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To compare the outcomes of Ventral inlay buccal mucosal graft urethroplasty (VIBMGU) with dorsal onlay buccal mucosal graft urethroplasty (DOBMGU) for the treatment of Female urethral stricture (FUS). This study included women who underwent either VIBMGU or DOBMGU between January 2016 and June 2023. The preoperative American Urological Association (AUA) symptom scores, maximal urinary flow rate (Qmax), post-void residual volume (PVR) on ultrasonography, and length and location of the stricture were obtained from a prospectively maintained electronic database. The data obtained from the patient's last visit were compared with the preoperative values for this study. The primary outcome was the success rate. The secondary outcomes were changes in AUA score, PVR, and Qmax. The patient's last follow-up visit was considered for the duration of the follow-up. Seventy-three patients were treated for BMGU for FUS. Forty-six patients underwent VIBMGU, and 27 patients underwent DOBMGU. The median duration of follow-up was 27.5 (11.00-55.00) versus 14 (7.00-17.00) months, respectively. The success rates of VIBMGU and DOBMGU were 89.13% and 88.89%, respectively. There was a reduction in AUA scores and PVR and an improvement in Qmax postoperatively in both groups. The difference in the reduction in AUA scores between the VIBMGU and DOBMGU groups was statistically significant. The difference was not statistically significant in terms of reduction in PVR and improvement in Qmax between the 2 groups. The ventral inlay technique can provide equal results to the dorsal technique with the added advantage of vaginal sparing. This is the single largest series in the literature on FUS with the largest follow-up period of 90 months. [ABSTRACT FROM AUTHOR]

• Hysteroscopy is the gold-standard approach for treating most intrauterine lesions. • Hysteroscopic visualization may not suffice for optimal management in complex cases. • Intraoperative ultrasound in hysteroscopy reduces uterine perforation risk. • Ultrasound-guided hysteroscopy increases the rate of complete resection of lesions. Hysteroscopy stands as the gold-standard approach for managing intrauterine pathology. However, in complex clinical cases, hysteroscopic evaluation alone may prove insufficient for the safest and successful patient management. Intraoperative ultrasound (IOUS) has emerged as a valuable adjunct to hysteroscopic surgery, offering real-time visualization of endometrial cavity, uterine walls and instruments within the uterine cavity, enabling precise delineation of anatomical structures, and helping to assess the extent of pathology during intricate interventions. This review aims to comprehensively assess the applications, efficacy and utility of IOUS in hysteroscopic surgery. Available evidence indicates that in hysteroscopic myomectomy, IOUS significantly reduces the risk of uterine perforation, particularly in submucosal FIGO 2 myomas, and enhances the likelihood of a single-step procedure. During hysteroscopic metroplasty, ultrasound guidance decreases the chance of incomplete uterine septum resection. In the hysteroscopic management of severe Asherman syndrome, IOUS reduces the risk of uterine perforation or false passage. For cesarean scar pregnancy (CSP), ultrasound is crucial in defining the most appropriate surgical approach and is effective in guiding the hysteroscopic treatment of endogenic CSP. The use of IOUS in hysteroscopy proves valuable in complex cases where the risk of uterine perforation or incomplete procedure is increased. [ABSTRACT FROM AUTHOR]

• Ultrasound accurately identified invasive placentation in 86.1% of women with placenta previa and prior cesarean delivery. • Disruption of the bladder-myometrial interface was the most reliable ultrasound sign. • All confirmed cases of placenta accreta had at least one ultrasound sign of invasive placentation. • Accurate antenatal ultrasound improves management, unnecessary hysterectomies and maternal and perinatal outcomes. To evaluate the performance of ultrasound for antenatal identification of invasive placentation in women with placenta previa in the setting of prior cesarean delivery. This was a multicenter, retrospective, cohort study. Singleton pregnancies at risk of placenta accreta because of persistent placenta previa in the setting of prior cesarean delivery who delivered at four centers, from January 2010 to May 2020, were included in the study. For this study, pregnancies with diagnosis of accreta, increta, or percreta were considered under the umbrella term of placenta accreta. All women with placenta previa identified in the second trimester had a follow-up ultrasound at 32–34 weeks. Only those with prior cesarean delivery were considered at risk of placenta accreta. Women were considered with suspected accreta in case of suspected prenatal ultrasound. Women with suspected placenta accreta had delivery planned via cesarean hysterectomy at 34+0 – 35+6 weeks, without any attempt to remove the placenta. The primary endpoint of the study was the performance of ultrasound for antenatal identification of invasive placentation. The following ultrasound signs were evaluated: placenta lacunae; loss of clear space; increased vascularity between myometrium and placenta; intracervical lake; rail sign; uterovesical hypervascularity; increased vascularity in the inferior part of the lower uterine segment potentially extending into the parametrial region; and disruption of bladder-myometrial interface. 180 singleton pregnancies with placenta previa in the setting of prior cesarean delivery were identified. Of them, 155 (86.1%) had antenatal suspected placenta accreta based on ultrasound, having at least one sign of invasive placentation. Of the 155 suspected cases, 99 had confirmed placenta accreta at the time of delivery. Among the 99 cases of confirmed placenta accreta, all of them had at least one sign of invasive placentation at ultrasound. Among the 81 cases with placenta previa, prior cesarean delivery, without placenta accreta, 25/81 (30.9%) had ultrasound scan negative for sign of invasive placentation, and 56/81 (69.1%) had at least one sign of invasive placentation). In particular, 12/81 (14.8%) had placenta lacunae, 16/81 (19.8%) had loss of clear space, 20/81 (24.7%) had increased vascularity between myometrium and placenta, 9/81 (11.1%) had intracervical lake, 14/81 (17.3%) had rail sign, 14 (17.3%) had uterovesical hypervascularity, 5/81 (6.2%) had increased vascularity in the inferior part of the lower uterine segment potentially extending into the parametrial region, 8/81 (9.9%) had disruption of bladder-myometrial interface. In the group of women with confirmed placenta accreta, the most common sign recorded was the disruption of bladder-myometrial interface, being recorded in 88/99 women. Disruption of bladder-myometrial interface had the highest sensitivity in detection placenta accreta. Women with disruption of bladder-myometrial interface at ultrasound had 73-fold increase in the risk of placenta accreta compared to those who did not. Prenatal ultrasound has an excellent diagnostic accuracy in identifying invasive placentation in women with placenta previa and prior cesarean delivery. [ABSTRACT FROM AUTHOR]

Point-of-care ultrasound demonstrates significant potential in biomedical research due to its noninvasive, real-time visualization, cost-effectiveness, and other biological benefits. Ultrasound irradiation can precisely control the mechanical and physicochemical effects on pathogenic lesions, enabling real-time visualization, tunable tissue penetration depth, and therapeutic applications. This review summarizes recent advancements in ultrasound-enabled diagnostics and therapeutics, focusing on mechanochemical effects that can be directly integrated into biomedical applications. Additionally, the structure-functionality relationships of sonotheranostic nanoplatforms are systematically discussed, providing insights into the underlying biological effects. Finally, the limitations of current ultrasonic medicine are discussed, along with potential expansions to facilitate patient-centered translations. This review summarizes the recent progress in the development of ultrasound-derived systems for ultrasonic molecular bioimaging and ultrasound-activatable therapy, with deep insights into the action mechanism, clinical challenges, and corresponding remedies. [Display omitted] [ABSTRACT FROM AUTHOR]

To develop and validate machine learning algorithms to automatically extract the rod length of the magnetically controlled growing rod from ultrasound images (US) in a pilot study. Two machine-learning (ML) models, called the "Boundary model" and "Rod model," were developed to identify specific rod segments on ultrasound images. The models were developed utilizing Mask Regional Convolutional Neural Networks (Mask RCNN). Ninety US images were acquired from 23 participants who had early onset scoliosis (EOS) surgeries; among those, 70 were used for model development, including training and validation, and 20 were used for testing by comparing the AI-based vs. manual measurements. The average precision (AP) of the ML models was 88.5% and 60.2%, respectively. The inter-method correlation coefficient (ICC) was 0.98, and the mean absolute difference ± standard deviation (MAD ± SD) between AI and manual measurements was 0.86 ± 1.0 mm. The Bland-Altman analysis showed no bias, and 90% of the data were within the 95% confidence interval. The automated method was reliable, accurate, and fast. Measurements were displayed in 4.6 seconds after the US image was inputted. This was the first AI-based method to measure the MCGR rod length on US images automatically. [ABSTRACT FROM AUTHOR]

Deep-learning algorithms have been widely applied in the field of automatic kidney ultrasound (US) image segmentation. However, obtaining a large number of accurate kidney labels clinically is very difficult and time-consuming. To solve this problem, we have proposed an efficient cross-modal transfer learning method to improve the performance of the segmentation network on a limited labeled kidney US dataset. We aim to implement an improved image-to-image translation network called Seg-CycleGAN to generate accurate annotated kidney US data from labeled abdomen computed tomography images. The Seg-CycleGAN framework primarily consists of two structures: (i) a standard CycleGAN network to visually simulate kidney US from a publicly available labeled abdomen computed tomography dataset; (ii) and a segmentation network to ensure accurate kidney anatomical structures in US images. Based on the large number of simulated kidney US images and small number of real annotated kidney US images, we then aimed to employ a fine-tuning strategy to obtain better segmentation results. To validate the effectiveness of the proposed method, we tested this method on both normal and abnormal kidney US images. The experimental results showed that the proposed method achieved a segmentation accuracy of 0.8548 in dice similarity coefficient on all testing datasets and 0.7622 on the abnormal testing dataset. Compared with existing data augmentation and transfer learning methods, the proposed method improved the accuracy and generalization of the kidney US image segmentation network on a limited number of training datasets. It therefore has the potential to significantly reduce annotation costs in clinical settings. [ABSTRACT FROM AUTHOR]

This research aimed to improve diagnosis of non-alcoholic fatty liver disease (NAFLD) by deep learning with ultrasound Images and reduce the impact of the professional competence and personal bias of the diagnostician. Three convolutional neural network models were used to classify and identify the ultrasound images to obtain the best network. Then, the features in the ultrasound images were extracted and a new convolutional neural network was created based on the best network. Finally, the accuracy of several networks was compared and the best network was evaluated using AUC. Models of VGG16, ResNet50, and Inception-v3 were individually applied to classify and identify 710 ultrasound images containing NAFLD, demonstrating accuracies of 66.2%, 58.5%, and 59.2%, respectively. To further improve the classification accuracy, two features are presented: the ultrasound echo attenuation coefficient (θ), derived from fitting brightness values within sliding region of interest (ROIs), and the ratio of Doppler effect (ROD), identified through analyzing spots exhibiting the Doppler effect. Then, a multi-input deep learning network framework based on the VGG16 model is established, where the VGG16 model processes ultrasound image, while the fully connected layers handle θ and ROD. Ultimately, these components are combined to jointly generate predictions, demonstrating robust diagnostic capabilities for moderate to severe fatty liver (AUC = 0.95). Moreover, the average accuracy is increased from 64.8% to 77.5%, attributed to the introduction of two advanced features with domain knowledge. This research holds significant potential in aiding doctors for more precise and efficient diagnosis of ultrasound images related to NAFLD. [ABSTRACT FROM AUTHOR]

[Display omitted] To explore the performance of ultrasound image-based radiomics in predicting World Health Organization (WHO)/International Society of Urological Pathology (ISUP) grading of clear-cell renal cell carcinoma (ccRCC). A retrospective study was conducted via histopathological examination on participants with ccRCC from January 2021 to August 2023. Participants were randomly allocated to a training set and a validation set in a 3:1 ratio. The maximum cross-sectional image of the lesion on the preoperative ultrasound image was obtained, with the region of interest (ROI) delineated manually. Radiomic features were computed from the ROIs and subsequently normalized using Z-scores. Wilcoxon test and least absolute shrinkage and selection operator (LASSO) regression were applied for feature reduction and model development. The performance of the model was estimated by indicators including area under the curve (AUC), sensitivity and specificity. A total of 336 participants (median age, 57 y; 106 women) with ccRCC were finally included, of whom 243 had low-grade tumors (grade 1–2) and 93 had high-grade tumors (grade 3–4). A total of 1163 radiomic features were extracted from the ROIs for model construction and 117 informative radiomics features selected by Wilcoxon test were submitted to LASSO. Our ultrasound-based radiomics model included 51 features and achieved AUCs of 0.90 and 0.79 for the training and validation sets, respectively. Within the training set, the sensitivity and specificity measured 0.75 and 0.92, respectively, whereas in the validation set, the sensitivity and specificity measured 0.65 and 0.84, respectively. In the subgroup analysis, for the training and validation sets Philips AUCs were 0.91 and 0.75, Toshiba AUCs were 0.82 and 0.90, and General Electric AUCs were 0.95 and 0.82, respectively. Ultrasound-based radiomics can effectively predict the WHO/ISUP grading of ccRCC. [ABSTRACT FROM AUTHOR]

• Relationships between skeletal muscle echogenicity and physical function were small to moderate but highly consistent. • Sub-analyses determined minimal between-muscle differences in predictive ability. • Ultrasonic echogenicity should be considered part of early detection screens for sarcopenia and other diseases. • Combining muscles tended to strengthen the model, although muscle quality appears systemic, allowing for a single scan to represent the total body. Assessment and quantification of skeletal muscle within the aging population is vital for diagnosis, treatment, and injury/disease prevention. The clinical availability of assessing muscle quality through diagnostic ultrasound presents an opportunity to be utilized as a screening tool for function-limiting diseases. However, relationships between muscle echogenicity and clinical functional assessments require authoritative analysis. Thus, we aimed to (a) synthesize the literature to assess the relationships between skeletal muscle echogenicity and physical function in older adults (≥60 years), (b) perform pooled analyses of relationships between skeletal muscle echogenicity and physical function, and (c) perform sub-analyses to determine between-muscle relationships. CINAHL, Embase, MEDLINE, PubMed, and Web of Science databases were systematically searched to identify articles relating skeletal muscle echogenicity to physical function in older adults. Risk-of-bias assessments were conducted along with funnel plot examination. Meta-analyses with and without sub-analyses for individual muscles were performed utilizing Fisher's Z transformation for the most common measures of physical function. Fisher's Z was back-transformed to Pearson's r for interpretation. Fifty-one articles (n = 5095, female = ∼2759, male = ∼2301, 72.5 ± 5.8 years, mean ± SD (1 study did not provide sex descriptors)) were extracted for review, with previously unpublished data obtained from the authors of 13 studies. The rectus femoris (n = 34) and isometric knee extension strength (n = 22) were the most accessed muscle and physical qualities, respectively. The relationship between quadriceps echogenicity and knee extensor strength was moderate (n = 2924, r = –0.36 (95% confidence interval: –0.38 to –0.32), p < 0.001), with all other meta-analyses (grip strength, walking speed, sit-to-stand, timed up-and-go) resulting in slightly weaker correlations (r : –0.34 to –0.23, all p < 0.001). Sub-analyses determined minimal differences in predictive ability between muscle groups, although combining muscles (e.g., rectus femoris + vastus lateralis) often resulted in stronger correlations with maximal strength. While correlations are modest, the affordable, portable, and noninvasive ultrasonic assessment of muscle quality is a consistent predictor of physical function in older adults. Minimal between-muscle differences suggest that echogenicity estimates of muscle quality are systemic. Therefore, practitioners may be able to scan a single muscle to estimate full-body skeletal muscle quality/composition, while researchers should consider combining multiple muscles to strengthen the model. [Display omitted] [ABSTRACT FROM AUTHOR]

Neuromuscular deficits affecting functional ability can occur in patients with Achilles tendinopathy during difficult balance activities. This study aimed to assess postural control in patients with Achilles tendinopathy after shockwave and sonotherapy, using advanced analytical methods, including rambling-trembling signal decomposition and sample entropy. What are the differences in postural control between patients with Achilles tendinopathy after shockwave therapy, ultrasound therapy, and placebo ultrasound? Thirty-nine patients were included in the study, and randomly assigned to 3 groups, i.e., shockwave therapy, ultrasound therapy and placebo ultrasound. Postural sway was assessed during quiet standing with eyes open and closed, with two force platforms, one for the affected and the other for the non-affected limb, at baseline and at weeks 1 and 6 after treatment. Rambling-trembling trajectories and sample entropy were calculated for the antero-posterior and medio-lateral directions. The parameters of trembling trajectory in both directions were significantly smaller for the affected compared to non-affected limb. The ultrasound group had significantly larger rambling-trembling trajectories in the antero-posterior and medio-lateral sway directions than the shockwave therapy group. Also, all patients had more difficulty controlling their postural sway while standing with eyes closed compared to eyes open. Sample entropy was not significantly affected by the therapy type, timepoint and limb condition. As opposed to sample entropy, rambling-trembling decomposition can complement or replace traditional linear measures of COP time series in functional assessment of the Achilles tendon. • Patients with Achilles tendinopathy have altered postural control. • Trembling trajectory is smaller for the affected compared to non-affected limb. • Rambling-trembling method may contribute to the assessment of the Achilles tendon. [ABSTRACT FROM AUTHOR]

Hydrogels can serve as local drug delivery depots that protect the biological activity of labile therapeutics. However, drug release from conventional hydrogels is typically rapid, which is not ideal for many therapeutic agents. We developed a composite hydrogel that enables sustained drug release in response to ultrasound. The composite, termed an acoustically responsive scaffold (ARS), consists of a fibrin hydrogel and a phase-shift emulsion. Upon exposure to ultrasound, the emulsion is vaporized into bubbles, which leads to release of drugs contained within the emulsion. Previously, ARSs have been used in regenerative applications to stimulate blood vessel growth. Here, we characterize the release kinetics and mechanisms of ARSs. Release exhibits a triphasic pattern compromising a slow phase prior to ultrasound exposure; a transient, fast phase immediately after ultrasound exposure that follows a sigmoidal profile; and a sustained, steady phase. In each phase, we demonstrate how derived kinetics parameters are impacted by the ARS composition (e.g., fibrin and emulsion concentrations) and ultrasound properties (e.g., acoustic pressure, pulse duration). Using confocal microscopy, protein assays, and B-mode ultrasound imaging, we demonstrate that drug release from an ARS is independent of fibrin degradation and dependent on bubble growth. These results are critical in optimizing ARSs for delivery of therapeutic agents. [Display omitted] [ABSTRACT FROM AUTHOR]

• Adnexal masses need thorough pre-op evaluation. A two-step strategy using ADNEX enhances stratification and communication. To evaluate and compare diagnostic performance of ultrasound-based reporting systems IOTA SR, ADNEX, GIRADS, ORADS for discrimination between benign and malignant adnexal masses. A prospective observational study in a tertiary care hospital's Obstetrics and Gynaecology department evaluated pre-operative ultrasound imaging for adnexal masses in 80 cases, comparing various reporting systems' sensitivity and specificity against histopathology as gold standard using STATA version 17.0 for data analysis. Among the 80 masses, 55 % (44/80) were confirmed as benign on histopathology, while 45 % were identified as malignant. The sensitivity and specificity of SR was 100 % (95 %CI: 90.0–100) and 97.1 % (95 %CI: 84.7–99.9) respectively. Eleven masses (13.8 %) were inconclusive, reducing specificity to 75 % (95 %CI:59.7–86.8). In ADNEX optimal cut-off for risk of malignancy was 34.1 % with sensitivity of 86.1 % (95 % CI: 70.5–95.3) and specificity of 90.9 % (95 % CI: 78.3–97.5). Considering GIRADS 4–5 and risk threshold of ≥10 % (ORADS 4–5) as predictors of malignancy sensitivity was 100 % (95 %CI: 90.3–100) and specificity was 70.5 % (95 %CI: 54.8–83.2) for GIRADS and ORADS. All reporting systems were comparable (p = 0.7). ADNEX identified 72.7 % (8/11) of inconclusive cases, outperforming GIRADS/ORADS which correctly classified 27.2 % (3/11) cases. When applied to misclassified GIRADS/ORADS 4–5 category, ADNEX demonstrated superior performance by correctly classifying 76.9 % (10/13) masses, while SR achieved correct classification in only 38.5 % (5/13) masses. All classification systems showed comparable accuracy in malignancy risk identification on imaging. GIRADS/ORADS tended to overestimate malignancy risk. The present study recommends a two-step strategy, leveraging higher specificity of ADNEX model for improved stratification of adnexal masses. [ABSTRACT FROM AUTHOR]

The purpose of this study was to analyze the independent risk factors of malignant subpleural pulmonary lesions (SPLs) on B-mode ultrasound (US) images, to construct the combined predictive indicators, and to prospectively verify their predictive efficacy. A total of 336 patients with SPLs were included in the prospective study, of whom the single-center included patients between September 2019 and December 2019 were the development cohort (DC) (n = 219); Patients who were concurrently enrolled in three centers between January and February 2020 were the validation cohort (VC) (n = 117). The clinical features and B-mode US parameters were collected. Based on the DC, a combined predictive indicators model was developed using binary logistic regression. Then the discrimination was verified externally in the VC. The reference criteria were from the comprehensive diagnosis of clinical-radiological-pathological made by two senior respiratory physicians. The combined predictive indicators model was finally constructed by five parameters: age, borderline, angle between the lesion border and thoracic wall, posterior echo of the lesion and invasion of the pleura. The fitting degree of the model was good (χ 2 = 9.198, p = 0.326). The area under ROC curve of the model was 0.872 (DC) and 0.808 (VC), yielding a higher net benefit than individual risk factors. The combined predictive indicators are useful in the assessment of malignant SPLs and are a useful adjunct diagnostic tool, especially in primary healthcare settings in developing countries. [ABSTRACT FROM AUTHOR]

This paper proposes an ultrasound imaging algorithm based on sub-beamformer and multi-apodization with cross-correlation (SUB-MAX), aiming to achieve high resolution close to the minimum variance (MV) beamforming with low complexity and to enhance image contrast while maintaining background quality. The output of two (N /2)-element DAS beamformers with asymmetric phase centers is subtracted, resulting in a large drop in the main-lobe amplitude, while the sidelobe maintains a relatively high amplitude level. Inspired by this characteristic, the coefficients with opposite trends compared with the subtracted output are obtained and fused with the normalized cross-correlation (NCC) weighting matrix acquired by using multi-pair received apodization, the proposed SUB-MAX obtains a new weighting matrix to weight the output of the DAS beamformer. For ats_wire point targets, the average full-width at half-maximum (FWHM) of SUB-MAX compared with DAS, DMAS, CF, and MAX decreases by 52.7%, 43.5%, 33.3%, and 52.7%, respectively. For geabr_0 cysts, the average contrast ratio (CR) of SUB-MAX compared with DAS, MV, DMAS, and CF increases by 57.7%, 86.8%, 2.5%, and 14.4%, respectively. Experiments on rat_tumor dataset also indicate that SUB-MAX has a superior comprehensive imaging performance. The experimental results indicate that the superior comprehensive imaging performance of the proposed SUB-MAX is expected to be suitable for real-time imaging systems due to its non-reliance on covariance matrix inversion. [ABSTRACT FROM AUTHOR]

The study aimed to determine the influencing factors, reference range, the changes of salivary gland secretion function and repeatability of measurements taken from ultrasound (US) viscoelastic imaging in the salivary glands of healthy adults. From August 2023 to October 2023, 206 healthy adults were recruited. In November 2023, 50 healthy adults were recruited for acid stimulation testing. All volunteers underwent conventional and viscoelastic US of the salivary glands. The viscoelasticity values in different regions of interest (ROI), observers, genders, ages, body mass index (BMI) groups and before and after acid stimulation were compared separately. A two-sided 95% reference range was estimated accordingly. There was no difference in the E-mean and V-mean values among different ROIs (p > 0.05). The intra-group correlation coefficient values between the different observers were all >0.908. Except for the influence of age on the E-mean value of the parotid gland, the V-mean of the parotid gland, the E-mean and V-mean of the submandibular gland were not affected by age, gender or BMI. Finally, differences were detected in the E-means and V-means of the parotid and submandibular glands before and after acid stimulation (p < 0.05). US viscoelastic imaging is a simple and reliable technique for evaluating the stiffness and viscosity of salivary glands in healthy adults. It also can be used to dynamically evaluate the changes of salivary gland secretion function. [ABSTRACT FROM AUTHOR]

Mechanical stiffness derived from force-elongation curves is fundamentally different from shear wave (SW) elastography-based tissue properties. We compared these techniques, with a total of five methods of assessing Achilles tendon (AT) stiffness. Seventeen participants (12 male and 5 female) with unilateral AT rupture performed submaximal contractions at 30% and 10% maximal isometric contraction torque of the un-injured limb. SW velocity was acquired at rest. Force-elongation curves were assessed from the free AT and the medial gastrocnemius (MG) tendon. Mechanical stiffness was determined near the end of the linear region of the force-elongation curve and from the toe region. Bivariate correlations between mechanical stiffness and SW velocity, as well as pairwise t -tests between limbs, were computed. In the injured limb, SW velocity correlated with MG tendon and free AT toe-region stiffness during 10% (r = 0.59, p = 0.020 and r = 0.60, p = 0.011, respectively) and 30% of submaximal contractions (r = 0.56, p = 0.018 and r = 0.67, p = 0.004, respectively). The un-injured limb showed no associations. In both limbs pooled together, SW velocity correlated with MG tendon toe-region stiffness in 30% of submaximal contractions (r = 0.43, p = 0.012). Free tendon mechanical stiffness was lower in the injured limb, with a mean difference of 148.5 Nmm⁻¹ (95% CI: 35.6–261.3, p = 0.013), while SW velocity was higher in the injured limb (1.67 m × s⁻¹, 95% CI; -2.4 to -0.9, p < 0.001). SW elastography may reflect AT viscoelastic properties at the initial slope of the force-length curve with strains <1% but cannot offer insight into AT mechanics at higher loads. Extended toe regions in the injured limb could have caused the association between mechanical stiffness and SW-based stiffness. [ABSTRACT FROM AUTHOR]

[Display omitted] The goal of this study was to evaluate the performance of different commercial ultrasound contrast microbubbles (MBs) when measuring bladder phantom pressure with sub-harmonic-aided pressure estimation (SHAPE) methodology. We hypothesized that SHAPE performance is dependent on MB formulation. This study aimed to advance the SHAPE application for bladder pressure measurements in humans. Using a previously designed and built bladder phantom, we tested four different commercial agents: Definity, Lumason, Sonazoid and Optison. A standard clinical cystometrogram (CMG) system was used to infuse a MB–saline mixture into the bladder phantom to measure pressure. Ultrasound imaging was performed using the GE Healthcare LOGIQ E10 scanner. All agents showed a predicted inverse linear relationship between change in pressure and SHAPE signal. However, they differ from each other in terms of stability, linear correlation, sensitivity to pressure and error. Generally, Definity and Lumason showed the highest performance during the SHAPE-based bladder phantom pressure assessments. Our results show that the SHAPE signal decreases as bladder phantom pressures increases, regardless of the agent or CMG phase, suggesting the possibility of using SHAPE for measuring bladder pressure without a catheter. However, the efficacy of SHAPE in measuring pressure varies by MB formulation. These observations support using Lumason and Definity in a human subject feasibility study as we advance toward a catheter-free solution for measuring voiding bladder pressure via SHAPE. [ABSTRACT FROM AUTHOR]

Intensity inhomogeneity often appears in medical images and causes great difficulties in image segmentation. Most active contour models perform poorly when applied to intensity inhomogeneous images because their energy functions use local intensity information in a fixed-size domain, causing the contour to evolve in the wrong direction. To overcome the difficulties caused by intensity inhomogeneity, we propose an adaptive multi-scale Gaussian kernel function based on image local entropy, which can determine the appropriate scale for each local region. Choosing the small scale and large scale for inhomogeneous and homogeneous areas respectively make the contour move toward the target boundary accurately. We also propose three adaptive multi-scale (AMS) models, AMS-region scalable fitting (AMS-RSF) model, AMS-local image fitting (AMS-LIF) model, AMS-local and global intensity fitting (AMS-LGIF) model, to segment medical images with intensity inhomogeneity and noise, including left atrial MR images and breast ultrasound images. The experimental results show that the adaptive multi-scale Gaussian kernel function enables the active contour model to effectively segment intensity inhomogeneous images and has a certain robustness to the initial contour and noise, which achieves good performance on MR left atrial images and ultrasound images of breast cancer. The AMS-LGIF model obtained the highest DICE coefficient of 0.9532, which was better than the 0.9429 obtained by the second-ranked LGIF model to segment left atrial MR images. For segmenting breast ultrasound images, the DICE coefficient is increased by 16% than that of the U-Net++ model. • An adaptive multi-scale Gaussian kernel function based on image local entropy is proposed. • Adaptive multi-scale RSF, LIF, and LGIF models are proposed. • The proposed adaptive multi-scale model is robust to initial contours and noise. • Numerical results such as DICE, JS, Precision, and Recall values are given. • The experimental results show that our adaptive multi-scale model is better than the other methods. [ABSTRACT FROM AUTHOR]

Ultrasound imaging is inexpensive, portable, and widely available. The development of a real-time transcutaneous spinal cord perfusion monitoring system would allow more precise targeting of mean arterial pressure goals following acute spinal cord injury (SCI). There has been no prior demonstration of successful real-time cord perfusion monitoring in humans. Four adult patients who had undergone posterior cervical decompression and instrumentation at a single center were enrolled into this prospective feasibility study. All participants had undergone cervical laminectomies spanning ≥2 contiguous levels ≥2 months prior to inclusion with no history of SCI. The first 2 underwent transcutaneous ultrasound without contrast and the second 2 underwent contrast-enhanced ultrasound (CEUS) with intravenously injected microbubble contrast. Using noncontrast ultrasound with or without Doppler (n = 2), the dura, spinal cord, and vertebral bodies were apparent however ultrasonography was insufficient to discern intramedullary perfusion or clear white-gray matter differentiation. With application of microbubble contrast (n = 2), it was possible to quantify differential spinal cord perfusion within and between cross-sectional regions of the cord. Further, it was possible to quantify spinal cord hemodynamic perfusion using CEUS by measuring peak signal intensity and the time to peak signal intensity after microbubble contrast injection. Time-intensity curves were generated and area under the curves were calculated as a marker of tissue perfusion. CEUS is a viable platform for monitoring real-time cord perfusion in patients who have undergone prior cervical laminectomies. Further development has the potential to change clinical management acute SCI by tailoring treatments to measured tissue perfusion parameters. [ABSTRACT FROM AUTHOR]

Most manual wheelchair users with pediatric-onset spinal cord injury (SCI) will experience shoulder pain or pathology at some point in their life. However, guidelines for preservation of the upper limb in children with SCI are limited. What are the relationships between manual wheelchair handrim kinetics and quantitative ultrasound parameters related to subacromial impingement in individuals with pediatric-onset SCI? Subacromial impingement risk factors including supraspinatus tendon thickness (SST), acromiohumeral distance (AHD), and occupation ratio (OR; SST/AHD) were measured with ultrasound in 11 manual wheelchair users with pediatric-onset SCI. Handrim kinetics were acquired during the stroke cycle, including peak resultant force (F R), peak rate of rise of resultant force (ROR) and fractional effective force (FEF). Variability of handrim kinetics was computed using the coefficient of variation and linear regression was performed to assess correlations between handrim metrics and quantitative ultrasound parameters. Peak resultant force significantly increased 1.4 % and variability of FEF significantly decreased 8.0 % for every 0.1 cm increase in AHD. FEF decreased 3.5 % for every 0.1 cm increase in SST. Variability of peak resultant force significantly increased 3.6 % and variability of peak ROR of resultant force significantly increased 7.3 % for every 0.1 cm increase in SST. FEF variability significantly decreased 11.6 % for every 0.1 cm increase in SST. Peak ROR significantly decreased 1.54 % with every 10 % increase in OR. FEF variability significantly decreased 1.5 % with every 10 % increase in OR. This is the first study to investigate relationships among handrim kinetics and shoulder structure in manual wheelchair users with pediatric-onset SCI. Associations were identified between subacromial impingement risk factors and magnitude and variability of wheelchair handrim kinetics. These results indicate the critical need to further explore the relationships among wheelchair handrim kinetics, shoulder joint dynamics, and shoulder pathology in manual wheelchair users with pediatric-onset SCI. • Wheelchair handrim kinetics are associated with risk of subacromial impingement. • Subacromial impingement risk decreases with increasing variability of handrim force. • Ultrasound can quantify risk factors of shoulder impingement in wheelchair users. • Supraspinatus tendon size correlates with handrim force variability and magnitude. • Subacromial occupation ratio decreases with increasing rate of force application. [ABSTRACT FROM AUTHOR]

Tendons transmit tensile load from muscles to the skeleton. Differential loading across a tendon can occur, especially when it contains subtendons originating from distinct muscles. Tendon shear wave speed has previously been shown to reflect local tensile stress. Hence, a tool that measures spatial variations in wave speed may reflect differential loading within a tendon during human movement. Do wave speeds measured via high-framerate ultrasound-based tensiometry correspond with differential loading across a tendon? Ultrasound-tensiometry uses an external mechanical actuator to induce waves and high-framerate plane wave ultrasound imaging (20 kHz) to track tissue displacements arising from wave propagation within a tendon. Local tissue displacements are temporally and spatially filtered to remove high-frequency noise and reflected waves. A Radon transform of the spatio-temporal displacement data is used to compute the shear wave speed across the tendon. We evaluated ultrasound-tensiometry's ability to measure differential loading across a tendon using in silico , ex vivo and in vivo approaches. The in silico approach used a finite element model to simulate wave propagation along two adjacent subtendons undergoing differential loading. The ex vivo experiment measured wave speed in adjacent porcine flexor subtendons subjected to differential loading. In vivo , we tracked wave speed across the Achilles tendon while a participant performed calf stretches to differentially load the subtendons, and while walking on a treadmill at 1.5 m/s. Wave speeds modulated with local tendon stress under both in silico and ex vivo conditions, with higher wave speeds observed in subtendons subjected to higher loads (6–16 m/s higher at 1.5× load differential). Spatial variations in in vivo Achilles tendon wave speeds were consistent with differential subtendon loading arising from distinct muscle loads (maximum range: 0–137 m/s, resolution: 0.1 mm×0.2 mm, precision: ±0.2 m/s). High-framerate ultrasound-tensiometry tracks spatial variations in tendon wave speed, which may be useful to investigate local tissue loading and to delineate individual muscle contributions to movement. • Ultrasound-tensiometry combines a mechanical tap with high-framerate ultrasound to measure spatial variations in shear wave speed within a tendon. • Measured spatial variations in wave speed indicate non-uniform loading within a tendon. • These measurements will improve our understanding of muscle-tendon function during dynamic movement. [ABSTRACT FROM AUTHOR]

• Observers do not consistently adhere to the 4-point Heckmatt grading scale. • A 3-point Heckmatt grading scale was always consistently used by observers. • Utilizing a simplified 3-point Heckmatt grading scale enhances accuracy and usability. The 4-point Heckmatt grading scale can easily be used to analyze muscle ultrasound images. The scale is used in an expanding set of muscles and neuromuscular disorders. This prompted the need for evaluation of the measurement properties of the scale in its current form. In this retrospective observational study we included muscle ultrasound images from patients who were undergoing an ultrasound exam for either clinical or research purposes. The primary outcome of this study was to investigate and improve the measurement properties of the Heckmatt scale using Rasch analysis. We investigated whether observers consistently used the 4 response categories. Data was available of 30.967 muscle ultrasound images from 1783 patients and 43 different individual muscles. In 8 of the 43 muscles, observers had difficulty to discriminate between the response categories, especially in bulbar muscles. After rescoring to a 3-point scale, the response categories were consistently used in all 43 muscles. In conclusion, a 3-point Heckmatt grading scale leads to improved accurate scoring compared to the original 4-point Heckmatt grading scale. Using the 3-point Heckmatt grading scale will not only simplify the use of the scale but also enhance its application in clinical practice and research purposes. [ABSTRACT FROM AUTHOR]

Ultrasound (US) is recommended for HCC surveillance in high-risk patients but has limited performance in detecting early-stage HCC. We aimed to compare the diagnostic performance of biannual US and annual non-contrast abbreviated magnetic resonance imaging (NC-AMRI) as HCC surveillance modalities in high-risk patients. This prospective, multicenter cohort study enrolled participants with an estimated annual risk of HCC greater than 5% between October 2015 and April 2017. Participants underwent six rounds of HCC surveillance at 6-month intervals, with both US and NC-AMRI at rounds 1, 3, and 5, and only US at rounds 2, 4, and 6. The sensitivity, diagnostic yield (DY), and false referral rate (FRR) for HCC detection by US and NC-AMRI were compared. In total, 208 participants underwent 980 US and 516 NC-AMRI examinations during 30 months of follow-up. Among them, 34 HCCs were diagnosed in 31 participants, with 20 (64.5%) classified as very early-stage and 11 (35.5%) as early-stage HCC. The sensitivity of annual NC-AMRI (71.0%, 22/31) was marginally higher than that of biannual US (45.2%, 14/31; p = 0.077). NC-AMRI showed a significantly higher DY than US (4.26% vs. 1.43%, p <0.001), with a similar FRR (2.91% vs. 3.06%, p = 0.885). A simulation of alternating US and NC-AMRI at 6-month intervals yielded a sensitivity of 83.9% (26/31), significantly exceeding that of biannual US (p = 0.006). Annual NC-AMRI showed a marginally higher sensitivity than biannual US for HCC detection in high-risk patients. The DY of annual NC-AMRI was significantly higher than that of biannual US, without increasing the FRR. Thus, alternating US and NC-AMRI at 6-month intervals could be an optimal surveillance strategy for high-risk patients. Current guidelines permit the use of magnetic resonance imaging (MRI) as a surveillance tool for hepatocellular carcinoma in patients in whom ultrasonography (US) is inadequate. However, the specific indications, imaging sequences, and intervals for MRI surveillance remain unclear. In our study, we found that annual non-contrast abbreviated MRI exhibited marginally higher sensitivity and significantly better diagnostic yield than biannual US in patients at high risk of hepatocellular carcinoma. Alternating US and non-contrast abbreviated MRI at 6-month intervals led to significantly improved sensitivity compared to biannual US, making it a potentially optimal surveillance strategy for high-risk patients. NCT02551250 [Display omitted] • Biannual US showed suboptimal performance for early-stage HCC detection. • Annual NC-AMRI had significantly higher diagnostic yield than biannual US, without increasing the false referral rate. • Alternating biannual US and NC-AMRI had significantly higher sensitivity than biannual US. [ABSTRACT FROM AUTHOR]

This study aimed to apply the International Ovarian Tumor Analysis (IOTA) Simple Rules (SR), the Ovarian-Adnexal Reporting and Data System (O-RADS) and contrast-enhanced ultrasound (CEUS) in an identical cohort of Chinese patients and to analyze their performance in discrimination of ovarian masses with solid components. This was a two-center retrospective study that included a total of 94 ovarian lesions in 86 women enrolled from January 2018 to February 2023. The lesions were classified by using the IOTA terminology and CEUS was performed for the lesions exhibiting solid components on ultrasonography, IOTA SR and O-RADS were applied, and CEUS images were analyzed retrospectively. We assessed the time to wash-in, time to peak intensity (PI), PI compared to myometrium, and time to wash-out, and observed statistically significant differences between benign and malignant lesions in the first three parameters. CEUS characteristics were employed to determine CEUS scores for benign (score 0) and malignant (score 3) lesions. Subsequently, the lesions were reassessed based on the IOTA SR and O-RADS classifications and CEUS scores. The sensitivity, specificity, and area under the receiver-operating-characteristics curve (AUC) of the different models were also determined. Among the 94 ovarian lesions, 46 (48.9%) were benign and 48 (51.1%) were malignant. It was found that in the 60 lesions to which the SR could be applied, the sensitivity, specificity, and AUC was 0.900, 0.667, and 0.783, respectively. The sensitivity, specificity, and AUC of O-RADS was observed to be 1.000, 0.283 and 0.641, respectively. When SR and O-RADS were combined with CEUS, their sensitivity, specificity, and AUC values were increased to 0.917, 0.891, 0.904, and 0.958, 0.783, 0.871, respectively. IOTA SR and O-RADS exhibited relatively low specificity in differentiating malignant from benign ovarian lesions with the solid components, and their diagnostic performance can be significantly improved when combined with CEUS. [ABSTRACT FROM AUTHOR]

Ultrasound imaging (USI) is the gold standard in the clinical diagnosis of thyroid diseases. Compared with two-dimensional (2D) USI, three-dimensional (3D) USI could provide more structural information. However, the unstable pressure generated by the hand-hold ultrasound probe scanning can cause tissue deformation, especially in soft tissues such as the thyroid. The deformation is manifested as tissue structure being compressed in 2D USI, which results in structural discontinuity in 3D USI. Furthermore, multiple scans apply pressure in different directions to the tissue, which will cause relative displacement between the 3D images obtained from multiple thyroid scans. In this work, we proposed a framework to minimize the influence of the variation of pressure in thyroid 3D USI. To correct pressure artifacts in a single scanning sequence, an adaptive method to smooth the position of the 2D ultrasound (US) image sequence is adopted before performing volumetric reconstruction. To build a whole 3D US image including both sides of the thyroid gland, an iterative closest point (ICP) based registration pipeline is adopted to eliminate the relative displacement caused by different pressure directions. Our proposed method was validated by in vivo experiments, including healthy volunteers and volunteers with thyroid nodules at different grading levels. The thyroid gland and nodule are rendered intelligently in the whole scanning region to facilitate the observation of 3D USI results by the doctor. This work might make a positive contribution to the clinical diagnosis of diseases of the thyroid or other soft tissues. [ABSTRACT FROM AUTHOR]

To enhance the quality of low-resolution (LR) ultrasound images and mitigate artifacts and speckle noise, which can impede accurate medical diagnosis, a novel method called the dual frequency-domain guided adaptation model (DF-GAM) is proposed. The method aims to achieve high-quality image reconstruction across diverse domains, including different ultrasound machines, diseases and phantom images. DF-GAM utilizes a dual-branch network architecture combined with frequency-domain self-adaptation and self-supervised edge regression. This approach enables cross-domain enhancement by focusing on the reconstruction of clear tissue structures and speckle patterns. The model is designed to adapt to various ultrasound imaging (USI) scenarios, ensuring its applicability in real-world clinical settings. Experimental evaluations of DF-GAM were conducted using five different datasets. The results demonstrated the method's effectiveness, with DF-GAM outperforming existing enhancement techniques. The average peak signal-to-noise ratio (PSNR) achieved was 34.62, and the structural similarity index (SSIM) was 0.91, indicating a significant improvement in image quality compared to other methods. DF-GAM shows great potential in improving medical image diagnosis and interpretation. Its ability to enhance LR ultrasound images across various domains without the need for extensive training data makes it a valuable tool for clinical use. The high PSNR and SSIM scores validate the method's effectiveness, suggesting that DF-GAM could significantly contribute to the field of USI diagnostics. [ABSTRACT FROM AUTHOR]

Ultrasound beams sometimes need to be steered from the edge of linear array transducers to reach the sample volume with a desired Doppler angle in vascular exams. This phantom study aims to evaluate the impact of apertures located at the array edge on peak velocity (PV) measurements. Three ultrasound scanner systems equipped with eight transducers from 3 major ultrasound vendors were tested using a flow phantom with a horizontal tube. Five spectral Doppler measurements with the aperture positioned at one edge of the array and 5 with the aperture at the center of the array were obtained using all available scanner-transducer combinations while maintaining all scan parameters and the sample volume in the same tube location. Differences in PVs between center and edge apertures were compared across 4 constant flow rates. The averaged PVs for all phantom flow rates ranged from 24.4 cm/s to 138.2 cm/s from the array center. The averaged PVs from the center aperture were significantly greater than the corresponding measurements from the edge aperture for each flow rate (all p < 0.001). The relative PV differences ranged from 6.7% to 19.4% across all transducers and flow rates. Significantly lower PVs were consistently shown with the Doppler beam aperture at the array edge compared to center among all tested systems. This may be due to a narrower aperture width, shifted central axis, and less intrinsic spectral broadening error at the array edge. Controlling variations in Doppler aperture location is important in clinical applications which depend on consistent velocity measurements. [ABSTRACT FROM AUTHOR]

Ultrasound image examination has become the preferred choice for diagnosing metabolic dysfunction-associated steatotic liver disease (MASLD) due to its non-invasive nature. Computer-aided diagnosis (CAD) technology can assist doctors in avoiding deviations in the detection and classification of MASLD. We propose a hybrid model that integrates the pre-trained VGG16 network with an attention mechanism and a stacking ensemble learning model, which is capable of multi-scale feature aggregation based on the self-attention mechanism and multi-classification model fusion (Logistic regression, random forest, support vector machine) based on stacking ensemble learning. The proposed hybrid method achieves four classifications of normal, mild, moderate, and severe fatty liver based on ultrasound images. Our proposed hybrid model reaches an accuracy of 91.34% and exhibits superior robustness against interference, which is better than traditional neural network algorithms. Experimental results show that, compared with the pre-trained VGG16 model, adding the self-attention mechanism improves the accuracy by 3.02%. Using the stacking ensemble learning model as a classifier further increases the accuracy to 91.34%, exceeding any single classifier such as LR (89.86%) and SVM (90.34%) and RF (90.73%). The proposed hybrid method can effectively improve the efficiency and accuracy of MASLD ultrasound image detection. [ABSTRACT FROM AUTHOR]

We would like the reader to consider the current paediatric point-of-care ultrasound (POCUS) landscape. Even in the most developed European healthcare systems, paediatric POCUS programmes and users mostly operate in silos and are un-, or at best underrepresented by major professional bodies. While international societies focus on the extent and content of POCUS investigations, guidelines and associated evidence, there is little to no established framework for education and clinical governance standards on this explosively advancing field. Borrowing from fluid dynamics, this rapid advancement generates cavitation, leaving providers and educators exposed in certain crucial areas of ongoing clinical practice covered contemporaneously, or worse, post hoc, allowing for clinical governance or medico-legal scrutiny. We give a glimpse into our prospective local POCUS clinical practice initiative and how it complements, advances and affirms our clinical decision making on a daily basis. We'll guide the reader through ward rounds, procedural applications, specialist assessments with allied health professionals, referrals, remote consultations, new patient admissions, and grand rounds. As we are in the process of building a robust, reliable and accountable clinical governance structure around our daily practice, we would also like to demonstrate the need and utility for introductory courses, ongoing educational sessions, established mentorship and regular governance meetings ensuring optimal clinical outcomes. We hope to give insights to clinical practice, deployment, recruitment, education and potential future applications like telemedicine. [ABSTRACT FROM AUTHOR]

Ultrasonic transducers, especially used in medical imaging, strike a balance between sensitivity and bandwidth to yield high-quality images. This challenge centers on the optimal transmission of acoustic energy across the layers of transducer. The backing layer stands as a critical component of transducers, orchestrating the conversion of acoustic impedance to enhance bandwidth. While traditional designs often utilize metal particle-polymer composites, issues arise from material limitations, complex fabrications, and deviations in sample properties. This study introduces an optimized multilayer backing (MLB) design using a metal-polymer structure. Implementing an equivalent circuit model, an MLB of epoxy-aluminum composite is designed. The ultrasonic transducer has an operating frequency of about 6 MHz, in which the backing layer is a stacking composite of 19.3 μm epoxy resin and 30 μm aluminum foil. Notably, this optimized design increased the -6dB bandwidth from 27.72 % to 33.44 % and verified its superior electro-acoustic performance based on ultrasonic imaging. Furthermore, this innovative design approach provides a wider range of acoustic impedance, improves the efficiency of ultrasonic energy transmission, and provides a streamlined approach to miniaturized transducer design. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore the value of ultrasound-based radiomics analysis for early recurrence after surgical resection of hepatocellular carcinoma (HCC). This retrospective study included 127 patients who underwent primary surgical resection for HCC between October 2019 and November 2021. The patients were subsequently divided into training and validation sets (7:3 ratio). All patients received preoperative routine ultrasound and contrast-enhanced ultrasound examination, with postoperative pathological confirmation of HCC. Radiomics features were extracted from maximum section of a two-dimensional ultrasound image. The least absolute shrinkage and selection operation logistic regression algorithm with 10-fold cross-validation was used to establish ultrasonic radiomics features. Logistic regression modelling was used to build models based on clinical and ultrasonic features (model 1, clinical–ultrasonic model), radiomics signature (model 2, ultrasonic radiomics model), and the combination (model 3, clinical–ultrasonic–radiomics model). Then, a nomogram model was established to predict the risk of early recurrence, and the application value of nomogram through internal verification was evaluated. Model 3 showed optimal diagnostic performance in both training set (area under the curve [AUC], 0.907) and validation set (AUC, 0.925), followed by the model 1 in training set (AUC, 0.846) and validation set (AUC, 0.855), both above two models performed better than model 2 in training set (AUC, 0.751) and validation set (AUC, 0.702) (p < 0.05). In the training set and validation set of model 3, the sensitivity were 83.3%, 77.8%, the specificity ware 95.8%, 100.0% and the C-index were 0.791, 0.778. The preoperative clinical–ultrasonic–radiomics model is anticipated to be a reliable tool for predicting the early recurrence of surgical resection of HCC. [ABSTRACT FROM AUTHOR]

The objectives of this ultrasound and anatomical study were: (1) To evaluate the reliability of ultrasound identification of the enthesis of the central slip of the extensor digitorum tendon (CSET) using cadaver specimens; (2) To assess the concordance of the measurement of the CSET thickness by ultrasound and gross anatomy; (3) To evaluate the variation in ultrasound identification of the CSET enthesis in a cadaveric experimental model of PIP synovitis. Four rheumatologist ultrasonographers blindly and independently measured by ultrasound the CSET enthesis thickness in the second to fifth fingers of 8 hands from fresh-frozen human cadavers in two rounds. These fingers were dissected and the thickness of the CSET measured by the anatomist. In addition, an artificial synovitis was created in the proximal interphalangeal (PIP) joints of a different cadaveric hand. The ultrasonographic CSET enthesis thickness was measured by the four investigators before and after intra-articular ultrasound guided injection of material. Intra- and inter-observer reliability of CSET enthesis thickness measurement were good to excellent (ICC 0.93 for intra-observer agreement and 0.89–0.92 for inter-observer agreement). Ultrasound measurements were consistent and only slightly smaller than the anatomical ones (µ = -0.039 mm). The differences between the measurements of CSET enthesis thickness before and after the synovitis model were not statistically significant. Ultrasound demonstrated high multiobserver reliability and agreement with gross anatomy in identifying the CSET enthesis and discriminated it from the capsular tissue of the PIP. Furthermore, an experimental model of PIP synovitis did not interfere with its identification. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the effectiveness of two contrast agents, SonoVue (SV) and Sonazoid (SZ), by comparing them intra-individually in contrast-enhanced ultrasound (CEUS)-CT/MRI fusion imaging (FI) to improve the visibility of inconspicuous liver malignancies on B-mode sonography for guiding percutaneous radiofrequency ablation (RFA). Additionally, the radiologists' preference between SonoVue- CT/MRI FI (SV-FI) and Sonazoid-CT/MRI FI (SZ-FI) was determined. This prospective study enrolled 23 patients with inconspicuous hepatic malignancies (≤ 3 cm) on B-mode US who underwent both SV-FI and SZ-FI for RFA guidance. The patients underwent real-time CEUS FI with CT/MRI on the same day, utilizing both SV and SZ with at least 15-min intervals. Tumor visibility and radiologists' preferences were assessed and graded using a 4-point scale during the dynamic phases of both SV-FI and SZ-FI and the Kupffer phase of SZ-FI. The tumor visibility scores obtained from CEUS-CT/MRI FI were significantly better than those obtained from US-FI. Indeed, SV-FI and SZ-FI demonstrated comparable visibility scores when corresponding phases were compared (p > 0.05). However, the Kupffer phase images of SZ-FI displayed superior visibility scores (3.70 ± 0.56 vs. 2.96 ± 0.88; p = 0.002) than the late vascular phase images of SV-FI. The radiologists favored SZ-FI in many cases, exhibiting moderate inter-observer agreement (Kappa value = 0.587; 95% CI, 0.403–0.772). Although CEUS-CT/MRI FI with either SV or SZ substantially improved the visibility of inconspicuous tumors on US-CT/MRI FI, radiologists preferred SZ to SV to guide the RFA procedure. [ABSTRACT FROM AUTHOR]

To identify musculoskeletal anatomical structures in real time by using deep learning techniques. An automated annotation system based on deep learning neural networks was designed to aid in the real-time identification of anatomical structures. Additionally, novel algorithms aimed at diminishing model training duration while enhancing accuracy were introduced. In this study, we proposed a semi-supervised learning (SSL) approach that substantially reduced annotation time. We also adopted the focal loss (FL) method to enhance the accuracy of challenging structures. Additionally, during the inference stage, we harnessed the temporal continuity of video frames, which involved leveraging information from preceding frames to facilitate recognition of structures in the current image. Training the model through a combination of SSL and FL yielded superior performance compared with supervised learning, while also substantially mitigating any expense linked to annotations. During inference, the incorporation of frame continuity helped to avoid discontinuity and bolster accuracy. Forearm tissue detection was demonstrated by properly configuring the SSL approach, including FL and the filtering threshold. Comparable performance with supervised learning was achieved while only using 30% of the training data. The real-time experimental results also demonstrated that implementing relation of frame reduced the number of missing frames during inference and successfully increased the confidence scores of detected objects. This proposed system has the potential to aid medical professionals in efficiently and effectively diagnosing musculoskeletal disorders, ultimately leading to enhanced patient outcomes. [ABSTRACT FROM AUTHOR]

The arterial wall not only moves in the radial direction to expand circumferentially but also moves in the axial (longitudinal) direction in a predictable bidirectional pattern during a normal cardiac cycle. While common carotid artery (CCA) longitudinal wall motion (CALM) has been described previously, there is a lack of evidence-based method standardization to align practices for human measurement. The purpose of this study was to evaluate whether different scanning planes impact CALM outcomes in healthy males and females to provide clarity on data collection strategies. Thirty-one healthy adults (16 females, 23 ± 3 y of age) underwent ultrasound scanning of the right CCA in the anterior, lateral, and posterior imaging planes. CALM was evaluated using a custom speckle-tracking algorithm and was analyzed as segmental motion outcomes (anterograde, retrograde, maximum displacement and radial-axial path length). No differences in any CALM outcome were observed between imaging planes (p > 0.05), and equivalence testing indicated that retrograde CALM displacement was similar between anterior and posterior distal walls (p = 0.04). We observed no differences (p > 0.05) in CALM outcomes between the proximal (free-wall, adjacent to the internal jugular vein [IJV]) and distal wall in the posterior imaging plane. Qualitatively, it was more difficult to successfully track vascular tissue between the IJV and CCA due to the thin wall components and highly mobile wall in the radial direction. In the absence of clear differences between scanning planes, we recommend standardizing acquisition in the lateral plane and avoiding the IJV free-wall when evaluating CALM in humans. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the performances of quantitative ultrasound (QUS) for the detection and assessment of hepatic steatosis when implemented using an ultraportable ultrasound scanner. Seven established QUS parameters were investigated. Ultrasound signals were acquired using a new ultraportable ultrasound device, the Hepatoscope. The feasibility of QUS using the Hepatoscope was first assessed in vitro. Clinical reliability, accuracy and staging capabilities were evaluated in 60 patients referred to a hepatology consultation for known chronic liver disease and enrolled in a prospective clinical investigation using the controlled attenuation parameter (CAP) as ground truth. QUS parameters showed moderate (intra-class correlation coefficient [ICC] >0.50) to excellent (ICC >0.90) reliability. Two parameters, namely Lizzi-Feleppa mid-band fit and attenuation, were both reliable (ICC = 0.89 and 0.86, respectively) and correlated with the CAP (squared Pearson correlation coefficient of R2 = 0.65 and R2 = 0.6, respectively). For steatosis detection (S0 vs. ≥S1), the two parameters yielded an area under the receiving operating characteristic curve of 0.90 and 0.86, respectively (95% confidence interval: [0.81–0.99] and [0.76–0.96], respectively). QUS can be reliably and accurately implemented on ultraportable ultrasound scanners. The combination of ultraportability and quantitative assessment of liver fat is promising for large-scale screening and monitoring of hepatic steatosis. [ABSTRACT FROM AUTHOR]

Volume status assessment of a patient by ultrasound (US) imaging of the inferior vena cava (IVC) is important for the diagnosis and prognosis of various clinical conditions. In order to improve the clinical investigation of IVC, which is mainly based on unidirectional US (in M-mode), automated processing of 2-D US scans (in B-mode) has enabled tissue movement tracking on the visualized plane and can average this in various directions. However, IVC geometry outside of the visualized plane is not under control and could result in errors that have not yet been evaluated. We used a method that integrates information from long- and short-axis IVC views (simultaneously acquired in the X-plane) to assess challenges in IVC diameter estimations using 2-D US scans in eight healthy subjects. Relative movements between the US probe and IVC induced the following problems when assessing IVC diameter via 2-D view: a median error (i.e. , absolute difference with respect to diameter measured in the X-plane) of 17% using 2-D US scans in the long-axis view of the IVC affected by medio-lateral displacements (median: 4 mm); and a median error of 7% and 9% when measuring the IVC diameter from a short-axis view in the presence of pitch angle (median: 0.12 radians) and cranio-caudal movement (median: 15 mm), respectively. Relative movements in the IVC that are out of view of B-mode scans cannot be detected, which results in challenges in IVC diameter estimation. [ABSTRACT FROM AUTHOR]

To summarize the preliminary application experience of intraoperative ultrasound with burr hole probe in minimally invasive neurosurgery and to explore its application value. Thirty-one patients who underwent intraoperative ultrasound guided puncture with burr hole probe in our center from August 2018 to May 2024 were collected, including 16 cases of ventriculoperitoneal shunt operation, 6 cases of assisted stereotactic needle biopsy, 3 cases of intracranial pressure probe implantation in lateral ventricle, 3 cases of brain abscess puncture for external drainage, and 3 cases of intracranial cyst puncture and peritoneal drainage. During the procedures, the burr hole probe was used to locate the intracranial targets and guide the puncture. The postoperative computed tomography (CT) scans or combined postoperative pathological results could verify the accuracy of puncture. In addition, the intervention effect and recovery status of patients were also recorded. The intraoperative ultrasound with burr hole probe could clearly display all the purposed targets and accurately guide the puncture procedures in all cases. All patients achieved satisfactory diagnostic and therapeutic results without new neurological dysfunction and serious complications. The intraoperative ultrasound with burr hole probe is an effective device for demonstrating intracranial structures. It not only enables minimally invasive and precise diagnosis or treatment of many neurosurgical diseases, but also is simple and safe to operate, which has important promotional value in the neurosurgery. [ABSTRACT FROM AUTHOR]

Functional neuroimaging studies demonstrate disinhibition of the cortico-striatal-thalamo-cortical circuit. However, structural imaging studies revealed conflicting results, some suggesting smaller volumes of the caudate nucleus (CN) in children with Gilles de la Tourette syndrome (TS). Here we wanted to find out whether transcranial sonography (TCS) detects alterations of raphe nuclei, substantia nigra, lenticular nucleus (LN), or CN in children with Tic disorder or TS (TIC/TS).The study included 25 treatment-naive children (age: 12.2 ± 2.5 years) with a DSM-V based diagnosis of Tic disorder or TS (10 subjects), without other psychiatric or neurologic diagnosis, and 25 healthy controls (age: 12.17 ± 2.57 years), matched for age and sex. Parental rating of behavioral, emotional abnormalities, somatic complaints and social competencies of the participants were assessed using the Child Behavior Check List (CBCL/4-18R). TCS of deep brain structures was conducted through the preauricular acoustic bone windows using a 2.5-MHz phased-array ultrasound system. Fisher's exact test and Mann-Whitney-U test were used for comparisons between TIC/TS patients and healthy volunteers. The number of participants with hyperechogenic area of left CN in the TIC/TS sample was increased, compared to the healthy control group. TIC/TS patients with hyperechogenic CN showed an increased occurrence of thought- and obsessive-compulsive problems. This TCS study revealed pathologic structural changes in CN, its higher occurrence in TIC/TS compared to healthy controls and the relation to comorbidity of thought problems. Further research should focus on the molecular cause of these alterations, probably the disturbed iron metabolism. [ABSTRACT FROM AUTHOR]

The current research aims to study the ultrasound assisted intensification of activity of commonly applied amylase enzyme, under varying parameters like power, frequency, duty cycle, temperature and enzyme concentration. Two ultrasonic reactor configurations as bath and horn are used for comparing the efficacy of reactor configuration. The initial activity of native amylase was found as 5.77 U/g at optimum temperature of 35° C and pH 7. Under US bath treatment, α amylase attained maximum activity of 7.498 U/g at best treatment conditions of 120 W power, 30% duty cycle and 15 minutes of exposure time. In the case of US horn, application of 60 W power, 30% duty cycle, and 5 minutes of exposure increased the enzyme activity to 6.907 U/ g. Set of treatment approaches explored for obtaining highest yield of reducing sugars revealed the best approach of ultrasonic treatment of food waste followed by ultrasonic bath intensified amylase hydrolysis, yielding maximum amount of reducing sugars as 8.14 g/L in only 15 min. Overall the work elucidated the role of ultrasound in intensifying the enzyme activity as well as food waste hydrolysis maximizing the utilization of sustainable resource. [Display omitted] • Elucidating the role of ultrasound in intensifying enzyme activity. • Understanding into effect of ultrasonic parameters on intensification. • Ultrasonic bath was more effective than probe due to controlled cavitation. • Analysing various combinations of ultrasound treatment for enzyme and food waste. • Maximum sugar yield as 8.14 g/L using ultrasonic bath treated food waste and enzyme. [ABSTRACT FROM AUTHOR]

Ultrasound imaging has been explored as a potential diagnostic tool for obstructive sleep apnea (OSA); we reported backscatter ultrasound imaging (BUI) of the tongue correlates with OSA severity in adults. We focus on anatomical features of the tongue using standardized ultrasonography and hypothesize that differences in morphology correlate with OSA severity. This prospective study was IRB approved (53,172) and conducted at Stanford University Sleep Surgery Clinic. Patients ≥18 years with polysomnography (PSG) underwent a standardized submental ultrasound scan using a laser alignment tool to observe the upper airway in supine position during tidal respiration. Images acquired from this scan were divided into 4 equiangular regions (A-D). A total of 144 patients (30 women) July 2020–December 2022 were included with mean age 41.6 years (±12.9 SD), BMI 27.2 kg/m2(±4.7 SD), and AHI 19.7 (±20.0 SD). Moderate-to-severe OSA patients had significantly narrower airspace at regions A, B and C with p-values ranging from <0.0001 to 0.0003. These patients had a significantly wider (p = 0.0021–0.0045 for regions A, B and C) tongue and thicker (p = 0.0403 for region B) deep tissue. The predictive model to assess the risk of moderate-to-severe OSA achieved an area under the receiver operating characteristic curve of 0.839 (95 % CI: 0.769 to 0.895). With standardized, computerized ultrasound imaging of the shape and configuration of the tongue, we identified regions that correlated well with OSA severity. Further research is needed to determine the clinical implications of such pathophysiological findings. • Use computerized anatomical features with standardized ultrasound imaging to overcome reproducibility concerns. • Visualizing and characterizing upper airway structures is critically important as its collapsibility is the mechanism of OSA. • With standardized ultrasound imaging, we have identified upper airway regions that correlate well with disease severity (AHI). • Further research is needed to determine the clinical implications of such pathophysiological findings. [ABSTRACT FROM AUTHOR]

This study aimed to develop and evaluate a deep learning-based model that could automatically measure anterior segment (AS) parameters on preoperative ultrasound biomicroscopy (UBM) images of implantable Collamer lens (ICL) surgery candidates. A total of 1164 panoramic UBM images were preoperatively obtained from 321 patients who received ICL surgery in the Eye Center of Renmin Hospital of Wuhan University (Wuhan, China) to develop an imaging database. First, the UNet++ network was utilized to segment AS tissues automatically, such as corneal lens and iris. In addition, image processing techniques and geometric localization algorithms were developed to automatically identify the anatomical landmarks (ALs) of pupil diameter (PD), anterior chamber depth (ACD), angle-to-angle distance (ATA), and sulcus-to-sulcus distance (STS). Based on the results of the latter two processes, PD, ACD, ATA, and STS can be measured. Meanwhile, an external dataset of 294 images from Huangshi Aier Eye Hospital was employed to further assess the model's performance in other center. Lastly, a subset of 100 random images from the external test set was chosen to compare the performance of the model with senior experts. Whether in the internal test dataset or external test dataset, using manual labeling as the reference standard, the models achieved a mean Dice coefficient exceeding 0.880. Additionally, the intra-class correlation coefficients (ICCs) of ALs' coordinates were all greater than 0.947, and the percentage of Euclidean distance distribution of ALs within 250 μm was over 95.24%.While the ICCs for PD, ACD, ATA, and STS were greater than 0.957, furthermore, the average relative error (ARE) of PD, ACD, ATA, and STS were below 2.41%. In terms of human versus machine performance, the ICCs between the measurements performed by the model and those by senior experts were all greater than 0.931. A deep learning-based model could measure AS parameters using UBM images of ICL candidates, and exhibited a performance similar to that of a senior ophthalmologist. [ABSTRACT FROM AUTHOR]

Although there are methods to identify regions of interest (ROIs) from echocardiographic images of myocardial tissue, they are often time-consuming and difficult to create when image quality is poor. Further, while myocardial strain from ultrasound (US) images can be estimated, US alone cannot obtain functional information, such as oxygen saturation (sO 2). Photoacoustic (PA) imaging, however, can be used to quantify sO 2 levels within tissue non-invasively. Here, we leverage deep learning methods to improve segmentation of the anterior wall of the left ventricle and apply both strain and oxygen saturation analysis via segmentation of murine US and PA images. Data revealed that training on US/PA images using a U-Net deep neural network can be used to create reproducible ROIs of the anterior wall of the left ventricle in a murine image dataset. Accuracy and Dice score metrics were used to evaluate performance of the neural network on each image type. We report an accuracy of 97.3% and Dice score of 0.84 for ultrasound, 95.6% and 0.73 for photoacoustic, and 96.5% and 0.81 for combined ultrasound and photoacoustic images. Rapid segmentation via such methods can assist in quantification of strain and oxygenation. [ABSTRACT FROM AUTHOR]

The main aim of this study was to determine whether the use of contrast-enhanced ultrasound (CEUS) could improve the categorization of suspicious breast lesions based on the Breast Imaging Reporting and Data System (BI-RADS), thereby reducing the number of benign breast lesions referred for biopsy. This prospective study, conducted between January 2017 and December 2018, enrolled consenting patients from eight teaching hospitals in China, who had been diagnosed with solid breast lesions classified as BI-RADS 4 using conventional ultrasound. CEUS was performed within 1 wk of diagnosis for reclassification of breast lesions. Histopathological results obtained from core needle biopsies or surgical excision samples served as the reference standard. The simulated biopsy rate and cancer-to-biopsy yield were used to compare the accuracy of CEUS and conventional ultrasound (US). Among the 1490 lesions diagnosed as BI-RADS 4 with conventional ultrasound, 486 malignant and 1004 benign lesions were confirmed based on histology. Following CEUS, 2, 395, and 211 lesions were reclassified as CEUS-based BI-RADS 2, 3, and 5, respectively, while 882 (59%) remained as BI-RADS 4. The actual cancer-to-biopsy yield based on US was 32.6%, which increased to 43.4% when CEUS-based BI-RADS 4A was used as the cut-off point to recommend biopsy. The simulated biopsy rate decreased to 73.4%. Overall, in this preselected BI-RADS 4 population, only 2.5% (12/486) of malignant lesions would have been miscategorized as BI-RADS 3 using CEUS-based reclassification. The diagnostic accuracy, sensitivity, and specificity of contrast-enhanced ultrasound reclassification were 57.65%, 97.53%, and 38.35%, respectively. Our collective findings indicate that CEUS is a valuable tool in further triage of BI-RADS category 4 lesions and facilitates a reduction in the number of biopsies while increasing the cancer-to-biopsy yield. [ABSTRACT FROM AUTHOR]

To assess the value of 3D multiparametric ultrasound imaging, combining hemodynamic and tissue stiffness quantifications by machine learning, for the prediction of prostate biopsy outcomes. After signing informed consent, 54 biopsy-naïve patients underwent a 3D dynamic contrast-enhanced ultrasound (DCE-US) recording, a multi-plane 2D shear-wave elastography (SWE) scan with manual sweeping from base to apex of the prostate, and received 12-core systematic biopsies (SBx). 3D maps of 18 hemodynamic parameters were extracted from the 3D DCE-US quantification and a 3D SWE elasticity map was reconstructed based on the multi-plane 2D SWE acquisitions. Subsequently, all the 3D maps were segmented and subdivided into 12 regions corresponding to the SBx locations. Per region, the set of 19 computed parameters was further extended by derivation of eight radiomic features per parameter. Based on this feature set, a multiparametric ultrasound approach was implemented using five different classifiers together with a sequential floating forward selection method and hyperparameter tuning. The classification accuracy with respect to the biopsy reference was assessed by a group-k-fold cross-validation procedure, and the performance was evaluated by the Area Under the Receiver Operating Characteristics Curve (AUC). Of the 54 patients, 20 were found with clinically significant prostate cancer (csPCa) based on SBx. The 18 hemodynamic parameters showed mean AUC values varying from 0.63 to 0.75, and SWE elasticity showed an AUC of 0.66. The multiparametric approach using radiomic features derived from hemodynamic parameters only produced an AUC of 0.81, while the combination of hemodynamic and tissue-stiffness quantifications yielded a significantly improved AUC of 0.85 for csPCa detection (p -value < 0.05) using the Gradient Boosting classifier. Our results suggest 3D multiparametric ultrasound imaging combining hemodynamic and tissue-stiffness features to represent a promising diagnostic tool for biopsy outcome prediction, aiding in csPCa localization. [ABSTRACT FROM AUTHOR]

The accurate measurement of the wall shear rate (WSR) plays a crucial role in the early diagnosis of cardiovascular disease progression and acute events such as aneurysms and atherosclerotic plaque ruptures. To address this need, the speckle decorrelation (SDC) technique has been used to measure WSR based on the 2-D out-of-plane blood flow speed. This technique is particularly advantageous because it enables the use of a 1-D array transducer to measure WSR over the entire luminal area. This study aims to develop a region-based singular value decomposition (SVD) filtering technique that selectively suppresses clutter noise in the vascular region to measure WSR using SDC. Ultrasound simulations, in-vitro flow experiments, and an in-vivo human study were conducted to evaluate the feasibility of this method's clinical application. The results demonstrated that WSR can be effectively measured across entire vascular walls using a conventional 1-D array transducer along with the proposed methodology. This study successfully demonstrates a noninvasive and accurate SDC-based method for measuring vital vascular WSR. This approach holds significant promise for assessing vascular WSR in both healthy individuals and high-risk cardiovascular disease patients. [ABSTRACT FROM AUTHOR]

This study investigated reliability and validity of muscle cross-sectional area and echo intensity using an automatic image analysis program. Methods: Twenty-two participants completed two data collection trials consisting of ultrasound imaging of the vastus lateralis (VL) at 10 and 12 MHz. Images were analyzed manually and with Deep Anatomical Cross-Sectional Area (DeepACSA). Reliability statistics (i.e., intraclass correlation coefficient [ICC] model 2,1, standard error of measure expressed as a percentage of the mean [SEM%], minimal differences [MD] values needed to be considered real) and validity statistics (i.e., constant error [CE], total error [TE], standard error of the estimate [SEE]) were calculated. Results: Automatic analyses of ACSA and EI demonstrated good reliability (10 MHz: ICC 2,1 = 0.83 – 0.90; 12 MHz: ICC 2,1 = 0.87–0.88), while manual analyses demonstrated moderate to excellent reliability (10 MHz: ICC 2,1 = 0.82–0.99; 12 MHz: ICC 2,1 = 0.73–0.99). Automatic analyses of ACSA presented greater error at 10 (CE = -0.76 cm2, TE = 4.94 cm2, SEE = 3.65 cm2) than 12 MHz (CE = 0.17 cm2, TE = 3.44 cm2, SEE = 3.11 cm2). Analyses of EI presented greater error at 10 (CE = 3.35 a.u., TE = 2.70 a.u., SEE = 2.58 a.u.) than at 12 MHz (CE = 3.21 a.u., TE = 2.61 a.u., SEE = 2.34 a.u.). Conclusion: The results suggest the DeepACSA program may be less reliable compared to manual analysis for VL ACSA but displayed similar reliability for EI. In addition, the results demonstrated the automatic program had low error for 10 and 12 MHz. [ABSTRACT FROM AUTHOR]

The aim of the work described here was to explore the predictive value of multimodal ultrasound combined with the BRAF gene in cervical lymph node metastasis (CLNM) of papillary thyroid microcarcinoma (PTMC). One hundred six patients (114 lesions) with PTMC confirmed by surgery and pathology at Yantai Yuhuangding Hospital from July 2021 to August 2022 were analyzed retrospectively. Routine ultrasound, contrast-enhanced ultrasound, shear wave elastography examination and BRAF V600E gene detection were performed before surgery. Patients were divided into two groups on the basis of post-operative pathology: non-metastasis group and metastasis group. Univariate and multivariate analyses were used to analyze the risk factors of cervical lymph node metastasis in PTMC. Univariate analysis revealed that there were significant differences in gender, high echo in lesions, enhancement level, peak intensity (PI) and average modulus of elasticity (E avg) between the two groups (p < 0.05), but there was no significant difference in BRAF gene mutation (p = 0.855). Multivariate analysis revealed that male gender, microcalcification and hyper- or iso-enhancing parametric increased the risk of CLNM in PTMC (p < 0.05), and that sensitivity (92.3%) and accuracy (73.9%) were higher for combined diagnosis than for single diagnosis; the differences were statistically significant (p < 0.05). Male gender, microcalcification and hyper- or iso-enhancing parametrics of CEUS are independent risk factors for CLNM in PTMC patients. Combined diagnosis is more effective. [ABSTRACT FROM AUTHOR]

Although hand-held ultrasound devices (HHUSDs) are currently used for a diverse range of diagnostic and interventional applications the imaging performance of such scanners is rarely considered. The aim of this study was to assess the imaging performance of a wide-range of HHUSDs and compare their imaging performance to cart-based systems utilized for the same clinical applications. The grayscale imaging performances of 19 HHUSDs from eight different manufacturers, manufactured between 2016 and 2021, were measured using a figure-of-merit known as the resolution integral. The imaging performance of the HHUSDs were compared to 142 cart-based ultrasound scanners. The HHUSD with the overall highest resolution integral (66) was a Butterfly (Burlington, MA, USA) wired phased array for small parts applications, followed by a Philips (Bothell, WA, USA) Lumify wired curvilinear transducer (57) for abdominal applications, a Butterfly wired phased array (56) for abdominal applications, a GE (Freiburg, Baden-Wurttemberg, Germany) VScan Air wireless linear array (56) for small parts applications, and a Healcerion (Seoul, Korea) Sonon 300L wireless linear array (56) for small parts applications. A GE VScan Extend wired phased array had the highest resolution integral (44) for cardiac applications. The Butterfly phased array had the highest resolution integral of all the 19 HHUSDs, although this value is still less than the majority of cart-based cardiac and abdominal ultrasound scanners manufactured from 2010 to 2017. Clinical users of HHUSDs should be mindful of the limitations in imaging performance of hand-held ultrasound devices. [ABSTRACT FROM AUTHOR]

Freehand three-dimensional (3D) ultrasound (US) is of great significance for clinical diagnosis and treatment, it is often achieved with the aid of external devices (optical and/or electromagnetic, etc.) that monitor the location and orientation of the US probe. However, this external monitoring is often impacted by imaging environment such as optical occlusions and/or electromagnetic (EM) interference. To address the above issues, we integrated a binocular camera and an inertial measurement unit (IMU) on a US probe. Subsequently, we built a tight coupling model utilizing the unscented Kalman algorithm based on Lie groups (UKF-LG), combining vision and inertial information to infer the probe's movement, through which the position and orientation of the US image frame are calculated. Finally, the volume data was reconstructed with the voxel-based hole-filling method. The experiments including calibration experiments, tracking performance evaluation, phantom scans, and real scenarios scans have been conducted. The results show that the proposed system achieved the accumulated frame position error of 3.78 mm and the orientation error of 0.36° and reconstructed 3D US images with high quality in both phantom and real scenarios. The proposed method has been demonstrated to enhance the robustness and effectiveness of freehand 3D US. Follow-up research will focus on improving the accuracy and stability of multi-sensor fusion to mak e the system more practical in clinical environments. [ABSTRACT FROM AUTHOR]