Search Results (75)

Ultrasound-stimulated microbubble (USMB) therapy, in combination with radiotherapy (XRT), represents a promising approach to enhancing the efficacy of conventional cancer treatments by targeting tumor vasculature. Recent preclinical studies using MRI-guided focused ultrasound have demonstrated that USMB enhances radiation effects in tumor blood vessels, resulting in significantly greater tumor cell death than radiation alone. Dynamic contrast-enhanced MRI (DCE-MRI) has been instrumental in this methodology in mapping tumor perfusion heterogeneity, allowing for precise targeting of additional USMB and XRT to specific vascular regions. This study employed four advanced texture analysis methods, GLCM, GLDM, GLSZM, and NGTDM, to quantitatively assess changes in the cellular structure of prostate tumors following different treatments, including combinations of USMB and XRT targeted to low- and high-perfusion regions. Texture features, particularly those derived from GLCM, GLDM, and GLSZM, revealed significant differences in cell structure patterns across treatment groups. The GLSZM methodology was identified as the most sensitive method for detecting treatment-induced structural changes, effectively identifying regions of necrosis and varied stages of cell death. Texture-derivative analyses further highlighted intra-tumoral heterogeneity, especially in response to additional USMB + XRT treatments. These results align with findings in other tissue models, underscoring the value of texture analysis for monitoring treatment response. Full article

Background: Endobronchial ultrasound-guided transbronchial biopsy (EBUS-TBB) is a valuable technique for diagnosing peripheral pulmonary lesions (PPLs). Although computer-aided diagnostic (CAD) systems have been explored for EBUS interpretation, most rely on manually selected 2D static frames and overlook temporal dynamics that may provide important cues for differentiating benign from malignant lesions. This study aimed to develop an artificial intelligence model that incorporates temporal modeling to analyze EBUS videos and improve lesion classification. Methods: We retrospectively collected EBUS videos from patients undergoing EBUS-TBB between November 2019 and January 2022. A dual-path 3D convolutional network (SlowFast) was employed for spatiotemporal feature extraction, and contrastive learning (SwAV) was integrated to enhance model generalizability on clinical data. Results: A total of 465 patients with corresponding EBUS videos were included. On the validation set, the SlowFast + SwAV_Frame model achieved an AUC of 0.857, accuracy of 82.26%, sensitivity of 93.18%, specificity of 55.56%, and F1-score of 88.17%, outperforming pulmonologists (accuracy 70.97%, sensitivity 77.27%, specificity 55.56%, F1-score 79.07%). On the test set, the model achieved an AUC of 0.823, accuracy of 76.92%, sensitivity of 84.85%, specificity of 63.16%, and F1-score of 82.35%. The proposed model also demonstrated superior performance compared with conventional 2D architectures. Conclusions: This study introduces the first CAD framework for real-time malignancy classification from full-length EBUS videos, which reduces reliance on manual image selection and improves diagnostic efficiency. In addition, given its higher accuracy compared with pulmonologists’ assessments, the framework shows strong potential for clinical applicability. Full article

Background: Fontan-associated liver disease (FALD) is a progressive condition resulting from chronic hepatic venous congestion following the Fontan procedure for univentricular heart defects. As survival improves in these patients, recognition and management of FALD have become increasingly important. Objective: To describe the pathophysiological mechanisms, imaging findings, and diagnostic approach to FALD, with a focus on the role of ultrasonography, including contrast-enhanced ultrasound (CEUS). Methods: This narrative review explores the evolution of FALD through a multidisciplinary lens, integrating cardiovascular and hepatic imaging data. Particular attention is paid to Doppler ultrasound and CEUS, both in early parenchymal changes and in the differential diagnosis of potential complications such as hepatic nodules. Results: FALD is characterized by progressive fibrosis due to long-standing passive congestion, resulting in a wide spectrum of imaging findings. B-mode ultrasound reveals hepatomegaly, heterogeneous parenchyma, and gallbladder wall thickening. Doppler studies show altered hepatic venous flow patterns, while CEUS provides dynamic vascular evaluation, highlighting areas of altered perfusion. In advanced stages, hypo-vascular areas in the late phase may simulate malignant lesions, emphasizing the need for careful interpretation. The role of liver biopsy, though limited by invasiveness, remains crucial in selected cases. Surveillance strategies are not standardized but require close multidisciplinary follow-up. Conclusions: FALD presents complex diagnostic challenges requiring integrated imaging and clinical assessment. CEUS emerges as a valuable, non-invasive tool in characterizing hepatic congestion and guiding management. Increased awareness and standardized protocols are essential for early detection and tailored care in this growing patient population. Full article

This study presents an optimized Real-Time Detection Transformer (RT-DETRv2) deep learning model for the automated assessment of Tartary buckwheat germination and evaluates the influence of soaking and ultrasonic pretreatments on the germination ratio. Model optimization revealed that image chip size critically affected performance. The 512 × 512-pixel chip size was optimal, providing sufficient image context for detection and achieving a robust F1-score (0.9754 at 24 h, tested with a ResNet-101 backbone). In contrast, smaller chips (e.g., 128 × 128 pixels) caused severe performance degradation (24 h F1 = 0.3626 and 48 h F1 = 0.1211), which occurred because the 128 × 128 chip was too small to capture the entire object, particularly as the elongated and highly variable 48 h sprouts exceeded the chip dimensions. The optimized model, incorporating a ResNet-34 backbone, achieved a peak F1-score of 0.9958 for 24 h germination detection, demonstrating its robustness. The model was applied to assess germination dynamics, indicating that 24 h of treatment with 0.1% CaCl₂ and ultrasound enhanced total polyphenol accumulation (6.42 mg GAE/g). These results demonstrate that RT-DETRv2 enables accurate and efficient automated germination monitoring, providing a promising AI-assisted tool for seed quality evaluation and the optimization of agricultural pretreatments. Full article

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

Chronic musculoskeletal pain (CMP) is the leading global cause of disability and a major contributor to healthcare burden. Its pathogenesis reflects regenerative failure, driven by extracellular matrix (ECM) fibrosis, calcific deposition, mitochondrial dysfunction, and neuroimmune sensitization. Conventional pharmacological therapies such as NSAIDs, corticosteroids, and opioids offer only transient symptomatic relief while exposing patients to systemic complications. In contrast, energy-based, drug-free regenerative interventions directly address underlying pathology and restore physiological function. This Perspective synthesizes recent evidence (2020–2025) on three modalities that together form a regenerative triad: extracorporeal shockwave therapy (ESWT), high-intensity laser therapy (HILT), and ultrasound-guided mechanical needling with sterile water injection (SWI). ESWT promotes mechanotransduction, angiogenesis, and ECM remodeling; HILT enhances mitochondrial bioenergetics and downregulates inflammatory pathways; and SWI disrupts fibrosis and calcification while restoring neurovascular dynamics. Evidence from randomized controlled trials and meta-analyses supports moderate-to-high certainty (GRADE B–A–) for ESWT and HILT. SWI, initially supported by large observational cohorts and comparative studies, is now reinforced by a randomized comparative trial and meta-analyses of lavage effects, justifying an upgrade from moderate (B) to moderate-to-high certainty (B–A–). Risk of bias assessment using Cochrane RoB 2.0 and the Newcastle–Ottawa Scale (NOS) indicates overall low-to-moderate concerns across modalities. Together, these interventions integrate mechanistic biology with translational rehabilitation practice. This Perspective outlines their mechanistic foundations, clinical evidence, and alignment with the WHO decade of healthy ageing, offering a drug-free, mechanism-based framework for sustainable CMP management. Full article

Intraoperative ultrasound (IOUS) has developed from a rudimentary adjunct into a versatile modality that now plays a crucial role in neurosurgery. Offering real-time, radiation-free and repeatable imaging at the surgical site, it provides distinct advantages over intraoperative magnetic resonance (MRI) and computed tomography (CT) in terms of accessibility, workflow integration and cost. The clinical spectrum of IOUS is broad: in cranial surgery it enhances the extent of resection of gliomas and metastases, supports dissection in meningiomas and enables localization of MRI-negative pituitary adenomas; in spinal surgery, it guides resection of intradural and intramedullary tumors, assists in myelotomy planning and confirms decompression in degenerative conditions such as cervical myelopathy and ossification of the posterior longitudinal ligament. IOUS also offers unique insights into cerebrospinal fluid disorders, including arachnoid webs, cysts, syringomyelia and Chiari malformation, where it visualizes cord compression and CSF flow restoration. In trauma and oncological emergencies, it provides immediate confirmation of decompression, directly influencing surgical decisions. Recent innovations, including contrast-enhanced ultrasound, elastography, three-dimensional navigated systems and experimental integration with artificial intelligence and robotics, are extending its functional scope. Despite heterogeneity of evidence and operator dependence, IOUS is steadily transitioning from an adjunctive tool to a cornerstone of multimodal intraoperative imaging, bridging precision, accessibility and innovation in contemporary neurosurgical practice. Full article

Background/Objectives: The Kocher–Langenbeck approach is widely used for surgical fixation of posterior acetabular wall fractures. While previous studies have focused on mechanical outcomes and the risk of post-traumatic osteoarthritis, the effects on peripheral circulation and neuromuscular recovery remain underexplored. This study aimed to evaluate dynamic changes in neuromuscular function and microcirculation following open reduction and internal fixation (ORIF) using this approach. Methods: A retrospective analysis was conducted on 34 patients (aged 23–75) treated for posterior acetabular wall fractures between 2014 and 2022. All patients underwent ORIF via the Kocher–Langenbeck approach. Assessments at 8 and 12 months postoperatively included electromyography (EMG), chronaximetry, and rheovasography (RVG). Asymmetry coefficients were calculated to quantify blood flow and functional differences. Results: At 12 months postoperatively, significant microcirculatory asymmetry persisted in the operated limb, with arterial and venous coefficients exceeding 25% (27.5% and 26.8%, respectively). EMG revealed sustained reductions in gluteus maximus and rectus femoris activity (asymmetry ~39%). Chronaximetry showed delayed nerve conduction recovery, particularly in the common peroneal nerve (AC = 44%). The femoral segment demonstrated the most severe impairment in both arterial inflow and venous outflow. Conclusions: ORIF via the Kocher–Langenbeck approach is associated with long-term disturbances in neuromuscular function and regional circulation. Further research should explore alternative surgical approaches (e.g., ilioinguinal, Stoppa) in prospective studies, assess vascular integrity using advanced imaging (e.g., contrast-enhanced ultrasound), and incorporate long-term functional outcomes. Studies on neurovascular-sparing techniques and optimised rehabilitation protocols may help reduce postoperative morbidity and improve recovery. Full article

Introduction: Ductal carcinoma in situ (DCIS) is a non-invasive precursor of breast cancer, usually detected on mammography as clustered microcalcifications. Many cases, however, lack calcifications and require complementary imaging. This study aimed to describe the multimodal imaging features of DCIS and evaluate the radiology–pathology correlation. Methods: We retrospectively reviewed 75 women (aged 36–52 years) with biopsy-proven DCIS (January 2023–June 2025). All underwent mammography, targeted ultrasound, and dynamic contrast-enhanced 1.5T MRI. Imaging findings were correlated with histopathology, and logistic regression was used to explore predictors of MRI kinetics. Results: Mammography detected microcalcifications in 53.8% of patients, while 46.2% showed no calcifications. Ultrasound frequently revealed non-mass, duct-oriented hypoechoic abnormalities in non-calcified cases. MRI consistently demonstrated non-mass enhancement, with weak or persistent kinetics without washout in 69.2% and washout in 30.8%. A moderate correlation between MRI and histological extent was found (r = 0.62, p < 0.001), with MRI tending to overestimate lesion size. Oral contraceptive use was common (61.5%) but not significantly associated with kinetic pattern or grade. Conclusions: Mammography remains essential for calcified DCIS, whereas MRI enhances detection of non-calcified lesions. Persistent kinetics without washout may represent a typical imaging feature of DCIS. However, moderate radiology–pathology concordance and frequent overestimation highlight the need for careful interpretation. These findings support a multimodal diagnostic approach that can improve detection accuracy and assist in more tailored surgical planning. Full article

The aim of this retrospective clinical pilot study is to evaluate multiparametric ultrasound liver parenchyma assessments in the diagnosis of Osler’s disease, and to detect micro-shunts using SRCEUS with quantifications at the capillary level. Material/Method: All examinations were performed by an experienced examiner with a multi-frequency probe on a high-resolution matrix ultrasound device (SC 7-1U), convex probe (Mindray A 20), and were stored digitally in the PACS system. Vascular ultrasound was performed using colour-coded Doppler ultrasound (CCDS) and ultrasound microangiography (UMA). The recent M-Ref tool was utilised for the purpose of liver tissue characterisation, encompassing the domains of shear wave elastography, fat evaluation, and viscosity. Dynamic CEUS, HiFR CEUS, and SR CEUS were performed after the intravenous bolus injection of 1–2.4 mL of ultrasound contrast agent (SonoVue^®). Measurements of SR CEUS capillary changes were performed independently by PACS-stored digital cine loops up to 5 s. Results: In the context of angiomas or haemangiomas, the initial contrast enhancement of echogenic or almost echogenic foci within 25 s without late wash-out was observed in 5/10 cases. In the evaluation of microvasculature, the presence of capsule-proximal shunts in Osler’s disease was observed, resulting in the identification of increased numbers of dilated capillaries within both peripheral and central shunts. In the control group, general liver tissue changes (20 cases) were observed in instances of inflammation (3/20 cases), peripherally in 4/20 cases with micro-shunts in altered parenchyma. In the context of multiparametric ultrasound, 16 out of 30 cases exhibited elevated fibrosis values, with a maximum recorded as high as 1.7 m/s, and in 13 out of 30 cases, there was an increase in fat values up to 0.65 dB/cm/MHz, indicative of moderate steatosis. Additionally, in seven cases, there was an increase in viscosity values up to 2.7 Pa·s, suggesting reactive changes. Conclusions: Recent advancements in medical imaging technology, specifically SR CEUS contrast ultrasound imaging, have led to the development of novel diagnostic tools that facilitate the evaluation of tissue and haemodynamic changes, in addition to capillary alterations, associated with Osler’s disease. Full article

The background of the article refers to the diagnosis of focal liver lesions (FLLs) through contrast-enhanced ultrasound (CEUS) based on the integration of spatial and temporal information. Traditional computer-aided diagnosis (CAD) systems predominantly rely on static images, which limits the characterization of lesion dynamics. This study aims to assess the effectiveness of Transformer-based architectures in enhancing CAD performance within the realm of liver pathology. The methodology involved a systematic comparison of deep learning models for the analysis of CEUS images and videos. For image-based classification, a Hybrid Transformer Neural Network (HTNN) was employed. It combines Vision Transformer (ViT) modules with lightweight convolutional features. For video-based tasks, we evaluated a custom spatio-temporal Convolutional Neural Network (CNN), a CNN with Long Short-Term Memory (LSTM), and a Video Vision Transformer (ViViT). The experimental results show that the HTNN achieved an outstanding accuracy of 97.77% in classifying various types of FLLs, although it required manual selection of the region of interest (ROI). The video-based models produced accuracies of 83%, 88%, and 88%, respectively, without the need for ROI selection. In conclusion, the findings indicate that Transformer-based models exhibit high accuracy in CEUS-based liver diagnosis. This study highlights the potential of attention mechanisms to identify subtle inter-class differences, thereby reducing the reliance on manual intervention. Full article

Background: Brachial plexopathies comprise a diverse array of illnesses with multifactorial etiologies, including trauma, inflammation, neoplasia, and iatrogenic damage, frequently manifesting with nonspecific clinical symptoms. Precise and prompt imaging evaluation is essential for diagnosis, treatment planning, and monitoring. Objective: To equip radiologists with interpretative tools for a systematic assessment of the brachial plexus utilizing advanced imaging modalities, specifically ultrasound (US) and magnetic resonance imaging (MRI), while emphasizing techniques, indications, limitations, and critical radiologic signs for differential diagnosis. Imaging Techniques: This narrative review concentrates on US and MRI. High-frequency linear probes with multiplanar dynamic scans provide US visualization of trunks, cords, and terminal branches in superficial areas. Specialized MRI procedures (T1, T2, STIR, DWI, contrast-enhanced) provide comprehensive evaluation of spinal roots and deep tissues, differentiating preganglionic from postganglionic lesions. A combined US–MRI methodology can enhance diagnostic efficacy. Findings: Ultrasound is excellent for superficial and dynamic assessment, especially in post-traumatic and iatrogenic lesions, while MRI is the gold standard for deep structures and complex disorders. The integration of two modalities enhances lesion identification and treatment direction. Emerging methodologies further enhance diagnostic and prognostic capabilities. Conclusions: The synergistic application of US and MRI, emphasizing nerve injury patterns and muscle denervation indicators, facilitates precise and prompt diagnosis of brachial plexopathies. Standardizing imaging standards and incorporating modern techniques are essential for interdisciplinary, customized patient care. Full article

Advanced Gastric Signet Ring Cell Carcinoma (SRCC) is characterized by aggressive behavior, high metastatic potential, and extremely poor prognosis. There is an urgent need for effective imaging modalities to evaluate systemic metastatic lesions and to dynamically monitor disease progression during treatment. We report a rare case of a 26-year-old female with advanced SRCC presenting with extensive systemic metastases, clinically staged as IV (cT4N3M1). High-frequency and conventional ultrasound imaging revealed metastatic lesions involving the scalp soft tissues, cervical lymph nodes, intercostal soft tissues, pancreatic-splenic hilum region, pelvic cavity, peritoneum and omentum. The ultrasonographic findings were highly consistent with contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) results. The patient received seven cycles of a modified BEMA regimen (oxaliplatin, leucovorin and 5-fluorouracil) combined with nivolumab. Serial ultrasound monitoring indicated continuous disease progression. Due to poor therapeutic response, the patient succumbed to acute obstructive renal failure caused by tumor progression seven months after diagnosis. This report provided a comprehensive ultrasonographic assessment of widespread and rare metastatic sites in advanced SRCC, a scenario seldom documented. The combination of high-frequency ultrasound and Super Microvascular Imaging (SMI) offered precise, radiation-free, and repeatable evaluation of both superficial and deep lesions, proving particularly valuable for real-time monitoring of treatment response in critically ill patients. These findings underscore the unique role of systemic ultrasound in enhancing metastatic detection and therapeutic evaluation for advanced SRCC. Full article

We report a low-cost protocol and platform for whole-abdomen 3D dynamic contrast-enhanced ultrasound (DCE-US) imaging in mice using a clinical matrix-array transducer. Background/Objectives: This platform addresses common limitations of preclinical ultrasound systems. In particular, these systems often lack real-time volumetric and molecular imaging capabilities. Methods: Using a modified silicone cup and water bath configuration, mice with dual subcutaneous tumors were imaged in vivo on a clinical EPIQ 7 system equipped with an X6-1 transducer. Results: Intravenous administration of targeted microbubbles enabled high-resolution, contrast-mode 3D imaging at multiple time points. Volumetric reconstructions captured both tumors and surrounding anatomy in a single scan, while time–intensity curves and Differential Targeted Enhancement (DTE) analysis revealed greater microbubble uptake in irradiated tumors, consistent with elevated P-selectin expression. Conclusions: This standardized imaging platform enables whole-abdomen molecular DCE-US in preclinical studies, facilitating intra-animal comparisons of vascular and molecular features across lesions or organs. Full article

Adhesive capsulitis is a painful and progressive condition marked by significant limitations in shoulder mobility, particularly affecting external rotation. Although magnetic resonance imaging is regarded as the reference standard for assessing intra-articular structures, its high cost and limited availability present challenges in routine clinical use. In contrast, musculoskeletal ultrasound has emerged as an accessible, real-time, and cost-effective imaging modality for both the diagnosis and treatment guidance of adhesive capsulitis. This narrative review compiles and illustrates current evidence regarding the role of ultrasound, encompassing static B-mode imaging, dynamic motion analysis, contrast-enhanced techniques, and sonoelastography. Key sonographic features—such as thickening of the coracohumeral ligament, fibrosis in the axillary recess, and abnormal tendon kinematics—have been consistently associated with adhesive capsulitis and demonstrate favorable diagnostic performance. Advanced methods like contrast-enhanced ultrasound and elastography provide additional functional insights (enabling evaluation of capsular stiffness and vascular changes) which may aid in disease staging and prediction of treatment response. Despite these advantages, the clinical utility of ultrasound remains subject to operator expertise and technical variability. Limited visualization of intra-articular structures and the absence of standardized scanning protocols continue to pose challenges. Nevertheless, ongoing advances in its technology and utility standardization hold promise for the broader application of ultrasound in clinical practice. With continued research and validation, ultrasound is positioned to play an increasingly central role in the comprehensive assessment and management of adhesive capsulitis. Full article