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CMUT/CMOS-based Butterfly iQ - A Portable Personal Sonoscope
Joyce Y Liu, BA, Jiajun Xu, MD, Flemming Forsberg, PhD, Ji-Bin Liu. MD, FAIUM
Advanced Ultrasound in Diagnosis and Therapy    2019, 3 (3): 115-118.   DOI: 10.37015/AUDT.2019.190819
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With the development of bioengineering technologies, medical ultrasound systems have evolved and advanced over the years, including the transition of ultrasound machines from analog devices to digital systems and improvements in transducer assembly from piezoelectric ceramics to single crystals. In the past several years, the further miniaturization of ultrasound units has become possible with the advancement of computer chip manufacturing and production. Most recently, a new handheld ultrasound system has been developed by the startup company Butterfly Network, using an innovative CMUT/CMOS-based probe technique. This paper will review the history, technology and features of this new device, as well as discuss its future potential as a personal sonoscope.

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Ultrasound-guided Microwave Ablation of Adenolymphoma of Parotid Gland: A Case Report
Xiaohui Ji, MD, Juanjuan Li, MD, Dongxia Gao, MD
Advanced Ultrasound in Diagnosis and Therapy    2022, 6 (1): 22-25.   DOI: 10.37015/AUDT.2021.200046
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Adenolymphoma is the second most common benign parotid tumor after pleomorphic adenoma. Although microwave ablation (MWA) has been proved to be effective for benign breast and thyroid nodules, there are few studies on ablation of adenolymphoma of parotid gland. An 82-year-old male with adenolymphoma of bilateral parotid gland treated with ultrasound-guided MWA. After 12 months of follow-up, the volume of bilateral parotid nodules was significantly reduced without recurrence and obvious complications. In conclusion, ultrasound-guided MWA is a safe and effective method for patients with parotid adenolymphoma who cannot tolerate surgery.

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Application and Development of Handheld Ultrasound in the Field of Medicine and Healthcare
Xing Yu, Yaoyao Cui, Yuankai Xuan, Tingyi Jiang, Ligang Cui
Advanced Ultrasound in Diagnosis and Therapy    2018, 2 (2): 155-160.   DOI: 10.37015/AUDT.2018.180816
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With the rapid development of microelectronics, handheld ultrasound devices emerged and have a widespread use in the field of medicine and healthcare. The handheld ultrasound is a modality of medical ultrasonic device that is portable (i.e., carried by hand), easy to operate and in some cases even combine the scanner with the host system. It normally has the characteristics of light weight, small size and low power consumption. With the wireless imaging transmission technique, remote and intelligent diagnosis is possible for the doctors using handheld ultrasound devices. As soon as the low-cost, highperformance handheld ultrasound device was launched, it attracted clinical attention and received a warm welcome from primary doctors and clinicians, thereby accelerating the development of ultrasonic clinical visualization. In this paper, we will illustrate the status and roles of handheld ultrasound for its clinical settings and applications in the past, current, and future.

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Evolution and Revolution of System Architecture with New Generation Technology
Tomohisa Imamura, Koichiro Kurita, Hiroyuki Shikata, Tetsuya Kawagishi
Advanced Ultrasound in Diagnosis and Therapy    2019, 3 (3): 166-173.  
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Advances in Modern Clinical Ultrasound
Sriharsha Gummadi, MD, John Eisenbrey, PhD, Jingzhi Li, MD, Zhaojun Li, MD, Flemming Forsberg, PhD, Andrej Lyshchik, MD, Ji-Bin Liu, MD
Advanced Ultrasound in Diagnosis and Therapy    2018, 2 (2): 51-63.   DOI: 10.37015/AUDT.2018.180801
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Advances in modern clinical ultrasound include developments in ultrasound signal processing, imaging techniques and clinical applications. Improvements in ultrasound processing include contrast and high-fidelity ultrasound imaging to expand B-mode imaging and microvascular (or microluminal) discrimination. Similarly, volumetric sonography, automated or intelligent ultrasound, and fusion imaging developed from the innate limitations of planar ultrasound, including user-operator technical dependencies and complex anatomic spatial prerequisites. Additionally, ultrasound techniques and instrumentation have evolved towards expanding access amongst clinicians and patients. To that end, portability of ultrasound systems has become paramount. This has afforded growth into the point-of-care ultrasound and remote or tele-ultrasound arenas. In parallel, advanced applications of ultrasound imaging have arisen. These include high frequency superficial sonograms to diagnose dermatologic pathologies as well as various intra-cavitary or lesional interrogations by contrast-enhanced ultrasound. Properties such as realtime definition and ease-of-access have spurned procedural and interventional applications for vascular access. This narrative review provides an overview of these advances and potential future directions of ultrasound.

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Absent Blood Flow in the Testis on Color Doppler Ultrasound: The Causes, Differential Diagnosis and Clinical Value
Shun-Ping Chen, MD, Bin Chen, MD
Advanced Ultrasound in Diagnosis and Therapy    2020, 4 (3): 223-229.   DOI: 10.37015/AUDT.2020.190035
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Objectives: To investigate the causes, differential diagnosis, and clinical significance of absent blood flow (ABF) in the testis detected by color Doppler ultrasound (CDU) in acute scrotum.
Methods: A total of 263 patients with ABF in the testis detected by CDU in our hospital were reviewed retrospectively. However, only 111 patients who underwent surgery were included in this study. The ultrasonographic features of the testis and paratesticular tissue were analyzed. The surgical or surgical-pathologic results were taken as the reference standard to determine the causes of ABF in the testis.
Results: The causes of ABF in the testis were testicular torsion (n = 98, torsion group) and non-testicular torsion related diseases (n = 13, non-torsion group, including 8 testicular rupture, 3 epididymitis-orchitis combination with testicular necrosis, and 2 tumors). Tunica albuginea of the testis, diffuse enlarged epididymis, whirlpool sign, and internal echo of the testis were the better parameters for diagnosing the causes of ABF in the testis detected by CDU. And the accuracies of these approaches were 93.7%, 91%, 83.8%, and 81.1%, respectively. Whirlpool sign had a 100% positive predictive value (PPV), and disrupted tunica albuginea of the testis and diffuse enlarged epididymis each had 100% specificity for predicting testicular torsion. When the ultrasonographic findings were combined with these methods to determine the causes, the accuracy was 96.4% (107/111).
Conclusion: ABF in the testis detected by CDU is not always indicative of testicular torsion in acute scrotum; Analyzing ultrasound findings of the testis and paratesticular tissue can help with differential diagnosis of the causes of ABF in the testis and guide clinical decision-making.

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Artificial Intelligence in Ultrasound Imaging: Current Research and Applications
Shuo Wang, BS, Ji-Bin Liu, MD, Ziyin Zhu, MD, John Eisenbrey, PhD
Advanced Ultrasound in Diagnosis and Therapy    2019, 3 (3): 53-61.   DOI: 10.37015/AUDT.2019.190811
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Artificial intelligence (AI) is an area of computer science that emphasizes the creation of intelligent software or system based on big data information, machine learning and deep learning technologies. The rapid development of science and technology as well as internet communication has enabled AI and big data to gradually apply to many fields of health care. The modern imaging medicine is one of the first areas where AI can play an important role and applications. As cross-sectional imaging, ultrasound (US) is well suitable for AI technology to standardize imaging protocols and improve diagnostic accuracy. This article reviews current AI technology and related clinical applications in the fields of thyroid, breast and liver US.

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Dual Modal Ultrasound Elastography of the Sternocleidomastoid Muscle in Healthy Infants: A Prospective Study
Na Xu, MD, Bei Xia, MD, Wei Shi, MD, Ningning Tang, MD, ZhiXia Wu, MD, Binxuan Huang, MD, Hongwei Tao, MD
Advanced Ultrasound in Diagnosis and Therapy    2019, 3 (4): 182-186.   DOI: 10.37015/AUDT.2019.191219
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Objective: To evaluate the reliability of ultrasonographic (US) elastography of the sternocleidomastoid (SCM) muscle and to define normal strain ratio and shear wave velocity (SWV) values in healthy infants.
Methods: Two hundred healthy infants (mean age ± standard deviation, 1.64±1.78 month; 113 boys and 87 girls) were included in this prospective study. The thickness of bilateral SCM muscles was measured by B-mode ultrasonography, and the stiffness of SCM muscles was measured in both the longitudinal and transverse sections, symmetrical and extensional supine position, by using strain and shear wave elastography. The correlation between thickness and elastic values of the SCM muscle and the following possible influential factors were evaluated: sex, different sides of SCM muscle, different ultrasonic sections and different infant positions.
Results: Both sex and the side of SCM muscle did not show significant correlation with the thickness or stiffness of the SCM muscle (P > 0.05). The stiffness of SCM muscle in the longitudinal section was significantly greater than in the transverse section (P < 0.05). The measurements of the SCM muscle in the stretching position were significantly greater than those in the symmetrical position (P < 0.05).
Conclusion: The stiffness of SCM measured by US elastography is affected by relative positions of the infants. Therefore, the factor should be taken into account when measuring the stiffness of SCM by US elastography. US elastography can evaluate the stiffness of SCM, which is helpful for clinical diagnosis and treatment of children with torticollis.

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3D Auto RV —Right Ventricular Quantification
Anke Sedlmeier, David Prater, MS
Advanced Ultrasound in Diagnosis and Therapy    2020, 4 (3): 264-266.  
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Critical Care Ultrasonography and Its Application for COVID-19
Xi Liu, MD, Yang Hai, MD, Bin Ma, MD, Weelic Chong, BA, Ji-Bin Liu, MD
Advanced Ultrasound in Diagnosis and Therapy    2020, 4 (2): 43-49.   DOI: 10.37015/AUDT.2020.200035
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Ultrasound has developed as an invaluable tool in diagnosis and proper management in the intensive care unit (ICU). Application of critical care ultrasonography is quite distinct from the routine comprehensive diagnostic ultrasound exam, because the urgent setting mandates a goal-directed approach. Performing accurate and efficient critical care ultrasound requires ultrasound providers to first understand the pathophysiology of the disease and related imaging findings, and then follow the protocols to perform a focused ultrasound exam. In the ongoing coronavirus disease 2019 (COVID-19) pandemic, ultrasound plays an essential role in diagnosing and monitoring critically ill COVID-19 patients in the ICU. Our review focuses on the basics and clinical application of critical care ultrasound in diagnosing common lung disease, COVID-19 pulmonary lesions, pediatric COVID-19, and cardiovascular dysfunction as well as its role in ECMO and interventional ultrasonography.

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Automated Machine Learning in the Sonographic Diagnosis of Non-alcoholic Fatty Liver Disease
Sriharsha Gummadi, MD, Nirmal Patel, Haresh Naringrekar, MD, Laurence Needleman, MD, Andrej Lyshchik, MD PhD, Patrick O’Kane, MD, Jesse Civan, MD, John R Eisenbrey, PhD
Advanced Ultrasound in Diagnosis and Therapy    2020, 4 (3): 176-182.   DOI: 10.37015/AUDT.2020.200008
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Objective: This study evaluated the performance of automated machine-learning to diagnose non-alcoholic fatty liver disease (NAFLD) by ultrasound and compared these findings to radiologist performance.
Methods: 96 patients with histologic (33) or proton density fat fraction MRI (63) diagnosis of NAFLD and 100 patients without evidence of NAFLD were retrospectively identified. The “Fatty Liver” label included 96 patients with 405 images and the “Not Fatty Liver” label included 100 patients with 500 images. These 905 images made up a “Comprehensive Image” group. A “Radiology Selected Image” group was then created by selecting only images considered diagnostic by a blinded radiologist, resulting in 649 images. Cloud AutoML Visionbeta (Google LLC, Mountain View, CA) was used for machine learning. The models were evaluated against three blinded radiologists.
Results: The “Comprehensive Image” group model demonstrated a sensitivity of 88.6% (73.3-96.8%) and a specificity of 95.3% (84.2-99.4%). Radiologist performance on this image group included a sensitivity of 81.0% (74.3-87.6%) and specificity of 86.0% (72.6-99.5%). The model’s overall accuracy was 92.3% (84.0-97.1%), compared with mean individual performance (83.8%, 78.4-89.1%). The “Radiology Selected Image” group model demonstrated a sensitivity of 88.6% (73.3 - 96.8%) and specificity of 87.9% (71.8-96.6%). Mean radiologist sensitivity was 92.4% (86.9-97.9%) and specificity was 91.9% (83.4-100%). The model’s overall accuracy was 88.2% (78.1-94.8%) which was comparable to the individual radiologist performance (92.2%, 90.1-94.2%) and consensus performance (95.6%, 87.6-99.1%).
Conclusions: An automated machine-learning algorithm may accurately detect NAFLD on ultrasound.

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Application Value of Lung Ultrasound in Asymptomatic Patients with Confirmed COVID-19
Haidan Lin, MD, Bingqi Zhang, MD, Haiyan Kou, MD, Yuanyuan Zhao, MD, Keyan Li, MD, Dudu Wu, MD, Shiyue Zhao, MD, Liuqiong Ren, MD, Xingxi Lin, MD, Zihao Zhang, MD, Zhiye Chen, MD, Xuexia Shan, MD, Yuqing Huang, MD, Shengzheng Wu, MD, Faqin Lv, MD
Advanced Ultrasound in Diagnosis and Therapy    2020, 4 (2): 67-72.   DOI: 10.37015/AUDT.2020.200025
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Objective: To investigate the value of lung ultrasound (LUS) in asymptomatic patients with confirmed COVID-19.
Methods: A retrospective analysis was performed on nine patients in a designated isolation hospital in Sanya from February 22nd, 2020 to February 23rd, 2020. All patients were confirmed with COVID-19 pneumonia by PCR test, but none had the typical symptoms of COVID-19. All patients first underwent LUS examination and then chest computed tomography (CT) scanning. The application value of LUS in asymptomatic confirmed patients with COVID-19 was evaluated, compared with chest CT which was regarded as the golden standard.
Results: Among nine asymptomatic patients with COVID-19, there were two cases (22.22%) with abnormal ultrasonic manifestations, of which one (11.11%) showed a fusion B3-line in zone 5 of the right lung, and the other showed localized pulmonary consolidation in zone 6 of the left lung. The remaining seven cases (77.78%) showed no abnormal changes in LUS, but only clear pleura sliding sign and A-line. Chest CT showed abnormal changes in three cases (33.33%). Two of them (22.22%) showed flocculent high-density shadow at the base of both lungs (especially in the right lung), while the other case showed ground-glass opacity with thickened interlobular septal in the left lower lobe, involving the pleura. There were no abnormalities on chest CT of the remaining six cases (66.67%). The two (22.22%) LUS-positive patients were in complete coincidence with CT-positive patients. This study showed that the coincidence rate of the two examination methods was 88.89%. Taking chest CT as golden standard, the sensitivity, specificity, positive predictive value, negative predictive value, and Kappa value of lung ultrasound in the diagnosis of COVID-19 were 66.67%, 100%, 100%, 85.71%, and 0.727, respectively.
Conclusion: LUS can evaluate lung lesions in asymptomatic patients with COVID-19. Compared with chest CT, the diagnostic coincidence rate and diagnostic consistency of LUS are relatively higher. For this asymptomatic type of patient, ultrasound can be used as a diagnosis method, which can avoid the risk of radiation exposure in a short period of time. As a rapid and dynamic assessment method, LUS can cooperate with remote consultation to provide timely and accurate guidance for clinical diagnosis and treatment when necessary.

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Distributed Cloud-based Ultrasound Platform: Innovative Pathway to Develop Ultrasound Imaging System
Jianqiao Zhou, MD
Advanced Ultrasound in Diagnosis and Therapy    2022, 6 (1): 33-37.   DOI: 10.37015/AUDT.2022.220002
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The current medical ultrasound imaging device is mainly divided into console ultrasound device and portable ultrasound device. In this article, a new concept along with an innovative pathway to develop ultrasound imaging devices, namely distributed cloud-based ultrasound system (DCUS), was proposed. In DCUS, the ultrasound probes from multiple terminals are used to complete the transmission and reception as well as analog-to-digital conversion of ultrasonic signals, and upload the original radio frequency (RF) signals or in-phase and quadrature (IQ) signals to the cloud server through ultra-bandwidth high-speed communication technology, while the centralized cloud server platform finishes processing of ultrasonic signals and transmits and distributes ultrasound imaging to each related terminal in real time. Various artificial intelligence (AI) algorithms can also be deployed on the cloud-based platform to achieve AI-powered imaging optimization, protocol standardization, and assisted diagnosis. Thus, by utilizing new cloud-based platform and super-high transmission technology and combining the advantages of console ultrasound and portable ultrasound systems with flexibility, high imaging quality and intelligent features, DCUS could become whole new ultrasound system for medical imaging applications in foreseeable future.

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Recent Advances in Microbubble-Augmented Cancer Therapy
Mohamed Tantawi, MD, Ji-Bin Liu, MD, John R Eisenbrey, PhD
Advanced Ultrasound in Diagnosis and Therapy    2020, 4 (3): 155-168.   DOI: 10.37015/AUDT.2020.200055
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Contrast-enhanced ultrasound (CEUS) applications in cancer management have expanded over the past two decades. Through detection of vascularization and perfusion changes, CEUS provides a potentially reliable means of early prediction of response to different cancer therapies including systemic chemotherapy and locoregional therapies. Ultrasound-induced cavitation of contrast agents has a range of effects on the surrounding microenvironment. These effects can be manipulated to sensitize the tumors to radio- and chemotherapy, as well as achieve targeted delivery through drug-loaded contrast agents. Newer forms of drug carriers are being developed with improved drug-carrying capacity and tissue penetration. This review aims at providing a synopsis of the latest developments in CEUS’ use in oncologic therapy. While the majority of work described in this review is still in the pre-clinical phases, results have been encouraging and show potential translational benefit for cancer patients in the near future.

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Estimation of Clinical Outcomes of Irreversible Electroporation Use During Locally Advanced Pancreatic Cancer: A Systematic Review and Meta-analysis
Tian’an Jiang, PhD, Guo Tian, MD, Liming Wu, PhD, Qiyu Zhao, PhD
Advanced Ultrasound in Diagnosis and Therapy    2018, 2 (2): 143-149.   DOI: 10.37015/AUDT.2018.180814
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Objective: Irreversible electroporation (IRE) is a novel nonthermal ablative technique that transmits pulsatile electricity to enable nanoscale damages of the cellular membrane and induce cellular apoptosis. To assess the safety and efficacy of IRE for locally advanced pancreatic cancer (LAPC).
Methods: Electronic databases of PubMed, Embase, Web of Science, Scopus were searched up to June 2018 for studies comparing the standardized mean differences (SMD) of size, amylase and carbohydrate antigen 19-9 (CA199) levels between pre- and post-operation for patients with pancreatic cancer. Sensitivity and stratified analyses were conducted. Quality was estimated using Newcastle-Ottawa Scale (NOS).
Results: We finally identified 10 studies including 203 participants during a mean 7.06 months of follow-up (range 1 to 29 months). The meta-analyses showed the declined tumor size at 6 months post-IRE but unchanged at 1 month, and increased amylase level at 1-day post-IRE while unchanged at the 1 week. No significant difference of CA199 level was observed between pre-IRE and post-IRE at 1 week and 1 month. No risk of publication bias was detectable, and the favorable quality and validity of all outcomes were assessed based on NOS.
Conclusions: IRE may be a relatively state-of-the-art therapy option for most patients with LAPC if imaging or explorative laparotomy indicated that LAPC was unable to be successfully resected.

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Recommendations for Operation, Measurement, Reporting and Application of Pediatric Lung Ultrasound: Chinese Experts Consensus
Pediatric Ultrasound Committee of Ultrasound Branch of Chinese Medical Education Association; Ultrasound Committee of Chinese Pediatric Society, Chinese Medical Association, Weiling Chen, MD, Bei Xia, MD, Lan Wang, MD, Lixue Yin, MD
Advanced Ultrasound in Diagnosis and Therapy    2021, 5 (1): 1-11.   DOI: 10.37015/AUDT.2021.200056
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Ultrasonic Thermal Strain Imaging for Noninvasive Temperature Estimation in Tissue
Wenlong Zeng, Christopher J Krueger, Zhifei Dai, PhD
Advanced Ultrasound in Diagnosis and Therapy    2018, 2 (2): 71-81.   DOI: 10.37015/AUDT.2018.180803
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By virtue of advantages including no exposure to radiation and low toxicity and side effects, hyperthermia has been increasingly applied in treating cancer and other diseases. However, the challenge of continuous temperature monitoring during hyperthermia limits its further application. Currently, temperature monitoring in the clinic is primarily carried out using invasive thermometry, which is hampered by incomplete detection and pain. To overcome the obvious limitations of invasive thermometry, a variety of noninvasive thermometry methods with suitable accuracy have been explored. Among these, ultrasonic thermal strain imaging (UTSI), which exploits the temperature dependence of ultrasonic echo time shift to form thermal strain images, shows significant potential. It not only possesses the merits of ultrasonography but also displays different tissue characteristics (thermal properties of tissue and sound velocity) from other ultrasound imaging methods, so it has been investigated extensively over the past few years. This paper reviews recent advances in UTSI for noninvasive thermometry and discusses its main limitations, hoping to show the strong clinical application potential of UTSI from solid basic theory and practical research results.

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Application of Ultrasonography in the Diagnosis and Management of Papillary Thyroid Microcarcinoma
Kun Huang, MD, Ji-Bin Liu, MD
Advanced Ultrasound in Diagnosis and Therapy    2020, 4 (4): 284-290.   DOI: 10.37015/AUDT.2020.200001
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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.

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Comparative Study of CT Characteristics in Imported Cases and Indigenous Cases with COVID-19
Rong Tan, MD, Nina Li, MD, Ping Liu, MD, Qi Tang, MD, Qizhi Yu, MD
Advanced Ultrasound in Diagnosis and Therapy    2020, 4 (2): 99-106.   DOI: 10.37015/AUDT.2020.200016
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Objective: The aims of the current study were to describe the serial CT characteristics of patients infected with COVID-19. In addition, in the light of the CT findings, we tried to determine whether virulence weakens during the transmission with quarantine management.
Methods: Demographics, comorbidity, clinical findings, CT scanning, and scores of the affected lung parenchyma were compared for 131 patients with abnormality on CT images classified as COVID-19 pneumonia and the patients were divided between an imported group (n = 83) and indigenous group (n = 48), according to infected location. Two reviewers scored chest CT examinations for segmental involvement, ground glass opacities, consolidation, and honeycombing opacities. The 55 patients with peak CT "severity score" were selected o make a comparative analysis.
Results: Patients’ demographics and comorbidities and clinical findings did not differ significantly between the two groups. The CT scores distribution trendline of the third CT scanning was lower than the former CT scanning. The peak CT scores trendline of the 55 selected COVID-19 patients in the indigenous group was lower than the imported group. The ROC analysis revealed an area under curve of 0.714 for the CT scanning with an optimal cutoff scores of 2.55 for prediction of contact history, a sensitivity of 76.3%, and a specificity of 52.9%.The peak CT scores of the imported cases were higher than of the indigenous cases and the lung consolidation predominance on CT findings was remarkable in the imported patients (P < 0.05).
Conclusions: CT scanning not only monitored the progression of patients with COVID-19 but also reflected their exposure status to some extent. We suggest that a follow-up CT scanning interval of more than 5 days might be cost effective. The pathogenicity of novel coronavirus may be weakened through transmission under adequate quarantine measures, since indigenous cases have much better progression than imported cases.

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Aorto-Left Ventricle Fistula in Aortic Valve Endocarditis Found to Mimic Valsalva Sinus Aneurysm Rupture into the Left Ventricle: A case study
Li Ji, MD, Yuman Li, MD, PhD, Li Zhang, MD, PhD, Yali Yang, MD, PhD, Mingxing Xie, MD, PhD
Advanced Ultrasound in Diagnosis and Therapy    2020, 4 (1): 18-20.   DOI: 10.37015/AUDT.2020.190034
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Aorto-cardiac fistula (ACF) is a rare condition that is often complicated by perivalvular extension of infective endocarditis. Here we report the case of 43-year-old woman with aorto-left ventricle fistula in aortic valve endocarditis, whose echocardiographic manifestations mimicked a ruptured Valsalva sinus aneurysm. The patient was treated successfully with aortic valve replacement and repair of aorto-left ventricle fistula. Based on this rare case, we analyze the factors of misdiagnosis and offer suggestions to improve the diagnostic accuracy of ACF.

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The Significance of Heat Shock Protein 70 Expression in Benign Thyroid Nodules During Thermal Ablation
Lei Yan, MM, Jianquan Zhang, MD, Jianguo Sheng, MM, Hang Zhang, MM, Zongping Diao, MM, Jianming Zheng, PhD
Advanced Ultrasound in Diagnosis and Therapy    2019, 3 (3): 103-108.   DOI: 10.37015/AUDT.2019.190817
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Objective: To investigate the change of HSP70 expression after microwave ablation of benign thyroid nodules.

Method: Ultrasound-guided microwave ablation (MWA) was conducted for treating 60 benign solid thyroid nodules in 60 patients. Three different region of interest (ROI), named as central zone, marginal zone and transitional zone, were artificially set in each nodule for quantitative investigation of HSP70 expression by using the immunohistochemistry (IHC) method based on the US-guided core-needle biopsy (CNB) technique. As a longitudinal comparative study design, each ROI experienced twice histological sampling twice by using CNB before and after MWA. IHC semi-quantitative determination of HSP70 expression was compared among the specimen from the three ROIs in a same nodule before ablation and between the specimen from the same ROI before and after ablation respectively as well.

Results: Of the 60 solid thyroid nodules, either in the central zone or in the marginal zone, HSP70 expression did not experienced significant change (P > 0.05) from before ablation to after ablation, however, a significant upgrading of HSP70 expression developed in the transitional zone after ablation (P < 0.05). After ablation, the transitional zone had a higher level of HSP70 than that in both the central and marginal zones (P < 0.05) in a same nodule, while the level of HSP70 was not found significantly different between the central zone and marginal zone (P > 0.05).

Conclusion: Thermal coagulation by MWA stimulates the upgrading of HSP70 expression in the heated tissue of benign thyroid nodules, but in a way of regional discrepancies. The remarkable increased expression of HSP70 in the transitional zone tissue might originate from a slower and less intensive temperature rise along with the attenuation of microwave radiation, and it is postulated to protect normal glandular tissue against heat damage. Fast and intensive temperature rise within the nodule causes more intensive and massive thermal coagulation changes and weakens the adequate expression and proper protective function of HSP70 in those two areas.

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Image Features-based Learning Effectively Improves Inter-Observer Agreement for Beginners in Evaluating Thyroid Nodule with Ultrasound
Ying Wang, MD, Luying Gao, MD, Yuxin Jiang, MD, Hui Pan, MD, Jun Zhao, MA, Xin Zhou, MA, Qiong Wu, MM, Ruyu Liu, MM, Bo Zhang, MD
Advanced Ultrasound in Diagnosis and Therapy    2019, 3 (1): 1-5.   DOI: 10.37015/AUDT.2019.190801
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Objective: Thyroid nodules are a common medical problem in China and in other parts of the world. Many guidelines use ultrasound (US) as the first choice for evaluating thyroid nodules. A major limitation of US is operator dependency, resulting in a variety of discrepancies in diagnosing thyroid nodules in the literatures. Risk stratification of thyroid nodules is based on the patterns of US features in the 2015 American Thyroid Association (ATA) management guidelines for adult patients with thyroid nodules. We hypothesize that special training targeting features recognition may increase the inter-observer agreement.
Methods: The study was conducted on 52 participants from Peking Union Medical College Hospital (PUMCH) from March to May 2018.The participants were divided into two groups by their own decision for their convenience. Image featuresbased learning (IF-BL) was used to train the participants to learn special features including shape, margin, echo level, internal structure, calcification, vascularity through 10 standard images based on the 2015 ATA guideline. Group A (27 subjects) received IF-BL during the first month, and Group B (25 subjects) received IF-BL during the second month. All participants evaluated US features and risk stratification in 60 US images of 20 thyroid nodules before and after the training. The test results were graded by a teaching assistant according to the rule of 0.5 points assigned to every feature and 2 points assigned to risk stratification, with a total of 100 points. Inter-observer agreements of US features and risk stratification were assessed and compared before and after the training.
Results: After the first month, Group A had better scores than Group B, the control group of the month (75.4±9.4 vs 68.7±8.4, p = 0.01). At the end of the second month during which both groups were trained, there was no difference of scores between Group A and Group B (74.5±10.4 vs 75.1±7.4, P = 0.78). Scores of all participants were significantly higher than the initial (74.8±9.0 vs 65.8±13.6, P < 0.01). After the training, the kappa values of US features improved from 0.28-0.43 to 0.43-0.75, and those of risk stratification improved from 0.13 to 0.55.
Conclusion: IF-BL can effectively help trainees correctly recognize US features and evaluate the risk stratification of thyroid nodule and can improve the inter-observer agreement.

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Doppler-based Renal Resistive Index for Prediction of Acute Kidney Injury in Critically Ill Patients: A Systematic Review and Meta-analysis
Jianing Zhu, MD, Ying Zhang, MD, Xiaoming Li, MD, Qiuyang Li, MD, PHD, Yukun Luo, MD, PHD
Advanced Ultrasound in Diagnosis and Therapy    2021, 5 (3): 183-196.   DOI: 10.37015/AUDT.2021.210013
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Objectives: To determine the efficacy of Doppler-based renal resistive index (RRI) in the prediction of acute kidney injury (AKI) in critically ill patients.
Methods: A systematic review and meta-analysis of cohort studies was conducted. Relevant studies were identified in PubMed, Embase and Cochrane Library from inception to November 1, 2020, and reference lists of identified primary studies. Prospective studies that examined the diagnostic accuracy of RRI in AKI were included.
Results: Among the 126 articles identified, 18 were included, with a total of 1656 patients. Bivariate analysis yielded pooled sensitivity and specificity of 0.81 (95% CI 0.74-0.86) and 0.75 (95% CI 0.65-0.83), respectively. The summary positive likelihood ratio was 3.2 (95% CI 2.2-4.6), and negative likelihood ratio was 0.26 (95% CI 0.19-0.36).
Conclusion: Elevated RRI may be an early predictor of AKI in critically ill patients. Further large-scale prospective studies are needed to confirm the predictive efficacy and determine the performance and optimal cutoff value of RRI among the included studies.

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The eL18-4 PureWave linear Array with Micro Flow Imaging and Contrast Enhanced Ultrasound (CEUS) Imaging in the Assessment of Asymptomatic Carotid Stenosis
D. Staub, Angiologist, MD
Advanced Ultrasound in Diagnosis and Therapy    2020, 4 (3): 270-272.  
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Development of 4G CMUT (CMUT Linear SML44 probe)
Tsuyoshi Otake, Hiroki Tanaka, Akifumi Sako, Makoto Fukada, Kengo Imagawa, Masahiro Sato
Advanced Ultrasound in Diagnosis and Therapy    2020, 4 (4): 379-382.  
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In 2009, Hitachi commercialized “Mappie*1, the world’s first Capacitive Micro-machined Ultrasound Transducer (CMUT) using semiconductor based technology. It generated high quality diagnostic images of mammary glands, thanks to its broad-band characteristics[1]. This year, the 4th generation CMUT (4G CMUT) “SML44” has been brought to the market, achieved using advanced design and precise control of the fabrication process. When combined with new imaging technologies avail-able with the ARIETTA*2 850, the SML44, in addition to excellent image quality, offers commonly used modalities and func- tions such as Tissue Harmonic Imaging (THI), Color Flow Mapping (CFM), Real-time Tissue Elastography*3 (RTE), and Real-time Virtual Sonography*4 (RVS). This report introduces the latest technology adopted in the 4G CMUT design.

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Solitary Necrotic Nodule of Liver with the Etiology of Parasite: A Report of Two Cases
Mingwei Sui, MD, Wenzhao Liang, MD, Ting Zhang, MD, Yang Bai, MD, Dezhi Zhang, MD
Advanced Ultrasound in Diagnosis and Therapy    2019, 3 (1): 18-21.   DOI: 10.37015/AUDT.2019.190804
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Solitary necrotic nodule of liver (SNNL) is a rare, benign lesion with an uncertain etiology. There are no typical diagnostic clinical or radiological features. The two patients we described underwent liver resection because it was not possible to exclude a malignancy on preoperative imaging. The histopathological findings suggest the SNNL may be parasitic in origin and find parasitic worm in the nodules.

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Chinese Expert Consensus on Ultrasonographic Acquisition, Measurement, and Reporting System for Developmental Dysplasia of the Hip
Writing Group of the Pediatric Ultrasound Committee of Ultrasound Branch of Chinese Medical Education Association, Na Xu, MD, Bei Xia, MD, Hongwei Tao, MD, Ke Sun, MD, Qinghua Liu, MD, Wenjuan Chen, MD, Dan Wang, MD, Hong Gao, MD, Yan Guo, MD, Yan Liu, MD, Jun Gao, MD, Jianbo Teng, MD
Advanced Ultrasound in Diagnosis and Therapy    2020, 4 (1): 1-8.   DOI: 10.37015/AUDT.2020.190041
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Role of PCA in Offering Certifications and Other Related Services to POCUS Users Worldwide
Victor V Rao, MBBS, DMRD, RDMS, James A DellaValle, MD, MBA, Samantha Forcum, M.Ed, Jasmine Rockett, Hannah Mason, MA, PMP, Dale R. Cyr, MBA, CAE
Advanced Ultrasound in Diagnosis and Therapy    2020, 4 (3): 260-263.   DOI: 10.37015/AUDT.2020.200058
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The POCUS Certification Academy, a subdivision of Inteleos, a non-profit certification organization, is striving to promote global standards and international certifications in the field of POCUS to enhance clinician proficiency and ensure patient safety. By offering relevant rigorous assessments, developing continuing education requirements, and promoting the use of point-of-care ultrasound worldwide, the POCUS Certification Academy is laying the foundation for the highest global standards in POCUS credentialing.

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Bedside Ultrasonography-Guided Nasogastric Tube Placement in COVID-19 Patients
Wenhong Gao, MD, Shunji Gao, MD, Qun-An Huang, MD, Huijuan Xiang, MD
Advanced Ultrasound in Diagnosis and Therapy    2020, 4 (2): 131-133.   DOI: 10.37015/AUDT.2020.200024
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Protective measures that are needed when treating patients with highly contagious severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) add difficulty when performing interventional procedures in isolation wards. We describe two cases of ultrasonography-guided nasogastric tube placement in severe COVID-19 patients, both disabled elderly patients who were unconscious and had complicated underlying diseases. The first is an 83-year-old patient with Alzheimer's, hemiplegia, and epilepsy; the second is a 67-year-old patient with hemiplegia and thoracic deformity. Nasogastric tube indwelling for severe patients like this was essential but challenging. With the help of ultrasonography, intubation proceeded successfully and rapidly. Operator’s confidence of appropriate placement was established because of definite tube visualization. These cases demonstrated that bedside ultrasonography in isolation wards can not only facilitate diagnosis but also assist interventional operations.

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Robot-assisted Teleultrasound Assessment of Cardiopulmonary Function on a Patient with Confirmed COVID-19 in a Cabin Hospital
Shengzheng Wu, MD, Keyan Li, MD, Ruizhong Ye, MD, Yuehua Lu, MD, Jufen Xu, MD, Linfei Xiong, MD, Ailin Cui, MD, Yaqing Li, MD, Chengzhong Peng, MD, Faqin Lv, MD
Advanced Ultrasound in Diagnosis and Therapy    2020, 4 (2): 128-130.   DOI: 10.37015/AUDT.2020.200023
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Real-time ultrasound imaging has been used for the evaluation of pulmonary abnormalities and other complications during the outbreak of COVID-19. However, conventional ultrasound examination requires operators to conduct scanning either in the examination room or patient ward, which may increase the potential infective risk. Tele-operated ultrasound robotics can provide a unique technique for doctors to remotely scan patients. During the COVID-19 pandemic, we attempted to apply a 5G network-based scanning robot to conduct remote ultrasound examination on COVID-19 patients and to explore the feasibility of this technique for teleultrasound diagnosis and consultation during critical infectious situations.

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Diagnosis and Treatment of Severe COVID-19 Complicated with Spontaneous Pneumothorax: A Case Report
Ruibing Lyu, MD, Xin Li, MD
Advanced Ultrasound in Diagnosis and Therapy    2020, 4 (2): 142-146.   DOI: 10.37015/AUDT.2020.200019
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This case report describes a patient with severe coronavirus disease 2019 (COVID-19) concomitated with spontaneous pneumothorax, along with retrospective analysis of effective diagnosis and treatment. The case shows how chest radiography and computed tomography can play an important role in diagnosing and providing useful information for clinical management. The patient’s outcome and prognosis was related to his clinical management. In particular, early comprehensive treatment was certainly key to reducing complications and mortality in severe novel coronavirus pneumonia.

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Micro/Nanobubbles Driven Multimodal Imaging and Theragnostics of Cancer
Xiaoting Zhang, BS, Zhifei Dai, PhD
Advanced Ultrasound in Diagnosis and Therapy    2021, 5 (3): 163-172.   DOI: 10.37015/AUDT.2021.200053
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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.

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Bedside Ultrasound in Assessment of 510 Severe and Critical Patients with COVID-19 Pneumonia in Wuhan, China
Bin Wang, MD, Li Zhang, MD, Danqing Zhang, MD, Hongliang Yuan, MD, Chun Wu, MD, Yongxing Zhang, MD, Lin He, MD, Rui Wang, MD, Jing Wang, MD, Mingxing Xie, MD, PhD
Advanced Ultrasound in Diagnosis and Therapy    2020, 4 (2): 60-66.   DOI: 10.37015/AUDT.2020.200018
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Objective: To discuss the value of bedside ultrasound in the diagnosis and treatment of 2019 novel coronavirus diseases (COVID-19).
Methods: Retrospective analysis of the results of bedside ultrasound of 510 patients with COVID-19 in our hospital was done from January 31, 2020 to March 4, 2020.
Results: (1) Among the 510 patients who underwent bedside ultrasound examination, a total of 327 (64.1%) underwent echocardiography, 494 (96.9%) underwent bilateral venous ultrasound examination of lower limbs, 86 (16.9%) underwent bilateral artery ultrasound examination of lower limbs, 48 (9.4%) underwent ultrasound examination of liver, gallbladder, spleen and pancreas, 26 (5.1%) underwent ultrasound examination of kidney, ureter and bladder, and the numbers of patients who underwent ultrasound examination of pericardium, pleural effusion, and peritoneal effusion were 16 (3.1%), 21 (4.1%), and 5 (1%), respectively. (2) Among the 327 patients who underwent bedside ultrasound examination of the heart, 96 (29.4%) showed results of positive for other abnormalities or complications, in which 31 (9.5%) had abnormal left ventricular wall motion, 42 (12.8%) were with valvular heart disease, 3 (0.9%) showed coronary heart disease, 19 (5.8%) showed the enlargement of right heart with pulmonary hypertension (PAH), and 1 (0.3%) had congenital heart disease. In addition, 6 of the 327 echocardiography patients showed negative results (no other abnormalities or complications), accounting for 1.8%. (3) Among the 494 patients who underwent bilateral venous examination of lower limbs, 182 (36.8%) had phlebothrombosis. Eighty-six (86) patients underwent bilateral artery examination of lower limbs, and 63 (73%) of them had positive results, in which 5 patients showed arterial occlusion and the other 57 patients showed atherosclerosis. (4) Thirty-three (33) patients underwent ultrasound examination of liver, gallbladder, spleen, and pancreas, and 23 (70%) of them showed positive results. Among the 26 patients who underwent the urological examination, 7 (26.9%) showed positive results. Additionally, there are 2 positive findings in 21 patients who underwent the examination of pleural effusion (9.5%), and 1 positive case in 5 patients who underwent the examination of abdominal effusion (20%).
Conclusion: Bedside ultrasound is important in the diagnosis and treatment of COVID-19. We hope to make better use of bedside ultrasound to help clinicians get accurate diagnosis and treatment strategies.

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Time-intensity Curve Analysis of Hepatocellular Carcinoma using Two Contrast-enhanced Ultrasound Methods: Contrast Pulse Sequencing and Contrast Harmonic Imaging
Mengna He, MD, PhD, Lei Xu, MD, Tian’an Jiang, MD, PhD
Advanced Ultrasound in Diagnosis and Therapy    2020, 4 (3): 217-222.   DOI: 10.37015/AUDT.2020.200007
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Objectives: To compare the features of the time-intensity curve (TIC) of hepatocellular carcinoma (HCC) by two different contrast-enhanced ultrasound (CEUS) methods: Contrast Pulse Sequencing (CPS) and Contrast Harmonic Imaging (CHI).
Methods: This prospective study included 22 HCC lesions. The CPS and CHI (Cadence? technique by Siemens) were performed in random order for each lesion, and the microbubbles were completely cleared between the two methods. The imaging by each method was recorded for 10 minutes. The CEUS video clips were analyzed off-line and the quantitative parameters of time intensity curve were obtained: the peak intensity (PI), time to peak (TTP), washout time (WT), relative value (RV) of intensity and AUC before WT and after WT, and the time of RV ≥15 dB lasted (RLT).
Results: Compared with CPS, CHI showed an earlier WT (64.0 ± 17.1 s vs 33.1 ± 7.0 s) of HCC lesions, a lower RV of intensity (36.8 ± 9.4 vs 10.3 ± 5.1) and AUC (1377.2 ± 205.7 vs 227.2 ± 56.7) before WT, but higher RV of intensity (17.8 ± 4.6 vs 32.2 ± 8.6) and AUC (1 124.1 ± 276.4 vs 2 664.1 ± 456.8) after WT, and longer RLT (121.4 ± 49.8 s vs > 150 s).
Conclusion: For long later phase observation after washout, CHI is better than CPS, but the observation of rapid perfusion before washout is not comparable to CPS. A combined use of these two methods is recommended based on our research.

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Research Advances in Ultrasound Imaging for Tumor in Situ
Ping Wang, MD, Lihong Sun, PhD, Suhui Sun, MD, Menghong Xu, MD, Lulu Zhang, MD, Jinxia Zhang, MD, Liquan Gao, PhD, Qingfeng Chen, PhD, Xiaolong Liang, PhD
Advanced Ultrasound in Diagnosis and Therapy    2020, 4 (3): 169-175.   DOI: 10.37015/AUDT.2020.190040
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Known for being highly sensitive and noninvasive, ultrasound imaging using microbubble contrast agents is widely used in the clinic. To use ultrasound to image tissue beyond the vasculature, researchers have developed strategies that include nanobubbles, ultrasound contrast agents generated in situ, and gene expression of ultrasound contrast agents in situ. All of these strategies offer the capability of targeting tumor cells, intratumoral imaging tumor cells and require just a small incision or no incision. In this review, we will first describe the application of nanobubbles acting as ultrasound contrast agents. Then, we will briefly introduce the stimuli-responsive formulations to generate ultrasound contrast agents in situ. Finally, we will provide an overview of the use of state-of-the-art of gene expression of ultrasound contrast agents in situ to monitor cellular location and function inside living organisms.

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Advances in Targeted Tumor Diagnosis and Therapy Based on Ultrasound-Responsive Nanodroplets
Yaqiong Li, PhD, Ruiqing Liu, MD, Shaobo Duan, MD, Lianzhong Zhang, MD
Advanced Ultrasound in Diagnosis and Therapy    2020, 4 (4): 273-283.   DOI: 10.37015/AUDT.2020.200043
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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.

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Trans-lymphatic Contrast-Enhanced Ultrasound in Combination with Blue Dye Injection is Feasible for Detection and Biopsy of Sentinel Lymph Nodes in Breast Cancer
Xiangmei Chen, MD, Jieyu Zhong, MD, Zhengming Hu, MD, Wei Wei, MD, Weihua Yin, MD, Ligang Cui, MD, Ji-Bin Liu, MD, Desheng Sun, MD
Advanced Ultrasound in Diagnosis and Therapy    2018, 2 (2): 94-100.   DOI: 10.37015/AUDT.2018.180805
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Objective: The best method for sentinel lymph node biopsy (SLNB) in early-staged breast cancer (EBC) remains controversial. This study aimed to evaluate a novel method by combining trans-lymphatic contrast-enhanced ultrasound (TLCEUS) with blue dye injection as a guidance of SLNB.
Methods: TLCEUS was performed in 88 patients with newly diagnosed EBC. Methylene blue dye was percutaneously injected into enhanced sentinel lymph nodes (SLNs) under ultrasound guidance, followed by standard SLNB and axillary lymph node dissection. Enhancement patterns and the arriving time (AT) of contrast agent within SLNs were evaluated. Histopathological examination of dissected nodes was performed to confirm metastasis.
Results: A total of 95 enhanced SLNs were identified and biopsied in 86 of 88 patients with identification rate of 97.7%. The specificity was 75.0%, sensitivity was 83.3%, and false-negative rate was 16.7%. Contrast-enhanced SLNs with type I, type II, and type III patterns had a metastatic positive rate of 11.4% (5/44), 57.1% (12/21) and 80.0% (24/30), respectively. Metastatic positive SLNs showed a mean AT of 61.6 ± 58.7 s while metastatic negative SLNs showed a mean AT of 41.3 ± 19.9 s, which was statistically significantly different.
Conclusion: The TLCEUS/blue dye method can be used as an alternative to the radioisotope/blue dye method for its feasibility and accuracy.

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Two- and Three-Dimensional Echocardiography for Primary Cardiac Lymphomas: A Case Report and Literature Review
Huan Cen, MS, Jinhua Li, MD, Bijing Li, MS, Pengtao Sun, MS
Advanced Ultrasound in Diagnosis and Therapy    2020, 4 (3): 255-259.   DOI: 10.37015/AUDT.2020.190043
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Cardiac lymphomas have an extremely low incidence, with primary cardiac lymphomas accounting for only 0.5% of all extranodal lymphomas and 2% of primary cardiac tumors. Early diagnosis is critical for these tumors, which can proliferate rapidly. Here, we report a rare case of a 66-year-old man with primary cardiac lymphomas in the right atrium and right ventricle. This case establishes that two- and three-dimensional echocardiography is instructive in establishing the relationship of the mass and surrounding tissues and providing relevant hemodynamic information.

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Analysis of Ultrasonic Manifestations of Pulmonary Lesions in Patients with COVID-19
Yi Huang, MD, Hua Wang, MD, Wenqi Cui, MD, Yujin Zong, MD, Chuyun Zheng, MD, Yue Liu, MD, Weili Min, MD, Sihan Wang, MD, Mingjun Hu, MD, Yaohui Zhang, MD
Advanced Ultrasound in Diagnosis and Therapy    2020, 4 (2): 73-78.   DOI: 10.37015/AUDT.2020.200034
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Objectives: To analyze the progression manifestations and characteristics of pulmonary lesions in patients with COVID-19 by bed-side pulmonary ultrasonography.
Methods: A total of 20 COVID-19 patients admitted to the hospital from January to March in 2020 were retrospectively recruited. All cases were diagnosed according to the "Novel Coronavirus Pneumonia Treatment Protocol (Trial 7th edition)". The imaging characteristics of bed-side pulmonary ultrasonography were analyzed and summarized during the different disease stages.
Results: The average course of disease was 21.2 days, including 10.5 days of the progression period and 10.7 days of the recovery period. The ultrasound images of the patients were mainly presented as unsmoothed or interrupted pleural line, and B-line distribution was observed in all cases (20/20,100%). The "inflatable signs" in the consolidation lesion were visualized in 16 cases (16/20, 75.00%). In progressive stage, the ultrasound image changed from B-line sign to sieve-like consolidation, then the consolidation aggravated from patchy to chunk-like gradually, with the decreasing air bronchogram sign within the consolidation lesion. While the imaging characteristics of the ultrasound in the recovery stage were opposite to the progress stage, Color mode showed that the perfusion in the lesions of consolidation gradually increased as well.
Conclusion: The ultrasonic manifestations of COVID-19 patients had certain characteristics in the different disease stages. The application of ultrasound in these patients could provide imaging evidence in evaluation of the disease courses and therapeutic efficacy.

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Transthoracic Echocardiography for Evaluation of an Intrapulmonary Artery Mass
Ting Sun, MD, Guoliang Lu, MD, Jian Fang, MD, Shaobo Xie, MD
Advanced Ultrasound in Diagnosis and Therapy    2020, 4 (4): 329-334.   DOI: 10.37015/AUDT.2020.190022
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Objective: Intrapulmonary artery mass is rare and prone to be misdiagnosed. The purpose of this study was to retrospectively review the evaluation of intrapulmonary artery masses by ultrasound imaging, summarize their characteristics, and suggest a standardized approach for clinical management.
Methods: Sixteen patients were enrolled in the study. Transthoracic echocardiography (TTE) showed a mass attached to the major pulmonary artery (MPA) trunk, straddling the bilateral pulmonary arteries or pulmonary valve (PV). The masses were diagnosed based on the site of the attachment, shape, size, mobility, and other morphological characteristics on ultrasound imaging examination. The pathological data were collected and analyzed from medical records.
Results: TTE images showed that the intrapulmonary artery mass was most frequently located in the MPA trunk. Eight patients had a pathological diagnosis and underwent complete mass resection. Five patients were suspected as having pulmonary thromboembolism (PTE) and were prescribed anticoagulation therapy, after which the masses decreased or disappeared on follow-up TTE. Three patients with suspected metastatic tumors died during hospitalization and had no pathological data. The 16 patients had the following distribution of diagnoses: thrombus (32%; 5/16), vegetations (12%; 2/16), primary benign lesions (12%; 2/16), primary malignant tumors (19%; 3/16), and metastatic tumors (25%; 4/16).
Conclusion: The majority of intrapulmonary artery masses were thrombi or primary pulmonary artery sarcomas. Primary tumors are much more common than metastatic tumors in the intrapulmonary artery.

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