Cryolipolysis for abdominal subcutaneous fat reduction: A prospective, multicenter, single arm, clinical study.

Various treatment methods are used for noninvasive body contouring. To evaluate the efficacy and safety of a newly designed cryolipolysis device using a three-dimensional cooling method for abdominal fat reduction. Twenty-five participants with clinically apparent abdominal fat tissue participated in the study. The thickness of fat tissue below the umbilicus level was measured using a caliper at baseline and 12 weeks after the first treatment. The height of abdominal subcutaneous fat tissue on ultrasonography and participant satisfaction were assessed at every visit for 16 weeks. All adverse events (AEs) during the study period were recorded. p values <0.05 were considered statistically significant. Twenty-four participants completed this study; the mean BMI of participants was 29.34 ± 2.36 kg/m2 . The mean thickness of abdominal subcutaneous fat was significantly lower at 12 weeks (40.4 ± 6.8 mm, p < 0.001) than at baseline (49.3 ± 8.5 mm). Differences in the height of abdominal subcutaneous fat compared to that at baseline were 1.02 ± 0.41 cm (12 weeks, p < 0.001) and 1.13 ± 0.44 cm (16 weeks, p < 0.001). Rates of abdominal subcutaneous fat reduction at 12 and 16 weeks compared to that at baseline were 28.45% and 31.13%, respectively. The ratio of abdominal circumference to hip circumference at 12 and 16 weeks was significantly decreased compared to that at baseline. Most participants (95.8%) reported improvement in satisfaction scores at 16 weeks. There were no serious AEs during the entire study period. The study demonstrated the efficacy of a noninvasive cryolipolysis device using a three-dimensional cooling method for reducing abdominal subcutaneous fat.

The first report of diagnosing of keratoacanthoma in Chinese Han patients using dermoscopy and reflectance confocal microscopy.

BACKGROUND: Keratoacanthoma (KA) is a special kind of tumor, which is regarded as a variant of squamous cell carcinoma (SCC) in some academic disciplines. But differentiating KA from SCC remains a diagnostic challenge. The noninvasive techniques dermoscopy and reflectance confocal microscopy (RCM) can provide new insights for diagnosis. OBJECTIVE: To observe the characteristics of KA under dermoscopy and reflectance confocal microscopy (RCM), in order to gain experience and reference for clinicians to facilitate earlier diagnosis. METHODS: We collected two cases of KA, which were confirmed by clinical and histopathological examination. The two cases were examined by dermoscopy and RCM, respectively. Then, we collected the microscopic characteristics of KA lesions. RESULTS: The dermoscopy features of KA are concentric circles of central crater, keratin mass, keratin scale, and polymorphic vascular pattern. The RCM features are described as refractile crust, atypical honeycomb pattern, dark center cells, large round nucleated cells, dendritic cells, and linear or round vessels traversing dermal papillae in the dermis. CONCLUSION: KA has some specific dermoscopy and RCM features, which can provide a basis for doctors to diagnose and intervene earlier.

The sensitivity of 38 heart rate variability measures to the addition of artifact in human and artificial 24-hr cardiac recordings.

BACKGROUND: Artifact is common in cardiac RR interval data derived from 24-hr recordings and has a significant impact on heart rate variability (HRV) measures. However, the relative impact of progressively added artifact on a large group of commonly used HRV measures has not been assessed. This study compared the relative sensitivity of 38 commonly used HRV measures to artifact to determine which measures show the most change with increasing increments of artifact. A secondary aim was to ascertain whether short-term and long-term HRV measures, as groups, share similarities in their sensitivity to artifact. METHODS: Up to 10% of artifact was added to 20 artificial RR (ARR) files and 20 human cardiac recordings, which had been assessed for artifact by a cardiac technician. The added artifact simulated deletion of RR intervals and insertion of individual short RR intervals. Thirty-eight HRV measures were calculated for each file. Regression analysis was used to rank the HRV measures according to their sensitivity to artifact as determined by the magnitude of slope. RESULTS: RMSSD, SDANN, SDNN, RR triangular index and TINN, normalized power and relative power linear measures, and most nonlinear methods examined are most robust to artifact. CONCLUSION: Short-term time domain HRV measures are more sensitive to added artifact than long-term measures. Absolute power frequency domain measures across all frequency bands are more sensitive than normalized and relative frequency domain measures. Most nonlinear HRV measures assessed were relatively robust to added artifact, with Poincare plot SD1 being most sensitive.

Infrared thermography as a noninvasive method to assess scrotal insulation on sperm production in beef bulls.

This study evaluated the thermoregulation and spermatogenic changes by scrotal temperature gradient using infrared thermography in testicular compromised bulls. Bulls were insulated (n = 6) for 72 hr and control animals (n = 3) remained without insulation during all the experimental period. Seminal evaluation was performed prior, at insult removal and once per week for 13 consecutive weeks. Mean temperature gradient in insulated animals was lower at the time of insulation removal compared to the week prior and after the insult (p < .05). Two weeks after insult, sperm motility was lower in insulated compared to control animals (p < .01) and spermatozoa total defects were higher in insulated compared to control animals (p < .05). Two and seven weeks after insult, the major defects were higher in insulated compared to control animals (p < .05). Scrotal temperature gradient showed a positive correlation with sperm mass motion (p < .01) and a negative correlation with ocular globe temperature (p < .01) in insulated animals. The infrared thermography can be used to evaluate ocular globe temperature in bulls; however, it is only effective to detect changes in scrotal temperature gradient at the insult removal.

Exhaled breath condensate biomarkers for the early diagnosis of lung cancer using proteomics.

We explored whether the proteomic analysis of exhaled breath condensate (EBC) may provide biomarkers for noninvasive screening for the early detection of lung cancer (LC). EBC was collected from 192 individuals [49 control (C), 49 risk factor-smoking (S), 46 chronic obstructive pulmonary disease (COPD) and 48 LC]. With the use of liquid chromatography and tandem mass spectrometry, 348 different proteins with a different pattern among the four groups were identified in EBC samples. Significantly more proteins were identified in the EBC from LC compared with other groups (C: 12.4 ± 1.3; S: 15.3 ± 1; COPD: 14 ± 1.6; LC: 24.2 ± 3.6; P = 0.0001). Furthermore, the average number of proteins identified per sample was significantly higher in LC patients, and receiver operating characteristic curve (ROC) analysis showed an area under the curve of 0.8, indicating diagnostic value. Proteins frequently detected in EBC, such as dermcidin and hornerin, along with others much less frequently detected, such as hemoglobin and histones, were identified. Cytokeratins (KRTs) were the most abundant proteins in EBC samples, and levels of KRT6A, KRT6B, and KRT6C isoforms were significantly higher in samples from LC patients (P = 0.0031, 0.0011, and 0.0009, respectively). Moreover, the amount of most KRTs in EBC samples from LC patients showed a significant positive correlation with tumor size. Finally, we used a random forest algorithm to generate a robust model using EBC protein data for the diagnosis of patients with LC where the area under the ROC curve obtained indicated a good classification (82%). Thus this study demonstrates that the proteomic analysis of EBC samples is an appropriated approach to develop biomarkers for the diagnosis of lung cancer.

Clinical usefulness of reflectance confocal microscopy in the management of facial lentigo maligna melanoma.

Facial lentigo maligna melanoma can be a diagnostic challenge in daily clinical practice as it has similar clinical and morphological features to other lesions such as solar lentigines and pigmented actinic keratoses. Confocal microscopy is a noninvasive technique that provides real-time images of the epidermis and superficial dermis with cellular-level resolution. We describe 3 cases of suspected facial lentigo maligna that were assessed using dermoscopy and confocal microscopy before histopathology study. In the first case, diagnosed as lentigo maligna melanoma, presurgical mapping by confocal microscopy was performed to define the margins more accurately. In the second and third cases, with a clinical and dermoscopic suspicion of lentigo maligna melanoma, confocal microscopy was used to identify the optimal site for biopsy.

1444-nm Nd:YAG for Laser-Assisted Lipolysis: A Minimally Invasive Technique for the Treatment of Pseudogynecomastia.

Background: The options for treating pseudogynecomastia are limited, and there is a growing demand for noninvasive breast fat reduction. We evaluated the efficacy and safety of a laser-assisted lipolysis (LAL) device emitting 1444 nm for the treatment of pseudogynecomastia. Methods: A total of 9 male patients diagnosed with pseudogynecomastia underwent laser procedure with a Nd:YAG laser emitting at 1444 nm. The goal was to generate adequate heat propagation and thermal action in the dermis as homogeneous as possible to induce fat cell lipolysis. The results were clinically evaluated by comparing pictures at baseline and 4 months later. Results: An independent comparison of baseline and post-treatment pictures by a physician evaluator 4 months after treatment revealed significant improvement in all patients. Three subjects (33%) showed grade 4 improvement; 4 (44%) showed grade 3 improvement, and 2 (22%) showed grade 2 improvement. Breast sizes decreased in all patients 4 months after 1444-nm LAL. All patients experienced an incident-free postoperative period. Conclusions: The LAL procedure performed in this study using 1444-nm Nd:YAG laser appears to be a very effective/comfortable outpatient solution to the problem for patients. It has proven a safe procedure, and all subjects in the study experienced a significant clinical improvement regarding their pseudogynecomastia, with a decrease in breast volume and visible skin contraction.

Determining the Site of Upper Airway Narrowing in Snorers Using a Noninvasive Technique.

Background In this study, we aimed to determine the site of obstruction if surgical treatment is considered. Flexible nasopharyngoscopy is an invasive procedure currently used for the assessment of snoring and the level of obstruction. Here, we examine the role of Somnoscreen™ plus, a noninvasive cardiorespiratory polysomnographic device, in identifying the site of obstruction in patients presenting with snoring. Methodology This cross-sectional study was conducted in the Sleep Research Center at King Abdulaziz University Hospital. Polysomnography was conducted using Somnoscreen™ plus. All participants underwent flexible nasopharyngoscopy after polysomnography. Results Nasopharyngoscopy revealed that the most common site of obstruction was the nose and the soft palate (35.4%), followed by the soft palate alone (25%). Somnoscreen revealed that the site of obstruction was the nose and the soft palate in 18 (37.5%) patients and the nose alone in 16 (33.3%) patients. However, distal obstructions were not detected using Somnoscreen. The concordance of nasopharyngoscopy and Somnoscreen was 52.9%. However, it showed a discrepancy in identifying distal obstructions, which Somnoscreen™ plus failed to detect. Conclusions Somnoscreen appears to be sensitive for identifying proximal airway obstructions. The audio signal recordings can potentially be used as a tool to detect the site of airway obstruction in snoring; however, further studies are needed.

CORP: quantification of human skeletal muscle carnosine concentration by proton magnetic resonance spectroscopy.

Noninvasive techniques to quantify metabolites in skeletal muscle provide unique insight into human physiology and enable the translation of research into practice. Proton magnetic resonance spectroscopy (1H-MRS) permits the assessment of several abundant muscle metabolites in vivo, including carnosine, a dipeptide composed of the amino acids histidine and beta-alanine. Muscle carnosine loading, accomplished by chronic oral beta-alanine supplementation, improves muscle function and exercise capacity and has pathophysiological relevance in multiple diseases. Moreover, the marked difference in carnosine content between fast-twitch and slow-twitch muscle fibers has rendered carnosine an attractive candidate to estimate human muscle fiber type composition. However, the quantification of carnosine with 1H-MRS requires technical expertise to obtain accurate and reproducible data. In this review, we describe the technical and physiological factors that impact the detection, analysis, and quantification of carnosine in muscle with 1H-MRS. We discuss potential sources of error during the acquisition and preprocessing of the 1H-MRS spectra and present best practices to enable the accurate, reliable, and reproducible application of this technique.

MET somatic activating mutations are responsible for lymphovenous malformation and can be identified using cell-free DNA next generation sequencing liquid biopsy.

OBJECTIVE: Germline mutations of either the endothelial cell-specific tyrosine kinase receptor TIE2 or the glomulin (GLMN) gene are responsible for rare inherited venous malformations. Both genes affect the hepatocyte growth factor receptor c-Met, inducing vascular smooth muscle cell migration. Germline mutations of hepatocyte growth factor are responsible for lymphatic malformations, leading to lymphedema. The molecular alteration leading to the abnormal mixed vascular anomaly defined as lymphovenous malformation has remained unknown. METHODS: A group of 4 patients with lymphovenous malformations were selected. Plasma was obtained from both peripheral and efferent vein samples at the vascular malformation site for cell-free DNA extraction. When possible, we analyzed tissue biopsy samples from the vascular lesion. RESULTS: We have demonstrated that in all four patients, an activating MET mutation was present. In three of the four patients, the same pathogenic activating mutation, T1010I, was identified. The mutation was found at the tissue level for the patient with tissue samples available, confirming its causative role in the lymphovenous malformations. CONCLUSIONS: In the present study, we have demonstrated that cell-free DNA next generation sequencing liquid biopsy is able to identify the MET mutations in affected tissues. Although a wider cohort of patients is necessary to confirm its causative role in lymphovenous malformations, these data suggest that lymphovenous malformations could result from postzygotic somatic mutations in genes that are key regulators of lymphatic development. The noninvasiveness of the method avoids any risk of bleeding and can be easily performed in children. We are confident that the present pioneering results have provided a viable alternative in the future for lymphovenous malformation diagnosis, allowing for subsequent therapy tailored to the genetic defect.

High-dose-rate brachytherapy with surface applicator in penile cancer.

PURPOSE: An alternative to surgery for penile cancer is radiation therapy which is administered with external beam techniques and/or brachytherapy (BT) either interstitial or using a surface applicator. Here we report our experience in penile cancer patients treated with high-dose-rate (HDR)-BT with the surface technique, analyzing dosimetric parameters and clinical outcomes. METHODS AND MATERIALS: Between June 2016 and December 2019, 7 patients with squamous cell carcinoma of the penis received HDR-BT by means of customized applicators that were constructed using a 3D printer or thermoplastic mask. The total dose was 57 Gy in 19 fractions. RESULTS: Median clinical target volume percentage receiving 95%, 125%, and 150% of the prescribed dose were 93.1% (range 92.2-98.5), 12% (range 7.4-32.2), and 0.24% (range 0-10.8), respectively. Median urethral volumes receiving 90% and 115% of the prescribed dose were 40.2% (range 21.0-83.8) and 0% (range 0-1), respectively. All patients achieved complete remission. No patient developed G3 or G4 acute or late toxicities. No patient experienced urethral stenosis. CONCLUSIONS: Surface HDR-BT in penile cancer is feasible and is associated with a high tolerance profile and good outcomes.

Assessment of Non-Contact Infrared Thermometer Measurement Sites in Birds.

The standard method of obtaining body temperature in a bird can be a stressful event, making routine evaluations challenging. Twenty-eight privately owned birds in good health were enrolled in the study to compare digital and infrared (IR) temperature readings. Digital thermometer readings in the cloaca were compared with two different IR thermometers, Ototemp (OT) and VetTemp (VT), used at the skin of the cloaca, breast, axillary area and tympanic membrane. The majority of the IR temperature readings were not significantly different from the cloacal digital reading. Additionally, the different IR thermometers read close to each other at individual reading sites. The IR measurements at the axilla (OT, mean = 40.35°C, SD = 1.24°C; VT, mean = 40.20°C, SD = 1.38°C) were most similar to the standard cloacal measurement (mean = 40.83°C, SD = 0.88°C). For veterinarians who currently avoid measuring cloacal body temperatures to prevent unnecessary stress on avian patients utilizing IR thermometers in the axillary region provide a less invasive and reasonable measurement of core body temperature in birds to allow for a more comprehensive assessment of health status.

Cell-free DNA next-generation sequencing liquid biopsy as a new revolutionary approach for arteriovenous malformation.

OBJECTIVE: Somatic mosaicism of KRAS gene is currently recognized as the only established molecular basis of arteriovenous malformations (AVM). However, given the limitations of the current technologies, KRAS somatic mutations are detected only in a limited proportion of AVMs and tissue biopsy remains an invasive high risky, sometimes life-threatening, diagnostic procedure. Next-generation sequencing liquid biopsy using cell-free DNA (cfDNA) has emerged as an innovative noninvasive approach for early detection and monitoring of cancer. This approach overcomes the space-time profile constraint of tissue biopsies opens a new scenario for vascular malformations owing to somatic mosaicism. Here, we propose a new approach as a fast noninvasive reliable tool in order to investigate the cfDNA coming from the AVMs. METHODS: A group of five patients suffering from AVM were selected. Blood samples from peripheral vein and efferent vein from vascular malformation were collected and cfDNA was extracted. The cfDNA libraries were performed using Oncomine Pan-Cancer Cell-Free Assay. We used Ion Proton for sequencing and Ion Reporter Software for analysis (Life Technologies, Carlsbad, Calif). RESULTS: In all cases, either G12D or G12V mutations in KRAS were identified. The mutational load was higher in the efferent vein than in peripheral blood, confirming the causative role of the identified mutation at a somatic level. CONCLUSIONS: We demonstrate that cfDNA next-generation sequencing liquid biopsy is able to identify the KRAS mutation detected in affected tissues. Moreover, we have shown that blood sample withdrawal at the lesion site increases variant allele frequency with an order of magnitude above the limit of detection (usually 0.05%), decreasing the risk of a false negative. Finally, the noninvasiveness of the method avoids any risk of bleeding, being easily performed also in children. We propose this technique as the method of choice to better investigate AVMs and consequently to identify the therapy tailored to the genetic defect. CLINICAL RELEVANCE: This article highlights the importance of using liquid biopsy as a new method to investigate the molecular profile of AVMs. In view of the frequent inaccessibility of vascular tissues owing to the invasiveness of solid biopsy and the relative high incidence of biopsies with low diagnostic power, here we evaluated the efficacy of detecting cfDNA fragments released into the bloodstream from the affected tissue cells. Through a simple blood draw from the efferent vein at the vascular malformation site, the liquid biopsy allowed us to identify KRAS pathogenic mutations piloting a personalized therapeutic approach and opening a new scenario for new therapeutic strategies.

Ripening of avocado fruits studied by spectroscopic techniques.

Avocados are considered very healthy due to the high content mono-unsaturated lipid, essential vitamins and minerals, minimal sugar and no cholesterol and are therefore sometimes referred to as "the perfect fruits". Avocados, mainly grown in Latin-America, are harvested unripe and sent overseas. However, the ripening process is very difficult to assess visually and tactilely. A tool for precise noninvasive judgment of the status would be valuable as the fruit is too expensive to be cut open unripe or overdue. A white-light source and a light-emitting diode unit with four excitation wavelengths (365, 385, 395, and 405 nm) were used for reflectance and fluorescence spectroscopy in a fiber-coupled set-up for noninvasive monitoring. Twelve non-ripe avocados, with approximately the same size and appearance, were studied and divided into three groups and kept at three different storage conditions; at room temperature, in a refrigerator and a combination of the two. We showed that fluorescence was useful for following the ripening process. A method, which compensates for the spatial variations in spectral properties around a fruit, is described. Remote fluorescence monitoring, intended for orchard use, was also demonstrated. A low-cost device based on fluorescence for avocado ripeness assessment is proposed.

A New Restorative Method for the Closure of Single-Tooth Gaps - Technique Description and Case Series.

PURPOSE: To present a new method for the closure of single-tooth gaps using metal-, ceramic-, and glass-fiber-free direct composite cantilever restorations. MATERIALS AND METHODS: The new technique is described step by step in a case report, showing the creation and adhesive bonding of a single-retainer composite pontic. Furthermore, six cases are reported with radiological and clinical follow-up assessments over a period of one to three years after gap closure. RESULTS: Excellent outcomes were observed clinically and radiologically. No failures due to material properties (such as composite fractures, chipping) or esthetic limitations through discoloration were observed. Due to good oral hygiene, no periodontal complications were found during the observation period. CONCLUSIONS: This new minimally invasive procedure expands the therapeutic spectrum for the management of single-tooth gaps. It does not require laboratory-fabricated restorations and can be considered when conventional treatments, such as fixed dental prostheses or implants, are not options for medical reasons or due to special patient preferences.

Intraoperative Vascular Neuromonitoring in Patients with Subarachnoid Hemorrhage: A Pilot Study Using Combined Laser-Doppler Spectrophotometry.

BACKGROUND: Intraoperative monitoring of cerebral microcirculation in patients with subarachnoid hemorrhage (SAH) may predict the postoperative neurologic outcome. In this pilot study, we examined the value of a novel noninvasive real-time measurement technique for detecting changes in local microcirculation. METHODS: We used the O2C (Oxygen to see) laser-Doppler spectrophotometry system in 14 patients with Hunt & Hess grade 2-5 SAH who underwent microsurgical cerebral aneurysm clipping. A subdural probe recorded capillary venous oxygenation (SO2), relative hemoglobin concentration, blood cell velocity, and blood flow at a tissue depth of 7 mm. Data were recorded immediately before dural closure. We also recorded somatosensory evoked potentials (SEPs) with median and tibial nerve stimulation. Results were compared with neurologic performance, as measured on the modified Rankin Scale, at the day of discharge from the hospital and 12 months thereafter. RESULTS: Patient functional outcomes after discharge and 12 months were correlated with pathological decreased flow and increased SO2 values. In 6 of 8 patients, microcirculatory monitoring parameters indicated ischemia during surgery, as shown by electrophysiological SEP changes and infarction detected on the postoperative computed tomography (CT) scan. Pathological SEP results correlated closely with infarct demarcation as seen on CT. CONCLUSIONS: Our results indicate the potential benefit of intraoperative combined laser-Doppler flowmetry and spectrophotometry for predicting postoperative clinical outcomes in this small patient sample. Larger-cohort testing is needed to verify our findings and show the possible merits of this novel method.

Oxygenation Saturation Index Predicts Clinical Outcomes in ARDS.

BACKGROUND: Traditional measures of ARDS severity such as Pao2/Fio2 may not reliably predict clinical outcomes. The oxygenation index (OI [Fio2 × mean airway pressure × 100)/Pao2]) may more accurately reflect ARDS severity but requires arterial blood gas measurement. We hypothesized that the oxygenation saturation index (OSI [Fio2 × mean airway pressure × 100)/oxygen saturation by pulse oximetry (Spo2)]) is a reliable noninvasive surrogate for the OI that is associated with hospital mortality and ventilator-free days (VFDs) in patients with ARDS. METHODS: Critically ill patients enrolled in a prospective cohort study were eligible if they developed ARDS (Berlin criteria) during the first 4 ICU days and had mean airway pressure, Spo2/Fio2, and Pao2/Fio2 values recorded on the first day of ARDS (N = 329). The highest mean airway pressure and lowest Spo2/Fio2 and Pao2/Fio2 values were used to calculate OI and OSI. The association between OI or OSI and hospital mortality or VFD was analyzed by using logistic regression and linear regression, respectively. The area under the receiver-operating characteristic curve (AUC) for mortality was compared among OI, OSI, Spo2/Fio2, Pao2/Fio2, and Acute Physiology and Chronic Health Evaluation II scores. RESULTS: OI and OSI were strongly correlated (rho = 0.862; P < .001). OSI was independently associated with hospital mortality (OR per 5-point increase in OSI, 1.228 [95% CI, 1.056-1.429]; P = .008). OI and OSI were each associated with a reduction in VFD (OI, P = .023; OSI, P = .005). The AUC for mortality prediction was greatest for Acute Physiology and Chronic Health Evaluation II scores (AUC, 0.695; P < .005) and OSI (AUC, 0.602; P = .007). The AUC for OSI was substantially better in patients aged < 40 years (AUC, 0.779; P < .001). CONCLUSIONS: In patients with ARDS, the OSI was correlated with the OI. The OSI on the day of ARDS diagnosis was significantly associated with increased mortality and fewer VFDs. The findings suggest that OSI is a reliable surrogate for OI that can noninvasively provide prognostic information and assessment of ARDS severity.

Contrast-enhanced ultrasound for quantitative assessment of portal pressure in canine liver fibrosis.

AIM: To explore the feasibility of non-invasive quantitative estimation of portal venous pressure by contrast-enhanced ultrasound (CEUS) in a canine model. METHODS: Liver fibrosis was established in adult canines (Beagles; n = 14) by subcutaneous injection of carbon tetrachloride (CCl4). CEUS parameters, including the area under the time-intensity curve and intensity at portal/arterial phases (Qp/Qa and Ip/Ia, respectively), were used to quantitatively assess the blood flow ratio of the portal vein/hepatic artery at multiple time points. The free portal venous pressures (FPP) were measured by a multi-channel baroreceptor using a percutaneous approach at baseline and 8, 16, and 24 wk after CCl4 injections in each canine. Liver biopsies were obtained at the end of 8, 16, and 24 wk from each animal, and the stage of the fibrosis was assessed according to the Metavir scoring system. A Pearson correlation test was performed to compare the FPP with Qp/Qa and Ip/Ia. RESULTS: Pathologic examination of 42 biopsies from the 14 canines at weeks 8, 16, and 24 revealed that liver fibrosis was induced by CCl4 and represented various stages of liver fibrosis, including F0 (n = 3), F1 (n = 12), F2 (n = 14), F3 (n = 11), and F4 (n = 2). There were significant differences in the measurements of Qp/Qa (19.85 ± 3.30 vs 10.43 ± 1.21, 9.63 ± 1.03, and 8.77 ± 0.96) and Ip/Ia (1.77 ± 0.37 vs 1.03 ± 0.12, 0.83 ± 0.10, and 0.69 ± 0.13) between control and canine fibrosis at 8, 16, and 24 wk, respectively (all P < 0.001). There were statistically significant negative correlations between FPP and Qp/Qa (r = -0.707, P < 0.001), and between FPP and Ip/Ia (r = -0.759, P < 0.001) in the canine fibrosis model. Prediction of elevated FPP based on Qp/Qa and Ip/Ia was highly sensitive, as assessed by the area under the receiver operating curve (0.866 and 0.895, respectively). CONCLUSION: CEUS is a potential method to accurately, but non-invasively, estimate portal venous pressure through measurement of Qp/Qa and Ip/Ia parameters.