Objectives Struma ovarii (SO) often presents as a multilocular-solid adnexal mass with abundant vascularity, easily misdiagnosed as an epithelial malignancy and leading to inappropriate surgical management. This study aimed to develop and validate a preoperative nomogram to differentiate O-RADS US 4/5 struma ovarii (SO) from early-stage high-grade serous carcinoma (HGSC) and to identify characteristic ultrasound signs of SO, enhancing diagnostic accuracy and clinical applicability. Methods This retrospective cohort study enrolled 93 SO lesions from 92 patients and 87 early-stage HGSC lesions from 79 patients at Peking Union Medical College Hospital between January 2017 and December 2025. Lesions were randomly divided into training and validation sets (7:3). Independent predictors were identified using univariate and multivariate logistic regression. An individualized risk prediction nomogram was then developed, along with a dynamic nomogram constructed using the "DynNom" and "shiny" packages in R. Model performance was evaluated using the area under the receiver operating characteristic curve, calibration curves, and decision curve analysis. Results Among SO cases, 65 (70.7%) were asymptomatic, 23 (25.0%) had elevated CA125 (> 35 U/mL). Ascites was present in 7 patients (7.6%). 80 lesions (86.0%) were classified as O-RADS 5, and 25 (26.9%) misdiagnosed as malignant. Most SO were pure lesions with low malignant transformation and no metastasis. 9 premenopausal patients (17.3%) underwent radical surgery, suggesting overtreatment. Multivariate logistic regression identified CA125, heterogeneous cyst fluid, comet-tail artifact, morphological pattern of the solid component, and echogenicity of the solid component as independent preoperative predictors. The clinical-ultrasound nomogram demonstrated excellent predictive performance, with an AUC of 0.971 (95% CI: 0.95–0.99) in the training set and 0.939 (95% CI: 0.88–0.99) in the validation set. Calibration curves indicated strong agreement between predicted and observed probabilities, and decision-curve analysis confirmed its clinical utility. Three typical ultrasound signs of SO—ovary-like sign, palette sign, and Cheerios sign—were summarized, and the interpretation of the “pearl sign” was refined. Conclusion The static and dynamic nomograms and ultrasound signs enable accurate preoperative differentiation of O-RADS US 4/5 SO from HGSC, which provide an innovative and reproducible framework for precise preoperative decision-making.

Aortic diseases are often clinically silent until advanced stages, and risk determinants beyond traditional cardiovascular factors remain incompletely characterised. Here, we investigate associations of 42 chronic conditions and multimorbidity with incident aortic disease in UK Biobank (UKB), with external validation in China Kadoorie Biobank (CKB). In UKB, 21 chronic conditions are associated with overall aortic disease after false discovery rate correction, including coronary heart disease, hypertension, atrial fibrillation, peripheral vascular disease, heart failure, and COPD; similar patterns are observed in CKB. Aortic atherosclerosis shows the broadest comorbidity profile, whereas dissection and aneurysm subtypes show narrower profiles. Higher multimorbidity burden is associated with higher incidence in both cohorts. In UKB, hypertension shows the largest estimated population-attributable fraction, with additional contributions from COPD and chronic kidney disease. Mendelian randomization supports selected associations, and machine-learning models show internal discriminatory performance. These findings support consideration of multimorbidity in aortic disease risk assessment. This study shows that multimorbidity and several chronic conditions, including cardiovascular, respiratory and kidney diseases, are associated with higher risk of aortic disease in two large cohorts.

Reliable methods for the non-invasive monitoring of placental status are essential for the management of preeclampsia. This study investigates the feasibility of multimodal photoacoustic-ultrasound (PA-US) imaging for the longitudinal assessment of placental oxygenation (sO2) and microvascular perfusion in a rat model. Our findings demonstrate that multimodal PA-US imaging parameters illustrate alterations in placental status non-invasively, which correlate strongly with histopathological markers, including hypoxia-inducible factor 1α (HIF-1α) and microvascular density (MVD). Besides, a characteristic inverted trajectory of imaging parameters during early gestation day 10–12 is observed. By enabling the simultaneous evaluation of oxygen and blood supply dynamics, multimodal PA-US imaging yields a more comprehensive view of placental function. Ultimately, these results suggest that multimodal PA-US imaging serves as a non-invasive and viable tool for detecting placental dysfunction and monitoring therapeutic responses in real time, laying a solid experimental foundation for advanced maternal-fetal care.

​Background: Sarcopenia is associated with a twofold higher risk of falls, frailty, and mortality. The 2025 Asian Working Group for Sarcopenia (AWGS) introduces agestratified diagnostic cutoffs, which enables earlier identification of muscle decline. Although several risk factors for sarcopenia have been identified, previous studies have focused on individual associations without quantified their relative contribution to disease burden. We therefore aimed to examine potentially modifiable risk factors and to quantify their population-level contribution using population attributable fractions (PAFs). Methods: We conducted a multicenter, cross-sectional study of 20484 adults aged 60 years or older from the Chinese Registry for Comprehensive Geriatric Assessment. Sarcopenia was defined according to the 2025 AWGS criteria. Associations were assessed using Poisson regression with robust variance estimators to obtain prevalence ratios (PRs). PAFs were calculated using PRs and exposure prevalence. Communality-based weighting was applied to account for correlation among risk factors. Sensitivity analyses assessed robustness. Findings: After accounting for shared variance, 22·2% (95% CI 19·7-25·1) of cases were attributable to 13 modifiable risk factors. For health-related conditions, cognitive impairment was the largest contributor (adjusted PAF 4·8%, 95% CI 4·1–5·5), followed by cerebrovascular disease (1·85%, 95% CI 1·45–2·28). For lifestyle behaviors, smoking and drinking contributed 2·22% (95% CI 1·68–2·77) and 1·62% (95% CI 1·04–2·21), respectively. Residential and care environment factors also showed varying contributions. Interpretation: Approximately one-fifth of sarcopenia was attributable to modifiable risk factors. A comprehensive public health system to control and manage sarcopenia is encouraged. Cognitive function training, restricting smoking and drinking might be an important part of sarcopenia management.

Rationale:Poor differentiation and microvascular invasion (MVI) are crucial prognostic indicators for hepatocellular carcinoma (HCC), but evaluating them before surgery is still difficult. Our goal was to develop a reproducible framework for ultrasound localization microscopy (ULM) using a clinical ultrasound system and assess its effectiveness in predicting tumor differentiation and MVI. Methods:Participants were prospectively enrolled and underwent contrast-enhanced ultrasound and ULM imaging. We first compared frame selection strategies by calculating coefficients of variation (COVs) of ULM parameters derived from motion-variance curve (MVC) alone versus MVC combined with time-intensity curve (TIC). ULM resolution and parameter stability were then assessed across low (0-399), medium (400-699), and high (700-1000) frame counts. Regions of interest (ROIs) were manually drawn on grayscale ultrasound and mapped to ULM images. Inter-operator agreement was evaluated using intraclass correlation coefficients (ICCs). Participants were grouped by pathological differentiation and MVI status. The predictive performance of ULM parameters was assessed with multivariable logistic regression. Results:Sixty-one HCC participants were enrolled (11 poorly differentiated, 50 well differentiated; 30 MVI-positive, 31 MVI-negative). The MVC+TIC strategy yielded significantly lower COVs, indicating higher repeatability of ULM parameters. Medium frame counts (400-699) provided high resolution (minimum vessel diameter 91.3 ± 22.7 μm) and stable parameters (COV < 20%), and were therefore selected for ULM reconstruction. All ULM parameters showed high inter-operator agreement (ICC 0.876-0.988). Based on the established ULM framework, higher intratumoral mean curvature was independently associated with poor differentiation [area under the curve (AUC) 0.91], and higher peritumoral mean curvature independently predicted MVI status (AUC 0.78). Conclusion:The reproducible ULM framework enables stable, high-resolution microvascular imaging of HCC. ULM-derived parameters hold potential as novel biomarkers for predicting differentiation grade and MVI status of HCC.

OBJECTIVES:Uterine polypoid adenomyoma (PA) tends to persist, recur, and carry a high risk of malignancy. However, preoperative distinction between PA and endometrial polyp (EP) remains challenging in clinical practice, often leading to suboptimal therapeutic decisions. This study aimed to compare the clinical and ultrasonographic characteristics of PA and EP and to develop a nomogram for accurate preoperative diagnosis. METHODS:We retrospectively identified women with pathologically confirmed PA diagnosed at Peking Union Medical College Hospital between January 2017 and April 2024. Patients with EP hospitalized during the same period and diagnosed postoperatively were randomly selected as the control group. Demographic, clinicopathological, ultrasound, and surgical data were extracted from medical records. Nomogram predictors were identified through univariate and multivariable logistic regression analyses. Model performance was assessed using the area under the receiver operating characteristic curve (AUC), with internal validation via bootstrap resampling (1000 iterations). RESULTS:A total of 52 patients with PA and 52 with EP were included. In the PA group, 32 cases (61.5%) were preoperatively diagnosed as benign by ultrasound, 15 (28.8%) unclassified, and 5 (9.6%) suspected of malignancy. Compared with the EP group, the PA group was significantly older (p < .05) and had higher proportions of postmenopausal status (32.7% versus 7.7%, p < .05) and postmenopausal bleeding (17.3% versus 0%, p < .05). Significant ultrasonographic differences were observed in lesion multiplicity, maximum diameter, morphology, echogenicity, intralesional cysts, blood flow signals, and moderate vascularity (all p < .05). The nomogram incorporated 4 ultrasound parameters: lesion multiplicity, maximum diameter, irregular morphology, and cystic components. The model achieved an AUC of 0.930 (95% CI: 0.884-0.975), outperforming individual parameters (AUC range: 0.606-0.798), with satisfactory calibration (Hosmer-Lemeshow p = .848). CONCLUSION:PA and EP exhibit distinct clinical and ultrasound features. The ultrasound-based nomogram demonstrates discriminative capacity for distinguishing PA from EP, providing a valuable tool for guiding clinical management. However, given the single-center design and limited sample size, further external validation in larger, multi-center prospective studies is warranted to confirm its generalizability and clinical utility.

Sonazoid, a combined blood pool and Kupffer-cell agent, can be specifically phagocytosed by Kupffer cells in the liver, allowing lesion detection and characterization of focal liver lesions (FLLs) at the post-vascular phase, apart from the vascular phase, which is similar to that of other second-generation ultasound (US) contrast agents. Sonazoid contrast-enhanced US (CEUS) is currently approved for use in some Asian countries. With the increasing use of Sonazoid CEUS for FLLs in clinical practice, developing consensus or guidelines to help standardize its use is required. The expert consensus aimed to review recent evidence and make evidence-based recommendations for radiologists and clinicians involved in the management of liver diseases regarding the use of Sonazoid CEUS in the surveillance or detection, characterization of FLLs, CEUS for interventional and intraoperative use, and tumor treatment response evaluation in patients with FLLs. This consensus was conducted without using artificial intelligence tools in accordance with the TITAN Guidelines 2025.

OBJECTIVES:As fibroblast-like synoviocyte activation and bone formation are associated with PsA, PET using the tracers of 68Ga-fibroblast activation protein inhibitor (FAPI) and 18F-sodium fluoride (NaF) may sensitively detect the disease. In this prospective study, we aimed to evaluate the performance of 68Ga-FAPI PET/CT in PsA and to compare it with 18F-NaF PET/CT. METHODS:Sixteen participants (female 7/16, age 42.31 ± 10.66 years) with PsA were prospectively enrolled and underwent dual-tracer PET/CT, clinical assessment and ultrasonography. PET/CT images were scored for PET-positive lesions at the peripheral joints, entheses, and axial joints. RESULTS:The positivity rate of 68Ga-FAPI in peripheral joints was higher than that in entheses and axial joints (21.84% vs 12.15% vs 0%), whereas high positivity rates of 18F-NaF in peripheral joints, entheses, and axial joints were observed (85.23%, 78.13% and 75%, respectively). The DAS 28 was higher in the PET-positive than in the PET-negative group with 68Ga-FAPI (5.25 ± 1.84 vs 2.55 ± 0.94, P = 0.037), but not with 18F-NaF. In addition, the PET joint count at 68Ga-FAPI PET/CT was positively correlated with the tender joint count (r = 0.604, P = 0.017), swollen joint count (r = 0.773, P = 0.001), DAS28-CRP (r = 0.556, P = 0.032), Psoriatic Arthritis Disease Activity Score (PASDAS) (r = 0.540, P = 0.038) and PsASon13 (r = 0.701, P = 0.005), while no correlation was observed in 18F-NaF PET/CT. CONCLUSION:The positivity rates of 68Ga-FAPI- and 18F-NaF PET/CT were different in patients with PsA in peripheral joints, entheses, and axial joints. The extent of joint involvement as shown in 68Ga-FAPI PET/CT correlated with clinical and US variables as well as with disease activity. TRIAL REGISTRATION:ClinicalTrials.gov, http://clinicaltrials.gov, NCT05686876.

Microvascular invasion is one of the critical factors influencing the prognosis of patients with hepatocellular carcinoma. Accurate preoperative prediction for its occurrence holds pivotal significance for the formulation of clinical individualized treatment decisions. Traditional diagnosis primarily relies on the evaluation of postoperative histopathological results, which exhibits a certain degree of lag. However, the emergence of radiomics features and biomarkers offers new insights for the preoperative prediction of microvascular invasion. The preoperative prediction model based on radiomics and biomarkers is capable of precisely analyzing and efficiently predicting the occurrence risk of microvascular invasion from both macroscopic imaging features and microscopic molecular levels, thereby providing multi-dimensional and precise scientific evidence for clinical decision-making.

Conventional ultrasound (US) evaluation of enthesitis in psoriatic arthritis (PsA) is limited by its inability to quantify metabolic alterations such as hypoxia, a key driver of disease activity. We introduce an oxygenation-integrated multimodal photoacoustic/ultrasound (PA/US) imaging framework designed to quantify entheseal oxygen saturation (SO2) for assessing entheseal disease activity in PsA. In this cross-sectional study, 25 PsA patients underwent bilateral PA/US imaging of 12 entheses, where ultrasound lesions were scored using the Outcome Measures in Rheumatology scoring system, and PA-derived SO2 levels, quantified via dual-wavelength PA imaging, were classified into hyperoxia or hypoxia groups using k-means clustering. This approach provides metabolic insights complementary to conventional ultrasonic assessment. A composite score integrating hypoxia with US parameters was validated against clinical disease activity indices (Disease Activity Score 28-C-reactive protein, DAS28-CRP; Disease Activity Index for Psoriatic Arthritis, DAPSA). Among 300 entheses, 103 (34.3%) exhibited PA positivity, with 40 (38.8%) classified as hypoxia. Hypoxia scores independently predicted DAS28-CRP ([Formula: see text] = 0.618, p = 0.001) and DAPSA ([Formula: see text] = 0.612, [Formula: see text]). The hypoxia-optimized PAUS score demonstrated superior correlation with disease activity indices compared to conventional US (DAS28-CRP: r = 0.615, p = 0.001 versus r = 0.474, p = 0.017; DAPSA: r = 0.743, [Formula: see text] versus r = 0.567, p = 0.003), alongside superior diagnostic accuracy for minimal disease activity (area under the curve, AUC 0.776 versus 0.614, p = 0.008) and low disease activity (AUC 0.853 versus 0.772, p = 0.009). This multimodal scoring system enhances the stratification of PsA disease activity by providing unique metabolic insights, offering a potential tool for therapeutic monitoring and guiding treat-to-target strategies.

Rheumatoid arthritis (RA) is characterized by poor oxygen supply and overproduction of reactive oxygen species (ROS), thereby exacerbating synovial inflammation. We synthesized MPDA@CeO2 nanoparticles (NPs) by incorporating mesoporous polydopamine (MPDA) NPs and CeO2 for photoacoustic imaging (PAI)-guided synergistic light-controlled PTT/oxygen-boosting/ROS-eliminating therapy. Upon irradiation with a near-infrared (NIR) laser, MPDA@CeO2 NPs trigger photothermal conversion to eradicate inflammatory cells and release CeO2, which have a catalytic activity to eliminate ROS and release oxygen. The oxygen-release and ROS-depleting efficiency was simultaneously augmented by heat to further combat the harmful environment of inflammation. We validated the therapeutic effect of MPDA@CeO2 in vitro and in vivo. We further applied multiwavelength PAI to observe the distribution of NPs and the change in oxygen saturation during the treatment process in vivo. The study highlights the therapeutic value of MPDA@CeO2 in inhibiting arthritis in RA through imaging-guided synergistic therapy.

This study aimed to develop a new ultrasonographic dating formula to estimate gestational age (GA) based on fetal crown–rump length (CRL) in a Chinese population, evaluate model accuracy and compare its performance with established dating formulas. A prospective, multicenter study was conducted across mainland China. Participants included healthy, low-risk women with spontaneously conceived singleton pregnancies and a regular menstrual cycle in the preceding year. Ultrasonography was performed between 11 and 14 weeks of gestation, with GA determined based on the last menstrual period. Participants were randomly assigned to a development or validation cohort in a 7:3 ratio. A best-fit regression model was constructed for GA estimation based on CRL in the development cohort. For validation, mean differences between the new estimated GA and menstrual age were calculated and compared with those obtained using five established CRL-based dating formulas in the validation cohort. All participants were followed through to delivery. The study recruited 4,710 women with singleton pregnancies, with 3,297 in the development cohort and 1,413 women in the validation cohort. The mean and standard deviation values of CRL changed linearly with GA during 11–14 weeks. CRL demonstrated a linear relationship with GA between 11 and 14 weeks, yielding the regression equation GA = 59.590085 + 0.458539×CRL (R2 = 0.8042). The mean difference between estimated GA and menstrual age was 0.32 days (95

Carotid atherosclerosis represents a significant health risk, with its early diagnosis primarily dependent on ultrasound-based assessments of carotid intima-media thickening. However, during carotid ultrasound screening, significant view variations cause style shifts, impairing content cues related to thickening, such as lumen anatomy, which introduces spurious correlations that hinder assessment. Therefore, we propose a novel causal-inspired method for assessing carotid intima-media thickening in frame-wise ultrasound videos, which focuses on two aspects: eliminating spurious correlations caused by style and enhancing causal content correlations. Specifically, we introduce a novel Spurious Correlation Elimination (SCE) module to remove non-causal style effects by enforcing prediction invariance with style perturbations. Simultaneously, we propose a Causal Equivalence Consolidation (CEC) module to strengthen causal content correlation through adversarial optimization during content randomization. Simultaneously, we design a Causal Transition Augmentation (CTA) module to ensure smooth causal flow by integrating an auxiliary pathway with text prompts and connecting it through contrastive learning. The experimental results on our in-house carotid ultrasound video dataset achieved an accuracy of 86.93 https://github.com/xielaobanyy/causal-imt .

Malignant tumors pose a great threat to human health due to their abnormal vascular system and high interstitial density, leading to high invasiveness and low curability. Tumor vasodilation and ensuring deep drug delivery are essential to elevating tumor elimination efficiency. Herein, a powerful nanoregulator is reported with tumor vessel vasodilation and tumor microenvironment (TME) reconstruction capacity for photoacoustic/magnetic resonance imaging-guided tumor starvation and ferroptosis therapy. This nanoregulator uses ultra-small ferrous sulfide (FeS) nanoparticles as a Fenton agent and hydrogen sulfide (H2S) as a donor. Additionally, glucose oxidase (GOx) serves as a glucose-depleting agent and poly (lactic-co-glycolic) acid (PLGA) functions as a building block. PLGA@ultra-small FeS-GOx nanoregulators can simultaneously promote accumulation and enhance penetration deep into tumors through H2S-induced vasodilation and acid-responsive degradation. Further, the TME can be regulated toward aggravated acidity, hydrogen peroxide up-regulation, glutathione down-regulation, and triphosadenine down-regulation by the released ferrous ion (Fe2+), H2S, and GOx. A large amount of lipid hydroperoxides (LPOs) accumulate in this antioxidant system-disabled microenvironment through the Fe2+-mediated Fenton reaction. In vivo data reveal that this synergistic energy depletion-induced starvation and LPO accumulation-driven ferroptosis efficiently kill tumor cells. This approach can guide the development of nanomedicines with clinical translation potential.

Fetal growth restriction (FGR) is associated with brain structure and functional abnormalities in fetal brain, significantly elevating perinatal morbidity and mortality. This condition is primarily attributed to placental dysfunction, resulting in chronic intrauterine hypoxia. Ultrasonography and magnetic resonance imaging (MRI) are principal imaging techniques employed for prenatal screening during mid-pregnancy. They are vital tools for diagnosing FGR and assessing its fetal brain morphological changes or functional impairments. With advances in medical imaging and the integrated use of these imaging techniques, the accuracy of assessing fetal development and detecting associated brain malformations has been greatly improved, with the potential to further explore the pathophysiologic mechanisms of fetal brain malformations. This review focuses on recent advancements and the clinical relevance of various brain imaging techniques for FGR, aiming to inform clinical diagnosis and treatment decisions.

Ultrasound localization microscopy (ULM) is an ultrasound technique capable of overcoming the acoustic diffraction limit to achieve super resolution imaging of microvasculature, simultaneously balancing imaging depth and resolution. Abdominal organs are rich in microvasculature, and pathological processes in these organs are often accompanied by microvascular alterations, such as in tumors, chronic liver and kidney diseases, and allograft. Therefore, for abdominal organs, ULM represents a promising tool for aiding disease diagnosis and monitoring. Currently, an increasing number of studies are exploring the preclinical and clinical applications of ULM in both healthy and diseased abdominal organs. This paper aims to provide a systematic review of ULM applications in abdominal organs, while briefly discussing its limitations and future prospects.