Ovarian endometrioma (OEM) remains a challenging manifestation of endometriosis, particularly in women with infertility, recurrent disease, or concern about ovarian reserve. Ultrasound-guided sclerotherapy has emerged as a minimally invasive treatment option in selected patients, but its appropriate use depends heavily on imaging-based decision-making. This review examines the role of ultrasound across the care pathway of sclerotherapy for OEM, with emphasis on diagnosis, risk stratification, patient selection, procedural planning, treatment guidance, and post-treatment surveillance. English-language literature up to May 2026 was searched in PubMed, Embase, Web of Science, and Scopus using terms related to OEM, endometriosis, transvaginal ultrasound, ultrasound-guided aspiration, sclerotherapy, ethanol sclerotherapy, recurrence, ovarian reserve, infertility, and assisted reproduction. Current evidence indicates that transvaginal ultrasound is central not only to confirming the diagnosis of OEM, but also to excluding mimickers and malignant red flags before intervention. In women considered for sclerotherapy, ultrasound provides key information on lesion morphology, disease extent, ovarian mobility, pelvic adhesions, accessibility, and puncture safety. Ultrasound-guided sclerotherapy appears to be a feasible minimally invasive option in selected women, particularly when preservation of ovarian reserve is prioritized. However, the available literature remains heterogeneous with regard to patient selection, procedural protocols, sclerosant exposure, definitions of response and recurrence, and follow-up intervals. Ultrasound may therefore play an important role not only in procedural guidance, but also in decision-making throughout the care pathway of OEM sclerotherapy. A standardized ultrasound-based framework may improve candidate selection, procedural consistency, and post-treatment surveillance, and may help better define the role of sclerotherapy in clinical practice.

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 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

Background:Pelvic masses present diagnostic challenges due to their complex origins and non-specific imaging characteristics. The accurate preoperative evaluation of pelvic masses plays a crucial role in guiding clinical decision making. This study sought to compare the efficacy and safety of ultrasound (US)-guided transluminal (transvaginal/transrectal) and transabdominal core needle biopsy (CNB) in the diagnosis of pelvic masses. Methods:A retrospective cohort study was conducted of 305 patients with pelvic masses, who were divided into the following two groups based on the biopsy approach: the US-guided transabdominal CNB group (the transabdominal group) and the transvaginal/transrectal CNB group (the transluminal group). The biopsy time, intraoperative blood loss, diagnostic accuracy, incidence of complications, and postoperative pain levels were evaluated and compared between the two groups. Results:US-guided biopsy was successfully performed in 305 patients. There were no significant differences between the two groups in terms of accuracy (98.7% vs. 99.3%), biopsy time (98.2±28.7 vs. 94.5±27.7 s, P=0.25), number of puncture needles (2.8±0.7 vs. 2.7±0.8, P=0.61), blood loss (4.3±1.7 vs. 4.6±1.4 mL, P=0.21), or post-puncture visual analogue scale (VAS) score after puncture (2.8±1.2 vs. 2.9±1.2, P=0.52). The long and short diameters of the masses were greater in the transabdominal group (107.5±36.1 mm; 74.7±26.6 mm) than the transluminal group (65.6±37.6 mm; 45.0±23.0 mm; both P<0.001). The diagnostic ability of the transluminal (transvaginal/transrectal) CNB in deep pelvic lesions was better than that of the transabdominal CNB (P<0.001). Conclusions:US-guided transluminal (transvaginal/transrectal) and transabdominal CNB have comparable diagnostic efficacy and safety for pelvic masses. Transvaginal or transrectal biopsy has substantial clinical value in the evaluation of deep pelvic masses.

To assess the diagnostic performance and inter-observer agreement of a PREoperative sarcoma scoring based on ultrasound (PRESS-US) in differentiating uterine leiomyosarcoma (uLMS) from leiomyoma (LM). We conducted a retrospective evaluation of patients who underwent surgery and received standardized ultrasound examinations due to the presence of uterine myoma-like masses. Histological diagnosis was used as the reference standard. The masses were analyzed using morphological uterus sonographic assessment criteria, and the diagnostic accuracy of PRESS-US was evaluated using ROC curve analysis. Kappa (κ) statistics were used to assess the inter-observer agreement between a less experienced and an expert radiologist. Among the 646 patients, 632 (97.8

目的 探讨多模态超声在GI-RADS 4类卵巢肿块良恶性鉴别诊断中的临床应用价值.方法 选取超声诊断为GI-RADS 4类的202个卵巢肿块为研究对象,所有患者术前均接受经阴道常规超声、SWE及CEUS检查.以术后病理结果为金标准,计算SWE、CEUS及多模态超声(CEUS+SWE)的灵敏度、特异度、阳性预测值、阴性预测值、准确度,并绘制ROC曲线比较三者的诊断效能.结果 卵巢良恶性病变造影增强表现、增强水平、包膜是否完整、包膜厚薄是否均匀、造影剂分布及血管走形比较,差异显著(P＜0.01).恶性病变组最大弹性模量值(Emax)和平均弹性模量值(Emean)均大于良性病变组(P＜0.05).多模态超声诊断的灵敏度、准确度及AUC均显著高于CEUS、SWE(P＜0.05).结论 CEUS、SWE及多模态超声在诊断卵巢GI-RADS 4类肿块的良恶性方面均具有临床应用价值,其中多模态超声诊断的灵敏度及准确度最高.

目的:比较恶性风险指数4(risk of malignancy index 4,RMI4)、超声国际卵巢肿瘤研究组(International Ovarian of Tumor Analysis,IOTA)简易标准及妇科影像报告与数据系统(gynecologic imaging reporting and data system,GI-RADS)鉴别诊断卵巢良恶性肿瘤的价值.方法:回顾分析对比经术后病理或最终临床随访证实的299例卵巢肿瘤患者的超声图像特征,分别用RMI4、IOTA简易标准和GI-RADS预测其肿块的良恶性,比较3种方法鉴别诊断卵巢肿瘤的效能.结果:299例卵巢肿块中,良性肿瘤191例,恶性肿瘤108例.IOTA简易标准的敏感度与准确度均高于GI-RADS,差异有统计学意义(χ2=5.860,P=0.015;χ2=7.650,P=0.006),特异度、阳性预测值及阴性预测值的差异则无统计学意义(χ2=2.276,P=0.131;χ2=2.599,P=0.107;χ2=5.465,P=0.019);IOTA简易标准的敏感度、阳性预测值、阴性预测值及准确度均高于RMI4,差异有统计学意义(χ2=20.415,P<0.017;χ2=6.841,P<0.017;χ2=16.897,P<0.017;χ2=22.643,P<0.017),特异度的差异则无统计学意义(χ2=4.702,P=0.030);GI-RADS的敏感度高于RMI4,差异有统计学意义(χ2=5.939,P=0.015),特异度、阳性预测值、阴性预测值及准确度的差异均无统计学意义(χ2=0.517,P=0.472;χ2=1.220,P=0.269;χ2=4.336,P=0.037;χ2=5.050,P=0.025).结论:IOTA简易标准、GI-RADS与RMI4对鉴别卵巢良恶性肿块均有重要临床价值,其中IOTA简易标准诊断效能最优.

OBJECTIVES:To investigate the diagnostic value of International Ovarian Tumor Analysis (IOTA) simple rules combined with contrast-enhanced ultrasound (CEUS) scoring system in the differential diagnosis of ovarian tumors, and the correlations of the scoring system with microvessel density (MVD) and vascular endothelial growth factor (VEGF).METHODS:One hundred eighty-nine patients with ovarian tumors were examined by routine ultrasound and CEUS. The enhanced characteristics of CEUS were observed, and the masses were classified by IOTA simple rules. To compare the diagnostic value of IOTA simple rules combined with CEUS scoring system and IOTA simple rules in the diagnosis of ovarian tumors. Immunohistochemistry was used to detect the expression of MVD and VEGF in postoperative tissue samples. The correlations between the new scoring system with MVD and VEGF were analyzed.RESULTS:The sensitivity (93.98%), specificity (94.34%), positive predictive value (92.86%), negative predictive value (95.24%), and accuracy (94.18%) of IOTA simple rules combined with CEUS scoring system in the diagnosis of ovarian tumors were higher than those of IOTA simple rules alone (all P < .05). The score system was significantly positively correlated with MVD and VEGF, and the r values were 0.77 and 0.63, respectively (P < .001).CONCLUSIONS:IOTA simple rules combined with CEUS scoring system was helpful to improve the accuracy of ultrasound diagnosis of ovarian tumors, which was significantly correlated with MVD and VEGF. It could provide important reference information for treatment scheme formulation and prognosis evaluation.

Our goal was to estimate the agreement between 360° 3-D transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI) of the vaginal invasion in cervical cancer and to discuss the clinical value of 360° 3-D TVUS. A total of 72 patients with untreated cervical cancer were included in the work. The percentage agreement between 2-D TVUS and MRI in assessing vaginal invasion (yes or no) was 77.8% (kappa, 0.400) and that between 360° 3-D TVUS and MRI was 97.2% (kappa, 0.873). The results of 2-D TVUS demonstrated the following agreement with those of MRI: 77.8% for the upper two-thirds of the vagina (kappa, 0.538), 83.3% for the lower third of the vagina (kappa, 0.471). The results of 360° 3-D TVUS demonstrated the following agreement with those of MRI: 95.8% for the upper two-thirds of the vagina (kappa, 0.907), 98.6% for the lower third of the vagina (kappa, 0.961). The results of 360° 3-D TVUS demonstrated good agreement with MRI, which is less costly and more readily available than MRI and should be considered in the pre-treatment work-up for cervical cancer.

目的 探讨甲状腺转移癌(TM)的临床特点、超声特征和其诊断价值.方法 回顾分析16例经术后病理证实的TM患者的超声声像图特征和临床资料.结果 16例患者的原发病灶依次为食管癌5例(31.2％),乳腺癌3例(18.7％),肺癌3例(18.7％),肾癌2例(12.5％),黑色素瘤2例(12.5％),前列腺癌1例(6.2％).TM超声表现分别为结节型(81.3％)和弥漫浸润型(18.7％).结节型TM超声声像图特征:76.5％(13/17)形态不规则;64.7％(11/17)边界不清;70.6％(12/17)实性低回声;41.2％(7/17)侵犯甲状腺包膜,呈浸润性生长;52.9％(9/17)钙化;70.5％(12/17)血流信号丰富.弥漫型TM甲状腺实质呈弥漫性不均匀低回声,没有明确边界,血流信号丰富.37.5％(6例)患者伴颈部淋巴结转移.结论 TM的超声声像图具有一定的特征性,结合其临床资料有助于提高诊断准确率.

OBJECTIVES:To explore the value of shear wave elastography in the diagnosis of cervical disease.METHODS:This work was a retrospective analysis of 246 cases of cervical lesions confirmed by transvaginal conventional ultrasound, shear wave elastography, and a cytologic test. The lesions were divided into 2 groups according to the final pathologic results: a malignant cervical group and a benign cervical group. In addition, the normal cervix was set as the control group.RESULTS:The maximum and mean shear wave velocity values ± SD were 5.24 ± 1.11 and 4.91 ± 1.12 m/s for the malignant cervical group, 3.93 ± 0.39 and 3.53 ± 0.52 m/s for the benign cervical group, and 3.27 ± 0.31 and 2.86 ± 0.23 m/s for the normal cervix, respectively. The areas under the receiver operating characteristic curves for the maximum and mean shear wave velocity in the differential diagnosis of a normal cervix and benign cervical tumors were 0.909 and 0.878 (both P < .001), whereas in the differential diagnosis of benign and malignant cervical tumors, they were 0.909 and 0.895 (both P < .001).CONCLUSIONS:Shear wave elastography can quantitatively analyze the elastic characteristics of cervical diseases, help differentially diagnose cervical diseases, accurately determine the extent of tumor invasion, and improve effective clinical staging and treatment.

Objective To explore the clinical value of shear wave elastography (SWE) in the identification of rectal tumors.Methods Sixty-six patients with rectal tumors were selected.Before operation,SWE pattern were started to detect the lesions.And images in SWE pattern were saved.The maximum Young's modulus (Emax) and the mean Young's modulus (Emean) in the lesion were recorded while the Emax and Emean in the normal intestinal wall tissue were recorded,and statistical analysis was performed.Results The Emax and Emean in rectal cancer was significantly higher than that of rectal adenoma group,the difference was statistically significant (P＜0.05).The Emax and Emean in rectal cancer and rectal adenoma was significantly higher than that in the normal intestinal wall,the difference was statistically significant (P＜0.05).There was no significant difference in the Young's modulus between the T1,T2,T3 and T4 stage of rectal cancer.The accuracy,sensitivity,and specificity of the elastosonography combined with ERUS differentiating benign and malignant rectal cancer was 90.6 ％,89.5 ％ and 92.3 ％.They are higher than that of ERUS (84.2％,84.5％ and 84.5％),the difference was statistically significant (P＜0.05).Conclusions Shearwave elastography can quantitatively evaluate the Young's modulus of rectal tumors,which can help to improve the differential diagnosis ability of ultrasound on benign and malignant rectal lesions.