Hepatocellular carcinoma (HCC) is a common malignant tumor, and early diagnosis and treatment are crucial. Contrast-enhanced ultrasound (CEUS) enables real-time observation and quantitative analysis of blood perfusion in lesion tissues, which helps improve the diagnostic accuracy and the ability to differentiate between HCC subtypes. It also provides effective support for personalized treatment. At present, CEUS has been gradually applied in various aspects of HCC management, including the diagnosis of different subtypes, personalized treatment planning, evaluation of therapeutic efficacy and prognosis, and molecular targeted diagnosis and treatment. This article reviews the current status and recent progress in the application of CEUS in the diagnosis of HCC subtypes and personalized treatment.
Cancer therapies may induce varying degrees of cardiac injury, leading to cancer therapy-related cardiovascular toxicity (CTR-CVT) that significantly impacts patient prognosis and long-term survival. Ultrasound microbubbles, as novel non-viral targeted delivery vehicles, exhibit unique physical properties, excellent biocompatibility, and ultrasound-triggered cavitation effects, demonstrating promising potential for CTR-CVT-targeted therapy. This review summarizes ultrasound microbubble characteristics and targeting mechanisms, with focus on recent advances in microbubble-mediated gene transfection and targeted drug delivery for systemic CTR-CVT treatment.
Objective To explore the value of an ultrasound radiomics model in preoperatively predicting CK19 protein expression in patients with hepatocellular carcinoma (HCC). Methods A total of 156 patients with pathologically confirmed HCC who had undergone CK19 immunohistochemical staining were retrospectively enrolled. Patients were randomly divided into a training set (n=110) and a validation set (n=46) in a 7∶3 ratio. Clinical data between the two groups were compared using the Chi-square test. A total of 5,936 radiomic features were extracted from grayscale ultrasound images. After Z-score normalization, feature selection and dimensionality reduction were performed in the training set using hypothesis testing, least absolute shrinkage and selection operator (LASSO) regression, and correlation analysis. A multivariate logistic regression model was then constructed. The model’s predictive performance for CK19-positivecases was evaluated using the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and accuracy. Clinical net benefit was assessed using decision curve analysis. Results There were no statistically significant differences in general clinical characteristics between the training and validation sets (all P>0.05). A total of 13 radiomic features were selected to construct the radiomics model. The model demonstrated good predictiveperformance in both the training and validation sets, with AUCs of 0.936 (sensitivity 87.5%, specificity 89.4%, accuracy 90.0%) and 0.881 (sensitivity 100%, specificity 81.0%, accuracy 84.8%), respectively. Decision curve analysis indicated that the model had good clinical utility. Conclusion The ultrasound radiomics model shows good predictive value for CK19 expression in HCC patients and may provide valuable information for clinical practice.
Objective To determine the postoperative upgrade rate of pure intraductal papilloma (IDP) diagnosed by ultrasound-guided core needle biopsy (CNB) and identify potential predictors of malignant upgrade, aiming to improve diagnostic accuracy and optimize clinical decision-making. Methods This retrospective study included 114 female patients with pathologically confirmed pure IDP via ultrasound-guided CNB, with a mean age of 45.8±9.3 years and 114 lesions. Based on postoperative pathology, the patients were divided into a benign group (n=108) and a malignant group (n=6). Among them, 78 patients underwent additional ultrasound-guided fine-needle aspiration (US-FNA) and were similarly categorized into a benign group (n=73) and a malignant group (n=5) based on surgical pathology. Welch’s t-test and Fisher’s exact test were used to compare clinical, imaging, and pathological characteristics between benign and malignant groups. Univariate logistic regression analysis was performed. Characteristics showing statistically significant differences in the group comparisons and univariate Logistic regression were further analyzed using multivariate Logistic regression to identify independent predictors of postoperative malignant upgrade. Results Among the 114 pure IDP cases, six (5.3%) were upgraded to malignant postoperatively. Group comparisons and univariate logistic regression analysis showed statistically significant differences between benign and malignant groups in patient age, US-FNA, maximum lesion diameter, presence of microcalcifications, ultrasound BI-RADS category, and ultrasound-pathology concordance, with all these factors showing some correlation with malignant upgrade (P<0.05 for all). Multivariate Logistic regression analysis identified the presence of microcalcifications (OR=9.068, P=0.044) and the detection of atypical/malignant/suspicious cells on US-FNA (OR=19.956, P=0.036) as independent predictors of postoperative malignant upgrade. Conclusion Microcalcifications observed on ultrasound, and presence of atypical, suspicious malignant, or malignant/cells detected by FNA are high-risk factors for malignant upgrade of IDP. Ultrasound-guided FNA can effectively reduce the false-negative rate of CNB, improve diagnostic accuracy for IDP, and assist in clinical decision-making.
Objective To evaluate the efficacy of neoadjuvant chemotherapy (NAC) for breast cancer throughout the treatment course using serial measurements of contrast-enhanced ultrasound (CEUS) parameters. Methods A total of 56 patients with breast cancer from two medical centers who completed the full course of NAC followed by surgical resection were retrospectively analyzed. The average age was 48.3±16.7 years. CEUS examinations were performed at four time points: before chemotherapy, after one cycle, after four cycles, and before surgery. Time-intensity curves (TICs) were used to derive quantitative parameters, including arrival time (AT), time to peak (TTP), peak intensity (PI), ascending slope (Grad), and area under the curve (AUC). Patients were divided into an effective group (32 cases) and an ineffective group (24 cases) based on the post-chemotherapy treatment outcome. Chi-square test or Fisher’s exact test was used to compare of baseline characteristics between the two groups. Serial measurements were analyzed during the NAC process to calculate the time-weighted average ultrasound parameter values and the time required to reach the lowest value. Comparisons between the two groups were performed using the t-test and Mann-Whitney U test. Results According to time-weighted average of serial measurements, the effective group had significantly lower time-weighted averages of lesion maximum diameter, mean diameter, PI, Grad, and AUC compared to the ineffective group (all P<0.05). The time required to reach the lowest Grad and AUC values was significantly longer in the effective group (both P<0.05), with the maximum time being 84 days, i.e., after the fourth chemotherapy cycle. Conclusion The CEUS parameters Grad and AUC have clinical value in evaluating the efficacy of NAC for breast cancer. Identifying the optimal timing for CEUS follow-up can aid in assessing NAC outcomes.
Objective To explore the predictive value of a nomogram model based on quantitative ultrasound parameters for breast cancer. Methods Clinical and imaging data of 135 female patients with breast tumors confirmed by biopsy or surgical pathology who underwent ultrasound examination were retrospectively collected. Patients were randomly divided into a modeling set (95 cases) and an internal validation set (40 cases) at a ratio of 7∶3. Additionally, 30 patients with breast tumors confirmed by biopsy or surgical pathology who underwent ultrasound examination were collected as an external validation set. The pathological diagnosis results were used as the "gold standard"to divide the modeling set into a benign group (60 cases) and a malignant group (35 cases). Color doppler ultrasound data were collected, including blood flow grading and hemodynamic parameters, along with elasticity imaging parameters. Multivariate Logistic regression was used to identify independent risk factors for breast cancer. A nomogram prediction model of breast cancer was constructed using R software. The predictive performance of the model was assessed using the area under the receiver operating characteristic (ROC) curve (AUC). The goodness-of-fit of the model was evaluated using the Hosmer-Lemeshow test. Results In the modeling set, the sensitivity, specificity, and accuracy of ultrasound diagnosis for breast cancer were 94.29%, 93.33%, and 93.68% respectively. Multivariate Logistic regression analysis revealed that a peak systolic velocity (PSV) ≥15.00 cm/s, maximum elastic modulus (Emax) ≥86.4 kPa, elasticity ratio (Eratio) ≥4.35, and standard deviation of elastic modulus (Esd) ≥17.0 kPa were independent risk factors for breast cancer (all P<0.05). The ROC curve showed good predictive performance of the model in the modeling, internal validation, and external validation cohorts, with AUCs of 0.900, 0.926, and 0.820, respectively. Calibration curve demonstrated good agreement between predicted and actual outcomes in all three cohorts, and the Hosmer-Lemeshow test showed no significant deviation between predicted and observed probabilities (all P>0.05). Conclusion The breast cancer nomogram model based on PSV, Emax, Eratio and Esd quantitative ultrasound parameters has high prediction performance and can provide an objective basis for the diagnosis of breast cancer.
Objective To analyze the incidence and related risk factors of severe biliary complications following percutaneous ultrasound-guided radiofrequency ablation (RFA) for malignant liver tumors. Methods Clinical data, laboratory examination, and imaging findings from 769 patients with malignant liver tumors who underwent percutaneous ultrasound-guided RFA were retrospectively collected. There were a total of 1,212 lesions with an average maximum diameter (1.9±0.8) cm. Based on whether severe biliary complications occurred after RFA,patients were divided into a complication group (9 cases) and a control group (760 cases). Clinical variables, laboratory indicators, pathological tumor types, and imaging featureswere compared between groups using Fisher’s exact test or the Mann-Whitney U test. Multivariate Logistic regression analysis was performed to identify independent risk factors for severe biliary complications. Results The incidence of severe biliary complications after RFA was 1.2% (9/769). Compared to the control group, the complication group had a higher proportion of patients with a history of cholecystectomy or choledochojejunostomy, preoperative albumin (ALB) <28 g/L, liver metastases from biliary system tumors, and tumors located near critical anatomical sites (all P<0.05). Multivariate Logistic regression analysis showed that a history of cholecystectomy or choledochojejunostomy (OR=22.563, 95%CI: 4.320-117.844), preoperative ALB <28 g/L (OR=175.982, 95%CI: 20.164-1 535.921), and liver metastases from biliary system tumors(OR=17.437, 95%CI: 3.143-96.728)were independent risk factors for severe biliary complications after RFA (all P<0.05). Conclusions Severe biliary complications following RFA for malignant liver tumors are rare and influenced by multiple factors.A history of cholecystectomy or choledochojejunostomy, preoperative ALB<28 g/L, and liver metastasis from biliary system tumors are independent risk factors for severe biliary complications.
Objective To investigate the efficacy and safety of ultrasound-guided radiofrequency ablation (US-RFA) in the treatment of papillary thyroid carcinoma (PTC) adjacent to the thyroid capsule. Methods A retrospective analysis was conducted on 126 patients with PTC who underwent US-RFA. Among them, 47 cases had PTC adjacent to the thyroid capsule, and 79 cases had non-capsule-adjacent PTC. All patients underwent fine-needle aspiration biopsy (FNAB) before the procedure to confirm pathological diagnosis, and patients with cervical lymph node or distant metastasis were excluded. During the ablation, techniques such as expanded ablation and hydrodissection were applied. Contrast-enhanced ultrasound was performed immediately after the procedure to assess the ablation range and ensure complete ablation. Follow-ups were conducted at 1, 3, 6, and 12 months postoperatively to monitor changes in the maximum diameter and volume of the ablation site, as well as the occurrence of recurrence, cervical lymph node metastasis, or distant metastasis.Differences between groups were analyzed using t-test, Mann-Whitney U test, and Chi-square test. Results All 126 cases of PTC achieved complete ablation. There were no statistically significant differences in gender, preoperative tumor maximum diameter, preoperative tumor volume, and BRAFV600E between the two groups (all P>0.05). However, the mean age in the capsule-adjacent group was significantly higher than in the non-capsule-adjacent group (P<0.05). The rate of hydrodissection use in the capsule-adjacent group (100%) was higher than that in the non-capsule-adjacent group (35.4%). During the follow-up period, there were no significant differencesbetween the two groups in terms of volume reduction rate of the ablation zone and complete tumor disappearance rates at 3 and 12 months postoperatively (all P>0.05). However,at 6 months after the operation, the complete disappearance rate of the tumor was higher in the non-capsule-adjacent group than in the capsule-adjacent group (P<0.05). During the follow-up period, no local tumor recurrence or lymph node metastasis was observed in either group. Conclusion US-RFA is a safe and effective treatment for PTC adjacent to the thyroid capsule without lymph node or distant metastasis.
Objective To analyze the ultrasonographic features of intramuscular lipoma and various subtypes of liposarcoma and assess their value in differential diagnosis. Methods All of 66 patients with pathologically confirmed adipocytic tumors located in trunk or limb muscles were retrospectively analyzed. According to pathological results, patients were divided into a lipoma group (45 cases) and a liposarcoma group (21 cases). The tumor’s shape, boundary, internal echo, degree of echo uniformity, presence of hypoechoic/anechoic areas, fine septations and blood flow signal grading were evaluated. The maximum diameter of tumor was recorded. Differences in clinical data and ultrasound features between the two groups were compared using the Mann-Whitney U test and chi-square test. Ultrasound parameters with statistical significance were further analyzed using receiver operating characteristic (ROC) curve to determine the area under the curve (AUC), sensitivity, and specificity.The ultrasonic characteristics of different liposarcoma subtypes were also analyzed. Results Compared with the lipoma group, the liposarcoma group had a significantly higher incidence of hypoechoic/anechoic areas, fine septations, and grade Ⅰ-Ⅱ blood flow signals, and showed larger maximum diameters (all P<0.05). Blood flow signal grading demonstrated the best diagnostic efficacy (AUC=0.837) for distinguishing lipoma from liposarcoma, while the maximum diameter achieved the highest sensitivity (0.90), and the the presence of hypoechoic/anechoic area yielded the highest specificity (0.91). Ultrasonographically, well-differentiated liposarcoma often showed fine septations and sparse vascularity. Myxoid liposarcomas were characterized by heterogeneous internal echogenicity, with hypoechoic/anechoic areas and relatively abundant blood flow. Undifferentiated liposarcoma typically presented with hyperechoic and hypoechoic, with clear boundaries and relatively rich blood flow signals. Pleomorphic liposarcoma showed mixed echogenicity and relatively abundant blood flow. Conclusion Muscularis lipoma and liposarcoma have different ultrasonic characteristics, such as the maximum diameter, the presence of hypoechoic/anechoic region, the presence of fine septations, and the blood flow signal, which have high diagnostic value in differentiating between lipomas and liposarcomas. Different subtypes of liposarcoma exhibit distinct ultrasonic manifestations.
Objective To systematically evaluate the age-related changes in total thalamic volume, left and right thalamic volumes, and volumes of 50 subregions, and 5 functional groups volumes, and to explore the influence of sex on these changes. Methods A total of 35 489 eligible participants from the large-scale UK Biobank (UKB) database were retrospectively included, comprising 16 873 males and 18 616 females, with a mean age of 64.1±7.6 years. Thalamic subregional volumes were segmented using Freesurfer as provided by UKB, including 50 anatomical subregions. These subregions were further categorized into five functional groups based on anatomical and functional connectivity: cognitive, visual, auditory & vestibular, motor, and somatosensory. General linear models were applied to analyze the effects of age and the interaction between age and sex on thalamic volumes, adjusting for total intracranial volume (TIV), body mass index (BMI), and education level. Analyses were also stratified by sex. Results Total thalamic volume, bilateral thalamic volumes, 34 subregions, and all five functional group volumes showed significant negative correlations with age (all P<8.62×10-4), with the most pronounced volume reductions observed in the bilateral mediodorsal magnocellular nucleus (MDm) and lateral geniculate nucleus (LGN). Eleven subregions showed significant positive correlations with age (all P<8.62×10-4), with the most marked increase found in the bilateral subgeniculate nucleus (L-SG). Significant age-by-sex interaction effects were found for total thalamic volume, bilateral thalamic volumes, 29 subregions, and the cognitive and motor functional groups (all P<8.62×10-4). In most cases, males exhibited a faster rate of volume decline compared to females. The most prominent interaction effects were seen in the bilateral anterior ventral nucleus (AV) and MDm. Conclusion This study reveals spatial heterogeneity in the age-related changes of thalamic subregional volumes and demonstrates that sex modulates age-related volume changes in total thalamic volume, 29 subregions, and the cognitive and motor functional groups.
Objective To investigate the optimization effects of using wide-detector CT combined with a high-concentration iodine contrast agent on image quality and radiation dose in brain-heart combined CT angiography (CTA). Methods A retrospective analysis was conducted on 70 patients who underwent brain-heart combined CTA with wide-detector CT. In the study group (35 cases), coronary CTA (CCTA) was performed at 100 kV and head-neck CTA (HNCTA) at 80 kV, using a contrast agent with 400 mg/mL iodine concentration. In the conventional group (35 cases), both CCTA and HNCTA were performed at 100 kV using a contrast agent with 320 mg/mL iodine concentration. Subjective image quality of the head-neck and coronary arteries was evaluated using the Likert scale. Image quality metrics, including vascular CT attenuation, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR), were analyzed. Differences in image quality and radiation dose parameters between the two groups were compared using the chi-square test or independent sample t-test. Results The subjective image quality score of head-neck arteries in the study group was significantly better than that in the conventional group (P<0.05), whereas no significant difference was observed for coronary arteries between the groups (P>0.05). In HNCTA, the CT values of the ascending aorta, common carotid artery, internal carotid artery, and middle cerebral artery were all higher in the study group compared to the conventional group (all P<0.05), with increases of 25.2%, 28.0%, 20.0%, and 16.7%, respectively. The SNR of the common and internal carotid arteries was lower in the study group, while the SNR of the ascending aorta was higher (all P<0.05). In CCTA, the CT values at the aortic root and obtuse marginal branch were lower in the study group (both P<0.05), while the CNR values at the left anterior descending and obtuse marginal branches were higher than in the conventional group (both P<0.05). The dose-length product (DLP), effective dose (ED), and total ED of the HNCTA part in the study group were significantly lower than those in the conventional group (all P<0.05). Conclusion Wide-detector CT combined with a high-concentration iodine contrast agent can improve image quality of both head-neck and coronary arteries while reducing radiation dose in brain-heart combined CTA, demonstrating high clinical application value.
Objective To evaluate the value of CT features of pulmonary ground-glass nodules (GGNs) in predicting the invasiveness and invasion degree of lung adenocarcinoma. Methods A retrospective study was conducted on 168 postoperative patients with isolated GGN on chest CT and complete pathological results from surgery or biopsy. Based on whether the lesion had invasive components, patients were divided into a non-invasive group (44 cases) and an invasive group (124 cases). The invasive group was further subdivided into minimally invasive adenocarcinoma group (MIA group, 61 cases) and invasive adenocarcinoma group (IAC group, 63 cases) according to the degree of invasion. CT features of the GGNs were analyzed, including long diameter, short diameter, mean CT value, and proportion of ground-glass opacity (GGO). The intraclass correlation coefficient (ICC) was used to assess interobserver agreement between two radiologists. Independent sample t-tests, Mann-Whitney U tests, and chi-square tests were used to compare CT features between groups. CT features with statistically significant differences were included in multivariate logistic regression analysis to identify independent predictors of invasiveness and invasion degree. Receiver operating characteristic (ROC) curves were used to analyze the predictive performance of independent and combined predictors. Results The measurement consistency measurements of GGN long diameter, short diameter, GGO proportion, and mean CT value between the two physicians was good (all ICC>0.9). Significant differences in the presence of spiculation, lobulation, vascular change, pleural retraction, shape, GGN type, long diameter, short diameter, mean CT value, and GGO proportion were observed between the non-invasive and invasive groups (all P<0.05). Among these, spiculation, mixed GGN (mGGN), and long diameter were independent risk factors for predicting GGN invasiveness (all P<0.05). Significant differences in lobulation, vascular change, vacuole sign, density uniformity, long diameter, short diameter, mean CT value, and GGO proportion were found between the MIA and IAC groups (all P<0.05). Among these, type Ⅱ vascular change, GGN long diameter, short diameter, and mean CT value were independent risk factors for predicting the degree of invasion (all P<0.05). Among single predictors of invasiveness, long diameter had the highest AUC (0.818); the combined predictor model had an AUC of 0.885, higher than any single predictor. For invasion degree prediction, short diameter had the highest AUC (0.896); the combined predictor model had an AUC of 0.945, again higher than any single factor. Conclusion A combined assessment of multiple CT imaging features of GGNs can improve the prediction of both the invasiveness and degree of invasion in lung adenocarcinoma, providing stronger radiological evidence for individualized clinical diagnosis and treatment planning.
Esophageal cancer is one of the most common malignant tumors of the digestive system. As a widely used imaging modality, CT plays a crucial role in the diagnosis, treatment, and follow-up of esophageal cancer. Deep learning can automatically extract features from CT images, enabling application in diagnosis, treatment planning, efficacy prediction, and prognosis assessment of esophageal cancer. This review summarizes the research progress of CT-based deep learning techniques in the diagnosis and treatment of esophageal cancer.
CT quantitative measurement is an important method for evaluating pulmonary hypertension (PH), as it provides both morphological and functional parameters of pulmonary vasculature, along with hemodynamic information. Artificial intelligence (AI) technology further enhances the accuracy and efficiency of PH assessment, enabling more precise diagnosis, monitoring of disease progression, and providing reliable prognostic evidence to support clinical intervention. This review synthesizes recent research advances in quantitative assessment of pulmonary perfusion and vasculature, as well as the application of AI in the evaluation of PH.
Synthetic MRI (SyMRI) is a novel quantitative relaxation technique based on multidynamic multiple echo (MDME) sequence. It can simultaneously generate various quantitative relaxation maps and contrast-weighted images from a single scan. SyMRI enables noninvasive diagnosis of rectal cancer, offering not only assess tumor pathologic staging and high-risk factors related to prognosis，but also monitor the response to neoadjuvant therapy. It provides key imaging support for the formulation of individualized clinical treatment plans. This review summarizes the application progress of synthetic MRI in the diagnosis and treatment of rectal cancer.
Prostate cancer (PCa) is the most common malignant tumor of the male reproductive system. Biochemical recurrence (BCR) after radical treatment remains the first sign of invasive disease such as PCa. In recent years, artificial intelligence (AI) technologies, particularly radiomics and deep learning, have demonstrated unique advantages and promising applications in medical image analysis. This article reviews the fundamental concepts of BCR in PCa, along with recent advances in AI-based approaches using multiparametric MRI to predict BCR and assess prognosis following radical treatment.
Image-guided percutaneous biopsy has increasingly become the preferred method for pathological diagnosis of bone and soft tissue tumors. Imaging techniques such as ultrasound, CT, MRI, and positron emission tomography (PET)/CT enable precise guidance of the biopsy needle into the lesion to obtain effective tissue samples, while clearly visualizing surrounding critical structures to reduce procedural risks. Ultrasound guidance is suitable for superficial lesions, offering real-time imaging without radiation exposure. CT guidance is more effective for deep or intraosseous lesions. MRI and PET/CT are mainly used for lesions that are inconspicuous on CT. Emerging technologies such as augmented reality, image fusion, and robotic assistance have demonstrated significant potential in improving the precision and safety of biopsy procedures. This article summarizes the applicable scope of various imaging-guided modalities and recent advances in multimodal imaging and cutting-edge technologies in percutaneous biopsy.
The imaging diagnosis of focal fat-containing hepatic poses a challenge due to the heterogeneity of fat components within the lesions and the overlap of imaging features. This article systematically analyzed the imaging differences among steatosis, adipose tissue, and liquid fat. It summarized the imaging features of focal fat-containing liver lesions such as hepatocellular carcinoma, hepatocellular adenoma, and angiomyolipoma. By identifying the specific type of fat within the lesion, accurately assessing other imaging features (e.g., enhancement patterns), and integrating relevant clinical information, the differential diagnosis can be narrowed, thereby improving diagnostic accuracy.
