Contrast-enhanced Ultrasonography In Diagnosis Research Articles

CEUS in diagnosis of renal masses

Introduction and purpose Contrast enhanced ultrasound (CEUS) is a modern diagnostic method that uses ultrasound waves in combination with intravenous administration of a contrast agent. It enables obtaining high resolution and assessing microcirculation in real time, thanks to which the researcher is able to analyze the enhancement and its features, which may help in diagnosing a specific pathology. Contrast agents, similar to CT and MRI, show specific phases of enhancement after administration - arterial, venous, delayed. Their additional advantage is safety, especially for patients with impaired kidney and thyroid function, and causing fewer allergic reactions. The aim of this review is to present the CEUS examination technique and the latest reports in the field of diagnosis of renal lesions. Material and methods This review was prepared based on the literature available from recent years in the PubMed and Google Scholar scientific databases using the keywords: ultrasonography, contrast enhanced ultrasonography, kidney, renal masses. Results Studies show that CEUS can be an effective method for imaging both cystic and solid lesions in the kidney. When using a contrast agent, the lesions show characteristic features that can guide the investigator to the diagnosis. Moreover, in comparative analyses, CEUS achieved comparable or better results than other diagnostic imaging methods. Conclusions CEUS is a modern and promising diagnostic method that can successfully compete with CT and MRI. Moreover, the metabolism and pharmacokinetics of contrast agents and their safety mean that CEUS can be used for the diagnosis of unclear pathologies in elderly patients, as well as for the control and supervision of changes that require frequent imaging. Keywords: ultrasonography, contrast enhanced ultrasonography, kidneys, renal masses

Integrated use of contrast-enhanced and grey-scale ultrasound in assigning American College of Radiology Thyroid Imaging–Reporting and Data System scores for characterisation of thyroid nodules: A prospective observational study

Background: The advent and increased use of high-resolution ultrasonography has resulted in improved detection of thyroid nodules. Even with the use of various Thyroid Imaging–Reporting and Data System, accurate imaging diagnosis of malignant thyroid nodules has been suboptimal, which necessitated use of newer modalities like contrast-enhanced ultrasonography alone and in combination for this purpose. Although the combined use of various Thyroid Imaging–Reporting and Data System and contrast-enhanced ultrasonography has turned out to be accurate in many studies, the ideal way to integrate contrast-enhanced ultrasonography into the Thyroid Imaging–Reporting and Data System algorithm is under-investigated. Purpose: To estimate and compare the diagnostic accuracy of American College of Radiology Thyroid Imaging–Reporting and Data System and contrast-enhanced ultrasonography in differentiating benign and malignant nodules alone and in combination. To estimate the diagnostic accuracy of contrast-enhanced ultrasonography in re-categorisation of Thyroid Imaging–Reporting and Data System 3 and Thyroid Imaging–Reporting and Data System 4 thyroid nodules. Materials and methods: This was a prospective cohort study performed in a tertiary care university–based hospital for 3 years. Adult patients with clinical or previous sonographic diagnosis of thyroid nodules were selected. Each of the nodules were assessed using ultrasonography and categorised using American College of Radiology Thyroid Imaging–Reporting and Data System criteria. The lesion was then assessed for contrast-enhanced ultrasonography features. The final diagnosis of the nodules was made using fine needle aspiration cytology. The diagnostic accuracy in diagnosis of malignant thyroid nodules for each of the American College of Radiology Thyroid Imaging–Reporting and Data System and contrast-enhanced ultrasonography alone and in combination was assessed. The diagnostic accuracy of contrast-enhanced ultrasonography in diagnosis of malignant thyroid nodules categorised as Thyroid Imaging–Reporting and Data System 3 and Thyroid Imaging–Reporting and Data System 4 was also assessed. Results: American College of Radiology Thyroid Imaging–Reporting and Data System had a sensitivity, specificity, negative predictive value, positive predictive value and diagnostic accuracy of 86.6%, 54.5%, 17.4%, 97.3% and 57.7%, respectively, in diagnosis of malignant thyroid nodules. Contrast-enhanced ultrasonography had a sensitivity, specificity, negative predictive value, positive predictive value and diagnostic accuracy of 86.6%, 95.4%, 67.9%, 98.4% and 94.4%, respectively, in diagnosis of malignant thyroid nodules. Contrast-enhanced ultrasonography had sensitivity, specificity, negative predictive value, positive predictive value and diagnostic accuracy of 93.3%, 100.0%, 100.0%, 99.2% and 99.3%, respectively, in re-categorisation of Thyroid Imaging–Reporting and Data System 3 and Thyroid Imaging–Reporting and Data System 4 nodules. Conclusion: Contrast-enhanced ultrasonography can play a key role in diagnosis of malignant thyroid nodules which are categorised as indeterminate on grey-scale ultrasound.

Clinical value of oral contrast-enhanced ultrasonography in diagnosis of gastric tumors.

The incidence of gastric cancer remains high, and it is the sixth most common cancer and the fourth leading cause of cancer deaths worldwide. Oral contrast-enhanced ultrasonography is a simple, non-invasive, and painless method for the diagnosis of gastric tumors. To explore the diagnostic value of oral contrast-enhanced ultrasonography for the detection of gastric tumors. The screening results based on oral contrast-enhanced ultrasonography and electronic gastroscopy were compared with those of the postoperative pathological examination. Among 42 patients with gastric tumors enrolled in the study, the diagnostic accordance rate was 95.2% for oral contrast-enhanced ultrasonography (n = 40) and 90.5% for electronic gastroscopy (n = 38) compared with postoperative pathological examination. The Kappa value of consistency test with pathological findings was 0.812 for oral contrast-enhanced ultrasonography and 0.718 for electronic gastroscopy, and there was no significant difference between them (P = 0.397). For the TNM staging of gastric tumors, the accuracy rate of oral contrast-enhanced ultrasonography was 81.9% for the overall T staging and 50%, 77.8%, 100%, and 100% for T1, T2, T3, and T4 staging, respectively. The sensitivity and specificity were both 100% for stages T3 and T4. The diagnostic accuracy rate of oral contrast-enhanced ultrasonography was 93.8%, 80%, 100%, and 100% for stages N0, N1-N3, M0, and M1, respectively. The accordance rate of qualitative diagnosis by oral contrast-enhanced ultrasonography is comparable to that of gastroscopy, and it could be used as the preferred method for the early screening of gastric tumors.

Value of contrast-enhanced percutaneous ultrasound in the diagnosis of rotator cuff tear subtype

To explore characteristics of contrast-enhanced ultrasound (CEUS) images features and diagnostic value of rotator cuff tear subtypes. From January 2019 to March 2022, percutaneous ultrasound-guided subacromial bursography (PUSB) with persutaneous ultrasound-guide tendon lesionography (PUTL) was performed on 114 patients with suspected rotator cuff injury were evaluated, including 54 males and 60 females ranged in age from 35 to 75 years old with an average of (58.8±8.7 ) years old;76 patients on the right side and 38 patients on the left side;the course of disease ranged from 0.13 to 111 months with an average of (10.2±9.8) months. GE LOGIQ E9 color doppler ultrasound diagnostic high frequency(6 to 12 MHz) was used to CEUS Using arthroscopy as gold standard, receiver operating characteristic (ROC) curve was used to evaluate diagnostic efficacy of US, MRI and CEUS for rotator cuff injury, also sensitivity, specificity, positive predictive value, negative predictive value and accuracy were calculated. The sensitivity of US in diagnosing full-thickness tears was 72.1%, specificity was 93.0%, and accuracy was 85.1%. The sensitivity, specificity and accuracy of MRI diagnosis of full-thickness tear were 90.9%, 92.6% and 92.1% respectively. The sensitivity, specificity and accuracy of CEUS in diagnosis of full-thickness tear were 100%. The sensitivity, specificity and accuracy of US in the diagnosis of partial tear were 85.7%, 77.2% and 79.8% respectively. The sensitivity, specificity and accuracy of MRI diagnosis of partial tear were 83.7%, 81.7% and 82.5% respectively. The sensitivity, specificity and accuracy of CEUS in diagnosis of partial tear were 95.7%, 92.6% and 93.9% respectively. There were significant differences in diagnosis results of US, MRI and CEUS for rotator cuff bursa tear (P<0.001). Kapp test showed good consistency between CEUS and arthroscopy in diagnosing rotator cuff tear subtypes (full-thickness and partial tears). Using PUSB/PUTL to observe distribution of contrast media in bursa, tendon and joint cavity to evaluate the type of rotator cuff tear, its diagnostic performance is significantly better than US and MRI. Therefore, percutaneous contrast-enhanced ultrasound can be a reliable method for diagnosing subtypes of rotator cuff tears.

Contrast-enhanced ultrasonographic findings in torsion of the appendix testis or epididymis in children: a case series.

Torsion of the appendix testis or epididymis is a cause of acute scrotum in children. Ultrasonography with color Doppler is the first-choice modality for diagnosis. However, this method requires skill and experience to make a diagnosis with confidence. Recently, contrast-enhanced ultrasonography for diagnosis in various fields has been reported. However, to our knowledge, there has been no report of this method being used to diagnose torsion of the appendix testis or epididymis. The purpose of this study was to retrospectively examine contrast-enhanced ultrasonographic findings in torsion of the appendix testis or epididymis. Patients who underwent contrast-enhanced ultrasonography for torsion of the appendix testis or epididymis at our institution between April 2010 and April 2023 were enrolled in this study (n = 12). Contrast-enhanced ultrasonography findings of the affected appendage and the testis parenchyma were examined retrospectively. The parenchyma of the testes was notably enhanced in all the cases. However, 9 of the 12 cases showed that the appendage with torsion was not enhanced at all. In the remaining three cases, only slight enhancement was seen. Nevertheless, it was notably less than that of the parenchyma of the testis. Our findings indicated that contrast-enhanced ultrasonography may be an easy and reliable method for diagnosing torsion of the appendix testis or epididymis.

Evaluation of Contrast-Enhanced Ultrasound in Diagnosis of Acute Kidney Injury of Patients in Intensive Care Unit.

Ultrasound can assess renal perfusion, but its role in the evaluation of acute kidney injury (AKI) is still unclear. This prospective cohort study was to investigate the value of contrast-enhanced ultrasound (CEUS) in the evaluation of AKI in intensive care unit (ICU) patients. Fifty-eight patients were recruited from ICU between October 2019 and October 2020, and CEUS was used to monitor the renal microcirculation perfusion within 24h after admission. Parameters included rise time (RT), time to peak intensity (TTP), amplitude of peak intensity (PI), area under the curve (AUC), time from peak to one half (TP1/2) of renal cortex and medulla. Ultrasonographical findings, demographics, laboratory, etc were collected for further analysis. There were 30 patients in the AKI group and 28 patients in the non-AKI group. The TTP, PI, TP1/2 of the cortex and the RT, TTP, TP1/2 of the medulla in the AKI group were significantly longer than in the non-AKI group (P < 0.05);. The TTP (OR = 1.261, 95% CI: 1.083-1.468, P = 0.003) (AUCs 0.733, Sen% 83.3, Spe%57.1), TP1/2 (OR = 1.079, 95% CI: 1.009-1.155, P = 0.027) (AUCs 0.658, Sen% 76.7, Spe%50.0) of the cortex and RT (OR = 1.453, 95% CI: 1.051-2.011, P = 0.024) (AUCs 0.686, Sen% 43.3, Spe%92.9) of the medulla were related to the AKI. Eight new-onset AKI cases occurred in the non-AKI group within 7 days, the RT, TTP, TP1/2 of the cortex and medulla were significantly longer in the new-onset AKI group than in the non-AKI group (P < 0.05), but serum creatinine and blood urea nitrogen were no differences between groups (P > 0.05). This study indicates CEUS can assess the renal perfusion in AKI. TTP and TP1/2 of the cortex and RT of the medulla can aid the diagnosis of AKI in ICU patients.

Application value of ultrasound TIC curve in the evaluation of ablation effect of liver tumors

ObjectiveTo evaluate the efficacy of ablation of hepatocellular carcinoma (HCC) and the diagnostic value of new intrahepatic nodules after ablation by studying the time-intensity curve (TIC) of contrast-enhanced ultrasound (CEUS), Maximize the survival time and quality of life of patients.so as to make treatment plans as early as possible and extend the survival time and quality of life of patients to the greatest extent. MethodsA total of 59 nodules were selected from 42 clinically confirmed HCC patients who planned to undergo ultrasound-guided microwave ablation in our hospital from October 2021 to October 2022. Among them, 31 were males and 11 were females, aged 38–72 years, with an average age of 56.7 ± 9.6 years. For all lesions included in the study, CEUS examination was performed before ablation and TIC was fitted. The patients were examined by routine B-ultrasound, CEUS alone, CEUS combined with TIC at 1 month, 3 months and 6 months after ablation. At the same time, CEUS alone and CEUS combined with TIC were performed for all new nodules found in the liver under conventional B-ultrasonography. The diagnostic efficacy of CEUS alone and CEUS combined with TIC on ablation and new nodules in the liver were compared and analyzed. At least two enhanced imaging tests (CEUS, enhanced CT, or enhanced MRI) plus relevant laboratory tests were used as the gold standard. Meanwhile, the quantitative parameters of recurrent lesions and TIC nodules in liver were compared with the surrounding normal tissues before and after surgery. Results(1) When evaluating the efficacy of ultrasound-guided microwave ablation, the specificity, accuracy and positive prediction rate of CEUS combined with TIC diagnosis group were lower than those of CEUS alone, and the difference was statistically significant; (2) The sensitivity, accuracy and negative predictive rate of CEUS combined with TIC in the diagnosis of new intrahepatic nodules after intrahepatic ablation were higher than those of CEUS alone, but the difference was not statistically significant; (3)The TIC peak time of primary hepatocellular carcinoma (HCC), local recurrence of HCC after microwave ablation and intrahepatic recurrence of HCC after ablation was shorter than the surrounding normal liver parenchyma, and the difference was statistically significant, while the slope of curve rise was larger than the surrounding normal liver parenchyma, and the difference was statistically significant.) ConclusionTIC is not suitable for evaluating the efficacy of ultrasound-guided microwave ablation for primary hepatocellular carcinoma, as TIC can significantly increase the false positive rate.For the diagnosis of new nodules in liver after microwave therapy of hepatocellular carcinoma, CEUS combined with TIC method is suitable, which can improve the diagnostic efficiency of the disease. At the same time, it was found in our study that the peak time of primary hepatocellular carcinoma, local recurrent liver cancer foci after microwave ablation, and intrahepatic recurrent liver cancer after ablation was less than that of surrounding normal liver parenchyma, and the upward slope of the curve was greater than that of surrounding normal liver parenchyma. Therefore, in the CEUS diagnosis of intrahepatic space-occupying lesions, the method of quantitative parameters can be adopted to quantitatively evaluate the nature of the lesions in order to obtain more accurate results.

VueBox® perfusion analysis of dynamic contrast enhanced ultrasound provides added value in the diagnosis of small thyroid nodules.

To explore the potential added value of dynamic contrast enhanced ultrasound (DCE-US) using VueBox® software for the diagnosis of small solid thyroid nodules (≤1.0 cm). This prospective study was approved by the institutional review board and it was performed at two hospitals from January 2020 to October 2020. B mode ultrasound and contrast enhanced ultrasound (CEUS) images were obtained for 79 small solid thyroid nodules (≤1.0 cm) confirmed by ultrasound-guided fine needle aspiration cytology results in 79 consecutive patients (55 women and 24 men, median age: 41 years). The CEUS time-intensity curves (TICs) of thyroid nodules and surrounding parenchyma were created by VueBox® software (Bracco, Italy). The CEUS quantitative parameters were obtained after curve fitting. The diagnostic performance of CEUS and DCE-US was evaluated and compared. The weighted kappa statistic (κ) was performed to assess the interobserver agreement and consistency between the diagnosis of CEUS and DCE-US. Among the 79 thyroid nodules, 56 (70.9 %) were malignant and 23 (29.1 %) were benign lesions. Hypoenhancement during the arterial phase of CEUS was associated with malignancy (P < 0.001), with an AUC of 0.705 (sensitivity 71.4 %, specificity 69.6 %). Among all CEUS quantitative parameters, the peak enhancement (PE), wash-in rate (WiR), and wash-out rate (WoR) of DCE-US in malignancies were significantly lower than those in benign nodules (P = 0.049, P = 0.046, and P = 0.020, respectively). The area under the receiver operating characteristic curves (AUCs) of PE, WiR, and WoR were 0.642 (sensitivity 65.2 %, specificity 67.9 %), 0.643 (sensitivity 43.5 %, specificity 91.1 %), and 0.667 (sensitivity 69.6 %, specificity 69.6 %) in differentiation between benign and malignant small solid thyroid nodules (≤1.0 cm), respectively. Comparing the quantitative parameters of DCE-US between small solid thyroid nodules and surrounding normal thyroid parenchyma, the PE, WiAUC, WiR, wash-in perfusion index (WiPI), WoAUC, WiWoAUC, and WoR of the nodules were significantly lower than those of normal thyroid tissue (P = 0.008, P < 0.001, P = 0.037, P = 0.009, P = 0.003, P = 0.002, P = 0.049, respectively). A total of 16 (20.3 %) nodules showed isoenhancement during the arterial phase of CEUS, while the median PE ratio of surrounding tissue and thyroid nodules was 1.70 (IQR: 1.33-1.89). VueBox® is a helpful tool for the evaluation of dynamic microvascularization of thyroid nodules, and DCE-US using VueBox® perfusion analysis could provide added values for differential diagnosis of small solid thyroid nodules (≤1.0 cm).

Clinical Value of Artificial Intelligence-Based Computer-Aided Diagnosis System Versus Contrast-Enhanced Ultrasound for Differentiation of Benign From Malignant Thyroid Nodules in Different Backgrounds.

The aim of this study was to compare the value of the AI-SONIC ultrasound-assisted diagnosis system versus contrast-enhanced ultrasound (CEUS) for differential diagnosis of thyroid nodules in diffuse and non-diffuse backgrounds. A total of 555 thyroid nodules with pathologically confirmed diagnosis were included in this retrospective study. The diagnostic efficacies of AI-SONIC and CEUS for differentiating benign from malignant nodules in diffuse and non-diffuse backgrounds were evaluated, with pathological diagnosis as the gold standard. The agreement between AI-SONIC diagnosis and pathological diagnosis was moderate in diffuse backgrounds (κ=0.417) and almost perfect in non-diffuse backgrounds (κ=0.81). The agreement between CEUS diagnosis and pathological diagnosis was substantial in diffuse backgrounds (κ=0.684) and moderate in non-diffuse backgrounds (κ=0.407). In diffuse backgrounds, AI-SONIC had slightly higher sensitivity (95.7 vs 89.4%, P=.375), but CEUS had significantly higher specificity (80.0 vs 40.0%, P=.008). In non-diffuse background, AI-SONIC had significantly higher sensitivity (96.2 vs 73.4%, P < .001), specificity (82.9 vs 71.2%, P=.007), and negative predictive value (90.3 vs 53.3%, P < .001). In non-diffuse backgrounds, AI-SONIC is superior to CEUS for differentiating malignant from benign thyroid nodules. In diffuse backgrounds, AI-SONIC could be useful for screening of cases to detect suspicious nodules requiring further examination by CEUS.

Additional value of microvascular flow imaging inthe assessment of cystic and solid renal lesions.

Contrast enhanced ultrasound (CEUS) is increasingly used in the evaluation of renal lesions, however, its availability remains limited. Thus, sensitive noncontrast ultrasound evaluation of renal lesion vascularity is an unmet need. In this single-center, retrospective study we assessed microvascular flow imaging (MV-flow) compared to CEUS in the evaluation of complex renal cysts and solid lesions. Out of 92 patients 28 were evaluated with both CEUS and MV-flow. Color Doppler, CEUS, and MV-flow was performed in 13 cases, whilst MV-flow, CEUS, and contrast-enhanced MV-flow (CE-MV-flow) was done in 16 cases. The CEUS diagnosis was considered gold standard. MV-flow showed a substantial agreement with the CEUS diagnosis (weighted Kappa = 0.806), excluding equivocal lesions (Bosniak 2F). MV-flow substantially outperformed color Doppler (weighted Kappa = 0.77 vs. 0.133). The agreement of CE-MV-flow and MV-flow was comparable (weighted Kappa = 0.79 vs. 0.69). MV-flow significantly improves evaluation of renal lesion vascularity compared to conventional techniques. However, the sensitivity is limited for equivocal lesions (e.g. Bosniak 2F cysts). Thus, MV-flow should be used as an ancillary technique, not as a substitute to CEUS. Current MV-flow presets are ill-suited for postcontrast imaging, therefore specific presets optimized for this purpose are needed to establish its potential.

Comparative diagnostic performance of contrast-enhanced ultrasound and dynamic contrast-enhanced magnetic resonance imaging for differentiating clear cell and non-clear cell renal cell carcinoma.

To compare the diagnostic efficiency of contrast-enhanced ultrasound (CEUS) with that of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for the differential diagnosis of clear and non-clear cell renal cell carcinoma, as confirmed by subsequent pathology. A total of 181 patients with 184 renal lesions diagnosed by both CEUS and DCE-MRI were enrolled in the study, including 136 clear cell renal cell carcinoma (ccRCC) and 48 non-clear cell renal cell carcinoma (non-ccRCC) tumors. All lesions were confirmed by histopathologic diagnosis after surgical resection. Interobserver agreement was estimated using a weighted kappa statistic. Diagnostic efficiency in evaluating ccRCC and non-ccRCC was compared between CEUS and DCE-MRI. The weighted kappa value for interobserver agreement was 0.746 to 0.884 for CEUS diagnosis and 0.764 to 0.895 for DCE-MRI diagnosis. Good diagnostic performance in differential diagnosis of ccRCC and non-ccRCC was displayed by both CEUS and DCE-MRI: sensitivity was 89.7% and 91.9%, respectively; specificity was 77.1% and 68.8%, respectively; and area under the receiver operating curve was 0.834 and 0.803, respectively. No statistically significant differences were present between the two methods (p = 0.54). Both CEUS and DCE-MRI imaging are effective for the differential diagnosis of ccRCC and non-ccRCC. Thus, CEUS could be an alternative to DCE-MRI as a first test for patients at risk of renal cancer, particularly where DCE-MRI cannot be carried out. • CEUS and DCE-MRI features can help differentiate ccRCC and non-ccRCC. • The differential diagnosis of ccRCC and non-ccRCC by CEUS is comparable to that of DCE-MRI. • Interobserver agreement is generally high using CEUS and DCE-MRI.

Contrast-Enhanced Ultrasound in Diagnosis of Pelvic Varicose Veins

Contrast-Enhanced Ultrasound in Diagnosis of Pelvic Varicose Veins

Using contrast-enhanced ultrasonography to assess the degree of acute testicular torsion: a case series

BackgroundThere are two types of testicular torsion: complete and incomplete. The degree and duration of symptoms of this condition are critical for treatment decision-making, as the consequences for untimely diagnosis and management can be serious. The preoperative assessment of the degree of acute testicular torsion using ultrasonography is particularly important for determining the appropriate intervention. The purpose of this study was to compare the effectiveness of high-frequency versus contrast-enhanced ultrasonography in determining the degree of acute testicular torsion.MethodsFifteen patients with clinically diagnosed acute testicular torsion underwent both high-frequency and contrast-enhanced ultrasonography. We compared the characteristics of the ultrasonographic images of the testicular parenchyma in both the afflicted and contralateral (healthy) testes to determine the reliability of contrast-enhanced ultrasonography in assessing the degree of acute testicular torsion.ResultsThe high-frequency ultrasound and contrast-enhanced ultrasound diagnosis of 4 complete testicular torsion and 11 incomplete testicular torsion were correct before operation. However, 5 patients with incomplete testicular torsion were misdiagnosed as complete testicular torsion because no blood flow was detected by high frequency ultrasound. Finally, low speed blood flow was detected by contrast-enhanced ultrasound and the diagnosis was corrected. The accuracy of diagnosing incomplete testicular torsion was 100% using contrast-enhanced ultrasonography and 66.7% using high-frequency ultrasonography; the difference between the two methods was statistically significant (χ2 = 2.50, P ≤ 0.05).ConclusionContrast-enhanced ultrasonography can diagnose testicular torsion with high accuracy and can detect low-velocity blood flow and show microcirculatory blood perfusion in the testicular parenchyma. This can avoid misdiagnosing incomplete testicular torsion as complete, thus averting unnecessary orchiectomy.

Application of Contrast-Enhanced Ultrasound in the Diagnosis of Gastrointestinal Acute Gvhd - Single Centre Experience

Introduction: Acute graft versus host disease (aGVHD) is one of the most common complications after allogeneic stem cell transplant, with gastro-intestinal (gut) involvement being associated with increased morbidity and mortality. The gastrointestinal symptoms are common and therefore pose differential diagnostic challenges. Biopsy with histopathological exam by endoscopy represent the gold standard for the diagnosis of gut aGVHD. In clinical practice, the endoscopy exam, a minimal invasive investigation, is difficult to tolerate by the patient and sometimes risky to perform due to the severe thrombocytopenia. For this reason, there is an urgent need to find some non-invasive diagnostic methods, such as standard ultrasound and contrast-enhanced ultrasound (CEUS), hoping that these investigations will help in the early diagnosis as well as in the follow-up response treatment. Aim: The aim of this study was to present our experience with CEUS in diagnosis of gut aGVHD after allogeneic stem cell transplantation Results: Between January 2019 and March 2022, in Fundeni Clinical Institute, 168 allogeneic stem cell transplants were performed. 20/168 were readmitted into the hospital with non-infectious diarrhea and with suspicion of gut aGVHD. All patients were investigated by classical GI tract ultrasound and CEUS. For 12 patients out of 20 we had histopathological confirmation of gut GVHD and could thus corelate with the CEUS findings. For all patients the bowel wall thickness was increased, and the most affected areas were ileal loops, followed by ileocecal region and ascending colon. The most common feature, contrast agent migration in the intestinal lumen (the penetration of microbubbles in the bowel lumen) was observed in 3/12 patients, but, 9/12 remaining patients performed CEUS after the first dose of treatment with corticotherapy. In conclusion, CEUS represent a noninvasive, simple and viable investigation for gut aGVHD, most valuable probably for ileal localization, where the endoscopic approach is difficult. Therefore, it is important to establish which is the exact period after the onset of symptoms when the microbubbles migrate in the bowel lumen and if this parameter can be used to monitor the response to treatment. Based on these results, we aim to introduce CEUS evaluation as standard investigation for aGVHD and monitor all the patients.

Differentiation of Thyroid Nodules (C-TIRADS 4) by Combining Contrast-Enhanced Ultrasound Diagnosis Model With Chinese Thyroid Imaging Reporting and Data System.

ObjectivesTo establish a contrast-enhanced ultrasound (CEUS) diagnostic schedule by CEUS analysis of thyroid nodules of C-TIRADS 4. To establish a CEUS-TIRADS diagnostic model to differentiate thyroid nodules (C-TIRADS 4) by combining CEUS with Chinese thyroid imaging reporting and data system (C-TIRADS).MethodsA total of 228 thyroid nodules (C-TIRADS 4) were estimated by CEUS. The arrival time, enhancement degree, enhancement homogeneity, enhancement pattern, enhancement ring, and wash-out time were analyzed in CEUS for all of the nodules. Multivariate factors logistic analysis was performed and a CEUS diagnostic schedule was established. If the nodule had a regular hyper-enhancement ring or got a score of less than 2 in CEUS analysis, CEUS-TIRADS subtracted 1 category. If the nodule got a score of 2 in the CEUS schedule, the CEUS-TIRADS category remained the same as before. If the nodule got a score of more than 2 in the CEUS schedule, CEUS-TIRADS added 1 category. When it reflected an absent enhancement in CEUS, the nodule was judged as CEUS-TIRADS 3. All of the C-TIRADS 4 nodules were re-graded by CEUS-TIRADS. We then compare the diagnosis performance of C-TIRADS, CEUS, and CEUS-TIRADS by sensitivity, specificity, and accuracy.ResultsAmong the 228 C-TIRADS 4 nodules, 69 were determined as C-TIRADS 4a, 114 were C-TIRADS 4b, and 45 were C-TIRADS 4c. The sensitivity, specificity, and accuracy of C-TIRADS were 93.1%, 55.3%, and 74.6% respectively. The area under the curve was 0.753. Later arrival time, hypo-enhancement, heterogeneous enhancement, centripetal enhancement, and rapid washout were risk factors of malignancy in multivariate analysis. The sensitivity, specificity, and accuracy of CEUS were 78.7%, 87.5%, and 83.3% respectively. The area under the curve was 0.803. By CEUS-TIRADS diagnostic model combining CEUS with C-TIRADS, a total of 127 cases were determined as malignancy (111 were malignant and 16 were benign) and 101 were diagnosed as benign ones (5 were malignant and 96 were benign). The sensitivity, specificity, and accuracy of CEUS-TIRADS were 95.7%, 85.7%, and 92.1% respectively. The area under the curve was 0.916. The diagnostic performance of CEUS-TIRADS was significantly better than CEUS and C-TIRADS. The difference was statistically significant (P<0.05).ConclusionsThe diagnostic schedule of CEUS could get better diagnostic performance than US in the differentiation of thyroid nodules. The CEUS-TIRADS combining CEUS analysis with C-TIRADS could make up for the deficient sensibility of C-TIRADS, showing a better diagnostic performance than US and CEUS.

Analysis of Contrast-Enhanced Ultrasound and Elastography in the Diagnosis of Benign and Malignant Apocrine Breast Tumors

In the past thirty years, breast cancer in women has continued to rise. The age of onset for women has become lower. Contrast-enhanced ultrasound (CEUS) can clearly show the blood perfusion and neovascularization of breast masses. Elastography provides information on the stiffness of tissues. The combination of them shows a good advantage in the various early diagnosis of breast cancer. The combined electrograph can distinguish benign and malignant apocrine breast tumors. The shear wave electrograph (SWE) combined with CEUS has the strongest consistency in the diagnosis and pathology of breast benign tumors. When they were diagnosed separately, it was found that SWE has higher diagnostic value than CEUS; the quantitative diagnosis of SWE is slightly higher than the qualitative diagnosis, and the qualitative diagnosis of CEUS is higher than the quantitative diagnosis. Both SWE and CEUS are valuable in the diagnosis of benign and malignant apocrine breast tumor when combined treatment is made.

The value of contrast-enhanced ultrasound in predicting postoperative recurrence of hepatocellular carcinoma: A protocol for systematic review and meta-analysis.

Background:As one of the key factors, postoperative recurrence of hepatocellular carcinoma (HCC) influences the therapeutic effects and survival period of patients. Therefore, the early diagnosis of postoperative recurrence of HCC plays an important role in improving the therapeutic effects and prognosis. Contrast-enhanced ultrasound (CEUS) plays an important role in the early diagnosis of postoperative recurrence of HCC. However, the accuracy of CEUS in predicting postoperative recurrence of HCC is still controversial. Therefore, in this study, a meta-analysis was carried out to further evaluate the accuracy of CEUS in predicting postoperative recurrence of HCC, thus providing evidence support for the early diagnosis of HCC.Methods:The literatures on the CEUS diagnosis of postoperative recurrence of HCC were collected by searching China National Knowledge Infrastructure, Wanfang, China Biology Medicine disc, PubMed, EMBASE, Cochrane Library, and Web of Science on computer. The retrieval time is set from the start of the database until April 2021. The meta-analysis of the literatures that meet the quality standards was conducted by Stata 16.0 software.Results:The results of this meta-analysis will be submitted to a peer-reviewed journal for publication.Conclusion:This study will provide evidence support for the accuracy of CEUS in the diagnosis of postoperative recurrence of HCC.Ethics and dissemination:The private information from individuals will not be published. This systematic review also should not damage participants’ rights. Ethical approval is not available. The results may be published in a peer-reviewed journal or disseminated in relevant conferences.OSF Registration Number:DOI 10.17605/OSF.IO/HB46W.

Value of preoperative staging of endometrial carcinoma with contrast-enhanced ultrasonography: A PRISMA compliant meta-analysis.

Introduction:Endometrial carcinoma (EC) is the most common gynecologic carcinoma in developed countries and accounts for nearly 5% of carcinoma cases and more than 2% of deaths due to female carcinomas worldwide. Because of this reported risk, it is very important to diagnose and stage it accurately. Therefore, we investigated the staging accuracy of EC with contrast-enhanced ultrasonography (CEUS). Due to a lack of studies on the use of CEUS in staging EC, we performed a systematic review and meta-analysis.Method:We searched PubMed, EMBASE, Cochrane Library, Scopus, Web of science, China National Knowledge Infrastructure (CNKI), and CBM for studies on CEUS in EC diagnosis. Our search keywords were “ultrasonic angiography,” “endometrial neoplasms,” and their synonyms. The studies were screened according to the inclusion and exclusion criteria, and 4 tabular data were extracted. Quality evaluation was performed with the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) scale. Statistical analysis was done with Stata version 15.1. A random effect model was selected to calculate the pooled sensitivity and specificity. The summary receiver operating characteristic (SROC) curve was obtained, and the area under the curve was calculated.Result:Fifteen studies with 685 patients were included in this quantitative synthesis. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio (OR) of CEUS in the diagnosis of EC was 0.81 (95% confidence interval, .76–.85), .90 (.87–.92), 8 (5.8–11.1), .21 (.16–.28), and 38 (22–67), respectively. The area under the curve was 0.93 (.90–.95).Conclusion:CEUS has a high sensitivity and specificity in the diagnosis of EC. It can be considered as an effective and feasible method for EC staging.

浅谈超声造影在妇产科疾病当中的研究进展

浅谈超声造影在妇产科疾病当中的研究进展

Value of contrast-enhanced malignancy imaging features in secondary grade diagnosis of BI-RADS-US type 4 breast lesions.

To explore the value of contrast-enhanced malignancy imaging features in secondary grade diagnosis of Breast Imaging Reporting and Data System for Ultrasonography (BI-RADS-US) type 4 breast lesions. After initial diagnosis by ultrasound, 124 BI-RADS-US type 4 patients with 130 lesions were examined by contrast-enhanced ultrasound (CEUS) and were classified again before surgery according to five contrast-enhanced malignancy imaging features: inhomogeneous enhancement, peripheral ring-like enhancement, expansive enhancement, internal filling defects, and surrounding radioactive convergence. Lesions with no contrast-enhanced features of malignancy were categorized as type 3; lesions with one, two, or three features of malignancy were categorized as type 4A, 4B, or 4C, respectively; and lesions with four or more indices of malignancy were categorized as type 5. The value of contrasted imaging features of malignancy in diagnosing BI-RADS-US type 4 breast lesions was analyzed. The accuracy of CEUS diagnosis for type 3 lesions was 93.8% (46/49), 76.9% (10/13) for type 4A, 71.4% (5/7) for type 4B, 75.0% (9/12) for type 4C, and 93.8% (46/49) for type 5 lesions. The sensitivity of CEUS in diagnosing malignant lesions was 90.4%, specificity was 83.6%, and accuracy was 86.9%. CEUS decreased the benign lesion biopsy ratio to 68.5% (46/67) and increased the diagnosis ratio of malignant lesions to 73.0% (46/63). CEUS can further optimize the classification of BI-RADS-US type 4 breast lesions and may provide a better reference basis for clinical diagnosis and treatment of those breast lesions.