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Objective This study explored the value of stomach ultrasound reporting and data system (Su-RADS) and two-dimensional shear wave elastography (2D-SWE) in the diagnosis of benign and malignant lesions of the gastric wall, evaluating the feasibility of combining the two methods for the diagnosis of gastric wall lesions. Methods 113 patients with gastric wall lesions were examined after oral gastric ultrasound contrast agent, and the grades of the gastric wall lesions were classified according to Su-RADS. Moreover, 2D-SWE was performed to measure the E value of the lesions. ROC curves were constructed to evaluate the diagnostic efficacy of Su-RADS, 2D-SWE and their combination for gastric wall lesions. Results The cutoff values for Emean and Emax were 8.01 kPa and 11.08 kPa, respectively. The sensitivity and specificity of 2D-SWE were 70.59%, 93.67% and 85.69%, 88.61%, respectively. The diagnostic sensitivity and specificity of Su-RADS were 91.18% and 82.28%, respectively. The AUC of combination of two methods was 0.951, which was greater than that of Su-RADS (0.940) or 2D-SWE alone (0.853, 0.903), and the sensitivity and specificity were 82.35% and 94.94%. The sensitivity and specificity of the combination of the two methods for the diagnosis of malignant gastric lesions were 82.35% and 94.94%, respectively. The AUC was 0.951, and the Youden index was 0.8064. The DeLong test was used to determine the AUC between the combination of two methods and 2D-SWE was P  < 0.05. Conclusion Compared with Su-RADS or 2D-SWE alone, the combination of the two methods is more effective at diagnosing of gastric wall.And improved the specificity in the diagnosis of gastric wall lesions.

Objectives To investigate the most common errors in residents’ preliminary reports, if structured reporting impacts error types and frequencies, and to identify possible implications for resident education and patient safety. Material and methods Changes in report content were tracked by a report comparison tool on a word level and extracted for 78,625 radiology reports dictated from September 2017 to December 2018 in our department. Following data aggregation according to word stems and stratification by subspecialty (e.g., neuroradiology) and imaging modality, frequencies of additions/deletions were analyzed for findings and impression report section separately and compared between subgroups. Results Overall modifications per report averaged 4.1 words, with demonstrably higher amounts of changes for cross-sectional imaging (CT: 6.4; MRI: 6.7) than non-cross-sectional imaging (radiographs: 0.2; ultrasound: 2.8). The four most frequently changed words (right, left, one, and none) remained almost similar among all subgroups (range: 0.072–0.117 per report; once every 9–14 reports). Albeit representing only 0.02% of analyzed words, they accounted for up to 9.7% of all observed changes. Subspecialties solely using structured reporting had substantially lower change ratios in the findings report section (mean: 0.2 per report) compared with prose-style reporting subspecialties (mean: 2.0). Relative frequencies of the most changed words remained unchanged. Conclusion Residents’ most common reporting errors in all subspecialties and modalities are laterality discriminator confusions (left/right) and unnoticed descriptor misregistration by speech recognition (one/none). Structured reporting reduces overall error rates, but does not affect occurrence of the most common errors. Increased error awareness and measures improving report correctness and ensuring patient safety are required. Key Points • The two most common reporting errors in residents’ preliminary reports are laterality discriminator confusions (left/right) and unnoticed descriptor misregistration by speech recognition (one/none). • Structured reporting reduces the overall the error frequency in the findings report section by a factor of 10 (structured reporting: mean 0.2 per report; prose-style reporting: 2.0) but does not affect the occurrence of the two major errors. • Staff radiologist review behavior noticeably differs between radiology subspecialties.

The study aimed to assess the diagnostic accuracy of point-of-care ultrasound (POCUS) in identifying small bowel obstruction (SBO) and to investigate the impact of clinician experience level and body mass index (BMI) on POCUS performance for diagnosing SBO in the Emergency Department. We systematically searched PubMed and Cochrane databases from January 2011–2022. We performed a meta-analysis using individual patient-level data from prospective diagnostic accuracy studies from which we obtained data from the corresponding authors. Overall test characteristics and subgroup analysis across clinician experience levels and a range of BMI were calculated. The primary outcome was SBO as the final diagnosis during hospitalization. We included Individual patient data from 433 patients from 5 prospective studies. Overall, 33% of patients had a final diagnosis of SBO. POCUS had 83.0% (95%CI 71.7%–90.4%) sensitivity and 93.0% (95%CI 55.3%–99.3%) specificity; LR+ was 11.9 (95%CI 1.2–114.9) and LR- was 0.2 (95%CI 0.1–0.3). Residents had exhibited a sensitivity of 73.0% (95%CI 56.6%–84.9%) and specificity of 88.2% (95%CI 58.8%–97.5%), whereas attendings had demonstrated a sensitivity of 87.7% (95%CI 71.1%–95.4%) and specificity of 91.4% (95%CI 57.4%–98.8%). Among those patients with BMI<30 kg/m2, POCUS showed a sensitivity of 88.6% (95%CI 79.5%–94.7%) and a specificity of 84.0% (95%CI 75.3%–90.6%), while patients with BMI ≥ 30 kg/m2 exhibited a sensitivity of 72.0% (95%CI 50.6%–87.9%) and specificity of 89.5% (95%CI 75.2%–97.1%). POCUS correctly identified those patients with SBO with high sensitivity and specificity. Diagnostic accuracy was slightly reduced when performed by resident physicians and among patients with a BMI ≥ 30 kg/m2. Registration: PROSPERO registration number: CRD42022303598.

Objectives To undertake a systematic review to assess the accuracy of fetal MRI in diagnosis of non-CNS congenital anomalies of the fetal body in comparison with antenatal ultrasound when correlated to postnatal diagnosis. Methods Searches were conducted from electronic databases, key journals and reference lists for eligible papers. Inclusion criteria was original research studies comparing the diagnostic results of antenatal ultrasound, fetal MRI and final postnatal diagnosis via imaging, surgery or post-mortem testing. Studies of CNS anomalies were excluded. Studies were assessed for risk of bias by two reviewers working independently and data was then extracted by a single reviewer. Results 12 studies were included with a total of 361 eligible patients who underwent USS and MRI and had a postnatal diagnosis. USS alone had a diagnostic accuracy of 60.6% whereas MRI had an improved diagnostic accuracy of 86.4%. The overall odds ratio was 0.86 (CI 0.202–1.519 and p -value < 0.01). Conclusion Fetal MRI makes a significant contribution to accurate diagnosis of congenital abnormalities of the fetal body; especially in genito-urinary anomalies. More research is needed to improve the evidence base for the role of fetal MRI in diagnosis of congenital anomalies in other body systems. Key points Antenatal ultrasound is the gold standard for detection of anomalies of the fetal body during pregnancy. Fetal MRI used in addition to ultrasound is more accurate at detecting anomalies of the fetal body. Fetal MRI is most useful in detection of bilateral renal disease and assessment of its severity, in cases where oligohydramnios affects ultrasound accuracy and in exclusion of cloacal abnormalities. This study may be limited by the sample size of included studies.

Objectives To evaluate the relevant factors associated with malignancy in Breast Imaging Reporting and Data System (BI-RADS) 4A and to determine whether it was possible to establish a safe follow-up guideline for lower-risk 4A lesions. Methods In this retrospective study, patients categorized as BI-RADS 4A on ultrasound who underwent ultrasound-guided biopsy or/and surgery between June 2014 and April 2020 was analyzed. Classification-tree method and cox regression analysis were used to explore the possible correlation factors of malignancy. Results Among 9965 patients enrolled, 1211 (mean age, 44.3 ± 13.5 years; range, 18–91 years) patients categorized as BI-RADS 4A were eligible. The result of cox regression analysis revealed the malignant rate was only associated with patient age (hazard ratio (HR) = 1.038, p  < 0.001, 95% confidence interval (CI): 1.029–1.048) and the mediolateral diameter of the lesion (HR = 1.261, p  < 0.001, 95% CI: 1.159–1.372). The malignant rate for patients (≤ 36 y) with BI-RADS 4A lesions (the mediolateral diameter ≤ 0.9 cm) was 0.0% (0/72). This subgroup included fibrocystic disease and adenosis in 39 patients (54.2%), fibroadenoma in 16 (22.2%), intraductal papilloma in 8 (11.1%), inflammatory lesions in 6 (8.3%), cyst in 2 (2.8%), and hamartoma in 1 (1.4%). Conclusions Patient age and lesion size are associated with the rate of malignancy in BI-RADS 4A. For patients with lower-risk BI-RADS 4A lesions (≤ 2% likelihood of malignancy), short-term follow-up with ultrasound may be offered as an acceptable alternative to immediate biopsy or surgery.

Background: The liver is involved in disseminated tuberculosis in more than 80% of cases while primary liver involvement is rare, representing <1% of all cases. Hepatic tuberculosis (TB) can be treated by conventional anti-TB therapy; however, diagnosing this disease remains a challenge. The diagnosis might be particularly difficult in patients with a single liver lesion that could be misdiagnosed as a tumor or other focal liver lesions. Although computed tomography (CT) and magnetic resonance imaging (MRI) findings have been described, there is a paucity of literature on contrast-enhanced ultrasound (CEUS) features of hepatic TB. Case Summary: herein, we describe a case of a patient with tuberculous lymphadenopathy and chronic Hepatitis C Virus (HCV)-related liver disease who developed a single macronodular hepatic TB lesion. Due to the finding of a hepatocellular carcinoma (HCC) highly suggestive CEUS pattern, specifically a LR5 category according to the Liver Imaging Reporting and Data System (LI-RADS), and a good response to antitubercular therapy, a non-invasive diagnosis of HCC was made, and the patient underwent liver resection. We also review the published literature on imaging features of hepatic TB and discuss the diagnostic challenge represented by hepatic TB when occurs as a single focal liver lesion. Conclusions: this report shows for the first time that the CEUS pattern of hepatic TB might be misinterpreted as HCC and specific imaging features are lacking. Personal history and epidemiological data are mandatory in interpreting CEUS findings of a focal liver lesion even when the imaging pattern is highly suggestive of HCC.

ObjectivesGlobalization and migration are increasing the demand for reports in different languages. We aimed to examine if structured reports created by non-German-speaking radiologists with multilingual templates show significant differences in quality to structured reports and free-text reports by German native speakers.MethodsWe used structured templates that allow radiologists to report in their mother tongue and then switch the report language to German or English automatically using proprietary software. German- and English-speaking radiology residents created structured reports in both German and English with these templates. Reports for three different exam types were created (intensive care chest x-ray, shoulder x-ray specifically for degenerative processes, and CT pulmonary angiogram for pulmonary embolism). The report quality of automatically translated German structured reports by English-speaking radiologists and German structured reports by German radiologists was then evaluated by German clinicians with a standardized questionnaire. The questionnaire was designed to assess attributes including content, comprehensibility, clinical consequences, and overall quality.ResultsStructured reports by English-speaking radiologists that were automatically translated into German and German structured reports by German radiologists both received very high or high overall quality ratings in the majority of cases, showing no significant differences in quality. Likewise, no significant differences were observed between the two report types regarding comprehensibility and clinical consequences. Structured reports by German radiologists received significantly better ratings for overall quality and comprehensibility compared to free-text reports by German radiologists.ConclusionsMultilingual structured reporting templates may serve as a feasible tool for creating high-quality radiology reports in foreign languages.Key Points• Multilingualism in structured reporting templates can be a useful tool for creating high-quality radiology reports in foreign languages.• German reports created with multilingual structured reporting templates by English-speaking radiologists and German structured reports by German radiologists exhibit no significant differences in overall report quality.• Multilingual structured reporting templates can help radiologists overcome communication barriers and facilitate teleradiology.

Photonics, especially optical coherence elastography (OCE) and second harmonic generation (SHG) imaging are novel high-resolution imaging modalities for characterization of biological tissues. Following our preliminary experience, we hypothesized that OCE and SHG imaging would delineate the microstructure of prostate tissue and aid in distinguishing cancer from the normal benign prostatic tissue. Furthermore, these approaches may assist in characterization of the grade of cancer, as well. In this study, we confirmed a high diagnostic accuracy of OCE and SHG imaging in the detection and characterization of prostate cancer for a large set of biopsy tissues obtained from men suspected to have prostate cancer using transrectal ultrasound (TRUS). The two techniques and methods described here are complementary, one depicts the stiffness of tissues and the other illustrates the orientation of collagen structure around the cancerous lesions. The results showed that stiffness of cancer tissue was ~57.63% higher than that of benign tissue (Young's modulus of 698.43±125.29 kPa for cancerous tissue vs 443.07±88.95 kPa for benign tissue with OCE. Using histology as a reference standard and 600 kPa as a cut-off threshold, the data analysis showed sensitivity and specificity of 89.6 and 99.8%, respectively. Corresponding positive and negative predictive values were 99.5 and 94.6%, respectively. There was a significant difference noticed in terms of Young's modulus for different Gleason scores estimated by OCE (P-value<0.05). For SHG, distinct patterns of collagen distribution were seen for different Gleason grade disease with computed quantification employing a ratio of anisotropic to isotropic (A:I ratio) and this correlated with disease aggressiveness.

ObjectiveTransabdominal ultrasound after oral administration of an echoic cellulose-based gastric ultrasound contrast agent (TUS-OCCA) has recently been suggested as a valuable mass-screening tool for gastric cancer. The aim of this study was to propose a producible stomach ultrasound reporting and data system (Su-RADS) using TUS-OCCA for gastric cancer screening.PatientsThe study includes information of 2738 patients who underwent both gastroscopy and TUS-OCCA examinations recorded in software system. Gastroscopy examination with pathological diagnosis was considered as gold standard. Various gastric lesions were classified into category 1–5 based on gastric wall thicknesses of them (especially the mucosa layer).ResultsThe total malignant ratios of patients enrolled in this study were 17.1% (469/2738). The malignant ratios for category 1–5 were, respectively, 1.1, 1.7, 12.2, 34.2 and 78.1%. Category 2 indicated mild thickening of gastric wall at low risk for malignancy (1.7%); category 3 indicated moderate thickening at moderate risk for malignancy (12.2%); category 4 indicated severe thickening at high risk for malignancy (34.2%); category 5 indicated extremely severe thickening at extremely high risk for malignancy (78.1%). If category 2 was identified as cut-off point distinguishing between benign and malignant, the sensitivity and specificity by Su-RADS are 95.1 and 78.6%, respectively.ConclusionThe Su-RADS system could inform the physicians about key findings, indicating the risk for malignancy and necessity of additional gastroscopy examination. Prospectively randomly controlled study design with larger clinical trial is needed for further investigations.

Technological developments in point-of-care ultrasound (POCUS), particularly with portable devices, are transforming POCUS use in austere, resource-limited environments (RLS) distinct from typical hospital or medical settings. POCUS has potential to improve diagnostic accuracy in military combat zones, low-resource environments such as the desert or tropics, microgravity, and high altitudes. Our updated narrative scoping review describes POCUS use in these global settings. Using the PRISMA-ScR guidelines, two ultrasound-trained emergency physicians searched PubMed, Embase, and Web of Science on August 6, 2024 for \"point-of-care ultrasound in austere environments\" and each individual category. Study titles and abstracts were independently screened, then full manuscripts, and data was abstracted with a data collection table. 324 articles met inclusion criteria: research studies describing POCUS in austere environments; involving healthcare professionals; and in English. We excluded abstracts, studies not involving POCUS in austere environments, and non-clinical studies. Reviewers critically appraised studies using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) Quality Assessment Tool. There were 39 military or conflict zone studies, 101 prehospital, 148 in RLS including low- and middle-income countries, 12 outer space, 15 high altitude, and 32 involving POCUS use in multiple austere environments. There were 6 randomized-control trials, 11 systematic/scoping reviews, 13 narrative reviews, 112 prospective observational/cohort, 34 prospective cross-sectional studies, 23 retrospective, 6 feasibility, 45 case reports, 13 case series, and 5 educational curriculum studies. GRADE study quality was variable, with 74 high quality, 129 moderate, 82 low, and 56 very low. The existing literature is mixed with variability in study settings, design, and POCUS examination types, providing an initial understanding of POCUS applications. Most studies are in RLS or prehospital settings. Additional high-quality studies are needed to guide POCUS training, disseminate use in non-hospital settings, and maximize impact for improved clinical outcomes in diverse austere environments.