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.

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

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

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

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

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

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

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

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

The ovaries are normally situated on the lateral aspect of the uterus in a shallow depression called an ovarian fossa. Maldescended ovaries occur when the ovary has not been localized in an intrapelvic location. Maldescended ovaries can be found with a normal uterus and more often with Mullerian duct abnormalities. There is no established association between ovarian tumors and maldescended ovaries. The present case report is a very rare case of mature cystic teratoma of a maldescended right ovary located within the subhepatic region. To bring this into focus in cases with an abnormal dermoid cyst site in a female. The patient should be carefully evaluated for ovarian sites and the possibility of maldescended ovaries should be taken into account. The maldescended ovaries with complicated cysts or with tumor should be included in the differential diagnosis of causes of abdominal pain in females.

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.

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.

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.

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.

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.

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.

Objectives: To investigate the clinical value of ultrasound in the diagnosis and treatment of reninoma.
Methods: We retrospectively analyzed the ultrasound findings of 9 patients with reninoma confirmed by pathology after surgical resection in our hospital between September 2012 and August 2019. All patients underwent conventional preoperative ultrasonography. Three underwent contrast-enhanced ultrasound (CEUS) and 3 with complete endogenetic tumor underwent intraoperative ultrasonography.
Results: Of the 9 patients with conventional ultrasound, 7 had renal space-occupying lesions and 2 had missed diagnosis. A hypoechoic or hyperechoic solid mass with regular morphology, clear boundary, capsule, weak echo halo around the mass, incomplete thin strip color blood flow signal around the mass were shown in 7 cases. Color Doppler displayed color flow signal of the incomplete thin strip around the mass and arterial blood supply with an internal thin branch. In 3 patients (including 2 with missing diagnosis by conventional ultrasound) who underwent preoperative contrast-enhanced ultrasound, the reninoma manifested as low enhancement, and the perfusion pattern showed as slow wash-in and slow wash-out compared with normal renal cortex. In 3 patients (including 2 cases of missed diagnosis by conventional ultrasound) with completely endogenic reninoma, intraoperative ultrasound clearly showed the tumor characteristics, and all successfully underwent laparoscopic ultrasound-guided partial nephrectomy.
Conclusions: Preoperative conventional ultrasound combined with CEUS, and clinical features, are helpful for the qualitative diagnosis of reninoma. Laparoscopic partial resection is the first-choice treatment for reninoma. Intraoperative ultrasound can provide real-time imaging, accurately evaluate the tumor status, and provide important information for surgeons.

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.

Objective: To evaluate the carotid viscoelasticity using ultrasound shear wave dispersion imaging (USWD) and determine its feasibility.

Methods: Forty-five volunteers were recruited and divided into the group1 (≥50 years old) and group 2 (<50 years old). The shear wave elastic modulus (SWE-A_R and SWE-P_R) and shear wave dispersion indexes (SWD-A_R and SWD-P_R), which located at the anterior and posterior walls of the common carotid artery (CCA), were obtained by USWD, and compared with pulse wave velocity (PWV). Pearson correlation analysis was applied to analyze the related factors of viscoelasticity.

Results: Before and after body mass index, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were adjusted, SWE-A_R, SWE-P_R, SWD-A_R and SWD-P_R were all higher in the group 2 than those of group 1 (all P < 0.05). In all subjects, SWE was negatively correlated with age, SBP, DBP and PWV, respectively (r = -0.282, -0.374, -0.321, -0.256 and all P < 0.05). The SWD was negatively correlated with PWV in the group 1, while positively correlated with SBP in the group 2 (r=-0.393 and r=0.366, all P < 0.05).

Conclusion: The viscoelasticity of arterial wall can be assessed by USWD. It provides a new way to describe arterial disease for clinical study.

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.

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.

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.

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

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

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

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

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.

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.

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.

ChatGPT is attracting widespread attention from all walks of life with its excellent multi-round dialogue ability and strong user intent understanding ability, triggering a new wave of artificial intelligence. From the perspective of technical analysis, this article sorts out the various related technologies used in the GPT (Generative Pre-training Transformer) series models as well as large-scale multimodal models, which are more powerful and perform better in multiple downstream tasks. Meanwhile, we guide users to use LLM (Large Language Model) along with GPT more scientifically to maximize their potential. Finally, we analyze the application prospect of the GPT as well as the large-scale multimodal models in the medical field, and the problems are discussed from the perspectives of the risks and limitations of large-scale models applied into the medical field.

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.

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.

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 4^th 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.

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

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

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

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

Objective: To investigate the influence of liver function damage in patients with hepatocellular carcinoma (HCC) after microwave ablation (MWA) on the prognosis and to establish an algorithm to predict liver function damage.
Methods: This is a retrospective study. A total of 745 patients were enrolled and classified into the modeling group and the validation group. The risk factors of liver function damage were analyzed by using logistic regression model. The β coefficients derived from a logistic analysis were used to calculate the risk score. Diagnostic accuracy based on risk score was assessed by the area under the curve (AUC).
Results: 69 patients in the modeling group suffered from liver function damage. The 1-,3-,5- and 7-year progression free survival were 69.4%, 37.2%, 22.6% and 12.4% for patients without liver function damage and 69.5%, 33.0%, 14.4% and 0% for patients with liver function damage, respectively (P = 0.537). The 1-, 3-, 5- and 7-year overall survival were 94.3%, 75.9%, 61.5% and 54.5% for patients without liver function damage and 81.3%, 57.1%, 42.7% and 42.7% for those with liver function damage (P = 0.004), respectively. The AUC of the risk score for predicting liver function damage was 0.798 for the modeling group and 0.832 for the validation group. The sensitivity and specificity of the risk score to identify liver function damage was 65.2%, 84.4% in the modeling group and 60.6%, 88.3% in the validation group, respectively.
Conclusion: Liver function damage after MWA is unfavorable the long-term prognosis. The prediction algorithm based on five risk factors is robust and can be used to predict possible liver function damage.

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.

It is particularly important to evaluate the efficacy of neoadjuvant chemotherapy (NAC) for breast cancer. This article reviews the current status and progress of imaging evaluations regarding the efficacy of NAC in women with breast cancer, including mammography, ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET-CT) and radiomics. Each imaging method has value for evaluating the efficacy of NAC for breast cancer, but certain defects and limitations. Therefore, the optimal selection will employ a combination of multiple imaging methods that will not only benefit patients but also avoid the unnecessary waste of medical resources.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.

CT perfusion imaging, a non-invasive functional imaging method, can accurately reflect the hemodynamic changes of pulmonary nodules. It plays an important role in the diagnosis, differential diagnosis, treatment effect assessment and prognosis prediction. This article reviews the hemodynamics of pulmonary nodules, the characteristics of the blood flow of CT perfusion imaging of the pulmonary nodules, the characteristics of the CT perfusion technique of the pulmonary nodules and the status of the clinical application in the characterization of pulmonary nodules.