. 2023 Jan;50(1):5-49.

doi: 10.1007/s10396-022-01272-w. Epub 2023 Jan 23.

Manual for abdominal ultrasound in cancer screening and health checkups, revised edition (2021)

Shinji Okaniwa¹, Toshiko Hirai², Masahiro Ogawa³, Sachiko Tanaka⁴, Kazuo Inui⁵, Takashi Wada⁶, Naoki Matsumoto³, Shigehiko Nishimura⁷, Yuko Chiba⁸, Hiroyoshi Onodera⁹, Takashi Kumada¹⁰, Masahisa Kojima¹¹, Michiko Nakajima¹², Yoshihiro Mizuma¹³, Shinji Tanaka¹⁴, Toru Nishikawa¹⁵, Shuichi Mihara¹⁶, Yoshioki Yoda¹⁷, Masaki Adachi¹⁸, Tomofumi Atarashi¹⁹; Working Group on Revision of the Manual for Abdominal Ultrasound in Cancer Screening and Health Checkups, Ultrasound Screening Committee of the Japanese Society of Gastrointestinal Cancer Screening

Collaborators, Affiliations

Collaborators

Working Group on Revision of the Manual for Abdominal Ultrasound in Cancer Screening and Health Checkups, Ultrasound Screening Committee of the Japanese Society of Gastrointestinal Cancer Screening:
Masayuki Kitano, Yutaka Chiba, Masahiko Nakata, Takashi Nishimura, Hiroshi Matsuo, Hideaki Mori, Noritaka Wakui, Kiyoka Sugita, Kenichi Maruyama, Kazuhiro Murakami, Akira Kuwajima, Ryuzo Sekiguchi, Satoru Ikeda, Yoshitomo Ishikawa, Kazuhiro Iwashita, Shinji Okaniwa, Masahiro Ogawa, Ayumi Oguri, Norikazu Obane, Mitsuko Kato, Masahiro Kaneko, Satoshi Kawabata, Kiyofumi Kawabata, Takako Kojima, Miho Saito, Hitomi Sasaki, Yoko Sugino, Asako Sugimoto, Seiichiro Suda, Ryosuke Taiji, Yu Tamura, Yuko Chiba, Mika Tojo, Ayaka Nakajima, Naomi Tanaka, Toru Nishikawa, Shigehiko Nishimura, Katsuyoshi Hayashi, Takeshi Hisa, Toshiko Hirai, Midori Hirayama, Megumi Honma, Nagaaki Marugami, Michie Miura, Masanori Miyashita, Yukiko Morimoto, Satoshi Yamauchi, Toshiki Yamamoto, Hiroka Yoshinaga, Satoshi Wakasugi, Noriko Watanabe, Yukinobu Watanabe

Affiliations

¹ Department of Gastroenterology, Iida Municipal Hospital, Iida, Nagano, Japan. sokaniwa.2@gmail.com.
² Department of General Diagnostic Imaging Center, Nara Medical University, Nara, Japan.
³ Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
⁴ Osaka Center for Cancer and Cardiovascular Disease Prevention, Osaka, Japan.
⁵ Department of Gastroenterology, Yamashita Hospital, Aichi, Japan.
⁶ Health Science, The Jikei University Graduate School of Medicine, Tokyo, Japan.
⁷ Department of Surgery, Sumitomo Hospital, Osaka, Japan.
⁸ Clinical Inspection Department, Hokkaido Industrial Health Management Fund, Hokkaido, Japan.
⁹ Cancer Detection Center, Miyagi Cancer Society, Miyagi, Japan.
¹⁰ Department of Nursing, Gifu Kyoritsu University, Gifu, Japan.
¹¹ Medical Examination Center, Urasoe General Hospital, Okinawa, Japan.
¹² Nakagaya Clinic, Nagano, Japan.
¹³ Department of Internal Medicine, Higashi Kobe Hospital, Hyogo, Japan.
¹⁴ Japanese Red Cross Society Kumamoto Health Care Center, Kumamoto, Japan.
¹⁵ Department of Clinical Laboratory, Fujita Health University Hospital, Aichi, Japan.
¹⁶ Mihara Life Care Clinic, Kumamoto, Japan.
¹⁷ Health Care Center, Yamanashi Koseiren Health Care Center, Yamanashi, Japan.
¹⁸ Health Management Center, Saitama Medical University Hospital, Saitama, Japan.
¹⁹ Medical Check-Up Center, JA Hokkaido P.W.F.A.C. Obihiro Kosei General Hospital, Hokkaido, Japan.

PMID: 36683097
PMCID: PMC9868003
DOI: 10.1007/s10396-022-01272-w

Manual for abdominal ultrasound in cancer screening and health checkups, revised edition (2021)

Shinji Okaniwa et al. J Med Ultrason (2001). 2023 Jan.

. 2023 Jan;50(1):5-49.

doi: 10.1007/s10396-022-01272-w. Epub 2023 Jan 23.

Authors

Collaborators

Working Group on Revision of the Manual for Abdominal Ultrasound in Cancer Screening and Health Checkups, Ultrasound Screening Committee of the Japanese Society of Gastrointestinal Cancer Screening:
Masayuki Kitano, Yutaka Chiba, Masahiko Nakata, Takashi Nishimura, Hiroshi Matsuo, Hideaki Mori, Noritaka Wakui, Kiyoka Sugita, Kenichi Maruyama, Kazuhiro Murakami, Akira Kuwajima, Ryuzo Sekiguchi, Satoru Ikeda, Yoshitomo Ishikawa, Kazuhiro Iwashita, Shinji Okaniwa, Masahiro Ogawa, Ayumi Oguri, Norikazu Obane, Mitsuko Kato, Masahiro Kaneko, Satoshi Kawabata, Kiyofumi Kawabata, Takako Kojima, Miho Saito, Hitomi Sasaki, Yoko Sugino, Asako Sugimoto, Seiichiro Suda, Ryosuke Taiji, Yu Tamura, Yuko Chiba, Mika Tojo, Ayaka Nakajima, Naomi Tanaka, Toru Nishikawa, Shigehiko Nishimura, Katsuyoshi Hayashi, Takeshi Hisa, Toshiko Hirai, Midori Hirayama, Megumi Honma, Nagaaki Marugami, Michie Miura, Masanori Miyashita, Yukiko Morimoto, Satoshi Yamauchi, Toshiki Yamamoto, Hiroka Yoshinaga, Satoshi Wakasugi, Noriko Watanabe, Yukinobu Watanabe

Affiliations

¹ Department of Gastroenterology, Iida Municipal Hospital, Iida, Nagano, Japan. sokaniwa.2@gmail.com.
² Department of General Diagnostic Imaging Center, Nara Medical University, Nara, Japan.
³ Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
⁴ Osaka Center for Cancer and Cardiovascular Disease Prevention, Osaka, Japan.
⁵ Department of Gastroenterology, Yamashita Hospital, Aichi, Japan.
⁶ Health Science, The Jikei University Graduate School of Medicine, Tokyo, Japan.
⁷ Department of Surgery, Sumitomo Hospital, Osaka, Japan.
⁸ Clinical Inspection Department, Hokkaido Industrial Health Management Fund, Hokkaido, Japan.
⁹ Cancer Detection Center, Miyagi Cancer Society, Miyagi, Japan.
¹⁰ Department of Nursing, Gifu Kyoritsu University, Gifu, Japan.
¹¹ Medical Examination Center, Urasoe General Hospital, Okinawa, Japan.
¹² Nakagaya Clinic, Nagano, Japan.
¹³ Department of Internal Medicine, Higashi Kobe Hospital, Hyogo, Japan.
¹⁴ Japanese Red Cross Society Kumamoto Health Care Center, Kumamoto, Japan.
¹⁵ Department of Clinical Laboratory, Fujita Health University Hospital, Aichi, Japan.
¹⁶ Mihara Life Care Clinic, Kumamoto, Japan.
¹⁷ Health Care Center, Yamanashi Koseiren Health Care Center, Yamanashi, Japan.
¹⁸ Health Management Center, Saitama Medical University Hospital, Saitama, Japan.
¹⁹ Medical Check-Up Center, JA Hokkaido P.W.F.A.C. Obihiro Kosei General Hospital, Hokkaido, Japan.

PMID: 36683097
PMCID: PMC9868003
DOI: 10.1007/s10396-022-01272-w

No abstract available

Keywords: Abdominal ultrasonography; Cancer screening; Category; Heath checkup; Ultrasound finding; Ultrasound screening.

PubMed Disclaimer

Conflict of interest statement

Members, etc., who created this manual were asked to declare the following conflicts of interest. With respect to companies/organizations from which the member himself or herself, a spouse, a first-degree or closer relative, an individual with whom he or she shares income/assets, or the director of an institution/division to which he or she belongs received some form of compensation: compensation (≥ 1 million yen), profit from stock (≥ 1 million yen, or ≥ 5%), patent royalty (≥ 1 million yen), lecture fee, etc. (≥ 500,000 yen), manuscript fee (≥ 500,000 yen), research expenses/grant (≥ 1 million yen), scholarship donation, etc. (≥ 1 million yen), endowed course provided by corporation, etc. (≥ 1 million yen), and provision of funds not directly related to research (≥ 50,000 yen). Masahiro OGAWA (compensation: GE Healthcare Japan, Canon Medical Systems, Dainippon Sumitomo Pharma), Shinji OKANIWA (compensation: GE Healthcare Japan, Canon Medical Systems), Masaki ADACHI (compensation: Medical Egg), Masayuki KITANO (lecture fee: Olympus, EA Pharma, Kaneka Medix, scholarship donation: AbbVie, Takeda Pharmaceutical), Masahiko NAKATA (scholarship donation: Hitachi Healthcare Business Unit), Takashi NISHIMURA(scholarship donation: Canon Medical Systems GE Healthcare Japan), Hiroshi MATSUO (lecture fee: Daiichi Sankyo).

Figures

**Fig. 1**
Twenty-five recommended sections to record

**Fig. 3**
Commonly focal spared area in fatty liver. If it is an irregular hypoechoic area in a commonly focal spared area without a disturbed speckle pattern, and no deviation in blood flow is detected on color Doppler, it is not considered a solid lesion (Figs. Liver-6 to 8)

**Fig. 4**
Post-local treatment. Left: post-radiofrequency ablation; right: post-hepatic arterial embolization. Category 3, Assessment C Please align the size of images(8,13-16, 21-26, 28-30, 32-34)

**Fig. 5**
Diffuse lesion. Any one of bright liver, liver-kidney (spleen) contrast, deep attenuation, or intrahepatic vascular blurring is present. Left: liver–kidney contrast; right: liver–spleen contrast. Category 2, Assessment C

**Fig. 6**
Diffuse lesion. Commonly focal spared area in fatty liver (Around the gallbladder: Cystic vein reflux region). Left: B-mode, Right: Power Doppler. Category 2, Assessment C

**Fig. 7**
Diffuse lesion. Commonly focal spared area in fatty liver (Right gastric vein ectopic reflux region). Left: Dorsal S4, Right: Dorsal S2. Category 2, Assessment C

**Fig. 8**
Diffuse lesion. Commonly focal spared area in fatty liver (Frontal S4 immediately below the liver surface: Sappey's venous reflux region). Category 2, Assessment C

**Fig. 9**
Diffuse lesion. Dull hepatic edge/rough parenchymal echo pattern or nodular rugged liver surface is present (either one) (only dull hepatic margin is noted). Left: right intercostal scan (right hepatic lobe) with convex probe; right: midline vertical scan (left hepatic lobe) with high-frequency probe. Category 3, Assessment C

**Fig. 10**
Diffuse lesion. Dull hepatic edge/rough parenchymal echo pattern or nodular rugged liver surface is present (either one). Bamboo blind sign (include in rough echo pattern). Left: right intercostal scan with convex probe; right: right intercostal scan with high-frequency probe. Category 3, Assessment C

**Fig. 11**
Diffuse lesion. Dull hepatic edge/rough parenchymal echo pattern and nodular rugged liver surface are present (all) (flag sign). Left: midline vertical scan with convex probe, right: midline vertical scan with high-frequency probe. Category 3, Assessment D2

**Fig. 12**
Diffuse lesion. Dull hepatic edge/rough parenchymal echo pattern and nodular rugged liver surface are present (all). Left: right intercostal scan (right hepatic lobe), right: midline vertical scan (left hepatic lobe). Category 3, Assessment D2

**Fig. 13**
Diffuse lesion. Dull hepatic edge/rough parenchymal echo pattern and nodular rugged liver surface are present (all) (high-frequency probe). Category 3, Assessment D2

**Fig. 14**
Solid lesion. A solid hepatic lesion is present (maximum diameter < 15 mm). Category 3, Assessment C

**Fig. 15**
Solid lesion. Solid lesion with involvement of Category 3 diffuse lesion. Category 4, Assessment D2

**Fig. 16**
Solid lesion. A solid lesion is present. Maximum diameter ≥ 15 mm. Category 4, Assessment D2

**Fig. 17**
Hepatic neoplastic lesion. Marginal strong echo. Left: Convex probe, Right: High-frequency probe. Category 2, Assessment C

**Fig. 18**
Hepatic neoplastic lesion. Chameleon sign/wax and wane sign (change in internal echo detected). Category 2, Assessment C

**Fig. 19**
Hepatic neoplastic lesion. Disappearing sign. Left: Before compression, Right: After compression. Category 2, Assessment C

**Fig. 20**
Hepatic neoplastic lesion. Sludge worm sign. Left: High-frequency probe, Right: Zoom image. Category 2, Assessment C

**Fig. 21**
Hepatic neoplastic lesion. Peripheral hypoechoic zone/posterior echo enhancement. Category 4, Assessment D2

**Fig. 22**
Hepatic neoplastic lesion. Multiple neoplastic lesions. Category 4, Assessment D2

**Fig. 23**
Hepatic neoplastic lesion. Distal bile duct dilatation. Category 4, Assessment D2

**Fig. 24**
Hepatic neoplastic lesion. Mosaic pattern. Category 5, Assessment D1

**Fig. 25**
Hepatic neoplastic lesion. Bright loop appearance. Category 5, Assessment D1

**Fig. 26**
Hepatic neoplastic lesion. Hump sign. Category 5, Assessment D1

**Fig. 27**
Hepatic neoplastic lesion. Cluster sign. Left: Convex probe, Right: High-frequency probe. Category 5, Assessment D1

**Fig. 28**
Hepatic neoplastic lesion. Bull's eye pattern (target sign). Category 5, Assessment D1

**Fig. 29**
Hepatic neoplastic lesion. Intraportal tumor embolism is present. Category 5, Assessment D1

**Fig. 30**
Cystic lesion. Solid component (intracystic nodules/wall thickening/septal thickening) is present. Intracystic nodules are present. Category 4, Assessment D2

**Fig. 31**
Cystic lesion. Solid component (intracystic nodules/wall thickening/septal thickening) and change in internal fluid (e.g., internal echogenic spots) are present. Left: cyst wall thickening; right: echogenic spots in internal fluid. Category 4, Assessment D2

**Fig. 32**
Cystic lesion. Distal bile duct dilatation. Category 3, Assessment D2

**Fig. 33**
Other findings. Calcified opacity. Comet-like echo. Category 2, Assessment C

**Fig. 34**
Other findings. Pneumobilia. Category 2, Assessment B

**Fig. 35**
Other findings. Vascular abnormality (portal-venous shunt). Left: B-mode; right: color Doppler. Category 2, Assessment D2

**Fig. 36**
Measurement of bile duct diameter

**Fig. 37**
The gallbladder wall is inevaluable (the wall is inevaluable due to being filled with stones). Category 3, Assessment D2

**Fig. 38**
The gallbladder wall is inevaluable (the wall is inevaluable due to food intake). Category 3, Assessment D2

**Fig. 39**
Gallbladder distension. Maximum short diameter ≥ 36 mm. Category 3, Assessment D2

**Fig. 40**
Wall thickening. Diffuse wall thickening (without small cystic structure or comet-like echo). Category 3, Assessment D2

**Fig. 41**
Wall thickening. Diffuse wall thickening (with cholecystolithiasis and small cystic structure or comet-like echo). Category 2, Assessment C

**Fig. 42**
Wall thickening. Diffuse wall thickening (with irregularity of the layered structure of the wall and disruption of the outermost hyperechoic layer). Category 4, Assessment D2

**Fig. 43**
Wall thickening. Localized wall thickening (without small cystic structure or comet-like echo). Left: convex probe; right: high-frequency probe. Category 4, Assessment D2

**Fig. 44**
Wall thickening. Localized wall thickening (mimicking debris echo without small cystic structure or comet-like echo). Left: long-axis view; right: short-axis view. Category 4, Assessment D2

**Fig. 45**
Wall thickening. Localized wall thickening (papillary without small cystic structure or comet-like echo). Category 4, Assessment D2

**Fig. 46**
Wall thickening. Localized wall thickening (with comet-like echo). Category 2, Assessment C

**Fig. 47**
Protruded or mass lesion (polyp). Pedunculated (maximum diameter < 5 mm). Category 2, Assessment B

**Fig. 48**
Protruded or mass lesion (polyp). Pedunculated [maximum diameter ≥ 5 mm, < 10 mm (mulberry-like)]. Category 2, Assessment B

**Fig. 49**
Protruded or mass lesion (polyp). Pedunculated [maximum diameter ≥ 5 mm, < 10 mm (with hyperechoic spot)]. Category 2, Assessment B

**Fig. 50**
Protruded or mass lesion (polyp). Pedunculated (maximum diameter ≥ 10 mm). Category 4, Assessment D2

**Fig. 51**
Protruded or mass lesion (polyp). Sessile (non-pedunculated) (without tear of the layered structure of the attached wall). Category 4, Assessment D2

**Fig. 52**
Protruded or mass lesion (polyp). Sessile (non-pedunculated) (with small cystic structures). Left: convex probe; right: high-frequency probe. Category 2, Assessment C

**Fig. 53**
Protruded or mass lesion (polyp). Sessile (broad-based) (with tear of the layered structure of the attached wall). Category 5, Assessment D1

**Fig. 54**
Other findings. Stone image (strong echo without wall thickening). Category 2, Assessment C

**Fig. 55**
Other findings. Pneumobilia (movable linear strong echo with position change). Category 2, Assessment C

**Fig. 56**
Other findings. Debris echo (gallbladder). Category 3, Assessment D2

**Fig. 57**
Other findings. Debris echo (mass lesion with the irregular outermost hyperechoic layer of the attached wall of the extrahepatic bile duct) (left: gallbladder, right: extrahepatic bile duct). Gallbladder is Category 3 and Assessment D2, but extrahepatic bile duct is Category 5 and Assessment D1

**Fig. 58**
Extrahepatic bile duct. Morphological abnormality. (Dilatation of the perihilar extrahepatic bile duct is present, but abnormal findings up to the distal bile duct near the papillary edge are not present.) Left: Perihilar extrahepatic bile duct, Right: Distal extrahepatic bile duct. Category 2, Assessment C

**Fig. 59**
Extrahepatic bile duct. Morphological abnormality. Extrahepatic bile duct dilatation with cystic shape. Category 4, Assessment D2

**Fig. 60**
Extrahepatic bile duct. Morphological abnormality. Extrahepatic bile duct dilatation with fusiform shape. Category 4, Assessment D2

**Fig. 61**
Wall thickening. Maximum wall thickness ≥ 3 mm (without irregularity of the mucosal surface and layered structure). Category 3, Assessment D2

**Fig. 62**
Wall thickening. Irregular layered structure (with irregularity of the mucosal surface and layered structure). Category 5, Assessment D1

**Fig. 63**
Protruded or mass lesion (polyp). Mass lesion (without disruption of the layered structure of the attached wall). Category 4, Assessment D2

**Fig. 64**
Protruded or mass lesion (polyp). Mass lesion (with disruption of the layered structure of the attached wall). Category 5, Assessment D1

**Fig. 65**
Other findings. Stone image (with acoustic shadow). Category 2, Assessment D1

**Fig. 66**
Other findings. Stone image (without acoustic shadow). Category 2, Assessment D1

**Fig. 67**
Other findings. Debris echo (with dilated extrahepatic bile duct). Category 3, Assessment D2

**Fig. 68**
Measurement of main pancreatic duct diameter

**Fig. 69**
Morphological abnormality. Maximum short diameter < 10 mm. Category 2, Assessment D2

**Fig. 70**
Morphological abnormality. Maximum short diameter ≥ 30 mm. Category 2, Assessment D2

**Fig. 71**
Morphological abnormality. Localized swelling (pancreatic head) (with decreased echo level). Category 4, Assessment D2

**Fig. 72**
Morphological abnormality. Localized swelling (pancreatic tail) (with decreased echo level). Category 4, Assessment D2

**Fig. 73**
Main pancreatic duct dilatation. Maximum diameter ≥ 3 mm at pancreatic body (with calcification of pancreatic parenchyma). Category 3, Assessment D2

**Fig. 74**
Main pancreatic duct dilatation. Maximum diameter ≥ 3 mm at pancreatic body (with calcification in the main pancreatic duct). Category 3, Assessment D2

**Fig. 75**
Main pancreatic duct dilatation. Maximum diameter ≥ 3 mm at pancreatic body (with papillary nodule in the main pancreatic duct). Category 4, Assessment D2

**Fig. 76**
Main pancreatic duct dilatation. Maximum diameter ≥ 3 mm at pancreatic body (with downstream (duodenal side) stenosis). Left: pancreatic body; right: main pancreatic duct stenosis in the pancreatic head. Category 4, Assessment D2

**Fig. 77**
Solid lesion. Hypo(iso)echoic or mixed hyper- and hypoechoic mass lesion (lesion presenting a mixed pattern with a mixture of solid and cystic components). Category 4, Assessment D2

**Fig. 78**
Cystic lesion. A solid component (mural nodules/wall thickening) is present (lesion presenting a mixed pattern with a mixture of solid and cystic components). Category 4, Assessment D2

**Fig. 79**
Solid lesion. Hyperechoic mass lesion (maximum diameter < 15 mm). Category 2, Assessment C

**Fig. 80**
Solid lesion. Hyperechoic mass lesion (maximum diameter ≥ 15 mm). Category 3, Assessment D2

**Fig. 81**
Solid lesion. Hypoechoic mass lesion. Category 4, Assessment D2

**Fig. 82**
Solid lesion. Hypoechoic mass lesion (with eggshell-like calcification). Category 4, Assessment D2

**Fig. 83**
Solid lesion. Hypoechoic mass lesion with the disrupted main pancreatic duct (mass lesion with dilatation of caudal pancreatic duct). Category 5, Assessment D1

**Fig. 84**
Cystic lesion (including branch dilatation). Maximum diameter ≥ 5 mm. Category 3, Assessment D2

**Fig. 85**
Cystic lesion (including branch dilatation). A solid component (mural nodules) is present. Category 4, Assessment D2

**Fig. 86**
Cystic lesion (including branch dilatation). A solid component (wall thickening) is present. Category 4, Assessment D2

**Fig. 87**
Cystic lesion (including branch dilatation). A change in internal fluid (internal echogenic spots) is present. Category 4, Assessment D2

**Fig. 88**
Cystic lesion (including branch dilatation). A change in internal fluid (internal echogenic spots) is present. Category 4, Assessment D2

**Fig. 89**
Other findings. Calcified lesion (calcification in the pancreatic body and tail). Category 2, Assessment C

**Fig. 90**
Other findings. Calcification lesion (calcification in the main pancreatic duct in the pancreatic head (without main pancreatic duct dilatation in the pancreatic body)). Category 2, Assessment C

**Fig. 91**
Other findings. Vascular abnormality (A cystic lesion is observed in the pancreas body by the B-mode, and an internal blood flow signal is present on color Doppler.). Left: B-mode; right: color Doppler. Category 2, Assessment D2

**Fig. 92**
Measurement of spleen diameter. Visualize the spleen in the long-axis view and measure the maximum diameter

**Fig. 93**
Post-local treatment (post-splenic embolization). Category 2, Assessment C

**Fig. 94**
Malformation. Maximum diameter ≥ 15 cm. Category 3, Assessment D2

**Fig. 95**
Solid lesion. Hyperechoic mass image. Category 3, Assessment D2

**Fig. 96**
Solid lesion. Hypoechoic mass image. Category 4, Assessment D2

**Fig. 97**
Solid lesion. Hyper/hypoechoic mixed mass image. Category 4, Assessment D2

**Fig. 98**
Solid lesion. Central hyperechoic mass image. Category 5, Assessment D1

**Fig. 99**
Cystic lesion. A solid component (intracystic nodules/wall thickening/internal echogenic spots) is present. Category 4, Assessment D2

**Fig. 100**
Other findings. Calcified opacity. Category 2, Assessment B

**Fig. 101**
Other findings. Vascular abnormality (collateral flow of splenic vein). Category 2, Assessment D2

**Fig. 102**
Other findings. Solid lesion in the splenic hilum. Category 3, Assessment D2

**Fig. 103**
Other findings. Solid lesion in the splenic hilum (image of oval mass with homogeneous internal echo at echo level equal to that of the spleen). Category 2, Assessment B

**Fig. 104**
Measurement of kidney diameter. Measure the longest diameter where the renal parenchyma would normally be, without including cyst protruding outside the kidney

**Fig. 105**
Post-partial resection/post-renal transplantation. Post-partial resection. Category 2, Assessment B

**Fig. 106**
Post-partial resection/post-renal transplantation. Transplanted kidney (post-transplantation in pelvic cavity). Category 2, Assessment B

**Fig. 107**
Morphological abnormality. Congenital deformity (renal column of Bertin). Category 2, Assessment B

**Fig. 108**
Morphological abnormality. Congenital deformity (double renal pelvis). Category 2, Assessment B

**Fig. 109**
Morphological abnormality. Congenital deformity (horseshoe kidney). Right abdominal vertical scan, abdominal midline horizontal scan, and left abdominal vertical scan. Category 2, Assessment B

**Fig. 110**
Morphological abnormality. Rugged contour is present (basket-like blood flow is displayed in lesion on color Doppler). Left: convex probe; right: power Doppler with high-frequency probe. Category 3, Assessment D2

**Fig. 111**
Morphological abnormality. A rugged contour is present (vascular structure similar to that of the normal renal parenchyma on color Doppler). Left: renal long-axis view; right: color Doppler. Category 2, Assessment B

**Fig. 112**
Morphological abnormality. Splitting and deformation of central echo complex. Category 3, Assessment D2

**Fig. 113**
Solid lesion. Hyperechoic mass with maximum diameter < 10 mm. Left: convex probe; right: high-frequency linear probe. Category 3, Assessment C

**Fig. 114**
Solid lesion. A solid lesion is present (hypoechoic mass with irregular contour). Category 3, Assessment D2

**Fig. 115**
Solid lesion. A peripheral hypoechoic zone is present in a round lesion with a distinct border and smooth contour. Category 4, Assessment D2

**Fig. 116**
Solid lesion. Deformation of the central echo complex is present (hypoechoic lesion with irregular contour). Category 4, Assessment D2

**Fig. 117**
Solid lesion. An internal anechoic region with a peripheral hypoechoic zone and lateral shadow is present in a round lesion with a distinct border and a smooth contour. Category 5, Assessment D1

**Fig. 118**
Solid lesion. Brightness equal to or higher than that of the central echo complex with an irregular contour. Maximum diameter < 40 mm. Category 2, Assessment C

**Fig. 119**
Solid lesion. Brightness equal to or higher than that of the central echo complex a comet image is present. Maximum diameter < 40 mm. Category 2, Assessment C

**Fig. 120**
Solid lesion. Brightness equal to or higher than that of the central echo complex with an irregular contour and comet image is present. Maximum diameter ≥ 40 mm. Category 2, Assessment D2

**Fig. 121**
Cystic lesion. No more than two thin septi are present. Category 2, Assessment B

**Fig. 122**
Cystic lesion. Microcalcification is present. Category 2, Assessment B

**Fig. 123**
Cystic lesion. Five or more cysts are present bilaterally (longest diameter > 9 cm on both sides). Left: right renal long-axis view; right: left renal long-axis view. Category 2, Assessment D2

**Fig. 124**
Cystic lesion. Five or more cysts are present bilaterally (longest diameter ≤ 9 cm). Left: right renal long-axis view, right: left renal long-axis view. Category 2, Assessment C

**Fig. 125**
Cystic lesion. Multiple thin septi are present. Category 3, Assessment C

**Fig. 126**
Cystic lesion. Multiple thin septi and nodular calcification are present. Left: convex probe; right: high-frequency probe. Category 3, Assessment C

**Fig. 127**
Cystic lesion. A solid component (septal thickening) is present. Category 4, Assessment D2

**Fig. 128**
Cystic lesion. A solid component (intracystic nodules) is present. Category 4, Assessment D2

**Fig. 129**
Other findings. Calcified lesion (in renal parenchyma). Category 2, Assessment B

**Fig. 130**
Other findings. Calcified lesion (in renal parenchyma/in pelviocaliceal system). Renal stone. Maximum diameter ≥ 10 mm. Category 2, Assessment D2

**Fig. 131**
Other findings. Calcified lesion. In the pelviocaliceal system. Maximum diameter < 10 mm. Left: long-axis view; right: short-axis view. Category 2, Assessment C

**Fig. 132**
Other findings. Calcified lesion. In the pelviocaliceal system. Maximum diameter ≥ 10 mm. Category 2, Assessment D2

**Fig. 133**
Other findings. Pyelectasis (unknown cause of occlusion). Category 3, Assessment D2

**Fig. 134**
Other findings. Mild pyelectasis (without caliectasis). Category 2, Assessment B

**Fig. 135**
Other findings. Pyelectasis (with calcified lesion in the occluded region). Category 2, Assessment D2

**Fig. 136**
Other findings. Pyelectasis (with calcified lesion in the ureter). Category 2, Assessment D2

**Fig. 137**
Other findings. Pyelectasis (with a solid lesion in the occluded region). Left: renal long-axis view; right: long-axis view of upper ureter from renal pelvis. Category 4, Assessment D2

**Fig. 138**
Other findings. Vascular abnormality. A cystic lesion is present in the renal hilus (left), and a blood flow signal is present on color Doppler (right). Left: renal short-axis view b-mode; right: color Doppler. Category 2, Assessment D2

**Fig. 139**
Other findings. Vascular abnormality. An irregular anechoic lesion is present in the renal central echo complex (left), and a blood flow signal is present on color Doppler (right). Left: renal long-axis view b-mode; right: color Doppler. Category 2, Assessment D2

**Fig. 140**
Measurement of fusiform aneurysm diameter. (https://www.jsum.or.jp/committee/diagnostic/pdf/aorticlesion2020.pdf)

**Fig. 141**
Post-treatment (stent-graft insertion). Category 2, Assessment B

**Fig. 142**
Localized aortic dilatation (32 mm). Fusiform dilatation. Maximum short diameter ≥ 30 mm, < 45 mm. Left: short-axis view; right: long-axis view. Category 2, Assessment C

**Fig. 143**
Localized aortic dilatation (62 mm). Fusiform dilatation. Maximum short diameter ≥ 55 mm. Left: Short-axis view; right: long-axis view. Category 2, Assessment D1P

**Fig. 144**
Localized aortic dilatation. Saccular dilatation (saccular aneurysm). Left: short-axis view; right: long-axis view. Category 2, Assessment D2P

**Fig. 145**
Other findings. A flap is present (maximum short diameter 23 mm). Category 2, Assessment D2

**Fig. 146**
Other findings. Plaque. Category 2, Assessment C

**Fig. 147**
Other findings. Wall thickening and calcification. Category 2, Assessment C

**Fig. 148**
Lymph-node swelling. Minor axis ≥ 7 mm. Category 3, Assessment C

**Fig. 149**
Lymph-node swelling. Either minor axis ≥ 10 mm or minor/major axis ratio ≥ 0.5. Category 4, Assessment D2

**Fig. 150**
Intraperitoneal fluid retention. Left: right upper abdominal horizontal scan; right: right lower abdominal horizontal scan. Category 3, Assessment D2

**Fig. 151**
Intraperitoneal fluid retention (with debris echo). Category 4, Assessment D2

**Fig. 152**
Intrathoracic fluid retention (without debris echo in pleural fluid). Category 3, Assessment D2

**Fig. 153**
Intrathoracic fluid retention (with debris echo in pleural fluid). Category 4, Assessment D2

**Fig. 154**
Intrathoracic fluid retention (with solid echo image in pleural fluid). Category 4, Assessment D2

**Fig. 155**
Fluid retention in cardiac cavity. Category 2, Assessment D2

**Fig. 156**
Abdominal cavity, retroperitoneum, or pelvic cavity (including adrenal gland). Retroperitoneal mass image. Category 3, Assessment D2

**Fig. 157**
Abdominal cavity, retroperitoneum, or pelvic cavity (including adrenal gland). Intravesical mass image. Category 3, Assessment D2

See this image and copyright information in PMC

Comment in

Letter to the Editor: Ultrasound criteria for T1b or T2 gallbladder carcinoma.
Fujimoto T. Fujimoto T. J Med Ultrason (2001). 2024 Jan;51(1):147-148. doi: 10.1007/s10396-023-01364-1. Epub 2023 Sep 23. J Med Ultrason (2001). 2024. PMID: 37740865 No abstract available.

References

1. Working Group on Revision of the Manual for Abdominal Ultrasound in Cancer Screening and Health Checkups, Ultrasound Screening Committee of the Japanese Society of Gastrointestinal Cancer Screening et al. Manual for abdominal ultrasound in cancer screening and health checkups. J Gastrointest Cancer Screen. 2014;52:471–493.
1. Committee of Abdominal Ultrasound Department for the Creation of Guidelines for Judgment of Imaging Examination by The Japan Society of Ningen Dock. Manual for abdominal ultrasound in cancer screening and health checkups. J Gastrointest Cancer Screen. 2015,http://www.ningen-dock.jp/wp/common/data/other/inspection/m_ultrasound_e.... (In Japanese, accessed on 5 Aug 2022).
1. Subcommittee on the Manual for Abdominal Ultrasound in Cancer Screening and Health Checkups Manual for Abdominal Ultrasound in Cancer Screening and Health Checkups, Terminology and Diagnostic Criteria Committee of The Japan Society of Ultrasonics in Medicine. Jpn J Med Ultrasonics. 2015;42:201–24 (In Japanese).
1. Working Group on Creation of the Manual for Abdominal Ultrasound in Cancer Screening and Health Checkups, Ultrasound Screening Committee of the Japanese Society of Gastrointestinal Cancer Screening Manual for Abdominal Ultrasound Cancer Screening. J Gastrointest Cancer Screen. 2011;49:549–565.
1. Sachiko T, Shinji O, Takashi K, et al. Outline of the guideline for abdominal ultrasound cancer screening. Jpn J Med Ultrasonics. 2013;40:549–565. doi: 10.3179/jjmu.JJMU.R.7. - DOI

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Manual for abdominal ultrasound in cancer screening and health checkups, revised edition (2021)

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Manual for abdominal ultrasound in cancer screening and health checkups, revised edition (2021)

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