Jul 2026· International journal of research and review· 0 citations· 22 references
Abstract
Background: Focal hepatic lesions span a wide spectrum from benign incidental findings to aggressive malignancies, and accurate characterisation is essential for management. Conventional grayscale ultrasonography is the usual first-line modality but is limited by artefacts, low signal-to-noise ratio and poor margin delineation. Tissue harmonic imaging (THI) reconstructs images from harmonic signals generated within tissue, potentially improving image quality. This study compared THI with conventional ultrasonography and assessed its diagnostic performance against histopathology.
Materials and Methods: In this prospective observational study, 80 patients with focal hepatic lesions underwent paired conventional ultrasonography and THI. Lesion conspicuity, margin definition, artefact burden, signal-to-noise ratio, posterior acoustic enhancement, fluid–solid differentiation and overall image quality were graded on an ordinal scale by two observers. Imaging was correlated with histopathology obtained by fine-needle aspiration cytology or biopsy. Paired image-quality scores were compared using the Wilcoxon signed-rank test.
Results: The cohort was predominantly elderly (mean age 62.5 years) and male (67.5%), with multifocal, right-lobe, hypoechoic or heterogeneously hypoechoic lesions predominating. Metastatic disease (47.5%) and hepatocellular carcinoma (38.8%) were the commonest diagnoses. THI was significantly superior for lesion conspicuity, margin definition, artefact suppression, signal-to-noise ratio, posterior acoustic enhancement, fluid–solid differentiation and overall image quality (p < 0.05). Against histopathology, THI showed a sensitivity of 85.5%, specificity of 77.8%, positive predictive value of 93.0%, negative predictive value of 60.9% and accuracy of 83.8% (area under the curve 0.816).
Conclusion: Tissue harmonic imaging significantly improves image quality and diagnostic confidence over conventional ultrasonography and should be routinely incorporated into hepatic ultrasound protocols.
Key words: Tissue harmonic imaging, Conventional ultrasonography, Focal hepatic lesions, Image quality, Hepatocellular carcinoma, Liver metastases.
BACKGROUND
Preoperative differentiation of benign and malignant salivary gland lesions remains challenging. Contrast-enhanced ultrasound (CEUS) enables real-time assessment of tumor microvascularization and has emerged as a promising adjunct to conventional ultrasound.
PURPOSE
To systematically review the evidence on CEUS in focal salivary gland lesions and to evaluate its diagnostic accuracy, including feature-level diagnostic performance.
MATERIALS AND METHODS
A systematic search of PubMed was conducted for studies published from database inception to December 2025, evaluating contrast-enhanced ultrasound (CEUS) in focal salivary gland lesions, using histopathology as the reference standard. Qualitative and quantitative CEUS features were synthesized. Diagnostic accuracy evidence was assessed at both study and feature levels. Risk of bias was evaluated using the QUADAS-2 tool.
RESULTS
Ten studies comprising 663 focal salivary gland lesions (470 benign and 193 malignant) were included in the qualitative synthesis. Malignant lesions were consistently associated with heterogeneous enhancement, ill-defined or blurred margins, non-enhancing areas suggestive of necrosis, and altered contrast kinetics. Quantitative CEUS analyses demonstrated shorter time to peak enhancement, higher peak enhancement, steeper wash-in slopes, and larger areas under the time-intensity curve in malignant tumors compared with benign lesions. Only a limited number of studies reported diagnostic accuracy outcomes using predefined criteria, and substantial heterogeneity in diagnostic thresholds and study design precluded reliable pooled meta-analysis. Across the two studies reporting complete diagnostic accuracy data, CEUS sensitivity ranged from 72.1 to 80.0%, whereas specificity ranged from 78.9 to 91.7%. Feature-level analysis indicated that ill-defined enhancement margins were highly specific for malignancy, whereas inhomogeneous enhancement showed higher sensitivity but limited specificity. Wash-in and wash-out kinetics demonstrated variable diagnostic performance across studies.
CONCLUSION
CEUS provides valuable functional information for the evaluation of focal salivary gland lesions and complements conventional ultrasound by depicting tumor microvascular characteristics. While several qualitative and quantitative CEUS features are associated with malignancy and may aid preoperative risk stratification, methodological heterogeneity and the limited number of high-quality diagnostic accuracy studies currently restrict definitive conclusions. CEUS should be considered an adjunctive imaging tool rather than a standalone alternative to histopathological diagnosis.
Alessio Frisone, G. Balice, M. Serroni et al.· Journal of Ultrasound· 0 citations
OBJECTIVES
Renal cystic lesions are exceedingly common and typically benign, though accurate diagnostic techniques are required to recognize the subset of malignant lesions that require timely intervention. Ultrasound (US) is the preferred first line test for renal cyst evaluation because it is safe, widely accessible, and low cost. US imaging, however, is limited in individuals with obesity, as subcutaneous fat introduces imaging artifacts (eg, aberration) that obscure features critical for assessing a cyst's malignant potential.
METHODS
In this work, we propose a 2-stage image-correction algorithm to improve the resolution, contrast, and potential diagnostic utility of US images of renal cysts. The method combines sound speed correction for beamforming with masking based on the spatial coherence of the beamformed signals.
RESULTS
In a pilot cohort of 10 subjects, we observed improved image sharpness and contrast-to-noise ratio in nearly all cases compared to baseline images (mean improvements of approximately 5 and 10%, respectively). Additionally, 2 expert readers preferred nearly universally the corrected images in a blinded review.
CONCLUSION
Together, the results from this pilot study suggest that our method has translational potential to improve US image quality and enhance clinical confidence in managing the common and clinically important challenge of renal cysts.
S. Schoen, Theodore T. Pierce, Sai Dhanush Reddy Jeggari et al.· Journal of ultrasound in med...· 0 citations
Dynamic contrast-enhanced (DCE) and diffusion-weighted imaging (DWI) magnetic resonance imaging are emerging as reliable non-invasive techniques for characterization of endometrial lesions. This prospective hospital-based study included 80 women with abnormal uterine bleeding who underwent pelvic MRI with DWI, ADC mapping and DCE sequences and findings were correlated with histopathology. Mean ADC values were significantly lower in endometrial cancer (0.86 ± 0.09 ×10⁻³ mm²/s) compared to normal endometrium (1.42 ± 0.15 ×10⁻³ mm²/s; p<0.001), with an optimal ADC cutoff ≤1.10 ×10⁻³ mm²/s yielding an AUC of 0.96. DCE-MRI demonstrated higher sensitivity (93.3%) and specificity (91.7%) than DWI alone and combined DCE+DWI analysis achieved diagnostic sensitivity of 95.2% for malignancy. Thus, data shows the ADC values showed significant inverse correlation with tumor grade, stage and lymph node involvement, indicating strong potential for non-invasive lesion characterization.
Contrast-enhanced low-mechanical-index endoscopic ultrasound (CELMI-EUS) extends the diagnostic capabilities of endoscopic ultrasound by enabling real-time assessment of hepatic microvascularization and perfusion using intravenous ultrasound contrast agents. Owing to its close proximity to the liver and high spatial resolution, CELMI-EUS is particularly suited for the detection and characterization of small or otherwise inconspicuous focal liver lesions. This review summarizes the technical principles of CELMI-EUS, contrast agent usage, vascular phase interpretation, and standardized assessment of benign and malignant focal liver lesions, including the potential and provisional application of CEUS Liver Imaging Reporting and Data System (LI-RADS) terminology in patients at risk for hepatocellular carcinoma, while acknowledging that dedicated validation for CELMI-EUS is lacking. Typical enhancement patterns of common benign lesions such as hemangioma, focal nodular hyperplasia, hepatocellular adenoma, biliary hamartomas, and abscesses are discussed, as well as malignant entities including metastases, hepatocellular carcinoma, and cholangiocarcinoma. In addition, the role of CELMI-EUS in lesion detection, interventional guidance, and its limitations and pitfalls are addressed. Integrated into a multimodality imaging approach alongside transcutaneous CEUS and cross-sectional imaging, CELMI-EUS represents a valuable complementary tool that improves diagnostic confidence and supports optimized management of patients with focal liver lesions.
C. F. Dietrich, K. Moeller, B. Napoléon et al.· Diagnostics· 0 citations
RATIONALE AND OBJECTIVES
This study aimed to explore the diagnostic value of super-resolution ultrasound (SRUS) in differentiating benign from malignant renal solid tumors by assessing microvascular characteristics, and to find if combining SRUS with conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS) potential enhances diagnostic utility.
MATERIALS AND METHODS
This prospective study included 114 pathologically confirmed renal lesions. All patients underwent conventional US, CEUS, and SRUS. We analyzed qualitative and quantitative parameters of CEUS and SRUS, screened significant parameters by univariate analysis, and used a comprehensive diagnostic score method for exploratory receiver operating characteristic (ROC) analysis to construct multiparametric diagnostic panels. Diagnostic performance was evaluated using the area under the receiver operating characteristic curve area under the curve (AUC).
RESULTS
Among 114 masses (88 malignant, 26 benign), malignant lesions exhibited more tortuous vessels and higher microvascular image complexity (p < 0.05). After normalization, microvascular density (MVD) and microbubble velocity showed high spatial heterogeneity in malignancies. CEUS excelled in macroscopic perfusion (AUC=0.842), while SRUS provided incremental microscopic structural information (AUC=0.678); both outperformed conventional US (AUC=0.638). Crucially, the combination of SRUS and CEUS demonstrated improved diagnostic performance (AUC=0.871) in this cohort, suggesting potential complementary value over either modality alone.
CONCLUSION
SRUS non-invasively reveals unique microvascular architecture and heterogeneity in renal malignancies. The combined SRUS-CEUS approach shows promise for improving differential diagnostic accuracy. These results are exploratory and provide preliminary evidence for the potential value of SRUS in renal tumor diagnosis. Key limitations include a relatively small proportion of benign tumors, lacking correction for multiple comparisons, and lack of integration with CEUS time-intensity curve quantitative parameters.
Lu Zhang, Jie Tian, Yilai Chen et al.· Academic Radiology· 0 citations
Abstract Purpose Invasive lobular carcinoma (ILC) exhibits an infiltrative growth pattern with frequent multifocal, multicentric, and bilateral involvement, often leading to underestimation on conventional imaging. This study aimed to compare the diagnostic performance of contrast-enhanced mammography (CEM) and contrast-enhanced magnetic resonance imaging (CE-MRI) for preoperative locoregional staging of ILC. Materials and Methods Women with histologically confirmed ILC who underwent both CEM and CE-MRI for preoperative staging were included in this retrospective single-center study. 46 of 70 consecutive patients met the inclusion criteria. Two dedicated breast radiologists independently and blindly reviewed all examinations. The number of enhancing lesions, maximum lesion diameter, multicentricity, and bilaterality were recorded. Quantitative variables were analyzed using the Wilcoxon signed-rank test, while paired categorical variables were compared using McNemar’s test. Inter-reader agreement was assessed using Cohen’s kappa and intraclass correlation coefficients. Results CEM and CE-MRI showed strong concordance in lesion size assessment, with no significant differences between modalities (p > 0.05). Agreement for bilaterality detection was high for both techniques, with no statistically significant differences. CE-MRI detected a significantly higher number of multicentric cases compared with CEM (p < 0.05). Inter-reader agreement was good to excellent across all parameters. Conclusion CEM demonstrates comparable performance to CE-MRI for assessing lesion size and bilaterality in ILC. However, CE-MRI remains superior for detecting multicentric disease, a key factor in surgical planning. CEM may represent a complementary imaging tool in selected cases. Key Points CEM and MRI show comparable accuracy for lesion size assessment. MRI demonstrates superior sensitivity for detecting multicentric disease. Multicentricity detection may impact surgical planning in selected patients. Citation Format Colarieti A, Minelli P, Bonetti A et al. Preoperative Staging of Invasive Lobular Carcinoma: CEM or CE-MRI?. Rofo 2026 DOI 10.1055/a-2906-1608
Anna Colarieti, Pierluca Minelli, Alice Bonetti et al.· RöFo - Fortschritte auf dem...· 0 citations
