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Aim: The aim of the study was to develop machine learning algorithms (MLA) for diagnosing acute graft dysfunction (AGD) in kidney transplant recipients based on contrast-enhanced ultrasound (CEUS) analysis of the graft.Materials and methods: This prospective study involved 71 patients with kidney transplant undergoing CEUS during follow-up. AGD wasdefined as an increase in serum creatinine levels of at least 25% compared to the baseline of the last three months. The control group consisted of patients with stable kidney graft function (SGF). The top five CEUS parameters that achieved the best discrimination between the AGD and SGF groups were selected based on ANOVA testing and then employed as input for training MLA (naïve Bayes (NB), k-nearest neighbors (k-NN), and logistic regression (LR)). The models were validated by leave-one-out cross-validation., Results: Among the 111 CEUS analyses, 21 corresponded to the AGD group and 90 to the SGF group. CEUS analyses yielded 44 parameters, from which five were selected: the wash out rate in segmental arteries,time to peak in segmental arteries, medullary mean transit time, renal mean transit time, and medullary time to fall. These five parameters were employed as input for MLA, yielding an AUROC of 0.68 for NB and k-NN and 0.72 for LR. The inclusion of graft survival in the MLA significantly improved discrimination accuracy, yielding an AUROC of 0.79 for NB, 0.76 for k-NN,and 0.81 for LR., Conclusions: The use of MLA represents a promising strategy for analyzing CEUS-derived parameters in the setting AGD.

Aim: Our study aimed to assess the usefulness of contrast-enhanced ultrasound (CEUS) in the initial evaluation of the graft function., Materials and Method: A cross-sectional study was conducted in the early postoperative period on patients with kidney transplantation, between September 2017 to November 2018. Two groups of patients were investigated; delayed graft function (DGF) and early graft function (EGF). All patients were examined by grey scale, Doppler ultrasound and CEUS., Results: Nineteen patients, aged from 23 to 64 years (mean age 50 years), 7 in the DGF group and 12 in the EGF group were evaluated. The resistive index (RI) show significantly higher values in the DGF group at the level of upper interlobar artery (p=0.025) and medium interlobar artery (p=0.02). The CEUS investigation shows a greater region of interest (ROI) area (p=0.02) and lower values for wash-out area under the curve (WoAUC) (p=0.047) and respectively wash-in and wash-out area under the curve (WiWoAUC) (p=0.031) for the DGF group. The quality of fit (QoF) proved lower in the DGF group either for evaluation of global graft (p=0.012), cortex (p=0.025), or medulla (p=0.009).A significant relationship among all patients was found between the glomerular filtration rate (GFR) [ml/min] and the renal artery fall time (FT) [s] (p=0.012), WoAUC [a.u.] (p=0.03), and WiWoAUC [a.u.] (p=0.024). The arterial QoF [%] was associated with the arterial ROI area (p=0.048)., Conclusions: Intensity CEUS parameters WoAUC and WiWoAUC may be useful to diagnose and follow-up grafts with delayed function. Additional studies on larger cohorts are required for the recommendation of CEUS as a routine evaluation of the transplanted kidney.

High flow priapism caused by perineal trauma is a relatively rare disorder. Early diagnosis represents a mandatory condition for the therapeutic resolution. Ultrasound examination is affordable and a within reach method for diagnosis also in an emergency context. We present the case of a 56-year-old male patient with traumatic priapism which was subsequently investigated by contrast-enhanced ultrasound and shear wave elastography. This may be one of the first cases presented in the literature.

Aim: To identify the mean values of Shear Wave Elastography (SWE) in pancreatic neoplasms., Material and Method: This pilot case-control study was conducted in a tertiary care setting and data were collected in a prospective manner. Thirty-three subjects were included and divided into two groups: 18 healthy subjects and 15 patients with pancreatic neoplasm, from which 14 patients were diagnosed with adenocarcinoma and one with intraductal papillary mucinous neoplasia. Inclusion criteria for patients with pancreatic neoplasia were histopathological confirmation obtained by endoscopic ultrasonography (EUS) with fine needle aspiration or surgically and imaging confirmation by computed tomography with contrast enhancement. A number of minimum 5 shear wave velocity (SWV) measurements regarding each segment respectively at the tumoral level was obtained among a series of elastograms., Results: The mean SWV of the pancreas in the control group was 1.21±0.27 m/s. Data regarding the pathological parenchyma indicated an increase of the SWV at the tumoral (cephalic) level corresponding to 1.54±0.32 m/s, with significant statistical difference between the control batch and tumoral group, p=0.02., Conclusions: Transabdominal SWE represents a surrogate but feasible method for differentiation cancer from the normal pancreatic tissue. In a clinical setting, data regarding the stiffness complementary to an ultrasound evaluation could guide high-risk patients for a close-up pancreatic monitoring.

Aim: The purpose of this study is to evaluate pancreatic stiffness by ARFI abdominal elastography. In the current literature, there are relatively few studies that have assessed the clinical utility of this technique., Material and Method: A number of 37 healthy subjects were included. The data were collected in a prospective manner and afterwards included in an observational, analytical and longitudinal study. Subsequently viewing the pancreatic parenchyma in bidimensional mode (2D-US) mode, 10 shear wave velocity (SWV) measurements for each segment: head, body and tail were performed. Statistical analysis by regression models targeted also the possible influence of other factors in assessing SWV. A comparative analysis was performed regarding the statistical significance of 5 versus 10 SWV measurements for each segment., Results: The pancreas was entirely evaluated in all subjects. The mean SWV from the entire parenchyma was 1.216 m/s±0.36 and between the three segments SWV were similar (head: 1.224 m/s, body: 1.227 m/s and tail: 1.191 m/s). A ratio of the IQR/Median >0.4 was interpreted as statistically invalid, relevant data being highlighted in the percentage of 83.78% for the head of the pancreas, 78.37% for the body, and 67.56% at the caudal level. Significant correlations were observed between the data (mean and median SWV) provided by the group with 5 measurements of the SWV versus the standard group: 93.9% for the head, 96.6% for the body, and 98.7% accordingly to the tail., Conclusions: SWV determination by percutaneous approach represents a useful imaging method for evaluating pancreatic stiffness, of course within these limitations. Because we did not observe statistically significant differences between the results obtained by 5 or 10 measurements, we suggest that it would be sufficient to perform only five measurements of the SWV per pancreatic segment. The data obtained in the normal pancreas could be used in future comparative assessments regarding the inflammatory or tumoral pathology of the pancreas.

Ultrasonography is generally accepted and performed as a first choice imaging technique in patients with jaundice. The method allows the discrimination between cholestatic and mechanical jaundice. The existing procedures are multiple: gray scale, Doppler, i.v. contrast enhancement, elastography, tridimensional ultrasonography, each of these with different contribution to the positive and differential diagnosis regarding the nature of the jaundice. The final diagnosis is a multimodal one and the efficiency is dependent on the level of the available technology, the examiner's experience, the degree and modality of integration of the data within the clinical context, as well as on the portfolio of available imaging procedures. This review shows the main ultrasonographic methods consecrated in the evaluation of the biliary tree. It also underlines the integrated character of the procedures, as well as the necessity to correlate with other imaging methods and the clinical situation.

Ultrasonography (US) is the essential imaging method in gallbladder examination being the most widespread and inexpensive technique. The method is indicated both in congenital and acquired disorders, inflammatory, tumoral, or degenerative pathology. Besides the basic technique (grey scale US), new sophisticated techniques exist: Doppler US, i.v. contrast enhanced harmonic examination, tridimensional US, elastography. Each technique provides specific information, while their combination helps, in most cases, to establish the accurate non-invasive diagnosis. However, the US findings should be correlated with the patient's clinical exam and other imaging methods. This paper is a synthesis of literature combined with our own experience, aiming to present the US features of gallbladder pathology and the correlations within the clinical picture and other imaging methods. Relevant images for this integrative approach are presented. The final conclusion is the necessity for a correlation of all clinical and imaging data in order to obtain an accurate diagnosis.