Thyroid nodules are common incidental findings but only a small proportion of cases are malignant (4-6.5%) or symptomatic. Numerous follow-up examinations and invasive diagnostic procedures, such as fine-needle aspiration, fine-needle biopsies, and thyroidectomies, are performed, leading to potentially costly and time-consuming diagnostic procedures and overtreatment. Most experts and scientific societies (EFSUMB, WFUMB...) encourage the use of multiparametric ultrasound evaluation to improve the thyroid nodule characterization thanks also to the continuous technological developments with different ultrasound software (Microvascular flow imaging, Elastosonography...), contrast media (CEUS) and artificial intelligence (AI). Therefore, the recognition and proper use of new multiparametric ultrasound features of thyroid nodules are essential to minimize unnecessary interventions and guide appropriate treatments, also stimulating their use in routine clinical practice, which is the aim of our guideline. In addition, we analyze the use of MPUS in some emblematic thyroid scenarios such as cytologically indeterminate nodule, multinodular goiter and extrathyroidal extension of the malignant nodule and the usefulness of MPUS as a guide to thyroid biopsy/aspiration and in the staging of cervical lymph nodes. For each question, recommendations based on the level of evidence of the published literature and on the EFSUMB expert group's consensus are given.

Thyroid nodules are common incidental findings but only a small proportion of cases are malignant (4-6.5%) or symptomatic. Numerous follow-up examinations and invasive diagnostic procedures, such as fine-needle aspiration, fine-needle biopsies, and thyroidectomies, are performed, leading to potentially costly and time-consuming diagnostic procedures and overtreatment. Most experts and scientific societies (EFSUMB, WFUMB...) encourage the use of multiparametric ultrasound evaluation to improve the thyroid nodule characterization thanks also to the continuous technological developments with different ultrasound software (Microvascular flow imaging, Elastosonography...), contrast media (CEUS) and artificial intelligence (AI). Therefore, the recognition and proper use of new multiparametric ultrasound features of thyroid nodules are essential to minimize unnecessary interventions and guide appropriate treatments, also stimulating their use in routine clinical practice, which is the aim of our guideline. In addition, we analyze the use of MPUS in some emblematic thyroid scenarios such as cytologically indeterminate nodule, multinodular goiter and extrathyroidal extension of the malignant nodule and the usefulness of MPUS as a guide to thyroid biopsy/aspiration and in the staging of cervical lymph nodes. For each question, recommendations based on the level of evidence of the published literature and on the EFSUMB expert group's consensus are given.

This study examines whether combining conventional textbook materials with the app-based ultrasound simulator Scanbooster enhances learning outcomes in fetal echocardiography, compared to using either method alone. It also evaluates the impact of the learning sequence.210 medical students were randomized into two groups: · PDF → App group (n=103): Textbook study followed by the Scanbooster ultrasound simulator app. · App → PDF group (n=107): Scanbooster ultrasound simulator app followed by textbook study. Knowledge was assessed before and after by identifying marked structures in ultrasound videos.There were no significant differences between the groups regarding age (p=0.564) and prior ultrasound experience (p=0.746). Both groups showed a significant improvement in identifying sonographic structures after the learning phase (p<0.001), with a mean learning effect of 104.96% and 102.16%, respectively, for fetal echocardiography-specific knowledge. The order of learning materials had no significant effect on learning success (p>0.05). In comparison with our previous study, we found that the combination of app-based simulation and textbooks led to the best learning outcomes in fetal echocardiography. This approach resulted in significantly higher performance compared to pure PDF learning (p<0.001) and was slightly, yet still significantly better than pure simulation (p=0.031).The combination of conventional textbook materials and app-based ultrasound simulation is the most effective approach for teaching fetal echocardiography. The learning sequence does not significantly impact the outcome.

This position paper of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) on professional standards in thoracic ultrasound is a supplement to EFSUMB's previously published professional standards in medical ultrasound - general aspects. The paper represents a position across the different medical professions within EFSUMB regarding optimal standards for the performing and reporting of thoracic ultrasound examinations by any professional ultrasound practitioner. It describes aspects that ensure procedure quality, effectiveness, efficiency, and sustainability in the application of thoracic ultrasound. The paper provides recommendations regarding safety and the indication for thoracic ultrasound examinations, requirements for examination rooms, structured examinations, systematic reporting of results, and the management, communication, and archiving of ultrasound data.

Ectopic pregnancy - any pregnancy outside the uterine cavity - affects 1-2 % of all pregnancies. While the diagnosis and treatment of the most common ectopic pregnancy (tubal pregnancy which accounts for > 90 % of cases) is established, other forms, such as Caesarean scar pregnancy, pose an increasing challenge. This article describes the different forms of ectopic pregnancies and the respective therapeutic options.

Arteria lusoria (AL), a rare vascular variant (0.5-3.2% prevalence), is linked to a right non-recurrent laryngeal nerve (RNRLN), increasing nerve injury risk during thyroid / parathyroid surgery. This study evaluates ultrasonography (US) for preoperative AL detection.

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Vascularization assessment is crucial for ovarian masses diagnosis; however, its subjectivity often results in suboptimal interobserver agreement. This study evaluated the impact of the OvAi denoising algorithm on IOTA color score assignment and perceived image quality in adnexal mass ultrasound.

Head rotation and subsequent hypoperfusion of the brain stem might be possible causal factors of sudden infant death. This study aimed to determine the quantitative changes of cerebral blood flow as assessed on ultrasound (US) Doppler with respect to dependence on the position and age of the subject.This single-center retrospective study was performed to assess US Doppler measurements on vertebral and basilar arteries of neonates and infants. After measuring peak systolic flow (Vs) and time-averaged velocity (TAM) in the middle supine position, each subject was positioned with the head rotated to the right and left both in a supine and a prone position. Both vertebral arteries were measured, and results were correlated to individual age at the time of investigation.A total of n=1889 subjects were analyzed. Vs was 63.0±15.3cm/s in the supine middle position and reduced after head rotation to 59.9±21.6 m/s (P <0.0001, head rotated right) and 59.4±15.6cm/s (P <0.0001, left). In the prone position Vs was 58.4±14.8cm/s (P <0.0001, head rotated right) and 58.1±15.0cm/s (P <0.0001, left). Comparable measurements were made for TAV. There was a correlation of TAV and Vs with individual postnatal age.Head rotation and different positioning of the neonate/young infant leads to lower Vs and TAV values in the basilar artery. It remains unclear if these changes may help to identify patients at risk of SIDS. Furthermore, Vs and TAV are age-dependent, which should be considered in the workup of transfontanellar US Doppler investigations.

Sensing ultrasound localization microscopy (sULM) enables radiation-free imaging of microvascular architecture and blood flow dynamics by tracking intravasal microbubble contrast agents. This technical development aims to enable the visualization of glomeruli in the renal cortex of neonates serving as a potential imaging biopsy.This technical report describes the first use of sULM in the human neonatal kidney. Neonatal subjects were examined by transabdominal contrast-enhanced ultrasound using a standard clinical ultrasound device. An image-based motion correction algorithm was implemented and the filtering, localization, and tracking of microbubbles during sULM analysis were refined. sULM algorithms were applied next to depict fast- and slow-moving microbubbles separately and to identify glomeruli by distance metric calculations.Five neonates were investigated. Slow-moving microbubbles were detected mainly in the cortical region, travelling a typical route through a glomerulus. By calculating the cumulative movement of every microbubble, the number of glomeruli could be counted over the entire organ.We report an effective sULM workflow within the human neonate and the first microvascular sULM maps of neonatal renal vascularity up to the scale of a single glomerulus. The assessment of glomeruli as smallest functional units over the whole kidney has high potential to serve as a non-invasive imaging biomarker in future studies.

Approximately 0.8 % of all children are born with heart defects, with the prenatal incidence naturally being even higher. Among all congenital heart defects (CHD), conotruncal anomalies are the most common critical heart defects - after ventricular and atrial septal defects. Conotruncal anomalies are anomalies of the infundibulum (conus arteriosus) and great vessels (truncus arteriosus). These anomalies predominantly affect the right ventricular outflow tract and account for about 25-30 % of all CHD cases. Based on their incidence and clinical relevance, this article describes perimembranous ventricular septal defects (VSD), tetralogy of Fallot (TOF), pulmonary atresia with VSD (PAVSD), transposition of the great arteries (TGA), and the less common double outlet right ventricle (DORV) and truncus arteriosus communis (TAC). Conotruncal anomalies are usually associated with a normal 4-chamber view, so the prenatal detection rate during prenatal care tends to be low. However, because undetected conotruncal anomalies have high rates of postnatal mortality and morbidity, in accordance with internationally recommended policies, the foetal heart should always be examined systematically and segmentally in different sectional planes, including the outflow tract and in combination with the color Doppler, to achieve a higher detection rate. This article provides an overview of prenatal sonographic diagnosis of conotruncal anomalies based on extensive imaging material.

(English Version) Ultrasound plays a central role in the diagnosis, monitoring, and management of liver diseases. Assessing hepatic fibrosis is essential in chronic liver disease, and several diagnostic modalities are available. The gold standard remains percutaneous liver biopsy, an invasive method using a 16-18-gauge needle. A breakthrough came in 2003 with transient elastography (TE), a noninvasive technique measuring liver stiffness (kPa) via elastic wave propagation. Later, shear wave elastography (SWE), integrated into modern ultrasound systems, was developed to assess tissue elasticity. SWE generates shear waves (SWs) through acoustic radiation force, assuming tissues to be linearly elastic and homogeneous, and provides quantitative stiffness data. Recent evidence shows hepatic tissue is viscoelastic, with wave propagation varying by frequency. Quantifying viscosity remains a challenge. Fibrosis affects viscoelastic properties and shear wave speed (SWS), while necroinflammation predominantly alters the viscous component, influencing shear wave dispersion slope (SWDS). This review provides an overview of ultrasound elastography, including stiffness and viscosity assessment, their physical principles, and clinical applications in hepatology. Abstract (German Version) Ultraschall ist zentral für Diagnose, Verlaufskontrolle und Therapie von Lebererkrankungen. Die Einschätzung des Fibrosegrads ist entscheidend im Management chronischer Lebererkrankungen. Goldstandard bleibt die invasive Leberbiopsie mit einer 16-18-Gauge-Nadel. Seit 2003 bietet die transiente Elastographie (TE) eine nichtinvasive Alternative, die die Lebersteifigkeit in kPa durch Messung elastischer Wellen bestimmt. Später wurde die Scherwellen-Elastographie (SWE) entwickelt, heute in moderne Ultraschallgeräte integriert. SWE erzeugt laterale Scherwellen (SWs) mittels akustischem Strahlungskraftimpuls und basiert auf der Annahme, dass Gewebe homogen und linear elastisch ist. Dies ermöglicht eine quantitative Bestimmung der Gewebesteifigkeit. Neuere Studien zeigen jedoch, dass Lebergewebe viskoelastisch ist - Wellen unterschiedlicher Frequenz breiten sich mit variabler Phasengeschwindigkeit aus. Die exakte Messung der Viskosität bleibt methodisch anspruchsvoll. Fibrose verändert viskoelastische Eigenschaften und die Scherwellen-Geschwindigkeit (SWS), während nekroinflammatorische Prozesse vor allem die viskose Komponente beeinflussen und damit den Scherwellen-Dispersions-Slope (SWDS). Diese Übersicht beleuchtet Elastographiemethoden zur Beurteilung von Steifigkeit und Viskosität, deren physikalische Grundlagen sowie klinische Anwendungen in der Hepatologie.

Ultrasound is a relevant tool in the diagnosis and characterization of gallbladder polyps. B-mode imaging can be used for the identification of echogenic formations attached to the gallbladder wall, while advanced techniques such as color Doppler, power Doppler, and micro-flow allow a thorough assessment of polyp vascularization. The integration of CEUS further improves diagnostic accuracy by confirming the integrity of the wall and the absence of pathological washout, which is characteristic of malignant lesions. In recent years, several guidelines have been published on the integrated clinical and ultrasound management of polypoid formations of the gallbladder. This review aims to summarize the main evidence regarding the ultrasound study of gallbladder polyps and to provide the sonographer with a clear and practical approach to the clinical management and follow-up of these patients.

In cases of severe or refractory carpal tunnel syndrome (CTS), carpal tunnel release (CTR) can be performed using open surgery, endoscopic techniques, or minimally invasive approaches under high-resolution ultrasound (HRUS) guidance. This study aimed to evaluate the long-term clinical outcomes following HRUS-guided CTR.A retrospective analysis was conducted on 302 HRUS-CTR cases. Patients who were available for a phone interview and had a minimum follow-up period of one year were assessed using the Boston Carpal Tunnel Questionnaire (BCTQ). Symptom severity and functional limitations were compared before and after the procedure.Of the 302 cases screened, 111 cases had to be excluded due to unavailability for the phone call, missing data, or death. Accordingly, 191 cases were included. The average patient age was 60.4 ± 15.5 years (range: 19 to 87 years). 126 cases (66%) were female and 65 cases (34.0%) were male. Overall, there was a significant reduction of 91.9% in CTS-related symptom severity and frequency for all items recorded in the questionnaire. Similarly, a significant reduction of 84.8% in difficulty with all self-reported daily activities was found. In addition, the procedures were performed by four physicians showing no significant differences in technical success and symptoms reduction.HRUS-CTR is a safe and effective method for the treatment of CTS, showing a statistically but mostly clinically significant reduction in symptom severity and hand discomfort, which persisted 1 year after release and should therefore be considered as an alternative approach to open or endoscopic CTR.

Metabolic dysfunction-associated steatotic liver disease (MASLD) can progress to fibrosis and cirrhosis. Fibrosis and steatosis assessment with vibration-controlled transient elastography (VCTE) and controlled attenuation parameter (CAP) requires a dedicated device and time to obtain ≥10 reliable measurements. Auto pSWE allows for the simultaneous collection of 15 ARFI-based liver stiffness measurements (LSM) and UDFF-based steatosis assessment in a single acquisition.This prospective study included patients undergoing liver biopsy, primarily during bariatric surgery, between 11/2021-12/2023. Paired LSM by Auto pSWE/VCTE and steatosis assessments by UDFF/CAP were performed within a median of 1 day before or after biopsy.134 patients (65% women, mean age: 42.6±13.3 years) with a high prevalence of obesity (mean BMI: 42.7±10.4; MASLD etiology: 88%) were included. Liver biopsy showed significant fibrosis (≥F2) in 27% of patients and moderate steatosis (≥S2) in 51%. A single 1×15 Auto pSWE acquisition and one UDFF measurement were as accurate as the median of 5 measurements. Auto pSWE (AUC: ≥F2=0.58, ≥F3=0.96, F4=0.97) and VCTE (AUC: ≥F2=0.60, ≥F3=0.92, F4=0.93) demonstrated high accuracy for advanced fibrosis stages. UDFF (AUC: ≥S1=0.79, ≥S2=0.78, S3=0.67) and CAP showed similar diagnostic accuracy.Auto pSWE and UDFF provide accurate, noninvasive tests for advanced liver fibrosis and steatosis in MASLD, even in severely obese patients. Notably, Auto pSWE captures 15 LSM with UDFF in a single acquisition, saving time and eliminating the need for a dedicated device.

The main goal of fetal growth monitoring is to identify fetuses at increased risk of morbidity and mortality. This study compares 5 commonly used growth charts (Hadlock, FMF, NICHD, INTERGROWTH-21, WHO) to assess their ability to identify pregnancies below the 10 percentile and predict adverse neonatal outcomes.We retrospectively analyzed 572 singleton pregnancies with an estimated fetal weight (EFW) <10 percentile according to Hadlock, excluding multiple pregnancies or cases with maternal comorbidities. Maternal and neonatal data were collected, and EFW and birthweight percentiles were recalculated using the different growth charts. Statistical analyses assessed the association between these charts and adverse neonatal outcomes.The WHO chart classified the fewest pregnancies below the 10 percentile and showed significant differences in composite adverse outcomes between the groups (p < 0.05). Despite a lack of statistical significance, the WHO chart had better prediction for NICU admission compared to others. At the 3 percentile cutoff, all charts showed similar results for NICU admission and adverse outcomes (p < 0.01). For severe adverse outcomes, only the WHO and FMF charts showed significant differences (p = 0.043, p = 0.029).The WHO chart showed superior performance at the 10 percentile cutoff, while all charts were comparable at the 3 percentile. Notably, the WHO and FMF charts significantly differentiated between patients with severe composite adverse outcomes at the 3 percentile to improve the accuracy of diagnosing and predicting neonatal outcomes in small-sized fetuses.