To identify the microvasculomic profiles of PDAC through SR-US, study the correlation between SR-US characteristics and pathological microvascular density (pMVD), and preliminarily explore the differential diagnostic value of pancreatic SR-US. We prospectively performed SR-US examinations for PDAC patients from August 2024 to June 2025. SR-US microvascular maps were reconstructed, and SR-US microvascular parameters were measured. pMVD was calculated, and the correlation between pMVD and SR-US characteristics was validated with Spearman correlation analysis. The differential diagnostic value of SR-US was analyzed by its capacity to differentiate PDAC and pancreatic neuroendocrine tumors (PNET), another common solid tumor of the pancreas, with the area under the curve (AUC) calculated. Seventy-two PDAC patients (median age: 64.00 years; 40 men) were enrolled for analysis, and 12 PNET patients were enrolled only for differential diagnosis. Thirty-seven (51.39

BACKGROUND & AIMS:The recent approval of pharmacological therapies for fibrotic metabolic dysfunction-associated steatohepatitis (MASH) has increased the need for accurate identification of treatment-eligible patients. Current recommendations increasingly rely on non-invasive tests (NITs), including vibration-controlled transient elastography (VCTE), while multiparametric ultrasound (MPUS) may provide additional opportunities for non-invasive assessment. However, agreement between histology and imaging-based approaches remains uncertain. We compared treatment eligibility based on histology, VCTE, and MPUS in two international biopsy-proven cohorts of metabolic dysfunction-associated steatotic liver disease (MASLD). METHODS:We analysed two biopsy-proven MASLD cohorts: CAP-IPDMA (n=1029), including VCTE and controlled attenuation parameter (CAP), and iLEAD (n=124), including MPUS. Treatment eligibility was assessed using histologically confirmed F2/F3 MASH and NIT-based recommendations from international expert panels. RESULTS:In CAP-IPDMA, 277/1029 patients (26.9%) met the histological definition of "at-risk MASH". Depending on the VCTE cut-off, 13.2-32.0% qualified for treatment. Overlap between histological "at-risk MASH" and VCTE thresholds was limited, reaching 27.8% when using VCTE 8-15 kPa, and decreasing when narrower or higher thresholds were applied. Among patients identified only by VCTE 8-15 kPa, males had lower median AST and ALT than those fulfilling only the histological indication (35 vs 48 IU/L p=0.034 and 45 vs 62 IU/L p=0.0072, respectively). In iLEAD, 21/124 patients (16.9%) met the histological definition, while 13.7-16.1% were eligible based on SWE thresholds, again with a similarly limited overlap. CONCLUSIONS:Histology and non-invasive tests capture partly distinct patient populations, meaning that both the number and type of patients selected for therapy depend on the chosen modality and cutoffs. As vibration-controlled transient elastography and multiparametric ultrasound become increasingly accessible in clinical practice, prospective validation is essential for establishing reliable non-invasive treatment pathways. IMPACT AND IMPLICATIONS:The current literature reflects a paradigm shift away from biopsy-based approaches toward NIT-based assessment of treatment eligibility in metabolic dysfunction-associated steatotic liver disease (MASLD), which may substantially affect which patients receive newly approved therapies. Our results are important for clinicians, researchers, and guideline developers because histology and current NIT cut-offs identify only partially overlapping patient populations, implying that different diagnostic strategies select different risk profiles. In practice, these findings support thoughtful implementation of NIT-based treatment pathways, the use of repeated measurements, and prospective validation of NIT thresholds to guide clinical care, trial design, and health policy decisions.

BACKGROUND & AIMS:After thermal ablation, patients with hepatocellular carcinoma (HCC) should undergo long-term surveillance for disease relapse. However, the optimal follow-up strategy remains unexplored. METHODS:We retrospectively analyzed the clinical data of patients who received complete ablation for initial HCC within the Milan criteria from two tertiary hospitals in China. The Ranger model was applied to develop low- or high-risk stratification for recurrence according to the cut-off value of recurrence probability. The follow-up strategies for each stratification were developed based on monthly probability of recurrence and validated by internal bootstraps and external validation. RESULTS:In total, 1,008 patients were included. Using a cut-off of 0.63 for the Ranger model-derived 2-year recurrence probability (based on γ-glutamyl transferase, α-fetoprotein, age, tumor number, and tumor size), patients were classified as low risk (≤0.63) or high risk (>0.63). Based on the Ranger model, an optimal surveillance schedule was established to maximize the power of detecting recurrence and reduce the number of total visits. Risk-based strategies were validated by internal bootstrap resampling and an external cohort. The proposed strategy entailed 10 visits for low-risk patients (2 per year for years 1-5) and 12 visits for high-risk patients (5, 4, 1, 1, and 1 in years 1, 2, 3, 4, and 5, respectively), whereas the guideline-recommended fixed schedule called for 14 visits. The risk-based surveillance strategies reduced delayed detection time (DDT) compared with clinical guidelines. Detailed follow-up arrangements are available through an interactive website (http://fahultrasound.site:8622/pafah). CONCLUSIONS:Compared with the fixed guideline schedule, our risk-stratified surveillance strategy reduced patient burden through fewer follow-up visits and enhanced early detection of recurrence in both low-risk and high-risk patients. This strategy provides a valuable reference for clinicians and patients to standardize the follow-up strategy following local ablation. IMPACT AND IMPLICATIONS:The Ranger model allows estimation of the prognosis of patients with early-stage HCC undergoing radical ablation and builds a risk-based follow-up strategy for individualized postoperative management. The risk-based follow-up strategy was more efficient in early detection of recurrence without increasing medical costs compared with guidelines. Our interactive website provides a valuable reference for both clinicians and patients to standardize the follow-up of patients with HCC after local ablation.

OBJECTIVE:Ablation is an important therapy for hepatocellular carcinoma (HCC). This study aims to explore the changes in pre- and short-term-post-ablative two-dimensional shear wave elastography (2D-SWE) measurements and assess the feasibility of using pre- and short-term-post-ablative indicators, including 2D-SWE measurements, to predict HCC progression after curative ablation. METHODS:A total of 161 treatment-naïve chronic hepatitis B-related HCC patients were divided into training (n = 107) and validation (n = 54) groups. Data, including 2D-SWE measurements (Emean), were collected pre-ablation, 1 mo post-ablation, and at other scheduled follow-ups. The independent predictor of progression-free survival (PFS) was analyzed using Cox regression analysis, and a prediction model was established. RESULTS:The median follow-up time was 12 mo (range 1-36 mo), and tumor progression occurred in 36 (22.4%) patients. Compared to the pre-ablation, the 1-mo-post-ablative Emean decreased in 40 (24.8%) patients, while increased in 71 (44.1%) patients, and did not significantly change in 50 (31.1%) patients. Cox analysis identified pre-ablative prothrombin time (PT; p = 0.014, HR = 1.54), 1-mo-post-ablative alpha-fetoprotein (AFP; p = 0.014, HR = 1.01), and categorized Emean change between pre-ablative and 1-mo-post-ablative period (with decrease as reference, not-significant-change: p = 0.096, HR = 0.38; increase: p = 0.014, HR = 0.22) as the independent predictor of PFS. The Cox model could significantly predict PFS in both training (p < 0.001, HR = 2.10) and validation (p = 0.009, HR = 1.17) groups. CONCLUSION:Longer pre-ablation PT, higher 1-mo post-ablation AFP, and decreased 1-mo post-ablation Emean were associated with shorter post-ablation PFS. Changes in 2D-SWE measurements may serve as a potential indicator of HCC progression after ablation.

Background The optimal sequencing of thermal ablation relative to systemic therapy for colorectal liver oligometastases (CLOM) remains controversial, with limited evidence to guide treatment planning. Purpose To compare the long-term survival outcomes of patients with CLOM receiving upfront ablation (UA) versus delayed ablation (DA) in combination with systemic therapies. Materials and Methods Patients with five or fewer CLOM (maximum lesion diameter, <5 cm) from 21 Chinese tertiary hospitals were included in this multicenter cohort study (October 2009 to March 2024). Patients were categorized into UA and DA groups based on the decisions of multidisciplinary teams. UA consisted of microwave ablation followed by adjuvant systemic therapy administered within 1 month. DA involved neoadjuvant systemic therapy (delivered over 2-3 months) combined with subsequent ablation. The primary outcome was progression-free survival (PFS), and a secondary outcome was overall survival (OS), both assessed using multivariable-adjusted Cox regression analysis and Kaplan-Meier survival curves. Procedure-related complication rates were analyzed. Sensitivity analyses, including propensity score matching, inverse probability treatment weighting, and overlap weighting, were performed to adjust for confounders. Results A total of 1047 patients were included (DA group [n = 536]: mean age, 57.53 years ± 10.99 [SD]; 381 male; UA group [n = 511]: mean age, 60.96 years ± 11.77; 356 male). The follow-up duration was 15 years. Median PFS (1.48 vs 0.98 years; hazard ratio [HR], 0.70 [95% CI: 0.61, 0.81]; P < .001) and OS (6.94 vs 4.74 years; HR, 0.70 [95% CI: 0.57, 0.87]; P = .001) were longer in the UA group compared with the DA group. Sensitivity analyses confirmed robustness (PFS HR, 0.67-0.80; OS HR, 0.73-0.77). UA benefits persisted across subgroups, including synchronous metastases (HR, 0.67 [95% CI: 0.55, 0.81]; P = .04) and lesions smaller than 3 cm (HR, 0.68 [95% CI: 0.58, 0.80]; P = .005). Elevated carcinoembryonic antigen levels (≥5 µg/L) and multiple metastases independently predicted worse survival (HR, 1.30 and 1.47, respectively; P < .001 for both). Conclusion UA combined with systemic therapy significantly improved long-term survival compared with DA, with similar complication rates. © RSNA, 2026 Supplemental material is available for this article. See also the editorial by Woodrum in this issue.

Background Lesions of infratemporal fossa (ITF) represent a group of pathologically heterogeneous diseases. Endoscopic biopsy has been the primary diagnostic method. To facilitate precise treatment, we introduced ultrasound fusion-guided core needle (UFCN) biopsy, which offers accuracy, minimal invasiveness, and real-time capability. This study aimed to evaluate the efficacy of UFCN biopsy for ITF lesions.Methods This retrospective cohort study compared patients with ITF lesions who underwent UFCN biopsy or not. Using logistic Poisson regression analysis, we evaluated the efficacy of UFCN biopsy by assessing the rate of general anesthesia endoscope biopsy, the time cost to final pathological diagnosis, and the rate of diagnosis-matched treatment.Results Thirteen patients who underwent UFCN biopsy were included in the US group, and 24 patients who did not undergo UFCN biopsy were included in the ES group. Patients in the US group had a significantly lower risk of undergoing endoscopic biopsy under general anesthesia (OR of 0.04 95% CI 0.00-0.25) and a reduced time to diagnosis (OR of 0.68 95% CI 0.54-0.86). Additionally, UFCN biopsy was associated with a higher rate of diagnosis-matched treatment (OR of 47.23 95% CI 4.18-2043.94).Conclusions UFCN biopsy was an effective solution for ITF lesion pathological diagnosis. It can reduce the need for endoscope biopsy under general anesthesia, increase the rate of diagnosis-matched treatment, and shorten the time to pathology confirmation.

OBJECTIVE:To investigate the value of Microvascular Flow (MV-Flow) vascular pattern and quantitative parameter vascular index (VI) in differentiating benign from malignant lymph nodes. METHODS:A total of ninety-five patients who underwent ultrasound-guided lymph node aspiration biopsy at the First Hospital of Sun Yat-sen University between February 2023 and September 2023 were prospectively enrolled. Conventional ultrasound and MV-Flow examinations were performed, and the diagnostic efficacy was analyzed. The influencing factors of the VI were investigated. RESULTS:Among grayscale features, lymph node hilum, shape, liquefaction, and calcification differed significantly between benign and malignant nodes (p < 0.05). In the vascular pattern of Color Doppler Flow Imaging (CDFI) and MV-Flow, benign nodes mainly showed hilar flow, while malignant nodes mainly showed mixed flow (p < 0.05 for both). MV-Flow and CDFI demonstrated comparable overall diagnostic performance (AUC: 0.682 vs. 0.646), with no statistically significant difference (p > 0.05). MV-Flow vascular pattern classification showed good interobserver agreement (κ = 0.801), and the vascular index (VI) demonstrated high reliability (ICC = 0.811). A moderate negative correlation was observed between lymph node depth and VI across all four sections. CONCLUSIONS:MV-Flow provided superior qualitative visualization of microvascular flow compared to CDFI, but this did not translate into a statistically significant improvement in quantitative diagnostic performance for differentiating benign from malignant lymph nodes. Therefore, it should serve as a secondary diagnostic adjunct for lymph nodes with indeterminate CDFI findings, particularly to microvascular architecture that traditional Doppler fails to detect.

Liquid biopsy as non-invasive diagnosis tool for tumor genotyping, was limited by its low sensitivity. Ultrasound targeted microbubble destruction (UTMD) technique could temporarily alter tissue permeability, but its role in circulating tumor DNA (ctDNA) released remains poor understood. This study included mouse experiments and a prospective clinical study, aimed to investigate whether UTMD could increase the release of ctDNA and thus enhance the sensitivity of liquid biopsy. To establish the safety profile, H&E staining, PCR and Flow cytometric assays were conducted to evaluated liver injury and tumor dissemination after UTMD treatment through VINNO 7. To evaluate UTMD induced ctDNA release, droplet digital PCR (ddPCR) was used to measure ctDNA levels before and at 5-30 minutes after UTMD in both BALB/c nude mice (SW1463 human cell line; n=28) and colorectal liver metastases (CRLM) participants (n=10). In murine models, UTMD under safety parameters (3~3.3 MHz frequency, 2 cycles pulse length, 500 Hz PRF, 52.5%~60% acoustic power and 0.5 MI) did not cause liver inflammation and tumor dissemination. UTMD treatment induced a transient, significant increase in human KRAS ctDNA levels (5-fold increase, P = .007), which returned to baseline within 30 minutes. In human participants with CRLM, sonication of the liver tumors resulted in a 2.2-fold increase (P = .045) in KRAS ctDNA levels measured 5 minutes after the procedure. These findings highlight the clinical utility of diagnostic ultrasound in detecting specific oncogene mutations in abdominal diseases (liver tumors; pancreatic diseases), which are critical for personalized cancer therapy.

INTRODUCTION:Multimodal large language models, including GPT-4 Omni (GPT-4o), have been applied for facilitating the healthcare process, but their capacity to interpret thyroid sonography images to aid report generation, as well as ways for improvements, are unclear. METHODS:120 thyroid nodules were retrospectively included for evaluation of GPT-4o to analyze ultrasound features and ACR TR categories (version 2017). In a zero-shot setting, 80 original images of unmarked nodules (zero-shot unmarked group) and images with nodules' boundary artificially depicted by senior radiologists with red circles (zero-shot marked group) were repetitively input into GPT-4o, respectively with identical prompts for 3 attempts without examples. In a few-shot setting, another 40 images with artificially marked nodule boundary (few-shot marked group) were input after 3 examples. The marking gold standard was established by 2 senior radiologists with over 10 years of experience in thyroid sonography. Consistency of GPT-4o was evaluated with the Gwet agreement coefficient (AC1) value calculated. The mean accuracy of GPT-4o across different settings was compared using the Mann-Whitney test with Bonferroni correction, in comparison to the mean accuracy of 2 junior radiologists with 1 and 3 years of experience in thyroid sonography, respectively. RESULTS:The AC1 values were 0.466 [0.367,0.564], 0.778 [0.696,0.860], 0.823 [0.711,0.934], respectively, for zero-shot unmarked group, zero-shot marked group, and few-shot marked group. The mean accuracy of the 3 groups to judge TR categories was 18.75% [13.78%,23.72%], 42.50% [36.20%,48.80%], 79.17% [71.80%,86.54%]. Zero-shot marked group outperformed zero-shot unmarked group, and the few-shot setting performed even better (p<0.001). Particularly, segmentation helped GPT-4o detect composition, shape, and margin of nodules, and a few-shot setting helped detect echogenicity, margin, and calcification (p<0.001). Compared with junior radiologists, the few-shot marked group achieved a similar accuracy in identifying composition, echogenicity, calcification, and TR categories (p>0.05) and performed even better in identifying the margin of thyroid nodules (p=0.004). DISCUSSION:GPT-4o's performance to analyze original images of thyroid nodules was insufficient, possibly owing to incorrect nodule recognition and a lack of standardized reference. After adopting segmentation methods and a few-shot setting, its performance was improved significantly. CONCLUSION:GPT-4o's consistency and accuracy of analyzing thyroid sonography images can be gradually improved by segmentation methods and a few-shot setting, and finally achieves a junior-radiologist level in this preliminary study. This can potentially benefit report generation, while multicenter validation is needed.

Objective To assess the performance of CEUS LI-RADS TRA v2024 in differentiating local tumor progression (LTP) and postprocedural inflammation of ablated hepatocellular carcinoma (HCC), and compare it with a modified version. Methods This retrospective study composed HCC patients who underwent CEUS after thermal ablation from June 2010 to June 2023 in our center. Each image of LTP and postprocedural inflammation was reviewed for CEUS LI-RADS TRA v2024 categorization. A modified CEUS LI-RADS TRA emphasizing intralesional washout in defining intralesional tumor viable was established. The diagnostic performance in distinguishing LTP and postprocedural inflammation of the two algorithms was compared. Results Among 2745 HCC patients who underwent 5612 procedures, 212 CEUS observations with 71 postprocedural inflammation (62 males and 9 females, 60.5 ± 11.5 years) and 141 LTPs (125 males and 16 females, 58.8 ± 11.5 years) were enrolled. Interreader agreement for the CEUS LI-RADS TRA category was good (κ = 0.75 [95% CI: 0.69, 0.81]). According to algorithm, 170 (80%) treated lesions were labeled as LR-TR viable and 42 (20%) were assigned as LR-TR equivocal. Emphasizing washout in intralesional viable, the modified LR-TR viable showed significantly greater specificity (58% vs 46%, p = 0.008), AUC (0.77 vs 0.70, p < 0.001) and accuracy (81% vs 78%, p = 0.04) without compromising sensitivity (93% vs 94%, p = 1.00) compared with the original LR-TR viable. Conclusion CEUS LI-RADS TRA performed well in detecting LTP in ablated HCC. The modified algorithm emphasizing intralesional washout in LR-TR viable significantly improved specificity without compromising sensitivity.

AIMS:Radiofrequency ablation (RFA) is a common treatment for malignant tumors, yet recurrence and metastasis persist a major challenge. The hypoxic microenvironment induced by RFA is a key driver of residual tumor aggressiveness and chemoresistance. This study aims to develop perfluoropentane-based doxorubicin-loaded nanodroplets (DOX-NDs) to overcome these limitations. MATERIALS AND METHODS:DOX-NDs were synthesized via thin-film hydration and characterized for morphology, stability, and heat-responsive behavior. In vitro studies examined the mechanisms of hypoxia alleviation, epithelial-mesenchymal transition reversal, and P-glycoprotein downregulation. Antitumor efficacy and biodistribution were evaluated in a 4T1 murine breast cancer model. RESULTS:DOX-NDs exhibited uniform spherical morphology and efficient oxygen loading. Upon thermal stimulation (>42°C), a phase transition in the nanodroplets triggered the rapid co-release of doxorubicin and oxygen. This oxygen replenishment promoted HIF-1α degradation, which restored E-cadherin expression and downregulated P-glycoprotein, thereby inhibiting cell motility and reversing chemoresistance. In vivo, the combination of DOX-NDs and RFA significantly suppressed tumor growth and pulmonary metastasis while demonstrating a favorable safety profile. CONCLUSIONS:Targeting the hypoxia-recurrence axis with an RFA-responsive nanoplatform is a viable strategy. The DOX-NDs successfully integrate chemotherapy with hypoxia modulation, presenting a potential means to improve outcomes following tumor ablation.

BACKGROUND & AIMS:Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality globally. Radiofrequency ablation (RFA) is a widely used treatment for HCC, but its efficacy is often limited by tumor relapse. Neutrophils, which serve as a double-edged sword in tumor immunology, have recently been implicated in antitumor immunity post RFA. Shear wave elastography (SWE) is a non-invasive examination of liver tissue and is associated with immune response. This study investigates the correlation between dynamic changes in SWE values and neutrophil response following RFA, and explores potential adjuvant strategies for RFA. METHODS:We conducted a comprehensive analysis using both clinical data from patients undergoing RFA (n = 102) and experimental studies in mouse models (n = 4-6 per group). Single-cell RNA sequencing (scRNA-seq) and multi-omics analyses, including multiplex immunofluorescence staining and flow cytometric analysis, were performed to identify neutrophil subsets. To assess the therapeutic potential of neutrophil-activating therapy to enhance antitumor immunity post RFA, we tested a CD40 agonist in combination with RFA in preclinical models. RESULTS:Increasing liver SWE values following RFA were significantly associated with reduced relapse (n = 102, p <0.001), a phenomenon that was linked to the inflammatory environment induced by the infiltration of neutrophils (2.5-fold increase, p <0.001). scRNA-seq analysis identified neutrophil subsets characterized by high expression of IFN-stimulated genes, which exhibited potent antitumor activity via nitric oxide. Importantly, treatment with a CD40 agonist significantly augmented this immune response, leading to reduced tumor growth in mice (149.6 ± 38.12 mm3vs. 23.92 ± 4.43 mm3, p = 0.008). CONCLUSIONS:Our results linked clinical features to neutrophil-mediated immunity post RFA. Thus, neutrophil-activating therapies, such as CD40 agonists, could prevent HCC relapse after RFA. IMPACT AND IMPLICATIONS:We report that increases in liver SWE are linked with neutrophil infiltration, providing a non-invasive biomarker for monitoring HCC relapse post RFA. Thus, pioneering innate immune modulators, such as CD40 agonists, could be viable adjuvant strategies following RFA.

OBJECTIVES:To elucidate the clinicopathological characteristics of intraductal papillary neoplasm of the bile duct (IPNB) and evaluate the sensitivity of multi-modality imaging techniques. Specifically, this study aims to: (1) characterize the ultrasound (US) features of intraluminal masses and bile duct dilation patterns; (2) systematically analyze the differential diagnostic criteria between invasive and noninvasive IPNB subtypes. METHODS:A retrospective cohort study included 48 histopathologically confirmed IPNB patients. Demographic, clinical, and imaging data were retrospectively collected. US features of intraluminal masses and bile duct dilation were systematically described. Receiver operating characteristic (ROC) curve analysis was performed to identify optimal biomarkers for differentiating invasive versus noninvasive IPNB, with sensitivity, specificity, and accuracy calculated. RESULTS:The sensitivity rate of IPNB using different imaging methods was as follows: CEUS 39.6%; CECT 32.5%; MRI 29.2%. Arterial enhancement of the intraluminal mass and bile duct dilation was the most important US features, which were detected in 40 (83.3%) and 47 patients (97.9%) respectively. Bile duct dilation can be further classified as cystic dilation/diffuse upstream bile duct dilation/slight peripheral bile duct dilation. Intraluminal mass can be polypoidal-like/plaque-like/invasive pattern. Bilirubin, CEA, and SCC levels differed significantly between invasive/noninvasive groups (all p < 0.05). Notably, when SCC < 0.55 μg/L and total bilirubin (TB) > 29.35 μmol/L were used as diagnostic markers, the diagnostic specificity increased to 100%, with a sensitivity of 54% and an accuracy of 87.5%, showing the best diagnostic performance. CONCLUSIONS:This study systematically described intraluminal mass morphologies and bile duct dilation patterns in IPNB using CEUS. The combined biomarker criterion (SCC < 0.55 μg/L and TB > 29.35 μmol/L) demonstrated exceptional specificity (100%) and accuracy (87.5%) for differentiating invasive from noninvasive IPNB, providing a potential clinical tool to guide therapeutic strategies.

Background Measurement of Crohn disease (CD) activity is crucial for guiding treatment decisions. Super-resolution contrast-enhanced US (SRCEUS) is an emerging technique that can be used to assess vascularity at micrometer scale; however, its performance in differentiating CD activity stages is not yet known. Purpose To evaluate SRCEUS in the assessment of disease activity in participants with CD. Materials and Methods This prospective study included participants with CD involving the terminal ileum or colon who underwent intestinal SRCEUS imaging between January 2025 and June 2025. Participants were classified into remission/mild or moderate/severe activity groups based on the Simple Endoscopic Score for Crohn's Disease. B-mode US, color Doppler flow imaging (CDFI), conventional contrast-enhanced US (CEUS), and SRCEUS were performed. SRCEUS parameters were calculated. Logistic regression modeling, receiver operating characteristic analysis, and the DeLong test were used to evaluate and compare diagnostic performance. Results This study included 54 participants (mean age, 30 years ± 8.5 [SD]; 42 men). Key SRCEUS vascular parameters were higher in the moderate/severe activity group than the remission/mild activity group, including maximum density (mean, 63.4 ± 13.1 vs 51.1 ± 15.6; P = .003), mean density (mean, 26.9 ± 5.3 vs 21.1 ± 8.0; P = .007), mean velocity (mean, 40.2 mm/sec ± 27.3 vs 23.0 mm/sec ± 14.9; P = .01), vascular density ratio (mean, 73.2% ± 12.8 vs 38.5% ± 17.8; P < .001), and fractal dimension (mean, 1.7 ± 0.1 vs 1.5 ± 0.1; P < .001). SRCEUS performed well in distinguishing participants with remission/mild activity from those with moderate/severe activity (area under the receiver operating characteristic curve [AUC], 0.92; sensitivity, 94.1%; specificity, 95.0%). SRCEUS performed better than conventional CEUS (AUC, 0.78; P = .03). Clinical, B-mode US, CEUS, and SRCEUS parameters were included in a combined model, in which the International Bowel Ultrasound Segmental Activity Score and vascular density ratio were identified as influential factors. The combined model had an AUC of 0.94, demonstrating superior performance to both CDFI (AUC, 0.82; P = .04) and conventional CEUS (P = .002) and similar performance to SRCEUS (P = .51). Conclusion SRCEUS demonstrated excellent performance in differentiating CD activity through high-resolution depiction of microstructural changes, with superior performance to conventional CEUS. © RSNA, 2026 Supplemental material is available for this article. See also the editorial by Katwal and Chernyak in this issue.

Purpose:Low back pain (LBP) is a leading cause of disability worldwide with limited effective pharmacotherapies. We aimed to identify novel therapeutic candidate targets for LBP through integrative genomics. Methods:We employed summary-data-based Mendelian randomization (SMR) with GWAS data from FinnGen (13,178 cases/164,682 controls) and tissue-specific expression quantitative trait loci (eQTLs) from peripheral blood (Westra cohort: n = 5,311; 15,636 genes) and brain tissue (UKBEC: n = 134; 16,309 genes). Heterogeneity in dependent instruments (HEIDI) analysis validated causal associations. Candidate targets were further assessed by pathway enrichment, drug prediction, and phenome-wide association studies (PheWAS). Results:Peripheral blood eQTLs identified four genes associated with LBP (PSMR < 3.2×10-, HEIDI P > 0.05): BTN2A3P, GFPT1, UHRF1BP1, SNRPC; brain eQTLs identified four genes associated with LBP (PSMR < 3.07×10-, HEIDI P > 0.05): CHST3, DCC, UHRF1BP1, SNRPC. Cross-tissue integration prioritized UHRF1BP1 and SNRPC as consensus candidates. Drug prediction suggested levamisole and taxifolin as potential UHRF1BP1-modulating compounds. PheWAS indicated low pleiotropic risk, with associations mainly with hypertension and celiac disease. Conclusion:This multi-omics framework prioritizes UHRF1BP1 (involved in epigenetic regulation) and SNRPC (RNA splicing modulator) as mechanistically novel, genetically supported candidate targets for LBP, providing a foundation for future experimental validation and therapeutic development.

No randomized trials or large-scale observational studies directly compared thermal ablation (TA) and hepatectomy (HT) for solitary colorectal liver metastases (SCLM) ≤ 5 cm with long-term follow-up. In this multicenter target trial emulation (2009–2024), 1,334 patients with SCLM ≤ 5 cm from 21 Chinese hospitals were enrolled. Propensity score matching (1:1) balanced baseline characteristics, yielding 437 matched pairs. Primary and secondary endpoints were progression-free survival (PFS) and overall survival (OS), respectively. Complications, hospital stay, and costs were analyzed. Sensitivity analyses were performed to evaluate the robustness of the results. After matching, median PFS was 1.81 years (95

Purpose: In this study, we aimed to evaluate the feasibility of SRUS quantitative analysis in diagnosing and staging lymphedema of limbs. Materials and Methods: This is a single-center retrospective study, we enrolled patients who underwent limbs SRUS examination from July 2025 to March 2026. Limbs were diagnosed and divided into partial and total lymphatic obstruction groups. Lymphoscintigraphy was the reference standard. All the limbs were performed CEUS and SRUS examination after subcutaneously injecting contrast agent. Quantitative parameters were compared using one-way analysis of variance and Kruskal-Wallis tests. Results: Forty-six limbs were analyzed. Lymphatic vessel ratios, perfusion index, lymphatic density and velocity showed significantly decreased in limbs lymphedema group (P<0.05). The area under the receiver operating characteristic curve (AUC) for CEUS in diagnosing lymphedema was 0.982 (95% confidence interval: 0.941, 1.000). The AUC for lymphatic velocity in diagnosing lymphedema was 0.857 (95% confidence interval: 0.748, 0.966). The optimal cut-off value of mean lymphatic velocity for diagnosing limb lymphedema was 7.47mm/s. The mean velocity values of the lymphedema group were lower than 7.47mm/s. The diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were 80.43%, 83.33%, 78.57%, 71.43%, and 88.00%, respectively. The lymphatic vessel ratios, lymphatics density, and the lymphatics velocity showed significantly different among no lymphatic obstruction, partial and total lymphatic obstruction groups, allowing for the effective differentiation between partial and total lymphatic obstruction. Conclusion: This study revealed both SRUS and CEUS performed excellent diagnostic efficacy, especially SRUS could distinguish partial from total lymphatic obstruction, suggesting that SRUS is a promising tool for the diagnosis and staging of limb lymphedema.

RATIONALE AND OBJECTIVES:Severe acute pancreatitis (SAP) carries a high mortality rate. This study aimed to develop a rapid scoring system using admission laboratory parameters to predict mortality in SAP and to evaluate whether high-risk patients identified by this score benefit from ultrasound-guided percutaneous catheter drainage (PCD). MATERIALS AND METHODS:In this retrospective study, 469 SAP patients (304 conservative, 165 PCD) from January 2015 to March 2023 were included. After propensity score matching for age, sex, and etiology, 316 well-balanced patients (158 per group) were analyzed. A scoring system was developed from the conservative cohort using multivariate logistic regression, with mortality as the primary outcome. RESULTS:A scoring system was created comprising procalcitonin >1.195 ng/ml (1 point), RBC <3.61×10¹²/L (1 point), WBC >20.2×10⁹/L (2 points), and platelet <149×10⁹/L (1 point). A cutoff of ≥3 points predicted mortality with an AUC of 0.965. Among high-risk patients (score≥3), mortality was significantly lower in the PCD group than in the conservative group (20.6% vs. 57.1%, p=0.006). Furthermore, PCD performed within two weeks of onset was associated with lower mortality than later intervention (9.5% vs. 22.2%, p=0.026). CONCLUSION:The proposed scoring system effectively identifies high-risk SAP patients who may obtain a substantial survival benefit from early PCD intervention.

BACKGROUND:To characterize the longitudinal pain relief pattern across successive pingyangmycin-based percutaneous sclerotherapy (PYM-PS) sessions in patients with venous malformations (VMs), and to evaluate whether treatment efficacy exhibits a plateau effect. METHODS:A linear mixed-effects model (LMM) was applied to analyze visual analogue scale (VAS) pain scores across successive PYM-PS sessions. Fixed effects included treatment session, baseline pain VAS score, age, lesion volume, and treatment interval, with patient-specific variability as random effect. Pretreatment and post treatment pain VAS scores and ultrasound (US) blood supply levels were compared, and complications were documented. RESULTS:A plateau effect in pain relief was observed after the third treatment session, with further sessions not completely ineffective yet offering limited therapeutic benefits. Fixed effects explained 46% of VAS score variance, rising to 68% when including random effect. Significant predictors of favorable clinical outcomes included increasing number of treatment sessions (P = 0.04), lower baseline pain score (P < 0.001), and younger age (P = 0.03), whereas lesion volume and treatment interval had no significant impact (P = 0.18 and P = 0.87, respectively). Significant differences in overall pain scores and US blood supply were observed after treatments (P < 0.001), with 83.4% overall treatment efficacy and no major complications. CONCLUSION:PYM-PS effectively and safely relieves pain in VM patients, with a plateau effect emerging after about 3 treatment sessions. These findings support a standardized protocol of 3 PYM-PS sessions as a reevaluation time point for optimizing individualized treatment planning.