): 313-320.   DOI: 10.37015/AUDT.2023.230049
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Interventional ultrasound (IUS) is an important branch of modern minimally invasive medicine that has been widely applied in clinical practice due to its unique techniques and advantages. As a relatively emerging field, IUS has progressed towards standardization, precision, intelligence, and cutting-edge directions alone with more than 40 years of development, which is becoming increasingly important techniques in clinical medicine. This article will briefly review the development and advancement of IUS for diagnosis and treatment in China in the era of precision medicine from the aspects of artificial intelligence, virtual navigation, molecular imaging, and nanotechnology.

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Accuracy of Prenatal Ultrasound in the Diagnosis of Isolated Fetal Cleft Palate in High-risk Patients
Hongmei Wu, MD, Shuqin Li, MD, Fengfeng Shi, MD, Yuxiu Gao, MD, Jiansheng Li, MD
Advanced Ultrasound in Diagnosis and Therapy    2024, 8 (2): 57-63.   DOI: 10.37015/AUDT.2024.230038
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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.

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Artificial Intelligence-assisted Medical Imaging in Interventional Management of Valvular Heart Disease
Wenwen Chen, BS, Yuji Xie, MD, Zisang Zhang, MD, Ye Zhu, MS, Yiwei Zhang, MD, Shuangshuang Zhu, MD, PhD, Chun Wu, MD, PhD, Ziming Zhang, MD, Xin Yang, PhD, Man wei Liu, MD, PhD, Mingxing Xie, MD, PhD, Li Zhang, MD, PhD
Advanced Ultrasound in Diagnosis and Therapy    2023, 7 (3): 217-227.   DOI: 10.37015/AUDT.2023.230030
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The integration of medical imaging and artificial intelligence (AI) has revolutionized interventional therapy of valvular heart diseases (VHD), owing to rapid development in multimodality imaging and healthcare big data. Medical imaging techniques, such as echocardiography, cardiovascular magnetic resonance (CMR) and computed tomography (CT), play an irreplaceable role in the whole process of pre-, intra- and post-procedural intervention of VHD. Different imaging techniques have unique advantages in different stages of interventional therapy. Therefore, single imaging technique can’t fully meet the requirements of complicated clinical scenarios. More importantly, a single intraoperative image provides only limited vision of the surgical field, which could be a potential source for unsatisfactory prognosis. Besides, the non-negligible inter- and intra-observer variability limits the precise quantification of heart valve structure and function in daily clinical practice. With the help of analysis clustered and regressed by big data and exponential growth in computing power, AI broken grounds in the interventional therapy of VHD, including preoperative planning, intraoperative navigation, and postoperative follow-up. This article reviews the state-of-the-art progress and directions in the application of AI for medical imaging in the interventional therapy of VHD.

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Cover, Foreword and Content
Advanced Ultrasound in Diagnosis and Therapy    2024, 8 (1): 0-0.  
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Spontaneous Remission of Pediatric Undescended Testis Torsion during Color Doppler Ultrasound Examination
Huiyong Hu, MS, Hairong Wang, MS, Yunfeng Xu, MS
Advanced Ultrasound in Diagnosis and Therapy    2023, 7 (3): 296-298.   DOI: 10.37015/AUDT.2023.220029
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Undescended testis or cryptorchidism is the most common reproductive system disease in children. About 3% of full-term and 30% of premature male infants are born with one or both testicles undescended. Most cryptorchidism is asymptomatic and is occasionally found due to inguinal pain caused by testicular torsion. Herein, we presented a case of pediatric patient with abdominal pain as initial symptom who was found the left inguinal cryptorchidism complicated by testicular torsion, and then spontaneous remission during the color Doppler ultrasonography examination.

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Ultrasound-Guided Attenuation Parameter May Replace B-mode Ultrasound in Diagnosing Nonalcoholic Fatty Liver Disease
Bo Jiang, MD, Yiman Du, MD, Xiang Fei, MD, Jianing Zhu, MD, Lianhua Zhu, MD, Qiuyang Li, MD, Yukun Luo, MD, PhD
Advanced Ultrasound in Diagnosis and Therapy    2023, 7 (3): 260-266.   DOI: 10.37015/AUDT.2023.220037
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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.

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Imaging Features and Misdiagnosis Analysis of Hyaline Vascular Castleman Disease in the Parotid Region: A Case Report
Pengyan Zhang, MS, Ling Ren, MD, Yuguang You, BS, Wenjun Xiao, MS
Advanced Ultrasound in Diagnosis and Therapy    2023, 7 (3): 302-304.   DOI: 10.37015/AUDT.2023.220048
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Castleman disease (CD), first described in 1954, is a rare lymphoproliferative disorder. A 20-year-old female patient was treated for a "painless mass below the right ear for 1 year". The imagological examination of the patient showed a soft tissue mass about 2.8 cm in diameter in the right parotid gland. Moreover, the patient underwent a right superficial parotidectomy and facial nerve dissection. The mass in the parotid gland was removed, and CD was confirmed by further pathological examination. Imagological examination contributes to the diagnosis and preoperative evaluation of CD.

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Contrast-Enhanced Ultrasound in the Detection and Evaluation of Maxillofacial Arteriovenous Malformation: A Case Report
Chang Liu, MD, Weiwei Shen, MD, Peng Fu, MD, Youchen Xia, MD, Jianxun Ma, MD, Ligang Cui, MD, Shi Tan, MD
Advanced Ultrasound in Diagnosis and Therapy    2023, 7 (3): 288-292.   DOI: 10.37015/AUDT.2023.220024
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Arteriovenous malformation (AVM) is a kind of congenital endothelial malformation that results from errors in vascular morphogenesis. Here we present a case of maxillofacial AVM in a 19-year-old male for its imaging characteristics on contrast-enhanced ultrasound (CEUS). On conventional ultrasound, the lesion was a large subcutaneous mass with abnormal vasculature. On CEUS, it manifested as a “quick wash-in and slow wash-out” enhancement. Moreover, CEUS showed a much larger range of the lesion than gray-scale imaging, with left ophthalmic artery involved. CEUS enabled real-time observation of the microcirculatory perfusion of the lesion and played a very important role in the detection and evaluation of maxillofacial AVM.

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Application Progress of Ultrasound Elastography in the Evaluation of Diabetic Peripheral Neuropathy
Siqi Zheng, MM, Min Bai, MM
Advanced Ultrasound in Diagnosis and Therapy    2024, 8 (1): 1-6.   DOI: 10.37015/AUDT.2024.230006
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Diabetic peripheral neuropathy (DPN) is one of the most common chronic complications of diabetes, which can lead to neuropathic pain, foot ulcers, and even disability, and greatly reduces survival. Therefore, early diagnosis and prevention of DPN is of great importance to reduce symptoms and disability rate. Ultrasound elastography is a noninvasive method to evaluate changes in nerve tissue composition by obtaining the elastic modulus of tissue and visually displaying the stiffness in the form of images. This paper summarizes the application progress of ultrasound elastography in the evaluation of peripheral neuropathy in recent years, in order to provide reference for the future clinical application of large samples.

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Ultrasound Assessment of Effect of Maternal Thyroid Function During Pregnancy on Fetal and Neonatal Bone Development
Hao Feng, MM, Yaqin Sun, MM, Jingjing Zhang, MM, Jiajia Wang, MM, Shuai Han, MM, Shumin Wang, PhD
Advanced Ultrasound in Diagnosis and Therapy    2024, 8 (2): 41-48.   DOI: 10.37015/AUDT.2024.230043
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Throughout pregnancy, maternal thyroid-related hormones are transported to the fetus via the placenta to allow normal fetal growth and development and are particularly important in the first and second trimesters of pregnancy. During maternal-fetal transport, in addition to thyroid-related hormones, thyroid-stimulating hormone receptor antibodies and antithyroid drugs can enter the fetus and interfere with development of the fetal thyroid gland and endocrine function, potentially leading to hyperthyroidism or hypothyroidism in the fetus or newborn. Several basic studies have been performed to demonstrate the important role of thyroid-related hormones in fetal and neonatal bone development. Ultrasound can assess neonatal skeletal maturity and bone development safely, rapidly, and effectively. This review aims to communicate the latest knowledge about maternal and fetal thyroid function in both normal and pathological pregnancies and summarize the latest advances in the potential effects of abnormal maternal thyroid function on bone development in the fetus and neonate. Finally, it discusses recent advances in research on ultrasound in the assessment of fetal and neonatal bone development.

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Diagnostic Utility of Superb Microvascular Imaging of ultrasound Examinations to Evaluate Hepatic Ischemia-reperfusion Injury
Guoying Zhang, MD, Ying Tang, BS, Mingyang Wang, MD, Weina Kong, MD
Advanced Ultrasound in Diagnosis and Therapy    2024, 8 (1): 15-21.   DOI: 10.37015/AUDT.2024.230010
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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.

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Schistosoma Japonicum Infection of the Ureter and Bladder: A Case Report and Literature Review
Rongchen Wang, MM, Li Qiu, MD
Advanced Ultrasound in Diagnosis and Therapy    2023, 7 (3): 293-295.   DOI: 10.37015/AUDT.2023.230005
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Schistosoma japonicum causes intestinal schistosomiasis, which affects mainly the rectum and sigmoid colon but rarely the urinary tract. Here we report a rare case of S. japonicum infection of the bladder and ureter, and describe its clinical features and imaging findings. We also put this case in perspective with the literature on S. japonicum infections in humans.

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Contrast-Enhanced Ultrasound LI-RADS: A Pictorial Review
Osama Mahmoud, BS, Ajay Makkena, BS, Corinne E. Wessner, MS, MBA, RDMS, Ji-Bin Liu, MD, John R. Eisenbrey, PhD, Andrej Lyshchik, MD, PhD
Advanced Ultrasound in Diagnosis and Therapy    2023, 7 (4): 321-332.   DOI: 10.37015/AUDT.2023.230041
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The American College of Radiology has implemented the Liver Imaging Reporting and Data System (LI-RADS) to help detect, interpret, and guide the management of suspected lesions on surveillance imaging for hepatocellular carcinoma (HCC) in patients with cirrhosis. The classification of indeterminate nodules with a grading algorithm can be used for multiple imaging modalities (US, CT, and MRI) and incorporates multiple imaging features to appropriately classify observations with different likelihood of being HCC. Contrast-enhanced ultrasound (CEUS) LI-RADS has been fully implemented since 2017. The aim of this pictorial article is to provide a comprehensive review of CEUS LI-RADS utilization, discuss its advantages, and highlight areas for potential improvement.

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Solitary Metastatic Carcinoma of Colon from Renal Cell Carcinoma Misdiagnosed as Primary Colon Carcinoma
Yemei He, MM, Danni He, MM, Xuankun Liang, MM, Zuofeng Xu, MD, PhD
Advanced Ultrasound in Diagnosis and Therapy    2023, 7 (3): 299-301.   DOI: 10.37015/AUDT.2023.220045
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The gastrointestinal tract, particularly the colon, represents a rare site of metastatic carcinoma. It is difficult to diagnose because of its nonspecific clinical and imaging features. Herein, we reported the case of a 64-year-old Asian male who presented with a solitary mass on his right colon. We successively performed contrast-enhanced ultrasonography, computed tomography (CT) and colonoscopy. Colonoscopy-guided biopsy revealed inflammatory granulomatous and necrotic tissue. The mass was resected and identified as a metastatic carcinoma of renal cell carcinoma (RCC). The details of the case and review of related articles are presented.

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Systematic Approaches and Designs for the Optimal Diagnosis and Treatment of Thyroid Nodules via Fine Needle Aspiration
Jian-Quan Zhang, PhD, Lei Yan, MD
Advanced Ultrasound in Diagnosis and Therapy    2023, 7 (3): 254-259.   DOI: 10.37015/AUDT.2023.230033
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With the increasing utilization of semi-thyroidectomy and rapid advancements in ultrasound-guided thermal ablation therapy for the management of papillary thyroid carcinoma (PTC) and PTC cervical lymph node metastasis, ultrasound-guided fine-needle aspiration biopsy (FNAB) has emerged as the predominant approach for the pre-treatment cytopathologic diagnosis of PTC. Numerous expert consensuses and practice guidelines have delineated the acquisition of sufficient, high-quality cellular specimens for cytological examination. However, new challenges keep emerging in the real-world practice of thyroid FNAB, primarily stemming from the perceptions and expertise of physicians or technicians who perform FNAB. The aim of this study was to delineate the key deficiencies in specimen collection during FNAB, elucidate principles of systematic thinking, and propose preventive measures for these issues, along with a range of innovative concepts and technical approaches. Effectively addressing these concerns will enhance FNAB implementation and facilitate advancements in novel therapeutic modalities, such as thermal ablation, to ameliorate prognosis.

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Cover, Foreword and Content
Advanced Ultrasound in Diagnosis and Therapy    2023, 7 (3): 0-0.  
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Clinical Usefulness of Atrioventricular Coupling in Cardiovascular Disease
Yang Lan, Li Zhenyi, Chen Ya, Chen Anni, Wang Xinqi, Jin Lin, Li Zhaojun
Advanced Ultrasound in Diagnosis and Therapy    2025, 9 (1): 1-9.   DOI: 10.37015/AUDT.2025.240060
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Atrioventricular Coupling (AV-Coupling) refers to the functional coordination between atrial and ventricular systole and diastole in the heart. Currently, the primary method for evaluating AV-Coupling is through the left atrioventricular coupling index (LACI), measured using imaging techniques. A higher LACI indicates a greater mismatch between the volumes of left atrium and left ventricle at the end of ventricular diastole, reflecting a more significant impairment of left AV-Coupling. AV-Coupling plays a vital role in the pathophysiology and progression of cardiovascular diseases. Therefore, early and accurate assessment of AV-Coupling is essential for evaluating a patient’s condition, guiding clinical decisions, stratifying risk, and determining prognosis. This review aims to summarize the physiological mechanisms and evaluation methods of AV-Coupling, as well as its clinical significance in various cardiovascular diseases.

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Semi-supervised Learning for Real-time Segmentation of Ultrasound Video Objects: A Review
Jin Guo, MD, Zhaojun Li, PhD, Yanping Lin, PhD
Advanced Ultrasound in Diagnosis and Therapy    2023, 7 (4): 333-347.   DOI: 10.37015/AUDT.2023.230016
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Real-time intelligent segmentation of ultrasound video object is a demanding task in the field of medical image processing and serves as an essential and critical step in image-guided clinical procedures. However, obtaining reliable and accurate medical image annotations often necessitates expert guidance, making the acquisition of large-scale annotated datasets challenging and costly. This presents obstacles for traditional supervised learning methods. Consequently, semi-supervised learning (SSL) has emerged as a promising solution, capable of utilizing unlabeled data to enhance model performance and has been widely adopted in medical image segmentation tasks. However, striking a balance between segmentation accuracy and inference speed remains a challenge for real-time segmentation. This paper provides a comprehensive review of research progress in real-time intelligent semi-supervised ultrasound video object segmentation (SUVOS) and offers insights into future developments in this area.

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Arterial Stiffness and Cardiovascular Risk: The Role of Brachial Cuff-measured Index
Lin Jin, MD, Xinyi Li, BS, Mengjiao Zhang, MS, Xujie Zhang, BS, Chaoyu Xian, BS, Fuyou Liang, PhD, Zhaojun Li, MD
Advanced Ultrasound in Diagnosis and Therapy    2023, 7 (4): 348-355.   DOI: 10.37015/AUDT.2023.230045
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Early detection of vascular disease is fundamental to the prevention and treatment of systemic vascular lesions. The timely identification of vascular damage can be achieved by comprehensively assessing the structural anomaly and/or functional degeneration of the vasculature. The assessment may to some extent indicate the long-term detrimental effects of cardiovascular disease (CVD) risk factors on vascular health. A key aspect in the evaluation of vascular function is the measurement of arterial stiffness. In 2012, the arterial velocity-pulse index (AVI) and arterial pressure-volume index (API) were introduced, which are noninvasively measured with a brachial cuff, and can reflect the status of arterial stiffness in both the aorta and the brachial artery. A large number of relevant studies have demonstrated the strong associations between AVI/API and various CVD risk factors, underlining the substantial relevance of the indices in CVD risk assessment. In this review, we provide a systematic review of the progresses made in brachial cuff-based measurements of arterial stiffness. In addition, we summarize the results of the recent studies focused on exploring the associations of AVI/API with relevant risk factors as well as their roles in CVD assessment.

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A Non-Invasive Follicular Thyroid Cancer Risk Prediction System Based on Deep Hybrid Multi-feature Fusion Network
Yalin Wu, PhD, Qiaoli Ge, MM, Linyang Yan, PhD, Desheng Sun, MD
Advanced Ultrasound in Diagnosis and Therapy    2023, 7 (4): 373-380.   DOI: 10.37015/AUDT.2023.230023
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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.

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Experience and Enlightenment of Handheld Ultrasound Applications in Multiple Scenarios Based on 5G Technology
Huihui Chai, MS, Xiaowan Bo, MD, Lehang Guo, MD, Chengzhong Peng, MD
Advanced Ultrasound in Diagnosis and Therapy    2023, 7 (4): 356-365.   DOI: 10.37015/AUDT.2023.230029
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In the digital age, the miniaturization of portable ultrasound equipment has brought both opportunities and challenges to the healthcare industry. Handheld ultrasound (HHU) devices are tablet or smartphone-sized scanners that are highly portable, have lower costs, produce no harmful side effects, and consume less power, making them suitable for use in different environments. HHU devices are primarily designed for new users of ultrasound scanners with varying backgrounds to evaluate different structures of the human body in various clinical settings. HHU applications based on Fifth-generation (5G) wireless network communication and artificial intelligence (AI) technology provide new healthcare solutions. The main application scenarios for HHU devices currently include in-hospital use, remote medical treatment, emergency rescue, and home monitoring. These scenarios allow for rapid image acquisition and real-time image interpretation, thereby improving the efficiency and quality of healthcare, reducing medical costs, and improving the allocation and utilization of medical resources. However, there remain some technical challenges and weaknesses such as device safety, data privacy, and network stability. With the continuous integration of AI technology, HHU applications will find wider use and promotion, bringing about more opportunities and challenges to the healthcare industry. This article reviews the application experience and insights of 5G technology in the field of HHU, aiming to provide fresh evidence and references for future research and applications.

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Evaluation of Atherosclerosis Development by Vascular Duplex Ultrasonography in ApoE-deficient Dogs Fed with a High-fat Diet
Lingyun Jia, MD, PhD, Yuan Li, PhD, Yang Hua, MD, Yumei Liu, MD, Nan Zhang, MD, Mingjie Gao, MD, Ke Zhang, MD, Jingzhi Li, MD, Benchi Chen, BS, Jidong Mi, MS, Nan Zhao, PhD
Advanced Ultrasound in Diagnosis and Therapy    2024, 8 (2): 49-56.   DOI: 10.37015/AUDT.2024.230037
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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.

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Review on Image Inpainting using Intelligence Mining Techniques
V. Merin Shobi, MCA, MPhil , ME, F. Ramesh Dhanaseelan, MSc, MTech , PhD
Advanced Ultrasound in Diagnosis and Therapy    2023, 7 (4): 366-372.   DOI: 10.37015/AUDT.2023.230007
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Objective Inpainting is a technique for fixing or removing undesired areas of an image.

Methods In present scenario, image plays a vital role in every aspect such as business images, satellite images, and medical images and so on.

Results and Conclusion This paper presents a comprehensive review of past traditional image inpainting methods and the present state-of-the-art deep learning methods and also detailed the strengths and weaknesses of each to provide new insights in the field.

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A Study on Left Atrial Function in Patients with Essential Hypertension Using Four-Dimensional Echocardiography
Junrong Hong, MD, Pingyang Zhang, MD, PhD, Mengyao Fei, MD, Lingling Wang, MD
Advanced Ultrasound in Diagnosis and Therapy    2024, 8 (2): 64-73.   DOI: 10.37015/AUDT.2024.230042
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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.

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Ultrasound Radiogenomics-based Prediction Models for Gene Mutation Status in Breast Cancer
Zhai Yue, Tan Dianhuan, Lin Xiaona, Lv Heng, Chen Yan, Li Yongbin, Luo Haiyu, Dan Qing, Zhao Chenyang, Xiang Hongjin, Zheng Tingting, Sun Desheng
Advanced Ultrasound in Diagnosis and Therapy    2025, 9 (1): 10-20.   DOI: 10.37015/AUDT.2025.240010
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Ultrasound radiogenomics, an emerging field at the intersection of radiology and genomics, employs high-throughput methods to convert radiological images into high-dimensional data, which are then processed to extract and analyze radiomic features. These features, including shape, texture, and intensity variations, are correlated with specific genetic mutations such as TP53 and PIK3CA, critical for cancer progression and treatment response. By integrating clinical data with ultrasonic features, predictive models are developed using machine learning techniques, aiming to refine the capability to diagnose and personalize treatment plans for breast cancer patients. This approach reduces the need for invasive biopsies and medical costs for patients through a better understanding of the tumor’s biological behavior using ultrasound images. This review focuses on the application of ultrasound radiogenomics for predicting gene mutations in breast cancer, highlighting its transformative potential in clinical practice and discussing ongoing challenges and future directions in this field.

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Evaluation Methods and Progress of Right Ventricular-pulmonary Artery Coupling
Wang Xinqi, Chen Anni, Yang Lan, Chen Ya, Li Zhenyi, Li Zhaojun, Jin Lin
Advanced Ultrasound in Diagnosis and Therapy    2024, 8 (4): 205-216.   DOI: 10.37015/AUDT.2024.240059
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Right ventricular-pulmonary artery coupling (RV-PAC) serves as an indicator of the efficiency of energy transfer from the right ventricle to the pulmonary circulation. It plays a critical role in the diagnosis, clinical treatment, and prognosis of conditions such as pulmonary hypertension, heart valve disease, and heart failure. Various non-invasive evaluation methods have recently been proposed for assessing RV contractility and arterial afterload, based on the end-systolic elastance to arterial elastance ratio (Ees/Ea), which is derived from invasive pressure-volume loops. In this review, we summarize the fundamental concepts, physiological mechanisms, examination methods, influencing factors, and clinical significance of RV-PAC to provide a valuable reference for clinical practice.

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The Role of Ultrasonography in the Diagnosis of Systemic Sarcoidosis: a Case Report and Literature Review
Hui Li, MD, Nan Zheng, MD, Penglin Zou, MD, Chao Jia, MD, Long Liu, MD, Gang Li, MD, Ziqi Wang, MD, Rong Wu, MD, Lianfang Du, MD, Qiusheng Shi, MD
Advanced Ultrasound in Diagnosis and Therapy    2024, 8 (1): 32-38.   DOI: 10.37015/AUDT.2024.230054
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Sarcoidosis is a granulomatous disease of unknown etiology that can involve various organs and tissues. The clinical manifestations vary greatly, so it is difficult to make a clear diagnosis of sarcoidosis with just the clinical manifestation and imaging findings. The diagnosis and treatment of a patient with systemic sarcoidosis was reported: a 51-year-old woman presented with a dry cough. Computed tomography (CT), magnetic resonance imaging (MRI), and conventional ultrasonography (US) suggested miliary nodules and inflammatory changes in the lungs, there was mediastinal, retroperitoneal and hilar lymph node enlargement and uneven liver echo, respectively. Positron emission tomography/computed tomography (PET-CT) further suggested that the lesions were distributed throughout the body, including the lymph nodes and muscles of the extremities; thus, systemic lymphoma was considered. Finally, ultrasound-guided biopsy of different sites yielded the same histopathological findings: sarcoidosis. The sarcoidosis in this case is characterized by a large number of involved sites with a wide range, and a variety of imaging data were complete but failed to suggest a diagnosis. Finally, a clear histopathological result was obtained under the guidance of ultrasound. This article reviewed the relevant literature and concluded that ultrasound-guided puncture to obtain histopathological results is a simple and effective method for the diagnosis of sarcoidosis.

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Identification of Differently Expressed miRNAs and Genes between Benign Prostatic Hyperplasia and Prostate Cancer
Yuqing Huang, MD, Cui Lei, BS, Xinyu Zhao, PhD, Jing Xiao, PhD, Xian-Quan Shi, PhD
Advanced Ultrasound in Diagnosis and Therapy    2024, 8 (1): 22-28.   DOI: 10.37015/AUDT.2024.230044
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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.

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Cover, Foreword and Content
Advanced Ultrasound in Diagnosis and Therapy    2024, 8 (2): 0-0.  
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Juvenile Granulosa Cell Tumor of the Testis: A Preoperative Approach of the Diagnosis with Ultrasound
Rodanthi Sfakiotaki, MS, Sergia Liasi, BM, Eleni Papaiakovou, BM, Irene Vraka, PhD, Marina Vakaki, PhD, Chrysoula Koumanidou, PhD
Advanced Ultrasound in Diagnosis and Therapy    2023, 7 (4): 409-411.   DOI: 10.37015/AUDT.2023.220038
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Granulosa cell tumor of the testis is a rare intermediate stromal cell tumor that can be distinguished in adult and juvenile type. The juvenile type is commonly presented in infants less than a year old-most often during the first 6 months of life and can be associated with ambiguous genitalia and chromosomal anomalies. We report two cases of juvenile granulosa cell tumor (JGCT) of the testis diagnosed in the neonatal period and review the typical sonographic findings of this entity.

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An Epstein-Barr Virus Positive Lymphoepithelioma-Like Cholangiocarcinoma in A Young Woman with Chronic Hepatitis B Treated through Microwave Ablation: A Case Report and Literature Review
Lanxia Zhang, MM, Qingjing Zeng, MD, Guanghui Guo, MM, Xuqi He, MM, Kai Li, MD
Advanced Ultrasound in Diagnosis and Therapy    2023, 7 (4): 405-408.   DOI: 10.37015/AUDT.2023.220049
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Lymphoepithelioma-like cholangiocarcinoma (LELCC) is a rare subtype of carcinoma that is poorly reported. We report a case of LELCC in a 28-year-old female with chronic hepatitis B. She underwent secondary microwave ablation for residual tumor following the failure of radiofrequency ablation (RFA). Image fusion technology was used to accurately diagnose that the second lesion represented residual tumor. This case is the second successful application of microwave ablation in the treatment of LELCC. We first reviewed the ultrasonographic features of LELCC. We report this case to improve our understanding of this disease and provide evidence for its clinical treatment.

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Advancements in the Application of Convolutional Neural Networks in Ultrasound Imaging for Breast Cancer Diagnosis and Treatment
An Zichen, Li Fan
Advanced Ultrasound in Diagnosis and Therapy    2025, 9 (1): 21-31.   DOI: 10.37015/AUDT.2025.240009
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Since 2020, breast cancer has held the highest incidence rate among cancers worldwide. Breast ultrasound (US) imaging technology plays a crucial role in the early diagnosis and intervention treatment of breast cancer patients. Deep learning (DL), as one of the most powerful machine learning techniques in the field of artificial intelligence (AI), has the ability to automatically select features from raw data, achieving remarkable advancements in breast US imaging. This review focuses on the application of convolutional neural networks (CNNs) within DL technology in the field of breast US. It summarizes the use of DL models in breast cancer screening and in preoperative prediction of molecular subtypes, response to neoadjuvant chemotherapy (NAC), and axillary lymph node (ALN) metastasis status. The review also identifies the data limitations of using CNN models in breast US and describes the development history and current applications of DL in breast cancer screening, diagnostic guidance, and prognostic prediction. Furthermore, it discusses the future research directions and potential challenges. Advancing the development of CNN technology in breast US, and improving the generalizability and reproducibility of these models, will significantly promote their translational application in clinical settings.

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ISSN 2576-2516 (Online)

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