Search Results (867)

Hypertension remains the leading modifiable cause of cardiovascular death, yet fewer than one in four treated adults achieves guideline-recommended blood pressure targets. Catheter-based renal denervation interrupts efferent and afferent renal sympathetic signalling and lowers blood pressure continuously and independently of medication adherence. After a decade of controversy following the neutral SYMPLICITY HTN-3 trial, a coherent body of second-generation sham-controlled randomised evidence, generated with radiofrequency, endovascular ultrasound, and perivascular alcohol platforms, has established a reproducible, modest, and durable antihypertensive effect with a favourable safety profile. Between 2024 and 2026, the field crossed three thresholds simultaneously: guideline endorsement on both sides of the Atlantic, including the first United States recommendation in the 2025 AHA/ACC guideline; a national coverage determination with coverage with evidence development; and the maturation of randomised and real-world follow-up to three years in cohorts exceeding 3000 patients. This state-of-the-art review synthesises the contemporary evidence base; quantifies the expected treatment effect and its heterogeneity; appraises safety across renal and vascular domains; examines emerging data in chronic kidney disease, diabetes, heart failure, and atrial fibrillation; and details the practical requirements for delivering renal denervation responsibly. We conclude by defining the research agenda that must now be addressed: the identification of responders, the development of an intraprocedural endpoint, a direct comparison with newly approved pharmacotherapy, and evidence of cardiovascular event reduction. Full article

Background: Dialysis adequacy is commonly assessed using Kt, a measure of urea clearance. Vascular access dysfunction, particularly thrombosis and access recirculation, may compromise dialysis efficiency despite apparently adequate treatment parameters. Ultrasound assessment of vascular anatomy can help identify individualized cannulation strategies to optimize dialysis delivery. Case Presentation: We report the case of a 78-year-old man undergoing maintenance hemodialysis who exhibited persistently low Kt values despite adequate dialysis time and blood flow. Doppler ultrasound revealed complete occlusive thrombosis involving the cephalic vein, resulting in altered venous drainage. Based on these findings, the conventional cannulation configuration was reversed by exchanging the arterial and venous needle positions. Dialysis adequacy during 11 consecutive sessions using reverse cannulation was compared with that of the previous 12 conventional sessions matched for treatment duration and dialysis volume. Results: Reverse needle cannulation was associated with improved dialysis adequacy. Mean Kt increased from 46.9 ± 6.7 L with conventional cannulation to 57.3 ± 5.8 L after reverse cannulation (p = 0.002), while dialysis duration and processed blood volume remained comparable between both periods. Conclusions: In selected patients with complex vascular anatomy secondary to arteriovenous fistula thrombosis, ultrasound-guided reverse needle cannulation may improve dialysis adequacy without changing treatment duration or the prescribed extracorporeal blood flow rate. This case highlights the value of individualized vascular access assessment and tailored cannulation strategies in patients with vascular access dysfunction. Full article

Cervical lymph node status is the single most important prognostic determinant in head and neck squamous cell carcinoma (HNSCC), yet conventional gray-scale ultrasound relies on morphological criteria that only indirectly reflect the underlying biological process driving nodal progression: tumor angiogenesis. This narrative review focuses specifically on cervical lymph nodes and examines whether multiparametric ultrasound (B-mode, Doppler, elastography, and contrast-enhanced ultrasound [CEUS]) can serve as a non-invasive, repeatable surrogate for nodal angiogenic activity in HNSCC and outlines a practical framework for its use in the head and neck clinic; evidence on the primary tumor itself was outside this review’s scope. A narrative synthesis of the literature on angiogenesis biology in HNSCC and on multiparametric ultrasound of cervical lymph nodes was performed, drawing on systematic reviews, meta-analyses, and clinical pilot studies identified through PubMed-indexed sources. Vascular endothelial growth factor (VEGF)-driven neoangiogenesis is a recognized diagnostic, prognostic, and predictive biological axis in HNSCC. Ultrasound modalities that visualize or quantify microvascular architecture and perfusion—Doppler vascularity patterns, shear-wave elastography, and CEUS—track features that are biologically continuous with angiogenesis (disorganized, high-permeability neovessels; altered tissue stiffness from stromal remodeling). Combining CEUS with B-mode ultrasound improves diagnostic accuracy for inconclusive cervical lymph nodes compared with either modality alone, and pilot multiparametric protocols in HNSCC show reproducible irregular contrast enhancement and elastographic heterogeneity in metastatic nodes. Multiparametric ultrasound does not replace histology, but it offers a repeatable, radiation-free, low-cost window onto the vascular phenotype of HNSCC that complements morphological staging. Given the heterogeneity and methodological limitations of the available evidence, multiparametric ultrasound should currently be regarded as a promising imaging biomarker rather than an established non-invasive surrogate for angiogenesis. Larger prospective, HNSCC-specific cohorts using standardized acquisition protocols, with direct histological correlation, are needed before this approach can be adopted into routine diagnostic pathways. Full article

Background: Ultra-high-frequency ultrasound (UHFUS), performed in the present study using 48 and 70 MHz transducers, enables high-resolution assessment of superficial tissues and may provide useful information on the morphology, internal architecture, vascularity, and anatomical relationships of oral cavity lesions. Methods: This retrospective single-center study included consecutive patients examined between January 2025 and June 2026. Of 137 eligible cases, five were excluded because of inadequate image or cine-loop quality, leaving 132 lesions for analysis. All examinations were performed by the same experienced radiologist using 48 and 70 MHz linear probes. Each lesion was assessed in B-mode in at least two orthogonal planes and with Color Doppler. Archived anonymized examinations were reviewed using a predefined structured form. Morphology, margins, echogenicity, echotexture, composition, posterior acoustic features, vascularity, dimensions, presumed plane of origin, and involvement of adjacent anatomic layers were evaluated. The qualitative synthesis was performed jointly by a radiologist and an oral pathologist, with disagreements resolved by consensus. Results: UHFUS allowed detailed visualization of mucosal, submucosal, muscular, and bone/periodontal interfaces and enabled qualitative characterization of lesion boundaries, internal structure, vascular patterns, and local extension. The combined use of 48 and 70 MHz probes provided complementary information according to lesion depth and tissue composition. Five representative histologically confirmed cases from the study cohort illustrated reactive/inflammatory, benign neoplastic, and malignant conditions. One additional clinically confirmed gingival fistula, not included in the analytical cohort, was presented solely as an illustrative example of a superficial fistulous tract detectable with UHFUS. Conclusions: UHFUS provides detailed, layer-based assessment of oral cavity lesions and may complement clinical examination and histopathology in lesion characterization and preoperative evaluation. Sonographic findings should be interpreted within a multimodal diagnostic framework rather than as stand-alone criteria. Full article

Background: The Extended Fetal Cardiovascular System (EFCS) encompasses the cardiac, infracardiac, and supracardiac vascular territories that contribute to fetal cardiovascular development and function. The CASSEAL 3 × 3 framework was developed to provide a structured anatomical assessment of the EFCS. This study aimed to evaluate its feasibility, reproducibility, and diagnostic performance during first-trimester screening. Methods: In this prospective single-center study, singleton pregnancies undergoing ultrasound examination between 11 + 0 and 13 + 6 weeks of gestation were assessed using the CASSEAL 3 × 3 framework. Feasibility, examination time, use of complementary techniques, interobserver reproducibility, and diagnostic performance were evaluated. Prenatal follow-up and postnatal findings served as the reference standard. Results: A total of 288 pregnancies were included in the final analysis. Complete visualization of all nine axial views was achieved in 86.5% of examinations. Mean examination time was 12.5 ± 3.3 min. Higher gestational age increased the likelihood of complete visualization, whereas higher maternal body mass index reduced feasibility. Interobserver agreement was high, with no significant systematic differences between operators. Six suspected EFCS abnormalities were identified during first-trimester examination. Diagnostic performance demonstrated high specificity (99.64%) and negative predictive value (98.58%), whereas sensitivity was moderate and should be interpreted cautiously due to the limited number of confirmed abnormalities. Conclusions: The CASSEAL 3 × 3 framework is a feasible and reproducible approach for structured first-trimester assessment of the EFCS. Diagnostic performance estimates should be interpreted cautiously given the limited number and spectrum of confirmed abnormalities and the use of a composite reference standard without systematic postnatal echocardiography. The framework may be better suited to specialized fetal medicine settings or as an adjunct to routine first-trimester assessment rather than as a universal screening tool. Full article

Background/Objectives: Immune-mediated inflammatory skin diseases (IMSDs), including psoriasis, atopic dermatitis, and systemic sclerosis, are chronic relapsing disorders that impose substantial physical, psychological, and economic burdens. Current assessment relies largely on subjective clinical scoring and conventional imaging modalities that provide limited functional information. This structured narrative review evaluates photoacoustic imaging (PAI) as a non-invasive optical-ultrasound technique for morphological and functional assessment in IMSDs. Methods: We searched PubMed studies published from January 2017 to December 2025 using terms related to photoacoustic imaging, optoacoustic mesoscopy, psoriasis, atopic dermatitis, systemic sclerosis, contact dermatitis, and immune-mediated inflammatory skin disease. Studies were narratively synthesized by disease, PAI modality, comparator, outcome, and translational limitation. Main Findings: PAI can map vascular and pigment-related optical absorption and estimate oxygenation, blood volume, and selected structural biomarkers. In psoriasis, atopic dermatitis, and systemic sclerosis, PAI-derived measures have been associated with clinical severity, subclinical vascular or epidermal changes, and treatment response. However, most available studies are small, single-center, heterogeneous, or based on prototype systems, and several biomarkers still require histopathological and external validation. Conclusions: Current evidence supports PAI as a feasible research and potential adjunctive assessment tool for IMSDs rather than an established replacement for standard clinical, histopathological, or imaging methods. Standardized protocols, validation across skin phototypes, cost-effective devices, and prospective multicenter studies are required before routine clinical adoption. Full article

Objectives: A percutaneous native kidney biopsy remains the gold standard for diagnosing glomerular, tubulointerstitial and vascular kidney diseases. Although generally safe, it may cause major haemorrhagic complications. Using the French national registry, Kaczmarek et al. developed a simplified bleeding risk score (anaemia, female sex, heart failure, acute kidney injury; range: 0–5), achieving an AUC of 0.755 in native biopsies. We aimed to externally validate this score in a Romanian cohort and to assess whether additional clinically relevant predictors could improve discrimination for major bleeding. Methods: We conducted a retrospective cohort study of all consecutive adults undergoing an ultrasound-guided percutaneous native kidney biopsy at a tertiary nephrology centre in Romania between January 2008 and December 2024. The primary outcome was a composite major bleeding event: clinically significant haematoma or haemorrhage, blood transfusion, angiographic intervention or nephrectomy. The Kaczmarek score was validated using a receiver operating characteristic (ROC) analysis. Candidate predictors were assessed by multivariable logistic regression, and a simplified score was derived from the regression coefficients. Results: Among 3081 patients, 162 (5.3%) experienced major bleeding. The Kaczmarek score showed modest discrimination (AUC: 0.624, 95% CI: 0.585–0.663). In the multivariable analysis (n = 2506 complete cases), anaemia, heart failure, solid neoplasm and fibrinogen were independently associated with major bleeding. An eight-component score (anaemia, heart failure, solid neoplasm, and fibrinogen < 511 mg/dL; female sex, hypertension, liver disease, and eGFR < 30 mL/min/1.73 m²) achieved an AUC of 0.676 (95% CI: 0.631–0.717), outperforming the Kaczmarek score. Conclusions: The French score performed only modestly in our cohort. Adding comorbidities, kidney function and haemostatic parameters, particularly fibrinogen, improved the risk discrimination. Full article

Background: The fibrovascular stalk is characteristic of papillary bladder tumors and may be visualized on MRI as the inchworm sign. Contrast-enhanced ultrasound (CEUS) may depict the same structure dynamically by demonstrating pedicle perfusion before tumor enhancement. We hypothesized that CEUS would be more sensitive than the MRI inchworm sign for detecting a histologically confirmed fibrovascular stalk and that stalk presence would be associated with non-muscle-invasive bladder cancer without completely excluding detrusor muscle invasion. Methods: This retrospective study assessed 80 consecutive patients with one focal bladder lesion; 69 patients with technically adequate imaging and an adequate TURBT reference standard were included in the final paired analysis. Dedicated retrospective rereads of anonymized stored CEUS cine loops and complete mpMRI datasets were independently performed by two experienced readers per modality, who were blinded to the other imaging modality, histopathology, and each other’s assessments. A blinded pathologist assessed fibrovascular stalk presence and detrusor muscle invasion. Paired performance was evaluated using exact McNemar testing. Results: Histopathology identified a stalk in 48 lesions. CEUS detected 46 of 48 stalks, and MRI detected 36, corresponding to sensitivities of 95.8% and 75.0%, specificities of 90.5% and 81.0%, and accuracies of 94.2% and 76.8%, respectively. Interobserver agreement was 94.2% for both signs, with almost-perfect agreement for the CEUS vascular stalk sign (κ = 0.86) and the MRI inchworm sign (κ = 0.88). For MIBC detection, overall CEUS impression and VI-RADS 4–5 showed sensitivities of 66.7% and 87.5% (paired p = 0.063), specificities of 88.9% and 68.9% (paired p = 0.004), and accuracies of 81.2% and 75.4% (paired p = 0.424), respectively. Conclusions: However, the two signs are not operationally equivalent because the MRI inchworm sign additionally requires preservation of the underlying muscular layer, a criterion that may have contributed to its lower observed sensitivity. The stalk strongly favored non-muscle-invasive disease but did not exclude detrusor invasion. CEUS provides complementary perfusion information, whereas MRI-based VI-RADS remains central to local staging. Full article

Objectives: To evaluate ¹⁸F-labelled fluoroazomycinarabinoside ([¹⁸F]F-FAZA) PET in post-transplant patients and examine the association of its kinetic and uptake parameters with kidney allograft function measurements, including laboratory and histopathological assessments. Methods: In this prospective pilot study, renal transplant patients were evaluated with a dedicated positron emission tomography/magnetic resonance imaging (PET/MR) protocol between 2018 and 2023. Twenty patients with impaired kidney allograft function (cases) and ten sex- and time-post-transplant-matched control patients with stable transplant allograft function (controls) were included. All patients underwent [¹⁸F]F-FAZA PET/MR, including initial dynamic and delayed static imaging. Cases underwent an ultrasound-guided biopsy for histopathological assessments. Results: From the [¹⁸F]F-FAZA PET-derived parameters, dynamic total volume distribution (V_T) was significantly higher in control patients than in cases (2.11 ± 0.55 vs. 1.62 ± 0.45; p = 0.026). When correlating [¹⁸F]F-FAZA PET parameters with creatinine levels and estimated glomerular filtration rate, V_T was again the only variable that significantly correlated with both metrics. Regarding histopathological parameters, a significant positive correlation was found between k₁ and vascular fibrous intimal thickening, a significant negative correlation between k₃ and arteriolar hyalinosis, and k₃/k₄ (binding potential) was significantly correlated with the percentage of globally sclerotic glomeruli and arteriolar hyalinosis. Additionally, V_T was significantly correlated with interstitial inflammation. SUV_mean on the static PET was significantly correlated with the percentage of globally sclerotic glomeruli. Conclusions: Non-invasive assessment of renal microcirculation using dynamic [¹⁸F]F-FAZA PET is potentially feasible. The dynamic PET-derived parameters showed strong correlations with renal function. There were also correlations with various histopathological findings. Additionally, static [¹⁸F]F-FAZA PET-derived parameters showed complementary findings with hypoxia-related end-stage histopathological indicators. Full article

Cardiovascular ultrasound is a cornerstone of noninvasive cardiac and vascular assessment, yet conventional interpretation remains operator-dependent, variable, and limited in sensitivity for subclinical disease. Artificial intelligence (AI), particularly machine learning (ML), deep learning (DL), and, most recently, vision–language and foundation models, offers tools to automate, standardize, and extend ultrasound analysis. This narrative review examines the role of AI-enhanced cardiovascular ultrasound in the transition from descriptive imaging toward predictive and personalized medicine. We conducted a structured literature search of PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar (January 2016–May 2026), combining Medical Subject Headings and free-text terms related to AI and cardiovascular ultrasound. Original studies, meta-analyses, reviews, consensus documents, and seminal works were considered. AI now spans the entire echocardiographic workflow, acquisition guidance, view classification, segmentation (Dice ≈ 0.92–0.94 on public datasets), and automated quantification of ejection fraction and global longitudinal strain, achieving expert-level accuracy and improved reproducibility. Across clinical domains, AI supports ischemia detection on stress echocardiography, heart-failure phenogrouping, Doppler-independent aortic stenosis detection, and carotid plaque characterization for stroke-risk stratification. Emerging vision–language and multitask foundation models (e.g., EchoCLIP, EchoPrime, and PanEcho) point toward general-purpose interpretation, and a growing number of tools (Caption Guidance, Us2.ai, and Ultromics EchoGo) have obtained FDA clearance and/or CE marking. Increasingly, AI-derived imaging biomarkers feed multimodal models that enable individualized risk prediction and therapy selection. AI-enhanced cardiovascular ultrasound is poised to become a central tool of precision cardiology. Realizing its potential will require prospective multicenter validation, cross-vendor standardization, attention to generalizability, interpretability, and reproducibility, and evolving regulatory and ethical frameworks. Full article

Background/Objectives: Gestational diabetes mellitus (GDM) is one of the most common metabolic complications of pregnancy and is associated with adverse maternal and neonatal outcomes. Current screening strategies are generally performed during the end of the second trimester, limiting opportunities for early intervention. Increasing evidence suggests that placental and fetal ultrasound markers detectable in early pregnancy may reflect the pathophysiological changes preceding the clinical diagnosis of GDM. This narrative review aims to summarize the current evidence regarding first- and second-trimester placental and fetal ultrasound markers associated with the subsequent development of GDM. Methods: A narrative review of the literature was conducted focusing on studies evaluating ultrasound markers of placental morphology, placental vascularization and function, uterine artery Doppler indices, placental volume, placental thickness, and fetal biometric and functional parameters in relation to later GDM diagnosis. Twenty-two studies were identified and analyzed to assess their clinical utility and predictive value. Results: Increasing evidence suggests that placental and fetal ultrasound markers detectable in early pregnancy may reflect pathophysiological changes preceding the clinical diagnosis of GDM. Three-dimensional power Doppler, particularly the vascularization–flow index, has demonstrated reduced placental vascularization in pregnancies subsequently complicated by GDM. Placental elastography and artificial intelligence-based radiomic analysis also show promising predictive potential. Uterine artery Doppler has demonstrated limited and inconsistent value. Fetal findings suggest that conventional biometry has limited predictive utility, whereas fetal growth velocity and markers of adiposity, including anterior abdominal wall thickness and abdominal overgrowth, more consistently identify early adaptations associated with later GDM. However, substantial methodological heterogeneity limits interpretation. Conclusions: Early placental and fetal ultrasound markers represent promising non-invasive tools for the early identification of pregnancies at risk for GDM. Further large-scale prospective studies are required to validate their predictive performance and establish standardized assessment protocols. Integrating maternal clinical characteristics and biochemical parameters may enhance future screening strategies for GDM. Full article

The aim of this narrative review was to provide a disease-oriented diagnostic framework for selecting and integrating multimodal imaging techniques according to the suspected optic disc disorder. A non-systematic PubMed search was performed to identify relevant literature on optic disc diseases and related imaging appearances. Searches included a combination of terms related to disease features and imaging modalities. The recent introduction of non-invasive imaging devices, such as optical coherence tomography (OCT) and OCT angiography (OCTA), has allowed a remarkable step forward in the knowledge of the optic disc. OCT has revolutionized the diagnosis and monitoring of glaucomatous eyes, providing useful quantitative biomarkers. Fundus examination and color fundus photography are the first step for evaluation of optic disc edema, which requires further exams, including fundus autofluorescence, to exclude the presence of optic disc drusen, ocular ultrasound and in certain cases, fluorescein angiography. Although still limited, OCTA could give a support in the evaluation of vascular diseases that involve the optic disc, such as anterior ischemic optic neuropathy, retinal vein occlusion and proliferative diabetic retinopathy. Analyzing the radial peripapillary capillary plexus, OCTA can also highlight early vascular changes in degenerative diseases (i.e., glaucoma, Alzheimer’s disease or multiple sclerosis). Multimodal imaging is a cornerstone in the neuro-ophthalmology field, offering unparalleled insight into optic nerve head architecture and vascular integrity in both normal and diseased states. Full article

Background: Combined bone and soft-tissue loss of the lower extremity requires complex reconstructive pathways. While acute post-traumatic infected defects and chronic osteomyelitis differ clinically, both present reconstructive challenges that demand radical debridement, infection-directed therapy, and radiology-guided soft-tissue coverage. Objective: To evaluate treatment options and functional recovery using a standardized orthoplastic workflow supported by radiological planning in patients with lower-extremity combined bone and soft-tissue loss of acute traumatic infectious etiology and chronic osteomyelitis. Methods: In this retrospective case series, 27 patients treated between May 2021 and December 2023 were included and divided into two groups: (A) acute post-traumatic bone and soft-tissue loss (n = 17) and (B) chronic osteomyelitis with fistula and soft-tissue loss (n = 10). Patients received multidisciplinary orthoplastic management with local and/or free flaps selected according to defect characteristics and radiology-guided vascular assessment (CT/MRI and angiographic CT; Doppler ultrasound for regional flap planning). Empirical broad-spectrum antibiotics were started after intraoperative biopsy sampling and later tailored to microbiological results. Healing was defined by bone union, infection/inflammation resolution, and flap healing. Functional outcomes were assessed using the Lower Limb Functional Index (LLFI). Due to baseline differences and a small sample size, within-group pre- vs. post-treatment changes in LLFI were analyzed separately. Results: Both groups demonstrated clinically relevant improvements in LLFI after treatment when assessed within each group. Flap selection and antibiotic strategy were implemented according to predefined multidisciplinary endpoints, achieving the study healing criteria in the included patients. Conclusions: A standardized orthoplastic reconstruction strategy supported by radiology-guided planning appears feasible in distinct clinical contexts of acute infected traumatic defects and chronic osteomyelitis, with improvement in lower-limb function assessed within groups. Full article

Background and Clinical Significance: Ruptured common iliac artery aneurysms may mimic urological disease, particularly when retroperitoneal bleeding causes ureteral compression and secondary hydronephrosis. This case is clinically relevant because the first symptom was acute stabbing testicular pain, followed by lumbar discomfort and ultrasound findings suggestive of obstructive uropathy. Case Presentation: A 73-year-old man with arterial hypertension and active smoking presented to the Emergency Department with sudden left lumbar pain that initially radiated to, or was perceived in, the left testicle. The testicular pain resolved spontaneously, but persistent poorly localized lumbar pain continued. He was afebrile and initially hemodynamically stable. Point-of-care ultrasound showed left hydronephrosis, while the abdominal aorta appeared unremarkable. Because the patient looked clinically unwell and the abrupt, stabbing onset was not fully explained by uncomplicated renal colic, contrast-enhanced abdominal and pelvic computed tomography was performed. CT revealed a fissured saccular aneurysm of the left common iliac artery with active contrast extravasation and a large retroperitoneal hematoma compressing the ipsilateral ureter, thereby causing secondary hydronephrosis. The patient underwent urgent endovascular treatment with percutaneous transluminal angioplasty and Bentley stent. Post-revascularization CT showed no further contrast extravasation, and the patient was discharged after seven days without complications. Conclusions: In older patients with cardiovascular risk factors, sudden testicular, flank, or lumbar pain may warrant consideration of retroperitoneal vascular emergencies, even when initial ultrasound suggests a urological diagnosis. In this patient, discordance between the clinical presentation and the initial ultrasound findings prompted contrast-enhanced CT, which enabled diagnosis and timely vascular management. Full article

Contrast-enhanced low-mechanical-index endoscopic ultrasound (CELMI-EUS) extends the diagnostic capabilities of endoscopic ultrasound by enabling real-time assessment of hepatic microvascularization and perfusion using intravenous ultrasound contrast agents. Owing to its close proximity to the liver and high spatial resolution, CELMI-EUS is particularly suited for the detection and characterization of small or otherwise inconspicuous focal liver lesions. This review summarizes the technical principles of CELMI-EUS, contrast agent usage, vascular phase interpretation, and standardized assessment of benign and malignant focal liver lesions, including the potential and provisional application of CEUS Liver Imaging Reporting and Data System (LI-RADS) terminology in patients at risk for hepatocellular carcinoma, while acknowledging that dedicated validation for CELMI-EUS is lacking. Typical enhancement patterns of common benign lesions such as hemangioma, focal nodular hyperplasia, hepatocellular adenoma, biliary hamartomas, and abscesses are discussed, as well as malignant entities including metastases, hepatocellular carcinoma, and cholangiocarcinoma. In addition, the role of CELMI-EUS in lesion detection, interventional guidance, and its limitations and pitfalls are addressed. Integrated into a multimodality imaging approach alongside transcutaneous CEUS and cross-sectional imaging, CELMI-EUS represents a valuable complementary tool that improves diagnostic confidence and supports optimized management of patients with focal liver lesions. Full article