This narrative review summarizes the physical principles and characteristic sonographic patterns of gas-related artifacts and focuses on their application in the rapid diagnosis of pneumoperitoneum, retroperitoneal gas, hepatic portal venous gas, and pneumatosis intestinalis. Recognition of pathological abdominal air should become an integral component of emergency abdominal ultrasound and POCUS.
Aim: This meta-analysis aimed to compare Contrast-enhanced ultrasound (CEUS) with blue dye with or without radioisotope (BD/RI) for sentinel lymph node (SLN) evaluation in patients with breast cancer (BC). Material and methods: Six databases were systematically searched. The SLN detection rate was defined as the primary endpoint, while secondary endpoints included the mean number of SLNs harvested, SLN positivity rate, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), false-negative rate (FNR), and overall accuracy rate. Results: Twenty-five articles involving 3337 patients were included. At the patient level, CEUS achieved a high SLN detection rate but was slightly inferior to BD/RI overall (RR: 0.97 [0.95, 0.99]), mainly driven by comparisons with BD+RI. Patient-based positive SLN rate, sensitivity, and FNR for detecting metastasis were comparable between CEUS and BD/RI. At the node level, CEUS identified fewer SLNs than BD/RI, with a lower detection rate (RR: 0.61 [0.44, 0.86]), lower sensitivity (RR: 0.93 [0.89, 0.97]), and fewer SLNs harvested (MD: -1.01 [-1.38, -0.65]). These findings were consistent in subgroup analyses comparing CEUS with BD alone and BD+RI. Conclusions: CEUS showed lower SLN detection yield than BD/RI, particularly when compared with BD+RI, but demonstrated favorable node-level specificity, PPV, and accuracy.
Aim: To establish baseline liver and spleen stiffness values in healthy young adults using two-dimensional shear wave elastography (2D-SWE) and to evaluate differences according to gender and body mass index (BMI). Material and methods: A total of 400 healthy medical students (160 males and 240 females; mean age 22.2 years) underwent abdominal ultrasound and 2D-SWE using the Supersonic Aixplorer MultiWave system. Participants were stratified by BMI. As stiffness values were not normally distributed, results are presented as median and interquartile range (IQR), and non-parametric tests were applied. Results: The median liver stiffness was 5.25 kPa (IQR: 4.55–5.70) and was significantly higher in males (p=0.016), with no significant association with BMI. Median spleen stiffness was 15.9 kPa (IQR: 15.1–17.1) and was significantly higher in individuals with BMI >25 kg/m² (p<0.001). A weak but significant correlation was observed between BMI and spleen stiffness (r=0.147, p=0.003), while no correlation was found with liver stiffness. The prevalence of hepatic steatosis and gallstone disease was higher among overweight participants. Conclusion: 2D-SWE provides reliable reference values for liver and spleen stiffness in healthy young adults. Liver stiffness was significantly higher in males in univariate analysis but was not independently associated with sex in multivariable analysis. Spleen stiffness showed a significant association with BMI, although the underlying mechanisms remain to be elucidated.
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.
