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:Inguinal lymph node (ILN) metastasis significantly affects prognosis and treatment strategies in patients with gynecological malignancies. Conventional ultrasound (US) provides morphological assessment but has limited sensitivity for detecting early metastatic changes. Three-dimensional shear wave elastography (3D-SWE) enables volumetric stiffness assessment with multiplanar visualization and may overcome the planar limitations of two-dimensional SWE (2D-SWE). This study aims to determine whether 2D-SWE or 3D-SWE improves the diagnostic performance of US for identifying ILN metastasis and to compare the complementary value of qualitative pattern analysis and quantitative elasticity metrics. Methods:We retrospectively included 131 ILNs from 125 women with gynecological malignancies who underwent conventional US, 2D-SWE, and 3D-SWE. Qualitative color pattern analysis and quantitative elasticity parameters (Emax, Emean) were evaluated alone and in combination with US features. Histopathology served as the reference standard. Diagnostic performance was assessed using receiver operating characteristic (ROC) analysis and compared with DeLong tests. Results:Of the 131 ILNs, 72 (55.0%) were malignant and 59 (45.0%) were benign. Among the three orthogonal 3D-SWE planes, the coronal plane demonstrated superior diagnostic performance across both qualitative and quantitative assessments. As standalone methods, qualitative coronal 3D-SWE achieved an area under the curve (AUC) of 0.846, while quantitative coronal-plane Emax achieved an AUC of 0.847, with no significant difference between them (P=0.920). When combined with conventional US, qualitative coronal 3D-SWE achieved the highest overall diagnostic performance [AUC 0.891, 95% confidence interval (CI): 0.834-0.947], with a sensitivity of 86.11% and a specificity of 88.05%, significantly outperforming conventional US alone (P<0.001). Among quantitative models, sagittal-plane Emax combined with US showed the best performance (AUC 0.858, 95% CI: 0.795-0.921), with a sensitivity of 87.50% and a specificity of 79.19%, also significantly better than conventional US alone (P<0.001). There was no significant difference between the best qualitative and quantitative combined models (AUC 0.891 vs. 0.858, P=0.331). Emax consistently outperformed Emean across all planes (AUC range, 0.809-0.847 vs. 0.749-0.795). Conclusions:In this retrospective study, integrating 3D-SWE with conventional US significantly improved the detection of ILN metastasis through multiplanar qualitative and quantitative elasticity assessment. The coronal plane demonstrated superior diagnostic performance across both qualitative and quantitative assessments, and qualitative and quantitative 3D-SWE offered comparable incremental value when combined with US. These findings support 3D-SWE as a useful adjunct to conventional US for preoperative ILN evaluation in gynecological malignancies, particularly vulvar and vaginal cancers, in which ILN status is a key prognostic determinant.

Glioblastoma (GBM) recurrence, driven by therapeutic resistance and diffuse infiltration, remains a critical clinical challenge, fundamentally sustained by a mitochondrial metabolic addiction. To leverage this, we developed a biomimetic nanoplatform (HM-NPs@CM) camouflaged with cancer cell-mitochondria hybrid membranes. This ensures efficient blood-brain barrier traversal and precise mitochondria-targeted co-delivery of sonosensitizer Ce6 and mitophagy inhibitor Mdivi-1 within orthotopic GBM. Upon ultrasound activation, the nanoplatform executes a synergistic ‘Attack-and-Trap’ strategy: sonodynamic therapy (SDT) launches a targeted oxidative assault, while concurrent pharmacological inhibition of mitophagy traps irreparably damaged mitochondria. This accumulation of damaged mitochondria triggers a lethal pathological cascade, where mitochondrial oxidative stress progresses into severe intracellular oxidative stress, culminating in irreversible lytic cell death and sustained cytosolic mtDNA leakage. The liberated mtDNA robustly activates the cGAS-STING pathway, driving Type I interferon synthesis and transforming tumor cells into immunogenic reservoirs. Subsequently, this severe oxidative stress forces the terminal rupture of the plasma membrane, orchestrating the massive release of pre-synthesized immune effectors and damage-associated molecular patterns (DAMPs). Capitalizing on these signals, combination with anti-PD-L1 blockade potently induces dendritic cell maturation and CD8+ T cell infiltration, significantly suppressing tumor growth. Ultimately, this multimodal strategy establishes durable immunological memory, providing comprehensive protection against tumor rechallenge and post-surgical recurrence.

Purposes To evaluate the diagnostic yield of contrast-enhanced ultrasound (CEUS)-guided percutaneous core needle biopsy (CNB) for peritoneal lesions and to identify factors associated with the initial diagnosis accuracy. Methods A total of 253 consecutive patients with peritoneal lesions who underwent CEUS-guided percutaneous CNB from January 2015 to March 2025 were retrospectively enrolled. Based on whether the initial pathological diagnosis matched the final diagnosis, patients were classified into an accurate initial diagnosis group (n = 239) and an inaccurate initial diagnosis group (n = 14). The final diagnosis was determined by integrating histopathological findings, multi-modality imaging, and clinical follow-up data. Baseline, conventional ultrasound (US), CEUS, and CNB-related characteristics were compared. The overall technical success rate, initial diagnostic accuracy, and complications of CEUS-guided CNB were evaluated. Factors affecting diagnostic accuracy were identified via univariate and multivariate analyses. Within subgroups stratified by the median maximum anteroposterior diameter (MAD), CNB-related characteristics were compared. Results The study achieved 100% (253/253) technical success, with an initial diagnostic accuracy of 94.5% (239/253). The overall complication rate was 9.1% (23/253), predominantly minor, with no visceral organ injury or needle tract seeding occurred. A prior history of cancer and a trans-ascitic approach were independent factors affecting initial accuracy (P < 0.05). Comparative analysis revealed statistically significant differences between the larger (MAD > 21 mm) and smaller (MAD ≤ 21 mm) lesion subgroups in five parameters: number of cores, diagnosis, lesion type, echo pattern, and arterial phase enhancement pattern (P < 0.05). Conclusions CEUS-guided percutaneous CNB is a safe, feasible, and highly accurate technique for diagnosing peritoneal lesions. Attention to prior tumor history and the selection of a non‑trans‑ascitic approach are important for improving initial diagnostic accuracy.

To determine a direct method for diagnosing axillary lymph node (ALN) tumor burden preoperatively in cT1-2N0 breast cancer patients, we developed and validated a deep learning (DL) model based on ultrasound (US) images of sentinel lymph nodes (SLNs) detected by contrast-enhanced lymphatic ultrasound (CEUS). Women with cT1-T2N0 breast cancer who received CEUS were enrolled prospectively from Peking Union Medical College Hospital between April 2020 and July 2021 and from Sichuan Cancer Hospital between April 2022 and July 2022. Heavy ALN tumor burden was defined as > 2 metastatic lymph nodes according to the Z0011 criteria. We developed a DL model, the modality-adaptive network with clinicopathological information (MAN + C), using grayscale or color Doppler US images and radioclinicopathological information to predict heavy tumor burden. A total of 595 SLNs from 374 patients met the inclusion criteria. The areas under the receiver operating characteristic curve (AUCs) were calculated to evaluate the predictive performance of the model, yielding values of 0.91[95

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

Background:Gastrointestinal stromal tumors (GISTs) can undergo malignant transformation, and thus, the risk grading assessment of postoperative patients is highly critical. This study sought to investigate the correlation between ultrasonic characteristics, clinicopathological features, and biological risk grading in patients with gastric GISTs and to determine whether the preoperative prediction of biological risk grading is feasible. Methods:The ultrasonic characteristics and clinicopathological data of gastric filling in 92 patients with GISTs confirmed by surgical pathology were retrospectively analyzed, the influencing factors of the biological risk classification of GISTs were assessed through univariate and multivariate analyses, and a prediction model was constructed. The receiver operating characteristic curve was plotted to analyze the predictive value of the logistic regression model. Results:Univariate analysis revealed that melena was significantly more common in the high-risk group (P<0.05). Tumor size, morphology, echogenicity, calcification, and cystic changes also differed significantly between the risk groups (P<0.05), while location, growth pattern, blood flow grade, and ulceration did not (P>0.05). Multivariate analysis indicated that the independent risk predictors were tumor size [odds ratio (OR) =0.028; P=0.002] and echogenicity (OR =0.092; P=0.011). The derived logistic model (area under the curve =0.934; 95% confidence interval: 0.887-0.981) showed high sensitivity (76.4%) and specificity (97.3%). In terms of pathological findings, the Ki-67 index and mitotic count correlated strongly with risk level (P<0.05) and may serve as key prognostic markers. Conclusions:Ultrasound-based tumor size and echogenicity are robust preoperative indicators for gastric GIST risk classification. The proposed model demonstrated excellent predictive performance and may be a practical tool for clinical assessment.

To evaluate the clinical value of real‑time transrectal ultrasound (TRUS) guidance in interstitial brachytherapy (ISBT) for patients with vaginal stump recurrence after hysterectomy for cervical cancer. This retrospective, non-randomized study included 32 patients receiving ISBT who were categorized into two groups: Group A (TRUS‑guided ISBT, n=16) and Group B (non‑TRUS‑guided ISBT, n=16). A total of 39 procedures were performed in Group A, involving 137 implanted interstitial needles, while Group B underwent 37 procedures with 145 needles implanted. Postoperative computed tomography (CT) was used to evaluate vaginal stump unintended perforation rates, penetration depth, and rectal or bladder perforation. A total of 282 interstitial needles were implanted across both groups.The vaginal stump unintended perforation rate in Group A was significantly lower than in Group B (16.06

Background: Color Doppler ultrasonography technology has demonstrated excellent diagnostic performance across diverse clinical scenarios; however, research on its use in rectal tumor evaluation remains underexplored. This study aimed to evaluate the diagnostic value of transrectal ultrasound (TRUS)-derived vascular features in differentiating between malignant and benign rectal lesions, preoperative tumor staging, and monitoring the neoadjuvant therapy (NT) response. Methods: A retrospective cohort of 452 patients with TRUS-detected gastrointestinal lesions was analyzed. Vascular parameters, including peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI), were recorded. Histopathological findings served as the diagnostic gold standard. Results: Of the 452 cases, 428 (94.7%) were pathologically confirmed as malignant, while 24 (5.3%) were benign. The malignant group exhibited significantly higher PSV and RI values than the benign group (P<0.05). An RI threshold of >0.67 for malignancy detection resulted in a sensitivity of 78% and a specificity of 80%. Grade 3 (G3) tumors had higher PSV than grade 2 (G2) tumors, and G2 tumors had higher PSV than grade 1 (G1) tumors. Among the three tumor grades (P<0.05), the G3 tumors had the highest RI value (0.77), while the G1 tumors had the lowest RI value (0.68). In the pathology nodal stage (pN-stage) cases, pN2-stage cases exhibited a significantly higher PSV (20.1 cm/s) compared to both the pN0 (16.7 cm/s) and pN1 (15.9 cm/s) cases (P<0.001). In pathology tumor stage (pT-stage) cases, only pT4-stage cases showed higher RI than pT1-stage cases. After NT, the PSV and RI values decreased significantly (18.3 vs. 13.7 cm/s and 0.75 vs. 0.67) (P<0.05). The partial response (PR) group showed greater decreases in both the PSV and RI values after NT than the stable disease (SD) group. Conclusions: TRUS vascular parameters, particularly PSV and RI, demonstrate strong diagnostic value in differentiating between malignant and benign rectal lesions, and differ significantly across some tumor differentiation grades and pN-/pT-stages. Additionally, these parameters can serve as effective biomarkers for monitoring NT efficacy.

The rising incidence and detection rate of thyroid cancer have led to a concomitant increase in the number of thyroidectomy procedures performed annually. Among the postoperative complications, recurrent laryngeal nerve injury (RLNI) remains a major factor affecting patients’ quality of life. In pursuit of precision therapeutic strategies and reduced nerve injury rates,clinicians have shown growing interest in the recurrent laryngeal nerve(RLN). In recent years, high-frequency ultrasound (HFUS) has been increasingly incorporated into the perioperative management of thyroidectomy. This study is the first to address RLN management during the perioperative period for thyroid cancer. The ultrasonographic characteristics of the RLN are systematically reviewed, with particular emphasis on the clinical utility of HFUS in preoperative screening, intraoperative monitoring, and postoperative follow-up. We also discuss the inherent limitations of this technique and outline future directions. Despite these promising advances, significant challenges persist in ensuring the accuracy and standardization of ultrasonographic examinations across diverse patient populations. In conclusion, this review highlights the transformative potential of HFUS in optimizing perioperative neural monitoring and functional evaluation for thyroid cancer. However, it also notes that ultrasound cannot currently replace laryngoscopy or intraoperative nerve monitoring (IONM), though it serves as a valuable complementary tool with clear clinical utility.

RATIONALE AND OBJECTIVES:This study aimed to comprehensively compare the diagnostic performance, technical efficacy, and safety profiles of four different approaches for core needle biopsy (CNB) of oropharyngeal and adjacent space lesions: transoral versus percutaneous approaches, each guided by either conventional ultrasound (US) or contrast-enhanced ultrasound (CEUS). MATERIALS AND METHODS:This retrospective cohort study consecutively enrolled eligible adults who underwent imaging studies showing suspected oropharyngeal, parapharyngeal, retropharyngeal space, and adjacent space tumors from October 2015 to December 2024. From 388 eligible patients (initial cohort: 416), 240 patients were selected using a 1:1:1:1 matched design with percutaneous US-guided CNB as the reference group to form four balanced groups: transoral or percutaneous CNB guided by either conventional US or CEUS (60 patients per group). Matching by age and maximum tumor diameter was performed to balance baseline characteristics among groups. All procedures used 18-G automated cutting needles. The primary outcome was diagnostic concordance between US/CEUS-guided CNB histopathology and the reference standard. The secondary outcomes included imaging concordance (US/CEUS concordance with histopathological reference standard); procedure efficacy (first-puncture success; total number of needle punctures; and overall procedure duration); safety profile, including infection and hemorrhagic complications; and pain assessment. Statistical analyses accounted for the matched design by applying linear models, conditional logistic regression, and generalized estimating equations for continuous, binary, and repeated-measures outcomes, respectively. RESULTS:Among 240 patients, transoral CEUS guidance demonstrated favorable perioperative outcomes across multiple domains. For procedural precision, first-attempt puncture success was significantly higher with transoral versus transcutaneous approaches (adjusted OR = 2.35, 95% CI: 1.18-4.68, P = 0.015). CEUS significantly reduced puncture attempts compared with conventional US (β = -0.69, 95% CI: -0.84 to -0.53, P < 0.001), with transoral CEUS achieving a notably greater reduction versus transcutaneous conventional US (β = -0.82, 95% CI: -1.04 to -0.60, P < 0.001). Intraoperative blood loss was statistically significantly lower with CEUS guidance overall (β = -0.30, 95% CI: -0.36 to -0.24, P < 0.001), with transoral CEUS showing a relatively greater effect (β = -0.34, 95% CI: -0.43 to -0.25, P < 0.001 vs transcutaneous conventional US). CEUS guidance was associated with a statistically significant prolongation of procedure time compared with US (β = 1.6 min; 95% CI: 1.3-1.9; P< 0.001). For transoral CEUS relative to percutaneous guidance, the prolongation was β = 1.7 min (95% CI: 1.4-2.0; P< 0.001). And transoral CEUS yielded a relatively more favorable pain profile, with significantly lower scores immediately postoperatively (β = -0.72, P < 0.001) and at 24 h (β = -0.40, P < 0.001). Diagnostic accuracy remained uniformly high across all groups (95.0-98.3%), with no significant differences by approach (P = 0.712) or guidance technique (P = 0.295). Complications were rare (1.25% overall: two hematomas, one infection), with no significant intergroup differences (P > 0.05); all resolved with conservative management. CONCLUSIONS:CEUS-guided transoral biopsy achieved superior technical success with fewer puncture attempts and improved pain control for oropharyngeal lesions, despite modest procedural time extension. This approach demonstrates notable advantages over conventional methods and represents a valuable diagnostic technique for oropharyngeal space lesions.

Treatments for secondary and tertiary hyperparathyroidism (SHPT/THPT) remain significant challenges in patients with end-stage renal disease. Thermal ablation (TA) has emerged as a minimally invasive, safe, and effective alternative to surgical resection (SR). However, technical variations and a lack of standardization have limited its widespread adoption. To address these challenges, an international expert panel developed consensus recommendations using a modified Delphi method, integrated with a systematic literature review. As a result, sixteen recommendations were formulated, addressing diagnosis, preoperative preparation, technical procedures, postoperative management, follow-up strategies, efficacy assessment, and complications associated with TA for SHPT/THPT. These recommendations aim to promote standardized treatment protocols, improve procedural safety, and provide evidence-based guidance for clinical practice and future research in ultrasound-guided TA for SHPT/THPT management.

Preoperatively distinguishing follicular thyroid carcinoma (FTC) from follicular thyroid adenoma (FTA) remains a significant clinical challenge. Current ultrasound risk stratification systems show limited efficacy for follicular neoplasms, and existing artificial intelligence (AI) approaches lack sufficient validation. We developed and validated a deep learning model using ultrasound images to differentiate FTC from FTA and classify FTC into invasion subtypes. This multicenter retrospective study incorporated data from 31 hospitals, using 1531 patients for model development and 900 across three external test sets for validation. The model demonstrated high diagnostic performance, with AUCs of 0.816-0.847 for FTC vs FTA discrimination across external test sets and robust performance across subtypes (AUC range 0.754-0.910), and generalized well to varied clinical settings. Triple-classification macro-AUCs were 0.818-0.861. It consistently outperformed radiologists and improved diagnostic accuracy as an assistive tool. Our AI model provides a reliable, non-invasive tool for preoperative diagnosis and risk stratification of follicular thyroid neoplasms.

This case describes the application of ultrasound-guided microwave ablation (MWA) in the management of a solitary breast metastatic lesion in a 59-year-old female with a history of lung adenocarcinoma. Over a 36-month follow-up period, imaging and clinical assessments demonstrated sustained local tumor control without recurrence or major complications, highlighting MWA as a viable minimally invasive therapeutic option for metastatic breast cancer patients.

ObjectiveTo assess and compare the diagnostic accuracy and safety of contrast-enhanced ultrasound (CEUS)-guided transoral and submental core needle biopsy (CNB) techniques in patients with suspected tonsillar masses, and to identify which approach offers superior diagnostic performance with fewer complications.MethodsBetween November 2019 and March 2024, 41 patients with suspected tonsillar masses were enrolled in this comparative study of two biopsy techniques. Each patient underwent either a transoral CNB or a submental CNB. Diagnostic metrics, including accuracy, sensitivity, negative predictive value (NPV), and positive predictive value (PPV) were calculated for each method. Pain levels before and after the procedures were recorded to evaluate patient discomfort, and any complications were documented to evaluate safety. Statistical analyses were conducted to determine whether differences in diagnostic performance, biopsy time, and complication rates between the two techniques were significant.ResultsA total of 41 patients were included in the analysis (transoral CNB, n = 22; submental CNB, n = 19). The transoral approach demonstrated higher diagnostic accuracy (95.45% vs. 89.47%), sensitivity (91.67% vs. 87.5%), and NPV (90.91% vs. 60.00%) compared with the submental approach; PPV was 100% for both methods. Pre- and post-biopsy pain scores were similar in both groups, with no significant differences observed. No significant complications occurred in the transoral group. In the submental group, two patients developed minor acute submandibular adenitis; however, this difference in complication rates (0% vs. 10.5%) was not statistically significant (P = 0.21).ConclusionThe transoral CEUS-guided CNB approach demonstrated higher diagnostic accuracy and lower post-procedural complication rates than the submental method in the evaluation of tonsillar tumors. These findings support the transoral route as the preferred technique for obtaining tonsillar biopsy specimens and may inform clinical practice changes aimed at improving patient outcomes through more accurate and timely diagnosis.

To establish a diagnostic model combining contrast-enhanced ultrasound (CEUS), human epididymis protein 4 (HE4), and Ovarian-Adnexal Reporting and Data Systems (O-RADS) US v2022, verify its diagnostic efficacy, and compare it with subjective evaluation. From January 2018 to August 2021 (the test group) and from September 2021 to September 2022 (the validation group), the data of patients classified as O-RADS US v2022 categories 2 to 5 who underwent adnexal ultrasound examinations were prospectively and continuously collected. In the test group, univariate and multivariate analyses were used to explore the relationship between age, body mass index (BMI), maximum diameter of the lesion, menopausal status, HE4, cancer antigen 125 (CA125), and the characteristics of CEUS and malignant lesions. Selecting independent influencing factors to construct diagnostic model, which was validated in the external validation group and compared with subjective evaluation. The test group included 563 patients (mean age, 48.7 ± 13.2), and the validation group included 246 patients (mean age, 47.6 ± 12.9). Univariate and multivariate analyses showed that enhancement time, enhancement intensity, dynamic changes, and HE4 were independent influencing factors for predicting adnexal malignant tumors. In the validation group, the sensitivities and specificities of O-RADS US v2022, O-RADS US v2022 + CEUS, O-RADS US v2022 + CEUS + HE4, and subjective assessment were 88.89

To investigate the feasibility of robot-assisted teleultrasound diagnosis for radioactive patients compared with conventional ultrasound diagnosis. In this prospective study (ChineseClinicalTrials.gov identifier, ChiCTR2200057253), 32 radioactive patients were examined by conventional ultrasound and MGIUS-R3 robot-assisted ultrasound from March 2022 to June 2022. After two scans, patients completed a satisfaction survey, including comfort score, fear score, tension score and pain score. The durations of both scans were recorded, and sonographers wore lead apron to prevent the radiation during the conventional examination. Subsequently, the ultrasonic images saved by sonographers were diagnosed and scored. Finally, we evaluated the feasibility of the robot-assisted teleultrasound diagnosis system regarding patients’ satisfaction, examination duration, image quality and diagnostic consistency via χ2 test, Kappa consistency test and Wilcoxon signed-rank test. Among 32 patients (mean age, 54.9 ± 9.8 [SD]; 16 women), 29 had consistent diagnoses and 3 had inconsistent diagnoses between two scans, but the diagnostic consistency was good (Kappa = 0.818, P < 0.001). In addition, there was no statistical difference between two scans with regard to image quality score (29.28 ± 0.47vs29.31 ± 0.44, P = 0.97), comfort score (10vs10, P > 0.99), tension score (0vs0, P > 0.99) and fear score (0.09vs0, P = 0.32). Although 7 patients felt slightly painful during teleultrasound scan, the pain intensity was acceptable (0.31vs0, P = 0.02). The mean duration of teleultrasound examinations was 11.1 min (6–24 min), which was longer than 5.9 min (2–17 min) of conventional examinations (P < 0.001). Comparing robot-assisted teleultrasound and conventional ultrasound, there was no evidence of differences regarding patients’ satisfaction and image quality, and the diagnostic consistency was remarkable.

Background:New ultrasound (US) techniques, such as contrast-enhanced ultrasound (CEUS) and shear wave elastography (SWE), are being used to identify artifacts, guide the interventions and evaluate the extent of resection, as it is difficult for gray-scale ultrasound to distinguish the artifacts in intraoperative ultrasound (IOUS). However, to date, no comparative study has been conducted on the role of several new US technologies in guiding brain tumor resection. Thus, this study sought to compare the roles of various new US technologies in guiding brain tumor resection to find a convenient and useful guiding technology for brain tumor resection. Methods:From July 2022 to July 2023, 64 brain tumor patients (33 men and 31 women), with ages ranging from 26 to 78 years (53.2±11.6 years), were included in the study. Before surgery, a planned resection (pRS) was determined for all of the included patients by a multidisciplinary neuro-oncology team. All patients underwent microsurgical resection of the lesion. After the craniotomy and before the dural opening, ultrasonic techniques, including B-mode, micro-flow imaging (MFI), CEUS, and SWE, were used to evaluate the features of the brain tumor and its surrounding structure. Then, those ultrasonic techniques were applied to each patient to confirm the microsurgical margin achieving the pRS at the end of the resection. Next, 3 days after surgery, a magnetic resonance imaging (MRI) scan was performed on each patient as the reference standard. The agreement between B-mode, color Doppler flow imaging (CDFI), MFI, CEUS, SWE, and MRI was measured by Fleiss' kappa agreement. Results:In the evaluation of the surgical resection edges, all the included US technologies showed substantial agreement compared to the MRI results. The Kappa values were 0.717, 0.751, 0.714, and 0.892 for B-mode, MFI, SWE, and CEUS, respectively. CEUS and MRI showed the best diagnostic consistency. CEUS had the highest sensitivity, specificity, positive predictive value, and negative predictive value under the receiver operating characteristic (ROC) curve analysis (77.78%, 100%, 100%, and 86.05%, respectively), followed by MFI. B-mode and SWE showed similar accuracy in detecting tumor residue. Conclusions:US is a convenient and cost-effective method for guiding the procedure and evaluating the extent of resection in neurosurgery. CEUS has the highest diagnostic accuracy for residual lesions among the new US technologies. Thus, MFI can be recommended as a technique for guiding and evaluating residues in neurosurgery in addition to CEUS.