Search Results (744)

Background and Objectives: Obesity has been increasing sharply worldwide and is related to diabetes, cardiovascular diseases, liver disease, and cancer. Sleeve gastrectomy is the most used surgical approach to reduce body weight and treat metabolic implications observed in patients with moderate-to-severe obesity. On the other hand, this procedure affects the musculoskeletal system, and investigating skeletal muscle is not routinely recommended for bariatric surgery. This study aimed to evaluate the psoas muscle in patients in the preoperative period of sleeve gastrectomy and six months after the procedure using abdominal computed tomography scans. Materials and Methods: This clinical, exploratory, and observational study, with a prospective longitudinal observational study design, was conducted at a single center with 31 women who underwent sleeve gastrectomy. The evaluations were performed before and after six months of the procedures. Results: Anthropometric, muscle strength, hepatic ultrasound, and psoas computerized tomography evaluations were performed. A significant reduction in body weight, body mass index, waist, neck, and calf circumference was observed. There was also a substantial reduction in right-hand strength and the area and index of the psoas muscle (but with an increase in density). Most presented a routine abdominal ultrasound. Conclusions: Our results suggest that muscle evaluation provides valuable information for clinical monitoring before and after bariatric surgery, helping to identify potential risks and guide multidisciplinary follow-up. Psoas muscle area and psoas muscle index decreased, but psoas muscle density increased, all significantly. These results indicate that conducting a muscle evaluation is helpful for patients undergoing bariatric surgery, supporting the use of the clinical approach before and after the procedure, predicting possible complications, and providing more accurate prognoses. Full article

Background: Liver steatosis assessment by 2D ultrasound is widely used but remains subjective. We previously developed a deep learning (DL) algorithm for objective steatosis quantification. This study aimed to (1) establish histology-based cutoffs, (2) evaluate their transferability across different imaging views, and (3) validate performance on a new scanner not included in training. Methods: We retrospectively analyzed 588 ultrasound studies from 457 histology-proven cases and prospectively collected paired scans using a new scanner (Philips Affiniti 70). Images from right intercostal, left hepatic lobe, and subcostal views were processed with the DL algorithm, and mean values from 3–5 images per view were correlated with histology. Results: Across three views, the DL algorithm achieved AUROCs of 0.891–0.936 across steatosis grades, consistently outperforming FibroScan’s controlled attenuation parameter (0.840–0.905), especially in moderate-to-severe steatosis (p < 0.001). Cutoffs established from right intercostal images (N = 565) were applied to images from left hepatic lobe (N = 464) and subcostal views (N = 341), yielding accuracies of 0.792–0.850. On Affiniti 70 images, AUROCs remained high (0.838–0.896), supporting scanner generalizability. Conclusions: The DL algorithm provides accurate, view-independent steatosis grading across different ultrasound scanners and outperforms CAP, supporting its real-world use for objective, reproducible quantification. Full article

Background and Clinical Significance: Hepatic sarcoidosis is a benign lesion of unknown etiology. The gold standard for diagnosing hepatic sarcoidosis is histopathological examination. The symptoms and imaging findings of patients with hepatic sarcoidosis are often atypical, leading to misdiagnosis as hepatocellular carcinoma (HCC). Ultrasound resolution microscopy (URM) can overcome the diffraction limit, enabling fine visualization and quantitative analysis of the microvascular networks. This study aimed to provide new evidence for the differential diagnosis of these two diseases by comparing the URM parameters of hepatic sarcoidosis initially misdiagnosed as HCC with those of HCC. Case Presentation: A 67-year-old woman was admitted to the hospital due to upper abdominal pain for two weeks. Ultrasonography revealed a liver mass. The lesion was located in segment IV of the left hepatic lobe, was approximately 18 × 10 mm in size, and appeared hypoechoic. Contrast-enhanced ultrasound and enhanced magnetic resonance imaging both showed a “fast-in, fast-out” pattern, strongly suggesting HCC. The tumor markers were within the normal range. The patient underwent a laparoscopic left hepatic lobectomy. The histopathological diagnosis of the resected specimen was “hepatic sarcoidosis”. URM examination was performed during the preoperative diagnostic process. Subsequently, the URM parameters of the patient’s lesion were analyzed and compared with those of HCC. The results showed differences in multiple URM parameters, including microvascular flow velocity, diameter, microvascular density ratio, and vascular distribution, between this case of hepatic sarcoidosis and HCC. Conclusions: URM can quantitatively and multidimensionally evaluate the microvasculature of liver lesions, providing new reference data for the diagnosis and differential diagnosis of hepatic sarcoidosis. Full article

Background/Objectives: Dengue is one of the leading causes of morbidity in children in endemic regions. Capillary leakage is the pathophysiological hallmark of severe dengue, and ultrasound has established as a sensitive tool for its early detection. However, evidence in the pediatric population remains limited. The aim of this study was to identify the presence of capillary leakage detected by ultrasound and its associations in children with dengue. Methods: Observational/descriptive/cross-sectional/retrospective study conducted in patients between 6 months and 14 years old with confirmed dengue and warning signs or severe dengue, treated at the Hospital Universitario del Valle in Cali, Colombia, between July 2019 and June 2020. Ultrasound examinations were performed and interpreted by radiologists following an institutional standardized protocol. Associations with capillary leakage were evaluated using the chi-square test and their respective OR and 95% CI. Results: A total of 132 children were included. Ultrasound capillary leakage was identified in 95.5%, mainly ascites (83.3%), pleural effusion (46.2%), hepatomegaly (40.9%), and vesicular thickening (39.4%). Associated factors were belonging to school/adolescent group (OR = 13.52; 95% CI = 1.41–646.51; p = 0.0031), elevated alanine aminotransferase (OR = 11.06; 95% CI = 1.32–94.82; p = 0.0007), and aminotransferase levels grades C–D (OR = 6.87; 95% CI = 0.82–54.59; p = 0.0110). Thrombocytopenia and hypoalbuminemia were common. Three deaths (0.9%) occurred in the initially confirmed cohort prior to ultrasound-based inclusion, all of whom presented multiple risk factors for capillary leakage. Conclusions: In this cohort ultrasound showed high sensitivity for detecting capillary leakage in pediatric dengue and was associated with school-age/adolescents and liver involvement. Its systematic use could improve early identification of severe forms and optimize clinical management in resource-limited settings. Full article

Background: The transition from the term non-alcoholic fatty liver disease (NAFLD) to steatotic liver disease (SLD), an umbrella term for several related conditions, offers benefits, particularly in identifying cardiometabolic risk factors more effectively. However, the impact of alcohol consumption on liver disease progression remains significant, leading to the recognition of a new entity: MetALD (metabolic dysfunction-associated steatotic liver disease with moderate alcohol intake). Aim: This study aimed to compare characteristics associated with liver disease progression in diabetic patients diagnosed with metabolic dysfunction-associated steatotic liver disease (MASLD) versus those with MetALD. Materials and Methods: In this prospective study, 286 diabetic patients were followed for 12 months. All patients underwent transient elastography (TE) and ultrasound to assess hepatic steatosis. Participants were classified into MASLD and MetALD groups. The performance of fibrosis-4 index (FIB-4), and NAFLD fibrosis score (NFS) were also evaluated. Results: MASLD was diagnosed in 58.2% (167 patients), of whom 4.9% (7 patients) had TE values suggestive for liver cirrhosis. Among those with MetALD, 17.6% (21 patients) had TE values compatible with advanced fibrosis. MASLD subjects presented a slight decrease in liver fibrosis values from 6.58 ± 2.27 kPa to 6.03 ± 1.57 kPa in the 12 months. On the contrary, MetALD subjects had an increase of liver stiffness measurements (LSM) values from 11.83 ± 6.27 kPa to 12.24 ± 8.66 kPa. Conclusions: in diabetic patients, the coexistence of moderate alcohol intake and cardiometabolic risk factors (MetALD) is associated with more advanced liver fibrosis and impaired long-term glycemic control, compared to MASLD alone. Full article

Objective: The aim of this study was to evaluate the consistency and reproducibility of attenuation coefficient (AC) measurements using different commercial ultrasound (US) across via a phantom experiment to investigate the relationship between the AC and MRI-derived proton density fat fraction (MRI-PDFF) values and the conversion equation. Methods: Twelve phantoms containing varying fat proportions (0–100%) were constructed. Phantom ACs were estimated via three US attenuation systems, including attenuation imaging (ATI), ultrasound attenuation analysis (USAT), and the US-guided attenuation parameter (UGAP), along with MRI-PDFF. Agreement among the AC values from the three ultrasonic attenuation systems was evaluated. Linear correlation analysis was used to explore the ACs, fat concentrations of the phantom, and MRI-PDFF measurements, from which a linear conversion formula between the ultrasonic attenuation parameters and the MRI-PDFF was derived. Results: MRI-PDFF and phantom fat concentration measurements appeared with a strong linear correlation (R² = 0.996, p < 0.001). For the three US attenuation parameters, both inter-operator and intra-operator intraclass correlation coefficients (ICCs) ranged from 0.990 to 0.995 and 0.989 to 0.995, respectively. Bland–Altman analysis revealed no significant differences between the above three (all p > 0.05). Significant linear relationships were demonstrated between ultrasound attenuation parameters and phantom fat concentration (r = 0.938–0.986; all p < 0.001), as well as between ultrasound attenuation parameters and MRI-PDFF values (r = 0.922–0.982; all p < 0.001). A conversion formula (fat proportions ≤ 50%) was derived: US (dB/cm/MHz) = 0.501 + 0.012 MRI-PDFF (%). Conclusions: AC across different commercial ultrasound devices demonstrated significant diagnostic value in fat concentrations that appeared good consistency in measuring phantom fat concentration both between and within groups. The linear relationship between AC and MRI-PDFF enables the application of a conversion formula. Full article

Background/Objectives: Biliary complications are common after liver transplantation (LT), with bile leaks representing a major cause of morbidity. Conventional imaging modalities such as ultrasound, CT, MRCP, and endoscopic techniques may fail to localize peripheral or complex leaks. This study aimed to evaluate the feasibility of [⁶⁸Ga]Ga-TEoS-DAZA-PET/CT for non-invasive localization of bile leaks after LT. Methods: Five male patients (mean age 53.2 years) with suspected bile leakage and inconclusive prior imaging underwent [⁶⁸Ga]Ga-TEoS-DAZA-PET/CT. The tracer was synthesized under GMP conditions and administered at a mean activity of 204 ± 42 MBq. Dynamic PET/CT imaging was performed for 60 min, and findings were classified according to the Nagano classification. Results: Bile leaks were detected and anatomically localized in all five patients. Sites included the liver resection surface, central bile ducts, bilioenteric anastomosis, and biliary drainage exit. PET/CT findings guided revision surgery in one case and endoscopic treatment in three, while one patient improved without intervention. No adverse effects occurred. Conclusions: [⁶⁸Ga]Ga-TEoS-DAZA-PET/CT is a feasible and safe imaging technique for the anatomical localization of bile leaks following LT. Its antegrade visualization of biliary flow, high spatial and temporal resolution, and lack of contraindications make it a promising complementary modality when conventional imaging is inconclusive or not feasible. Larger studies are warranted to validate its diagnostic value and clinical utility in postoperative and post-traumatic biliary injuries. Full article

This study investigates advanced deep learning methods to improve the detection of periportal fibrosis (PPF) in medical imaging. Schistosoma mansoni infection affects over 54 million individuals globally, predominantly in sub-Saharan Africa, with around 20 million experiencing chronic complications. PPF, present in up to 42% of these cases, is a leading outcome of chronic liver disease, significantly contributing to morbidity and mortality. Early and accurate detection is critical for timely intervention, yet conventional ultrasound diagnosis remains highly operator-dependent. We adapted and trained a convolutional neural network (CNN) using ultrasound images to automatically identify and classify PPF severity. The proposed approach achieved a diagnostic accuracy of 80%. Sensitivity and specificity reached 84% and 76%, respectively, demonstrating robust generalisability across varying image qualities and acquisition settings. These findings highlight the potential of deep learning to reduce diagnostic subjectivity and support scalable screening programmes. Future work will focus on validation with larger datasets and multi-class fibrosis grading to enhance clinical utility. Full article

Conventional ultrasound (US) has long been central to hepatocellular carcinoma (HCC) surveillance in cirrhotic patients, due to its low cost, wide availability, non-invasiveness, and adequate sensitivity for detecting small nodules. However, its specificity in distinguishing HCC from other lesions is limited. Contrast-enhanced ultrasound (CEUS) has significantly improved the characterization of nodules first identified on conventional US. Yet, when CEUS is performed using sulfur hexafluoride (SonoVue)—the only contrast agent available in Western countries—assessment remains restricted to a single nodule per examination, and enhanced CT or MRI is still required for full characterization and staging. In clinical settings, such as hepatology, internal medicine, infectious diseases, and surgery, CEUS offers the advantage of immediate availability, enabling rapid characterization of suspicious nodules in cirrhotic livers and facilitating timely therapeutic decisions. Although the introduction of direct-acting antivirals (DAAs) has substantially reduced HCV-related HCC, HCC incidence is increasingly driven by metabolic dysfunction-associated steatohepatitis (MASH). Evidence on surveillance strategies for MASH patients remains limited, and current EASL guidelines recommend monitoring only patients with >F2 fibrosis. Additionally, the effectiveness of US in obese or diabetic/obese populations is under ongoing investigation; abbreviated non-contrast MRI has been proposed as an alternative surveillance tool, but its adoption would entail significant economic implications for healthcare systems. HCC arising from MASH—sometimes even without cirrhosis—exhibits different sonographic and pathological features. Instead of small, hypoechoic nodules, typically seen in HCV-related cirrhosis, clinicians increasingly encounter larger or multiple lesions, often accompanied by macrovascular invasion, limiting access to curative treatments. Furthermore, typical CEUS LI-RADS patterns are less frequently observed. This review summarizes the evolving US findings in the era of MASH-related HCC and underscores the continued importance of US as the primary imaging tool in routine clinical practice. Full article

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) commonly coexists with type 2 diabetes (T2D), but their independent contributions to redox imbalance, inflammation and immune signaling remain uncertain. Objectives: This study aimed to evaluate whether the presence of MASLD alone, and the presence of T2D within MASLD, are independently associated with high-risk profiles of oxidative/antioxidant markers, peripheral blood mononuclear cell (PBMC) gene expression and adipocytokines. Methods: A total of 190 participants were categorized via abdominal ultrasound as controls (n = 46), MASLD (n = 83) or MASLD with T2D (n = 61). Measurements included advanced oxidation protein products (AOPP) and paraoxonase-1 (PON1) activity in serum; messenger ribonucleic acids expression of cluster of differentiation 36 (CD36), Toll-like receptor 9 (TLR9), and glutathione peroxidase-1 in PBMC; and adiponectin, leptin, and resistin in plasma. Biomarker values were adjusted and statistical comparisons among groups were performed using the Quade test. Subsequently, biomarkers were stratified into tertiles to examine associations between high-risk biomarker levels and the presence of MASLD or T2D in patients with MASLD using multivariate binary logistic regression. Results: Multivariate analysis showed that MASLD presence was independently associated with both increased AOPP and decreased resistin levels in the circulation. Furthermore, T2D presence in patients with MASLD was independently associated with increased CD36 and decreased TLR9 gene expression in PBMCs, as well as elevated circulating leptin levels. Conclusions: Collectively, these findings underscore the complex interplay between oxidative stress, insulin resistance, inflammation, and immune signaling in the pathogenesis of MASLD, which are fundamental factors contributing to this condition. Full article

Background: Deep learning models have been used in the past for non-invasive liver fibrosis classification based on liver ultrasound scans. After numerous improvements in the network architectures, optimizers, and development of hybrid methods, the performance of these models has barely improved. This creates a need for a sophisticated method that helps improve this slow-improving performance. Methods: We propose LivSCP, a method to train liver fibrosis classification models for better accuracy than the traditional supervised learning (SL). Our method needs no changes in the network architecture, optimizer, etc. Results: The proposed method achieves state-of-the-art performance, with an accuracy, precision, recall, and F1-score of 98.10% each, and an AUROC of 0.9972. A major advantage of LivSCP is that it does not require any modification to the network architecture. Our method is particularly well-suited for scenarios with limited labeled data and computational resources. Conclusions: In this work, we successfully propose a training method for liver fibrosis classification models in low-data and computation settings. By comparing the proposed method with our baseline (Vision Transformer with SL) and multiple models, we demonstrate the state-of-the-art performance of our method. Full article

Industrial wastewater can be reused in other everyday processes to help combat water scarcity worldwide. One contaminant in industrial wastewater is hexavalent chromium, which is highly toxic and can cause kidney, liver, and respiratory problems, making its removal vital. In this study, PLA-based films containing modified zirconia nanoparticles were developed via a solution-mixing process for hexavalent chromium adsorption. Obtaining the films involved two stages: the first was the chemical modification of ZrO₂ nanoparticles with thiamine hydrochloride (vitamin B1) using fixed-frequency ultrasound at an output of 750 W and 50% amplitude for 60 min. The second stage involved preparing the films by mixing them in the solution using an ultrasonic bath. The nanoparticle concentrations were 0.25, 0.5, and 1 wt%. The results obtained from characterization using Fourier-transform infrared spectroscopy (FT-IR) revealed the characteristic bands of PLA and the characteristic peak of the Zr-O bond corresponding to the ZrO₂ nanoparticles. Thermogravimetric analysis (TGA) showed that the ZrO₂ nanoparticles provided thermal stability to the PLA polymer. X-ray diffraction (XRD) showed a broad peak of amorphous PLA at 16.8° and signals corresponding to the crystalline phase of ZrO₂. The morphology of a cross-section of the films was observed using scanning electron microscopy (SEM), revealing a rough surface with pores. Finally, hexavalent chromium adsorption tests were carried out, measuring the adsorption efficiency under the parameters of pH, concentration, and contact time. The PLAZrO₂ sample achieved an adsorption efficiency of 83% at pH 2. Full article

Humans with chronic biliary tract disease (CBTD) have low serum liposoluble vitamins (A, D, E). Few studies have been performed in veterinary medicine to evaluate whether vitamins vary in canine CBTD. This study aimed to compare liposoluble vitamin between CBTD and healthy dogs. A total of 84 client-owned dogs with CBTD and 50 healthy dogs were included. CBTD diagnosis was based on clinical, blood biochemistry and abdominal ultrasound. Dogs with CBTD were divided into subgroups according to their cholestasis ultrasound severity. To measure vitamin concentrations, leftover serum samples were used. The 25-hydroxyvitamin D, α-tocopherol, and retinol, respectively, vitamin D, E, and A metabolites, were measured with HPLC. Both, 25-hydroxyvitamin D and α-tocopherol were significatively lower in CBTD than in healthy dogs. In contrast, retinol was higher in CBTD dogs. In CBTD dogs, no significant differences in vitamin concentrations considering ultrasound severity were found. Presence of biliary disease in dogs results in lower blood vitamins D and E, and higher vitamin A concentration. Lower vitamins D and E concentration could reflect a possible lipid malabsorption. The higher concentration of vitamin A could be in line with recent human studies, where retinol increases as an expression of dysregulated homeostasis during chronic liver disease. 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 review explores the evolving role of endoscopic ultrasound (EUS) in the diagnosis and management of liver diseases, with a particular focus on chronic liver disease, focal hepatic lesions, portal hypertension, and post-transplant anatomy. A comprehensive literature review of PubMed, MEDLINE, and Embase studies up to August 2025 was conducted to identify the latest evidence on EUS-guided procedures, comparing them with traditional techniques. In diagnostics, EUS-guided liver biopsy provides real-time visualisation and precise tissue sampling, achieving longer specimen lengths and better patient outcomes compared to traditional percutaneous and transjugular approaches. For portal hypertension assessment, EUS-guided portal pressure gradient measurement is a promising alternative to conventional methods, with validation studies demonstrating strong correlation with hepatic venous pressure gradient measurements. In therapeutic applications, EUS facilitates precise interventions including gastric variceal treatment through combined coil and glue injection, management of visceral arterial pseudoaneurysms, selective portal vein embolisation, and targeted tumour ablation. While some applications remain in developmental stages, studies support the safety and efficacy of EUS in improving diagnostic accuracy and expanding therapeutic options for liver diseases. Ongoing technological advances in needle design, imaging capabilities, and artificial intelligence integration are expected to further enhance the utility of EUS in hepatology. Full article