Objectives Conventional ultrasound (US) elastography lacks specificity in distinguishing benign from malignant breast lesions. This study employed US to assess breast tissue viscosity and elasticity. The primary objective was to evaluate the diagnostic performance of US-derived viscoelasticity parameters. Secondary objectives included investigating the consistency of parameters in the mechanical properties of breast tissue.
Materials and methods Two doctors independently measured the viscosity and elasticity of specific positions in the breasts of 20 health females for consistency assessment. Then the doctors selected region of interest (ROI) to measure viscoelasticity. ROI-1, ROI-2, and ROI-3 represent the tumor, peritumoral, and peripheral areas, respectively. The viscosity modulus and elasticity modulus of 3 ROIs were analyzed. The viscosity and elasticity parameters with the highest area under the curve (AUC) were selected as the optimal ones. Finally, elasticity and viscosity parameters were combined to assess their diagnostic performance in differentiating breast lesions.
Results US viscoelasticity parameters can be measured with high consistency. Among conventional US elasticity parameters, 1-Emax demonstrated the highest AUC (0.746) for differentiating benign and malignant breast lesions. In US viscoelasticity parameters, 2-Emax achieved the highest AUC of 0.801, while 2-Vmax showed the highest AUC of 0.835. The highest specificity (0.903) was observed when both 2-Emax and 2-Vmax exceeded their respective cutoff values (P < 0.05 for all).
Conclusion Quantitative ultrasound viscoelasticity parameters play a crucial role in breast cancer diagnosis, with tumor boundary parameters being particularly significant for cancer screening and prevention strategies.

Objective Uterine and ovarian development is influenced by both age and hormonal milieu. Sonographic assessment of normal pubertal and pre-puberty girls provides critical insights into the physiological trajectory of female gonadal maturation and its potential pathological deviations.
Methods This was a cross-sectional study conducted at Gilani Ultrasound Center, Lahore, Pakistan. The duration of the study was 9 months. Uterus length, width, height, volume, right/left ovary volume and Fundo/Cervical ratio were measured.
Results A total of 384 subjects were included in our study, categorizing them into pre-puberty (age 2-6 years), early puberty (age 7-11 years), and late puberty (age 12-18 years) groups. In the pre-puberty group (n = 111, mean age 4.29 ± 1.20 years), uterine measurements revealed a mean length of 2.95 cm, height of 0.97 cm, width of 1.41 cm, and volume of 4.82 cm³. The mean volumes of the right and left ovaries were 1.24 cm³ and 1.10 cm³, respectively, with a mean F/C ratio of 1.33. For the early puberty group (n = 99, mean age 9.15 ± 1.45 years), uterine measurements included a mean length of 4.03 cm, height of 1.22 cm, width of 1.80 cm, and volume of 12.37 cm³. In the late puberty group (n = 31, mean age 12.63 ± 1.21 years), uterine measurements showed a mean length of 5.29 cm, height of 1.82 cm, width of 2.65 cm, and volume of 31.11 cm³. The mean volumes of the right and left ovaries were 4.70 cm³ and 5.26 cm³, respectively, with a mean F/C ratio of 1.26.
Conclusion Uterine and ovarian dimensions, including volumes, correlate directly with age and pubertal status, except for the (Fundus/Cervical) ratio, which shows individual variability. This normative data could serve as a basis for the evaluation of Uterine and ovarian dimensions and volume in the local population.

Objective Plantar fascia (PF) is a thick connective tissue on the plantar surface of the foot that plays a crucial role in maintaining the longitudinal arch. Plantar fasciitis, characterized by inflammation of the medial tuberosity of the calcaneus, is one of the most common causes of heel pain. Imaging is essential for accurate diagnosis, with ultrasonography widely applied to evaluate PF thickness, monitor therapeutic outcomes, and guide interventions. However, its application is limited by operator dependency. This study aimed to investigate the inter- and intra-rater reliability of musculoskeletal ultrasound in measuring PF thickness in patients with plantar fasciitis.
Methods In this cross-sectional analytical study, 40 participants were enrolled, including 26 females and 14 males. The reliability of PF measurements on different sides was assessed using Cronbach’s alpha and intraclass correlation coefficients (ICC).
Results A total of 40 participants (age range: 20-60 years) were included in the study. PF thickness in patients with plantar fasciitis measured by Observer 1 ranged from 3.8-6.9 mm (left) and 3.2-6.0 mm (right), whereas measurements by Observer 2 ranged from 2.9-7.1 mm (left) and 3.2-6.0 mm (right). Intra-rater reliability showed ICCs ranging from 0.618-0.857 for Observer 1 and 0.76-0.92 for Observer 2, indicating moderate (> 0.60) to excellent reliability.
Conclusion PF is a deep structure, and its visualization may be influenced by operator technique. Ultrasound measurement of tendon thickness shows good reliability in patients with established plantar fasciitis.

Objective To compare fetal cardiac morphology and function between small-for-gestational-age (SGA) and appropriate-for-gestational-age (AGA) fetuses using two-dimensional speckle-tracking echocardiography (2D-STE), and to evaluate global longitudinal strain (GLS), global sphericity index (GSI), and fractional area change (FAC) in both ventricles with FetalHQ software.
Methods This cross-sectional observational study included 101 pregnant women, comprising 36 with SGA and 65 with AGA fetuses. Five- to fifteen-second four-chamber view (4CV) cine loops of the fetal heart were acquired and analysed using fetal heart quantification and speckle tracking (FetalHQ) software. GLS, GSI, and FAC of both left ventricle (LV) and right ventricle (RV) were measured.
Results SGA fetuses demonstrated significantly lower GSI values, consistent with a more globular cardiac shape. LV-FAC and RV-FAC were significantly lower in SGA compared with AGA fetuses, reflecting impaired systolic function. Both LV-GLS and RV-GLS values were significantly higher (less negative) in the SGA group, indicating early biventricular systolic dysfunction. These findings align with previously reported adaptive responses of the fetal myocardium to chronic hypoxia.
Conclusion The study highlights distinct alterations in fetal cardiac morphology and function between SGA and AGA groups. FetalHQ-based deformation analysis may potentially detect subclinical biventricular dysfunction in SGA fetuses before Doppler abnormalities become apparent, offering potential for earlier clinical intervention and closer monitoring.

Objective Aortic stenosis (AS), a prevalent valvular disease, demands accurate diagnosis. Current methods, notably Doppler echocardiography, face limitations like dynamic image challenges and reliance on cardiologist experience. To assess aortic stenosis, measuring the LVOT diameter is critical, as a 1 mm difference can result in a 10% variation in stroke volume. Accurate Doppler beam alignment and LVOT VTI measurement are also essential to avoid errors. Our study, utilizing the TMED 2 dataset, introduces a novel artificial intelligence program for precise aortic stenosis diagnosis. By leveraging AI, we aim to overcome existing constraints and significantly enhance diagnostic accuracy.
Methods a novel method that involves using convolutional neural networks (CNNs), were used to grade AS based on various views of transthoracic echocardiography (TTE) images from the TMED 2 dataset. This innovative method aimed to take advantage of CNN’s abilities to recognize detailed patterns in echocardiographic data, making AS diagnosis more accurate. We evaluated the performance of our CNN models using confusion metrics and the area under the receiver operator curve (AUROC).
Results Our CNN networks were trained on a dataset comprising view_and_diagnosis_labeled_set, which included 599 studies from 577 unique patients (some with multiple studies on distinct days). For classification, we chose three classes: no aortic stenosis, aortic stenosis, and mild aortic stenosis. The detection of aortic stenosis achieved an accuracy of 85.74%. External validation using three views (PLAX, PSAX, and A4C) of outpatient transthoracic echocardiograms demonstrated effective screening for AS, yielding respective AUROCs of 0.81, 0.88, and 0.48.
Conclusion Our novel CNN-based approach achieved an 85,74% accuracy in AS detection using diverse views from the TMED 2 dataset. External validation on outpatient echocardiograms demonstrated robust screening capabilities, with AUROCs of 0.81, 0.88, and 0.48 for PLAX, PSAX, and A4C views, respectively. These promising results suggest the potential of AI in improving AS diagnosis for clinical applications. Moving forward, our future endeavors will focus on addressing data imbalances and detecting the view of images, in addition to assessing the severity of aortic stenosis, to further refine and optimize our diagnostic approach.

Objective: Simple hepatic steatosis can no longer be ignored as a "benign finding", and the management and evaluation of the clinical interventions depend on the degree of hepatic steatosis. Here, we aimed to investigate the feasibility and diagnostic performance of thermoacoustic imaging (TAI) for assessing hepatic steatosis grades in a rabbit model.

Methods: High-fat diet was used for the rabbits. To collect various degrees of hepatic steatosis, the diet duration was different (4, 8, 12, 16, 20, and 24 weeks). An in-vivo liver TAI imaging system was developed. At the end of the feed point, rabbits underwent the TAI and laparotomy for liver histopathology.

Results: We performed TAI and histopathologic examinations for 33 rabbits developing none (n = 4), mild (n = 16), moderate (n = 6), and severe (n = 7) steatosis with/without hepatic fibrosis. A strong correlation was found between the thermoacoustic fat coefficient (TAFC) derived from TAI and liver fat percentage (Pearson correlation coefficient, 0.865; P < 0.001). Besides, TAFC showed significant differences between the consecutive grades of steatosis. TAI potentially provided a good diagnostic performance, with 83% sensitivity and 100% specificity for mild steatosis, 92% sensitivity and 95% specificity for moderated steatosis, and 100% sensitivity and 92% specificity for severe steatosis. The fibrosis stage did not significantly affect the TAFC.

Conclusion: Our findings demonstrate that TAI is a promising way to evaluate hepatic steatosis grades.

Objective: To investigate the ultrasonographic characteristics and outcomes of fetal umbilical-portal-systemic venous shunts (UPSVS).

Methods: UPSVS cases at a single center between January 2015 and December 2022 were retrospectively investigated. The ultrasonographic features, types, and postnatal outcomes of fetal UPSVS were analyzed and the outcomes were followed up on. The study was approved by our institutional review board (Approval Number KY2021130).

Results: Forty UPSVS cases, including 4 Type I, 18 Type II, and 18 Type III (16 with IIIa and 2 with IIIb) were identified. Two Type I cases were terminated because of the complete absence of the portal venous (PV) system. Genetic assessment revealed that one patient with Type I had a q22.11 deletion in trisomy 21. Type II is characterized by structural malformations, particularly cardiovascular abnormalities. Couples opted for pregnancy termination in four cases of Type II. The most common anomaly in Type III shunts was cardiac enlargement, followed by fetal growth restriction. Pregnancy was terminated in six cases of Type IIIa as requested by the couples, one resulting from premature birth, and two because of the completely absent PV system. Genetic tests showed that trisomy X had a microduplication in one patient. The shunt spontaneously closed after birth in all Type IIIa cases.

Conclusions: Prenatal diagnosis of UPSVS using ultrasonography is feasible and valuable for perinatal management and prenatal consultation. The fetal postnatal prognosis is determined by the presence of anomalies in the PV system, genetics, or structure.

Objective: This study investigates the correlation between early B-type natriuretic peptide (BNP) levels and ultrasound hemodynamics following liver transplantation, with the aim of evaluating short-term prognosis.

Methods: We analyzed data from 924 patients who underwent liver transplantation between December 2012 and October 2022. Ustilizing the clinical liver transplantation ultrasound imaging database software V1.0 developed by Tianjin First Central Hospital, we recorded various ultrasonic dynamic parameters, including peak systolic velocity (PSV), end-diastolic velocity (EDV), peak systolic/diastolic flow velocity (S/D), resistance index (RI), pulsatility index (PI), and portal vein velocity (PVV). Additionally, BNP values were recorded within 24 hours post-surgery. We analyzed the correlation between ultrasound blood flow parameters and BNP levels. Patients were categorized into death and survival groups based on their prognosis at 3 months, and differences in blood flow parameters were compared between these groups. Furthermore, short-term prognosis was assessed based on blood flow parameters associated with diastolic blood flow.

Results: Negative correlations were observed between BNP and the resistance index (RI) and pulsatility index (PI) on the first day after surgery (r = -0.473, r = -0.602, both P < 0.05). Similar correlations were found on the fifth day post-surgery (r = -0.406, r = -0.518, both P < 0.05). Additionally, peak systolic velocity (PSV), end diastolic velocity (EDV), and BNP levels were significantly higher in the death group compared to the survival group on both the first and fifth days after surgery (all P < 0.05), while RI and PI were lower in the death group (both P < 0.05). The systolic/diastolic (S/D) ratio in the death group was also lower than that in the survival group on the first and fifth days post-surgery (both P = 0.001). Furthermore, the presence of early diastolic blood flow after surgery was not associated with short-term prognosis in either group (both P > 0.05).

Conclusion: Early BNP levels correlate with ultrasound blood flow parameters following liver transplantation, providing a foundation for evaluating cirrhotic cardiomyopathy. Patients with a poor short-term prognosis exhibit elevated BNP levels, altered dynamic circulation, and low-resistance blood flow

Objective: Non-alcoholic fatty liver disease (NAFLD) is a chronic liver disease with a high incidence worldwide, and its incidence is increasing year by year. Plasma atherogenic Index (AIP) is used to assess the risk of cardiovascular disease and metabolic dysfunction, and albumin to glutamyltransferase ratio (AGR) is often used to assess liver function, nutritional status, and immune system diseases. This study aimed to assess the association of AIP, AGR and non-alcoholic fatty liver disease and to establish a practical and cost-effective prediction model.

Methods: Using data from the National Health and Nutrition Examination Survey (NHANES) from March 2017 to March 2020, residents 18 years of age and older with complete demographic, laboratory, and instantaneous elastography test data were included. SPSS 27.0 and R 4.4.0 were used to analyze the data, single-factor Logistic regression analysis was applied to screen the influencing factors of NAFLD, stepwise regression was applied to screen the variables, and multi-factor Logistic regression was performed to construct the prediction model and draw the column graph.

Results: AIP (OR = 3.549, 95% CI: 1.876-6.712) was a risk factor for NAFLD, and AGR (OR = 0.782, 95% CI: 0.655-0.934) was a protective factor for NAFLD. The calibration curve of NAFLD was stable, and the ROC curve AUC was 0.859.

Conclusion: AIP is an independent risk factor for NFLAD. AGR is an independent protective factor for NAFLD

Purpose: Early diagnosis and treatment of non-alcoholic fatty pancreatic disease (NAFPD) can effectively intervene in the development of type 2 diabetes. This study aimed to evaluate the utility of an improved ultrasound method for diagnosing NAFPD.

Methods: All patients underwent abdominal ultrasonography (US) and magnetic resonance imaging (MRI) mDixon-Quant technique. Patients with a pancreatic fat fraction (PFF) > 6.2% were in the NAFPD group (NA) and the rest were in the normal group (NC). MRI mDixon-Quant technique was used to evaluate the diagnostic efficiency of NAFPD with improved ultrasound diagnosis.

Results: This study included 46 participants. The MRI mDixon-Quant had good repeatability and reproducibility in measuring PFF. The kappa value of the improved version ultrasound (IVUS) method and MRI diagnosis was 0.760 (95% confidence interval [CI] = 0.662-0.858, P < 0.001). That of traditional version ultrasound (TVUS) and MRI diagnosis was 0.497 (P < 0.001). Statistical analyses revealed that pancreatic grading based on both ultrasound evaluation methods correlated with PFF, with IVUS (R² = 0.812) superior to TVUS (R² = 0.496). Body weight, body mass index, triglyceride level, abdominal circumference, abdominal visceral fat, total abdominal fat, abdominal visceral fat area, and liver fat content were significantly higher in the NA versus NC group (P < 0.05). Fat fractions of the pancreatic head, body, and tail in the NA group were significantly higher than those in the NC group (P < 0.05).

Conclusion: IVUS more consistently predicts NAFPD and correlates better with MRI than TVUS.