• Diagnosis
• Endosonography
• Esophageal neoplasms
• Lymphatic metastasis
• Meta-analysis
• Stomach neoplasms

• Humans
• Lymphatic Metastasis/diagnostic imaging
• Gastrointestinal Neoplasms/diagnostic imaging
• Endosonography
• Upper Gastrointestinal Tract/diagnostic imaging
• Esophageal Neoplasms

• advance imaging
• endoscopic ultrasound
• shear wave elastography
• strain elastography

• Advance imaging
• Contrast enhancement
• Diagnosis
• Elastography
• Endoscopic ultrasound

• Chronic pancreatitis
• Endoscopic ultrasound-guided
• Lymph node
• Pancreatic cancer
• Strain histogram
• Strain ratio

• Elasticity Imaging Techniques/methods
• Endosonography/methods
• Humans
• Pancreas/pathology
• Pancreatic Neoplasms/pathology
• Pancreatitis, Chronic/diagnostic imaging

Tuberculosis (TB) remains a global threat, with the rise of multiple and extensively drug resistant TB posing additional challenges. The International health community has set various 5-yearly targets for TB elimination: mathematical modelling suggests that a 2050 target is feasible with a strategy combining better diagnostics, drugs, and vaccines to detect and treat both latent and active infection. The availability of rapid and highly sensitive diagnostic tools (Gene-Xpert, TB-Quick) will vastly facilitate population-level identification of TB (including rifampicin resistance and through it, multi-drug-resistant TB). Basic-research advances have illuminated molecular mechanisms in TB, including the protective role of Vitamin D. Also, Mycobacterium tuberculosis impairs the host immune response through epigenetic mechanisms (histone-binding modulation). Imaging will continue to be key, both for initial diagnosis and follow-up. We discuss advances in multiple imaging modalities to evaluate TB tissue changes, such as molecular imaging techniques (including pathogen-specific positron emission tomography imaging agents), non-invasive temporal monitoring, and computing enhancements to improve data acquisition and reduce scan times. Big data analysis and Artificial Intelligence (AI) algorithms, notably in the AI sub-field called “Deep Learning”, can potentially increase the speed and accuracy of diagnosis. Additionally, Federated learning makes multi-institutional/multi-city AI-based collaborations possible without sharing identifiable patient data. More powerful hardware designs - e.g., Edge and Quantum Computing- will facilitate the role of computing applications in TB. However, “Artificial Intelligence needs real Intelligence to guide it!” To have maximal impact, AI must use a holistic approach that incorporates time tested human wisdom gained over decades from the full gamut of TB, i.e., key imaging and clinical parameters, including prognostic indicators, plus bacterial and epidemiologic data. We propose a similar holistic approach at the level of national/international policy formulation and implementation, to enable effective culmination of TB’s endgame, summarizing it with the acronym “TB - REVISITED”.

• Tuberculosis
• Radiology
• GenXpert
• Artificial intelligence
• Molecular imaging
• Quantum computing

The differential diagnosis between benign and malignant lymph nodes (LNs) has a fundamental role in the characterization and staging of malignant conditions, as well as in subsequent patients’ management. All imaging modalities (i.e. computed tomography and magnetic resonance imaging) rely mainly on size; endoscopic ultrasound (EUS) criteria based on B-mode evaluation and Doppler features fail to adequately characterize with high specificity LNs nature. The introduction of EUS-elastography and contrast-enhanced harmonic EUS are useful techniques to increase the diagnostic yield in identifying metastatic LNs, to identify which suspicious LN should require pathological characterization and, finally, to target tissue acquisition. EUS-guided tissue acquisition (EUS-TA) is increasingly being used for diagnosing lymphadenopathy whenever the characterization modifies patients’ subsequent management and when no superficial LN is accessible. Since target therapy are currently available (i.e. lung cancer, breast cancer), EUS-TA of malignant LNs could be required to identify tumor biology. In this field, both fine needle aspiration and biopsy needles are able to guarantee accurate results with almost perfect specificity and sub-optimal sensitivity. We finally propose a diagnostic algorithm based on most recent, high-level evidence for the diagnostic approach to suspected LNs assessment.

• Endoscopic ultrasound-guided tissue acquisition
• Endoscopic ultrasound-fine needle aspiration
• Endoscopic ultrasound-fine needle biopsy
• Biopsy
• Aspiration
• Cancer

• Ultrasound elastography
• imaging.
• ocular tissues
• periocular tissues
• shear wave elastography
• strain elastography

Endoscopic ultrasound tissue acquisition, in the form of both fine needle aspiration (EUS-FNA) and fine needle biopsy (EUS-FNB), is utilized for pancreatic mass lesions, subepithelial lesions, and lymph node biopsy. Both procedures are safe and yield high diagnostic value. Despite its high diagnostic yield, EUS-FNA has potential limitations associated with cytological aspirations, including inability to determine histologic architecture, and a small quantitative sample for further immunohistochemical staining. EUS-FNB, with its larger core biopsy needle, was designed to overcome these potential limitations. However, it remains unclear which technique should be used and for which lesions. Comparative trials are plagued by heterogeneity at every stage of comparison; including variable needles used, and different definitions of endpoints, which therefore limit generalizability. Thus, we present a review of prospective trials, systematic reviews, and meta-analyses on studies examining EUS-FNA vs EUS-FNB. Prospective comparative trials of EUS-FNA vs EUS-FNB primarily focus on pancreatic mass lesions, and yield conflicting results in terms of demonstrating the superiority of one method. However, consistent among trials is the potential for diagnosis with fewer passes, and a larger quantity of sample achieved for next generation sequencing. With regard to subepithelial lesions and lymph node biopsy, fewer prospective trials exist, and larger prospective studies are necessary. Based on the available literature, we would recommend EUS-FNB for peri-hepatic lymph nodes.

• Endoscopic ultrasound fine needle aspiration
• Endoscopic ultrasound fine needle biopsy
• Pancreatic lesions
• Subepithelial lesions
• Lymph node biopsy

• Endoscopic Ultrasound-Guided Fine Needle Aspiration
• Endosonography
• Humans
• Lymph Nodes/diagnostic imaging
• Needles
• Pancreatic Neoplasms/diagnostic imaging
• Prospective Studies

• strain histogram
• strain ratio
• solid pancreatic lesions

• Adult
• Aged
• Aged, 80 and over
• Elasticity Imaging Techniques/methods
• Endosonography/methods
• Female
• Humans
• Male
• Middle Aged
• Pancreatic Neoplasms/diagnostic imaging
• Predictive Value of Tests
• Prospective Studies
• Rural Population
• Sensitivity and Specificity
• Urban Population
• Pancreatic Neoplasms

• EUS-FNA
• endoscopic ultrasound
• pancreas
• slow-pull
• suction

• Diagnosis
• endoscopic ultrasound-guided fine needle aspiration
• lymphadenopathy
• meta-analysis

Elastography is a widely used procedure in conventional ultrasonography that has recently been incorporated in echoendoscopy. This is an innovative and promising technology that aims to increase the negative predictive value of endoscopic ultrasonography and fine-needle aspiration punctures. It is useful for directing punctures in suspect areas and, consequently, improves diagnostic performance. This is a non-invasive technique, easy to perform, without additional costs or complications. The main indications are the analysis of solid pancreatic masses, lymph nodes, subepithelial lesions, lesions in the left hepatic lobe and in the left adrenal. Negative or inconclusive cases of fine-needle aspiration can be submitted to elastography when there is a strong suspicion of malignancy. Elastography has a high precision for the differential diagnosis of solid masses and in difficult-to-access anatomic sites, as well as in mediastinal lymph nodes and pancreatic tumors. The procedure is based on the degree of tissue elasticity measurement, with a good correlation between the elasticity index and histopathological features. We report the case of four patients evaluated by echoendoscopy and qualitative elastography who had differential diagnoses in mediastinal lymph nodes: sarcoidosis, lymphoma, histoplasmosis and esophageal neoplasia.

Endoscopic ultrasound fine-needle aspiration (EUS-FNA) is preferred for sampling of lymph nodes (LNs) adjacent to the gastrointestinal wall; however, fine-needle biopsy (FNB) may provide improved diagnostic outcomes. This study aimed to evaluate the comparative efficacy and safety of FNA versus FNB for LN sampling.

This was a multicenter retrospective study of prospectively collected data to evaluate outcomes of EUS-FNA and EUS-FNB for LN sampling. Characteristics analyzed included sensitivity, specificity, accuracy, the number of needle passes, diagnostic adequacy of rapid on-site evaluation (ROSE), cell-block analysis, and adverse events.

A total of 209 patients underwent EUS-guided LN sampling. The mean lesion size was 16.22±8.03 mm, with similar sensitivity and accuracy between FNA and FNB ([67.21% vs. 75.00%, respectively, p=0.216] and [78.80% vs. 83.17%, respectively, p=0.423]). The specificity of FNB was better than that of FNA (100.00% vs. 93.62%, p=0.01). The number of passes required for diagnosis was not different. Abdominal and peri-hepatic LN location demonstrated FNB to have a higher sensitivity (81.08% vs. 64.71%, p=0.031 and 80.95% vs. 58.33%, p=0.023) and accuracy (88.14% vs. 75.29%, p=0.053 and 88.89% vs. 70.49%, p=0.038), respectively. ROSE was a significant predictor for accuracy (odds ratio, 5.16; 95% confidence interval, 1.15–23.08; p=0.032). No adverse events were reported in either cohort.

Both EUS-FNA and EUS-FNB are safe for the diagnosis of LNs. EUS-FNB is preferred for abdominal LN sampling. EUS-FNA+ ROSE was similar to EUS-FNB alone, showing better diagnosis for EUS-FNB than traditional FNA. While ROSE remained a significant predictor for accuracy, due to its poor availability in most centers, its use may be limited to cases with previous inconclusive diagnoses.

• Endoscopic ultrasound
• Endoscopic ultrasound-guided tissue acquisition
• Fine-needle aspiration
• Fine-needle biopsy
• Lymph nodes

• Bronchoscopy
• Computer-assisted image interpretation
• Elasticity imaging techniques
• Endoscopic ultrasonography
• Lung cancer

• Adult
• Aged
• Aged, 80 and over
• Elasticity Imaging Techniques/methods
• Endoscopic Ultrasound-Guided Fine Needle Aspiration
• Female
• Humans
• Lung Neoplasms/diagnostic imaging
• Lymph Nodes/diagnostic imaging
• Male
• Middle Aged
• Retrospective Studies

• anorectal melanoma
• colonoscopy
• endoscopic ultrasound

Ultrasound findings in autoimmune hepatitis (AIH) have not been reported systematically so far. The use of reliable and accurate noninvasive methods for determining fibrosis stage is important in evaluation of treatment efficacy and fibrosis regression in AIH. Imaging plays an important role in detection of complications and ruling out other possible causes of chronic liver diseases. Ultrasound elastography cut-off values in AIH patients are not the same as those in patients with chronic viral hepatitis or non-alcoholic fatty liver disease. AIH is characterized by wide fluctuations in inflammatory activity. Here we report on current knowledge of ultrasound findings in AIH.

• Autoimmune hepatitis
• Fibrosis stage
• Ultrasound
• Elastography
• Chronic liver diseases

• Biomarkers/analysis
• Diagnosis, Differential
• Elasticity Imaging Techniques/methods
• Hepatitis, Autoimmune/diagnostic imaging
• Hepatitis, Autoimmune/drug therapy
• Hepatitis, Autoimmune/pathology
• Humans
• Immunosuppressive Agents/therapeutic use
• Liver/diagnostic imaging
• Liver/pathology
• Liver Cirrhosis/diagnostic imaging
• Liver Cirrhosis/drug therapy
• Liver Cirrhosis/pathology
• Severity of Illness Index

Strain elastography as used in EUS (EUS-real-time tissue elastography [RTE]) is a qualitative technique and provides information on the relative stiffness between one tissue and another. This article reviews the principles, technique, and interpretation of EUS-RTE in various organs. It includes information on how to optimize the technique as well as a discussion on pitfalls and artifacts. We also refer to the article describing RTE using conventional ultrasound transducers.

• EUS
• real-time tissue elastography
• ultrasound

• Contrast enhanced endoscopic ultrasound
• Endoscopic ultrasound elastography
• Endoscopic ultrasound-guided drainage
• Endoscopic ultrasound-guided fine needle aspiration
• Endosonography

• Adult
• Aged
• Endosonography/methods
• Endosonography/trends
• Female
• Gastroenterology/methods
• Gastroenterology/trends
• Humans
• Male
• Middle Aged
• Young Adult

To investigate the efficacy and safety of a combination of sufentanil and propofol injection in patients undergoing endoscopic injection sclerotherapy (EIS) for esophageal varices (EVs).

Patients with severe EVs who underwent EIS with sufentanil and propofol anesthesia between April 2016 and July 2016 at our hospital were reviewed. Although EIS and sequential therapy were performed under endotracheal intubation, we only evaluated the efficacy and safety of anesthesia for the first EIS procedure. Patients were intravenously treated with 0.5-1 μg/kg sufentanil. Anesthesia was induced with 1-2 mg/kg propofol and maintained using 2-5 mg/kg per hour of propofol. Information, regarding age, sex, weight, American Association of Anesthesiologists (ASA) physical status, Child-Turcotte-Pugh (CTP) classification, indications, preanesthetic problems, endoscopic procedure, successful completion of the procedure, anesthesia time, recovery time, and anesthetic agents, was recorded. Adverse events, including hypotension, hypertension, bradycardia, and hypoxia, were also noted.

Propofol and sufentanil anesthesia was provided in 182 procedures involving 140 men and 42 women aged 56.1 ± 11.7 years (range, 25-83 years). The patients weighed 71.4 ± 10.7 kg (range, 45-95 kg) and had ASA physical status classifications of II (79 patients) or III (103 patients). Ninety-five patients had a CTP classification of A and 87 had a CTP classification of B. Intravenous anesthesia was successful in all cases. The mean anesthesia time was 33.1 ± 5.8 min. The mean recovery time was 12.3 ± 3.7 min. Hypotension occurred in two patients (1.1%, 2/182). No patient showed hypertension during the endoscopic therapy procedure. Bradycardia occurred in one patient (0.5%, 1/182), and hypoxia occurred in one patient (0.5%, 1/182). All complications were easily treated with no adverse sequelae. All endoscopic procedures were completed successfully.

The combined use of propofol and sufentanil injection in endotracheal intubation-assisted EIS for EVs is effective and safe.

• Endoscopic injection
• Esophageal varices
• Propofol
• Sclerotherapy
• Sufentanil

• Adult
• Aged
• Aged, 80 and over
• Anesthesia/adverse effects
• Anesthesia/methods
• Anesthetics, Intravenous/administration & dosage
• Anesthetics, Intravenous/adverse effects
• Esophageal and Gastric Varices/therapy
• Esophagoscopy/adverse effects
• Esophagoscopy/instrumentation
• Esophagoscopy/methods
• Female
• Humans
• Intubation, Intratracheal/adverse effects
• Intubation, Intratracheal/methods
• Male
• Middle Aged
• Polidocanol
• Polyethylene Glycols/administration & dosage
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Propofol/administration & dosage
• Propofol/adverse effects
• Sclerotherapy/adverse effects
• Sclerotherapy/instrumentation
• Sclerotherapy/methods
• Sufentanil/administration & dosage
• Sufentanil/adverse effects
• Time Factors
• Treatment Outcome

• Endoscopic ultrasound
• gastric cancer
• neoadjuvant therapy
• prognosis
• tumor staging

To evaluate the accuracy of the elastography score combined to the strain ratio in the diagnosis of solid pancreatic lesions (SPL).

A total of 172 patients with SPL identified by endoscopic ultrasound were enrolled in the study to evaluate the efficacy of elastography and strain ratio in differentiating malignant from benign lesions. The semi quantitative score of elastography was represented by the strain ratio method. Two areas were selected, area (A) representing the region of interest and area (B) representing the normal area. Area (B) was then divided by area (A). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated by comparing diagnoses made by elastography, strain ratio and final diagnoses.

SPL were shown to be benign in 49 patients and malignant in 123 patients. Elastography alone had a sensitivity of 99%, a specificity of 63%, and an accuracy of 88%, a PPV of 87% and an NPV of 96%. The best cut-off level of strain ratio to obtain the maximal area under the curve was 7.8 with a sensitivity of 92%, specificity of 77%, PPV of 91%, NPV of 80% and an accuracy of 88%. Another estimated cut off strain ratio level of 3.8 had a higher sensitivity of 99% and NPV of 96%, but with less specificity, PPV and accuracy 53%, 84% and 86%, respectively. Adding both elastography to strain ratio resulted in a sensitivity of 98%, specificity of 77%, PPV of 91%, NPV of 95% and accuracy of 92% for the diagnosis of SPL.

Combining elastography to strain ratio increases the accuracy of the differentiation of benign from malignant SPL.

• Endoscopic Ultrasound
• Elastography
• Strain Ratio
• Real Time
• Pancreatic lesions

• Diagnosis, Differential
• Elasticity Imaging Techniques/methods
• Endoscopic Ultrasound-Guided Fine Needle Aspiration
• Endosonography/methods
• Female
• Humans
• Male
• Middle Aged
• Pancreas/diagnostic imaging
• Pancreas/pathology
• Pancreatic Neoplasms/diagnostic imaging
• Pancreatic Neoplasms/pathology
• Pancreatitis/diagnostic imaging
• Pancreatitis/pathology
• Predictive Value of Tests
• Prospective Studies
• ROC Curve
• Sensitivity and Specificity

• EBUS-TBNA
• diagnosis
• elastography
• lung cancer
• lymph nodes

• EUS
• FNAC
• Lymphadenopathy

• elastography
• endobronchial ultrasound
• endobronchial ultrasound-guided transbronchial needle aspiration
• malignancy
• strain ratio

Isolated pancreatic tuberculosis (PTB) is extremely rare worldwide. The purpose of this multicenter retrospective study is to analyze imaging features of histologically confirmed isolated PTB in order to determine the diagnostic features of the new methods contrast enhanced ultrasound (CEUS), ultrasound elastography and contrast enhanced endoscopic ultrasound (CE-EUS).

We report on a retrospective data collection of 12 cases of PTB confirmed by histology or cytology. All examinations were interpreted by two independent readers in consensus. CEUS, CE-EUS and ultrasound elastography were performed according to the European Federation of Societies for Ultrasound in Medicine and Biology guidelines.

In PTB patients the common bile duct was never dilated. Multiple retroperitoneal lymph nodes are the second important B-mode ultrasound feature detected in 75% of PTB patients. CE-EUS was performed in three PTB patients demonstrating hyperenhancement. On elastography, all PTB lesions were markedly stiffer than surrounding pancreatic parenchyma.

Here we report the first time on CEUS and elastography features of PTB. PTB had some typical imaging features with iso- or hyperenhancement on CE(E) US. PTB is markedly stiffer on elastography. If clinicians are aware of clinical features of PTB and conduct appropriate investigations with multiple modalities including B-mode ultrasound, CEUS, and EUS guided fine needle aspiration, diagnosis of PTB without laparotomy is possible and the disease can be effectively treated with anti-tuberculous drugs.

• Contrast enhanced endoscopic ultrasound
• contrast enhanced ultrasound
• elastography
• guidelines
• pancreatic tuberculosis

New applications of confocal laser endomicroscopy (CLE) have been developed, such as needle-based CLE (nCLE) for pancreatic masses, pancreatic cystic tumors, and lymph nodes. nCLE is feasible during endoscopic ultrasound (EUS) examination, and preliminary results are very encouraging and suggest this technology may be used in future as a useful adjunct in cases of inconclusive EUS-guided fine-needle aspiration. The aim of this paper is to give an update in this new technology and to define its place in the diagnosis of pancreatic masses and mediastinal diseases.

• benign and malignant
• contrast-enhanced endoscopic ultrasound
• discrimination
• elastography
• lymph node

• Animal model
• Biomicroscopy
• Endoscopy
• Esophagitis
• Rat
• Ultrasound

• Animals
• Disease Models, Animal
• Endoscopy/methods
• Esophagitis/diagnosis
• Esophagitis/diagnostic imaging
• Esophagitis/pathology
• Esophagus/diagnostic imaging
• Male
• Microscopy, Acoustic/methods
• Rats
• Rats, Wistar

Non-invasive methods for liver stiffness assessment have been introduced over recent years. Of these, two main methods for estimating liver fibrosis using ultrasound elastography have become established in clinical practice: shear wave elastography and quasi-static or strain elastography. Shear waves are waves with a motion perpendicular (lateral) to the direction of the generating force. Shear waves travel relatively slowly (between 1 and 10 m/s). The stiffness of the liver tissue can be assessed based on shear wave velocity (the stiffness increases with the speed). The European Federation of Societies for Ultrasound in Medicine and Biology has published Guidelines and Recommendations that describe these technologies and provide recommendations for their clinical use. Most of the data available to date has been published using the Fibroscan (Echosens, France), point shear wave speed measurement using an acoustic radiation force impulse (Siemens, Germany) and 2D shear wave elastography using the Aixplorer (SuperSonic Imagine, France). More recently, also other manufacturers have introduced shear wave elastography technology into the market. A comparison of data obtained using different techniques for shear wave propagation and velocity measurement is of key interest for future studies, recommendations and guidelines. Here, we present a recently introduced shear wave elastography technology from Hitachi and discuss its reproducibility and comparability to the already established technologies.

• guideline
• healthy
• liver
• liver stiffness measurement
• recommendation

• Guidelines
• anatomic landmarks
• central venous catheters
• intervention
• ultrasound-guidance (US-guidance)
• vascular access

Elastographic techniques have recently become available as advanced diagnostic tools for tissue characterization. Strain elastography is a real-time technique used with transcutaneous ultrasound (US) and endoscopic US. Convincing evidence is available demonstrating a significant value of strain elastography for the discrimination of benign and malignant lymph nodes (LNs). This paper reviews preliminary data demonstrating the feasibility of performing real-time elastography during endobronchial US (EBUS) and a potential application of this technique for selection of LNs for EBUS-guided transbronchial needle aspiration in patients with lung cancer and extrathoracic malignancies.