Objective:To verify and compare the correlation and diagnostic efficacy of international bowel ultrasound segmental activity score（IBUS-SAS），bowel ultrasound score（BUSS），simple ultrasound score for Crohn's disease（SUS-CD），and simple ultrasound score（Simple-US）with endoscopic disease activity in Crohn's disease（CD）patients. To provide external validation of the diagnostic efficacy of intestinal ultrasound（IUS）score and theoretical basis for clinical selection of optimal IUS score.Methods:A total of 160 patients with clinical diagnosis of CD combined with IUS and intestinal endoscopy were retrospectively analyzed in the Second Affiliated Hospital of Zhejiang University School of Medicine from January 2022 to August 2024. IUS parameters were measured and scored with IBUS-SAS，SUS-CD，BUSS and Simple-US scores. Endoscopic SES-CD was used to evaluate intestinal disease activity in patients without history of intestinal resection，and Rutgeerts score was used to evaluate intestinal disease activity in patients with history of intestinal resection. Endoscopic remission in patients with CD was defined as SES-CD < 3 or Rutgeerts score i0 and i1，mild endoscopic disease activity was defined as 7 > SES-CD≥3 or Rutgeerts score = 2，moderate endoscopic disease activity was defined as 15 > SES-CD≥7 or Rutgeerts score i3，severe endoscopic disease activity was defined as SES-CD≥15 or Rutgeerts i4. The correlation and diagnostic efficacy of IBUS-SAS，SUS-CD，BUSS and Simple-US scores with endoscopic disease activity in patients with CD were compared and analyzed.Results:IUS scores including IBUS-SAS，SUS-CD，BUSS and Simple-US were significantly correlated with endoscopic intestinal disease activity，SES-CD and Rutgeerts scores in CD patients（ r s = 0.706，0.492，0.502，0.526；0.825，0.581，0.584，0.603；0.541，0.434，0.437，0.467；all P＜0.05）. Among them，IBUS-SAS showed better correlation than the other three IUS scores. ROC curve showed that IBUS-SAS，SUS-CD，BUSS，and Simple-US had high predictive values for endoscopic disease activity and endoscopic disease moderate-severe activity in patients with CD（AUC = 0.886，0.748，0.730，0.756；all P＜0.05）. The diagnostic efficacy of IBUS-SAS on the presence of endoscopic disease activity in patients with CD was significantly higher than those of the other three IUS scores . Conclusions:IBUS-SAS，SUS-CD，BUSS and Simple-US are significantly correlated with the endoscopic results of on intestinal disease activity of CD，and have high predictive values for intestinal disease activity status，among which IBUS-SAS is superior to the other three IUS scores. It is recommended that IBUS-SAS be used first to evaluate intestinal disease activity in patients with CD.

Carotid ultrasound is the primary imaging modality for evaluating carotid artery diseases.In recent years,novel ultrasound techniques such as pulse wave velocity imaging,shear wave elastography,superb microvascular imaging,three-dimensional ultrasound and contrast-enhanced ultrasound,have been employed in assessment of carotid pathologies,providing important evidences for clinical diagnosis and prognostic evaluation.The progresses of clinical applications of carotid ultrasound were reviewed in this article.

Carotid ultrasound is the primary imaging modality for evaluating carotid artery diseases.In recent years,novel ultrasound techniques such as pulse wave velocity imaging,shear wave elastography,superb microvascular imaging,three-dimensional ultrasound and contrast-enhanced ultrasound,have been employed in assessment of carotid pathologies,providing important evidences for clinical diagnosis and prognostic evaluation.The progresses of clinical applications of carotid ultrasound were reviewed in this article.

Objective:To verify and compare the correlation and diagnostic efficacy of international bowel ultrasound segmental activity score（IBUS-SAS），bowel ultrasound score（BUSS），simple ultrasound score for Crohn's disease（SUS-CD），and simple ultrasound score（Simple-US）with endoscopic disease activity in Crohn's disease（CD）patients. To provide external validation of the diagnostic efficacy of intestinal ultrasound（IUS）score and theoretical basis for clinical selection of optimal IUS score.Methods:A total of 160 patients with clinical diagnosis of CD combined with IUS and intestinal endoscopy were retrospectively analyzed in the Second Affiliated Hospital of Zhejiang University School of Medicine from January 2022 to August 2024. IUS parameters were measured and scored with IBUS-SAS，SUS-CD，BUSS and Simple-US scores. Endoscopic SES-CD was used to evaluate intestinal disease activity in patients without history of intestinal resection，and Rutgeerts score was used to evaluate intestinal disease activity in patients with history of intestinal resection. Endoscopic remission in patients with CD was defined as SES-CD < 3 or Rutgeerts score i0 and i1，mild endoscopic disease activity was defined as 7 > SES-CD≥3 or Rutgeerts score = 2，moderate endoscopic disease activity was defined as 15 > SES-CD≥7 or Rutgeerts score i3，severe endoscopic disease activity was defined as SES-CD≥15 or Rutgeerts i4. The correlation and diagnostic efficacy of IBUS-SAS，SUS-CD，BUSS and Simple-US scores with endoscopic disease activity in patients with CD were compared and analyzed.Results:IUS scores including IBUS-SAS，SUS-CD，BUSS and Simple-US were significantly correlated with endoscopic intestinal disease activity，SES-CD and Rutgeerts scores in CD patients（ r s = 0.706，0.492，0.502，0.526；0.825，0.581，0.584，0.603；0.541，0.434，0.437，0.467；all P＜0.05）. Among them，IBUS-SAS showed better correlation than the other three IUS scores. ROC curve showed that IBUS-SAS，SUS-CD，BUSS，and Simple-US had high predictive values for endoscopic disease activity and endoscopic disease moderate-severe activity in patients with CD（AUC = 0.886，0.748，0.730，0.756；all P＜0.05）. The diagnostic efficacy of IBUS-SAS on the presence of endoscopic disease activity in patients with CD was significantly higher than those of the other three IUS scores . Conclusions:IBUS-SAS，SUS-CD，BUSS and Simple-US are significantly correlated with the endoscopic results of on intestinal disease activity of CD，and have high predictive values for intestinal disease activity status，among which IBUS-SAS is superior to the other three IUS scores. It is recommended that IBUS-SAS be used first to evaluate intestinal disease activity in patients with CD.

Objective:To investigate the effect of clinical practice of evidence-based medicine (EBM) in facilitating the essential competent capability of ultrasound medicine residents.Methods:A total of 39 residents undergoing standardized residency training in the Department of Ultrasound Medicine at the Second Affiliated Hospital of Zhejiang University School of Medicine from October 2021 to October 2024 were randomly assigned into two groups: control group (19 residents) and an evidence-based traceability group (20 residents). The two groups received same EBM theoretical teaching materials, however, the evidence-based traceability group was additionally required to complete a clinical practice component in ultrasound medicine as part of their EBM curriculum. A comparison was made between the two groups at the conclusion of the teaching cycle with respect to self-assessment (EBM attitude, skills, knowledge), objective test (case analysis, theoretical knowledge), and teaching satisfaction.Results:After the teaching period, the evidence-based traceability group exhibited significantly elevated self-assessment scores in both EBM theoretical knowledge and practice skills when compared to the control group with scores of (26.70±1.17)score vs (21.37±4.15)score and (22.40±1.39)score vs (17.79±3.15)score, respectively (both P<0.001). In the objective test (case analysis, theoretical knowledge), the evidence-based traceability group scored higher in case analysis relevant to clinical scenarios compared to the control group[(59.55±4.56) score vs (52.11±6.58) score, P<0.001], while no statistically significant difference was observed in theoretical knowledge[(29.00±3.08) score vs (27.89±4.19) score, P=0.357]. Both groups reported high teaching satisfaction, with no significant difference between groups ( P>0.05). Conclusions:The incorporation of clinical practice in EBM education for ultrasound medicine residents enhances their clinical practice abilities and improves their analytical and problem-solving skills in real clinical scenarios, contributing to the development of general competent capability among residents.

Objective:To investigate the effect of clinical practice of evidence-based medicine (EBM) in facilitating the essential competent capability of ultrasound medicine residents.Methods:A total of 39 residents undergoing standardized residency training in the Department of Ultrasound Medicine at the Second Affiliated Hospital of Zhejiang University School of Medicine from October 2021 to October 2024 were randomly assigned into two groups: control group (19 residents) and an evidence-based traceability group (20 residents). The two groups received same EBM theoretical teaching materials, however, the evidence-based traceability group was additionally required to complete a clinical practice component in ultrasound medicine as part of their EBM curriculum. A comparison was made between the two groups at the conclusion of the teaching cycle with respect to self-assessment (EBM attitude, skills, knowledge), objective test (case analysis, theoretical knowledge), and teaching satisfaction.Results:After the teaching period, the evidence-based traceability group exhibited significantly elevated self-assessment scores in both EBM theoretical knowledge and practice skills when compared to the control group with scores of (26.70±1.17)score vs (21.37±4.15)score and (22.40±1.39)score vs (17.79±3.15)score, respectively (both P<0.001). In the objective test (case analysis, theoretical knowledge), the evidence-based traceability group scored higher in case analysis relevant to clinical scenarios compared to the control group[(59.55±4.56) score vs (52.11±6.58) score, P<0.001], while no statistically significant difference was observed in theoretical knowledge[(29.00±3.08) score vs (27.89±4.19) score, P=0.357]. Both groups reported high teaching satisfaction, with no significant difference between groups ( P>0.05). Conclusions:The incorporation of clinical practice in EBM education for ultrasound medicine residents enhances their clinical practice abilities and improves their analytical and problem-solving skills in real clinical scenarios, contributing to the development of general competent capability among residents.

Objective:To investigate the value of Breast Ultrasound Report and Data System (BI-RADS) classification in diagnosis of special types of breast cancer.Methods:A total of 112 patients with special type of breast cancer (112 breast lesions) confirmed by pathology were analyzed by using BI-RADS ultrasound category in the Second Affiliated Hospital, Zhejiang University School of Medicine from August 2009 to August 2020. All patients underwent ultrasound before surgery. The breast lesions were evaluated by senior attending and junior resident according to BI-RADS ultrasound category respectively. Taking histopathological result as the gold standard, the sensitivity and accuracy of BI-RADS classification in the diagnosis of special types of breast cancer were calculated.The differences between different special types of breast cancer in terms of ultrasound characteristics and pathological features were analyzed. Kappa consistency test was used to evaluated the consistency of the results of two physicians.Results:In the 112 patients, pathological results showed that there were 20 cases of metaplastic carcinoma, 19 cases of invasive carcinoma with medullary features, 16 cases of differentiated carcinoma of apocrine gland, 12 cases of mucinous carcinoma, 12 cases of invasive micropapillary carcinoma, 10 cases of invasive papillary carcinoma, 6 cases of invasive lobular carcinoma and 17 cases of other special types of carcinoma. Among them, 4 cases (3.5%) were BI-RADS 3, 13 cases (11.6%) were BI-RADS 4a, 42 cases (37.5%) were BI-RADS 4b, 47 cases (42.0%) were BI-RADS 4c and 6 cases (5.4%) were BI-RADS 5. The accuracy and sensitivity of BI-RADS classification in diagnosis of special types of breast cancer was 96.43% and 96.43%, respectively. There was significant difference in BI-RADS grade among different special types of breast cancer ( P<0.05). Most lesions were characterized by hypoechoic with irregular shape and angular or microlobulated margin. The nodule size, boundary, echo and posterior echo in breast cancer with different special types showed significant differences (all P<0.05). There was a good consistency between the two physicians (Kappa=0.789). Conclusions:The ultrasonography features of different special types of breast cancer are different. BI-RADS classification has great value in diagnosis of special types of breast cancer.

Objective:To evaluate the value of ultrasound imaging in cervical lymphoma by constructing a prediction model of cervical lymphoma based on gray-scale ultrasonography radiomics.Methods:Retrospective analysis of ultrasonic sonographic data of 294 patients with cervical lymphadenopathy from June 2016 to June 2020 in the Affiliated Hangzhou Chest Hospital of Zhejiang University School of Medicine. The image features were extracted by imaging method, and the computer-generated random numbers were assigned to the training queue and the verification queue according to 7∶3 ratio. The minimum absolute contraction and selection algorithm (LASSO) were used to screen the optimal features, and support vector machine (SVM) was used to construct the imaging prediction model. The area under the ROC curve (AUC) was calculated to evaluate the performance of the prediction model.Results:Of the 294 cervical lymph nodes, 95 were lymphoma (32 Hodgkin′s lymphoma, 63 Non-Hodgkin′s lymphoma ), 199 cases were other lymph node diseases(34 metastatic lymph nodes, 67 lymph node tuberculosis, 98 reactive proliferative lymph nodes). A total of 107 features were extracted from gray scale ultrasound images, and after pretreatment and screening, 5 features were significantly associated with lymphoma. AUC, sensitivity, specificity and accuracy in the training and validation cohorts were 0.835, 85.1%, 85.7%, 85.5%, 0.793, 82.1%, 83.1%, 82.8%, respectively. The AUC, sensitivity, specificity and accuracy for a senior ultrasund doctor were 0.714, 65.3%, 79.9%, 75.2% in the idagnosis of cervical lymphoma.The diagnostic efficacy of the imaging prediction model was better than that of senior ultrasound doctor (AUC: 0.793 vs 0.714, Z=0.434), and the difference was statistically significant ( P<0.05). Conclusions:The imaging features based on gray scale ultrasound can provide more information on the diagnosis of lymphoma, and have good efficacy in the diagnosis of cervical lymphoma. Its diagnostic efficacy is better than that of the senior ultrasound attending physician.

Objective:To evaluate the relationships among contrast-enhanced ultrasound (CEUS) features, molecular type, and biomarker expression of breast cancer.Methods:A retrospectively analysis of breast cancer patients confirmed by pathology were performed using Breast Imaging Report And Data System (BI-RADS) ultrasound category lesions in the Second Affiliated Hospital Zhejiang University School of Medicine from May 2020 to April 2021. All patients underwent conventional ultrasound and CEUS before biopsy and/or surgery. The relationships among BI-RADS category, quantitative and qualitative CEUS features and biomarker expression of breast cancer were evaluated.Results:All 149 patients with 149 breast lesions were included. The numbers of BI-RADS category 4A, 4B, 4C, and 5 were 8, 60, 49, and 32, respectively. Among them, the numbers of Luminal A like, Luminal B like (human epidermal growth factor receptor-2 (HER-2) positive), Luminal B like (HER-2 negative), HER-2 overexpression and triple negative type were 81, 29, 17, 15, and 7. No significant correlations were found among BI-RADS category, molecular types, and biomarker estrogen receptor (ER), progesterone receptor (PR), HER-2, and antigen Ki-67 (Ki-67) expression (all P>0.05). There were no correlations between quantitative or qualitative CEUS features and molecular types of breast cancer (all P>0.05). There were no correlations between qualitative CEUS variables and ER, PR, HER-2, and Ki-67 expression (all P>0.05). Ascending slope (AS) were negatively correlated with ER and PR expression( r=-0.40, P=0.01; r=-0.35, P=0.03). Descending slope (DS) were positively correlated with ER and PR expression( r=0.42, P=0.01; r=0.36, P=0.03). Arrive time (AT) were positively correlated with HER-2 expression( r=0.37, P=0.02). Conclusions:AS and DS are correlated with ER and PR expression.Arrive time (AT) is correlated with HER-2 expression. The quantitative variables of CEUS are helpful for evaluation of biomarker expression in breast cancer.

Objective:To assess the interobserver and inter-modalities agreement with two non-invasive diagnostic modalities of hepatocellular carcinoma in high-risk patients: contrast-enhanced ultrasound liver imaging reporting and data system (CEUS LI-RADS) and magnetic resonance imaging liver imaging reporting and data system (MRI LI-RADS).Methods:From August 2017 to August 2019, the CEUS and MRI data of patients at high risk for HCC from the Second Affiliated Hospital of Zhejiang University School of Medicine were analyzed retrospectively. A total of 217 lesions in 173 patients were classified according to CEUS LI-RADS v. 2017 or MRI LI-RADS v. 2018, by 4 blinded independent observers with more than 10 years of experience of CEUS or MRI. Interobserver and inter-modalities agreement was assessed with Cohen′s kappa.Results:The interobserver agreement was moderate and comparable for CEUS/MRI LI-RADS category (κ=0.606/0.603), the inter-modalities agreement was moderate for CEUS and MRI LI-RADS category (κ=0.564), LI-RADS 3, M, 4 and 5 by two imaging methods showed that the Kappa values were 0.739, 0.551, 0.734 and 0.592, respectively.Conclusions:The total inter-modalities agreement between CEUS and MRI LI-RADS categories is moderate, while the agreements of LI-RADS 3, 4 are strong, and LI-RADS M, 5 are moderate.