BACKGROUND & AIMS:The recent approval of pharmacological therapies for fibrotic metabolic dysfunction-associated steatohepatitis (MASH) has increased the need for accurate identification of treatment-eligible patients. Current recommendations increasingly rely on non-invasive tests (NITs), including vibration-controlled transient elastography (VCTE), while multiparametric ultrasound (MPUS) may provide additional opportunities for non-invasive assessment. However, agreement between histology and imaging-based approaches remains uncertain. We compared treatment eligibility based on histology, VCTE, and MPUS in two international biopsy-proven cohorts of metabolic dysfunction-associated steatotic liver disease (MASLD). METHODS:We analysed two biopsy-proven MASLD cohorts: CAP-IPDMA (n=1029), including VCTE and controlled attenuation parameter (CAP), and iLEAD (n=124), including MPUS. Treatment eligibility was assessed using histologically confirmed F2/F3 MASH and NIT-based recommendations from international expert panels. RESULTS:In CAP-IPDMA, 277/1029 patients (26.9%) met the histological definition of "at-risk MASH". Depending on the VCTE cut-off, 13.2-32.0% qualified for treatment. Overlap between histological "at-risk MASH" and VCTE thresholds was limited, reaching 27.8% when using VCTE 8-15 kPa, and decreasing when narrower or higher thresholds were applied. Among patients identified only by VCTE 8-15 kPa, males had lower median AST and ALT than those fulfilling only the histological indication (35 vs 48 IU/L p=0.034 and 45 vs 62 IU/L p=0.0072, respectively). In iLEAD, 21/124 patients (16.9%) met the histological definition, while 13.7-16.1% were eligible based on SWE thresholds, again with a similarly limited overlap. CONCLUSIONS:Histology and non-invasive tests capture partly distinct patient populations, meaning that both the number and type of patients selected for therapy depend on the chosen modality and cutoffs. As vibration-controlled transient elastography and multiparametric ultrasound become increasingly accessible in clinical practice, prospective validation is essential for establishing reliable non-invasive treatment pathways. IMPACT AND IMPLICATIONS:The current literature reflects a paradigm shift away from biopsy-based approaches toward NIT-based assessment of treatment eligibility in metabolic dysfunction-associated steatotic liver disease (MASLD), which may substantially affect which patients receive newly approved therapies. Our results are important for clinicians, researchers, and guideline developers because histology and current NIT cut-offs identify only partially overlapping patient populations, implying that different diagnostic strategies select different risk profiles. In practice, these findings support thoughtful implementation of NIT-based treatment pathways, the use of repeated measurements, and prospective validation of NIT thresholds to guide clinical care, trial design, and health policy decisions.

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.

OBJECTIVES:This observational study aimed to define a standardized sonographic approach for evaluating the elementary lesions of the tendon-bone junction (TBJ) in insertional Achilles tendinopathy (IAT). METHODS:Using high-frequency transducers, we matched the histological microarchitecture and the anatomical features of the TBJ of the Achilles tendon in patients with a clinical diagnosis of IAT. Colour/power Doppler assessments have been performed as well. RESULTS:Fifty-eight patients, with a mean age of 54 years (54.50 ± 11.72) and a gender distribution of 32 males (55.17%) and 26 females (44.83%), were enrolled in this observational study. Five elementary lesions of IAT were sonographically defined: bone spur, calcified longitudinal fissuration, intra-tendinous bony formation, tendon-bone disjunction, and fibrocartilage hyperemia. Moreover, specific sonographic signs have been identified to differentiate bony spurs in the growing phase and end-stage. CONCLUSIONS:Using high-frequency B-mode and high-sensitive Doppler imaging, detailed sonographic assessment of the TBJ can be performed in IAT patients. The aforementioned 5 elementary lesions can be considered as a standardized approach for prompt examination of this complex/anatomical region. ADVANCES IN KNOWLEDGE:Recent advances in ultrasound equipment allow for accurate assessment of the TBJ of the AT. The present observational study defined 5 elementary sonographic lesions of the IAT as bone spur, calcified longitudinal fissuration, intra-tendinous bony formation, tendon-bone disjunction, and fibrocartilage hyperemia. Pertinent ultrasound-guided procedures targeting the TBJ are also discussed.

BackgroundMultiparametric ultrasound (mpUS) integrates BI-RADS (Breast Imaging Report And Data System) morphological assessment with biomechanical biomarkers, including strain elastography (SE) and shear-wave elastography (SWE), along with microvascular flow (M-Flow). Furthermore real-time computer-aided diagnosis (CAD/AI) systems, including Live Breast Assist and S-Detect are employed to standardize image interpretation, thereby reducing operator dependence.PurposeTo evaluate the diagnostic accuracy and reproducibility of mpUS supported by CAD/AI versus B-mode ultrasound alone, assessing their concordance with histopathology for the benign/malignant dichotomy and the incremental contribution of SE, SWE, and M-Flow. Additionally inter-operator agreement was quantified.Materials and methodsIn this single-center prospective study 78 consecutive patients presenting with 78 breast lesions, underwent B-mode/BI-RADS evaluation, Color Doppler, M-Flow (percentage of vascularization), SE (strain ratio), and SWE (quantitative stiffness in kPa). Live Breast Assist was semi-automatically employed during data acquisition, while S-Detect provided focal lesion characterization when deemed necessary. Histopathological examination served as the gold standard.ResultsHistology identified 60 malignancies (76.9%) and 18 benign lesions (23.1%).The highest diagnostic performance was shown by M-Flow (AUC 0.926), reaching 95.1% of sensitivity and 82.4% of specificity. SE also showed strong discriminative ability (AUC 0.885). SWE exhibited lower accuracy (AUC 0.658). B-mode alone achieved an AUC of 0.864. Although with a higher false-negative rate compared with the expert operator, Live Breast Assist demonstrated high specificity (88.2%) and an excellent PPV (96.4%). Inter-operator agreement was substantial (kappa = 0.63).ConclusionmpUS with CAD/AI support enhanced diagnostic accuracy and reproducibility for benign/malignant distinction, providing robust biomechanical and vascular biomarkers. This approach may reduce unnecessary biopsies in indeterminate BI-RADS lesions, though tumor grading remains the purview of pathology.

Accurate interpretation of arterial spectral Doppler tracings, when performed in conjunction with B-mode sonographic evaluation of the parenchymal vessels, enables an indirect yet quantitatively robust assessment of underlying organ and vascular pathology. This integrative approach provides invaluable diagnostic insight by combining structural imaging with functional hemodynamic data. In emergency settings, the ability to rapidly distinguish between ischemic, obstructive, and congestive etiologies is paramount. Consequently, spectral Doppler analysis plays a critical role in optimizing clinical decision-making processes, guiding both diagnostic pathways and therapeutic interventions in a wide spectrum of emergency scenarios, whether traumatic or non-traumatic in origin. This comprehensive methodology, acting as a real-time morpho-functional evaluation, thus enhances the precision, speed, and effectiveness of patient management in acute parenchymal emergencies.

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/Objectives: Cysts are the most common kidney lesions identified in patients undergoing abdominal imaging, with ultrasound (US) typically serving as the initial diagnostic tool. Contrast-enhanced ultrasound (CEUS) has emerged as a highly effective modality for the evaluation of cystic renal lesions, particularly when conventional B-mode ultrasound (US) or CE-CT are inconclusive. While simple renal cysts are readily characterised on US, cystic renal lesions require further assessment. Methods: The Bosniak classification, originally developed for CE-CT, remains the cornerstone for categorising cystic renal lesions, guiding management from surveillance to surgical intervention. Recent efforts to standardise CEUS-specific imaging parameters and adapt the Bosniak criteria aim to improve interobserver agreement, reduce subjectivity, and enhance diagnostic accuracy. Results: CEUS offers superior sensitivity for detecting slow blood flow and minimal vascularity within septa, wall or solid components, often outperforming CE-CT in real-time vascular assessment. However, the high sensitivity of CEUS can reveal additional septa or subtle enhancement, potentially leading to lesion overscoring, if the different sensitivity of CEUS and CT/MRI for detecting enhancement is not taken into account. CEUS also plays a crucial role in the follow-up of non-surgical cystic lesions, providing a radiation-free and cost-effective alternative for long-term monitoring. Certain scenarios, such as post-interventional changes, traumatic cystic rupture, or infected cysts, fall outside the scope of the Bosniak system and require careful clinical correlation. Conclusions: By integrating CEUS into the diagnostic pathway, sonologists can achieve accurate lesion characterisation, optimise patient management, and minimise unnecessary invasive procedures, reinforcing CEUS as an essential tool in the evaluation and follow-up of complex renal cystic masses.

OBJECTIVES:Recently, a novel dynamic maneuver in which the retrocalcaneal soft tissues are squeezed (CoRi sign) has been described for the diagnosis of partial tears involving the deep fibers of the Achilles tendon. This cross-sectional study aims to assess the prevalence of the CoRi sign in a cohort of patients with a clinical diagnosis of IAT. METHODS:A consecutive cohort of 58 patients (32 males, 26 females) seen at our institution with a clinical diagnosis of IAT comprised the study group for a cross-sectional study to assess the prevalence of the CoRi sign in the study population and to correlate the findings on static B-mode and color/power Doppler sonography with the CoRi dynamic maneuver. RESULTS:The prevalence of CoRi sign was 15.5% in the study cohort (9/58) and 26.4% (9/34) in the subgroup of IAT patients with bursal effusion in B-mode coupled with synovial hyperemia in color/power Doppler. Of the nine patients with a positive dynamic maneuver, eight of them presented insertional tendinosis with intratendinous hyperemia at color/power Doppler; in addition, none showed Achilles bone spurs of the calcaneal tuberosity. Lastly, four of the nine patients with a positive CoRi sign showed tendon-bone junction hyperemia in the absence of a bone spur. CONCLUSIONS:Tendon undersurface disruption in IAT patients is not uncommon, and dynamic ultrasound imaging is valuable for diagnosis. Hyperemic retrocalcaneal bursitis, insertional tendinosis with intratendinous hyperemia, and tendon-bone junction hyperemia are the most common static sonographic findings, respectively, in CoRi-positive patients. LEVEL OF EVIDENCE:Level IV-cross-sectional study.

BACKGROUND:Imaging plays a pivotal role in the diagnosis and stratification of appendiceal abscess, a distinct phenotype of complicated appendicitis. Persistent heterogeneity in anatomic terminology, radiological grading, and diagnostic pathways continues to hinder reproducibility, clinical decision-making, and cross-study comparability. A standardized, imaging-centered framework integrating reproducible anatomic descriptors, validated severity grading, and evidence-based imaging strategies is therefore urgently needed. METHODS:Under the auspices of the Italian Society of Research in Surgery and the Italian Society of Emergency and Trauma Surgery, a multidisciplinary expert panel conducted a 4-round modified Delphi process, culminating in an in-person consensus conference held in Rome on November 6, 2025. Statements were iteratively refined through anonymous voting, achieving predefined thresholds for consensus (≥80%) and strong consensus (≥95%). RESULTS:The panel endorsed (1) mandatory anatomotopographic classification of appendiceal abscess (pelvic, mesenteric, retrocecal/retrocolic, and anterior with abdominal wall involvement); (2) adoption of the Jeffrey radiological grading system (grades 1-3: phlegmon/small abscess ≤3 cm; well-circumscribed abscess >3 cm; and extensive/poorly defined with multicompartment extension); and (3) structured imaging recommendations. These include contrast-enhanced computed tomography as the reference modality in adults, with selective use in suspected malignancy, particularly in patients >50-55 years, ultrasound-first/magnetic resonance imaging-second pathways during pregnancy, and symptom-driven follow-up after conservative management. CONCLUSION:This consensus establishes a unified and imaging-guided diagnostic framework that harmonizes anatomotopographic localization with reproducible radiological stratification and pathway-oriented recommendations. Standardized definitions and structured reporting are expected to reduce practice variability, enhance interpretative consistency, and enable reliable cross-institutional and cross-study comparisons. These statements complement, rather than replace, clinical judgment and are aligned with recent international updates, including the 2025 World Society of Emergency Surgery Jerusalem Guidelines. Prospective multicenter validation is warranted to assess their impact on clinical outcomes, drainage success, recurrence prediction, and the prognostic performance of the integrated anatomotopographic-Jeffrey approach.

Acute scrotum poses diagnostic challenges due to its diverse etiology and potential severity. Multiparametric ultrasound has proven to be a fundamental and valuable imaging modality in this context, improving early-phase sensitivity through various techniques, including B-Mode, color Doppler, power Doppler, pulsed Doppler, microflow studies, and elastography. In this context, Contrast-Enhanced Ultrasound (CEUS) emerges as a rapid, safe, and valuable tool in enhancing diagnostic accuracy and therapeutic decisions for acute scrotal conditions. This study involves a detailed analysis of various ultrasound imaging techniques and investigates the optimal circumstances and methods for employing CEUS in emergency situations to improve diagnostic accuracy and therapeutic decisions. Multiparametric ultrasound plays a crucial role in diagnosing various pathologies, including testicular torsion, appendage torsion, inflammation, ischemia/infarction, and trauma. CEUS provides real-time assessment of vascular perfusion, aiding in early diagnosis and accurate characterization of scrotal pathologies and significantly reducing the need for unnecessary surgical interventions, especially in trauma cases. Its role in differentiating between various pathologies and guiding therapeutic decisions underscores its importance in clinical practice, contributing significantly to improve patient outcomes.

We primarily assessed the capability of ultrasound quantitative microvascularity imaging (qMI) in identifying high risk thyroid nodules. In addition, the diagnostic performance of computer aided diagnosis (CAD) was evaluated and correlated with qMI and cytology results. This single centre prospective study was carried out from 2023 to 2024 and included 165 target thyroid nodules,that were assessed by using CAD for semi-automatic EU-TIRADS classification and qMI, that. Subsequently, all nodules underwent Fine Needle Aspiration Biopsy and Cytology. CAD derived EU-TIRADS and qMI results (Vascularity Index - VI) were correlated with cytology results, that were used as a reference standard, using regression analyses. Target nodules showed mean size of 15.6 mm ± 9 (range 4–40 mm) and mean vascularity index of 29.03

Background: Non-calcific supraspinatus tendinopathy (SNCCT) is a frequent cause of shoulder pain, often associated with functional impairment and reduced quality of life. Recent advancements in diagnostic imaging, including shear wave elastography (SWE), provide quantitative data on tendon stiffness and thickness, facilitating more precise evaluations. Extracorporeal shockwave therapy (ESWT) has emerged as a minimally invasive and effective treatment for SNCCT, but its effects on tendon properties measured through SWE require further investigation. Objective: This retrospective observational study aimed to evaluate the impact of ESWT on supraspinatus tendon characteristics in patients with SNCCT by assessing tendon thickness, SWE velocity, and clinical outcomes. Methods: This observational study enrolled 39 patients with SNCCT, aged 30–75 years, who received three ESWT sessions over 3 weeks. The intervention was delivered using a Modulith SLK system at an energy level of 0.20 mJ/mm2 with 2400 pulses per session. SWE and conventional ultrasound were used to measure tendon thickness and SWEv at baseline (T0) and 6 months post-treatment (T1). Clinical outcomes were assessed using the Visual Analog Scale (VAS), Constant and Murley Score (CMS), and modified Roles and Maudsley scale. Data were analyzed using paired t-tests and correlation analyses. Results: At baseline, affected tendons exhibited increased thickness (7.5 ± 0.9 mm) and reduced SWEv (3.1 ± 0.7 m/s) compared to healthy tendons (4.5 ± 0.7 mm and 6.9 ± 1 m/s, respectively; p < 0.05). Six months after ESWT, tendon thickness decreased significantly (6.2 ± 0.9 mm, p < 0.05), and SWEv increased (5.7 ± 1.8 m/s, p < 0.05), indicating improved elasticity. Clinical outcomes improved significantly, with the VAS scores decreasing from 6.5 ± 1.4 to 3.2 ± 2.1, the CMS score rising from 59.1 ± 17.3 to 78.2 ± 17.7, and the modified Roles and Maudsley scale improving from 2.3 ± 0.6 to 1.5 ± 0.8 (p < 0.05 for all). SWEv positively correlated with the CMS (r = 0.4) and negatively with the VAS and the modified Roles and Maudsley scale (r = −0.6 and r = −0.5, respectively). Conclusions: ESWT significantly reduces tendon thickness and enhances elasticity, correlating with improvements in pain and functional scores. SWE proved to be a reliable method for monitoring structural and clinical changes in SNCCT. Further research, including randomized controlled trials, is recommended to confirm these findings and explore longer-term outcomes.

Purpose: This study aimed to compare: the performance of K-TIRADS, EU-TIRADS and ACR TIRADS when used by observers with different levels of experience compared with the gold standard of cytology, and to evaluate the diagnostic performance of CAD (computer-aided design) compared with TI-RADS systems. Methods and Materials: In total, 323 thyroid nodules were evaluated in patients who were candidates for needle aspiration. Three observers with different levels of experience evaluated the diagnostic accuracy of three risk stratification systems (ACR TI-RADS, EU-TIRADS and K-TIRADS) and CAD software (S-Detect, made by Samsung) in characterizing the nodules. The results were compared with cytology examination. All nodules were characterized in terms of shape, margins, composition, calcifications, size, echogenicity and microcalcifications, and by stratifying individual nodules by using the three TIRADS systems; then S-detect software was applied and the data were compared with each other and with the gold standard. Results: Through cytology, 308 benign and 33 malignant nodules were identified. ACR-TIRADS showed a sensitivity of 100%, a specificity of 86%, a positive predictive value of 43% and a negative predictive value of 100%. EU-TIRADS showed a sensitivity of 100%, a specificity of 79%, a positive predictive value of 33% and a negative predictive value of 100%. K-TIRADS showed a sensitivity of 100%, a specificity of 89%, a positive predictive value of 50% and a negative predictive value of 100%. S-Detect combined with EU-TIRADS showed a high agreement (>95%) with the gold standard. Conclusions: K-TIRADS’s positive predictive power was slightly better than the other TIRADS, suggesting greater accuracy in correctly diagnosing positive cases. S-DETECT combined with EU-TIRADS has similar results to S-Detect with ACR- and K-TIRADS in terms of sensitivity, specificity and negative predictive power. However, it has a slightly better positive predictive power, suggesting greater accuracy in correctly diagnosing positive cases than the ACR- and K-TIRADS classification systems. In general, S-Detect cannot yet be considered a substitute for the human observer but only as an important support for human evaluation and an excellent and fast help to provide a comprehensive and complete report. Clinical Relevance/Application: S-Detect is a valuable tool for characterizing thyroid nodules when integrated with radiologist evaluation. It is also an important support tool for less experienced observers. Particularly interesting is the approach of use in integrated combination of the K-TIRADS by the human observer with S-Detect using EU-TIRADS, which could increase the overall diagnostic efficiency of the systems.

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.

PURPOSE:Ultrasound fat fraction estimation (USFF) using quantitative ultrasonography (QUS) is a promising method for assessing liver fat in metabolic dysfunction-associated steatotic liver disease (MASLD). However, its performance across different ethnicities remains unclear. This study aimed to externally validate and compare USFF accuracy in Asian and Caucasian cohorts. METHODS:This retrospective analysis used QUS data from three institutions. Participants underwent QUS and magnetic resonance imaging of the proton density fat fraction (MRI-PDFF), the reference standard. A multivariable regression model was developed using two QUS parameters. Linear regression was used to estimate fat fraction, with adjusted R2 values assessing model fit. The diagnostic performance of USFF for hepatic fat content thresholds (≥ 5%, ≥ 10%, ≥ 20%) was evaluated using the area under the receiver operating characteristic curve (AUC). RESULTS:The development set included 427 South Korean participants, while the validation set comprised 100 from Hungary and 79 from Italy. R 2 values were 0.689, 0.702, and 0.485 for the development, internal validation, and external validation sets, respectively. AUC for detecting hepatic steatosis (MRI-PDFF ≥ 5%) was 0.939 (development) and 0.863 (external validation). Using a cutoff > 0.513, USFF achieved 85.1% sensitivity and 87.4% specificity. CONCLUSION:USFF is effective but shows variability across populations, highlighting the need for ethnicity-specific models.

Background: Attenuation coefficient (AC) and shear-wave speed (SWS) are established US markers for assessing patients with metabolic dysfunction-associated steatotic liver disease (MASLD), while shear-wave dispersion slope (DS) is not. Purpose: To assess the relationship between the multiparametric US imaging markers DS, AC, and SWS and liver histopathologic necroinflammation in patients with MASLD. Materials and Methods: This international multicenter prospective study enrolled consecutive patients with biopsy-proven MASLD between June 2019 and March 2023. Before biopsy, all participants underwent multiparametric US, and measurements of DS, AC, and SWS were obtained. Multivariable linear regression analyses were performed to assess the association of clinical variables and imaging markers with pathologic findings. The diagnostic performance of imaging markers for determining inflammation grade, steatosis grade, and fibrosis stage was assessed using the area under the receiver operating characteristic curve (AUC). Results: A total of 124 participants (mean age, 53 years +/- 15 [SD]; 62 males) were evaluated. In multivariable regression, lobular inflammation was associated with DS (regression coefficient, 0.06; P = .02), alanine aminotransferase level (regression coefficient, 0.002; P = .002), and Hispanic or Latino ethnicity (regression coefficient, -0.68; P = .047), while steatosis was associated with AC (regression coefficient, 3.66; P < .001) and fibrosis was associated with SWS (regression coefficient, 2.02; P < .001) and body mass index (regression coefficient, 0.05; P = .02). DS achieved an AUC of 0.72 (95% CI: 0.63, 0.82) for identifying participants with inflammation grade A2 or higher (moderate to severe inflammation). AC showed excellent performance for identifying participants with grade S1 (mild) or higher steatosis (AUC, 0.92 [95% CI: 0.87, 0.97]), while SWS showed excellent performance for identifying participants with fibrosis stage F2 or higher (clinically significant fibrosis) (AUC, 0.91 [95% CI: 0.86, 0.96]). Of the three US markers, SWS showed the highest AUC (0.81 [95% CI: 0.74, 0.89]) for the diagnosis of metabolic dysfunction-associated steatohepatitis. Conclusion: Of the three US imaging markers (DS, AC, and SWS), DS was most associated with lobular inflammation grade at histologic examination and demonstrated fair diagnostic performance in distinguishing moderate to severe lobular inflammation. ClinicalTrials.gov Identifier: NCT04012242 Published under a CC BY 4.0 license.

Background:Distal deep venous thrombosis (DDVT) is a clinical condition that can affect patients hospitalized in internal medicine wards and may result in pulmonary embolism. However, many aspects of distal thrombosis in hospitalized medical patients remain poorly understood. Objective:This study aimed to evaluate the rate of asymptomatic DDVT at admission, the occurrence of DDVT during hospitalization, and to analyze the factors associated with thrombotic events. Methods:A multicenter, prospective observational study (AURELIO) was conducted across eight centers affiliated with the Ultrasound Study Group of the Italian Society of Internal Medicine. Venous ultrasound of the lower limb veins was performed within 48 hours of admission and at discharge to diagnose distal deep vein thrombosis. Results:Among 1,458 patients (721 males and 737 females; mean age 71 ± 16 years), asymptomatic distal thrombosis was detected in 59 patients (4%) upon admission. Of these, 47% (n = 28) were classified as isolated DDVT, while 31 cases involved DDVT that extended to the proximal tract. At discharge, 9 additional cases of distal thrombosis were identified, bringing the total to 68 cases. Of these, 46% were DDVT, while 54% DDVT extended to the proximal venous system. Multivariate analysis identified reduced mobility (p = 0.036) and active malignancy (p = 0.02) as independent risk factors for DDVT extending to the proximal tract. Additionally, pneumonia (p = 0.043) and active malignancy (p = 0.008) were associated with DDVT. Conclusion:The study emphasizes the high prevalence of DDVT in hospitalized patients and the risk of proximal extension. Ultrasound screening should be considered for oncology patients and those with pneumonia to ensure early diagnosis and timely anticoagulant therapy.