PURPOSE: Thyroid nodules are highly prevalent in the general population, yet large-scale ultrasound screening is limited by its reliance on experienced sonographers. Autonomous robotic ultrasound systems have the potenti...PURPOSE: Thyroid nodules are highly prevalent in the general population, yet large-scale ultrasound screening is limited by its reliance on experienced sonographers. Autonomous robotic ultrasound systems have the potential to enable standardized thyroid screening with reduced operator dependency. METHODS: In this pilot prospective study, a fully autonomous robotic ultrasound system was evaluated for thyroid nodule screening in a clinical setting. Twenty-one consecutive participants underwent both autonomous robotic ultrasound and standard operator-performed ultrasound examinations in a randomized order. The primary outcome was participant-level thyroid nodule detection rate compared with operator-performed ultrasound. Secondary outcomes included feasibility, thyroid gland coverage, and participant-reported comfort. RESULTS: Autonomous robotic ultrasound was successfully completed without human intervention in 20 of 21 participants (95.2%). Thyroid nodules were identified on operator-performed ultrasound in nine participants, of whom eight were correctly detected by the autonomous system, corresponding to a participant-level detection rate of 88.9%. Complete coverage of the left lobe, right lobe, and isthmus was achieved in 100%, 95%, and 80% of participants, respectively. Participant-reported comfort was neutral to positive, with a median Likert score of 3 (interquartile range, 3-4). CONCLUSION: This pilot study demonstrated the feasibility of fully autonomous robotic ultrasound for standardized thyroid nodule screening. The system achieved high completion rates and acceptable screening performance in a controlled clinical setting, supporting further validation in larger and more diverse populations.
Matsumoto N, Ogawa M, Konishi A
… +7 more, Totsuka M, Kaneko T, Honda M, Arima S, Watanabe Y, Masuzaki R, Kogure H
J Med Ultrason (2001)
· 2026 Jun · PMID 42377809
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PURPOSE: Accurate evaluation of tumor viability during immunotherapy for unresectable hepatocellular carcinoma (HCC) remains challenging using contrast-enhanced computed tomography or magnetic resonance imaging (CECT/CEM...PURPOSE: Accurate evaluation of tumor viability during immunotherapy for unresectable hepatocellular carcinoma (HCC) remains challenging using contrast-enhanced computed tomography or magnetic resonance imaging (CECT/CEMRI), particularly after treatment-induced vascular changes. This exploratory study investigated whether contrast-enhanced ultrasound (CEUS) detects residual intratumoral perfusion differently from CECT/CEMRI and whether CEUS perfusion patterns are associated with depth of response (DpR) in selected patients receiving immunotherapy-based combination therapy. METHODS: Twenty-five patients with unresectable HCC treated with atezolizumab plus bevacizumab, durvalumab plus tremelimumab, or nivolumab plus ipilimumab who underwent both CEUS and CECT/CEMRI within a 3-month interval were retrospectively analyzed. CEUS was performed at a median of 33 days after treatment initiation. Arterial-phase enhancement patterns were classified as hyper-, iso-, or hypoenhancement relative to surrounding liver parenchyma. Tumor response was evaluated using RECIST version 1.1 and modified RECIST. DpR was defined as the maximum percentage reduction in tumor size from baseline. RESULTS: CEUS demonstrated hyperenhancement in 14 lesions compared with six lesions on CECT/CEMRI. Enhancement patterns were discordant in 13 cases, with CEUS demonstrating hyperenhancement in 10 lesions classified as iso- or hypoenhancement on CECT/CEMRI (p = 0.049). Tumor size reduction did not differ significantly among enhancement categories on CECT/CEMRI (p = 0.325), whereas CEUS enhancement patterns were significantly associated with DpR (p = 0.008). CONCLUSION: In selected patients with unresectable HCC undergoing immunotherapy-based therapy, CEUS detected residual intratumoral perfusion more frequently than CECT/CEMRI and was significantly associated with DpR. CEUS may provide complementary information for exploratory assessment of tumor viability in this setting.
Nagaoka R, Umemura SI, Omura M
… +1 more, Hasegawa H
J Med Ultrason (2001)
· 2026 Jun · PMID 42360671
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Pulse inversion (PI) harmonic imaging has been commonly used because of its contrast and spatial resolution superior to conventional fundamental imaging. However, it requires two transmissions with opposite phases, which...Pulse inversion (PI) harmonic imaging has been commonly used because of its contrast and spatial resolution superior to conventional fundamental imaging. However, it requires two transmissions with opposite phases, which reduces the imaging frame rate by half. This study aimed to solve this problem METHOD: An ultrasonic array probe consisting of piezoelectric elements with two polarization-inverted layers, which requires only one transmission to extract the second harmonic components, was developed. Its characteristics, such as electric impedance and its phase, were predicted by solving piezoelectric as well as wave equations, and then compared with measurement. The acoustic pressures produced from the developed probe, when excited at the lower and higher resonant frequencies, were measured using a hydrophone. Finally, imaging of wires in water and phantoms containing wires and a cyst model were performed using the developed probe RESULT: The spatial resolution, especially in the axial direction, was significantly improved with the developed probe consisting of the two piezoelectric layer elements in comparison with the conventional second harmonic imaging (HI) using a band pass filter. It was almost comparable to that of conventional PI imaging despite only one transmission being required CONCLUSION: A probe consisting of two piezoelectric layer elements enabling one-transmission HI was developed. The spatial resolution obtained using the developed probe was slightly worse but almost comparable to that of conventional PI imaging even with only one transmission.
Izumori A, Kokubu Y, Sakai T
… +4 more, Akiyama F, Iwase T, Moon WK, Ueno T
J Med Ultrason (2001)
· 2026 Jun · PMID 42360670
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PURPOSE: To determine whether a dynamic ultrasound approach, termed anatomical scanning and interpretation, improves diagnostic performance in differentiating benign from malignant breast lesions compared with convention...PURPOSE: To determine whether a dynamic ultrasound approach, termed anatomical scanning and interpretation, improves diagnostic performance in differentiating benign from malignant breast lesions compared with conventional static-image BI-RADS assessment. METHODS: This prospective study evaluated 102 breast lesions (33 masses, 41 non-masses, and 28 distortions) classified as BI-RADS 3, 4a, or 4b. Fourteen ultrasound technologists underwent dedicated training in dynamic anatomical scanning and interpretation. Each lesion was evaluated using real-time video clips and independently categorized as requiring follow-up or biopsy. A subsequent physician-technologist consensus was performed. With histopathology as the reference standard, performance was assessed using ROC analysis, with AUC comparisons performed using the DeLong test. RESULTS: Among 102 lesions (58 benign, 44 malignant), individual technologist interpretation with dynamic imaging significantly improved diagnostic performance (AUC = 0.748, p = 0.0191) over static BI-RADS assessment (AUC = 0.619). Physician-technologist consensus showed further significant improvement (AUC = 0.865, p < 0.0001). In subgroup analysis, dynamic interpretation outperformed static assessment for masses (AUC = 0.849, p = 0.0036), but not for non-mass lesions (AUC = 0.794) or distortions (AUC = 0.618). In contrast, physician-technologist consensus interpretation demonstrated superior performance compared with static assessment across all lesion types: masses (AUC = 0.879, p < 0.0001), non-mass lesions (AUC = 0.910, p = 0.0005), and distortions (AUC = 0.838, p = 0.0432). CONCLUSION: Dynamic anatomical scanning and interpretation significantly improve diagnostic performance over conventional static BI-RADS assessment. For non-mass lesions and architectural distortions, anatomical interpretation based on consensus between the physician and the technologist is considered essential to achieve optimal diagnostic accuracy.
Abe T, Kuroda H, Nishimura T
… +6 more, Yoshida M, Kuroiwa S, Fujiwara Y, Yano H, Matsumoto T, Iijima H
J Med Ultrason (2001)
· 2026 Jun · PMID 42334696
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PURPOSE: The increasing prevalence of steatotic liver disease (SLD) underscores the need for reliable, noninvasive tools to assess hepatic steatosis. Existing methods, such as the controlled attenuation parameter (CAP) u...PURPOSE: The increasing prevalence of steatotic liver disease (SLD) underscores the need for reliable, noninvasive tools to assess hepatic steatosis. Existing methods, such as the controlled attenuation parameter (CAP) under ultrasound, have limitations in accuracy. This study aimed to examine whether combining attenuation imaging (AI) and hepatorenal index (HRI) measurements improves discrimination of steatosis in participants with chronic liver disease (CLD). METHODS: This multicenter prospective cohort study enrolled 121 participants with CLD from two centers during 2022-2023. All participants underwent liver biopsy and ultrasound examinations, including AI and HRI measurements using a Philips EPIQ system, and CAP assessment. An AI-HRI composite score was developed using logistic regression and evaluated against individual variables through receive operating characteristic analysis, category-free net reclassification improvement (cf-NRI), and integrated discrimination improvement (IDI). Internal validation was performed using bootstrap sampling. RESULTS: The area under the curve values for discrimination for the AI-HRI composite score, AI, HRI, and CAP were 0.91, 0.87, 0.86, and 0.80, respectively. At a cutoff of -0.083, the sensitivity and specificity were 84.1% and 90.0%, respectively. The cf-NRI and IDI analyses demonstrated improved discrimination compared to other variables (p < 0.01). Bootstrap analysis confirmed the internal validity of the score (C-index: 0.90). CONCLUSIONS: The AI-HRI composite score provides superior discrimination of steatosis in participants with CLD, potentially offering a more accurate and reliable tool for clinical assessment. These findings could facilitate improved management and early intervention in SLD.
Kawakami Y, Nakamura K, Yasui H
… +4 more, Aoshima K, Sasaki N, Yokoyama N, Takiguchi M
J Med Ultrason (2001)
· 2026 Jun · PMID 42301565
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PURPOSE: Lung ultrasound is widely used in clinical practice, but B-mode findings often lack disease specificity. Shear wave elastography (SWE) enables quantitative assessment of tissue elasticity and may help overcome t...PURPOSE: Lung ultrasound is widely used in clinical practice, but B-mode findings often lack disease specificity. Shear wave elastography (SWE) enables quantitative assessment of tissue elasticity and may help overcome this limitation. This study aimed to evaluate whether SWE can be used to detect lung surface changes associated with airway pressure and pulmonary fibrosis. METHODS: Ex vivo porcine lungs (n = 3) were used to examine the effects of airway pressure. Airway pressure was adjusted to 10, 20, and 30 cmHO, and shear wave speed (SWS) was measured on the lung surface. Pulmonary fibrosis was induced in Sprague-Dawley rats (n = 13) by means of right thoracic irradiation. After 26 weeks, SWE was performed on excised lungs, and histopathological analysis of fibrosis and air proportions was conducted using QuPath-based image analysis. Statistical analyses included Spearman's correlation, Wilcoxon signed-rank test, and multiple regression with isometric log-ratio (ILR) transformation. RESULTS: In porcine lungs, SWS increased with airway pressure and showed a strong positive correlation. In the radiation-induced fibrosis model, irradiated lungs had significantly higher SWS than non-irradiated lungs. Histopathology confirmed increased fibrosis and reduced air without inflammation. Multiple regression showed a significant association between fibrosis and SWS. CONCLUSION: Lung surface SWE detected changes related to airway pressure and pulmonary fibrosis. SWS increased with both, although other factors, such as lung reduction in air content and tensile stress, can also affect measurements.
Hata T, Takahashi Y, Konishi M
… +3 more, Koyanagi A, Miyagi Y, Miyake T
J Med Ultrason (2001)
· 2026 Jun · PMID 42247184
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PURPOSE: To determine reference values for Japanese fetal penile length using ultrasonography at 18-21 + 6 as well as 28-31 + 5 weeks of gestation. METHODS: Three hundred and five pregnant women were enrolled in the stud...PURPOSE: To determine reference values for Japanese fetal penile length using ultrasonography at 18-21 + 6 as well as 28-31 + 5 weeks of gestation. METHODS: Three hundred and five pregnant women were enrolled in the study, and fetal penile length was measured at both 18-21 + 6 and 28-31 + 5 weeks of gestation. All 305 fetuses were successfully measured. Outer penile length (OPL) of the male fetus was measured, and OPL reference values were determined. Intra- and inter-observer agreements regarding OPL were also assessed with Bland-Altman plots and intra- and inter-correlation coefficients. RESULTS: OPL showed an increasing trend with advancing gestation at 18-21 + 6 (r = 0.2757, p < 0.001) and 28-31 + 5 (r = 0.2306, p < 0.001) weeks. Intra- and inter-reproducibilities of OPL were excellent. Intra- and inter-correlation coefficients of OPL were 0.982287 and 0.885602, respectively, at 18-21 + 6 weeks, and 0.994104 and 0.97343, respectively, at 28-31 + 5 weeks. CONCLUSION: Our results provide reference values for Japanese fetal penile length, which may promote accurate prenatal diagnoses of hypospadias, micropenis, and buried penis in Japan.
Kuroda S, Yuzuriha S, Takahashi K
… +3 more, Naruse J, Nakajima N, Shoji S
J Med Ultrason (2001)
· 2026 Jun · PMID 42243380
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Magnetic resonance imaging (MRI) has become an essential tool for localizing intraprostatic tumors and detecting clinically significant prostate cancer (csPC). However, limitations related to cost, availability, and the...Magnetic resonance imaging (MRI) has become an essential tool for localizing intraprostatic tumors and detecting clinically significant prostate cancer (csPC). However, limitations related to cost, availability, and the presence of MRI-invisible lesions have driven interest in alternative imaging modalities. Transrectal ultrasound (TRUS), routinely performed by urologists, has evolved substantially with the development of advanced ultrasound technologies. Conventional gray-scale TRUS enables real-time assessment of prostate morphology and provides guidance for biopsy; however, its sensitivity for detecting csPC remains limited. Recent advances, including 29-MHz micro-ultrasound, color and power Doppler imaging, contrast-enhanced ultrasound, superb microvascular imaging (SMI), and elastography, have significantly expanded the diagnostic capability of ultrasound. Micro-ultrasound offers high-resolution visualization of ductal architecture and lesion morphology, and it has demonstrated diagnostic performance comparable to multiparametric MRI (mpMRI) in several prospective studies. Doppler-based techniques and SMI enable assessment of tumor-associated vascularity, while elastography provides quantitative assessment of tissue stiffness, which correlates with tumor aggressiveness. The integration of multiple ultrasound modalities, known as multiparametric ultrasound (mpUS), has shown promising diagnostic accuracy for csPC detection. Recent studies suggest that mpUS can identify clinically significant cancers missed by mpMRI and may serve as a complementary or alternative imaging strategy, particularly when MRI is unavailable or impractical.
Uchida Y, Kawabata M, Kumazawa Y
… +7 more, Ogawa A, Takagi K, Miyatake K, Kobayashi T, Watanabe H, Kenmoku T, Takahira N
J Med Ultrason (2001)
· 2026 May · PMID 42204070
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PURPOSE: Grade III lateral ankle sprains feature complete anterior talofibular ligament rupture and severe mechanical instability. Although conservative care is standard, the time course of anterior displacement remains...PURPOSE: Grade III lateral ankle sprains feature complete anterior talofibular ligament rupture and severe mechanical instability. Although conservative care is standard, the time course of anterior displacement remains unclear. METHODS: This single-center retrospective case series included eight consecutive patients (≥ 12 years old) with Grade III lateral ankle sprains confirmed by radiography and ultrasound (April 2021-December 2023). Patients underwent ultrasound-guided reverse anterior drawer testing at four time points: initial consultation and weeks 1, 3, and 5. The primary outcome was change in talofibular distance (max-min during testing). All measurements were obtained by one examiner using automated length measurement system software. Patients were immobilized for up to 2 weeks, then used a functional brace until week 8. Early weight-bearing was allowed. Rehabilitation began after immobilization, with jogging and sport-specific drills at week 3, with return to sport targeted for week 8. RESULTS: Mean change in talofibular distance (mm) was 2.99 ± 1.06 at baseline, 2.73 ± 1.08 at week 1, 1.02 ± 0.97 at week 3, and 1.32 ± 0.96 at week 5; unaffected side 1.23 ± 0.23. Significant improvement was seen between weeks 1 and 3 (p = 0.007) and relative to baseline at weeks 3 (p < 0.001) and 5 (p = 0.020). CONCLUSIONS: In this small, single-center retrospective series, anterior displacement decreased most prominently by week 3 after injury. These findings are hypothesis-generating and require confirmation in larger prospective studies before informing treatment protocols or return-to-sport decisions.
Shimizu S, Kawabata M, Sano Y
… +4 more, Saito K, Nagano Y, Watanabe H, Takahira N
J Med Ultrason (2001)
· 2026 May · PMID 42192000
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PURPOSE: Ulnar neuropathy is a common condition among athletes who perform repetitive throwing motions. Dynamic displacement of the ulnar nerve during elbow flexion may contribute to medial elbow pain and impaired finger...PURPOSE: Ulnar neuropathy is a common condition among athletes who perform repetitive throwing motions. Dynamic displacement of the ulnar nerve during elbow flexion may contribute to medial elbow pain and impaired finger function. However, the reported prevalence of ulnar nerve displacement varies considerably, and differences in postural evaluation may contribute to these discrepancies. Therefore, this study aimed to determine whether shoulder abduction angle influences the prevalence of dynamic ulnar nerve displacement observed during ultrasonographic assessment in high school baseball players. METHODS: This cross-sectional study included 51 male high school baseball players from a single team. Dynamic ultrasonographic assessment of both elbows was performed at shoulder abduction angles of 30° and 100° to evaluate ulnar nerve displacement. Displacement during elbow flexion was classified into three categories: non-dislocation, subluxation, and dislocation. RESULTS: At 30° shoulder abduction, ulnar nerve displacement occurred in 35/50 (70.0%) throwing-side elbows and 26/50 (52.0%) non-throwing-side elbows. At 100° shoulder abduction, it occurred in 38/50 (76.0%) throwing-side elbows and 27/50 (54.0%) non-throwing-side elbows. The incidence rates were significantly higher on the throwing side than on the non-throwing side under both conditions (p = 0.001). Increasing shoulder abduction from 30° to 100° resulted in only a slight increase in the prevalence of ulnar nerve displacement, from 70.0% to 76.0% on the throwing side and from 52.0% to 54.0% on the non-throwing side; however, neither change was statistically significant (p = 0.69). CONCLUSION: In high school baseball players, the prevalence of ulnar nerve displacement did not differ significantly between 30° and 100° of shoulder abduction. This finding suggests that shoulder abduction alone may have a limited influence on ulnar nerve dynamics.
Saito M, Okuda H, Ohtani A
… +4 more, Sato H, Nitta K, Koike K, Someya M
J Med Ultrason (2001)
· 2026 May · PMID 42177384
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PURPOSE: To retrospectively evaluate the diagnostic performance and safety of ultrasound (US)-guided biopsy for thoracic lesions, exploring the potential role of contrast-enhanced US (CEUS) for tissue sampling accuracy....PURPOSE: To retrospectively evaluate the diagnostic performance and safety of ultrasound (US)-guided biopsy for thoracic lesions, exploring the potential role of contrast-enhanced US (CEUS) for tissue sampling accuracy. METHODS: This single-center retrospective study included 14 consecutive cases that underwent US-guided biopsy for thoracic lesions. The mean age was 68 ± 12 years (8 males, 6 females). Lesions were located in the lung (n = 3), mediastinum (n = 4), chest wall (n = 3), and rib (n = 4). Biopsies were performed using an 18- or 20-gauge core needle under B-mode and color Doppler guidance. CEUS using Sonazoid was employed in three cases: two with suspected necrosis and one with renal impairment. The primary outcome measures were technical and clinical success, diagnostic accuracy, and complications. RESULTS: Technical and clinical success rates were both 100% (14/14). Diagnostic accuracy was 92.8% (13/14) with a false-negative rate of 9.1% (1/11 malignant cases). Median biopsies: 2 (range: 1-4); mean procedure time: 24.0 ± 12.5 min. Diagnoses included three benign and 11 malignant lesions. One complication (7.1%) occurred: mild pneumothorax managed conservatively. This case required four biopsies due to necrotic tissue sampling. CEUS-guided cases achieved diagnosis within three biopsies without complications, with successful identification of viable tissue in all cases. CONCLUSION: US-guided biopsy for thoracic lesions demonstrates high success rates and safety comparable to those in the literature. In this limited series, CEUS showed potential for identifying viable tissue in cases with suspected necrosis and enabled lesion evaluation while minimizing iodinated contrast exposure in patients with renal impairment. Validation in larger studies is needed.
Omori Y, Hirokawa M, Higuchi M
… +5 more, Oshita M, Yamaoka H, Fujishima M, Miyauchi A, Akamizu T
J Med Ultrason (2001)
· 2026 May · PMID 42156636
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PURPOSE: Papillary thyroid microcarcinoma (PTMC) with acoustic shadowing without a high-echo signal is occasionally encountered in clinical practice. However, the pathophysiology underlying such findings has not been inv...PURPOSE: Papillary thyroid microcarcinoma (PTMC) with acoustic shadowing without a high-echo signal is occasionally encountered in clinical practice. However, the pathophysiology underlying such findings has not been investigated. We aimed to elucidate the clinical significance of acoustic shadowing without a high-echo signal in PTMC. METHODS: Nine PTMC nodules with acoustic shadowing but no high-echo signal and 76 PTMC nodules without acoustic shadowing or high-echo signal were included. Nodules were analyzed using ultrasound, aspiration cytology, and histological examination. RESULTS: Punctate echogenic foci were not observed in PTMC nodules with acoustic shadowing but no high-echo signals. The frequency (11.1%) of psammoma bodies in PTMC nodules with acoustic shadowing was lower than that in nodules without acoustic shadowing (31.6%); however, the difference was not significant. Extensive hyalinization was observed in 66.7% and 3.9% of PTMC nodules with and without acoustic shadowing, respectively (p < 0.001). The distributions of acoustic shadowing and hyalinized stroma were correlated. CONCLUSIONS: Acoustic shadowing without a high-echo signal is caused not by calcification but rather by extensive hyalinization. Our results may help refine the sonographic criteria for PTMC and provide a novel imaging marker for identifying indolent tumors, thereby supporting active surveillance strategies and potentially reducing overtreatment.
Yamane N, Matoba Y, Uyama T
… +9 more, Enokizono Y, Nakamoto K, Teraoka Y, Oomori Y, Tomono K, Yamazaki T, Mukai Y, Banno K, Yamaguchi K
J Med Ultrason (2001)
· 2026 May · PMID 42149291
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PURPOSE: Mid-pregnancy cervical length (CL) has limited predictive performance for spontaneous preterm birth (sPTB) in the normal range. The uterocervical angle (UCA) is a promising marker, but evidence regarding late-pr...PURPOSE: Mid-pregnancy cervical length (CL) has limited predictive performance for spontaneous preterm birth (sPTB) in the normal range. The uterocervical angle (UCA) is a promising marker, but evidence regarding late-pregnancy UCA and its longitudinal change is limited. We evaluated UCA in mid- and late-pregnancy and the % change (ΔUCA) as predictors of sPTB, and developed a pragmatic risk-stratification scheme using these parameters. METHODS: In a single-center retrospective study, 163 singleton pregnancies were analyzed. UCA was measured on transvaginal ultrasound at 16-24 weeks (mid-pregnancy) and 25-33 weeks (late-pregnancy). ΔUCA was calculated as the % change from mid to late-pregnancy. Predictive performance for sPTB (< 37 weeks) was assessed using logistic regression and receiver operating characteristic analysis. RESULTS: A mid-pregnancy UCA ≥ 105° had a sensitivity of 85.4%, specificity of 76.9%, and area under the curve (AUC) of 0.858 (95% CI 0.768-0.948) for prediction of sPTB. In contrast, CL < 25 mm had a sensitivity of 8.3% (mid-pregnancy) and 17.9% (late-pregnancy). A late-pregnancy UCA ≥ 112° had a sensitivity of 81.8%, specificity of 56.7%, and AUC of 0.728 (95% confidence interval [CI], 0.623-0.833), and ΔUCA ≥ + 12% predicted sPTB with a sensitivity of 81.2%, specificity of 66.7%, and AUC of 0.742 (95% CI 0.579-0.905). Using three criteria (mid-pregnancy UCA ≥ 105°, late-pregnancy UCA ≥ 112°, ΔUCA ≥ + 12%), preterm birth rates were 1.4% (low-risk: 0 points) vs. 46.2% (high-risk: 3 points) (p < 0.001). CONCLUSIONS: UCA in mid- and late-pregnancy and ΔUCA predict sPTB with higher sensitivity than CL shortening alone, offering a noninvasive complement to current screening. In particular, a mid-pregnancy UCA ≥ 105° and ΔUCA ≥ + 12% may identify clinically important high-risk cases.