Purpose:Beckwith-Wiedemann Syndrome (BWS) predisposes children to hepatoblastoma and other cancers and requires tumor screening with abdominal ultrasound and magnetic resonance imaging (MRI) when lesions are seen. Contrast-enhanced ultrasound (CEUS) may offer an alternative to MRI, which often requires sedation. Our aim was to evaluate the diagnostic performance of CEUS compared to MRI in this group when evaluating liver lesions, to compare sedation requirements, and to assess imaging features correlated with malignancy. Materials and Methods:This was a retrospective review of patients with molecular BWS and liver lesions who underwent MRI and CEUS within 6 months. Demographics, sedation requirement, and final diagnosis (pathology or follow-up imaging) were recorded. Two blinded radiologists per category classified lesions (benign/malignant/indeterminate) and detailed imaging features. Test performance and inter-rater reliability (Cohen's κ) were calculated. Results:12 patients (7 females, mean age 3 months) were included. A final diagnosis of 3 hepatoblastomas and 9 benign lesions was derived from pathology in 4 cases and from imaging follow-up in 8. Ten MRI examinations (83%) and no CEUS examinations required sedation. On consensus read, CEUS had a sensitivity of 67% and a specificity of 89%; κ = 0.70. MRI had a sensitivity of 75% and a specificity of 100%; κ = 0.25. Iso-enhancement and washout on CEUS and cystic change, necrosis, and diffusion restriction on MRI correlated with malignancy. Conclusion:Our findings suggest that CEUS has good diagnostic accuracy and high inter-rater reliability and allows sedation avoidance, suggesting that its use could allow MRI to be reserved for indeterminate or malignant lesions.
PURPOSE:To describe associated anomalies and outcomes of prenatally diagnosed Ebstein's anomaly (EA)/tricuspid valve dysplasia (TVD) in a multicenter cohort and to identify predictors of adverse outcome (intrauterine or postnatal death). MATERIALS AND METHODS:In this retrospective study, cardiothoracic ratio, aortic valve diameter (AVD), pulmonary and atrioventricular valve measurements, ventricular dimensions, vena contracta, chamber areas, Celemajer index, peak tricuspid regurgitation velocity (TR_max), and pulmonary flow direction between survivors and non-survivors were compared across three gestational intervals. RESULTS:Among 87 fetuses, 7 (8.0%) intrauterine deaths and 7 (8.0%) terminations occurred; 14 (16.1%) were lost to follow-up. Fifty-nine (67.8%) live births with follow-up were documented; 52 (88.1%) underwent active postnatal management, with a survival rate of 69.2% (36/52). Non-survivors more frequently had hydrops, earlier delivery, and lower birth weight. z-score AVD (zAVD) was lower and pulmonary flow more often retrograde in non-survivors before 32 weeks. TR_max was lower in interval 1 (<24 weeks), and right atrial area and vena contracta were larger in interval 2 (24-32 weeks). No significant differences were observed after 32 weeks. CONCLUSION:This is one of the largest prenatal multicenter cohorts employing a longitudinal design, with echocardiographic data evaluation across three gestational intervals. Established predictors (pulmonary flow, TR_max) were confirmed and zAVD was identified as a simple, clinically applicable parameter, highlighting the relevance of left ventricular involvement in EA/TVD. Zusammenfassung: Ziel: Ziel dieser retrospektiven, multizentrischen Studie war es, assoziierte Anomalien und das Outcome bei pränatal diagnostizierter Ebstein-Anomalie /Trikuspidalklappendysplasie (EA/TVD) zu analysieren sowie Prädiktoren für ein ungünstiges Outcome (intrauteriner Fruchttod (IUFT), postnataler Tod) zu identifizieren. MATERIAL UND METHODEN:Retrospektiv wurden kardiothorakale Ratio, Aortenklappendurchmesser (AVD), pulmonale und atrioventrikuläre Klappen, Ventrikeldimensionen, Vena contracta, Vorhof-/Ventrikelflächen, Celemajer-Index, maximale Trikuspidalinsuffizienzgeschwindigkeit (TR_max) und Pulmonalflussrichtung zwischen Überlebenden und Nicht-Überlebenden in drei3 Gestationsintervallen verglichen. Ergebnisse: Von 87 Feten traten 7 (8,0%) IUFT auf, 7 (8,0%) Schwangerschaftsabbrüche erfolgten, 14 (16,1%) waren lost to follow-up. Insgesamt wurden 59/87 (67,8%) Lebendgeburten dokumentiert; 52 (88,1%) erhielten ein aktives postnatales Management mit einer Überlebensrate von 69,2% (36/52). Nicht-Überlebende zeigten häufiger Hydrops, frühere Entbindung und geringeres Geburtsgewicht. Der Z-Score des AVD (zAVD) war <32 Wochen niedriger, der Pulmonalfluss häufiger retrograd. TR_max war <24 Wochen niedriger, rechte Vorhoffläche und Vena contracta zwischen 24-32 Wochen größer. Nach 32 Wochen bestanden keine signifikanten Unterschiede. Schlussfolgerung: : Dies ist eine der größten pränatalen, multizentrischen Kohorten mit longitudinaler Auswertung über drei3 Gestationsintervalle. Etablierte Prädiktoren (Pulmonalfluss, TR_max) wurden bestätigt, und zAVD als einfacher, klinisch anwendbarer Parameter identifiziert, der die Relevanz der linksventrikulären Beteiligung bei EA/TVD unterstreicht.
Introduction:The primary objective of breast-conserving surgery (BCS) is complete excision of the tumor with histologically negative margins (R0 resection). Intraoperative ultrasound (IOUS) has been shown to reduce re-excision rates (R1) for sonographically visible breast cancer. However, a standardized IOUS technique has not yet been established. This study aimed to evaluate whether standardization using the "Tübingen Ultrasound Ruler" can reduce R1 resection rates. Patients and Methods:This retrospective study included 273 patients who underwent BCS between January 2020 and December 2023 for unilateral or bilateral ductal carcinoma in situ and/or invasive breast cancer, regardless of tumor biology, the presence of microcalcifications, or prior chemotherapy. All surgeries were performed by a single surgeon. Tumors were excised with a sonographically assessed margin of >10 mm in all directions. After specimen imaging, additional margin shavings were obtained when indicated. Results:A total of 282 specimens were analyzed, with a mean specimen weight of 110.5 g. Considering the main resection specimen alone, the R1 rate was 18.8%. Targeted IOUS-guided shavings significantly reduced the R1 rate to 8.5%. Compared with the mean R1 rate of the average figures of OnkoZert-certified breast centers reported between 2020 and 2023 (12.34%), the use of the "Tübingen Ultrasound Ruler" in combination with specimen imaging was associated with a significantly lower R1 rate (p = 0.043). Conclusion:Standardization of the IOUS technique combined with imaging-guided targeted shavings makes it possible to achieve a low R1 rate (8.5%) in breast-conserving surgery.
Introduction:Multimodal large language models (LLMs) can process text and images to support diagnostic processes, yet their ability to apply standardized ovarian ultrasound classification systems remains unexplored. This study evaluates Google Gemini's performance with regard to interpreting ovarian ultrasound using the Ovarian-Adnexal Reporting and Data System (O-RADS) and International Ovarian Tumor Analysis (IOTA) criteria (IOTA simple rules) compared to expert evaluation. Methods:This retrospective study included 30 ultrasound examinations from the University Hospital of Basel: 10 normal ovaries, 10 benign lesions, and 10 malignant lesions. Each examination included B-mode and Doppler images. Google Gemini was prompted to assess normal ovarian images for pathology and apply the O-RADS categories and IOTA simple rules to pathologic cases. Two blinded experts independently evaluated responses using the Global Quality Score (GQS, 1-5 scale). The reference standard was histopathology for pathologic cases and expert assessment for normal ovaries. Results:Google Gemini achieved a mean GQS of 3 across all categories. The model mischaracterized 6/10 normal ovaries as pathologic. For benign lesions, 6/10 were incorrectly assigned to high-risk O-RADS categories (4-5) with frequent misidentification of malignant IOTA features. While 6/10 malignant cases were correctly identified (GQS 4-5), 3/10 were misclassified as benign (O-RADS 2, GQS 1). The remaining case of a mucinous borderline tumor was also misclassified by the LLM (O-RADS 3, GQS 1). Conclusion:Google Gemini seems to not be ready for independent clinical application in ovarian ultrasound interpretation. Critical inconsistencies including overdiagnosis and dangerous misclassification of malignancies indicate the need for specialized, domain-specific models with rigorous validation before clinical implementation.
Purpose The carotid-subclavian artery index (CSAI) has shown high sensitivity and specificity for diagnosing coarctation of the aorta (CoA) in fetuses and neonates. We investigated whether variations in aortic arch (AA) branching without CoA affect CSAI by comparing fetuses with the classical pattern to those with a brachiobicephalic trunk (BBCT), the most frequent variant. Material and Methods In this prospective cohort study of 335 low-risk singleton pregnancies (19 - 22 weeks of gestation), standardized fetal echocardiography was used to assess AA branching in a sagittal view. Two blinded observers classified branching patterns and calculated CSAI. Results Adequate image quality was obtained in 262/335 (78.2%). 194/262 (74%) fetuses showed a classical pattern and 66 (25.2%) a branching variant. Furthermore, two fetuses (0.8%) due to disagreement on branching pattern. 50/66 (76.8%) fetuses with isolated BBCT were compared with 194 cases with classical AA branching pattern. 16 other variants were excluded. Interobserver agreement showed an intraclass correlation coefficient (ICC) of 0.87 (95%CI: 0.89-0.95). Mean CSAI was significantly lower in BBCT (0.71 ± 0.14) than in classical branching (1.46 ± 0.37; P < 0.001). None required cardiac intervention within two years. Conclusions Targeted fetal echocardiography showed a lower CSAI in cases with BBCT than in classical branching pattern. Future studies are warranted to assess the diagnostic impact of our findings in the setting of suspected CoA. Zielsetzung: Der Carotis-Subclavian-Artery-Index (CSAI) wird in der Diagnostik der Aortenisthmusstenose (CoA) eingesetzt. Wir untersuchten, ob der CSAI bei Feten mit Varianten der Aortenabgänge eine Rolle spielt und verglichen diesen mit Werten bei Aortenbögen mit klassischen Abgängen. Material und Methoden: In dieser prospektiven Kohortenstudie wurden 335 Einlingsschwangerschaften mit niedrigem Risiko zwischen der 19. und 22. Schwangerschaftswoche mittels standardisierter fetaler Echokardiografie untersucht. Der Aortenbogen wurde in sagittaler Ebene dargestellt. Zwei voneinander unabhängige Untersuchende beurteilten verblindet das Abgangsmuster und berechneten den CSAIErgebnisse: Eine ausreichende Bildqualität konnte bei 262 von 335 Fällen (78,2 %) erzielt werden. 194/262 (74 %) Feten zeigten ein klassisches Abgangsmuster, 66 (25,2 %) eine Variante. Bei zwei Feten (0,8 %) bestand Uneinigkeit über das Abgangsmuster. 50/66 (76,8 %) Feten mit isoliertem BBCT wurden mit den 194 Fällen mit klassischem Abgang verglichen; 16 weitere Varianten wurden ausgeschlossen. Die Interobserver-Übereinstimmung zeigte einen Intraklassen-Korrelationskoeffizienten (ICC) von 0,87 (95 %-KI: 0,89-0,95). Der mittlere CSAI war bei BBCT signifikant niedriger (0,71 ± 0,14) als bei klassischem Abgang (1,46 ± 0,37; p < 0,001). Kein Kind benötigte innerhalb von zwei Jahren eine kardiale Intervention. Schlussfolgerung: Die gezielte fetale Echokardiografie zeigte einen signifikant niedrigeren CSAI bei Feten mit BBCT im Vergleich zu Feten mit klassischem Aortenbogenabgang. Weitere Studien sind erforderlich, um die diagnostische Bedeutung dieser Befunde im Kontext eines Verdachts auf Aortenisthmusstenose zu klären.
The diversity of healthcare systems across Europe has predictably resulted in significant variations in point-of-care ultrasound (PoCUS) training and practice for emergency medicine (EM). To encourage a more synchronized approach and address these inconsistencies, the European Society of Emergency Medicine (EUSEM) chartered its ultrasound section to develop a comprehensive curriculum compendium that should serve as a foundational guide for European Emergency Medicine PoCUS clinical and educational guidelines and policies. Under the leadership of a dedicated task force, the EUSEM ultrasound section developed this compendium to provide a structured, tiered framework designed to meet the needs of physicians at every skill level, from novice to advanced users. The compendium emphasizes applications that are currently practiced in different and diverse emergency departments in Europe, including a broad range of topics. An important goal was allowing flexibility to accommodate the unique resources and challenges of different healthcare environments, so that EM physicians can achieve PoCUS competencies matching their local circumstances and needs. To achieve this goal, good educational and clinical stewardship throughout this process is a key part to the success of advancing PoCUS in European EM. This compendium is intended as a resource for creating standardized yet adaptable training pathways. It represents a major step toward harmonizing and advancing PoCUS practice in European EM. Die Vielfalt der verschiedenen Gesundheitssysteme in Europa hat dazu geführt, dass grosse Unterschiede in der Ausbildung und Anwendung des Point-of-Care-Ultraschalls (PoCUS) in der Notfallmedizin bestehen. Um einen stärker synchronisierten Ansatz zu fördern und diesen Unterschieden zu begegnen, hat die Europäische Gesellschaft für Notfallmedizin (EUSEM) ihre Ultraschallsektion damit beauftragt, ein umfassendes Curriculum-Kompendium zu entwickeln. Dieses soll als ein Leitfaden für Europäische Richtlinien und Standards für PoCUS in der klinischen Ausbildung in der Notfallmedizin dienen. Unter der Leitung einer Task Force hat die Ultraschallsektion der EUSEM dieses Kompendium erarbeitet, um Rahmenbedingungen zu schaffen, die den Bedürfnissen von Ärztinnen und Ärzten auf jedem Kompetenzniveau - vom Einsteiger bis zum fortgeschrittenen Anwender - gerecht werden. Das Kompendium beinhaltet Ultraschallanwendungen, die in derzeit sehr diversen Notfallstationen in ganz Europa praktiziert werden, und deckt daher ein breites Spektrum PoCUS-Anwendungen in der Notfallmedizin ab. Ein zentrales Ziel dieser Arbeit war es, Flexibilität zu ermöglichen, um die spezifischen Merkmale wie auch Ressourcen der jeweiligen Gesundheitssysteme zu berücksichtigen, sodass Notfallmediziner:innen PoCUS-Kompetenzen erwerben können, die ihren lokalen Gegebenheiten und Anforderungen entsprechen. Um das Ziel der Weiterentwicklung von PoCUS in der europäischen Notfallmedizin zu erreichen, ist ein entscheidender Erfolgsfaktor eine gute Begleitung sowohl in der klinischen Anwendung, wie auch in der Ausbildung. Dieses Kompendium soll als Grundlage zur Entwicklung standardisierter, zugleich aber anpassungsfähiger Ausbildungspfade dienen. Es stellt einen wichtigen Schritt zur Harmonisierung und Weiterentwicklung des PoCUS in der europäischen Notfallmedizin dar.
Multiparametric ultrasound (MPUS) integrates B-mode, Doppler techniques and microvascular imaging, contrast-enhanced ultrasound (CEUS) and elastography, enhancing diagnostic precision across a wide spectrum of scrotal diseases. Developed under the auspices of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB), these guidelines provide evidence-based recommendations for the clinical use of MPUS in scrotal imaging. Based on the Oxford Centre for Evidence-Based Medicine framework, this document outlines the diagnostic value of MPUS in acute scrotal pain, trauma, infertility, focal and extratesticular lesions, cryptorchidism, and testicular incidentalomas. The recommendations highlight CEUS as the reference method for vascular assessment and elastography as a complementary tool for tissue characterization. These guidelines aim to standardize MPUS practice and promote its integration into routine scrotal imaging.
Purpose:Post-ablation ultrasound findings after microwave ablation (MWA) for benign breast lesions (BBLs) can mimic malignancy, leading to diagnostic confusion. This study aimed to characterize the longitudinal evolution of sonographic features after MWA and identify factors associated with malignant-like echogenic patterns (MEPs). Materials and Method:This retrospective study included female patients with BBLs who underwent ultrasound-guided percutaneous MWA between August 2015 and October 2022. Ultrasound features were documented at baseline and at 1-6 months, 1 year, 2 years, and 3 years post-ablation. Independent predictors of MEPs were identified using multivariable logistic regression with Firth's penalized likelihood, and an XGBoost model was constructed to predict MEPs and evaluate feature importance. Results:A total of 314 patients (mean age: 38 ± 12 years) with 549 BBLs (1.5 cm (IQR, 0.6-4.0 cm)) were included. At 1-6 months, 85.8% of lesions showed benign evolution patterns (BEPs), 12.0% presented as concentric circular echogenicity (CCE) lesions, and 2.2% as nodular uneven low echogenicity (NULE, classified as MEP) lesions. By 3 years, 75.8% of BEP lesions progressed to complete absorption, while 54.5% of CCE lesions and 83.3% of NULE lesions persisted as MEPs. Independent predictors of MEPs included NULE at 1-6 months, CCE, adjacency to the pectoralis muscle, fibroglandular background, Doppler flow, irregular shape, and heterogeneous echogenicity. Conclusion:Although MEPs may mimic malignancy, histology confirmed their benign nature. Recognizing these evolving sonographic changes can improve diagnostic confidence and reduce unnecessary interventions.
Purpose:Pulsed-wave (pw) Doppler is widely used for quantitative blood flow assessment, but its accuracy depends on the guidance imaging modality used to position the sample volume. Modern ultrasound systems provide several guidance modes - B-mode, color-coded duplex sonography (CCDS), power Doppler, B-flow, and microvascular imaging (MVI) - the influence of which on pw-Doppler measurements has not yet been systematically evaluated. Materials and Methods:In this prospective paired-methods study, pw-Doppler flow of the brachial artery was measured in 454 adults while simultaneously using four guidance imaging modalities (CCDS, power Doppler, B-Flow, MVI). B-mode pw-Doppler measurements were interspersed as a reference. Differences in measured flow were analyzed using Bland-Altman statistics, analysis of variance, and linear mixed-effects models. Results:CCDS, power Doppler, and B-flow produced pw-Doppler flow values closely matching the interpolated B-mode reference (bias < 6 mL/min). In contrast, MVI consistently underestimated flow (bias 50-60 mL/min, p < 0.001) and showed an additional flow-dependent bias. Bland-Altman analyses demonstrated markedly wider limits of agreement for MVI. No patient-related factors explained these deviations. Conclusion:Guidance imaging modality significantly affects pw-Doppler flow measurements. MVI introduces systematic, flow-dependent underestimation, whereas CCDS, power Doppler, and B-flow yield consistent results. MVI should not be used when accurate pw-Doppler quantification is required.
Purpose:To evaluate the impact of changes in legislation regarding termination of pregnancy (TOP) and new diagnostic procedures such as non-invasive prenatal testing (NIPT) on timing and diagnoses of medically indicated TOPs at a tertiary obstetric center during a 22-year period. Materials and Methods:This retrospective study was conducted at the Department of Obstetrics and Gynecology of a tertiary obstetric center between 2002 and 2023. Data on TOP was extracted from the electronic patient files. Cases were divided into subgroups according to legislative changes as well as groups before and after the introduction of NIPT. Descriptive statistics were computed and Mann-Whitney-U and Kruskal-Wallis tests were conducted to compare the non-normally distributed variables among subgroups. Results:1726 cases of TOP were included in this study. Altogether, there was no noticeable change in diagnoses for TOP over the 22-year study period. We observed a noticeable increase in gestational age at the time of TOP which remained, however, below fetal viability. Towards the end of the study period, there was a noticeable increase in TOP requiring feticide. Conclusion:Neither changes in TOP legislation nor the introduction of NIPT resulted in a steep increase in TOP for certain diagnoses. The increase in gestational age as well as the increasing number of feticides can most likely be attributed to multiple factors beyond changes in legislation and diagnostic procedures.
Purpose:To evaluate cesarean scar morphology following vaginal birth after cesarean section (VBAC) and to examine associations of scar parameters with labor and clinical parameters. Materials and Methods:In a prospective cohort study at a single tertiary center, women who had undergone one prior low-transverse cesarean section and delivered vaginally underwent two transvaginal ultrasound examinations: one immediately after delivery and one 24-48 hours postpartum. Scar depth and width, adjacent myometrial thickness (AMT), and residual myometrial thickness (RMT) were measured. Correlations with clinical and labor variables were analyzed. Results:50 women were included. The mean maternal age was 30.7 ± 4.8 years and the mean BMI was 30.3 ± 4.4 kg/m². 41 women completed both examinations. Between the two ultrasound examinations, the mean scar depth and width decreased (15.8 ± 6.7 mm vs. 13.1 ± 4.1 mm; p = 0.009 and 16.8 ± 9.6 mm vs. 12.2 ± 5.8 mm; p = 0.007, respectively), while the AMT and RMT remained unchanged (p > 0.7). Non-spontaneous labor onset was associated with deeper scars (p = 0.027), and spontaneous rupture of membranes correlated with a greater RMT (p = 0.041). Women with a BMI ≥30 kg/m² had a thinner AMT and RMT (p = 0.022 and 0.025, respectively) and more frequent labor augmentation (p = 0.006). No uterine ruptures or major maternal and neonatal complications occurred. Conclusion:Immediate postpartum ultrasound after VBAC elucidated early remodeling of the previous cesarean scar. Non-spontaneous labor onset and a higher BMI were associated with a less favorable scar morphology, though without adverse short-term maternal or neonatal outcomes.
Abstract Spinal pain interventions are traditionally performed exclusively using landmarks or fluoroscopy or computed tomography. However, ultrasound offers a radiation-free method that not only takes individual anatomy into account but also allows for highly precise infiltration. This significantly reduces intervention times and improves patient comfort.
Abstract:This document was initiated by the Safety Committee (ECMUS) of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) and prepared together with the Executive Board. It gives directions as to how to perform live ultrasound demonstrations at courses, meetings, and conferences with respect to the patients and models including informed consent.
Abstract:Over the past decade, there has been marked progress in artificial intelligence (AI) and its application in medicine. In the field of hepatology, AI can aid in predicting disease risk and prognosis, optimizing patient care through improvements in diagnostic efficiency, and developing therapeutic strategies. Therefore, it seems that physicians must become more acquainted with the different AI modalities and their potential applications. In this article, we explore the current status and applications of AI in liver ultrasound illustrating the key principles and concepts in the field. We also highlight the main obstacles facing AI implementation in clinical practice and the potential future benefits and directions.
