Objective Test the impact of clutter filtering and feasibility of ultrasound blood speckle tracking (BST) to evaluate flow patterns in abdominal aortic aneurysms. Methods Data were acquired for 7 patients diagnosed with an abdominal aortic aneurysm with minor intraluminal thrombus (ILT) volume, and 6 patients having substantial ILT volume, of which 10 patients were included in the assessment. A multi-observer assessment was done to tune and compare the performance of clutter filtering based on singular value decomposition (SVD) and polynomial regression, prior to BST. The quality of the resulting vector flow images was assessed in a second multi-observer assessment. Results After selecting a suitable filter threshold for each patient recording, only two out of 10 measurements had remaining clutter in the spectrograms during systole, and in one case during diastole. During systole, for 8 out of 10 patients 80% of the lumen area or more was deemed to have physiologically correct vector flow imaging (VFI) estimates. During diastole, this was only the case for 2 patients. For 4 patients, this percentage was lower than 50% during diastole. Conclusion During systole, BST can be applied to get accurate VFI results in the abdominal aortic aneurysm. Quantifying the lower velocity flow during diastole was less successful.
To expand access to diagnostic breast ultrasound, experts recommend training non-radiologist clinicians. Robust strategies to assess trainee competence are needed to ensure ultrasound quality. This review sought to answer the question, “What strategies have been used to assess breast ultrasound skill?,” describe skill domains assessed, and determine whether tools’ measurement validity has been established. Following PRISMA guidelines, we searched Medline, Embase, Scopus, and Web of Science.Of 3422 records, 21 studies were included; 61.9% were from high-income countries. Skill assessment strategies included comparison to a gold standard (n = 8) and review of images with known findings (n = 6). Lesion detection and characterization and BI-RADS were the most common skills assessed. No study systematically validated a tool. Existing methods for evaluating breast ultrasound skill are varied and unvalidated. Validated tools could help optimize breast ultrasound training and quality globally.
Objective This study aimed to precisely quantify the individual and interactive effects of ankle-knee angles and spasticity grades on passive acoustic and biomechanical properties of the Achilles tendon in post-stroke patients, using shear wave elastography (SWE) - an angle-specific, non-invasive biomarker for static passive tendon assessment. Methods A prospective cohort study was carried out. Two - dimensional ultrasound and SWE were employed to measure the structural parameters and material properties of the triceps surae/Achilles tendon (AT) at various ankle/knee positions in 35 post - stroke patients. Spasticity was evaluated using the Modified Ashworth Scale (MAS). Log - transformed mean Young's modulus (YM) and shear - wave velocity (SWV) data were analyzed via a linear mixed - effects (LME) model. Results The injured side had higher: gastrocnemius medialis (GM)/soleus (SOL) YM and SWV (all P ≤ 0.027) and increased AT thickness in neutral ankle positions (P ≤ 0.039). LME models explained 68.6% (YM) and 71.9% (SWV) of total variance. Ankle dorsiflexion significantly increased AT stiffness (YM β = 0.270; SWV β = 0.320, all P < 0.001), whereas knee extention produced smaller but significant increments (YM β = 0.140, SWV β = 0.160, all P < 0.001). with marginal ankle - knee interaction (P = 0.060–0.084). Spasticity grade (MAS 0 - 2) and higher - order interactions had no significant effects (all P > 0.05). Conclusion Joint angle has a greater impact than spasticity grade on prone-measured passive post-stroke Achilles tendon stiffness, with marginally significant ankle-knee interactions. SWE is a non-invasive, angle-specific biomarker for static passive AT mechanical assessment.
Purpose Ring-down artifacts are frequently observed in the presence of gases, a phenomenon traditionally attributed to resonance within a so-called resonance horn. However, variations in appearance, particularly those associated with dynamic changes in gas configuration, suggest that this mechanism alone may not fully explain the phenomenon. This study aimed to determine whether interference between multiple reverberations provides an additional or alternative explanation. Methods Two hundred patients with no known bowel disease underwent abdominal ultrasonography. The frequency of ring-down artifacts was evaluated. Gas-related echoes were systematically categorized into four representative patterns to aid interpretation. Experimental models were designed to examine both resonance- and reverberation-based mechanisms. Two- and three-bubble configurations were used to reproduce artifacts under controlled conditions. Frequency and spectral analyses were also performed. Results Ring-down artifacts were observed in 96% of the patients with normal gastrointestinal tracts. Although the resonance horn model did not reproduce the characteristic signal pattern, the two- and three-bubble models generated vertical signals with thicknesses and periodicities similar to those observed in vivo. Frequency analysis showed no distinct spectral features suggestive of dominant resonance; however, the findings were consistent with the signals generated by interacting reverberations. Conclusion The findings suggest that interference among multiple reverberations may offer a more consistent explanation for the characteristic features of ring-down artifacts, including their persistence with depth, thickness, and periodicity. This interpretation, which does not rule out a contribution from resonant phenomena, offers a complementary perspective on its acoustic basis.
Objectives The objectives of this study were threefold; (1) to determine how practitioners performing obstetric and gynaecologic (O&G) ultrasound examinations reprocess endocavity (EC) transducers post scan; (2) whether practitioners use a transducer cover for EC scans, and (3) if infection prevention and control (IPC) guidelines and training are available for transducer reprocessing. Methods An international survey was created using Survey Monkey. Questions asked included country of practice, use of transducer covers for EC scans, availability of IPC guidelines, training in EC transducer reprocessing, and type of EC transducer reprocessing undertaken. The survey was open for six months and promoted via multiple ultrasound society websites, trade partners and at relevant international ultrasound conferences. A non-probability convenience sampling approach was used for analysis. Results were analysed overall as well as in global regions. Results A total of 912 persons responded from 102 countries with 43% using high level disinfection (HLD) for reprocessing EC transducer post scan. 42% of respondents had access to IPC guidelines, and 50% received training in reprocessing EC transducers post use. There were difference in IPC practice between global regions. Conclusion The survey results demonstrated that worldwide, there was a wide variation in IPC standards and access to educational support material to reduce the risk of transmission of bacterial and viral pathogens when performing endocavity ultrasound examinations. Incorrect transducer reprocessing post scan can place patient safety at risk.
Background and aims: Idiopathic granulomatous mastitis (IGM) is a rare form of chronic mastitis that often mimics breast cancer on diagnostic imaging and clinically. Mammography, conventional ultrasound (CUS), and magnetic resonance imaging have long been used to differentiate these two entities, but yield inconclusive results. Ultrasound elastography (UE) is a non-invasive technique used to evaluate tissue stiffness. However, there is insufficient information on the diagnostic utility of UE in differentiating IGM from breast cancer. This systematic review and meta-analysis was therefore conducted to ascertain the diagnostic utility of UE and how it compares to CUS. Methods: This systematic review and meta-analysis was reported following the PRISMA guidelines. Four electronic databases were searched, namely EMBASE, MEDLINE, Scopus, and the Cochrane Library. Data were extracted independently by two review authors. Quantitative data were analyzed using Review Manager 5 and Metadisc 2.0. Results: The meta-analysis was conducted using a random effects model and standard mean difference. Diagnostic test accuracy (DTA) analysis was also performed. The results of the meta-analysis revealed statistically significant pooled mean differences of 3.64 (95% CI: 3.25-4.02) and 2.68 (95% CI: 2.40-2.96) in strain ratio (SR) and shear wave elastography (SWE), respectively, between IGM and breast cancer patients.The results for the DTA analysis showed a high pooled sensitivity and a relatively low specificity of 90.0% and 73.0% for CUS. Shearwave elastography (SWE) yielded the best results with both the pooled sensitivity and specificity being high at 94.0% and 93.0% respectively. Conclusion: Ultrasound elastography, especially SWE, enhances the ability to distinguish IGM from breast cancer. However, geographical limitations and variability in techniques highlight the need for standardization and multicenter studies to improve reliability and global applicability.
Objective: To evaluate the diagnostic performance of a computer-aided diagnosis (CAD) system compared with radiologist assessment for ACR TI-RADS classification of thyroid nodules on ultrasound. Methods: This retrospective cross-sectional study included 332 thyroid nodules from 306 patients. Seven radiologists with different levels of experience (junior and senior) independently classified nodules according to the five ACR TI-RADS ultrasound features. The same images were analyzed using the CAD software AmCAD-UTTM Detection. Diagnostic performance was assessed using sensitivity, specificity, positive predictive value, negative predictive value, accuracy, positive likelihood ratio, and negative likelihood ratio. Results: Senior radiologists achieved the highest specificity and overall accuracy, with sensitivity of 57.4%, specificity of 80.0%, and accuracy of 69.7%, whereas junior radiologists showed sensitivity of 66.7%, specificity of 64.2%, and accuracy of 64.5%. The AI system showed sensitivity of 53.6% and specificity of 68.4%. Conclusion: The evaluated AI system does not outperform radiologist assessment in ACR TI-RADS classification of thyroid nodules and cannot replace human expertise. However, it may serve as a complementary tool, particularly as a second opinion or training support for less experienced radiologists.
Artificial intelligence (AI) is reshaping the landscape of diagnostic ultrasound at an unprecedented pace, offering the promise of improved diagnostic consistency, expanded access in resource-limited environments, and enhanced workflow efficiency. Yet enthusiasm must be tempered by a critical appraisal of the field's current limitations, including algorithmic bias, fragmented regulatory frameworks, risks of operator deskilling, and unresolved questions of clinical liability. This editorial argues that AI in ultrasound is not a distant horizon but an unfolding clinical reality, one that demands proactive, profession-led stewardship. Ultrasound societies, journal editors, educators, and clinicians must collectively define the standards, validate frameworks, and create educational curricula that will determine whether this technology fulfils its considerable promise or becomes a source of unintended harm.
Non-mass lesions (NMLs) of the breast lack the typical mass effect, which makes conventional ultrasound diagnosis difficult and often leads to missed or incorrect diagnoses. Multimodal ultrasound (MUS) integrates gray-scale ultrasound, elastography, contrast-enhanced ultrasound, and automated breast volume scanning to assess lesions from multiple angles—morphology, stiffness, blood flow perfusion, and spatial structure—greatly improving diagnostic accuracy. In recent years, rapid advances in AI have further driven the intelligent evolution of MUS. Studies show that multimodal ultrasound fusion strategies can achieve an AUC above 0.930 for distinguishing benign from malignant non-mass lesions. Adding deep learning pushes the AUC to 0.960, and machine learning–based multimodal models reach an AUC of 0.947 for molecular subtyping prediction. Moreover, ultrasound imaging features correlate to some extent with molecular subtypes such as Luminal, HER2-overexpressing, and triple-negative breast cancer. Emerging techniques like explainable artificial intelligence and multi-view visual Transformers also show promise. This paper systematically reviews the progress of integrating multimodal ultrasound with artificial intelligence for diagnosing non-mass breast lesions, focusing on deep learning models, radiomics, and molecular subtyping prediction, aiming to guide future research and clinical translation.
Objective: Reducing fat infiltration in skeletal muscle may potentially improve health outcomes, such as overall survival and cancer-related fatigue, among colorectal cancer (CRC) survivors. We investigated the effect of a person-centred lifestyle intervention on fat infiltration in skeletal muscle assessed with ultrasound echointensity among CRC survivors with cancer-related fatigue. Methods: This secondary analysis of a parallel randomized controlled trial included stage I-III CRC survivors with cancer-related fatigue. The intervention comprised twelve lifestyle coaching sessions over six months to improve physical activity and dietary intake. The control group did not receive lifestyle coaching. Fat infiltration in the rectus femoris muscle, assessed using 8-bit B-mode ultrasound-derived echointensity (arbitrary units [a.u.]), and cancer-related fatigue, measured using the Functional Assessment of Chronic Illness Therapy Fatigue scale, were evaluated at baseline and six months. Mediation analysis explored whether fat infiltration in skeletal muscle mediates the intervention's effect on cancer-related fatigue. Results: We included 161 CRC survivors with cancer-related fatigue (64.1 +/- 10.9 years, 55.3% women), who were randomized to the intervention (n = 80) or control group (n = 81). The change in echointensity over time did not differ between the intervention and control group (Delta 2.21 a.u. 95%CI:-1.04; 5.46). Additionally, fat infiltration in skeletal muscle did not mediate the effect of the lifestyle intervention on cancer-related fatigue. Conclusions: The lifestyle intervention had no effect on fat infiltration in the rectus femoris muscle among CRC survivors with cancer-related fatigue. Although no effect on skeletal muscle echointensity was observed in the present study, our findings demonstrate the feasibility of echointensity assessment in studies focusing on muscle quality and support its potential value for future research in this field.
The infiltration between the popliteal artery and the capsule of the knee (IPACK) block is a motor-sparing regional anaesthetic technique that provides analgesia to the posterior knee capsule by targeting sensory articular branches of the tibial, sciatic, common peroneal, and obturator nerves. It is commonly used as part of multimodal analgesia for total knee arthroplasty, cruciate ligament surgery, and other knee procedures, with its clinical effectiveness and safety depending on accurate identification of posterior knee sono-anatomy. This narrative educational review aims to provide a detailed, anatomy-focused sonographic guide to standardise identification of key posterior knee structures relevant to the safe and effective performance of both proximal and distal IPACK block techniques. The review synthesises current knowledge of posterior knee sono-anatomy, procedural considerations, and available clinical evidence. Ultrasound-guided IPACK techniques are described, including patient positioning, probe orientation, identification of sono-anatomical landmarks, needle trajectories, and expected patterns of local anaesthetic spread for proximal and distal approaches. Particular emphasis is placed on anatomical relationships critical for safe needle placement, avoidance of vascular and neural injury, and optimisation of posterior capsular analgesia, with comparison between proximal and distal techniques. Consistent sonographic identification of the femur–popliteal artery interval and adjacent neural structures is essential for reliable IPACK performance. Evidence from existing clinical studies suggests that both proximal and distal approaches provide effective posterior knee analgesia, although the proximal technique may offer more consistent visualisation and a lower risk of unintended motor blockade. Clarifying and standardising relevant posterior knee sono-anatomy may enhance anatomical understanding, improve technical accuracy, and support safer, more effective application of the IPACK block within multimodal perioperative analgesia for knee surgery.
Objectives: To investigate the feasibility of ultrasound backscatter parameters in assessing upper trapezius muscle (UTM) hypertonicity. Methods: We prospectively measured pixel intensity on B-mode ultrasound images of UTM and adjacent subcutaneous tissue (SUBC) using Image J histogram, and calculated backscatter reduction rate and anisotropy following beam steering at 5°, 10°, 15°, and 20° from 0°. We analyzed differences in backscatter parameters of UTM and SUBC between three age groups using one-way analysis of variance (ANOVA), between normal and hypertonic UTMs using paired t-test, diagnostic performances of backscatter parameters for determining ≥ mild hypertonic UTM using area under receiver operating characteristic curve (AUC), and inter- and intra-observer reliability in measuring pixel intensity using intraclass correlation coefficient (ICC) and Blant-Altman analysis. Results: We recruited 125 adult subjects (39 with normal UTM, 86 with hypertonic UTM) in three age groups (young age: 18-44y; middle age: 45-64y; old age: ≥65y). Differences in backscatter parameters between normal and hypertonic UTM were significant in young and middle-aged groups (p < 0.01) but not in old-aged group (p > 0.05). AUC of muscle backscatter reduction rate at beam steering 20° for determining ≥ mild hypertonicity was 0.89, 0.80, and 0.64 in young, middle-aged, and old-aged participants, respectively. ICCs of observer reliability for measuring pixel intensity were >0.80. Conclusions: The muscle backscatter reduction rate at beam steering 20° can distinguish hypertonic muscles from normal muscles in young and middle-aged with good intra- and inter-operator reliability. Muscle backscatter reduction rate in adults decreases with aging and the occurrence of hypertonicity.
Metabolically associated steatotic liver disease (MASLD) is a prevalent and serious global health concern, affecting 20-40% of the population. Early detection and accurate quantification of liver steatosis (LS) are crucial for preventing disease progression [1]. Current imaging methods, including ultrasound (US), and magnetic resonance imaging (MRI), play key roles in noninvasive diagnosis. Among these, MRI-proton density fat fraction (MRI-PDFF) serves as the reference standard for quantitative assessment; however, its cost and limited availability restrict widespread use. This study evaluated the diagnostic performance of attenuation coefficient measurements (ACM) for detecting and quantifying LS in MASLD using MRI-PDFF as the reference standard. This prospective study included 168 patients aged 18-64 years. Demographic, anthropometric, and laboratory data were collected. US evaluation included right and left liver lobe thickness, hepatorenal index (HRI), shear wave elastography (SWE), and ACM quantification. MRI-PDFF was performed on a 1.5-T system. Statistical analysis included the Kruskal-Wallis test, correlation analysis, and receiver operating characteristic (ROC) curve assessment. A strong correlation was found between ACM and MRI-PDFF (r = 0.83, p < 0.0001), confirming high diagnostic reliability. ACM demonstrated high diagnostic accuracy for identifying hepatic steatosis (AUC = 0.94, 95% CI: 0.88-0.96), with specificity and sensitivity of 89.8% and 82.2%, respectively. Compared with other ultrasound techniques, ACM outperformed HRI (AUC = 0.89) and SWE (AUC = 0.72). The established ACM cut-off values for LS stages were 2.29 dB/cm (S0-S3), 2.24 dB/cm (S1), 2.51 dB/cm (S2), and 2.88 dB/cm (S3). ACM demonstrates high diagnostic accuracy for detecting and quantifying LS and shows strong agreement with MRI-PDFF. Given its noninvasive nature, accessibility, and reliability, ACM has strong potential as a primary screening and monitoring tool for MASLD. Further validation in larger cohorts is recommended to support widespread clinical implementation.
Introduction Hypertensive disorders in pregnancy (HDP) have a direct impact on placental function. However, the relationship between placental function and maternal cardiac function in HDP patients is not well understood. Aims The main objective of this study was to assess if a correlation exists between placental function and maternal cardiac function in women with pre-eclampsia. Method This study enrolled 148 pregnant women in their 2nd and 3rd trimesters (74 normotensive and 74 preeclamptic). We performed obstetric ultrasounds to assess these umbilical artery Doppler indices, namely the Resistive Index (RI) and Systolic and Diastolic (S/D) ratios. Transthoracic echocardiography was conducted on the participating mothers to evaluate chamber dimensions, wall thickness, and systolic and diastolic functions. The assessed systolic and diastolic function parameters included ejection fraction (EF), E/A ratio, and E/E’. Results Significant differences were observed between the two groups in parameters such as left ventricular dimensions (LVDd, IVSd, PWd, LVMI, LAD, AoR), diastolic function (E, A, E/A ratio), and placental indices (RI, S/D ratio). The ejection fraction was not significantly different between the two groups.In accounting for overall geometric remodelling, left ventricular hypertrophy (LVH) was exclusive to the pre-eclamptic group, with 4% exhibiting concentric and 19% eccentric hypertrophy. Concentric remodelling was observed in 20% of the preeclamptic group and 23% of the normotensive group. 77% and 57% of participants did not experience any form of remodelling in the normal and pre-eclamptic groups, respectively. Furthermore, the maternal left ventricular systolic and diastolic function parameters (EF, E/A ratio and E/E’ ratio) correlated with placental function indices (RI and S/D ratios), suggesting an interplay between maternal cardiovascular adaptation and placental perfusion abnormalities in preeclampsia. Conclusion The study establishes a weak to moderate correlation between maternal diastolic and systolic function parameters and placental function indices (RI and S/D ratios) in preeclampsia. This supports the hypothesis that maternal cardiovascular maladaptation may contribute to placental dysfunction. Further studies are recommended to assess the persistence of cardiac remodelling postpartum. Implication for practice Clinicians might now consider more comprehensive cardiac assessments during prenatal care for patients at risk of preeclampsia. Monitoring maternal cardiac function could provide earlier insights into potential placental complications.
Focused ultrasound (FUS) is a promising noninvasive modality for neuromodulation, with the ability to induce both inhibitory and excitatory neural effects. However, significant variation in reported acoustic parameters, experimental models, and outcome measures has limited comparability across studies and slowed clinical translation. To address this gap, this review synthesizes the limited available evidence describing how stimulation parameters-including frequency, pressure amplitude or intensity, duty cycle, pulse repetition frequency (PRF), exposure duration, and temporal stimulation pattern-can be associated with neuromodulatory outcomes such as inhibitory and excitatory effects, while highlighting current limitations and critical gaps found in the preliminary and heterogeneous nature of the existing literature. The authors reviewed ten peer-reviewed experimental and early translational studies that report explicit acoustic parameters (frequency, pressure amplitude/intensity, duty cycle, pulse repetition frequency, and exposure duration) along with measurable neural, structural, or behavioral outcomes, encompassing rodent, ex vivo, and human motor cortex models. Inhibitory responses including hippocampal long-term depression and motor-evoked potential suppression were most commonly associated with lower intensities, longer sonication durations, continuous stimulation paradigms, or specific parameter interactions favoring reduced cortical excitability. Conversely, repeated low-intensity pulsed ultrasound at moderate PRFs (similar to 500 Hz) and higher peak negative pressures (approximate to 0.4-0.5 MPa) was associated with increased dendritic spinogenesis, increased excitatory postsynaptic activity, and improved memory performance. In addition, multiple studies demonstrated a capacity for bidirectional modulation depending on stimulation pattern or parameter definition alone. These findings suggest that neuromodulatory direction is governed by interacting acoustic and temporal parameters such as PRF, pressure amplitude, and stimulation duration, rather than single-variable thresholds. However, the limited number of controlled studies, heterogeneity in experimental design, and ongoing technical challenges-including skull attenuation, targeting verification, and safety considerations-preclude definitive parameter mapping at present. With FUS being an evolving technique with possible therapeutic potential, standardized reporting and dose-response modeling remain essential for establishing reliably tunable neuromodulatory protocols.
This review examines future directions by focusing on the latest findings, limitations, and challenges in the clinical application of artificial intelligence (AI)-based ultrasound imaging for carpal tunnel syndrome (CTS) and osteochondritis dissecans (OCD). In these conditions, ultrasonography (US) imaging is clinically applied. Over the past few years, AI has significantly enhanced the diagnostic capabilities of US by providing real-time imaging and accurate lesion delineation. The integration of deep learning models has led to significant advancements in automatic segmentation and object detection, enabling high prediction accuracy in diagnosing these conditions. Numerous studies have demonstrated the effectiveness of AI models, such as YOLO and Mask R-CNN, in accurately identifying and classifying musculoskeletal disorders. These advancements have the potential to streamline clinical workflows and improve diagnostic outcomes. The continued development of AI-based US imaging has significant potential for improving diagnostic accuracy and efficiency. However, there are limitations to its clinical application, and further studies, including the use of large-annotated datasets for training AI models and establishing standardized protocols for US imaging diagnostics, are crucial.
Objectives: To assess inter-reader agreement for color Doppler vascularity and contrast-enhanced ultrasound (CEUS) enhancement in indeterminate renal lesions and to compare their sensitivity for characterizing renal masses. Methods: In this retrospective study, patients who underwent CEUS evaluation of indeterminate renal lesions at two tertiary care centers between January 1, 2019, and March 15, 2025, were identified. Two board-certified, subspecialty-trained radiologists, blinded to final diagnoses, independently assessed color Doppler vascularity and enhancement using sulfur hexafluoride microbubble contrast. Inter-reader agreement was evaluated using Cohen's kappa. Discordant interpretations were classified as negative. Feature frequencies were compared using McNemar's test. Pathology results were available and documented as the reference standard for 20% of the lesions (n = 9). Sensitivity and 95% confidence intervals were reported. Results: 45 renal lesions (12 solid, 33 cystic) in 38 patients (mean age 66.7 years; 21 male) were identified. Mean maximum lesion diameter was 32 mm (range: 8-99 mm). There was strong inter-reader agreement for assessment of vascularity (Kappa 0.738) and presence of enhancement (Kappa 0.814). Lesions were more likely to enhance (n = 34,76%) than show vascularity (n = 13, 29%), p < 0.001. Only 7 (21%) enhancing lesions showed vascularity. 9 biopsied lesions were neoplasms (8 renal cell carcinoma, 1 oncocytoma); all 9 demonstrated enhancement (100% sensitivity; 95% CI: 66-100%), but only 5 demonstrated vascularity (56% sensitivity; 95% CI: 21-86%). Conclusion: CEUS demonstrated near perfect interobserver agreement and superior sensitivity compared with color Doppler ultrasound for detecting enhancement in indeterminate renal lesions. Most enhancing lesions do not demonstrate Doppler vascularity.
Knee osteoarthritis (KOA) is a degenerative joint disease, involving various knee tissues. As it is widely recognized that treatment is most efficient in an early-stage of the disease, early diagnosis of KOA is of crucial importance. Early identification of KOA, however, has been difficult due to limitations of common clinical diagnostic methods. Ultrasound offers a solution, but acquisition and interpretation of US images requires extensive training. Automated detection and measurement of KOA-related characteristics could be of added value. This review provides an overview of the available literature on automatic measurement and detection of KOA characteristics using ultrasound. IEEE Xplore and PubMed were searched for relevant publications, followed by iterative forward and backward citation search to identify all relevant literature. One author screened for relevant publications and extracted data from included publications. The literature search in this study resulted in 10 papers. Although there is increasing recognition that KOA involves multiple knee structures rather than only cartilage, most studies still focused on cartilage (8/10 publications). Five papers present a fully-automatic algorithm, of which four were artificial intelligence (AI) based. The remaining five publications describe a semi-automatic method. Study population sizes ranged from one to 29, and only one study included four KOA patients. The small study sizes and lack of patient data make it impossible to draw conclusions on the generalizability and clinical relevance of the proposed methods. Future research should expand the focus from cartilage to multiple KOA-related characteristics and to inclusion of more subjects, including patients with KOA.
Placental dysfunction contributed to many pregnancy complications, highlighting the need to clarify normal placental mechanisms and improve early detection. Contrast-enhanced ultrasound (CEUS) has demonstrated utility in visualizing the (micro)vasculature across other fields of medicine. However, its use in obstetrics for detailed visualization and characterization of the placental (micro)vasculature remains to be validated.This pilot study explores the feasibility of CEUS for ex-vivo visualization of the fetal placenta, aiming to improve the understanding of feto-placental vascularization. It evaluates CEUS as a viable imaging method and its potential for quantifying vascular patterns in pregnancy complications, using advanced techniques like semi-quantitative CEUS and ultrasound localization microscopy (ULM) for detailed vascular assessments.In this ex-vivo feasibility study, CEUS imaging of the fetal side of the placenta was performed by injecting an ultrasound contrast agent (UCA) in the umbilical vein. This allowed assessing the (micro)vascular perfusion using semi-quantitative CEUS, by analysis of the gray-level time evolution. In addition, ultrasound localization microscopy (ULM) was used to characterize the (micro)vascular architecture at high resolution.Our finding demonstrate the feasibility of advances CEUS imaging approaches for both quantitative analysis and localization microscopy, providing high-resolution visualization and comprehensive characterization of the fetal side of the placental vasculature.
