To evaluate left atrial structure and function in patients with heart failure with preserved ejection fraction (HFpEF) complicated by paroxysmal atrial fibrillation (AF) using four-dimensional automated left atrial quantification (4D Auto LAQ) technology, and to explore the correlation between LA remodeling and AF in HFpEF patients.

A total of 109 HFpEF patients admitted to the First Affiliated Hospital of Zhengzhou University from December 2023 to December 2024 were enrolled and divided into a paroxysmal AF group (n=40) and a non-AF group (n=69). Clinical data were collected, and echocardiographic parameters (2D, color Doppler, and tissue Doppler) were measured. 4D Auto LAQ was applied to obtain LA volumetric and strain parameters [left atrial minimum volume (LAV_min), left atrial maximum volume index (LAVI_max), left atrial pre-systolic volume (LAV_preA), left atrial stroke volume (LAEV), left atrial total ejection fraction (LAEF), left atrial systolic longitudinal and circumferential strain (LASr/LASr-c), left atrial pipeline longitudinal and circumferential strain (LAScd/LAScd-c), and left atrial systolic longitudinal and circumferential strain (LASct/LASct-c)]. Differences in these parameters between the two groups were assessed using the t-test. Receiver operating characteristic (ROC) curve analysis was performed to assess the overall diagnostic efficacy of left atrial parameters for HFpEF combined with paroxysmal AF and calculate the optimal cut-off value. Logistic regression analysis was utilized to analyze the correlation between left atrial parameters and the occurrence of paroxysmal AF in patients with HFpEF.

Compared to the non-AF group, the paroxysmal AF group showed increased LAV_min, LAVI_max, and LAV_preA [(64.08±16.44) ml vs (36.67±15.68) ml; (51.68±11.56) ml/m²vs (38.13±10.38) ml/m²; (71.93±16.80) ml vs (50.17±16.99) ml], and the differences were statistically significant (t=-6.610, -6.297, and -5.660, respectively, all P＜0.001). The absolute values of LAEV, LAEF, LASr, LASr-c, LAScd, LAScd-c, LASct, and LASct-c were all decreased [(20.93±6.44) ml vs (27.26±9.28) ml; (25.23±7.88)% vs (43.55±9.70)%; (6.78±3.42)% vs (14.41±4.15)%; (7.60±4.25)% vs (21.25±9.59)%; (-4.93±3.08)% vs (-8.65±3.46)%; (-4.93±3.38)% vs (-10.14±5.60)%; (-1.90±3.39) vs (-5.81±3.26); (-2.83±3.24)% vs (-11.72±5.89)%; all P＜0.001). LASr demonstrated the highest diagnostic performance for identifying HFpEF with paroxysmal AF (area under the curve [AUC]=0.928, 95% confidence interval [CI]: 0.875-0.980, P＜0.001), with an optimal cutoff value of 8.5%, sensitivity of 72.5%, and specificity of 97.1%. Logistic regression analysis demonstrated that LASr was independently associated with paroxysmal AF in HFpEF patients after adjusting for clinical and other echocardiographic parameters (odds ratio=0.340, 95%CI: 0.137-0.847, P=0.011).

The LASr measured by 4D Auto LAQ technology is independently associated with the presence of paroxysmal AF in patients with HFpEF.

To compare hemodynamic responses, incidence of adverse reactions, and diagnostic performance of regadenoson (RSE) versus adenosine stress echocardiography (ASE) in patients with obstructive coronary artery disease (OCAD).

A total of 54 patients scheduled for coronary angiography (CAG) for suspected OCAD at Shaanxi Provincial People's Hospital (December 2023-April 2024) were enrolled in a two-stage randomized crossover trial (≥24 h washout). All participants underwent both RSE and ASE. Time to peak effect, heart rate (HR), systolic/diastolic blood pressure (SBP/DBP), and adverse reactions were compared. Coronary angiography (stenosis≥50% in any major epicardial vessel defined as positive) served as the gold standard. Diagnostic performance for overall OCAD was evaluated using contingency tables and area under the ROC curve (AUC), with subgroup analysis performed for patients with left anterior descending artery (LAD) lesions. AUC values were compared by the DeLong test. Other comparisons were performed using paired t-tests, Wilcoxon signed-rank tests, or chi-square tests as appropriate.

Time to peak effect was shorter with RSE than with ASE [50.00 (46.47, 54.79) s vs 90.00 (88.59, 108.67) s, Z=-6.179, P＜0.001]. RSE induced a greater ΔHR increase [32.20 (25.75, 39.25) beats/min vs 23.00 (18.75, 29.25) beats/min, Z=-5.041, P＜0.001] and a more moderate ΔDBP decrease [(24.93±10.55) mmHg vs (20.63±9.61) mmHg, t=2.724, P=0.009]. The rate of adverse reactions was lower with RSE (33.33% vs 64.81%, χ²=10.71, P＜0.001). Sensitivity, accuracy, specificity, or AUC for OCAD diagnosis showed no significant differences in overall or LAD subgroup analysis (all P＞0.05).

Compared to ASE, RSE offers advantages including a shorter time to peak, a more pronounced heart rate response, milder blood pressure fluctuations, and a lower incidence of adverse reactions.

To quantify and compare the changes in global/regional longitudinal and circumferential left ventricular strain in patients with severe aortic stenosis with preserved versus reduced ejection fraction (EF).

A total of 73 patients with severe aortic stenosis who were diagnosed and treated at the First Affiliated Hospital of Xinjiang Medical University between June 2021 and September 2024 were enrolled. The patients were divided into an EF-preserved group (n=50) and an EF-reduced group (n=23) based on an ejection fraction cutoff of 50%. A third group of 50 healthy volunteers, enrolled during the same period, served as controls. Conventional echocardiography and speckle tracking were utilized to obtain left ventricular parameters, global and regional longitudinal myocardial strain, circumferential strain, and left ventricular-arterial coupling parameters. Differences in these parameters among the three groups were evaluated using one-way ANOVA or the Kruskal-Wallis H test.

Both groups of severe aortic stenosis patients showed decreased longitudinal strain in all segments compared to the control group (P＜0.001). The reduced EF group showed decreased longitudinal strain in approximately 55% (10/18) of segments compared to the preserved EF group [basal anteroseptal segment: (-7.85±2.88)% vs (-9.47±4.37)%; mid inferoseptal segment: (-8.90±3.30)% vs (-12.74±3.24)%; mid inferior segment: (-9.23±3.37)% vs (-11.76±3.58)%; mid anterolateral segment: (-7.66±2.89)% vs (-10.05±3.12)%; apical anteroseptal segment: (-12.56±6.04)% vs (-16.17±5.11)%; apical inferoseptal segment: (-12.31±4.53)% vs (-17.62±3.57)%; apical inferior segment: (-11.71±4.01)% vs (-15.88±4.71)%; apical posterior segment: (-8.90±3.40)% vs (-13.26±4.84)%; apical anterolateral segment: (-8.91±3.83)% vs (-13.40±3.48)%; apical anterior segment: (-10.36±3.67)% vs (-13.80±7.19)%, P＜0.001]. Both groups of severe aortic valve stenosis patients showed decreased circumferential strain in all segments compared to the control group (P＜0.001). The reduced EF group showed decreased circumferential strain in approximately 83% (15/18) of segments compared to the preserved EF group [basal anteroseptal segment: (-13.61±6.08)% vs (-19.47±5.59)%; basal inferoseptal segment: (-14.60±5.30)% vs (-18.58±4.66)%; basal inferior segment: (-14.35±7.59)% vs (-19.02±5.54)%; basal posterior segment: (-14.70±6.78)% vs (-18.72±5.90)%; basal anterolateral segment: (-12.82±5.39)% vs (-16.58±4.88)%; basal anterior segment: (-14.12±6.51)% vs (-18.81±6.14)%; mid anteroseptal segment: (-14.29±7.56)% vs (-19.71±4.51)%; mid inferoseptal segment: (-15.53±6.88)% vs (-20.89±5.37)%; mid inferior segment: (-16.48±7.36)% vs (-21.70±5.32)%; mid posterior segment: (-15.80±7.75)% vs (-19.64±5.18)%; mid anterolateral segment: (-14.04±5.87)% vs (-17.69±5.62)%; apical inferoseptal segment: (-16.54±7.72)% vs (-20.71±5.17)%; apical inferior segment: (-16.06±7.75)% vs (-21.51±5.39)%; apical anterolateral segment: (-15.47±7.56)% vs (-19.79±5.59)%; apical anterior segment: (-15.49±6.99)% vs (-20.66±5.34)%; P＜0.001]. In In terms of transmural gradient strain, both longitudinal and circumferential transmural gradients were reduced in the EF-preserved group and EF-reduced group compared with the control group. Furthermore, a more pronounced reduction in the transmural gradient was observed in the EF-reduced group than in the EF-preserved group. In both groups of patients with severe aortic stenosis [EF-preserved group: 0.67 (0.62, 0.79); EF-reduced group: 1.26 (1.07, 1.68)], the left ventricular-arterial coupling index was increased compared with the control group [0.56 (0.53, 0.62)], and the increase was more significant in the EF-reduced group than in the EF-preserved group (H=78.275, P＜0.001). In patients with severe aortic stenosis, both global longitudinal strain (GLS) and global circumferential strain (GCS) showed a decreasing trend as the ejection fraction decreased. Among these, when left ventricular ejection fraction decreased from 50% to 40%, the decrease in GLS and GCS was most marked.

Compared with normal controls, the global/regional longitudinal strain and circumferential strain of the left ventricular wall are reduced in patients with severe aortic stenosis, while left ventricular-arterial coupling is elevated. In patients with reduced EF, the above strain parameters are reduced more significantly than in those with preserved EF, while the index of left ventricular-arterial coupling is further elevated.

To explore the feasibility of using ultrasound vector flow imaging (V Flow) technology to evaluate wall shear stress (WSS) across different segments of the femoral-popliteal arteries in healthy adults, and to analyze its distribution patterns and influencing factors.

A total of 101 healthy adult volunteers (202 limbs) recruited from Peking University International Hospital between May 2022 and May 2023 were included. Using a Mindray Resona7 ultrasound system equipped with V Flow software (v2.5), the maximum wall shear stress (WSS_max) and mean wall shear stress (WSS_mean) were measured in the common femoral artery, common femoral artery bifurcation, proximal superficial femoral artery, mid superficial femoral artery, distal superficial femoral artery, and popliteal artery. Blood flow velocity (T-Max) was simultaneously measured at each site. A linear mixed model was used to analyze differences in WSS across segments and its correlation with blood flow velocity, as well as to examine the effects of gender, age, body mass index, and systolic blood pressure on WSS. Images from 30 randomly selected volunteers were independently measured by two doctors, and inter-observer consistency was assessed using intraclass correlation coefficient (ICC) and Bland-Altman analysis.

Both WSS_max [(4.09±1.04) Pa] and WSS_mean [(0.69±0.25) Pa] at the common femoral artery bifurcation were significantly lower than those in adjacent segments (both P＜0.001). From the proximal superficial femoral artery to the popliteal artery, WSS_max and WSS_mean showed a gradually decreasing trend. WSS was significantly positively correlated with blood flow velocity (WSS_max: r=0.660, P＜0.001; WSS_mean: r=0.705, P＜0.001). Age was an independent influencing factor for WSS_mean (F=10.197, P=0.002), with WSS_mean decreasing as age increased. For every 1-year increase in age, WSS_mean decreased by 0.005 Pa (95% confidence interval: -0.008 to -0.002). Inter-observer consistency analysis showed ICC values of 0.918 for WSS_max and 0.880 for WSS_mean, and Bland-Altman analysis indicated no significant systematic measurement bias between observers.

Ultrasound V Flow technology can noninvasively and reliably measure WSS in the femoral-popliteal arteries of healthy adults. WSS is significantly lower at the common femoral artery bifurcation compared with adjacent segments, and shows a gradually decreasing trend from the proximal superficial femoral artery to the popliteal artery, consistent with hemodynamic principles. WSS is significantly positively correlated with blood flow velocity and decreases with advancing age.

To evaluate the utility of a nomogram model integrating clinical parameters, B-mode ultrasound features, and super-resolution contrast-enhanced ultrasound (SR-CEUS) characteristics for predicting human epidermal growth factor receptor 2 (HER-2) positive breast cancer.

We enrolled 132 patients with pathologically confirmed invasive breast cancer (55 HER-2 positive, 77 HER-2 negative) from the Second Hospital of Shanxi Medical University between March and September 2025. All patients underwent preoperative B-mode ultrasound and SR-CEUS examinations. Predictors were screened through univariate and multivariate logistic regression analyses. Three predictive models were constructed: Model 1 (clinical parameters + B-mode ultrasound features), Model 2 (SR-CEUS characteristics alone), and Model 3 (clinical parameters + B-mode ultrasound features + SR-CEUS characteristics). A nomogram was developed based on Model 3. Internal validation was performed using the bootstrap method. Model performance was assessed via receiver operating characteristic (ROC) curves, with area under the curve (AUC) differences compared using DeLong test. Calibration curves and the Hosmer-Lemeshow test were used to evaluate calibration and goodness-of-fit, while decision curve analysis (DCA) was performed to quantify clinical decision benefit.

Univariate analysis revealed significant associations between HER-2 status and estrogen receptor (ER), progesterone receptor (PR), calcification, perfusion defects, vascular density, flow weighted vessel density (FWVD), perfusion index (PI), and blood flow velocity (OR=0.174, 0.149, 3.399, 2.837, 1.085, 1.104, 1.231, 1.081, all P＜0.05). Multivariate analysis identified PR negativity (odds ratio [OR]=0.211), calcification (OR=2.553), perfusion defects (OR=3.469), FWVD (OR=1.088), and PI (OR=1.184) as optimal predictors. The AUC values for Models 1, 2, and 3 in predicting HER-2 positive breast cancer were 0.763, 0.832, and 0.880, respectively. The combination model (Model 3) demonstrated a significantly higher AUC than Model 1 (P＜0.001) and Model 2 (P=0.039). Internal validation confirmed model stability. Calibration curves and the Hosmer-Lemeshow test indicated good calibration and fit. DCA showed superior net clinical benefit across a wide threshold probability range for the combination model.

The nomogram integrating clinical parameters, B-mode ultrasound features, and SR-CEUS characteristics effectively predicts HER-2 positive breast cancer.

To compare the diagnostic value of the American College of Radiology thyroid imaging reporting and data system (ACR TI-RADS) and Chinese thyroid imaging reporting and data system (C-TIRADS) in thyroid micronodules.

A total of 1213 patients with 1599 thyroid micronodules confirmed by surgical pathology were enrolled. According to the ACR TI-RADS and C-TIRADS, thyroid micronodules were evaluated and scored. Using surgical pathology as the golden standard, a ROC curve was constructed to determine the optimal cut-off value. Nodules with scores above the cutoff were classified as malignant, while those below as benign. The diagnostic efficacy of ACR TI-RADS and C-TIRADS systems for thyroid microcarcinomas was then analyzed and compared by DeLong test.

Both ACR TI-RADS and C-TIRADS scores and classifications of malignant nodules were higher than those of benign nodules (P＜0.05), with AUC values being 0.702, 0.658, 0.710, and 0.686, respectively. The DeLong test shows the AUC values of the scoring systems were greater than those of the classification systems (Z=3.768 and 2.370, respectively, P=0.0002 and 0.0178, respectively). When the Youden index was the largest, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the ACR TI-RADS system were 89.66%, 41.70%, 89.93%, and 59.00%, respectively; and the corresponding values of the C-TIRADS system were 88.71%, 44.26%, 90.23%, and 59.69%, with no statistically significant differences between the two systems (χ²=0.642, 0.313, 0.070, and 0.025, respectively, P=0.423, 0.576, 0.791, and 0.875, respectively).

Although the ACR TI-RADS and C-TIRADS scoring systems demonstrate superior diagnostic efficacy compared to their classification counterparts, their overall performance remains suboptimal, which may compromise the diagnostic accuracy for thyroid nodules to some extent.

To explore the clinical and imaging features of breast fibromatosis (BF).

Clinical data of 39 patients (with a total of 48 lesions) who underwent ultrasound examination and were pathologically confirmed as having BF in the First Affiliated Hospital with Nanjing Medical University from January 2015 to August 2025 were collected. A retrospective analysis was performed on the clinical, ultrasound, mammographic, and MRI data.

The mean age of BF patients was (30.7±9.4) years, and the mean maximum diameter of the lesions was (27.6±17.8) mm. Among the patients who were followed up, 10 cases showed signs of recurrence after surgery, as indicated by ultrasound or MRI. On conventional ultrasound, BF lesions were mainly located in the glandular layer (33/48, 68.8%), and were predominantly of non-mass type (31/48, 64.6%). Most lesions presented as irregular hypoechoic lesions (40/48, 83.4%), with typically homogeneous internal echoes (45/48, 93.8%), clear boundaries (29/48, 60.4%), frequent spiculated or angular margins (42/48, 87.5%), rare calcifications (1/48, 2.1%), and mostly no change in posterior echoes (44/48, 91.7%). The Adler blood flow grade was typically grade 1 (24/48, 50.0%) or grade 2 (20/48, 41.7%). On elastography, BF lesions commonly scored 3 (16/35, 45.7%) or 4 (17/35, 48.6%). On contrast-enhanced ultrasound (CEUS), most BF lesions presented as heterogeneous enhancement (5/6, 83.3%), with absent or minimal internal enhancement and prominent peripheral rim enhancement. Mammographic examination showed that BF mostly appeared as round-like high-density nodules (12/23, 52.2%), while a minority presented as glandular structure retraction (4/23, 17.4%) or irregular masses with spiculation (4/23, 17.4%). A total of 27 lesions underwent MRI, among which 17 were mass-type lesions, most of which exhibited an irregular shape (10/17, 58.8%) and showed homogeneous contrast enhancement (11/17, 64.7%). In contrast, non-mass-type BF (10 lesions) manifested as ill-defined non-mass-like enhancement (10/10, 100%). The time-intensity curves on dynamic contrast-enhanced MRI were predominantly of the progressive type (20/27, 74.1%), and the apparent diffusion coefficient was (1.16±0.22)×10^-3 mm²/s.

BF exhibits certain clinical and imaging characteristics. The three imaging modalities—ultrasound, MRI, and mammography—are complementary to each other, providing important reference information for the diagnosis and treatment of BF.

To compare the diagnostic efficacy, safety, and clinical value between direct core needle biopsy and coaxial-assisted biopsy for pancreatic lesions under ultrasound guidance.

This retrospective study enrolled 134 consecutive patients who underwent ultrasound-guided percutaneous pancreatic core needle biopsy at the First Affiliated Hospital of Zhengzhou University between January 2020 and December 2024. The patients were stratified into two groups according to the biopsy approach used: direct biopsy group (n=45) and coaxial needle-assisted biopsy group (n=89). Given the potential for selection bias and imbalanced sample sizes, one-to-one propensity score matching (PSM) was employed to balance baseline characteristics between groups, with age, gender, lesion size, and lesion location serving as matching covariates. After PSM, 45 matched pairs (90 patients in total) were included in the final comparative analysis. Primary outcomes included technical success rate and pathological diagnostic accuracy. Secondary outcomes comprised the number of needle passes, procedure duration, and complication rates. Statistical comparisons were performed using the independent samples t-test for continuous variables and the chi-square test or Fisher's exact test for categorical variables, as appropriate.

After matching, baseline characteristics were well-balanced between groups (all P＞0.05). Both groups achieved a 100% technical success rate. The diagnostic accuracy was 97.8% (44/45) in both groups, showing no significant difference (P＞0.05). The direct biopsy group demonstrated significantly shorter operation time [(15.3±3.2) min vs (22.8±4.0) min] and fewer needle passes [(1.38±0.65) vs (2.51±0.98)] compared with the coaxial-assisted biopsy group (t=9.512 and 6.437, respectively; both P＜0.001). Complication rates were 11.1% (5/45) in the direct biopsy group and 13.3% (6/45) in the coaxial-assisted group, showing no significant difference (P＞0.05). No severe complications occurred in either group. In the matched cohort, 76 cases (84.4%) were diagnosed with malignant tumors and 14 (15.6%) with benign lesions.

This study demonstrates that ultrasound-guided direct core needle biopsy is safe and effective for diagnosing pancreatic lesions, showing comparable diagnostic efficacy to coaxial-assisted biopsy while being simpler to perform and requiring less time. It may be considered as the preferred method for pancreatic lesion biopsy.