Transthoracic ultrasound (TUS) is an established imaging modality for the diagnosis and bedside monitoring of pleural effusions, pneumothorax, inflammatory pleural disease, thoracic wall lesions, peripheral pulmonary consolidations, and interstitial lung diseases. Contrast-enhanced ultrasound (CEUS) further improves lesion characterization by differentiating viable inflammatory tissue from necrosis and abscess formation. While the sonographic appearance of common thoracic diseases is well described, ultrasound findings in rare pulmonary and pleural conditions remain insufficiently documented. This review presents the characteristic transthoracic ultrasound (TUS) findings in several uncommon thoracic disorders, including abscessing fire-eater's pneumonia after paraffin aspiration, tracheal hemangioma, thoracic wall hemangioma, biliopleural fistula following percutaneous transhepatic cholangiodrainage (PTCD), bronchial rupture with hemopneumothorax, spontaneous pneumomediastinum, esophagopleural fistula, diaphragmatic cyst, and post-traumatic diaphragmatic paralysis. The sonographic findings are correlated with the clinical presentation and complementary imaging modalities.
Aims: To preliminarily evaluate the clinical value of high frame rate contrast-enhanced ultrasound (H-CEUS) for assessing intraplaque neovascularization (IPN) in carotid arteries among physicians with different levels of experience.Methods: A total of 66 patients with 114 carotid plaques who underwent both CEUS and H-CEUS were enrolled. One senior physician and two beginners (A and B) performed semi-quantitative grading of the number and distribution of IPN. The inter-modality agreement between CEUS and H-CEUS was assessed. The consistency between the senior physician and the beginners was compared. Learning curves were used to analyze the beginners' proficiency progression in evaluating IPN using CEUS and H-CEUS.Results: Assessment of IPN using the two contrast-enhanced ultrasound modes showed moderate interobserver agreement among senior physicians. With H-CEUS mode, the senior physician and two beginners demonstrated strong interobserver agreement in assessing both the number (p<0.001) and distribution (p<0.001) of IPN. The learning curve analysis further revealed that, H‑CEUS enabled beginners A and B to achieve competency faster and attain higher final concordance rates than CEUS.Conclusion: This technique provides clear visualization of intraplaque neovascularization, thereby offering a more objective basis for accurate assessment and demonstrating potential clinical value.
We present the case of a young woman in whom the association between sarcoidosis, extensor digitorum longus tendon tenosynovitis, and the presence of numerous rice bodies within the tendon sheath revealed a new clinical manifestation of sarcoidosis, in the absence of pulmonary or lymph nodes involvement. The most important aspect of this case is the assessment of tenosynovitis using multimodal ultrasound (grey scale, color/power Doppler, strain elastography, contrast enhanced ultrasound) which demonstrated specific findings that may facilitate further recognition of this clinical condition.
AIM:To develop a comprehensive clinicopathologic-radiomic model for predicting early recurrence (ER) after thermal ablation for hepatocellular carcinoma (HCC), and to explore optimal ablation strategies for high-risk tumors. MATERIAL AND METHODS:This multicenter retrospective study of 325 HCC patients undergoing microwave ablation divided them into training (n=182), internal (n=78), and external test sets (n=65). We extracted 3,499 radiomic features from pre-procedural ultrasound images and combined them with clinicopathological variables to train seven machine learning classifiers using 10-fold cross-validation. Model performance was assessed primarily by the area under the ROC curve, with decision curve and calibration analyses for clinical utility. The optimal minimal ablative margin (MAM) threshold for high-risk tumors was determined in the internal set using ROC analysis and validated externally. RESULTS:The integrated clinicopathological-radiomics model demonstrated superior predictive performance, with an AUC of 0.870 (95% CI: 0.762-0.978) and showed good calibration and positive net benefit on decision curve analysis. SHapley Additive exPlanations analysis identified key predictive features, predominantly from arterial-phase CEUS images. In this cohort, a larger MAM (threshold 7.7 mm derived internally) was associated with lower ER in predicted high-risk tumors. CONCLUSION:An integrated clinicopathological-radiomics model effectively predicts ER of HCC following microwave ablation and provides an effective strategy for high-risk tumors to reduce ER occurrence.
AIMS:To determine whether ultrasonography (US) provide similar accuracy as ileocolonoscopy, magnetic resonance enterography (MRE), and computed tomography enterography (CTE) in Crohn's disease (CD) diagnosis. MATERIAL AND METHODS:In this systematic review and meta-analysis PubMed, EMBASE, and Cochrane CENTRAL were searched from inceptionto December 2024 for studies that evaluated the diagnostic performance of US. Pooled sensitivity, specificity, and hierarchical summary receiver operating characteristic (HSROC) parameters were calculated. Subgroup and sensitivity analyses were performed, and publication bias was assessed with Deeks' funnel plot. RESULTS:Nine prospective and 2 retrospective studies were included. The pooled sensitivity and specificity of US for detecting active bowel lesions were 0.86 (95% confidence interval [CI]: 0.65-0.95) and 0.88 (95% CI: 0.69-0.96, respectively). The HSROC model indicated ultrasound had strong overall diagnostic performance, with a diagnostic odds ratio (OR) of 43.85 (95% CI: 9.68-198.53). No evidence of publication bias was detected, and sensitivity analyses confirmed the robustness of the results. CONCLUSIONS:Ultrasonography demonstrates high diagnostic accuracy for CD and represents a reliable, non-invasive imaging modality. Standardization of protocols and further multicenter validation are warranted to optimize its clinical application.
AIM:This systematic review and meta-analysis was designed to evaluate the diagnostic accuracy of contrast-enhanced ultrasound (CEUS) in distinguishing renal cancers from benign renal masses. MATERIAL AND METHODS:Meta-regression evaluated the sources of heterogeneity across studies and subgroup analyses for individual clinical classifications were conducted. Subgroup diagnostic performance for solid vs. cystic masses was also performed. The methodological quality evaluation was performed using the Quality Assessment of Diagnostic Accuracy Studies version 2 (QUADAS-2). Publication bias was assessed using the Begg funnel plot and Egger's test. RESULTS:Thirty-six articles involving 4,530 renal masses (3,221 malignant, 1,309 benign) were included in the analysis. The pooled sensitivity, specificity, PLR, NLR, and DOR were 0.94 (0.91-0.96), 0.85 (0.79-0.89), 6.24 (4.54-8.56), 0.07 (0.04-0.11), and 89.46 (51.66-154.94), respectively. The accuracy was 0.95 (0.93-0.97). I2 values of sensitivity (I2=95.91%) and specificity (I2=80.43%) were both >50%. Subgroup analyses demonstrated that CEUS had higher sensitivity for cystic renal masses than solid renal masses (0.99 vs. 0.88), but lower specificity (0.80 vs. 0.87). No publication bias was found (p=0.123). CONCLUSION:This meta-analysis demonstrated that CEUS could be an excellent tool for differentiating between malignant and benign renal masses, particularly for cystic renal masses.
AIM:Accurate assessment of axillary lymph nodes is crucial for breast cancer staging and clinical decision-making. This study evaluated the predictive value of quantitative morphologic ultrasound parameters and developed an objective scoring system to identify malignant axillary lymph nodes. MATERIALS AND METHODS:This retrospective study included 534 axillary lymph nodes with histopathological confirmation. Quantitative sonographic parameters-cortical thickness, cortex-to-short-axis ratio (C/S), and short-to-long-axis ratio (S/L)-were measured. Diagnostic performance was assessed using ROC analysis, and optimal cut-off values were determined. Multivariable logistic regression identified independent predictors of malignancy. A practical points-based scoring system, informed by the multivariable model and ROC findings, was developed to support standardized biopsy decisions. RESULTS:Cortical thickness showed the highest discriminative ability (AUC=0.883; optimal cut-off = 5.0 mm; sensitivity = 90.3%, specificity = 70.9%). In the combined model, cortical thickness, C/S ratio, S/L ratio, and age were independently associated with malignancy (p<0.001). CONCLUSION:Quantitative cortical morphologic parameters, particularly cortical thickness, are strong predictors of axillary lymph node malignancy. A multiparametric approach improves diagnostic accuracy and provides a more objective, reproducible method to guide biopsy decisions.
AIM:To classify the ultrasonographic features of glottic laryngeal carcinoma and to explore the concordance between two-dimensional ultrasound findings, color Doppler flow imaging (CDFI) characteristics and endoscopic morphological classifications under white light and narrow-band imaging (NBI). MATERIAL AND METHODS:This retrospective study included 151patients with pathologically confirmed glottic laryngeal carcinoma. Ultrasonographic findings were categorized based on twodimensionalgrayscale and CDFI findings. The concordance between ultrasound-based classifications and morphological types observed under white-light and NBI endoscopy was analyzed. The influencing factors of different vascular patterns were also investigated. RESULTS:The morphological classifications identified by two-dimensional ultrasound - i.e., mass, moth-eaten, popcorn-like, and thickened types - were significantly correlated with endoscopic morphological types. Blood flow patterns observed on CDFI - i.e., star-like, tree-branch, and firework-like - were strongly correlated with intrapapillary capillary loop (IPCL) classifications under NBI. Tumor length and the resistive index (RI) were significantly associated with blood flow patterns (p < 0.05), and multivariate logistic regression analysis revealed that the RI was an independent predictor of blood flow patterns. CONCLUSION:Two-dimensional ultrasound can be used to obtain quantitative vascular parameters and to noninvasively assess both the morphology and vascular characteristics of glottic laryngeal carcinoma. These sonographic findings exhibit high concordance with endoscopic evaluations, thus providing support for the use of ultrasound as a valuable adjunct in the pretreatment assessment of glottic carcinoma.
Nodal lymphoma requires precise diagnosis and longitudinal monitoring. Ultrasound is now established as a first-line tool for evaluating superficial lymphadenopathy, and the introduction of shear-wave elastography, contrast-enhanced ultrasound, super-resolution contrast-enhanced ultrasound, and artificial-intelligence-based decision support has expanded its role far beyond simple morphological assessment. This updated review outlines the evolving role of multimodal ultrasound and its advanced applications in the comprehensive management of nodal lymphoma, from initial diagnosis and biopsy guidance to treatment evaluation and prognosis stratification, highlighting current evidence, clinical utility, and future research directions.
