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Objectives: To evaluate the concordance between an automatic software program and manual evaluation in reconstructing, delineating, and measuring the levator hiatus (LH) on maximal Valsalva maneuver. Methods: This was a retrospective study analyzing archived raw ultrasound imaging data of 100 patients underwent transperineal ultrasound (TPUS) examination. Each data were assessed by the automatic Smart Pelvic System software program and manual evaluation. The Dice similarity index (DSI), mean absolute distance (MAD), and Hausdorff distance (HDD) were calculated to quantify delineation accuracy of LH. Agreement between automatic and manual measurement of levator hiatus area was assessed by intraclass correlation coefficient (ICC) and Bland–Altman method. Results: The satisfaction rate of automatic reconstruction was 94%. Six images were recognized as unsatisfactory reconstructed images for some gas in the rectum and anal canal. Compared with satisfactory reconstructed images, DSI of unsatisfactory reconstructed images was lower, MAD and HDD were larger (p = 0.001, p = 0.001, p = 0.006, respectively). The ICC was up to 0.987 in 94 satisfactory reconstructed images. Conclusions: The Smart Pelvic System software program had good performance in reconstruction, delineation, and measurement of LH on maximal Valsalva maneuver in clinical practice, despite misidentification of the border of posterior aspect of LH due to the influence of gas in the rectum. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the diagnostic value of HyCoSy using sulfur hexafluoride microbubbles for fallopian tubal patency assessment in infertile females. Twenty‐four studies, including 1358 females with 2661 detected fallopian tubes published from January 2003 to May 2019, were identified. The pooled sensitivity was 93% (95% CI: 90–95%), while the specificity was 90% (95% CI: 87–92%). The area under the receiver‐operating characteristic curve was 0.96 (95% CI: 94–98%). The specificity of the four‐dimensional HyCoSy subgroup was higher than the 2D/3D subgroup; an increased dose of contrast agent did not affect the specificity, with only a slightly reduced sensitivity. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Translabial ultrasound is currently regarded as one of the most promising modalities in the evaluation of female pelvic organ prolapse. However, abnormal bladder descent on pelvic floor ultrasound has not been established among Chinese women. This study aimed to establish optimal cutoffs for defining bladder prolapse among Chinese women using translabial ultrasound. Methods: In this prospective multicenter study, 674 women with symptoms of lower urinary tract dysfunction and/or pelvic floor dysfunction were finally included and underwent interview, Pelvic Organ Prolapse Quantification (POP-Q) examinations and 4D translabial ultrasound. The receiver-operating characteristic (ROC) statistic was used to assess accuracy and define the optimal cutoffs. Results: The mean patient age was 42.6 (range, 19–82) years. Multivariable analysis showed that both POP-Q assessment and translabial ultrasound findings for anterior compartment were significantly associated with prolapse symptoms. The ROC statistics suggested an optimal cutoff value of 10 mm below the symphysis pubis of bladder position on Valsalva for predicting prolapse symptoms, with an area under the curve (AUC) of 0.73. Compared to translabial ultrasound, POP-Q stage showed similar accuracy for predicting prolapse symptoms (AUC: 0.74; P = 0.79), with an optimal cutoff of POP-Q stage ≥ 2. Conclusions: This study proposed that the descent of the bladder to ≥ 10 mm below the symphysis pubis on Valsalva should be proposed as an optimal cutoff value for defining abnormal bladder prolapse on translabial ultrasound among the Chinese population. These cutoff values are nearly identical to those previously established in mainly Caucasian women. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: The aim of the study was to develop artificial intelligence (AI) algorithms using 2D transperineal ultrasound (TPUS) static images to simplify the clinical process of diagnosing stress urinary incontinence (SUI) in practice. Methods: The study involved 400 patients in total, including 265 SUI patients and 135 non-SUI patients who underwent a routine clinical evaluation process by urologists and TPUS. They were classified into different groups based on the International Consultation on Incontinence Questionnaire (ICIQ) to assess the impact of inconvenience on patients' lives. Four AI models were developed by 2D TPUS images: Model A (a single-mode model based on Valsalva maneuver images to classify G-0, G-1, and G-2); Model B (a dual-mode model based on Valsalva maneuver and resting state images to classify G-0, G-1, and G-2); Model C (a single-mode model based on Valsalva maneuver images to classify G-2 and G-01); Model D (a dual-mode model based on Valsalva maneuver and resting state images to classify G-2 and G-01). The performance of the four models was evaluated by confusion matrices and the area under the receiver-operating characteristic curve (AUC). Results: The dual-mode model based on the Valsalva maneuver and resting-state images (Model D) had a higher accuracy of 86.3% and an AUC of 0.922, which was significantly higher than the AUCs of the other three models: 0.771, 0.862, and 0.827. Conclusions: The AI algorithm using 2D TPUS static images of the Valsalva maneuver and resting state may be a promising tool in the diagnosis of SUI patients in to relieve clinical processes in practice given its ease of use in clinical applications. [ABSTRACT FROM AUTHOR]

The aim of this study is to evaluate the efficacy of qualitative analysis of contrast-enhanced ultrasound (CEUS) in discrimination of adnexal masses which were undetermined by conventional ultrasound (US). A total of 120 patients underwent transabdominal CEUS. The initial enhancement time and intensity compared with the uterine myometrium, contrast agent distribution patterns and dynamic changes of enhancement were assessed. The sensitivity (Sen), specificity (Spe), positive predictive value (PPV), negative predictive value (NPV), accuracy (ACC) and Youden’s index were calculated for contrast variables. The gold standard was the histological diagnosis. There were 48 malignant tumors and 72 benign tumors. The enhancement features of malignant masses were different from benign ones. Earlier or simultaneous enhancement with inhomogeneous enhancement yielded the highest capability in differential diagnosis, and Sen, Spe, PPV, NPV, ACC, Youden’s index was 89.6%, 97.2%, 93.2%, 95.6%, 93.3%, and 0.88, respectively. The qualitative evaluation of CEUS is useful in the differential diagnosis of adnexal masses where conventional US is indeterminate. [ABSTRACT FROM AUTHOR]

As problems with the overuse of radical prostate cancer (PCa) treatment are increasingly exposed, focal therapy represents the direction of low- or intermediate-risk PCa management in the future. However, inaccurate diagnosis and low controllability of focal therapy hinder its clinical translation. In this study, we develop simple structural cyclic arginine-glycine -aspartic (cRGD) peptide-modified and indocyanine green (ICG)-loaded microbubbles (cRGD-ICG-MBs) for ultrasound-photoacoustic imaging and multi-synergistic photothermal therapy (PTT) to address the above problems. Precise PCa diagnosis is achieved by molecular ultrasound imaging. cRGD-targeting and low-frequency ultrasound with an amplitude of 500 kPa convert MBs into nanoparticles for enhanced ICG delivery. A low frequency 2500 kPa amplitude ultrasound enables temporary vasculature destruction, which minimizes heat loss during PTT. Specifically, ICG in the tumor region is 14-fold higher than the control, resulting in satisfactory PTT. Our study highlights that this theranostic strategy possesses considerable clinical translational potential, especially in mini-invasive and individualized PCa therapy. Simple structural multifunctional microbubbles are designed as cRGD-modified and indocyanine green-loaded (cRGD-ICG-MBs) for theranostic of prostate cancer. With sequential applications of various kinds of ultrasound and laser, cRGD-ICG -MBs realize tumoral molecular ultrasound imaging, efficient ICG delivery, temporary vasculature destruction, and synergistic photothermal therapy. The results show that such simple structure cRGD-ICG -MBs hold great clinical translation potential in mini-invasive and precise tumor therapy. Unlabelled Image [ABSTRACT FROM AUTHOR]

The aim of this study was to determine whether incorporating qualitative parameters of contrast-enhanced ultrasound (CEUS) can increase the accuracy of adnexal lesion assessments with Ovarian–Adnexal Reporting and Data System (O-RADS) ultrasound category 4 or 5. Retrospective analysis of patients with adnexal masses who underwent conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS) examinations between January and August of 2020. The study investigators reviewed and analyzed the morphological features of each mass before categorizing the US images independently according to the O-RADS system published by the American College of Radiology. In the CEUS analysis, the initial time and intensity of enhancement involving the wall and/or septation of the mass were compared with the uterine myometrium. Internal components of each mass were observed for signs of enhancement. The sensitivity, specificity, and Youden's index were calculated as the contrast variables and O-RADS. Receiver operating characteristic curve analysis revealed that the best cutoff value was higher than O-RADS 4. When information on the extent of enhancement was applied to selectively upgrade O-RADS category 4 and selectively downgrade O-RADS category 5, the overall sensitivity increased to 90.2%, while the level of specificity (91.3%) remained the same. Incorporating additional information from CEUS with respect to the extent of enhancement helped to improve the sensitivity of O-RADS category 4 and 5 masses without loss of specificity. [ABSTRACT FROM AUTHOR]