Multiparametric ultrasound (MPUS) combines B-mode, Doppler techniques, microvascular imaging, contrast-enhanced ultrasound (CEUS), and elastography, thereby enhancing diagnostic precision across a wide spectrum of scrotal diseases. Developed under the auspices of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB), these guidelines provide evidence-based recommendations for the clinical use of MPUS in scrotal imaging. Based on the framework of the Oxford Centre for Evidence-Based Medicine, this document outlines the diagnostic value of MPUS in acute scrotal pain, trauma, infertility, focal and extratesticular lesions, cryptorchidism, and testicular incidentalomas. The recommendations highlight CEUS as the reference method for vascular assessment and elastography as a complementary tool for tissue characterization. These guidelines aim to standardize MPUS practice and promote its integration in routine scrotal imaging.

Multiparametric ultrasound (MPUS) integrates B-mode, Doppler techniques and microvascular imaging, contrast-enhanced ultrasound (CEUS) and elastography, enhancing diagnostic precision across a wide spectrum of scrotal diseases. Developed under the auspices of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB), these guidelines provide evidence-based recommendations for the clinical use of MPUS in scrotal imaging. Based on the Oxford Centre for Evidence-Based Medicine framework, this document outlines the diagnostic value of MPUS in acute scrotal pain, trauma, infertility, focal and extratesticular lesions, cryptorchidism, and testicular incidentalomas. The recommendations highlight CEUS as the reference method for vascular assessment and elastography as a complementary tool for tissue characterization. These guidelines aim to standardize MPUS practice and promote its integration into routine scrotal imaging.

Focal treatment has emerged as a precision-oriented alternative to whole-gland treatment approaches for localized prostate cancer. It aims to selectively destroy clinically significant tumor foci while preserving surrounding structures that are essential for urinary continence and sexual function. Irreversible electroporation (IRE) is a relatively new and increasingly investigated focal treatment modality. By delivering short high-voltage pulses, IRE creates permanent nanopores in cell membranes and induces cell death predominantly through non-thermal mechanisms.This theoretical advantage - tissue ablation with relative preservation of the collagen-rich extracellular matrix - has heightened interest in IRE, particularly for tumors located near sensitive structures such as the neurovascular bundles, the urethral sphincter complex, and the rectal wall.In this review, we outline key procedural and technical aspects and summarize the clinical evidence for IRE in localized prostate cancer. Data from both prospective and retrospective case series demonstrate encouraging early and intermediate-term oncologic outcomes, although patterns of recurrence and the need for retreatment vary between cohorts and depend on the respective follow-up protocols. Functional outcomes are consistently excellent: continence is preserved in the vast majority of patients, and potency preservation is often high, typically ranging from approximately 75 to 95% among men who were potent prior to treatment.Despite these promising findings, widespread adoption in routine clinical practice is limited by the lack of robust long-term endpoints and the absence of randomized comparisons with established standards such as radical prostatectomy, radiotherapy, or risk-adapted active surveillance. While prospective comparative studies are highly challenging as they require large sample sizes, long follow-up periods, and careful endpoint definition, they are essential to clarify the role of irreversible electroporation within treatment algorithms, optimize patient selection, standardize follow-up and salvage strategies, and ultimately confirm durable tumor control with a sustained functional benefit.

The integration of the multitude of ultrasound techniques into a "one-stop" liver clinic model will revolutionize the management of liver diseases. This approach streamlines patient care by providing immediate imaging assessment, facilitating prompt diagnosis, and expediting treatment plans. The traditional ultrasound methods of B-mode imaging and Doppler techniques have been supplemented by the newer techniques of tissue elastography, fat quantification, and contrast-enhanced ultrasound-termed multiparametric ultrasound. The deployment of these techniques to establish in more detail the underlying status of liver disease has been profound. The encompassing ultrasound techniques have allowed the ultrasound practitioner to establish a comprehensive assessment of liver disease, allowing further accurate management, and negating the need for additional, often more expensive, imaging to establish the diagnosis. This paper explores the implementation, benefits, and challenges of ultrasound-based one-stop liver clinics, emphasizing their impact on patient outcomes and healthcare efficiency. A detailed assessment of the techniques and their position in the diagnostic armamentarium is reviewed with a comprehensive overview established. CRITICAL RELEVANCE STATEMENT: Multiparametric liver ultrasound integrating B-mode, Doppler, CEUS, elastography and fat quantification provides a practical, low-cost one-stop pathway for staging chronic liver disease, assessing portal hypertension surrogates and characterizing incidental lesions, thereby speeding up treatment. KEY POINTS: Ultrasound is the first-line imaging investigation for liver disease, with established criteria on B-mode imaging for steatosis and cirrhosis. Multiparametric ultrasound integrates morphology, hemodynamics, fibrosis, steatosis, and lesion assessment. A one-stop liver ultrasound clinic accelerates decisions and reduces additional imaging.

Background: Tumor progression is associated with alterations in tissue mechanical properties. Experimental studies in cancer mechanobiology suggest that increased viscosity of the tumor habitat can promote tumor growth, while malignant tumors often exhibit pronounced mechanical heterogeneity with coexisting soft and rigid regions that facilitate cell motility. Elastography enables noninvasive viscoelastic profiling of soft-tissue properties in vivo and may therefore detect tumor malignancy. Purpose: To investigate whether multiparametric external vibration-based ultrasound time-harmonic elastography (THE) can differentiate benign from malignant liver tumors and identify viscoelastic parameters associated with tumor malignancy. Materials and Methods: In this prospective study conducted from January 2025 to March 2026, 94 patients with focal liver lesions underwent THE. Eighty-four patients were included in the final analysis (41 benign, 39 malignant; 45 women; age range 30-87 years). Liver and tumor stiffness (shear wave speed; SWS), viscosity (loss angle; φ), and spatial mechanical heterogeneity (spatial standard deviation, SWS-SD) were quantified. Diagnostic performance for differentiating benign and malignant tumors was assessed using the area under the receiver operating characteristic curve (AUC). Results: Tumor heterogeneity and surrounding habitat viscosity provided the most pronounced differentiation between malignant and benign lesions. Malignant tumors demonstrated higher SWS-SD (0.41±0.20 vs. 0.28±0.11 m/s) and increased φ (0.76[plusmn]0.09 vs. 0.71±0.05 rad) with a combined discriminative power of AUC=0.72. These viscoelastic differences were more pronounced in larger tumors of ≥2.5 cm2 area (SWS-SD: 0.47±0.19 vs. 0.32±0.11 m/s; : 0.78±0.10 vs 0.70±0.04 rad) yielding AUC=0.88 while excellent discriminative power of AUC=0.97 for ≥6 cm2 tumor area. Conclusion: Elevated viscosity of the tumor habitat combined with increased tumor stiffness-heterogeneity measured by multiparametric THE can differentiate liver malignancies from benign liver lesions. THE may thus provide a rapid, cost-effective approach for viscoelastic profiling of liver tumors in clinical diagnostic imaging. ### Competing Interest Statement Thomas Fischer reports having received consultancy honoraria from Bracco and Canon Medical Imaging. ### Funding Statement Funding of the German Research Foundation is gratefully acknowledged (GRK 2260 "BIOQIC", SFB 1340 "Matrix in Vision", FOR 5628 "Physics in Cancer"). Dr. Spiesecke is participant in the BIH Charite Junior Clinician Scientist Program funded by the Charite-Universitaetsmedizin Berlin, and the Berlin Institute of Health at Charite (BIH). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The ethics committe of the Charite - Universitaetsmedizin Berlin gave ethical approval of this work (EA4/165/24). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors

Der Point-of-Care-Ultraschall (POCUS) hat sich in der Akutversorgung als wichtiges diagnostisches Instrument etabliert, jedoch fehlen validierte Schulungskonzepte mit nachweislich nachhaltiger Kompetenzentwicklung. Evaluation eines strukturierten Blended-Learning-Kurses hinsichtlich Wissens‑, Praxis- und Selbstsicherheitskompetenzen sowie deren Stabilität nach mehreren Monaten. Retrospektive, longitudinale Kohortenanalyse über 18 Kurse (01.03.2021–13.11.2023). Von 683 Teilnehmenden stimmten 474 (69,4

OBJECTIVE:Ultrasound fusion imaging is a hybrid technique that combines real-time ultrasonography (US) with pre-acquired computed tomography (CT) or magnetic resonance imaging (MRI), using electromagnetic (EM) tracking to enable precise spatial correlation between modalities. This technology is increasingly used for liver imaging and interventions, especially when conventional B-mode US fails to provide adequate lesion visualization. The aim of this technical review and position statement is to evaluate the technical accuracy (target registration errors) and lesion visibility of ultrasound fusion imaging based on published evidence and expert consensus. METHODS:This manuscript was designed as the technical component of a two-part World Federation for Ultrasound in Medicine and Biology (WFUMB) position statement. A systematic review was conducted using a PICO framework focused on two core questions: (i) to evaluate EM-tracked fusion target registration errors (PICO T1), and (ii) whether fusion improves visibility of lesions in difficult-to-image liver lesions (PICO T2). Literature from January 2012 to January 2025 was searched across PubMed, Scopus, Embase, and IEEE Xplore, with manual citation tracking and AI-assisted query generation. Eligible studies included research on US/CEUS fusion with CT/MRI, reporting technical accuracy and lesion conspicuity. RESULTS:The technical accuracy of fusion imaging was consistently high, with target registration errors (TRE) of ∼1-3 mm in ideal phantom settings and ∼4-14 mm in clinical studies. Automatic registration methods were faster and similarly accurate as manual registration, possibly reducing operator dependence. Fusion imaging improved the detectability of lesions not visible (occult) on conventional B-mode US, increasing the diagnostic yield and enabling successful interventions (e.g., ablation) in up to 90%-95% of cases. Safety profiles across studies were favorable, with major complication rates generally below 2%. Furthermore, fusion imaging might prove especially beneficial for treating tumors in difficult locations (e.g., caudate lobe, peribiliary lesions). CONCLUSION:Ultrasound fusion imaging significantly enhances the spatial accuracy of liver interventions by aligning real-time US with CT/MRI datasets. It improves interventional procedures guidance and maintains a low complication profile as compared to conventional US alone. Advancements in artificial intelligence (AI) and augmented reality (AR) are expected to further optimize image co-registration workflows and clinical outcomes. This technical review supports the broader adoption of fusion imaging as a key tool in liver imaging and intervention.

Objectives: Heart failure is an increasing global health problem. Approximately 50% of patients with heart failure have heart failure with preserved ejection fraction (HFpEF) and concomitant diastolic dysfunction (DD), in part caused by increased myocardial stiffness not detectable by standard echocardiography. While elastography can map tissue stiffness, cardiac applications are currently limited, especially in patients with a higher body mass index. Therefore, we developed cardiac time-harmonic elastography (THE) to detect abnormal diastolic myocardial stiffness associated with DD. Material and Methods: Cardiac THE was developed using standard medical ultrasound and continuous external vibration for regionally resolved mapping of diastolic shear wave speed as a proxy for myocardial stiffness. The method was prospectively applied to 54 healthy controls (26 women), 10 patients with moderate left ventricular hypertrophy (mLVH; 5 women), and 45 patients with wild-type transthyretin amyloidosis (wTTR; 4 women), 20 of whom were treated with tafamidis. Ten healthy participants were reinvestigated after 2 to 6 months to analyze test-retest reproducibility by intraclass correlation coefficients. Results: Myocardial shear wave speed was measured with good reproducibility (intraclass correlation coefficient = 0.82) and showed higher values in wTTR (3.0 +/- 0.7 m/sec) than in mLVH (2.1 +/- 0.6 m/sec) and healthy controls (1.8 +/- 0.3 m/sec, all P < .05). Area under the curve values were 0.991 and 0.737 for discriminating wTTR and mLVH from healthy controls, respectively. Shear wave speed was reduced in patients after tafamidis treatment (2.6 +/- 0.6 m/sec, P = .04), suggesting the potential value of THE for therapy monitoring. Shear wave speed was quantified in the septum, posterior wall, and an automatically masked region (here stated for the septal region). Conclusions: Cardiac THE detects abnormal myocardial stiffness in patients with DD with high penetration depth, independent of body mass index and region selection. Based on standard ultrasound components, cardiac THE is cost-effective and has the potential to become a point-of-care method for stiffness-sensitive echocardiography.

Objective Around 6.2% of patients report symptoms as fatigue, muscle pain and dyspnea more than three months after SARS-CoV-2 infection, defined as post COVID-19 condition (PCC). Non-hospitalized patients with PCC often show normal pulmonary functioning tests and imaging but suffer from respiratory symptoms. On clinical examination, PCC with dyspnea show signs of diaphragmatic dysfunction. The study aimed to objectively visualize and quantify the diaphragmatic function using sonographic parameters in PCC patients with and without dyspnea. Materials and Methods Adult PCC patients were prospectively assessed for dysfunctional breathing and diaphragmatic stiffness using sonographic imaging. Multiparametric sonography evaluated diaphragm thickness, mobility, stiffness and elasticity in different breathing cycles using B-mode imaging, M-mode and quantitative shear wave elastography. PCC patients were stratified into two groups with and without dyspnea. Results Fifty-four post-COVID patients were assessed, of whom n=24 (44.4%) reported dyspnea and presented dysfunctional breathing, while 30 PCC without dyspnea served as control. PCC with dyspnea compared to PCC without dyspnea showed a less deep first breath (5.8 mm vs. 6.5 mm, p=0.044), reduced diaphragm thickness on inspiration (3.4 mm vs. 3.9 mm, p=0.030), as well as less increase of diaphragmatic elasticity (108% vs. 146%; p=0.027) and diaphragmatic stiffness (40% vs. 53%; p=0.022) during inspiration. Conclusions Diaphragm dysfunction as a possible origin of dyspnea in PCC can be assessed and objectively quantified using multiparametric sonography and may help evaluate therapeutic interventions that are otherwise overlooked.

The use of contrast-enhanced ultrasound (CEUS) in clinical practice is theoretically limited to the licensed indications: focal liver lesions, breast, peripheral arterial system, and the heart. In reality, there has been a continuous expansion of the deployment of CEUS examinations to many other organs and body parts over the last 20 years. Many of these applications are a natural extension of the diagnostic capabilities of the CEUS examination, used to achieve a better imaging outcome. These applications have been supported by guidelines issued by scientific societies, detailing the application, accuracy, and safety of the clinical performance. Nevertheless, there are some areas in which it remains more difficult to establish the use of CEUS in the diagnostic pathway. In the pregnant patient, CEUS is an ideal examination-a natural extension of B-mode ultrasound, avoiding ionising radiation and iodinated contrast. The contrast agents used in ultrasound do not cross the placental barrier. Ultrasound in the paediatric patient is used widely, and extending this to a CEUS examination improves diagnostic capabilities, avoiding less child-friendly imaging techniques. The parent can be in the room at the time of the ultrasound examination. Other aspects of CEUS usage are hampered by the lack of physician engagement despite the proven advantages of the technique, the reduction in the morbidity associated with CT and MR imaging, particularly the contrast agents used in these modalities. Complex renal cyst classification, follow-up of blunt abdominal trauma and the surveillance following placement of an aortic stent graft are all areas of potential benefit to the diagnosis. All these are better imaged on a CEUS examination. Furthermore, cost savings can be achieved using CEUS, mostly by alleviating downstream costs of CT and MR imaging. CRITICAL RELEVANCE STATEMENT: CEUS use outside licensed uses is becoming established, driven by the unique ability to achieve diagnostic standards safely and with patient acceptability, pushing the boundaries in areas of abdominal trauma, pregnancy, paediatrics, aortic implants, and complex renal cysts. KEY POINTS: CEUS has a narrow range of licensed applications in medical imaging, but is used widely. An exclusively intravascular agent allows assessment of vascular flow at the capillary level. CEUS is extremely safe and can be used in many areas that require repeated high-resolution imaging.

Geriatric patients are characterized by an advanced age and typical geriatric multimorbidity. The prevalence of pain increases with age. In geriatric patients in particular, pain is one of the most frequently occurring characteristic complexes. In Germany, a trend has been observed that the prevalence and intensity of pain in older people has continued to increase in recent years. Pain management in this particularly vulnerable group poses major challenges for the patients themselves, their relatives and healthcare professionals. For this reason, the expiring S3 guideline on "Pain assessment in older people in full inpatient care for the elderly" will be taken up, updated and expanded to include pain therapy and extended to outpatient and acute inpatient care.

Purpose:Contrast-enhanced ultrasound (CEUS) is a reliable tool to diagnose focal liver lesions, which appear ambiguous in normal B-mode ultrasound. However, interpretation of the dynamic contrast sequences can be challenging, hindering the widespread application of CEUS. We investigate the use of a deep-learning-based image classifier for determining the diagnosis-relevant feature washout from CEUS acquisitions. Approach:We introduce a data representation, which is agnostic to data heterogeneity regarding lesion size, subtype, and length of the sequences. Then, an image-based classifier is exploited for washout classification. Strategies to cope with sparse annotations and motion are systematically evaluated, as well as the potential benefits of using a perfusion model to cover missing time points. Results:Results indicate decent performance comparable to studies found in the literature, with a maximum balanced accuracy of 84.0% on the validation and 82.0% on the test set. Correlation-based frame selection yielded improvements in classification performance, whereas further motion compensation did not show any benefit in the conducted experiments. Conclusions:It is shown that deep-learning-based washout classification is feasible in principle. It offers a simple form of interpretability compared with benign versus malignant classifications. The concept of classifying individual features instead of the diagnosis itself could be extended to other features such as the arterial inflow behavior. The main factors distinguishing it from existing approaches are the data representation and task formulation, as well as a large dataset size with 500 liver lesions from two centers for algorithmic development and testing.

Abstract Background/Introduction Heart failure, including HFpEF, is a growing global health problem. Diastolic dysfunction (DD) is a critical component of HFpEF and is mainly caused by increased myocardial stiffness(1). Current cardiac elastography methods allow the noninvasive quantification of myocardial stiffness(2, 3). Time harmonic elastography (THE) combines conventional ultrasound with continuous external vibrations(4) to generate full field-of-view stiffness maps. Novel, cost-effective cardiac THE (cTHE) with full coverage of the left ventricle (LV) in parasternal long axis view (PLAX) has recently been shown to be sensitive to increased myocardial stiffness in patients with wild-type amyloidosis (wtATTR)(5). Numerous heart diseases are linked to both myocardial stiffening and LV hypertrophy. However, they differ in the underlying pathophysiology such as reactive fibrosis due to pressure overload (hypertension (HT) or aortic stenosis (AS)) or storage disease (ATTR or Fabry disease (FD)). Purpose We aim to investigate the diagnostic value of myocardial stiffness as a quantitative parameter for the characterization of cardiac function independent of wall thickness. Methods 62 participants were enrolled in our study, including 11 healthy controls (age range 27-88 years), 19 patients with HT (age range 44-79 years), 13 patients with AS (age range 61-89 years), 11 patients with wtATTR (age range 64-86 years), 3 patients with HCM (age range 36-70 years) and 5 patients with FD (age range 50-60 years). All subjects underwent a standard echo examination before cTHE (figure 1). Multifrequency vibrations (60,70,80Hz) were induced using a custom portable vibration pillow (Elastance Imaging, Columbus, Ohio, US) underneath the subject’s thorax. A customized ultrasound scanner (GAMPT, Merseburg, Germany) was used for image acquisitions in PLAX with 15cm depth. Images were acquired in breath-hold over 4s with 100Hz frame rate. Measurements were repeated five times. Time-resolved shear wave speed maps (SWS) were generated using k-MDEV inversion(6). Diastolic frames were averaged to obtain a map of diastolic myocardial stiffness. Regions of interest for averaging were manually drawn for the septum and posterior wall. Results Using cTHE, we observed an increase in myocardial stiffness in all groups (Controls: 1.5±0.2ms/s, HT: 1.8±0.4ms/s, AS: 2.0±0.2ms/s, HCM: 2.0±x0.4ms/s, Fabry: 1.9±0.3ms/s, wtATTR: 2.1±0.3ms/s, all p<0.05). SWS correlated with wall thickness only in a pooled analysis (R=0.47, p<0.01), but not within individual groups (figure 2). Conclusions cTHE detects increased myocardial stiffness in a variety of cardiac diseases. Myocardial stiffness is known to be associated with increased wall thickness(7), however our analysis within individual groups showed independence of both parameters. Quantitative assessment of myocardial stiffness could add important diagnostic information to the detection and treatment monitoring of myocardial disease. Figure 1: Setup of cTHE Figure 2: Stiffness Maps/Correlations

Background Accurate preoperative differentiation of parotid gland tumors (PGTs) is essential for facial nerve preservation. This study evaluates a novel, real-time multiparametric ultrasound (mpUS) approach combining B-mode, shear wave elastography (SWE), and contrast-enhanced ultrasound (CEUS), based on qualitative image interpretation.Methods Eighty-nine patients with 91 PGTs underwent mpUS prior to surgery or ultrasound-guided biopsy. Two blinded experts independently reviewed the images and reached consensus through real-time discussion. Only qualitative features were assessed. Histopathology served as the reference.Results mpUS achieved 83% sensitivity (95% CI: 62.6-94.0), 94% specificity (95% CI: 84.3-98.1), and 91% accuracy (95% CI: 82.4-96.3). CEUS and SWE provided complementary perfusion and stiffness data. CCDS was excluded due to limited value.Conclusion mpUS improves diagnostic accuracy compared to single-modality US and supports early, targeted treatment. Limitations include the small number of malignancies, single-center design, and qualitative evaluation. Broader use may require training and equipment access.

BACKGROUND:To investigate the inter- and intraobserver variability in comparison to an expert gold standard of the new and modified renal cyst Bosniak classification proposed for contrast-enhanced ultrasound findings (CEUS) by the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) in 2020.MATERIALS AND METHODS:84 CEUS examinations for the evaluation of renal cysts were evaluated retrospectively by six readers with different levels of ultrasound expertise using the modified Bosniak classification proposed for CEUS. All cases were anonymized, and each case was rated twice in randomized order. The consensus reading of two experts served as the gold standard, to which all other readers were compared. Statistical analysis was performed using Cohen's weighted kappa tests, where appropriate.RESULTS:Intraobserver variability showed substantial to almost perfect agreement (lowest kappa κ=0.74; highest kappa κ=0.94), with expert level observers achieving the best results. Comparison to the gold standard was almost perfect for experts (highest kappa κ=0.95) and lower for beginner and intermediate level readers still achieving mostly substantial agreement (lowest kappa κ=0.59). Confidence of rating was highest for Bosniak classes I and IV and lowest for classes IIF and III.CONCLUSION:Categorization of cystic renal lesions based on the Bosniak classification proposed by the EFSUMB in 2020 showed very good reproducibility. While even less experienced observers achieved mostly substantial agreement, training remains a major factor for better diagnostic performance.

Background Irreversible electroporation (IRE) is a nonthermal ablative method based on the formation of nanoscale defects in cell membranes leading to cell death. Clinical experience with the technique for treatment of prostate cancer remains limited. Purpose To evaluate urogenital toxicity and oncologic outcome of MRI-transrectal US fusion-guided IRE of localized prostate cancer. Materials and Methods In this prospective study, men with biopsy-proven, treatment-naive, low- to intermediate-risk prostate cancer (prostate-specific antigen [PSA], ≤15 ng/mL; Gleason score, ≤3 + 4; clinical stage, ≤T2c; lesion size at multiparametric MRI, ≤20 mm) underwent focal MRI/transrectal US fusion-guided IRE between July 2014 and July 2017. Primary end point was the urogenital toxicity profile of focal IRE by using participant-reported questionnaires. Secondary end points were biochemical, histologic, and imaging measures of oncologic control. Analyses were performed by using nonparametric and χ2 test statistics. Results Thirty men were included (median age, 65.5 years); mean PSA level was 8.65 ng/mL and mean tumor size was 13.5 mm. One grade III adverse event (urethral stricture) was recorded. The proportion of men with erection sufficient for penetration was 83.3% (25 of 30) at baseline and 79.3% (23 of 29; P > .99) at 12 months. Leak-free and pad-free continence rate was 90% (27 of 30) at baseline and 86.2% (25 of 29; P > .99) at 12 months. Urogenital function remained stable at 12 months according to changes in the modified International Consultation on Incontinence Questionnaire Male Lower Urinary Tract Symptoms, or ICIQ-MLUTS, and the International Index of Erectile Function, or IIEF-5, questionnaires (P = .58 and P = .07, respectively). PSA level decreased from a baseline median value of 8.65 ng/mL (interquartile range, 5-11.4 ng/mL) to 2.35 ng/mL (interquartile range, 1-3.4 ng/mL) at 12 months (P < .001). At 6 months, 28 of 30 participants underwent posttreatment biopsy. The rate of in-field treatment failure was 17.9% (five of 28) as determined with multiparametric prostate MRI and targeted biopsies at 6 months. Conclusion After a median follow-up of 20 months, focal irreversible electroporation of localized prostate cancer was associated with low urogenital toxicity and promising oncologic outcomes. © RSNA, 2019 Online supplemental material is available for this article.

Introduction Ultrasound (US) is considered the imaging method of choice in the diagnosis of parotid gland tumors (PGT). Although PGT are mostly benign, malignant transformation is possible even in benign tumors. For this reason, surgical removal is preferred. Since the surgical treatment strategy differs in terms of radicality between benign and malignant PGT, an optimal preoperative assessment of malignancy is important. The aim of this prospective study was to improve the diagnostic performance of PGT-US through qualitative analysis of multiparametric US (mpUS).