Review Article

Research Progress on the Application of Irreversible Electroporation Ablation in Cancers

Zhang Rong, Xie Liting, Jin Qijing, Zhang Chengyue, Guo Teng, Zhao Qiyu, Jiang Tian’an

2025, 9 (3): 229-244. DOI:10.26599/AUDT.2025.240052

Abstract ( 15 ) HTML ( 4 ) PDF ( 3120KB ) ( 389 ) 　　

Irreversible electroporation (IRE) is an innovative non-thermal ablation technique increasingly utilized in cancer treatment due to its unique operational principles and clinical advantages. As a novel interventional ultrasound technology, IRE has undergone extensive research, development, and practical application over the years. IRE ablation, particularly in conjunction with immunotherapy, has emerged as a significant modality in cancer treatment and related fields. This article aims to present the advancements in irreversible electroporation ablation for cancer through an examination of both basic research and clinical applications.

Therapeutic Focused Ultrasound: Advances in Antitumor Immunotherapy of Solid Tumors

Yang Jie, Liu Xiaodi, Wang Wenhui, Liao Min, Wu Zhe, Galeano July, Perez-Buitrago Sandra, Lu Qiang

2025, 9 (3): 245-253. DOI:10.26599/AUDT.2025.240044

Abstract ( 16 ) HTML ( 3 ) PDF ( 808KB ) ( 387 ) 　　

Cancer, one of the leading causes of global mortality, arises from dysregulated cellular processes that create an immunosuppressive tumor microenvironment (TME), promoting immune evasion and therapeutic resistance. While immunotherapy activates the immune system to combat tumors and provide durable benefits, its efficacy is often constrained by the hostile TME. Focused ultrasound (FUS) has emerged as a non-invasive, and precise therapeutic modality capable of mechanically or thermally ablating solid tumors. This review discusses the dual mechanisms of FUS—thermal ablation (T-HIFU) and mechanical disruption (M-HIFU, e.g., histotripsy)—and their role in modulating the TME. Specifically, it examines how FUS-induced immune activation can overcome immunosuppressive barriers, promote T-cell infiltration, and synergize with immunotherapy to improve outcomes in solid tumors, while also highlighting current challenges and future directions.

Application of Two-Dimensional Speckle Tracking Echocardiography in Evaluation of Neonatal Pulmonary Hypertension

Feng Qing, Yang Huihui, Xu Wanting, He Yu

2025, 9 (3): 254-259. DOI:10.26599/AUDT.2025.240068

Abstract ( 17 ) HTML ( 2 ) PDF ( 455KB ) ( 381 ) 　　

Objective It is always a clinical challenge to identify neonatal pulmonary hypertension (NPH). Although the diagnostic gold standard of pulmonary hypertension (PH) is the true measurement of resting pulmonary arterial pressure (PAP) through cardiac catheterization, it is inappropriate for delicate newborns. Hence, echocardiography examination has become the most common inspection tool for NPH despite its limitations.
Methods After outlining the conventional echocardiographic parameters for detecting NPH and their drawbacks in newborns, this review mainly discussed the roles of two-dimensional speckle tracking echocardiography, including RV global longitudinal strain and segmental longitudinal strain, in the evaluation of NPH, hoping to provide more information for detecting NPH.
Results When combined with conventional echocardiographic parameters, RV longitudinal strain would be a great help for the evaluation of NPH. Furthermore, based on the preliminary research, our finding revealed that the magnitude of the apical segmental strain of RVFW was significantly lower, and the basal-to-apical strain ratio (Ratio bas/api) of RVFW was remarkably higher in infants with PH than those without PH.
Conclusion Based on the particularity of newborns, neonatal echocardiography is the preferred inspection method for NPH. It provides hemodynamic, morphological and functional information for evaluating NPH. RV longitudinal strain is sensitive to subtle changes of RV function and closely related to PH. It could be considered not only as the key factor affecting the prognosis of NPH but also as a potential index to detect and identify NPH.

Comparing Sonography and CVS for Early Detection of Congenital Disorders Before 12 Weeks

Khan Javeria, Batool Fatima, Noor Jasia, Rasheed Arif

2025, 9 (3): 260-269. DOI:10.26599/AUDT.2025.240072

Abstract ( 13 ) HTML ( 3 ) PDF ( 468KB ) ( 379 ) 　　

Objective To improve infant outcomes and guide treatment decisions, early and accurate diagnosis of congenital abnormalities during pregnancy is crucial. Despite its excellent accuracy, chorionic villus sampling (CVS) has procedural dangers; sonography offers a non-invasive, safer substitute. With an emphasis on clinical value, safety, and diagnostic accuracy, this evaluation assesses how well sonography performs in identifying congenital diseases prior to 12 weeks of gestation when compared to CVS.
Methods A comprehensive review of the literature was conducted using databases such as Web of Science, PubMed, and Scopus. Studies published between 2015 and 2024 that examined the diagnostic sensitivity, specificity, and accuracy of sonography and CVS for congenital illness identification were included.
Results With a sensitivity of 85-90%, sonography shows excellent accuracy in identifying anatomical abnormalities such organ malformations and nuchal translucency. Although CVS has a 0.5-1% chance of miscarriage, it is still the gold standard for identifying chromosomal abnormalities with an accuracy of around 99%. Combining the two modalities reduces hazards while improving diagnostic accuracy.
Conclusion For low-risk populations in particular, sonography provides a dependable, non-invasive screening method for congenital abnormalities prior to 12 weeks. For high-risk instances that need genetic investigation, CVS is advised. Integration of both approaches could optimize prenatal diagnostic protocols.

Original Research

Ultrasound Viscoelasticity for Breast Tumor: High Diagnostic Performance at the Peritumoral Boundary

Shi Junni, Xu Jiatong, Chen Chuanjian, Xiang Guanghua, Zheng Wen, Chen Man

2025, 9 (3): 270-276. DOI:10.26599/AUDT.2025.250075

Abstract ( 8 ) HTML ( 3 ) PDF ( 2335KB ) ( 383 ) 　　

Objectives Conventional ultrasound (US) elastography lacks specificity in distinguishing benign from malignant breast lesions. This study employed US to assess breast tissue viscosity and elasticity. The primary objective was to evaluate the diagnostic performance of US-derived viscoelasticity parameters. Secondary objectives included investigating the consistency of parameters in the mechanical properties of breast tissue.
Materials and methods Two doctors independently measured the viscosity and elasticity of specific positions in the breasts of 20 health females for consistency assessment. Then the doctors selected region of interest (ROI) to measure viscoelasticity. ROI-1, ROI-2, and ROI-3 represent the tumor, peritumoral, and peripheral areas, respectively. The viscosity modulus and elasticity modulus of 3 ROIs were analyzed. The viscosity and elasticity parameters with the highest area under the curve (AUC) were selected as the optimal ones. Finally, elasticity and viscosity parameters were combined to assess their diagnostic performance in differentiating breast lesions.
Results US viscoelasticity parameters can be measured with high consistency. Among conventional US elasticity parameters, 1-Emax demonstrated the highest AUC (0.746) for differentiating benign and malignant breast lesions. In US viscoelasticity parameters, 2-Emax achieved the highest AUC of 0.801, while 2-Vmax showed the highest AUC of 0.835. The highest specificity (0.903) was observed when both 2-Emax and 2-Vmax exceeded their respective cutoff values (P < 0.05 for all).
Conclusion Quantitative ultrasound viscoelasticity parameters play a crucial role in breast cancer diagnosis, with tumor boundary parameters being particularly significant for cancer screening and prevention strategies.

Sonographic Assessment of Uterine and Ovarian Development in Normal Girls aged 2-18 Years in Pakistan

Irshad Ayesha, Muhammad Yousaf Farooq Syed, Fatima Mehreen, Gilani Syed Amir, Yousaf Muhammad

2025, 9 (3): 277-282. DOI:10.26599/AUDT.2025.240008

Abstract ( 7 ) HTML ( 2 ) PDF ( 454KB ) ( 381 ) 　　

Objective Uterine and ovarian development is influenced by both age and hormonal milieu. Sonographic assessment of normal pubertal and pre-puberty girls provides critical insights into the physiological trajectory of female gonadal maturation and its potential pathological deviations.
Methods This was a cross-sectional study conducted at Gilani Ultrasound Center, Lahore, Pakistan. The duration of the study was 9 months. Uterus length, width, height, volume, right/left ovary volume and Fundo/Cervical ratio were measured.
Results A total of 384 subjects were included in our study, categorizing them into pre-puberty (age 2-6 years), early puberty (age 7-11 years), and late puberty (age 12-18 years) groups. In the pre-puberty group (n = 111, mean age 4.29 ± 1.20 years), uterine measurements revealed a mean length of 2.95 cm, height of 0.97 cm, width of 1.41 cm, and volume of 4.82 cm³. The mean volumes of the right and left ovaries were 1.24 cm³ and 1.10 cm³, respectively, with a mean F/C ratio of 1.33. For the early puberty group (n = 99, mean age 9.15 ± 1.45 years), uterine measurements included a mean length of 4.03 cm, height of 1.22 cm, width of 1.80 cm, and volume of 12.37 cm³. In the late puberty group (n = 31, mean age 12.63 ± 1.21 years), uterine measurements showed a mean length of 5.29 cm, height of 1.82 cm, width of 2.65 cm, and volume of 31.11 cm³. The mean volumes of the right and left ovaries were 4.70 cm³ and 5.26 cm³, respectively, with a mean F/C ratio of 1.26.
Conclusion Uterine and ovarian dimensions, including volumes, correlate directly with age and pubertal status, except for the (Fundus/Cervical) ratio, which shows individual variability. This normative data could serve as a basis for the evaluation of Uterine and ovarian dimensions and volume in the local population.

Inter and Intra-Rater Reliability of Musculoskeletal Ultrasound to Measure Plantar Fascia Thickness in Patients with Established Plantar Fasciitis

Farooq Syed Muhammad Yousaf, Rasool Kinza, Gilani Syed Amir, Fatima Mehreen, Malik Sajid Shaheen

2025, 9 (3): 283-289. DOI:10.26599/AUDT.2025.240033

Abstract ( 24 ) HTML ( 3 ) PDF ( 1756KB ) ( 384 ) 　　

Objective Plantar fascia (PF) is a thick connective tissue on the plantar surface of the foot that plays a crucial role in maintaining the longitudinal arch. Plantar fasciitis, characterized by inflammation of the medial tuberosity of the calcaneus, is one of the most common causes of heel pain. Imaging is essential for accurate diagnosis, with ultrasonography widely applied to evaluate PF thickness, monitor therapeutic outcomes, and guide interventions. However, its application is limited by operator dependency. This study aimed to investigate the inter- and intra-rater reliability of musculoskeletal ultrasound in measuring PF thickness in patients with plantar fasciitis.
Methods In this cross-sectional analytical study, 40 participants were enrolled, including 26 females and 14 males. The reliability of PF measurements on different sides was assessed using Cronbach’s alpha and intraclass correlation coefficients (ICC).
Results A total of 40 participants (age range: 20-60 years) were included in the study. PF thickness in patients with plantar fasciitis measured by Observer 1 ranged from 3.8-6.9 mm (left) and 3.2-6.0 mm (right), whereas measurements by Observer 2 ranged from 2.9-7.1 mm (left) and 3.2-6.0 mm (right). Intra-rater reliability showed ICCs ranging from 0.618-0.857 for Observer 1 and 0.76-0.92 for Observer 2, indicating moderate (> 0.60) to excellent reliability.
Conclusion PF is a deep structure, and its visualization may be influenced by operator technique. Ultrasound measurement of tendon thickness shows good reliability in patients with established plantar fasciitis.

Comparative Analysis of Fetal Ventricular Function: AGA vs. SGA Fetuses Using 2D Speckle-Tracking

Lohith Kumar Bittugondanahalli Prakash, Shivakumar Neeraj, Gaduputi Jahnavi, Kashif Mohammed S, K Praneethi, Reddy Manda Pranay, S Sampangi Ramaiah, Krishnamurthy Umesh, Prabhakar Suman

2025, 9 (3): 290-297. DOI:10.26599/AUDT.2025.240066

Abstract ( 23 ) HTML ( 3 ) PDF ( 4161KB ) ( 383 ) 　　

Objective To compare fetal cardiac morphology and function between small-for-gestational-age (SGA) and appropriate-for-gestational-age (AGA) fetuses using two-dimensional speckle-tracking echocardiography (2D-STE), and to evaluate global longitudinal strain (GLS), global sphericity index (GSI), and fractional area change (FAC) in both ventricles with FetalHQ software.
Methods This cross-sectional observational study included 101 pregnant women, comprising 36 with SGA and 65 with AGA fetuses. Five- to fifteen-second four-chamber view (4CV) cine loops of the fetal heart were acquired and analysed using fetal heart quantification and speckle tracking (FetalHQ) software. GLS, GSI, and FAC of both left ventricle (LV) and right ventricle (RV) were measured.
Results SGA fetuses demonstrated significantly lower GSI values, consistent with a more globular cardiac shape. LV-FAC and RV-FAC were significantly lower in SGA compared with AGA fetuses, reflecting impaired systolic function. Both LV-GLS and RV-GLS values were significantly higher (less negative) in the SGA group, indicating early biventricular systolic dysfunction. These findings align with previously reported adaptive responses of the fetal myocardium to chronic hypoxia.
Conclusion The study highlights distinct alterations in fetal cardiac morphology and function between SGA and AGA groups. FetalHQ-based deformation analysis may potentially detect subclinical biventricular dysfunction in SGA fetuses before Doppler abnormalities become apparent, offering potential for earlier clinical intervention and closer monitoring.

Advanced Diagnosis of Aortic Stenosis Disease Based on Ultrasound Images: A Novel Artificial Intelligence Approach

Elkouahy Fatima Ezzahra, Bennis Ahmed, Merke Nicolas, Ouahid Hajar, Malali Hamid El, Taleb Lhoucine Ben, Mouhsen Azeddine

2025, 9 (3): 298-306. DOI:10.26599/AUDT.2025.240067

Abstract ( 4 ) HTML ( 2 ) PDF ( 1780KB ) ( 382 ) 　　

Objective Aortic stenosis (AS), a prevalent valvular disease, demands accurate diagnosis. Current methods, notably Doppler echocardiography, face limitations like dynamic image challenges and reliance on cardiologist experience. To assess aortic stenosis, measuring the LVOT diameter is critical, as a 1 mm difference can result in a 10% variation in stroke volume. Accurate Doppler beam alignment and LVOT VTI measurement are also essential to avoid errors. Our study, utilizing the TMED 2 dataset, introduces a novel artificial intelligence program for precise aortic stenosis diagnosis. By leveraging AI, we aim to overcome existing constraints and significantly enhance diagnostic accuracy.
Methods a novel method that involves using convolutional neural networks (CNNs), were used to grade AS based on various views of transthoracic echocardiography (TTE) images from the TMED 2 dataset. This innovative method aimed to take advantage of CNN’s abilities to recognize detailed patterns in echocardiographic data, making AS diagnosis more accurate. We evaluated the performance of our CNN models using confusion metrics and the area under the receiver operator curve (AUROC).
Results Our CNN networks were trained on a dataset comprising view_and_diagnosis_labeled_set, which included 599 studies from 577 unique patients (some with multiple studies on distinct days). For classification, we chose three classes: no aortic stenosis, aortic stenosis, and mild aortic stenosis. The detection of aortic stenosis achieved an accuracy of 85.74%. External validation using three views (PLAX, PSAX, and A4C) of outpatient transthoracic echocardiograms demonstrated effective screening for AS, yielding respective AUROCs of 0.81, 0.88, and 0.48.
Conclusion Our novel CNN-based approach achieved an 85,74% accuracy in AS detection using diverse views from the TMED 2 dataset. External validation on outpatient echocardiograms demonstrated robust screening capabilities, with AUROCs of 0.81, 0.88, and 0.48 for PLAX, PSAX, and A4C views, respectively. These promising results suggest the potential of AI in improving AS diagnosis for clinical applications. Moving forward, our future endeavors will focus on addressing data imbalances and detecting the view of images, in addition to assessing the severity of aortic stenosis, to further refine and optimize our diagnostic approach.