Contrast-enhanced Ultrasound Parameters Research Articles

Application of Contrast-Enhanced Ultrasound Parameters of Metastatic Axillary Lymph Nodes in Breast Cancer Patients in Predicting the Efficacy of Neoadjuvant Chemotherapy in Early Stage.

To investigate the performance of contrast-enhanced ultrasound(CEUS) parameters of metastatic axillary lymph nodes (ALNs) before and after two courses of neoadjuvant chemotherapy (NAC) in breast cancer patients in predicting the efficacy of NAC. A total of 41 postoperative breast cancer patients were selected. All patients underwent NAC, and ALN biopsy was positive before chemotherapy. Metastatic ALN was examined by CEUS before and after two courses of NAC. The CEUS parameters of metastatic ALNs before and after two courses of NAC were analyzed to determine the performance of CEUS parameters in predicting the efficacy of NAC in early stage. The NAC was effective for 28 cases and ineffective for 13 cases. There were no statistically significant differences in the CEUS parameters between effective NAC and ineffective NAC individuals before and after two courses of NAC. But, there were statistically significant differences in long diameter (LD), short diameter (SD), Peak intensity (Peak%) and area under the curve (AUC) between the effective and ineffective NAC patients after two courses of NAC. Receiver operating characteristic curve (ROC) analysis suggested the drop-out value of LD, SD, Peak% and AUC after two courses of NAC can be used as important indicators to evaluate the efficacy of NAC (p < 0.05). CEUS parameters of metastatic axillary lymph nodes (ALNs) before and after two courses of neoadjuvant chemotherapy (NAC) in breast cancer patients can predict the efficacy of NAC in early stage.

Construction of nomogram model based on contrast-enhanced ultrasound parameters to predict the degree of pathological differentiation of hepatocellular carcinoma

ObjectiveTo predict the degree of pathological differentiation of hepatocellular carcinoma (HCC) by quantitative analysis the correlation between the perfusion parameters of contrast-enhanced ultrasound (CEUS) and the pathological grades of HCC using VueBox® software.MethodsWe enrolled 189 patients who underwent CEUS and liver biopsy at our hospital from July 2019 to September 2024 and were pathologically confirmed with primary HCC. The Edmondson-Steiner pathological classification system was used as the gold standard for dividing the patients into the low-grade and high-grade groups. The patients were randomly divided into training set and testing set in a ratio of 7:3, in which the parameters of the training set were analyzed by univariate analysis and then stepwise regression to construct the prediction model, and the diagnostic efficacy of the validation model was evaluated by discrimination, calibration, and clinical applicability.ResultsA total of 189 patients with primary hepatocellular carcinoma were enrolled, including 118 patients in the low-grade group and 71 patients in the high-grade group; they were randomly divided into training set of 128 patients and testing set of 61 patients. The prediction model was constructed by logistic regression in the training set, and the final model included three variables: mTTI, FT, and maximum diameter of a single lesion, resulting in the equation was Y=−2.360+1.674X1+1.019X2+0.753X3(2)+1.570X3(3).The area under the ROC curve (AUC) of the training set was 0.831, with a sensitivity of 82.0% and a specificity of 79.5%; the area under the ROC curve (AUC) of the testing set was 0.811, with a sensitivity of 81.0% and a specificity of 70.0%.ConclusionThe regression model constructed by combining multiple parameters can effectively improve the diagnostic performance of CEUS in predicting the pathological differentiation grade of HCC, thus providing a clinical basis and empirical support for the use of CEUS as a diagnostic imaging method for this disease.

P0235 Intestinal Ultrasound and Its Advanced Modalities in Characterizing Strictures in Crohn's Disease

Abstract Background Crohn’s disease (CD) strictures exhibit varying levels of inflammation and chronicity. Treatment decisions are likely to improve when the predominant phenotype is known1. Intestinal ultrasound (IUS) allows transmural evaluation with potential to characterize this predominant phenotype2. Here, we evaluated whether conventional intestinal ultrasound (IUS) in combination with advanced modalities (contrast-enhanced ultrasound (CEUS) and shear-wave elastography (SWE)) is accurate in characterizing the predominant phenotype of CD strictures. Methods CD patients with a confirmed stricture at endoscopy (non-passable with the endoscope) or MRE1 were included. All patients underwent IUS prior to a small bowel segmental resection. Histology in the resection specimen was assessed in location-matched tissue sections. Following a consensus session, two pathologists blindly assessed the predominant phenotype (inflammatory (IP), chronic (CP) or mixed (MP)) in the strictures. The primary objective of the study was to find a (combination of) IUS parameter(s) to identify strictures with an IP. Results Out of 107 patients with a CD stricture, 36 were included (median IUS and surgery: 14 days). Histology revealed an inflammatory phenotype in 7/36 (20%), chronic in 16/36 (44%) and mixed in 13/36 (36%). In univariate analysis loss of wall layer stratification (WLS) (OR:7.86, p=0.029) and CEUS parameters (best performing: wash-in area under the curve (WiAUC): cut-off:38.20 dB, AUROC:0.84, p=0.011, sens:86%/spec:77%) were associated with an IP. Bowel wall thickness (BWT) (5.74 vs 7.46 mm, p=0.002) was lower and colour Doppler signal (CDS) (OR:0.14, p=0.03) and loss of WLS (OR:0.14, p=0.027) were less present in CP. The optimal BWT to determine a CP was &amp;lt;6.4 mm (AUROC: 0.83, p=0.001, sens/spec: 75%). SWE correlated inversely with hypervascularity (CEUS parameters [ρ=-0.36 to -0.47, all p&amp;lt;0.04] and CDS [ρ=-0.68, p&amp;lt;0.001]) but did not determine the predominant phenotype. In multivariate analysis, loss of WLS and WiAUC≥38.20 dB indicated an IP, whereas lower BWT and CDS≤2 indicated a CP. With these parameters, the Stricture Score Amsterdam (SSA) (Table 1) was constructed where a score &amp;gt;2 demonstrated high accuracy for an IP (AUROC:0.88, p=0.002) and a negative score (&amp;lt;0) high accuracy for a CP (AUROC:0.90, p&amp;lt;0.0001) (Figure 1). Inter-observer agreement for the score was good (ICC:0.73, p&amp;lt;0.0001). A combination of IUS and CEUS is accurate to differentiate between inflammatory and chronic strictures in CD. The SSA needs external validation and evaluating its potential as a diagnostic decision aid when choosing between surgical and available medical treatments.

Prognostic value of contrast-enhanced ultrasound in dogs with acute renal injury treated with haemodialysis.

It is clinically relevant to predict outcomes in dogs with acute kidney injury (AKI) treated with haemodialysis. The aim of this study was to evaluate the prognostic value of contrast-enhanced ultrasound (CEUS) and its role in discriminating between AKI and acute impairment associated with chronic kidney disease (AKI/CKD). Dogs diagnosed with AKI or AKI/CKD were prospectively enrolled in the study. For all dogs, CEUS was performed at admission (T0). In addition, in haemodialysis-treated dogs, it was performed after the first dialysis (T1) and 7days (T7) and 30 days (T30) after admission. A total of 41 dogs were enrolled, of which 30 were treated with haemodialysis and 11 received medical therapy. No significant difference was found between CEUS values at T0 in surviving and non-surviving patients after haemodialysis. A significant difference in cortical peak enhancement intensity (PI) values was found between T0, T1, T7 and T30, with the highest PI value at T0, a significant reduction at T1 and a progressive reduction in subsequent checks. There were no significant differences in CEUS parameters at T0 between patients with AKI and AKI/CKD. AKI aetiology was unknown in most cases, which limits the generalisability of the findings. Furthermore, the small sample size means that the statistical analysis is likely underpowered. CEUS could be helpful in evaluating of the prognosis of dogs with AKI during haemodialysis.

Clinical utility of quantitative ultrasonography parameters combined with serum cancer antigen 15‑3, human epidermal growth factor receptor 2 and soluble E‑cadherin in diagnosing mass‑type breast cancer.

Contrast-enhanced ultrasonography (CEUS), a newly developed imaging technique, holds certain value in differentiating benign from malignant tumors. Additionally, serum tumor markers also exhibit significant clinical importance in the diagnosis and monitoring of malignant tumors. Reports have indicated abnormal expression of HER-2, CA153 and sE-cad in breast cancer. Early diagnosis of breast cancer facilitates early clinical intervention and enhances the overall quality of life for patients. Therefore, this study aims to explore the clinical value of quantitative CEUS parameters combined with serum levels of CA153, HER-2 and sE-cad in diagnosing mass-type breast cancer. In total, 49 patients with breast cancer (breast cancer group) and 56 patients with benign breast tumors (benign group) were selected as the study participants, while 50 healthy women served as the control group. Ultrasonography was performed on the patients in the breast cancer and benign groups using diagnostic color Doppler ultrasonography. The serum CA15-3, HER-2 and sE-cad levels in all three study groups were measured using a fully automated electrochemiluminescence immunoassay. Pearson's correlation test was used to analyze the correlation between the quantitative ultrasonography parameters and serum CA15-3, HER-2 and sE-cad levels. Logistic multivariate regression analysis was performed to analyze the independent risk factors, and a receiver operating characteristic curve was plotted to assess the diagnostic value of these factors. The peak intensity (PI), wash-in slope (WIS), gradient (Grad) and local mean transit time (mTTI), along with the CA15-3, HER-2 and sE-cad levels in the breast cancer group were significantly higher, and the time to peak (TTP) was significantly lower, compared with those values in the benign and control groups. CA15-3, HER-2 and sE-cad were negatively correlated with TTP in the breast cancer group (all P<0.05) and positively correlated with PI, WIS, Grad and mTTI (all P<0.05). The area under the curve (AUC) values for CA15-3, HER-2, sE-cad, PI, WIS, Grad, mTTI and TTP for the diagnosis of malignant breast cancer were 0.640, 0.730, 0.687, 0.683, 0.692, 0.737, 0.697 and 0.671, respectively. The AUC for the combined diagnosis was 0.919, with a sensitivity of 0.857 and a specificity of 0.911, outperforming each index alone for a single diagnosis. Logistic multivariate regression analysis revealed that HER-2, TTP, PI, WI and Grad were independent risk factors for malignant breast cancer. In conclusion, combining the quantitative ultrasonography parameters with the CA15-3, HER-2 and sE-cad levels facilitated the differential diagnosis of benign and malignant breast lesions, and may provide a reference for clinical treatment in the future.

The benefits of contrast-enhanced ultrasound in the differential diagnosis of suspicious breast lesions.

Contrast-enhanced ultrasound (CEUS) shows potential for the differential diagnosis of breast lesions in general, but its effectiveness remains unclear for the differential diagnosis of lesions highly suspicious for breast cancers. This study aimed to evaluate the diagnostic value of CEUS in differentiating pathological subtypes of suspicious breast lesions defined as category 4 of US-BI-RADS. The dataset of 150 breast lesions was prospectively collected from 150 patients who underwent routine ultrasound and CEUS examination and were highly suspected of having breast cancers. All lesions were pathologically confirmed by US-guided needle biopsy and surgery. The qualitative features and the quantitative parameters of CEUS of these breast lesions were analyzed. The CEUS and biopsy examinations were performed after informed consent. In the qualitative features, crab clam-like enhancement, the presence of more than two enhanced vessels within lesions, and surrounding enriched vessels inserting into lesions were able to differentiate atypical fibroadenomas (FIB) and mass-like non-puerperal mastitis (NPM) from invasive ductal carcinomas (IDC) and ductal carcinomas in situ (DCIS) (p < 0.05). The enlarged scope, irregular shape, and perfusion deficiency were valuable to the differential diagnosis of FIB from the others (p < 0.05). In the four quantitative parameters of CEUS, only the peak intensity (IMAX) contributed to the differential diagnosis between malignant and benign tumors (p < 0.05, ROCAUC: 0.61, sensitivity: 60.4% and specificity: 65.9%, accuracy: 62.1%). However, IMAX did not show any difference in the paired comparison of IDC, DCIS, FIB, and NPM (p > 0.05). The logistic regression analysis results showed that heterogeneous perfusion, crab clam-like enhancement, and partial_ IMAX were independent risk factors for benign and malignant breast lesions (p < 0.05). The area under a receiver operating characteristic of the integrated model was 0.89. In the diagnosis of benign and malignant pathological subtypes of breast lesions, independent risk factors and integrated models had no statistical significance in the diagnosis of IDC and DCISs, FIB, and NPM (p > 0.05). Some qualitative risk features of CEUS can distinguish malignant breast lesions from NPM and atypical FIB with a high score of US-BI-RADS, aiding physicians to reduce the misdiagnosis of suspicious breast lesions in clinical practice.

Can Multiparametric Ultrasound Analysis Predict Malignancy in Testes? An 11-Year Single Center Experience with Testicular Masses.

Introduction/Objective: Contrast-enhanced ultrasound (CEUS) is a promising modality for differentiating benign and malignant lesions in various organs, including the testis. Testicular tumors, common in young men, are often treated with radical orchiectomy, which can have significant consequences. This study aimed to analyze CEUS parameters and their association with malignant testicular tumors. Materials and Methods: Between May 2009 and September 2020, 342 patients with suspected testicular lesions underwent CEUS at a tertiary referral center. Multiparametric ultrasound, including B-mode, Color Doppler, CEUS, and elastography, was performed. Exclusion criteria were the absence of a testicular lesion in the CEUS examination. Histological results, CEUS parameters, and elastography data were analyzed, and statistical correlations were evaluated using chi-square and Mann-Whitney U tests, with multivariate logistic regression for significant findings. Results: Of the 342 patients, 114 (33.3%) had suspicious CEUS findings, and 84 underwent surgical exploration. Malignancy was confirmed in 48 cases (57.1%). The sensitivity and specificity of CEUS for detecting malignancy were 93.8% and 85.2%, respectively. Contrast enhancement was observed in 93.3% of malignant tumors, but not statistically significant compared to benign lesions (p = 0.107). However, elastography revealed higher tissue stiffness in 77.8% of malignant tumors versus 41.0% in benign lesions (p = 0.009). Multivariate analysis indicated that tissue stiffness was significantly associated with malignancy (HR 8.29, 95%CI 1.26-54.58, p = 0.028). Conclusions: CEUS is a valuable tool for testicular lesion evaluation, with elastography showing strong potential in predicting malignancy through tissue stiffness. However, contrast enhancement and "wash-in/-out" were not reliable malignancy indicators. Further research is needed to standardize CEUS and elastography techniques for routine clinical use.

Clinical and Multimodal Imaging Features of Hepatic Inflammatory Pseudotumors: A Two-Center Retrospective Study.

Current literature on imaging characteristics of hepatic inflammatory pseudotumor (HIPT) is limited. This study aimed to analyze the contrast-enhanced ultrasound (CEUS) features in HIPT and compare them with contrast-enhanced computed tomography (CECT) and contrast-enhanced magnetic resonance imaging (CEMRI). A total of 83 patients with histologically proven HIPT from two medical institutions were included in this study. All patients underwent CEUS within 1 week before surgery or biopsy. Some patients received additional CECT or CEMRI. B-mode ultrasound (BMUS) features, enhancement parameters of CEUS, CECT and CEMRI were analyzed. Chi-square test was used to compare the enhancement patterns and diagnostic sensitivity between CEUS and CECT/CEMRI. On the BMUS, HIPT mainly appeared hypoechoic (83.5%, 66/79), irregular shapes (62.0%, 49/79), heterogeneous echogenicity (72.2%, 57/79), and unclear boundary (65.8%, 52/79). A total of 61.5% (51/83) lesions exhibited mild hyper- or iso-enhancement in the arterial phase (AP), 59.0% (49/83) lesions had internal nonenhanced areas, and most lesions (71.1%, 59/83) showed early wash-out (<60 seconds) on the CEUS. There were significant differences between CEUS and CECT/CEMRI in enhancement intensity of AP and wash-out pattern (P < .05). The sensitivity in the diagnosis of HIPT among the three had no statistical difference (P>.05). The CEUS features of HIPT lesions typically include mildly hyper-enhanced or iso-enhanced in AP, rapid wash-out in PVP, and often small nonenhanced areas within the mass. Furthermore, the wash-out pattern of CEUS and CECT/CEMRI are inconsistent, more akin to cholangiocarcinoma. The diagnostic efficacy of the three modalities is similar.

The diagnositic value of dynamic contrast-enhanced ultrasound for evaluation of tissue oxygen status in rat hepatoma model

BackgroundHypoxia is a characteristic of solid tumors, but whether significant hypoxia exists in the hepatocellular carcinoma remains unclear. This animal study aims to explore the value of dynamic contrast-enhanced ultrasound (CEUS) quantitative parameters to evaluate the oxygen status in two rat hepatoma models.Materials and methodsN1S1 and McA-RH7777 S-D rat orthotopic hepatoma models were established. Once the tumors reached a diameter of 10–15 mm, CEUS and oxygen partial pressure (pO2) polarography were performed. Immunohistochemical staining for HIF-1α and pimonidazole was conducted after euthanizing the rats. Correlation between quantitative CEUS parameters, pO2, and the immunohistochemical integrated optical density (IOD) was analyzed to assess the predictive ability of CEUS quantitative parameters for the tissue oxygen environment.ResultEleven N1S1 models and ten McA-RH7777 models were established successfully. There was no significant difference in pO2 (35.5 mmHg vs 32.2 mmHg, P = 0.917), IOD of HIF-1α (13.4 vs 20.0, P = 0.159) and pimonidazole (0.70 vs 1.30, P = 0.926) between the tumor and the peritumoral liver tissue. The pO2 values were correlated with CEUS quantitative parameters including mean time-intensity curves (mTIC) (P = 0.003), peak intensity (PKI) (P = 0.010), area under the curve (AUC) (P = 0.009), area under the wash-in curve (WiAUC) (P = 0.006), and arrival time (AT) (P = 0.033). The IOD of HIF-1α correlated with AUC (P = 0.022), WiAUC (P = 0.009), ascending slope (AS) (P = 0.044), and falling time (FT) (P = 0.009). Multiple linear regression indicated that the “short AT” was an independent protective factor for hypoxia (β = -2.347, 95% CI: -4.948, -0.394, P = 0.022), and CEUS had the ability to predict the tumor pO2 (P = 0.003).ConclusionNo evidence of significant hypoxia was identified in two rat orthotopic hepatoma models. Quantitative CEUS parameters correlated with the oxygen status of the tumor, which could be utilized to predict the tumor tissue pO2.

Correlation of early contrast-enhanced ultrasound parameters with postoperative graft function and at six months after kidney transplantation

Abstract Purpose We analyzed which contrast-enhanced ultrasound (CEUS) parameters are associated with reduced kidney function in the early postoperative period and are prognostic for kidney function six months after transplantation. Materials and Methods This prospective observational study included 74 patients in whom quantitative CEUS analysis and Doppler ultrasound were performed early after kidney transplantation (10±6 days). For each region of interest (ROI) the time-to-peak intensity (TTP) and the respective delta between ROIs within interlobar artery, cortex, and medulla were compared. Results were correlated with kidney function at the time of imaging and six months later. Results Patients with an eGFR&lt;30 ml/min at the time of investigation had significantly slower cortical enhancement with a longer cortical TTP (cTTP: 16.1±0.9 vs. 11.7±0.7 sec, p&lt;0.001), as well as a significant delay between the arterial and cortical phases (c–a), as shown in longer ∆TTP (c–a): 8.2±0.9 vs. 4.2 ± 0.5 sec, p&lt;0.001. There was a significant negative correlation between cTTP and eGFR with a correlation coefficient of −0.37 (p&lt;0.001), as well as between ∆TTP (c–a) and eGFR with a correlation coefficient of −0.40 (p&lt;0.001). Reduced kidney function after 6 months correlated significantly with the findings of the initial CEUS examination (p=0.005, correlation coefficient −0.39). Conclusion CEUS revealed significant differences in temporal enhancement dynamics in patients with reduced kidney function after transplantation. Quantitative CEUS might therefore be able to depict graft function regarding microvascular damage and be of prognostic value regarding long-term renal outcomes.

Contrast-enhanced ultrasound can differentiate the level of glioma infiltration and correlate it with biological behavior: a study based on local pathology.

The objective of this study is to assess the diagnostic efficacy of contrast-enhanced ultrasound (CEUS) in determining the level of glioma infiltration and to investigate its correlation with pathological markers. A prospective study involving 16 adult glioma patients was conducted. Preoperative US-(Magnetic Resonance)MR fusion imaging was utilized for tumor infiltration localization, while CEUS was employed to assess hemodynamic alterations. Parameters such as peak intensity (PI), rise time (RT), time to peak (TTP), and area under the curve (AUC) were measured. Utilizing contralateral normal brain tissue as the reference standard. The Kruskal-Wallis H-test was conducted to compare CEUS and pathological parameters (significance level, p < 0.05; bonferroni correction) among tumor margins, infiltration zones, and normal tissues, as well as between low-grade glioma (LGG) and high-grade glioma (HGG) within the infiltration zone, based on whole slide pathological images analysis. Spearman correlation analysis was employed to determine the correlation coefficient between hemodynamics and pathology. Receiver operating characteristic (ROC) curves were drawn to evaluate the performance of CEUS in tumor classification. From tumor margin to normal tissue, PI, AUC, Ki67, EGFR, and 1p/19q showed a significant decreasing trend, while TTP, IDH-1, and MGMT gradually increased. RT was lower at the tumor margin but did not show statistically significant differences. In the infiltration zones, there was a significant increase in parameters such as PI, normalized PI (Nor_PI), AUC, and Ki67 from LGG to HGG, while RT, Nor_RT, TTP, Nor_TTP, IDH-1, and MGMT significantly decreased. Nor_AUC and EGFR increased but were not significant, and 1p/19q decreased but was not significant. RT and Nor_TTP were independent risk factors for distinguishing between LGG and HGG in the infiltration zone, with a combined diagnostic efficacy ROC of 0.891. The sensitivity reached 96.64% and the specificity reached 82.35%. There was a significant correlation between hemodynamic indicators and pathological indicators. CEUS can effectively differentiate levels of infiltration zones, which correlates with their biological behavior, with RT + Nor_TTP showing particularly highest diagnostic efficacy. These findings contribute to improving the accuracy of diagnosing infiltration zones and provide essential biological insights for subsequent treatments.

The value of postoperative contrast-enhanced ultrasound parameters in lymph node metastasis, tumor node metastasis, and treatment response evaluation of resected hepatocellular carcinoma.

To explore the application value of postoperative contrast-enhanced ultrasound (CEUS) parameters for lymph node metastasis (LNM), tumor, node, metastasis staging, and treatment response evaluation of resected hepatocellular carcinoma (HCC). We retrospectively analyzed 100 patients with liver cancer who underwent liver CEUS at our hospital between October 2020 and October 2022. The patient's LNM, pathological staging, and therapeutic effects were recorded based on the histopathological results. CEUS parameters were analyzed and compared CEUS parameters between different lymph node metastases, pathological stages, and therapeutic effects. Twenty-three patients experienced LNM, 77 patients did not experience LNM; and the rise time (RT), peak intensity (PI), and area under the curve (AUC) of the metastatic group were significantly smaller than those of the nonmetastatic group (P < .05). 44 cases were classified into groups I to II by pathological staging, and 56 cases were classified into groups III to IV. The RT, PI, and AUC of groups III to IV were significantly lower than those of groups I-II (P < .05). Seventy-nine cases were complete necrosis, 21 cases were residual or recurrent; The RT, PI, and AUC of the residual or recurrent group were significantly lower than those of the complete necrosis group (P < .05). The receiver operating characteristic curve shows that RT, PI, and AUC have a certain value in evaluating LNM, pathological staging, and treatment response of HCC, and the combined evaluation/evaluation value of these 3 factors is relatively high. The postoperative CEUS parameters RT, PI, and AUC can be used for LNM, pathological staging evaluation, and treatment response evaluation of HCC. Moreover, the combination of the 3 parameters is feasible and valuable in evaluating LNM, tumor, node, metastasis staging, and treatment response of HCC.

The treatment response evaluation through the combination of contrast-enhanced ultrasound and squamous cell carcinoma antigen in cervical cancer.

The evaluation of the treatment response after concurrent chemotherapy and radiotherapy (CCRT) for locally advanced cervical cancer is closely related to the formulation of treatment strategies. Magnetic resonance imaging (MRI) is a recommended method for efficacy evaluation; however, a unified consensus has not yet been reached on its use, and it has its limitations. This study aimed to evaluate the diagnostic value of a combination of contrast-enhanced ultrasound (CEUS) parameters and the squamous cell carcinoma antigen (SCC-Ag) to establish another efficient and feasible examination method. The data of 94 patients with cervical cancer who underwent transvaginal contrast-enhanced ultrasound (TV-CEUS) from October 2020 to March 2023 were retrospectively collected. Based on the inclusion and exclusion criteria, 70 patients diagnosed with cervical squamous cell carcinoma (SCC) who underwent CCRT were selected for inclusion in the study. The patients were divided into the residual disease (RD) group (comprising 26 patients) and the complete response (CR) group (comprising 44 patients) according to the diagnostic standard. Data on the grayscale echogenicity, color Doppler flow imaging (CDFI), CEUS parameters, and the SCC-Ag of all the patients were collected by two experienced radiologists. Inter-observer reliability was assessed using the intraclass correlation coefficient (ICC). Receiver operating characteristic (ROC) curves were created based on the non-parametric U-test or t-test results for the two groups. Delong's test was used to compare the area under the curve (AUC) between different ROC curves. A subgroup analysis was conducted based on the patient's age, tumor diameter, and disease stage. The ICCs between the two observers ranged from 0.915 and 0.947. Hypervascular hyper-enhancement in the arterial phase, hypo-enhancement in the venous phase, and the SCC-Ag differed significantly between the RD and CR groups (P<0.05). The AUC of the ROC curve combining these indicators was 0.890 [95% confidence interval (CI): 0.792-0.989], which was higher than the AUC of any indicator alone (P<0.05). The subgroup analysis showed that the AUCs of the patients aged ≥53 and <53 years were 0.922 (95% CI: 0.816-1.00) and 0.896 (95% CI: 0.782-1.00), respectively, those of the patients with stage II, III, and IV were 0.881 (95% CI: 0.732-1.00), 0.955 (95% CI: 0.894-1.00), and 1.000 (95% CI: 1.00-1.00), respectively, and those of the patients with a tumor diameter ≤10 mm, 10 mm < tumor diameter (post) <20 mm, and tumor diameter (post) ≥20 mm were 0.976 (95% CI: 0.910-1.00), 0.883 (95% CI: 0.763-1.00), and 1.00 (95% CI: 1.00-1.00) respectively. Transvaginal ultrasound (TVUS), TV-CEUS, and the SCC-Ag can be used in combination to evaluate the patient response to CCRT in locally advanced cervical SCC. This integrated approach enhanced the accuracy of the diagnosis of residual lesions and may be helpful in treatment plan optimization.

Perfusion Patterns of Peripheral Pulmonary Metastasis Using Contrast-Enhanced Ultrasound (CEUS) and Their Correlation with Immunohistochemically Detected Vascularization Pattern.

Description of the perfusion of pulmonary metastasis by contrast-enhanced ultrasound (CEUS) and their correlation with vascularization patterns represented by immunohistochemical CD34 endothelial staining. The data of 54 patients with histologic proven peripheral pulmonary metastasis, investigated between 2004 and 2023 by CEUS. These CEUS parameters were evaluated: time to enhancement (TE), categorized as early pulmonary-arterial (PA) or delayed bronchial-arterial (BA) patterns; extent of enhancement (EE), either marked or reduced; homogeneity of enhancement (HE), homogeneous or inhomogeneous; and decrease of enhancement (DE), rapid washout (<120 s) or late washout (≥120 s). Additionally, tissue samples in 45 cases (83.3%) were stained with CD34 antibody for immunohistochemical analysis. In total, 4 lesions (7.4 %) exhibited PA enhancement, and 50 lesions (92.6%) demonstrated BA enhancement. Furthermore, 37 lesions (68.5%) showed marked enhancement, while 17 lesions (31.5%) exhibited reduced enhancement. The enhancement was homogeneous in 28 lesions (51.86%) and inhomogeneous in 26 lesions (48.14%). Additionally, 53 lesions (98.1%) displayed a rapid washout. A chaotic vascular pattern indicative of a bronchial arterial blood supply was identified in all cases (45/45, 100%), including all 4 lesions with PA enhancement. Pulmonary metastases in CEUS predominantly reveal bronchial arterial enhancement and a rapid washout. Regarding EE and HE, pulmonary metastases show heterogeneous perfusion patterns. A PA enhancement in CEUS does not exclude BA neoangiogenesis.

Value of perfusion characteristics evaluated by CEUS combined with STQ parameters in diagnosing the properties of SLN in breast cancer.

Accurate sentinel lymph node (SLN) characterization is essential for breast cancer management, prompting advancements in imaging technologies such as contrast-enhanced ultrasound (CEUS) and sound touch quantification (STQ) to enhance diagnostic precision. To explore the value of perfusion characteristics evaluated by CEUS combined with STQ parameters in diagnosing the properties of sentinel lymph node (SLN) in breast cancer. A total of 91 breast cancer patients (91 SLNs) admitted to the hospital from February 2022 to December 2023 were selected for this study. Among them, 26 patients with metastatic SLN confirmed by surgery and pathology were included in the metastatic SLN group, and 65 patients with non-metastatic SLN were included in the non-metastatic SLN group. Preoperative examination results of CEUS and STQ were retrospectively analyzed. The diagnostic efficacy of perfusion characteristics evaluated by CEUS and STQ parameters for the properties of SLN in breast cancer was analyzed using the receiver operating characteristics (ROC) curve. Statistical methods such as chi-square tests and logistic regression analysis were employed to analyze the data. Enhancement patterns differed significantly between the metastatic SLN and non-metastatic SLN groups (p< 0.05). ROC curve analysis indicated that CEUS perfusion characteristics had an AUC value of 0.823 for diagnosing SLN properties, with a sensitivity of 84.62% and specificity of 70.77% using type I as the critical value. Additionally, STQ measurement showed significantly higher values in the metastatic SLN group (44.18 ± 6.53 kPa) compared to the non-metastatic SLN group (34.69 ± 6.81 kPa) (t= 6.075, p< 0.001). The AUC value for STQ parameters in diagnosing metastatic SLN was 0.849, with a sensitivity of 73.08% and specificity of 92.31% using 42.40 kPa as the critical value. Though the AUC value of STQ measurement was higher than CEUS perfusion characteristics alone, the difference was not statistically significant (Z= 0.393, p= 0.695). Moreover, combining CEUS perfusion characteristics with STQ parameters yielded an AUC value of 0.815 for diagnosing SLN properties, showing no significant difference compared to diagnosis with CEUS or STQ parameters alone (Z= 0.149, 0.516, p= 0.882, 0.606). Combined use of perfusion characteristics evaluated by CEUS and STQ parameters can significantly improve the diagnostic specificity of SLN in breast cancer. It is worthy of clinical promotion.

Contrast-enhanced ultrasound (CEUS) characteristics of atypical-enhanced papillary thyroid carcinoma (PTC).

To investigate the diagnostic value of CEUS in atypical-enhanced PTC. The clinical data, qualitative and quantitative parameters of CEUS in 177 Iso/hyper-enhanced thyroid nodules with definite pathological results were retrospectively analyzed in the Lanzhou University Second Hospital from June 2019 to January 2021. And the clinical value of CEUS in the diagnosis of atypical-enhanced PTC was assessed using univariate and multivariate analysis. Among the 177 thyroid nodules, 59 were benign and 118 were PTC. There were significant differences in age, enhancement border, ring enhancement, speed of wash in, speed of wash out, enhancement pattern, capsule interruption, time to peak, time to wash out, RT, TPH, and TTP (P < 0.05). Multivariate analysis showed unclear enhancement border and concentric enhancement were independent risk factors for the diagnosis of atypical-enhanced PTC by CEUS. The sensitivity, specificity, PPV, NPV, and accuracy of the model in diagnosing atypical-enhanced PTC were 88.1%, 71.2%, 86.0%, 75.0%, and 82.5%, respectively. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve was 0.910. The diagnosis of atypical-enhanced PTC can be better performed by enhancement characteristics and time intensity curve (TIC) of CEUS, which have a good clinical application value.

Quantitative and qualitative analysis of contrast-enhanced ultrasound for differentiating benign and malignant superficial enlarged lymph nodes.

In many clinical situations, it is critical to exclude or identify abnormally lymph nodes (LNs). The nature of superficial abnormally LNs is closely related to the stage, treatment, and prognosis of the disease. Ultrasound (US) is an important method for examining superficial LNs due to its cheap and safe characteristics. However, it is still difficult to determine the nature of some LNs with overlapping benign and malignant features in images. Contrast-enhanced ultrasound (CEUS) can be used to evaluate the microperfusion status of tissues in real time, and it can improve diagnostic accuracy to a certain extent. Therefore, in this study, we will analyze the correlation between CEUS quantitative parameters and benign and malignant superficial abnormally LNs, to evaluate the efficacy and value of CEUS in distinguishing benign and malignant superficial LNs. This study retrospectively analyzed 120 patients of abnormal LNs who underwent US and CEUS at the China-Japan Union Hospital of Jilin University from December 2020 to August 2023. All 120 cases of abnormal LNs underwent US-guided coarse needle biopsy, and accurate pathological results were obtained, along with complete US and CEUS images. According to the pathological results, LNs were divided into benign and malignant groups, and the qualitative and quantitative parameters of US and CEUS between the two groups were analyzed. The cutoff value is determined by the receiver operating characteristic (ROC) curve of the subjects, and sensitivity, specificity, and accuracy are applied to evaluate the ability of the cutoff value to distinguish between the two groups. There were a total of 120 LNs, including 36 in the benign group and 84 in the malignant group. The results showed that malignant LNs were usually characterized by the disappearance of lymphatic hilum, round ness index (L/T) <2, irregular morphology, and the manifestation of uneven perfusion (P<0.05). The differences in the quantitative parameters peak enhancement (PE), rise time (RT), time to peak (TTP), wash-in rate (WIR), and wash-out rate (WOR) were statistically significant (P<0.05). The result showed that RT and TTP in the malignant LNs were higher than those in the benign LNs, while the PE, WIR, and WOR were lower. A comparison of the ∆ values showed that the differences in ∆PE, ∆WIR, and ∆fall time (FT) were statistically significant (P<0.05), Among them, the ∆PE and ∆WIR of malignant LNs were higher than those of benign LNs, while the ∆FT was lower than that of benign LNs. Quantitative analysis of CEUS features is valuable in the diagnosis of benign and malignant LNs, and US combined with CEUS helps to improve the accuracy of identifying the nature of LNs.

Contrast-Enhanced Ultrasonography Findings Within 3 Days Postoperatively Are Associated With 1-Month Graft Failure After Split Liver Transplantation

Purpose:To evaluate whether Doppler ultrasonography (DUS) and contrast-enhanced ultrasonography (CEUS) within 3 days postoperative can identify 1-month graft failure after split liver transplantation (SLT). Materials and methodsA total of 58 consecutive patients who underwent SLT between February 2022 and September 2023 were included. The DUS and CEUS images and parameters within 3 days postoperatively were analyzed and recorded. The DUS parameters included peak systolic velocity (PSV), resistive index, and systolic acceleration time for the hepatic artery, PSV for the portal vein and hepatic vein. The CEUS qualitative analysis variables included the liver parenchyma enhancement pattern and the posterior enhancement attenuation. Logistic regression and Cox proportional hazard regression were used to evaluate the relationship between DUS/CEUS findings and 1-month graft failure. ResultsSeven of the 58 liver grafts failed within one month. Poor CEUS enhancement (pattern Ⅱ/Ⅲ) was observed in 5 of 7 patients (71.4%) of graft failure, whereas good contrast enhancement (pattern Ⅰ) was found in 47 of the 51 patients (92.1%) in the successful group on postoperative day 3. Multivariate logistic regression analysis revealed that 1-month graft failure was independently predicted by operative time (OR=3.79, 95% CI: 1.27–11.29, p=.017) and CEUS enhancement pattern on postoperative day 3 (OR=90.88, 95% CI: 2.77–2979.56, p=.011). Cox proportional hazard regression showed that operative time ( HR=1.6, 95% CI: 1.15–2.22, p =.005) and CEUS enhancement pattern on postoperative day 3 (HR=11.947, 95% CI: 2.04–69.98, p =.006) were independent predictors for graft failure. ConclusionsPoor CEUS enhancement (pattern Ⅱ/Ⅲ) was associated with 1-month graft failure in SLT recipients. CEUS may serve as a noninvasive, valuable prognostic tool to predict clinical outcomes early after SLT.

Contrast-enhanced ultrasound features as a potential biomarker for the prediction of breast cancer recurrence.

To investigate the associations between contrast-enhanced ultrasound imaging features and disease recurrence among patients with locally advanced breast cancer treated with neoadjuvant chemotherapy. In the study, pre- and post-neoadjuvant chemotherapy contrast-enhanced ultrasound images of 43 patients with breast cancer were retrospectively analysed. Post-acquisition image processing involved the placement of freehand-drawn regions of interest, followed by the generation of blood flow kinetics representing blood volume and velocity for these regions of interest. Qualitative and quantitative contrast-enhanced ultrasound parameters were compared to predict recurrence, and receiver operating characteristic analysis was used to evaluate predictive ability. Among the 43 patients, 10 (23%) exhibited disease recurrence (median [range]: 27 [4-68] months). Post-neoadjuvant chemotherapy peak enhancement, wash-in area under the curve, wash-out area under the curve, and wash-in and wash-out area under the curve (p=0.003, p=0.004, p=0.026, and p=0.014, respectively) differed between the no-recurrence and recurrence groups. The area under the receiver operating characteristic curve (0.88; 95% confidence interval: 0.75-1.00) for post-neoadjuvant chemotherapy peak enhancement was the highest among the contrast-enhanced ultrasound parameters, with a cut-off of 13.33 arbitrary units. Higher peak enhancement on post-neoadjuvant chemotherapy contrast-enhanced ultrasound images was associated with recurrence in women with locally advanced breast cancer and is a potential biomarker of tumor recurrence.

#751 Noninvasive evaluation of histopathology in immunoglobulin A nephropathy by contrast-enhanced ultrasonography

Abstract Background and Aims IgA nephropathy is a common primary glomerulonephritis. Renal pathology provides a visual reflection of renal lesions, but percutaneous renal biopsy carries risks This study explores a non-invasive method for evaluating the renal pathological changes in IgA nephropathy patients. We attempt to correlate contrast-enhanced ultrasonography parameters with IgA nephropathy pathological changes, discussing the potential value of this approach in assisting the assessment of IgA nephropathy renal pathology. Method This prospective study included 26 IgAN cases eventually confirmed through renal pathology. Prior to renal biopsy, patients underwent contrast-enhanced ultrasound examination and conventional renal ultrasound. Ultrasound contrast parameters, including time-intensity curve (TIC) peak intensity, time to peak, rise time, and mean transit time, were recorded. Correlation analyses were conducted between conventional ultrasound, contrast-enhanced ultrasound parameters, clinical data, and pathology scores. Results Significant differences in peak intensity were observed between different Oxford C scores, with significant statistical differences between C0 and C1, as well as C0 and C2 (P &amp;lt; 0.05). Quantitative analysis revealed correlations between peak intensity, time to peak, and C scores (r = −0.571, P &amp;lt; 0.05; r = 0.498, P &amp;lt; 0.05). Time to peak correlated with T scores (r = −0.445, P &amp;lt; 0.05). No correlations were found between other contrast-enhanced ultrasound parameters and Lee's grading, Oxford MEST-C M, E, or S scores. Conclusion Contrast-enhanced ultrasonography parameters, specifically time-intensity curve peak intensity and time to peak, correlate with renal pathology C scores. Contrast-enhanced ultrasound holds clinical significance in the non-invasive assessment of renal pathological changes in IgA nephropathy patients.