BACKGROUND & AIMS:Dynamic contrast-enhanced ultrasound (D-CEUS) could be a valuable tool for the non-invasive diagnosis of hepatocellular carcinoma (HCC) with atypical vascular imaging features. METHODS:Between January 2021 and November 2023, consecutive patients with chronic liver disease and liver nodules who were candidates for liver biopsy were enrolled in this cohort study. CEUS was performed in all patients before biopsy and categorized according to the CEUS Liver Imaging Reporting and Data System (LI-RADS). Clips were examined using VueBox® software. Clinical and ultrasound parameters were compared among the different histological entities, analyzed with univariable analysis, and incorporated into a logistic regression model for HCC diagnosis. The diagnostic accuracy of the identified model was evaluated by receiver operating characteristic (ROC) curve and relative AUC. The model was then tested on a validation cohort comprising consecutive patients from two centers. RESULTS:A total of 88 patients (57 with HCC, 17 with intrahepatic cholangiocarcinoma, 11 with liver metastases, and three with benign lesions) were enrolled. Statistically significant differences between patients with and without HCC in the training cohort were incorporated in an optimal logistic regression model that included the following predictive variables: sex, number of nodules ≥4, peripheral rim-like hyperenhancement, and peak enhancement (PE) ratio (PE-rim-like enhancement-Sex-Nodules≥4; PERSoN4). The model displayed high accuracy (AUC 0.91) for the diagnosis of HCC. In the validation cohort, the model showed a sensitivity of 48.8% and a specificity of 100.0%, with a positive predictive value (PPV) of 100.0%, maintaining good diagnostic accuracy (AUC of 0.74). CONCLUSIONS:PERSoN4 could improve the performance of CEUS LI-RADS criteria, possibly leading to a non-invasive diagnosis of HCC in nearly 50% of patients currently referred for liver biopsy. However, this model requires further external validation before entering clinical practice. IMPACT AND IMPLICATIONS:Accurate non-invasive diagnosis of HCC remains challenging in patients with atypical vascular patterns on CEUS, providing the scientific rationale for developing a multiparametric D-CEUS-based risk model that integrates quantitative perfusion analysis with clinical and imaging features. Our findings suggest that the PERSoN4 model could meaningfully enhance the diagnostic performance of CEUS LI-RADS, particularly by identifying a subset of patients in whom HCC can be diagnosed with very high specificity and PPV, which is relevant for hepatologists, radiologists, and multidisciplinary tumor boards managing indeterminate nodules. This approach could reduce the need for liver biopsy in nearly half of currently eligible patients, streamlining diagnostic pathways and potentially lowering procedure-related risks and costs. However, given the moderate sensitivity and the limited sample size, further large-scale external validation is essential before widespread clinical implementation.

Background/Objectives: The attenuation coefficient (AC) is a quantitative ultrasound parameter that describes the frequency-dependent reduction of acoustic energy as ultrasound waves propagate through biological tissues. Recently, AC has gained increasing relevance in abdominal ultrasound as an objective and reproducible biomarker for tissue characterization, particularly in the assessment of diffuse parenchymal diseases. Unlike conventional qualitative B-mode imaging, AC provides standardized numerical measurements that improve interobserver reproducibility and facilitate longitudinal monitoring. Methods: This review provides a comprehensive and critical overview of the current clinical applications of AC measurements in abdominal ultrasound, mainly focusing on liver steatosis quantification. Emphasis is placed on the comparative evaluation of commercially available AC-based technologies, highlighting their methodological differences, validation evidence, and diagnostic performance to support future efforts toward harmonization and standardization across ultrasound platforms. Results: Several studies have demonstrated a strong correlation between AC values and established reference standards, including magnetic resonance imaging-proton density fat fraction (MRI-PDFF) and histopathological grading, supporting its role in the noninvasive evaluation of liver steatosis. The growing clinical adoption of AC has been accompanied by the development of multiple vendor-specific software implementations integrated into modern ultrasound systems. Although these platforms share a common physical basis, they differ substantially in algorithmic design, signal processing strategies and region-of-interest selection. These differences may influence absolute AC values and diagnostic cutoff thresholds, therefore limiting direct comparability across systems. Another factor that further contributes to the heterogeneity of reported cutoff values is the variability in validation approaches, with some technologies validated against liver biopsy and others against MRI-PDFF. Conclusions: AC is a promising quantitative ultrasound biomarker for noninvasive liver steatosis assessment, showing strong correlation with histology and MRI-PDFF. However, inter-vendor variability currently limits cross-platform comparability. Standardized acquisition protocols, unified quality-control criteria, phantom-based cross-calibration, and consistent vendor-specific reporting are essential to ensure reliable longitudinal monitoring and broader clinical implementation.

Background: The aim of this study was to investigate the accuracy in fibrosis staging of a novel shear wave elastography (SWE) device (S-Shearwave Imaging by Samsung) and a previously validated 2D-SWE by Supersonic Imagine (SSI) in patients with biopsy proven metabolic dysfunction-associated steatotic liver disease (MASLD). Methods: This prospective study included 75 consecutive patients with MASLD who underwent liver biopsy for suspected MASH. All patients underwent S-Shearwave Imaging by Samsung and 2D-SWE with SSI on the same day of liver biopsy. Fibrosis was histologically assessed using the METAVIR classification system. Agreement between the equipment was assessed with the Pearson coefficient. A receiver operator characteristic curve (ROC) analysis with the Youden index was used to establish thresholds for fibrosis staging. Results: A good correlation was found between S-Shearwave Imaging by Samsung and 2D-SWE with SSI (Pearson’s R = 0.68; p < 0.01). At multivariate regression analysis, S-Shearwave Imaging was associated with advanced fibrosis (≥F3) independently from age, diabetes and platelets (OR 2.94, CI 1.69–5.11, p < 0.01). The fibrosis diagnostic accuracy of both S-Shearwave Imaging and 2D-SWE was good to optimal with AUROCs of 0.81 and 0.70 for significant fibrosis (≥F2), 0.94 and 0.91 for severe fibrosis (≥F3), respectively. The accuracy of S-Shearwave is not significantly different from Fibroscan and Agile3+ (DeLong test p value 0.16 and 0.15, respectively) while is slightly better than 2D-SWE, FIB4 and NFS (DeLong test p value < 0.05). For S-Shearwave Imaging by Samsung, the best cut-off values for diagnosing fibrosis ≥F2, ≥F3 were, respectively, 7.9 kPa (Sens 74.4%, Spec 87.5%) and 8.1 kPa (Sens 95.6%, Spec 78.8%). For 2D-SWE by SSI, the best cut-off values for diagnosing fibrosis ≥F2, ≥F3 were, respectively, 7.2 kPa (Sens 55.8%, Spec 84.4%) and 7.6 kPa (Sens 82.6%, Spec 84.6%). Conclusion: S-Shearwave Imaging is a useful and reliable non-invasive technique for staging liver fibrosis in patients with MASLD. Its diagnostic accuracy is non-inferior to other shear wave elastography techniques (TE and 2D-SWE by SSI).

Background/Objectives: Liver fibrosis is a progressive consequence of chronic liver injury that can evolve into cirrhosis, liver failure, or hepatocellular carcinoma, representing a major global health burden. Fibrogenesis is driven by hepatic stellate cell (HSC) activation, excessive extracellular matrix deposition, and structural disruption of liver tissue, with transforming growth factor-β (TGF-β) signaling and inflammatory mediators as central pathways. Current therapies primarily target the underlying causes, which may halt disease progression but rarely reverse established fibrosis. This review aims to outline current and emerging therapeutic strategies for liver fibrosis, informing both clinical practice and future research directions. Methods: A narrative synthesis of preclinical and clinical evidence was conducted, focusing on pharmacological interventions, microbiota-directed strategies, and innovative modalities under investigation for antifibrotic activity. Results: Bile acids, including ursodeoxycholic acid and derivatives, modulate HSC activity and autophagy. Farnesoid X receptor (FXR) agonists, such as obeticholic acid, reduce fibrosis but are limited by adverse effects. Fatty acid synthase inhibitors, exemplified by denifanstat, show promise in metabolic dysfunction-associated steatohepatitis (MASH). Additional strategies include renin–angiotensin system inhibitors, omega-3 fatty acids, and agents targeting the gut–liver axis. Microbiota-directed interventions—probiotics, prebiotics, symbiotics, antibiotics (e.g., rifaximin), and fecal microbiota transplantation—are emerging as potential modulators of barrier integrity, inflammation, and fibrogenesis, though larger clinical trials are required. Reliable non-invasive biomarkers and innovative trial designs, including adaptive platforms, are essential to improve patient selection and efficiently evaluate multiple agents and combinations. Conclusions: Novel modalities such as immunotherapy, gene editing, and multi-targeted therapies hold additional potential for fibrosis reversal. Continued translational efforts are critical to establish safe, effective, and accessible treatments for patients with liver fibrosis.

Short bowel syndrome (SBS), usually resulting from massive small bowel resections or congenital defects, may lead to intestinal failure (IF), requiring intravenous fluids and parenteral nutrition to preserve patients’ nutritional status. Approximately 15% to 40% of subjects with SBS and IF develop chronic hepatic damage during their life, a condition referred to as intestinal-failure-associated liver disease (IFALD), which ranges from steatosis to fibrosis or end-stage liver disease. Parenteral nutrition has been largely pointed out as the main pathogenetic factor for IFALD. However, other elements, such as inflammation, bile acid metabolism, bacterial overgrowth and gut dysbiosis also contribute to the development of liver damage and may deserve specific treatment strategies. Indeed, in our review, we aim to explore IFALD pathogenesis beyond parenteral nutrition. By critically analyzing recent literature, we seek to delve with molecular mechanisms and metabolic pathways underlying liver damage in such a complex set of patients.

BACKGROUND:Endoscopic variceal band ligation (EVBL) represents a pivotal treatment in the prophylaxis of esophageal varices bleeding in patients with cirrhosis, but in some cases a single session of EVBL is unable to eradicate esophageal varices completely, and a control endoscopy after 2-4 weeks is required to assess eradication and/or the need for another band ligation. Liver stiffness measurement (LSM) is being increasingly used as a screening non-invasive tool to predict varices according to Baveno VII criteria. However, to date, there are no instruments able to non-invasively predict the outcome of EVBL. AIM:To identify non-invasive predictors of varices eradication (VE) after EVBL through multiparametric ultrasound (US). Secondary aim was to develop a prediction model of successful variceal eradication based on non-invasive parameters. METHODS:We prospectively enrolled consecutive cirrhotic patients intolerant or with contraindications to beta-blockers undergoing EVBL for bleeding prophylaxis. Patients underwent multiparametric US with LSM, spleen stiffness measurement (SSM) and dynamic contrast-enhanced US (DCE-US) on liver parenchyma and portal vein, at baseline (T0) and one month (T1) after EVBL. Each US parameter and their variations from baseline were correlated with VE evaluated by control endoscopy performed at T1. RESULTS:We enrolled 41 patients (median age 64 years, 75.6% males). At T1 28 patients (68.3%) reached VE, whereas 13 (31.7%) required a second EVBL. Patients who achieved VE showed a significant decrease in SSM (P = 0.018), and a significant increase in peak enhancement, area under the curve and wash-in rate of both liver parenchyma and portal vein after treatment (P < 0.001). Statistically significant differences between the two groups of patients were incorporated in a multivariate analysis and used to develop three prediction models. CONCLUSION:A multimodal US approach based on DCE-US parameters, LSM and SSM might become a reliable predictor of VE and a useful non-invasive alternative to endoscopy.

In this editorial, we comment on the article by Teerasarntipan et al published in a recent issue of the World Journal of Gastroenterology. Dengue infection is a major mosquito-borne disease with global significance. Dengue-induced severe hepatitis (DISH) is a rare complication though severe, as it can lead to acute liver failure (ALF) with an incidence rate between 0.7% and 2.0% and mortality rates from 47.0% to 58.8%. In this context, the identification of patients at risk of ALF could improve prognosis in DISH patients. Teerasarntipan et al retrospectively enrolled 2532 dengue patients, counting 193 DISH and 20 ALF. The authors explored the prognostic role of liver-specific scores, as the model for end-stage liver disease (MELD) score, albumin-bilirubin (ALBI) score, easy (EZ)-ALBI score, and platelet-ALBI (PALBI) score. Univariate analysis identified international normalized ratio (INR), total bilirubin, albumin, and creatinine as independent laboratory factors associated with ALF, while age, gender, and liver comorbidities were not linked to in-hospital mortality. The presence of dengue shock syndrome significantly increased mortality, with an odds ratio (OR) of 28.05 (95%CI: 7.21-109.18, P < 0.001). High INR and low albumin were laboratory markers associated with death from DISH, with ORs of 5.83 (95%CI: 2.59-13.12, P < 0.001) and 0.15 (95%CI: 0.05-0.44, P < 0.001), respectively. Multivariate analysis confirmed that INR remained the only significant predictor of both ALF and death, with adjusted ORs of 19.54 (95%CI: 3.37-113.38, P < 0.001) and 3.86 (95%CI: 1.13-13.18, P = 0.031), respectively. Among prognostic models, the MELD score performed best in predicting ALF, with a very high accuracy [area under the receiver operating characteristic curve (AUROC) of 0.929, 87.5% sensitivity, 89.3% specificity at a cutoff of 16], followed by the EZ-ALBI, ALBI, and PALBI scores, with AUROCs of 0.865, 0.832, and 0.797, respectively. As MELD remains the best scoring system for predicting poor outcomes in DISH-related ALF, EZ-ALBI is a valid adjunct tool that could improve medical care in these patients.

Pancreatic neuroendocrine tumors (pNETs) are rare malignancies, accounting for 1–2% of pancreatic cancers, with an incidence of ≤1 case per 100,000 individuals annually. Originating from pancreatic endocrine cells, pNETs display significant clinical and biological heterogeneity. Traditional classification based on proliferative grading does not fully capture the complex mechanisms involved, such as oxidative stress, mitochondrial dysfunction, and tumor-associated macrophage infiltration. Recent advances in molecular profiling have revealed key oncogenic drivers, including MEN1 (menin 1), DAXX (death domain–associated protein), ATRX (alpha thalassemia/mental retardation syndrome X-linked), CDKN1B (cyclin-dependent kinase inhibitor 1B) mutations, chromatin remodeling defects, and dysregulation of the mTOR pathway. Somatostatin receptors, particularly SSTR2, play a central role in tumor biology and serve as important prognostic markers, enabling the use of advanced diagnostic imaging (e.g., Gallium-68 DOTATATE PET/CT) and targeted therapies like somatostatin analogs and peptide receptor radionuclide therapy (PRRT). Established biomarkers such as Chromogranin A and the Ki-67 proliferation index remain vital for diagnosis and prognosis, while emerging markers, like circulating tumor DNA and microRNAs, show promise for enhancing disease monitoring and diagnostic accuracy. This review summarizes the molecular landscape of pNETs and highlights genomic, transcriptomic, proteomic, and epigenomic factors that support the identification of novel diagnostic, prognostic, and therapeutic biomarkers, ultimately advancing personalized treatment strategies.

Soft tissue tumors (STTs) are a heterogeneous group of mesenchymal neoplasms requiring accurate differentiation for optimal patient management. While histopathology remains the gold standard, imaging plays a crucial role in non-invasive assessment. Multiparametric ultrasound (mpUS) has emerged as a promising, cost-effective alternative to MRI, integrating B-mode, color and power Doppler, shear wave elastography (SWE), and contrast-enhanced ultrasound (CEUS) to provide comprehensive morphological, vascular, and biomechanical insights. Each modality offers distinct yet complementary diagnostic value, enhancing accuracy and potentially reducing unnecessary biopsies. This narrative review aims to serve as a practical guide, providing a readily accessible reference for mpUS parameters useful in the differential diagnosis of soft tissue tumors.

Sarcopenia, a progressive age-related loss of skeletal muscle mass, strength, and function, is a major contributor to disability, reduced quality of life, and mortality in older adults. While current diagnostic approaches, such as dual-energy X-ray absorptiometry (DXA), bioelectrical impedance analysis (BIA), magnetic resonance imaging (MRI), and computed tomography (CT), are widely used to assess muscle mass, they have limitations in detecting early qualitative changes in muscle architecture and composition. Shear Wave Elastography (SWE), an ultrasound-based technique that quantifies tissue stiffness, has emerged as a promising tool to evaluate both muscle quantity and quality in a non-invasive, portable, and reproducible manner. Studies suggest that SWE can detect alterations in muscle mechanical properties associated with sarcopenia, providing complementary information to traditional morphometric assessments. Preliminary evidence indicates its good reproducibility, feasibility in various clinical settings, and potential for integration into routine evaluations. This narrative review summarizes current evidence on the use of SWE for the assessment of sarcopenia across diverse populations.

The expression “lung–gut–liver axis” refers to the interconnected processes occurring in the lungs, gastrointestinal tract, and liver, particularly in relation to immune function, microbial regulation, and metabolic responses. Over the past decade, growing concern has emerged regarding the detrimental impact of air pollution on liver disease. Air pollutants, including particulate matter (PM) and chemical gases such as nitrogen oxides (NOx), can influence the microbiome in the lungs and gut by generating reactive oxygen species (ROS), which induce oxidative stress and local inflammation. This redox imbalance leads to the production of altered secondary microbial metabolites, potentially disrupting both the alveolar–capillary and gut barriers. Under these conditions, microbes and their metabolites can translocate to the liver, triggering inflammation and contributing to liver diseases, particularly metabolic dysfunction-associated steatotic liver disease (MASLD), cirrhosis, and hepatocellular carcinoma (HCC). This manuscript aims to review recent findings on the impact of air pollution on liver disease pathogenesis, exploring the molecular, genetic, and microbiome-related mechanisms underlying lung–gut–liver interactions, providing insights into potential strategies to prevent or mitigate liver disease progression.

Refeeding syndrome (RS) is defined as the spectrum of metabolic and biochemical disorders related to rapid nutritional replenishment after a prolonged period of fasting. It is caused by an abrupt shift in electrolytes and fluid among intra- and extracellular compartments, leading to metabolic disturbances like hypophosphatemia, vitamin deficiency, and fluid overload. RS often remains underdiagnosed due to variability in definition and diagnostic criteria adopted, overlapping clinical features with other complications and low awareness among clinicians. Critically ill individuals, particularly those admitted to intensive care units (ICUs), represent a cohort with peculiar features that may heighten RS risk due to their baseline frailty, frequent undernutrition, and the metabolic stress of acute illness. However, studies specifically conducted in ICU settings have yielded conflicting results regarding incidence rates, prognostic impact, and specific risk factors. Despite these differences, all evidence consistently highlights RS as a frequent and serious complication in critically ill patients. Early detection and prevention are essential, relying on prompt nutritional assessment at ICU admission, careful monitoring of serum electrolytes before and during refeeding, and a conservative caloric approach to nutrient reintroduction, alongside supportive therapy and electrolyte supplementation if RS manifestations occur. Clinicians should be aware of the significant prevalence and potential severity of RS in critically ill patients, along with the ongoing challenges related to its early recognition, prevention, and optimal nutritional management. This review aims to provide a comprehensive overview of the current knowledge on the incidence, prognostic impact, risk factors, clinical manifestations, and nutritional management of RS in critically ill patients while highlighting existing evidence gaps and key areas requiring clinical attention.

Abstract Background Ulcerative Colitis (UC) is a chronic inflammatory disease characterized by periods of relapse and remission. While colonoscopy is currently the gold standard for assessing disease activity, its invasiveness, low patient tolerance and associated risks make it unsuitable for frequent monitoring of intestinal inflammation. Despite these challenges, a "treat-to-target" approach is crucial in the era of biological therapies. Intestinal Ultrasound (IUS) offers a non-invasive, cost-effective and well-tolerated alternative to monitor treatment response. Indeed, the Milan Ultrasound Criteria (MUC), based on B-mode and color-doppler parameters, have been recently developed to assess disease activity in UC1,2. Dynamic Contrast-Enhanced Ultrasound (D-CEUS) allows visualization of tissue microvascularization, providing objective quantitative parameters derived from time-intensity curve analysis, potentially representing a promising tool to quantify bowel inflammation. The aim of our study was to assess the role of D-CEUS in predicting 6 months clinical remission to advanced therapies (biologic and small molecules). Methods We prospectively enrolled consecutive UC patients starting a new advanced treatment for clinical practice. Patients underwent IUS, D-CEUS and clinical assessment at baseline and at 8 (T1), 16 (T2) and 24 (T3) weeks after starting treatment. According to STRIDE-II consensus3, clinical remission at T3 was defined as partial Mayo score <3 and no subscore <1. Time-intensity curves were analyzed through VueBox® software (figure 1). Patients needing surgery or treatment change before T3 were classified as "non-responders". Logistic regression analysis was performed to evaluate the predictive role of D-CEUS in achieving clinical remission at T3. Statistical significance was defined as p<0.05. Results 40 patients were enrolled (mean age 39±13 years, 60% males), 44.4% (n=18) of which had previously failed at least one line of advanced therapy. At T3, 50% of patients achieved clinical remission (n=20). Univariate logistic regression analyses showed that reductions of Peak Enhancement (PE) and Wash-in Perfusion Index (WiPI) at T2 were predictive of clinical remission at T3 (OR=0.99, p=0.032 and OR=0.25, p=0.036 respectively). Moreover, the percentage changes between T2 and T0 (△% T2 – T0) of PE and WiPI were associated with 6 months clinical remission (OR=0.19 p=0.019 and OR=0.26 and p=0.04, respectively). Lastly, our results confirmed the value of MUC (at T1 and T2) in predicting clinical remission at T3 (OR=0.62, p=0.03 and OR=0.73, p=0.048, respectively). Conclusion D-CEUS provides early predictors of 6 months clinical remission in UC patients treated with advanced therapies. References 1.Allocca M, Fiorino G, Bonovas S, Furfaro F, Gilardi D, Argollo M, Magnoni P, Peyrin-Biroulet L, Danese S. Accuracy of Humanitas Ultrasound Criteria in Assessing Disease Activity and Severity in Ulcerative Colitis: A Prospective Study. J Crohns Colitis. 2018 Nov 28;12(12):1385-1391. doi: 10.1093/ecco-jcc/jjy107. PMID: 30085066; PMCID: PMC6260119. 2.Allocca M, Filippi E, Costantino A, Bonovas S, Fiorino G, Furfaro F, Peyrin-Biroulet L, Fraquelli M, Caprioli F, Danese S. Milan ultrasound criteria are accurate in assessing disease activity in ulcerative colitis: external validation. United European Gastroenterol J. 2021 May;9(4):438-442. doi: 10.1177/2050640620980203. Epub 2021 Feb 16. PMID: 33349199; PMCID: PMC8259285. 3.Turner D, Ricciuto A, Lewis A, D'Amico F, Dhaliwal J, Griffiths AM, Bettenworth D, Sandborn WJ, Sands BE, Reinisch W, Schölmerich J, Bemelman W, Danese S, Mary JY, Rubin D, Colombel JF, Peyrin-Biroulet L, Dotan I, Abreu MT, Dignass A; International Organization for the Study of IBD. STRIDE-II: An Update on the Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE) Initiative of the International Organization for the Study of IBD (IOIBD): Determining Therapeutic Goals for Treat-to-Target strategies in IBD. Gastroenterology. 2021 Apr;160(5):1570-1583. doi: 10.1053/j.gastro.2020.12.031. Epub 2021 Feb 19. PMID: 33359090.

Fusobacterium nucleatum, a gram-negative anaerobic bacterium, has emerged as a significant player in colorectal cancer (CRC) pathogenesis. The bacterium causes a persistent inflammatory reaction in the colorectal mucosa by stimulating the release of pro-inflammatory cytokines like IL-1β, IL-6, and TNF-α, creating an environment conducive to cancer progression. F. nucleatum binds to and penetrates epithelial cells through adhesins such as FadA, impairing cell junctions and encouraging epithelial-to-mesenchymal transition (EMT), which is associated with cancer advancement. Additionally, the bacterium modulates the host immune system, suppressing immune cell activity and creating conditions favorable for tumor growth. Its interactions with the gut microbiome contribute to dysbiosis, further influencing carcinogenic pathways. Evidence indicates that F. nucleatum can inflict DNA damage either directly via reactive oxygen species or indirectly by creating a pro-inflammatory environment. Additionally, it triggers oncogenic pathways, especially the Wnt/β-catenin signaling pathway, which promotes tumor cell growth and longevity. Moreover, F. nucleatum alters the tumor microenvironment, impacting cancer cell behavior, metastasis, and therapeutic responses. The purpose of this review is to elucidate the molecular mechanisms by which F. nucleatum contributes to CRC. Understanding these mechanisms is crucial for the development of targeted therapies and diagnostic strategies for CRC associated with F. nucleatum.

BACKGROUND:Shear wave elastography (SWE) is a non-invasive ultrasound-based technique used to assess tissue stiffness, which reflects underlying pathological changes. While SWE has been widely applied for liver fibrosis evaluation, its application to other abdominal organs, such as the spleen and pancreas, is gaining interest. However, normal stiffness values and inter-system agreement remain poorly defined. AIM:To assess the feasibility and agreement of liver, spleen, and pancreas stiffness using three SWE methods. METHODS:This single-center observational study enrolled 50 healthy adult volunteers. Liver, spleen, and pancreas stiffness were assessed using three SWE methods: Point-SWE (p-QElaXto) and 2-Dimensional-SWE (2D-QElaXto) with Esaote MyLab 9, and 2D-SWE with SuperSonic Imagine. Feasibility, inter-operator reproducibility, and concordance among systems were evaluated. Stiffness was expressed as median kPa values, and technical reliability was assessed using the interquartile range/median ratio and stability index thresholds. RESULTS:Liver and spleen stiffness assessment was feasible in > 98% of patients, while pancreas stiffness was measurable in 84%-88% depending on the SWE technique. Mean liver stiffness ranged between 3.9-4.7 kPa across techniques, spleen stiffness ranged from 19.4-23.0 kPa, and pancreas stiffness from 5.2-7.6 kPa. Inter-operator agreement was excellent for liver (intraclass correlation coefficient > 0.90) and good to moderate for spleen and pancreas (intraclass correlation coefficient from 0.43 to 0.90). Bland-Altman analysis confirmed good correlation but also systematic differences among devices, especially in pancreas measurements. CONCLUSION:This is the first study to establish normal liver, spleen, and pancreas stiffness using MyLab 9 SWE integrated methods as compared to SuperSonic Imagine, with acceptable inter-technique agreement. Liver and spleen values matched existing guidelines; pancreas SWE showed more variability and reduced reproducibility.

Gastro-entero-pancreatic neuroendocrine tumors (GEP-NETs) represent a rare and varied class of neoplasms, characterized by diverse clinical presentations and prognostic trajectories. Accurate and prompt diagnosis is vital to inform and optimize therapeutic decisions. Ultrasound, including standard B-mode imaging and advanced methods such as contrast-enhanced ultrasound (CEUS) and endoscopic ultrasound (EUS), serves as a key component in the diagnostic evaluation of these tumors. B-mode US and CEUS provide non-invasive, accessible methods for early detection and characterization. On B-mode imaging, GEP-NETs typically present as well-defined, hyperechoic, or iso-echoic lesions, while CEUS highlights their characteristic vascularity, marked by arterial-phase hyperenhancement and venous-phase washout. Compared to CT and MRI, ultrasound offers real-time, dynamic imaging without ionizing radiation or nephrotoxic contrast agents, making it particularly advantageous for patients requiring frequent monitoring or with contraindications to other imaging modalities. CT and MRI are widely regarded as the preferred methods for staging and surgical planning due to their detailed anatomical visualization. However, ultrasound, especially CEUS, provides a significant adjunctive role in both early detection and the follow-up on GEP-NETs. This analysis delves into the strengths, challenges, and innovations in ultrasound technology for diagnosing pancreatic NETs, focusing on its contribution to comprehensive imaging strategies and its impact on patient care decisions.

Transarterial chemoembolization (TACE) is a well-established treatment for intermediate-stage hepatocellular carcinoma (HCC), shown through randomized trials to improve survival compared to supportive care in patients with large, unresectable tumors who are not candidates for liver transplantation or local ablation. As the most commonly used transarterial intervention, TACE is also employed to downstage advanced HCC, allowing certain patients to become eligible for orthotopic liver transplantation under the Milan criteria. Despite its widespread use, variability in therapeutic outcomes highlights the need for improved procedural guidance. Recent advancements in intra-arterial contrast-enhanced ultrasound (IA CEUS) offer new opportunities to enhance TACE precision with real-time imaging that provides superior visualization of tumor vasculature and chemoembolic agent distribution. This review explores the role of IA CEUS in refining TACE for HCC, emphasizing its potential to increase intraprocedural accuracy and reduce the risk of incomplete tumor embolization. The enhanced spatial resolution of IA CEUS enables real-time tracking of embolic agent dispersion within tumor vessels, which could improve therapeutic efficacy by ensuring complete tumor targeting and minimizing non-target embolization. Additionally, IA CEUS may decrease procedural complications by allowing dynamic adjustment of embolic delivery based on real-time imaging feedback. By reviewing existing evidence on IA CEUS applications in TACE, this article highlights the modality’s potential to transform treatment protocols, improve outcomes, and expand the patient population eligible for TACE.

Ulcerative colitis (UC) is traditionally considered a mucosal disease, with endoscopy as the gold standard for diagnosis and monitoring. However, emerging evidence increasingly supports the integration of intestinal ultrasound (IUS) as a non-invasive, accurate, and dynamic imaging modality in the management of UC. Traditionally confined to the assessment of Crohn's disease due to its transmural nature, IUS has demonstrated strong associations with clinical, endoscopic, and histologic scores in UC, enabling real-time assessment of disease activity, therapeutic response, and long-term outcomes. In this comprehensive review, we summarize the current evidence on the diagnostic and prognostic utility of IUS in UC, with a focus on validated ultrasonographic scores. Moreover, we explore novel applications of IUS in special clinical settings, including acute severe ulcerative colitis (ASUC), as well as in specific disease localizations such as proctitis and pouchitis, where transperineal ultrasound (TPUS) may offer diagnostic advantages. Furthermore, we review its emerging role in point-of-care scenarios and its utility within specific patient populations, notably pediatric patients.