Objectives: This study aimed to construct a prediction model based on contrast-enhanced ultrasound (CEUS) ultrasomics features and investigate its efficacy in predicting early recurrence (ER) of primary hepatocellular carcinoma (HCC) after resection or ablation. Methods: This study retrospectively included 215 patients with primary HCC, who were divided into a developmental cohort (n = 139) and a test cohort (n = 76). Four representative images—grayscale ultrasound, arterial phase, portal venous phase and delayed phase—were extracted from each CEUS video. Ultrasomics features were extracted from tumoral and peritumoral area inside the region of interest. Logistic regression was used to establish models, including a tumoral model, a peritumoral model and a combined model with additional clinical risk factors. The performance of the three models in predicting recurrence within 2 years was verified. Results: The combined model performed best in predicting recurrence within 2 years, with an area under the curve (AUC) of 0.845, while the tumoral model had an AUC of 0.810 and the peritumoral model one of 0.808. For prediction of recurrence-free survival, the 2-year cumulative recurrence rate was significant higher in the high-risk group (76.5%) than in the low-risk group (9.5%; p < 0.0001). Conclusion: These CEUS ultrasomics models, especially the combined model, had good efficacy in predicting early recurrence of HCC. The combined model has potential for individual survival assessment for HCC patients undergoing resection or ablation. Advances in knowledge: CEUS ultrasomics had high sensitivity, specificity and PPV in diagnosing early recurrence of HCC, and high efficacy in predicting early recurrence of HCC (AUC > 0.8). The combined model performed better than the tumoral ultrasomics model and peritumoral ultrasomics model in predicting recurrence within 2 years. Recurrence was more likely to occur in the high-risk group than in the low-risk group, with 2-year cumulative recurrence rates, respectively, 76.5% and 9.5% (p < 0.0001).

Lesion localization and tracking are critical for accurate, automated medical imaging analysis. Contrast-enhanced ultrasound (CEUS) significantly enriches traditional B-mode ultrasound with contrast agents to provide high-resolution, real-time images of blood flow in tissues and organs. However, many trackers, designed primarily for natural RGB or B-mode ultrasound images, underutilize the extensive data from dual-screen enhanced images and fail to account for respiratory motion, thus facing challenges in achieving accurate target tracking. To address the existing challenges, we propose an adaptive-weighted dual mapping (ADMNet), an online tracking framework tailored for CEUS. Firstly, we introduced a novel Multimodal Atrous Attention Fusion (MAAF) module, innovatively designed to adapt the weightage between B-mode and enhanced images in dual-screen CEUS, reflecting the clinician’s dynamic focus shifts between screens. Secondly, we proposed a Respiratory Motion Compensation (RMC) module to correct motion trajectory interferences due to respiratory motion, effectively leveraging temporal information. We utilized two newly established CEUS datasets, totaling 35,082 frames, to benchmark the ADMNet against various advanced B-mode ultrasound trackers. Our extensive experiments revealed that ADMNet achieves new state-of-the-art performance in CEUS tracking. Ablation studies and visualizations further underline the effectiveness of MAAF and RMC modules, demonstrating the promising potential of ADMNet in clinical CEUS tracing, thus providing novel research avenues in this field.

Takotsubo cardiomyopathy (TCM) is a brief ventricular dysfunction that usually occurs after emotional or physical stress. Here, we report a patient who underwent cardiac surgery and then developed TCM during the postoperative period. A 51-year-old woman was admitted to our hospital complaining of chest tightness, palpitations and dyspnoea after activity. An echocardiogram performed by our hospital showed rheumatic heart disease (severe mitral stenosis and regurgitation) with normal cardiac function and wall motion. After mitral valve replacement, this patient developed heart failure with low blood pressure and tachycardia. Urgent bedside echocardiography demonstrated akinesis in the middle and apical segments of the left ventricle and a depressed ejection fraction (EF) of 36%. Myocardial contrast echocardiography (MCE) showed similar enhancement intensity in the basal, middle and apical segments. Quantitative analysis showed approximately equivalent maximum intensity in these regions. The diagnosis was considered TCM instead of myocardial infarction. Then, an intra-aortic balloon pump was inserted to maintain effective circulation and reduce the postcardiac load. Given ventilation therapy, postoperative anticoagulation therapy and anti-infection treatment, the patient recovered quickly. In the follow-up examination, the patient remained asymptomatic and showed normalization of ventricular wall motion in the apical segment. This report presents a case of TCM in which MCE was used to demonstrate intact microvascular perfusion despite apical akinesis. This report might support the use of MCE as a substitute for invasive coronary angiography.