Conventional Ultrasonography Research Articles

Electromagnetic acoustic imaging methods: resolution, signal-to-noise, and image contrast in phantoms.

Purpose: Electromagnetic acoustic imaging (EMAI) is a hybrid imaging technique using radio-frequency irradiation to induce ultrasound (US), providing an US image in which spatial conductivity differences provide image contrast. The method is potentially clinically important in that the added diagnostic parameter has been shown to be useful in cancer detection and vascular space delineation. Approach: We report the development of coil configurations and imaging processing techniques designed to address the low signal-to-noise of EMAI and demonstrate achievable resolution and contrast in phantoms along with EMAI signals in excised animal tissue. Experiment results are compared with theoretical calculations. Results: EMAI signal intensities depend on the square of the ampere-turns in the coil radio frequency coil as predicted theoretically. Resolution is shown to be comparable to conventional US imaging with contrast and signal intensity depending on source conductivity. Optimizing signal-to-noise depends on coil design, orientation of the electromagnetic fields, and coherent processing. Conclusions: Two-dimensional EMAI images are shown to have the expected resolution of conventional US with image contrast dependent on conductivity. Achievable signal-to-noise is sufficient to form potentially clinically useful images.

Comparison of conventional, doppler and contrast-enhanced ultrasonography in differential diagnosis of ovarian masses: a systematic review and meta-analysis

ObjectivesTo assess the value of conventional, Doppler and contrast-enhanced ultrasonography (CEUS) (conventional ultrasonography (US), Doppler US and CEUS) for diagnosing ovarian cancer.DesignSystematic review and meta-analysis.Data sourcesPubMed, Embase and the Cochrane...

Strain Imaging in the Evaluation of Thyroid Nodules: The Associated Factors Leading to Misdiagnosis.

This study analyzed which imaging characteristics may contribute to misdiagnosis of benign and malignant thyroid nodules (TNs) through strain imaging (SI). We analyzed SI parameters and conventional ultrasound (CUS) characteristics of 264 nodules with histopathology results and we applied binary logistic regression analysis to select independent variables for incorrect SI results. The elastography imaging (EI) score and the virtual touch tissue imaging (VTI) score of malignant TNs were remarkably higher than that in benign TNs. VTI, of which the false-positive rate (FPR), the false-negative rate (FNR), and the cutoff value were 47.6% (39/82), 17.6% (32/182) and 3.5, presented higher diagnostic performance than EI. Aspect ratio (odd ratio [OR]: 14.208) and intra-nodular calcification (OR: 20.384) were significantly associated with false-positive VTI findings, while posterior acoustic feature (OR: 30.424) was significantly associated with false-negative VTI findings. Sex (OR: 0.221) and aspect ratio (OR: 0.268) were negatively associated with false-negative EI findings. In conclusion, sex and aspect ratio significantly affect the accuracy of EI results, while aspect ratio, intra-nodular calcification and posterior acoustic features notably affect the accuracy of VTI results. These CUS features of TNs should not be ignored before explaining SI examination results.

A case of congenital diaphragmatic hernia with malrotation of gut, delayed presentation in adult

Congenital diaphragmatic hernia (CDH), which mainly occurs in the new born or in childhood with severe respiratory distress and is associated with high mortality, is rarely found in adult. Pulmonary hypoplasia and pulmonary hypertension contribute to the high mortality and morbidity due to CDH. These patients adjust their lifestyle to manage symptoms associated with frank herniation of the large bowel, omentum, and other viscera inside the diaphragmatic hernia. We report a 25-year-old male who presented with shortness of breath on exertion diagnosed as having CDH. The disease was detected using chest X-ray (CXR) and was confirmed on contrast enhanced CT scan. A defect was noted in the posterolateral right diaphragm with omentum, small bowel, caecum, appendix, and colon herniating through it with malrotation (incomplete rotation) of gut. CT scan and CXR were the two useful methods in diagnosis of CDH in this patient, but sometimes becomes challenging because of rare incidence and types prior to surgery. For better outcome of CDH patients long term follow up and more investigations are needed. In some cases, where conventional CT scan and ultrasonography fails to diagnose a case of CDH & malrotation of gut, diagnostic laparoscopy plays a key role in facing such situations. Keywords: diaphragmatic hernia; malrotation of gut

Cilengitide Inhibits Neovascularization in a Rabbit Abdominal Aortic Plaque Model by Impairing the VEGF Signaling.

Background Cilengitide is a selective αvβ3 and αvβ5 integrin inhibitor. We sought to investigate the effect of cilengitide on the neovascularization of abdominal aortic plaques in rabbits and explore its underlying antiangiogenic mechanism on human umbilical vein endothelial cells (HUVECs). Materials and Methods For the in vivo experiment, the abdominal aortic plaque model of rabbits was established and injected with different doses of cilengitide or saline for 14 consecutive days. Conventional ultrasound (CUS) and contrast-enhanced ultrasound (CEUS) were applied to measure the vascular structure and blood flow parameters. CD31 immunofluorescence staining was performed for examining neovascularization. Relative expressions of vascular endothelial growth factor (VEGF) and integrin of the plaque were determined. For in vitro experiments, HUVECs were tested for proliferation, migration, apoptosis, and tube formation in the presence of different doses of cilengitide. Relative expressions of VEGF, integrin, and Ras/ERK/AKT signaling pathways were determined for the exploration of underlying mechanism. Results CEUS showed modestly increased size and eccentricity index (EI) of plaques in the control group. Different degrees of reduced size and EI of plaques were observed in two cilengitide treatment groups. The expressions of VEGF and integrin in the plaque were inhibited after 14 days of cilengitide treatment. The neovascularization and apoptosis of the abdominal aorta were also significantly alleviated by cilengitide treatment. For in vitro experiments, cilengitide treatment was found to inhibit the proliferation, migration, and tube formation of HUVECs. However, cilengitide did not induce the apoptosis of HUVECs. A higher dose of cilengitide inhibited the mRNA expression of VEGF-A, β3, and β5, but not αV. Lastly, cilengitide treatment significantly inhibited the Ras/ERK/AKT pathway in the HUVECs. Conclusions. This study showed that cilengitide effectively inhibited the growth of plaque size by inhibiting the angiogenesis of the abdominal aortic plaques and blocking the VEGF-mediated angiogenic effect on HUVECs.

Single-Sided Ultrasound Imaging of the Bone Cortex: Anatomy, Tissue Characterization and Blood Flow.

In this chapter, we first review the reasons why conventional ultrasonography fails to image the interior of bones. Next we show our recent work on imaging a cortical bone layer with ultrasound. Revealing the shape of the cortex of a bone, in particular its thickness, is of interest for evaluating bone strength. In addition we describe how the process of reconstructing a truthful image of the bone cortex includes the estimation of ultrasound wave-speed in cortical bone tissue. Cortical bone exhibits elastic anisotropy, which causes anisotropy of ultrasound wave-speed as well. Therefore a faithful and high-quality picture of the bone cortex is obtained if wave-speed anisotropy is taken into account during image reconstruction. Capitalizing on prior knowledge on the elastic anisotropy of cortical bone, a procedure for estimating wave-speed and its anisotropy is described. It is based on the measurement of a head-wave velocity and an autofocus approach. The latter relies on the fact that the reconstructed ultrasound image shows optimal quality if the wave-speed model is correct. In order to achieve real-time imaging of a bone cortex, image reconstruction is performed with a delay-and-sum algorithm. Finally, we report recent advances in the measurement of blood flow in cortical bone.

Qualitative Diagnosis of Liver Tumors Based on Ultrasound-Guided Automatic Biopsy.

The goal of this study was to see if automatic biopsy guided by ultrasound could be used to provide a qualitative diagnosis of a liver tumor. Methods. A total of 40 patients (101 focuses) were treated with automatic liver parenchyma biopsy under ultrasound guidance, and the correlation between pathological outcomes and ultrasound images was investigated. The lesion size in the observation group was compared to that in the control group using conventional ultrasound (P > 0.05), and there was no significant difference. Under contrast-enhanced ultrasound (CEUS), there was no statistically significant difference in lesion size between the observation and control groups (P > 0.05). The difference in lesion size between the conventional ultrasonography and CEUS observation groups was statistically significant (P 0.05). Conclusion. Ultrasound-guided automated biopsy of the liver parenchyma is a simple and effective procedure with fewer problems and a high diagnostic rate, and it deserves to be promoted clinically.

Detection and Characterization of Sentinel Lymph Node by Ultrasound Molecular Imaging with B7-H3-Targeted Microbubbles in Orthotopic Breast Cancer Model in Mice.

Accurate identification and assessment of sentinel lymph node (SLN) using noninvasive imaging methods can play a vital role in tumor staging, surgical planning, and prognostic evaluation. In this study, we assessed the efficacy of B7-H3-targeted molecular-ultrasound imaging for the early SLN detection, and characterization in a mouse model of orthotopic breast cancer. We established a mouse breast cancer model with lymph node metastasis by injecting MAD-MB 231 cells which were engineered to express firefly luciferase reporter gene into the fat pad of the right 4th mammary gland in female BALB/c nude mice. The sole lymph node (LN) close to the tumor was regarded as the SLN for imaging investigation, which included metastatic and non-metastatic SLNs. The LN in the right 4th mammary gland from normal mice was used as normal control (normal mice LN). The commercially available preclinical streptavidin-coated, perfluorocarbon-containing lipid-shelled microbubbles (VisualSonics, Toronto, Canada) were used to generate B7-H3-targeted microbubbles (MBB7-H3) and control microbubbles (MBControl). Then, ultrasound molecular imaging (USMI) was performed using a high-resolution transducer (MS250; center frequency, 21MHz; Vevo 2100; VisualSonics, Toronto, Canada) after intravenous injection of microbubbles. The SLN was clearly detected and located under conventional (B-mode) and contrast-enhanced ultrasonography with microbubble injection. The metastatic SLNs showed a markedly higher signal from B7-H3-targeted microbubbles (MBB7-H3) compared to the non-metastatic SLNs and normal LNs. The metastatic SLN was further confirmed by ex vivo bioluminescence imaging and eventually verified by histological analysis. Our findings suggest the potential value of USMI using B7-H3 targeted microbubbles in breast cancer and establish an effective imaging method for the non-invasive detection and characterization of SLN.

Comparison between conventional duplex ultrasonography and the dual-gate Doppler mode for hemodynamic measurements of the carotid arteries.

PurposeThis study investigated the correlations of hemodynamic parameters measured to quantify stenosis between the gold-standard duplex ultrasonography and the dual-gate Doppler mode.MethodsPatients examined due to suspicion of carotid artery stenosis or for surveillance of known stenosis were invited to participate in this prospective single-center study. Upon acceptance, the hemodynamic characteristics of the carotid arteries were determined successively in standard duplex and dual-gate Doppler modes. The correlations between the two modes were analyzed by computing Pearson coefficients (r2) and Lin concordance coefficients (ρc). The degree of agreement between the two methods was visualized using Bland-Altman graphical representations.ResultsThe correlation between internal carotid artery peak systolic velocity measured by standard duplex ultrasonography and dual-gate Doppler mode was good (r2=0.642). The same high level of correlation was observed for the carotid ratio (r2=0.544). However, the Bland-Altman graphical representation and the Lin concordance coefficients (ρc=0.75 and ρc=0.74 for the internal carotid artery peak systolic velocity and carotid ratio, respectively) showed that a lack of precision generated some discrepancies between the two measurement methods.ConclusionAlthough some discrepancies were observed, the hemodynamic measurements were closely correlated between the two ultrasonography modes. Therefore, the dual-gate Doppler mode may have obvious advantages over conventional ultrasonography, offering interesting development possibilities.

Value of contrast-enhanced ultrasound combined with percutaneous ultrasound-guided fine-needle aspiration in the diagnosis of solid pancreatic lesions.

Background:Contrast-enhanced ultrasound (CEUS) can detect lesions hidden in inflammatory regions and find necrosis or areas of severe fibrosis within the lesion. This retrospective study aimed to compare the diagnostic accuracy of solid pancreatic lesions using percutaneous ultrasound (US)-guided fine-needle aspiration (FNA) with or without CEUS assessment.Methods:Clinical, imaging, and pathologic data of 181 patients from January 2014 to December 2018 in Pecking Union Medical College Hospital, with solid pancreatic masses who underwent percutaneous US-FNA and ThinPrep cytologic test were retrospectively evaluated. Patients were divided into CEUS and US groups according to whether CEUS was performed before the biopsy. According to FNA cytology diagnoses, we combined non-diagnostic, neoplastic, and negative cases into a negative category. The positive category included malignant, suspicious, and atypical cases. The final diagnosis was confirmed by pathology or clinical and radiological follow-up for at least 12 months. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of US-FNA were evaluated between the two groups.Results:This study enrolled 107 male and 74 female patients (average age: 60 years). There were 58 cases in the US group and 123 cases in the CEUS group. No statistically significant differences in age, gender, or lesion size were found between the two groups. The diagnostic accuracy of the CEUS group was 95.1% (117/123), which was higher than the 86.2% (50/58) observed in the US group (P = 0.036). The sensitivity, specificity, PPV, and NPV of the CEUS group were increased by 7.5%, 16.7%, 3.4%, and 18.8%, respectively, compared with the US group. However, the differences of the two groups were not statistically significant.Conclusions:Compared with the conventional US, the use of CEUS could improve the biopsy accuracy and avoid the need for a repeat biopsy, especially for some complicated FNA cases.

Clinical Value of Shear Wave Elastography Color Scores in Classifying Thyroid Nodules.

ObjectiveTo evaluate the clinical value of qualitative shear wave elastography (SWE) color in the differential diagnosis of benign and malignant thyroid nodules.MethodsFrom January 2017 to July 2018, 241 patients with 261 thyroid nodules, who underwent conventional ultrasonography and SWE examination before surgical resection, were enrolled. The nodules were also evaluated by histopathologic analyses. The SWE color characteristics that could differentiate malignant and benign thyroid nodules were selected and scored based on the malignancy rate. The diagnostic performances were evaluated by receiver operating characteristic (ROC) curves analysis.ResultsAmong the 261 thyroid nodules, 58 were benign, and 203 were malignant. Malignancy was associated with orange or red as the color of maximum hardness inside a nodule, green as the primary color, with a “stiff rim,” inhomogeneous internal color, and inhomogeneous color between the nodules and its surrounding areas. The SWE color scores for benign thyroid nodules were mainly 0 and 1, while 4 and 5 were for malignant thyroid nodules. The area under the ROC curve (AUC) of the SWE color score ≥3 for the diagnosis of malignant thyroid nodules was 0.828 (95% CI: 0.764, 0.891) with a sensitivity of 82.8%, a specificity of 82.8%, and an accuracy of 83.1%. Additionally, conventional ultrasound combined with SWE color scores had a higher diagnostic performance than conventional ultrasound (AUC 0.820 vs AUC 0.796, P = 0.04).ConclusionThe SWE color scores might be a convenient and effective method to assist in differentiating thyroid nodules.

Can Ultrasound Elastography Help Better Manage Mammographic BI-RADS Category 4 Breast Lesions?

BackgroundTo assess the performance of conventional ultrasound (US) combined with strain elastography (SE) in the Breast Imaging Reporting and Data System (BI-RADS) category 4 lesions on mammography. Materials and MethodsWomen with breast lesions identified as having mammography BI-RADS 4 lesions and underwent US examination were included in China. US features and US BI-RADS assessment were recorded in real-time and prospectively reported. The pathological result was referred to as the gold standard. The performance of US in the mammographic BI-RADS category 4 lesions was evaluated. Diagnostic performances of US BI-RADS, SE and combined both were compared. ResultsA total of 751 women with 751 breast lesions classified as mammographic BI-RADS category 4 were included. For mammographic findings, 530 (70.6%) were true positive and 221 (29.4%) were false positive. Conventional US achieved higher positive predictive value (PPV) than mammography (78.5% vs. 70.6%, P=.001). The specificity increased from 34.4% to 47.1% (P< .001) without any loss in sensitivity and the PPV increased to 81.9% (P = .122) when conventional US was used in combination with SE. For conventional US combined with SE, it led to a correct diagnosis of no breast cancer in 104 of the 221 false-positive findings (47.1%) and achieved higher PPV than mammography regardless of patient age and lesion size. ConclusionConventional US combined with SE is a helpful tool for the noninvasive examination of breast lesions classified as BI-RADS category 4 on mammography. It helped increase the PPV and had the potential to avoid unnecessary biopsies of BI-RADS category 4 lesions detected on mammography.

Analysis of breast cancer subtypes and their correlations with receptors and ultrasound.

The study aim was to evaluate the ultrasound (US) signs of the mammary lesions classified in the Breast Imaging-Reporting and Data System (BI-RADS) score category 3, 4, and 5, corresponding to US BI-RADS. It also followed the correlation between US changes of lesions suggestive for malignancy with the histopathological results and evaluated the proper management of those lesions. There were correlations of breast cancer (BC) subtypes with the receptors [estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2)], and Ki67 index, and the signs of conventional ultrasonography and US elastography. We selected 108 female patients examined with US, mammography and fine-needle biopsy who presented suspicions for malignancy lesions. Following the immunohistochemical analysis, they were classified in one of the BC subtypes. According to chi-squared analysis of molecular cancer subtypes correlation to receptors and Ki67 index, we found significant associations between both luminal A and luminal B HER2-negative subtypes and hormone receptors (ER, PR). These have an inverse relationship with Ki67 index elevated values; luminal B HER2-positive subtype has a direct association with HER2 presence; HER2-enriched subtype was statistically significant associated to HER2 presence and elevated Ki67 index values but had an inverse relationship to hormone receptors (ER, PR); triple-negative subtype was strongly associated to Ki67 index values and inversely correlated to ER and PR. We found luminal A subtype as being the most common and luminal B HER2-positive subtype as having the fewer cases.

238 Luteal Color Doppler Ultrasonography for Early Pregnancy Diagnosis in Postpartum Bos Taurus Beef Cows

Abstract The objective of this study was to evaluate the use of corpus luteum (CL) color doppler ultrasonography (CD) for early pregnancy diagnosis in Bos taurus beef cows and evaluate differences in CL blood perfusion among cows that experience late embryonic/early fetal mortality (LEM). Postpartum Bos taurus beef cows (n = 214) from three locations were exposed to a 7-d CO-Synch + CIDR protocol followed by fixed-time artificial insemination (day 0). On days 20 and 22, B-mode and CD ultrasonography were performed to evaluate CL morphometries and blood perfusion, respectively. Cows were considered non-pregnant when CL area was &amp;lt; 20 mm2 or estimated blood perfusion was ≤ 25%. Conventional ultrasonography on day 29 was utilized as the gold standard method. Pregnant cows had greater CL diameter, CL area, and CL volume when compared to non-pregnant cows on day 20 and 22 (P &amp;lt; 0.001; Table 1). Additionally, percentage of central, peripheral, and total luteal blood perfusion, as well as the respective blood perfusion scores were greater (P &amp;lt; 0.001) in pregnant compared with non-pregnant cows on both day 20 and 22. Sensitivity, specificity, positive predicted value (PPV), negative predicted value (NPV), and accuracy for the CD on day 20 were 100, 74, 81, 100, and 88%, respectively. Sensitivity, specificity, PPV, NPV, and accuracy for CD on day 22 were 100, 86, 89, 100, and 93%, respectively. Pairwise comparison of receiver operating characteristics curve analysis indicated no differences between CD on days 20 and 22 (P = 0.12). No differences in luteal blood perfusion were observed on day 20 or 22 among cows that maintained pregnancies compared with LEM cows (P ≥ 0.27). In conclusion, CD successfully detected most non-pregnant cows (81 and 89% on day 20 and 22, respectively) and false negative results were absent (NPV = 100%).

Logistic regression analysis of contrast-enhanced ultrasound and conventional ultrasound of follicular thyroid carcinoma and follicular adenoma.

Follicular thyroid carcinoma (FTC) is prone to recurrence and hematogenous metastasis, preoperative accurate diagnosis is still needed to help clinicians select the best surgical methods to improve the prognosis of patients. The aim of this study was to find specific conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS) characteristics of FTC and to explore their diagnostic value in the differential diagnosis between FTC and follicular adenoma (FA). This retrospective study included 258 thyroid follicular neoplasms (172 FAs and 86 FTCs) in 244 consecutive patients who underwent preoperative conventional US, and 72 of them underwent both conventional US and CEUS. Sonograms were reviewed in consensus by two experienced radiologists for various conventional US and CEUS features. Multivariate logistic regression analysis was performed to determine independent risk factors for FTC. Independent risk factors of conventional US for FTC were heterogenicity (OR =7.477, 95% CI: 2.848-19.629), unevenly thick halo (OR =5.643, 95% CI: 3.234-9.848) and calcifications (OR =1.748, 95% CI: 1.098-2.783). While independent risk factors determined with the combination of CEUS and conventional US were unevenly thick halo (OR =5.770, 95% CI: 1.310-25.409) and absent or irregular rim enhancement (OR =27.000, 95% CI: 2.445-298.178). The area under the receiver operating characteristic curve of the final two logistic regression models was 0.835 and 0.838. Conventional US is an efficient diagnostic tool in the differential diagnosis of FTC and FA to help clinicians in making appropriate decisions while CEUS failed to provide additional diagnostic value in the study, thus the value of CEUS remains to be verified by further studies with larger sample sizes.

The role of Sonoelastography in characterization of solid breast lesions

Abstract Background Mammography and Sonography are the important sensitive imaging modalities available in detection of breast cancer. Sonoelastography is a relatively new imaging technique which acts as a complementary tool to improve the diagnostic ability of ultrasound for evaluating patients with breast masses. Objective To evaluate the role of sonoelastography characterization information on solid breast lesions over conventional sonography and mammography either benign or malignant lesions to reduce the number of benign biopsies performed. Methods A prospective study was carried at private centers, starting from august 2019 till december 2019. Results The study conducted on 40 patients with palpable breast lesions classified to BIRADS 3 and 4a according to conventional ultrasound and mammographic criteria. Their ages ranged from 18 to '75 years with a mean age 47.72 14.91, 22 cases (55%) had no family history of pervious breast disease, and 18 cases (45%) had family history of pervious breast disease. All patients were subjected to full history taking, clinical examination, conventional gray scale ultrasound, and mammography and ultrasound elastography. All patients underwent histopathological assessment to reach the final diagnosis. Among Studied cases , 28 lesions were sampled by fine needle biopsy (70%) and 12 lesions were sampled by true cut needle (30%) .the results revealed 27 breast lesions were benign (67.5%), 9 malignant lesions (22.5%) and 4 lesions shows atypia (10%) according to histopathological assessment. Among final diagnosis of breast lesions fibro adenoma was the most frequent benign breast lesion detected as 12 lesions from 27 benign breast lesions were fibroadenoma., Also infiltrative ductal carcinoma was the moste frequent among malignant breast lesions as 5 lesions from 9 malignant lesions were infiltrative ductal carcinoma. Conclusion Ultrasoundelastography has significant complementray role beside conventional mammogram and ultrasound in characterization of solid breast lesions.

An ex vivo investigation of ultrasonic shear wave imaging for detecting liver cracks

Liver crack is a type of liver trauma in which a capsular tear of different geometries occurs due to external impacts. Since liver crack is an important source of morbidity and mortality in emergency medicine, a timely and accurate detection of the crack location and geometry is highly demanded. In current emergency care, ultrasonography, although has a low accuracy, is mostly used for initial examination of liver trauma due to its immediate availability, high mobility, and nonionizing nature. To improve the diagnosis accuracy, ultrasonic shear wave imaging, a technique based on shear wave generation and tracking in liver tissue, was proposed. In this study, the feasibility and effectiveness of this method was investigated in an ex vivo scenario. A porcine liver with cracks of different geometries was tested. Shear waves were generated using acoustic radiation force impulse and recorded using ultrafast ultrasound imaging. To find the best way to display the cracks, different methods of signal processing based on time-of-flight, shear wave modulus, and accumulated shear wave path were applied to the shear wave displacement extracted. The results show that shear wave imaging is a more sensitive method than the conventional ultrasonography in detecting liver cracks.

Diagnostic role of contrast-enhanced ultrasonography versus conventional B-mode ultrasonography in cirrhotic patients with early hepatocellular carcinoma: a retrospective study.

Early diagnosis of hepatocellular carcinoma (HCC) is very important for the prognosis of patients. However, there are very few studies that compared the diagnostic accuracy of contrast-enhanced ultrasonography (CEUS) and B-mode ultrasonography for early HCC in cirrhotic patients. This retrospective study included cirrhotic patients, who were suspected of early HCC between January 2020 and June 2021. The diagnosis of patients was based on the pathology results of surgery or biopsy. Demographic and clinical characteristics of included patients were recorded. The diagnoses of suspected lesions using both types of ultrasonography were recorded, and the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of early HCC in cirrhotic patients were calculated. Eventually, 137 patients with solitary lesions in the liver were included in this study, including 89 patients diagnosed with HCC and 48 patients diagnosed with non-HCC. The median diameter of suspected lesions was 26 mm, and the median level of alpha fetoprotein (AFP) was 37.2 ng/mL. When comparing the demographic and clinical characteristics of cirrhotic patients with HCC and non-HCC, it was found that patients with HCC had significantly higher levels of AFP than those with non-HCC (P=0.03). The sensitivity, specificity, PPV, NPV, and accuracy of CEUS in early HCC were 73%, 93.8%, 95.6%, 65.2% and 80.3%, respectively. In CEUS, all of these parameters were much higher than those in B-mode ultrasonography, i.e., 64%, 75%, 82.6%, 52.9%, and 67.9%. It was also found that the diagnostic accuracy of CEUS was much higher than that of B-mode ultrasonography especially regarding lesions <20 mm. To further improve the sensitivity of CEUS in early HCC, AFP was combined with CEUS for the diagnosis of early HCC. As a result, the sensitivity, specificity, PPV, NPV, and accuracy of CEUS combined with AFP level were 83.1%, 87.5%, 92.5%, 73.7%, and 84.7%, respectively. Our study confirmed that CEUS' diagnostic accuracy for early HCC in cirrhotic patients was significantly higher than that of B-mode ultrasonography. However, the sensitivity of CEUS needs to be improved further, and the combination of CEUS and AFP level may be a potential solution.

A Narrative Review of Ultrasound Technologies for the Prediction of Neoadjuvant Chemotherapy Response in Breast Cancer.

The incidence and mortality rate of breast cancer (BC) in women currently ranks first worldwide, and neoadjuvant chemotherapy (NAC) is widely used in patients with BC. A variety of imaging assessment methods have been used to predict and evaluate the response to NAC. Ultrasound (US) has many advantages, such as being inexpensive and offering a convenient modality for follow-up detection without radiation emission. Although conventional grayscale US is typically used to predict the response to NAC, this approach is limited in its ability to distinguish viable tumor tissue from fibrotic scar tissue. Contrast-enhanced ultrasound (CEUS) combined with a time-intensity curve (TIC) not only provides information on blood perfusion but also reveals a variety of quantitative parameters; elastography has the potential capacity to predict NAC efficiency by evaluating tissue stiffness. Both CEUS and elastography can greatly improve the accuracy of predicting NAC responses. Other US techniques, including three-dimensional (3D) techniques, quantitative ultrasound (QUS) and US-guided near-infrared (NIR) diffuse optical tomography (DOT) systems, also have advantages in assessing NAC response. This paper reviews the different US technologies used for predicting NAC response in BC patients based on the previous literature.

Endoscopic Ultrasound versus Conventional Ultrasonography as A Diagnostic Tool for Patients with Obstructive Jaundice

Abstract Background Patient presented with jaundice, initial evaluation should be ultrasonography for evaluation of liver parenchymal changes, cirrhosis and assessment of hepatic vascularity and evaluation of intrahepatic, extrahepatic biliary system. Aim of the Work to compare between the Conventional US and Endoscopic Ultrasound in diagnosis of obstructive jaundice and other diagnostic modality including CT/MRI, ERCP for diagnosis and evaluation of the cause of OJ. Patients and Methods This study was conducted on 60 patients with obstructed jaundice as evident by ultrasonography in the form of dilated CBD with IHBRDs, with visualization of Gall bladder content and pancreas if can be well visualized, all patients had clinically apparent jaundice with disturbance of liver biochemical profile, all patient underwent EUS and compare finding with US including CBD diameter and IHBRDs degree. Results EUS provide better visualization of CBD and IHBRDs with diagnosis of pathological lesion including stones, malignancy. EUS also has better visualization of pancreatic pathology including inflammation and malignancy and extent of the tumor including local extent, lymphatic spread with vascular invasion. Conclusion EUS is better than US and other modality CT&amp;MRI and ERCP in diagnosis of distal CBD stricture including malignant obstruction especially in cases of early malignancy and small tumors, and calculary distal obstruction. CT is insensitive in diagnosis of periampullary cancer, EUS provide early diagnosis of Pancreaticobiliary malignancy and give better advandage for early resectability .