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A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Medical Imaging and Theranostics".

Deadline for manuscript submissions: closed (31 March 2026) | Viewed by 9076

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Dr. Laith Riyadh Sultan

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Clinical Research Core, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
Interests: advanced ultrasound imaging; contrast enhanced ultrasound; quantitative image analysis; computer-aided diagnosis; machine learning; radiomics
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Special Issue Information

Dear Colleagues,

This Special Issue on “Advanced Ultrasound Techniques in Diagnosis” seeks to spotlight cutting-edge ultrasound innovations that are revolutionizing diagnostic accuracy across a wide spectrum of medical disciplines. With ultrasound continuing to evolve as the cornerstone of non-invasive imaging, this issue will delve into its latest breakthroughs, including contrast-enhanced ultrasound (CEUS), microvascular imaging (MVI), super-resolution imaging, elastography, and the integration of AI-powered technologies.

We invite high-impact contributions that introduce novel applications, report significant technical advancements, and validate the clinical implementations of these advanced ultrasound modalities. The scope spans quantitative analysis, ultrasound radiomics, multi-modal ultrasound integration, and the creation of new imaging protocols aimed at enhancing diagnostic precision. This Special Issue will explore transformative ultrasound techniques, offering a comprehensive platform for research bridging traditional and emerging ultrasound technologies, fostering innovation, and delivering actionable insights for improving patient outcomes, shaping the future of diagnostic imaging.

Dr. Laith Riyadh Sultan
Guest Editor

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Keywords

super-resolution imaging
microvascular imaging (MVI)
contrast-enhanced ultrasound
AI-guided ultrasound
quantitative analysis
diagnostic imaging

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Related Special Issue

Advanced Ultrasound Techniques in Diagnosis, Second Edition in Diagnostics

Published Papers (8 papers)

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14 pages, 1038 KB

Open AccessArticle

Radial Artery Occlusion Impairs Median Nerve Perfusion—A Study Using Microvascular Imaging in Healthy Volunteers

by Tobias Rossmann, Paata Pruidze, Johannes Mayerhofer, Michael Veldeman, Wolfgang K. Pfisterer, Wolfgang J. Weninger and Stefan Meng

Diagnostics 2026, 16(5), 695; https://doi.org/10.3390/diagnostics16050695 - 27 Feb 2026

Viewed by 363

Abstract

Background/Objectives: The transradial approach is widely used for vascular access in many disciplines. Radial artery occlusion (RAO) is a frequent sequel, and hand/arm pain affects 7.8% of patients. We aimed to elucidate whether RAO or ulnar artery occlusion (UAO) causes impaired neural blood flow and, thus, if symptoms may be attributable to claudication or nerve damage. Methods: Forty healthy volunteers (73% female), with a mean age of 38 years and without clinical or sonographic signs of carpal tunnel syndrome, were included. All underwent a standardized ultrasound examination (Aplio i800 and i22LH8 linear transducer, Canon Medical Systems) of the forearm, investigating the median nerve and its intraneural blood flow as well as the vascular status of the limb. The radial and ulnar arteries were then sequentially compressed, while changes to intraneural blood flow were noted. Thereafter, the (reverse) Barbeau test and the (inverse) modified Allen Test (MAT) were performed. Results: Simulated RAO and UAO halted intraneural blood flow in 65% and 62.5% of individuals, respectively. A total of 32.5% of participants reported discomfort in the hand/arm. Absent flow during occlusion was found at a significantly higher rate in symptomatic individuals. MAT and inverse MAT were abnormal (>10 s) in 17.5% and 7.5% of patients. Barbeau and reverse Barbeau produced type D results in 15% and 20%, respectively. Conclusions: Both simulated RAO and UAO caused the cessation of intraneural blood flow of the median nerve in two-thirds of participants, and a large proportion reported symptoms. MAT and Barbeau tests did not seem to be useful in predicting impaired neural blood flow. Full article

(This article belongs to the Special Issue Advanced Ultrasound Techniques in Diagnosis)

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15 pages, 2644 KB

Open AccessArticle

Early Detection of Liver Fibrosis Using Scatteromics Based on Multimodal QUS Envelope Statistics Imaging

by Ya-Wen Chuang, Duy Chi Le, Chiao-Yin Wang, Dar-In Tai, Zhuhuang Zhou and Po-Hsiang Tsui

Diagnostics 2026, 16(4), 564; https://doi.org/10.3390/diagnostics16040564 - 13 Feb 2026

Viewed by 397

Abstract

Objectives: Radiomics has enhanced quantitative ultrasound (QUS) imaging based on envelope statistics for liver fibrosis evaluation. However, early detection of liver fibrosis in patients with hepatic steatosis remains challenging. This study is to develop ultrasound scatteromics prediction models, utilizing simplified feature sets from multimodal QUS envelope statistics imaging, for detecting early-stage liver fibrosis (stage ≥ F1) and significant fibrosis (≥F2) in the presence of hepatic steatosis. Methods: The dataset in this prospective study included 252 subjects (n = 125 for training and validation; n = 127 subjects for independent testing), which underwent blood tests, liver biopsy, and ultrasound radiofrequency data acquisition. In scatteromics analysis, multimodal QUS envelope statistics imaging (Nakagami, homodyned K, and information entropy statistics) was employed. For each imaging, a predefined simplified feature set was calculated, followed by feature selection for machine learning using support vector machine (SVM), random forest (RF), and linear discriminant analysis (LDA). The scatteromics model was obtained using a repeated five-fold stratified cross-validation and then independently tested. The performance was evaluated by the area under the receiver operating characteristic curve (AUROC); scatteromics features were also compared with aspartate aminotransferase (AST) and alanine aminotransferase (ALT). Results: Scatteromics features showed no significant correlation with AST and ALT, with correlation coefficients ranging from 0.003 to 0.28. In patients with coexisting hepatic steatosis, scatteromics significantly outperformed QUS envelope statistics imaging in identifying early-stage liver fibrosis, achieving AUROC values of 0.85 to 0.87 for the training and validation datasets, and 0.78 to 0.81 for the testing dataset. In comparison, scatteromics demonstrated modest performance in detecting significant liver fibrosis (≥F2), with AUROC ranging from 0.66 to 0.71 in the training cohort and 0.64 to 0.76 in the testing cohort. Conclusions: The proposed scatteromics model streamlines the data analysis workflow of conventional QUS radiomics, enabling early detection of liver fibrosis with reduced dependence on inflammation and hepatic steatosis. Full article

(This article belongs to the Special Issue Advanced Ultrasound Techniques in Diagnosis)

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14 pages, 1017 KB

Open AccessArticle

Illuminating the Intricacies: A Comparative Cross-Sectional Sonographic Evaluation of Degenerative Changes in Leiomyomas Through Post-Processing Technique

by Mahasin G. Hassan, Nouf Aldrees, Sadeem Aldawsari, Raghad Alanazi, Noura Alboqami, Maryem Alanazi, Renad Alanazi, Khadejah Alrashidi and Basim S. Almutairi

Diagnostics 2025, 15(23), 2943; https://doi.org/10.3390/diagnostics15232943 - 21 Nov 2025

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Abstract

Background: Leiomyomas are benign tumors that may cause symptoms and affect fertility, requiring careful assessment. Magnetic Resonance Imaging (MRI) becomes crucial when ultrasonography results are inconclusive; however, it is expensive and time-consuming. Utilizing post-processing techniques could enhance the ultrasound results. Using ultrasound with Fiji (ImageJ) enables precise evaluation of leiomyoma degeneration and may reduce the need for MRI. Aim: This study aims to evaluate the effectiveness of a post-processing technique using Fiji (ImageJ) to detect degenerative changes in leiomyomas and compare these findings with those obtained from conventional ultrasound and MRI results. Methods: A cross-sectional analytical study was conducted at King Saud Medical City involving 41 females diagnosed with uterine leiomyomas using ultrasound and MRI. Ultrasound images were analyzed using Fiji software to identify degenerative changes and compare results with ultrasound and MRI reports. Results: ImageJ outperformed ultrasound across all diagnostic metrics, with higher sensitivity (84.2% vs. 63.2%), specificity (81.8% vs. 22.7%), and accuracy (82.9% vs. 41.5%). ROC analysis showed superior diagnostic performance of ImageJ (AUC = 0.830) compared to ultrasound (AUC = 0.429), with a significant correlation to MRI findings (p < 0.001). Fibroids with and without degeneration showed no significant differences in Fiji parameters (p > 0.05). Conclusions: Integrating post-processing tools such as ImageJ with ultrasound imaging significantly improves the detection of degenerative changes in uterine leiomyomas, potentially reducing dependence on costly and less accessible modalities like MRI. Future studies should utilize a prospective design with larger sample sizes to strengthen the validity and generalizability of these findings. Full article

(This article belongs to the Special Issue Advanced Ultrasound Techniques in Diagnosis)

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12 pages, 1072 KB

Open AccessArticle

Microvascular Imaging of Hepatic Hemangiomas

by Hakan Baş and Süleyman Filiz

Diagnostics 2025, 15(22), 2917; https://doi.org/10.3390/diagnostics15222917 - 18 Nov 2025

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Abstract

Background/Objectives: We aimed to characterize the microvascular imaging (MI) to demonstrate in hepatic hemangiomas in routine practice and to quantify the impact of lesion depth on MI signal detectability, and—when present—describe the distribution of MI appearances. Methods: In this single-center, retrospective study from January 2021 to December 2023, we screened 91 patients with 121 focal hepatic lesions on ultrasound. Lesions without typical hemangioma enhancement on dynamic MRI or dynamic CT were excluded. Two radiologists independently assessed MI signals and patterns using the Jeon classification, blinded to clinical and CT/MRI data; inter-observer agreement was quantified with Cohen’s κ. Results: Of 121 screened lesions, 36 lacked typical enhancement and were excluded; 85 hemangiomas remained. A total of 13 were excluded for motion artifacts near the heart or pulsatile vessels, yielding 72 hemangiomas (61 patients) for analysis. No lesion showed flow on color or power Doppler. MI signals were detected in 68/72 hemangiomas (94.4%). Among signal-positive lesions (n = 68), the patterns were non-specific in 25.0% (17/68), nodular rim in 22.1% (15/68), strip rim in 17.6% (12/68), central dot-like in 16.2% (11/68), peripheral dot-like in 10.3% (7/68), and staining in 8.8% (6/68). Signal-negative lesions were deeper than signal-positive lesions (median depth: 85 mm vs. 41.5 mm; p < 0.05). The inter-observer agreement was very good (κ = 0.821, 95% CI 0.767–0.921). Conclusions: MI is a reproducible, contrast-free technique that demonstrates hemangioma vascularity with high detection rates, particularly in more superficial lesions. In this cohort, lesion depth rather than size was the primary determinant of MI signal detectability. MI should be considered complementary to CT/MRI and may be especially useful where contrast agents are unavailable or contraindicated. Full article

(This article belongs to the Special Issue Advanced Ultrasound Techniques in Diagnosis)

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13 pages, 1423 KB

Open AccessArticle

Quantifying “Medical Renal Disease”: A Pediatric Pilot Study Using Ultrasound Radiomics for Differentiating Acute Kidney Injury and Chronic Kidney Disease

by Laura De Leon-Benedetti, Laith R. Sultan, Hansel J. Otero, Tatiana Morales-Tisnés, Joya Sims, Kate Fitzpatrick, Julie C. Fitzgerald, Susan Furth, Benjamin L. Laskin and Bernarda Viteri

Diagnostics 2025, 15(16), 2112; https://doi.org/10.3390/diagnostics15162112 - 21 Aug 2025

Cited by 1 | Viewed by 1900

Abstract

Background: Differentiating acute kidney injury (AKI) from chronic kidney disease (CKD) in children remains a critical unmet need due to the limitations of current clinical and biochemical markers. Conventional ultrasound lacks the sensitivity to discern subtle parenchymal alterations. This study explores the application of ultrasound radiomics—a novel, non-invasive, and quantitative image analysis method—for distinguishing AKI from CKD in pediatric patients. Methods: In this retrospective cross-sectional pilot study, kidney ultrasound images were obtained from 31 pediatric subjects: 8 with oliguric AKI, 14 with CKD, and 9 healthy controls. Renal parenchyma was manually segmented, and 124 advanced texture features were extracted using the open-source ©PyFeats. Features encompassed multiple categories (e.g., GLCM, GLSZM, WP). Statistical comparisons evaluated intergroup differences. Principal Component Analysis identified the top 10 most informative features, which were used to train supervised machine learning models. Model performance used five-fold cross-validation. Results: Radiomic analysis revealed significant intergroup differences (p < 0.05). CKD cases exhibited increased echogenicity and heterogeneity, particularly in GLCM and GLSZM features, consistent with chronic fibrosis. AKI cases displayed more homogeneous texture, likely reflecting edema or acute inflammation. While echogenicity separated diseased from healthy kidneys, it lacked specificity between AKI and CKD. Among ML models, XGBoost achieved the highest macro-averaged F1 score (0.90), followed closely by SVM and Random Forest, demonstrating strong classification performance. Conclusions: Radiomics-based texture analysis of grayscale ultrasound images effectively differentiated AKI from CKD in this pilot study, offering a promising, non-invasive imaging biomarker for pediatric kidney disease. These preliminary findings justify prospective validation in larger, multicenter cohorts. Full article

(This article belongs to the Special Issue Advanced Ultrasound Techniques in Diagnosis)

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11 pages, 4522 KB

Open AccessArticle

Evaluation of Ovarian Stromal Microvascularity and Clinical-Hormonal Associations in Reproductive-Aged Women with Polycystic Ovary Morphology

by Hakan Baş and Süleyman Filiz

Diagnostics 2025, 15(11), 1376; https://doi.org/10.3390/diagnostics15111376 - 29 May 2025

Cited by 1 | Viewed by 1508

Abstract

Background/Objectives: This study aims to assess ovarian stromal vascularity using microvascular imaging in reproductive-aged women with polycystic ovarian morphology (PCOM) and to explore its associations with endocrine parameters and polycystic ovary syndrome (PCOS) phenotypes. Methods: We conducted a retrospective, single-center study between January 2021 and November 2023. Women aged 18–49 who met the PCOM criteria (≥20 follicles measuring 2–9 mm or an ovarian volume >10 cm³ in at least one ovary) were included. Pelvic ultrasound with MV-Flow Doppler imaging was used to quantify the stromal vascularity index (VI). On the same day, serum levels of FSH, LH, total and free testosterone, DHEAS, and estradiol were measured. PCOS phenotypes (A, C, D, and non-PCOS) were classified according to the Rotterdam criteria. Statistical analysis involved interobserver agreement using intraclass correlation coefficients (ICCs), correlation analysis for hormonal associations, and group comparisons using ANOVA. Results: A total of 111 women (mean age: 27.4 ± 6.1 years) were evaluated. The mean VI was 43.88 ± 19.84, with good interobserver agreement (ICC = 0.79; 95% CI: 0.65–0.88). VI was highest in Phenotype A (61.36 ± 10.11), followed by Phenotype C (42.57 ± 3.59), Phenotype D (26.47 ± 4.24), and Non-PCOS individuals (9.95 ± 5.44; p < 0.001). VI showed strong positive correlations with total testosterone (r = 0.797) and free testosterone (r = 0.778), and a moderate negative correlation with DHEAS (r = −0.483; p < 0.001). Conclusions: Microvascular imaging is a promising tool for quantifying ovarian stromal vascularity in PCOM. Its strong correlation with androgen levels, especially in hyperandrogenic phenotypes, highlights its potential role in enhancing diagnostic precision and deepening our understanding of PCOS pathophysiology. Full article

(This article belongs to the Special Issue Advanced Ultrasound Techniques in Diagnosis)

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18 pages, 1153 KB

Open AccessSystematic Review

Quantitative Ultrasound SWE of Carotid Plaque in Symptomatic and Asymptomatic Patients: A Systematic Review and Meta-Analysis

by Salahaden R. Sultan, Faisal Albin Hajji, Muyaser Fatani, Ahmad Albngali, Abrar Alfatni, Amal Alsalamah, Reem T. Alturki, Abdullah M. Abdullah, Reda Jamjoom, Mohammad Khalil, Mohammed Alkharaiji and Adel Alzahrani

Diagnostics 2026, 16(7), 1085; https://doi.org/10.3390/diagnostics16071085 - 3 Apr 2026

Viewed by 381

Abstract

Background/Objectives: Ultrasound shear-wave elastography (SWE) enables quantitative assessment of tissue stiffness and may provide a non-invasive biomarker of carotid plaque vulnerability. This study aimed to evaluate the ability of SWE to differentiate symptomatic from asymptomatic carotid plaques and to assess its reproducibility. Methods: A systematic search of PubMed, Web of Science, EMBASE, and the Cochrane Library was conducted in the last ten years until January 2026 for publications evaluating carotid plaques using ultrasound SWE. Inclusion criteria required original publications that used quantitative ultrasound SWE parameters for the evaluation of carotid plaque in symptomatic and asymptomatic patients and/or investigated the reproducibility of SWE parameters for carotid plaques; non-carotid studies, non-original articles, and studies not comparing symptomatic versus asymptomatic plaques or not reporting reproducibility were excluded. Fourteen studies comprising 1781 carotid plaques were included. Quantitative SWE measurements were meta-analyzed using random effects. Differences between symptomatic and asymptomatic plaques were assessed using standardized mean differences (SMDs). The reproducibility of SWE measurements was evaluated using pooled correlation coefficients. Publication bias was evaluated using funnel plots and Egger’s regression test. Results: Ten studies including 1246 plaques compared SWE stiffness between symptomatic (n = 472) and asymptomatic plaques (n = 774). The meta-analysis demonstrated significantly lower stiffness values in symptomatic plaques compared with asymptomatic plaques (SMD −1.10, p < 0.001). Reproducibility analysis of correlation coefficients extracted from seven studies demonstrated excellent agreement for SWE measurements (r = 0.92, n = 602). Heterogeneity was observed across the included studies. No statistically significant evidence of publication bias was detected. Conclusions: Ultrasound SWE is a promising approach for assessing carotid plaque vulnerability, with lower SWE stiffness observed in symptomatic plaques compared to asymptomatic plaques. This finding should be interpreted with consideration of methodological heterogeneity and the cross-sectional nature of the available assessed evidence. Further prospective studies with standardized imaging protocols and longitudinal follow-up are needed to determine clinically applicable stiffness thresholds and evaluate the prognostic value of ultrasound SWE in cerebrovascular risk stratification. Full article

(This article belongs to the Special Issue Advanced Ultrasound Techniques in Diagnosis)

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10 pages, 4287 KB

Open AccessCase Report

Ultrasound-Guided Dextrose Hydrodissection for Mixed Sensory–Motor Wartenberg’s Syndrome Following a Healed Scaphoid Fracture: A Case Report

by Yonghyun Yoon, King Hei Stanley Lam, Jeimylo C. de Castro, Jihyo Hwang, Jaeyoung Lee, Teinny Suryadi, Anwar Suhaimi, Chun-Wei Kang, Jaeik Choi and Seungbeom Kim

Diagnostics 2026, 16(1), 156; https://doi.org/10.3390/diagnostics16010156 - 4 Jan 2026

Cited by 1 | Viewed by 1293

Abstract

Background and Clinical Significance: Wartenberg’s syndrome (cheiralgia paresthetica) is classically described as a pure sensory neuropathy of the superficial branch of the radial nerve (SBRN). However, in rare circumstances, dynamic mechanical irritation around the radial styloid may produce an atypical clinical phenotype with concurrent motor impairment, broadening the clinical significance of recognizing motion-related compression mechanisms. Case Presentation: A 35-year-old woman presented with persistent dorsoradial wrist pain and numbness, accompanied by progressive weakness of thumb extension, five years after a conservatively treated nondisplaced scaphoid fracture. Neurological examination demonstrated sensory loss in the SBRN distribution and Medical Research Council (MRC) grade 3/5 strength of the extensor pollicis longus (EPL). Nerve conduction studies revealed a markedly prolonged EPL motor latency (4.5 ms; normal ≤ 2.5 ms) with preserved sensory conduction. High-resolution ultrasound showed focal enlargement of the SBRN (cross-sectional area 0.13 cm²) and, critically, dynamic snapping of the nerve over the radial styloid that reproduced the patient’s symptoms. The patient underwent ten weekly sessions of ultrasound-guided hydrodissection with 5% dextrose. After treatment, the pain Visual Analog Scale improved from 8/10 to 0/10 and EPL strength recovered to MRC 5/5. Follow-up nerve conduction studies demonstrated normalization of EPL motor latency (2.1 ms), and repeat ultrasound confirmed resolution of SBRN enlargement and snapping. Conclusions: This case expands the phenotype of Wartenberg’s syndrome to include mixed sensory–motor involvement associated with dynamic SBRN snapping at the radial styloid. Dynamic ultrasound was pivotal for identifying the motion-dependent mechanism, and ultrasound-guided 5% dextrose hydrodissection achieved complete sensory and motor recovery as a minimally invasive and effective treatment option. Full article

(This article belongs to the Special Issue Advanced Ultrasound Techniques in Diagnosis)

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