Conventional Ultrasonography Research Articles

Imaging surveillance for the detection of ipsilateral local tumor recurrence in patients who underwent oncoplastic breast-conserving surgery with acellular dermal matrix: abbreviated MRI versus conventional mammography and ultrasonography

BackgroundTo evaluate the usefulness of surveillance-abbreviated magnetic resonance imaging (AB-MRI) for the detection of ipsilateral local tumor recurrence (LTR) in patients who underwent oncoplastic breast-conserving surgery (BCS) with acellular dermal matrix (ADM) by comparing its diagnostic performance with that of mammography (MG) and ultrasonography (US).MethodsThe postoperative MG, US, and AB-MRI findings of the ipsilateral breast and pathological results of 324 patients who underwent oncoplastic BCS using ADM were reviewed. The cancer detection rate (CDR), sensitivity, specificity, positive predictive value (PPV) for biopsy, accuracy, and area under the curve (AUC) for each imaging modality were calculated.ResultsA total of 8 ipsilateral LTRs were diagnosed, and most cancers (87.5%) were stage 0 or 1 (median size of invasive cancer, 1.44 cm; range, 0.7–2 cm). The CDRs of MG, US, MG + US, and AB-MRI were 0.009, 0.012, 0.015, and 0.025 per woman, respectively. Three cancers were detectable on only AB-MRI, and the additional CDR of AB-MRI was 0.010. The sensitivity and specificity of MG, US, MG + US, and AB-MRI were 37.5%, 50%, 62.5%, and 100% and 99.7%, 98.4%, 98.1%, and 97.8%, respectively. The PPVs for biopsy were 75%, 44.4%, 45.5%, and 53.3%, respectively. The AUC was significantly higher for AB-MRI (0.989) than for MG alone (0.686, P = 0.0009), US alone (0.742, P = 0.009), and MG + US (0.803, P = 0.04). A total of 66.7% of cancers visible on only AB-MRI were located at the deep posterior portion of the excision cavity, which might have been missed with MG or MG + US due to masking by the ADM filler.ConclusionAB-MRI can improve the detection of ipsilateral LTR despite postoperative changes caused by ADM fillers compared to conventional MG and US. Patients who undergo BCS with ADM can be candidates for AB-MRI surveillance considering improved cancer detection and high sensitivity.

Clinical Value of Three Combined Ultrasonography Modalities in Predicting the Risk of Metastasis to Axillary Lymph Nodes in Breast Invasive Ductal Carcinoma.

ObjectiveThe present study aimed to assess the clinical value of conventional ultrasound (C-US), ultrasound elastography (UE), percutaneous contrast-enhanced ultrasound (P-CUES), and the combination of these three ultrasonography modalities for evaluating the risk of axillary lymph node (ALN) metastasis in breast invasive ductal carcinoma (IDC).MethodsThis retrospective analysis included 120 patients with pathologically confirmed IDC who underwent sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND). Based on the gold standard of postoperative pathology, ALN pathology results were evaluated and compared with findings obtained using C-US, UE, P-CUES, and the three modalities combined.Results(1) There was a statistically significant difference between the histological grade of the tumor and the pathological condition of ALNs. (2) The difference between C-US parameters and UE score were statistically significant. The accuracy of P-CEUS localization of SLNs was 100% (96/96) when compared with localization guided by methylene blue. The difference in the distribution of the four SLN enhancement patterns was statistically significant. (3) The sensitivity, specificity, positive predictive value, and negative predictive value of C-US and UE were 75%, 71%, 58%, and 89%, and 71%, 72%, 50%, and 86%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of P-CUES were 91%, 82%, 78%, 92%, respectively. When all three modalities were combined, the sensitivity, specificity, positive predictive value, and negative predictive value were 94%, 89%, 86%, and 95%, respectively. In the detection of ALN metastasis, there was a good correlation between histopathological results and evaluations based on the three combined ultrasonography modalities (kappa: 0.82, p<0.001).ConclusionsWhen compared to C-US, UE, or P-CEUS alone, the combination of the three ultrasonography modalities was found to be superior in distinguishing metastatic and non-metastatic ALNs. This combined strategy may aid physicians in determining the most appropriate approach to ALN surgery as well as the prognosis of breast IDC.

Contrast-enhanced ultrasound as a valuable imaging modality for characterizing testicular lesions.

Contrast-enhanced ultrasound (CEUS) is a new form of ultrasound (US) that can dynamically display microvessels in a highly sensitive manner. The purpose of this study was to investigate the efficacy of CEUS for characterizing testicular lesions in comparison with conventional US. Forty-seven patients with testicular lesions were enrolled. The histopathology results revealed that 31 cases were neoplastic (11 cases of seminomas, 8 nonseminomatous germ cell tumors, 8 lymphomas, 2 Leydig cell tumors, and 2 nonspecific tumors), and 16 cases were nonneoplastic (8 cases of infarctions, 3 epidermoid cysts, and 5 inflammation). The indicators of shallow lobulated morphology and cystic-solid echogenicity on conventional US were suggestive of germ cell tumors. More indicators on CEUS were found to be useful for characterizing testicular lesions. All the neoplastic lesions showed hyperenhancement on CEUS. Moreover, germ cell tumors presented with heterogeneous enhancement (73.7%, 14/19), a twisted blood vessel pattern, rapid wash-in and wash-out, and peripheral rim hyperenhancement signs. Lymphoma was characterized by nonbranching linear vessel patterns (87.5%, 7/8), rapid wash-in and slow wash-out. In nonneoplastic lesions, infarction and epidermoid cysts showed no enhancement, and abscesses were observed with marginal irregular enhancement. The sensitivity, specificity, and accuracy of CEUS for differentiating between neoplastic and nonneoplastic lesions were 100%, 93.8%, and 97.9%, respectively, and these values were higher than those for conventional US (90.3%, 62.5%, and 80.9%, respectively). CEUS can sensitively reflect the microvascular perfusion in testicular lesions and offers high accuracy for characterizing them.

Assessment of hepatic involvement by two-dimensional shear wave elastography in paediatric patients with cystic fibrosis.

This study aimed to investigate parenchymal changes in the liver in paediatric patients with cystic fibrosis (CF) and to analyse diagnostic performance of two-dimensional shear wave elastography (2D-SWE) for the detection of hepatic involvement. Patients with CF treated and followed at our centre were evaluated prospectively. All patients underwent liver tissue stiffness (TS) measurements by 2D-SWE, in addition to routine clinical assessments, laboratory work-up and abdominal ultrasound imaging. Data from patients with CF were compared with healthy control subjects. This study included 39 patients with CF and 37 healthy controls. Patients had a mean body weight of 29.9 (16.6-55) kg, mean age of 9 (5-17) years, mean height of 130 (107-172) cm and a mean body mass index of 16.1 (12.8-21.4) kg/m2 . Average SWE values of the liver were 1.02 (0.70-1.60) m/s in patients with CF (n=39) and 0.89 (0.60-1.35) m/s in healthy controls (n=37). Cystic fibrosis patients had significantly increased tissue stifness by liver elastography compared to controls (P=0.005). Parenchymal liver changes may occur early in cystic fibrosis, which cannot be detected by conventional ultrasonography but may be demonstrated by 2D-SWE. Based on this cross-sectional study, 2D-SWE may be a promising, simple and non-invasive modality for objective monitoring of patients with cystic fibrosis who require lifelong follow-up, by providing numerical data for tissue stiffness early in the disease.

Value of shear wave elastography combined with the Toronto clinical scoring system in diagnosis of diabetic peripheral neuropathy.

To evaluate the diagnostic values of shear wave elastography (SWE) alone and in combination with the Toronto clinical scoring system (TCSS) on diabetic peripheral neuropathy (DPN) in patients with type 2 diabetes mellitus (T2DM).The study included 41 DPN patients, 42 non-DPN patients, and 21 healthy volunteers. Conventional ultrasonography and SWE were performed on the 2 sides of the tibial nerves, and cross-sectional area (CSA) and nerve stiffness were measured. TCSS was applied to all patients. A receiver operating characteristic curve analysis was performed.The stiffness of the tibial nerve, as measured as mean, minimum or maximum elasticity, was significantly higher in patients in the DPN group than the other groups (P < .05). The tibial nerve of subjects in the non-DPN group was significantly stiffer compared to the control group (P < .05). There was no significant difference of the tibial nerve CSA among the 3 groups (P > .05). Mean elasticity of the tibial nerve with a cutoff of 71.3 kPa was the most sensitive (68.3%) and had a higher area under the curve (0.712; 0.602–0.806) among the 3 shear elasticity indices for diagnosing DPN when used alone. When combining SWE with TCSS in diagnosing DPN, the most effective parameter was the EMax, which yielded a sensitivity of 100.00% and a specificity of 95.24%.SWE is a better diagnostic tool for DPN than the conventional ultrasonic parameter CSA, and a higher diagnostic value is attained when combining SWE with TCSS.

Added Value of Superb Microvascular Imaging and Virtual Touch Imaging Quantification in Assisting Thyroid Cancer Classification

This prospective study determined the value added by superb microvascular imaging (SMI) and Virtual Touch imaging quantification (VTIQ) to conventional ultrasonography in classifying malignant and benign thyroid nodules. One hundred eighty-three thyroid nodules (TNs) in 120 patients (112 benign and 71 malignant TNs) were evaluated. SMI revealed noticeable variance between benign and malignant TNs (p < 0.001). Malignant nodules tended to have rich vascularity (grade 3: 38/71, 53.5%) compared with benign nodules (grade 3: 33/112, 29.5%). There is a statistically significant difference between malignant and benign TNs with respect to shear-wave speed (SWS) values (all p values <0.001). The SWS mean, maximum and ratio of malignant nodules were 3.97 ± 1.34, 4.79 ± 1.70 and 1.25 ± 0.39, respectively. The SWS mean, maximum and ratio of benign nodules were 2.65 ± 0.42, 2.97 ± 0.46 and 1.15 ± 0.35, respectively. With respect to area under the curve values, the combined use of SMI or VTIQ improved the diagnostic performance of classifying malignant and benign TNs compared with that of ultrasonography alone. The combination of three modalities achieved the greatest area under the curve values (0.9811, 95% confidence interval: 0.95529–1.000), followed by US + VTIQ (0.9747, 0.94543–1.000), US + SMI (0.9032, 0.85345–0.95391) and ultrasonography (0.8291, 0.76417–0.89403).

MP38-03 XPERT BLADDER CANCER MONITOR AND NARROW BAND IMAGING IN ROUTINE FOLLOW UP OF PATIENTS WITH NON-MUSCLE INVASIVE BLADDER CANCER

You have accessJournal of UrologyBladder Cancer: Epidemiology & Evaluation I (MP38)1 Sep 2021MP38-03 XPERT BLADDER CANCER MONITOR AND NARROW BAND IMAGING IN ROUTINE FOLLOW UP OF PATIENTS WITH NON-MUSCLE INVASIVE BLADDER CANCER Lukas Hefermehl, Venkat Ramakrishnan, Andreas Schoetzau, Uwe Rogel, Daniel Disteldorf, Philipp Maletzki, Marc Hofmann, Jean-Pascal Adank, Kurt Lehmann, and Gad Singer Lukas HefermehlLukas Hefermehl More articles by this author , Venkat RamakrishnanVenkat Ramakrishnan More articles by this author , Andreas SchoetzauAndreas Schoetzau More articles by this author , Uwe RogelUwe Rogel More articles by this author , Daniel DisteldorfDaniel Disteldorf More articles by this author , Philipp MaletzkiPhilipp Maletzki More articles by this author , Marc HofmannMarc Hofmann More articles by this author , Jean-Pascal AdankJean-Pascal Adank More articles by this author , Kurt LehmannKurt Lehmann More articles by this author , and Gad SingerGad Singer More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002053.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Continuous follow-up after the treatment of non-muscle invasive bladder cancer (NMIBC) is mandatory for early recurrence detection. This study investigates the clinical relevance of new diagnostic tools such as an mRNA-based urine test (Xpert© Bladder Cancer Monitor, Cepheid, USA) and Narrow Band Imaging© (NBI, Olympus) and compares them to the established follow-up methods. METHODS: This was a prospective single-center study involving patients undergoing NMIBC screening with enrollment from January 2018 to March 2020; the follow-up concluded in January 2021. Aside from performing the standard of care, including conventional white light cystoscopy (WLC), cytology, and sonography, patients also submitted urine for the XPERT© urine test and underwent NBI cystoscopy. These latter two tests were compared against WLC and the anatomic pathology in cases of NMIBC recurrence. Follow-up data were included in cases in which (a) WLC findings were ambiguous and pathology was postponed, or (b) in instances where XPERT© yielded a positive result while WLC was negative. According to the manufacturer, the XPERT© cut-off value (COV) for a positive result was set at a linear discriminant analysis (LDA) value of 0.5. The sensitivity (SE), specificity (SP), positive an negative predictive values (PPV, NPV) and median LDA values for tumor negative and tumor positive low- (LG) and highgrade (HG) lesions were calculated. SE and SP for different XPERT© LDA thresholds were also calculated. RESULTS: 301 patients were enrolled during the study period. 49 patients demonstrated NMIBC disease recurrence. In this subset, NBI cystoscopy was congruent with WLC in all patients. Cytology harbored an SE and SP of 27% and 97% (PPV: 65%; NPV 0.87%), respectively, whereas with XPERT©, the SE and SP were 58% and 89% (PPV: 51%; NPV: 92%; AUC: 0.79 (0.76-0.871)). Assessment of higher XPERT© LDA thresholds elicited higher SE and accordingly lower SP (for e.g., when the LDA was raised to 0.76, the SE was 98% and SP was 40%; when LDA was further raised to 1.0, the SE was 99% while SP was 23%). The overall median LDA values in a tumor negative setting was 0.33 (0.17 – 0.45); in an overall tumor positive bladder, the median LDA was 0.56 (0.35 – 0.95), while LG disease exhibited an LDA of 0.38 (0.26 – 0.52) and HG disease was 0.85 (0.51 – 1.06) (p < 0.001). A subgroup analysis revealed better SE but similar SP (PPV, NPV) for HG compared to LG recurrence, where SE was 74% and SP of 89% (39%, 97%) vs. SE of 33%, and SP of 89% (21%, 94%). CONCLUSIONS: NBI cystoscopy does not necessarily offer any additional benefit to standard WLC, and WLC remains the gold standard for visualization in NMIBC surveillance. Yet, the XPERT© Bladder Cancer Monitoring platform may confer better sensitivity and a diagnostic advantage in high grade, but not low grade, disease recurrence. Source of Funding: No direct financial support. Tests were provided by Cepheid/Axonlab © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e693-e693 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Lukas Hefermehl More articles by this author Venkat Ramakrishnan More articles by this author Andreas Schoetzau More articles by this author Uwe Rogel More articles by this author Daniel Disteldorf More articles by this author Philipp Maletzki More articles by this author Marc Hofmann More articles by this author Jean-Pascal Adank More articles by this author Kurt Lehmann More articles by this author Gad Singer More articles by this author Expand All Advertisement Loading ...

Quantitative assessment of fatty liver using ultrasound attenuation imaging.

Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease, with an incidence of 20-40% worldwide, making it a major healthcare problem. Because NAFLD can progress to liver fibrosis and cirrhosis through non-alcoholic steatohepatitis, early detection and monitoring of hepatic steatosis are essential for management of NAFLD patients. Even though conventional B-mode ultrasound (US) has been widely used for the evaluation of NAFLD owing to its safety and easy accessibility, its subjective nature and limited accuracy in detecting mild steatosis are major limitations. To overcome the current limitations of conventional B-mode US, attenuation imaging (ATI) based on two-dimensional B-mode US has been developed. ATI can quantitatively assess the degree of hepatic steatosis by calculating the attenuation coefficient, which reflects the degree of US beam attenuation transmitted into the liver tissue. After the first study was published in 2019, several clinical studies using ATI to evaluate hepatic steatosis have reported promising results. In this review, the basic physics, measurement protocol, and reported diagnostic accuracy of ATI in evaluating hepatic steatosis will be discussed.

Application of conventional ultrasonography combined with contrast-enhanced ultrasonography in the axillary lymph nodes and evaluation of the efficacy of neoadjuvant chemotherapy in breast cancer patients.

Objective:Axillary lymph node status assessment has always been an important issue in clinical treatment of breast cancer. However, there has been no effective method to accurately predict the pathological complete response (pCR) of axillary lymph node after neoadjuvant chemotherapy (NAC). The objective of our study was to investigate whether conventional ultrasonography combined with contrast-enhanced ultrasonography (CEUS) can be used to evaluate axillary lymph node status of breast cancer patients after NAC.Methods:A total of 74 patients who underwent NAC were recruited for the present study. Prior to and after NAC, examinations of conventional ultrasonography and CEUS were performed. After evaluating the images of conventional ultrasonography, four characteristics were recorded: lymph node medulla boundary, cortex of lymph node, lymph node hilus, and lymph node aspect ratio. Two additional imaging characteristics of CEUS were analyzed: CEUS way and CEUS pattern. Receiver operating characteristiccurve analysis was applied to evaluate their diagnostic performance.Results:After 6~8 cycles of NAC, 46 (71.9%) patients had negative axillary lymph node, and 18 (28.1%) patients turned out non-pCR. According to statistical analysis, lymph node medulla, lymph node aspect ratio and CEUS way were independently associated with pCR of axillary lymph node after NAC. The area under the curve of the prediction model with three imaging characteristics was 0.882 (95% confidence interval: 0.608–0.958), and the accuracy to predict the patients’ lymph node status was 78.1% (p < 0.01).Conclusions:Conventional ultrasonography combined with CEUS technology can accurately predict axillary lymph nodes status of breast cancer patients after NAC.Advances in knowledge:The usefulness of CEUS technology in predicting pCR after neoadjuvant chemotherapy is highlighted.

Sonographic features of various dental materials and foreign bodies.

To reveal the sonographic characteristics of various foreign bodies and dental materials to aid diagnosis. 24 objects consisting of various dental materials and foreign bodies were included in the study. Objects were embedded in bovine gelatin. Images of the objects were obtained by conventional radiography and ultrasonography (USG). Opacities were evaluated by conventional radiography. Their visibility and posterior acoustic behaviors were examined by USG. In addition, the actual sizes of the objects and their dimensions measured by USG were compared. All objects included in the study, including non-opaque ones, could be visualized by USG. When the posterior acoustic behavior of objects was examined, 15 of the objects (62.5%) caused posterior acoustic shadowing on USG. While 6 of the objects (25%) did not have any USG artifacts, 2 of them (8,3%) had comet tail artifact and 1 of them (4,2%) had reverberation artifact. There was no statistically significant difference between the actual dimensions of the objects and their dimensions measured by USG (p > 0,05). USG is a very useful technique for imaging foreign bodies and dental materials, it can even show objects that cannot be seen in X-rays on in-vitro environment.

Intra-oral Ultrasonography of Young Adult Mandibular Foramen: A Reliable Method

Background: The inferior alveolar nerve (IAN) block is the most commonly used mandibular injection method for local anesthesia in restorative and surgical procedures. Ultrasound images can provide more accurate information about the location of the inferior alveolar neurovascular bundle. Objectives: This study aimed to evaluate the ultrasound images of patients to determine the location of the mandibular foramen (MF) relative to the adjacent landmarks. Patients and Methods: In this cross-sectional analytical study, 50 patients were subjected to intra-oral ultrasonography of the right and left sides of the mandible. An Alpinion ultrasound system (Seoul, South Korea) was used for detecting the MF, as well as its distance from different landmarks. Results: In all patients, the MF was found using color Doppler ultrasonography. The probability of detecting MF in conventional ultrasonography was estimated at 36% and 18% for the right and left sides of the mandible without using the Doppler technique, respectively. The mean MF distance from the anterior border of the ramus was 14.6 ± 2.1 and 16.1 ± 2.1 mm on the right and left sides, respectively. Also, the vertical distance of MF from the occlusal plane was 7.5 ± 1.1 mm on the right side and 8.7 ± 1.2 mm on the left side of the mandible. In all studied patients, the MF was above the occlusal plane. Conclusion: The results of this study showed that ultrasonography is not only a suitable option for intra-oral imaging due to its non-ionizing beams, but is also appropriate for localization of the MF and its related landmarks.

Sonographic Advancements in Characterization of Benign and Malignant Ovarian Masses

Background: Characterization of ovarian masses is essentially required and inevitable for optimization of clinical decision making, patient care and management. The diagnosis of ovarian masses is a frequent dilemma in clinical work. Ultrasonography remains the modality of choice in the early investigation of suspected adnexal masses because of its availability and being a safe modality. Aim: To review the current literature on different patterns of manifestation of ovarian masses on ultrasound and its various modes, helping in differential diagnosis on the basis of morphologic, vascular and other characteristics as seen on ultrasound. Methods: Electronic database was searched (PubMed, Google Scholar, Science direct) with data ranging from year 2000 to 2021. Most relevant studies, relating to sonographic appearances of ovarian masses were selected. Results: Twenty five most relevant articles were found: 8 articles were regarding gray-scale ultrasound, 3 articles regarding three dimensional ultrasonography, 2 articles regarding contrast enhanced ultrasonography, 2 regarding elastography and rest were regarding combined use of gray-scale and Doppler ultrasound including color and power Doppler ultrasonography for the assessment of ovarian masses. Our results show that conventional 2D sonography, in conjunction with latest advancements helps improving the diagnosis based on typical sonographic appearances of masses. Screening for ovarian cancer also proves to be helpful for early diagnosis and improvement in survival rate. Conclusion: Ultrasonoraphy and its different modalities such as 3DUS, CEUS, elastography along with conventional 2D and Doppler studies accurately identifies morphologic, structural and vascular featuresof the adnexal masses and differential diagnosis by escapingunnecessary surgeries and improving the survival rate. Keywords: Ultrasonography, Ovarian masses, malignant ovarian masses, contrast enhanced ultrasound,

Axillary lymph node status in BIRADS 4-5 female patients: can shear wave and strain ultrasound elastography help?

BackgroundThe status of axillary nodes is a determining factor of management and prognosis for patients having a recent diagnosis of breast cancer. Axillary nodes are usually evaluated by ultrasonography (US) and biopsy, if indicated. Ultrasound-guided sampling and intraoperative or sentinel nodal sampling are available options, however, are invasive and hold risks of potential complications, calling for reliable, non-invasive axillary imaging. In the current prospective study, we assessed the performance of shear wave (SWE) and strain (SE) ultrasound elastography regarding preoperative axillary assessment. Sixty axillary nodes from 60 patients (age 28–65 years, mean 49.88 ± 7.61 SD) were included, all scoring BIRADS 4–5 on sonomammography.ResultsFor US, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were 100%, 66.67%, 84.78%, 100%, and 88.33%, respectively. Cortical thickness and vascularity were the most sensitive. For qualitative SWE, indices were 76.92%, 80.95%, 88.24%, 65.38% and 78.33%, respectively. Calculated cut-off for Emax was 59.3 and for Eratio was 4.56, giving statistical indices of 76.9%, 90.5%, 93.75%, 67.86%, and 81.67% for Emax and 76.9%, 100%, 100%, 70% and 85% respectively for Eratio. Both Emax and Eratio were greater for malignant (Emax 81.77 ± 1.904, Eratio 8.95 ± 5.69) than for benign nodes (Emax 37.59 ± 33.37, Eratio 2.5 ± 1.37) (P values < 0.001). For qualitative SE, sensitivity and specificity were 92.31% and 57.14%, while PPV, NPV, and accuracy were 80% each (P values < 0.001). The calculated cut-off value for SR was 3.85, giving indices of 87.2%, 76.2%, 76.19%, 87.18% and 83.33% respectively.ConclusionAdding elastography evaluation to conventional US positively impacts the specificity and accuracy of the preoperative axillary nodal status assessment in patients having newly diagnosed breast cancer.

Antenatal detection of aberrant subclavian artery (ARSA) by 4D-volume contrast ?maging in mid-trimester ultrasound exam

Background and Purpose: To report a small series of ARSA (Aberrant Right Subclavian Artery) cases which were diagnosed by 4-D (Dimensional) ultrasound (Volume Contrast Imaging-A Plane) with high definition flow technique. Methods: Clinical data of total 1859 singleton, low risk pregnancies from the hospital database. Total 13 cases with isolated ARSA cases were identified. Results: Total 13 cases with isolated ARSA cases were identified. Median maternal age was 32 years old. Median gestational age at ultrasound exam was 21 weeks. Eleven of thirteen cases were isolated. Case 3 had a muscular ventricular septal defect (VSD) and case 6 had an aberrant left subclavian artery. All cases were detected by 4D VCI-A with high definition flow technique successfully. One fetus with ARSA who was misdiagnosed as normal by conventional 2-D ultrasound, 4D VCI-A with high definition flow revealed abnormal courses of the right subclavian artery. Course of azygos vein was discriminated from the ARSA in all cases. Conclusion: 4D VCI-A mode activated with HD-flow (High Definition) is a valuable tool for the investigation of outflow tracts of fetal heart and proximal branches of aorta in midtrimester scans and carries some advantages over conventional 2D sonography combined with High Definition Flow mode.

Abstract 2812: A multi-modality robotic ultrasound and bioluminescence system provides a low-cost alternative to magnetic resonance imaging for measurement of orthotopic pancreatic tumors

Abstract Solid tumor models are widely used to evaluate efficacy of novel therapeutics. Calipers, a rapid but error-prone technique that is often used to measure volume in subcutaneous models, cannot measure orthotopic tumors, which have been proven to better represent clinical disease. Bioluminescence Imaging (BLI) on the other hand, is a well-established and non-invasive technique for tumor development. Yet several of factors should be carefully considered when interpreting BLI data (signal depth attenuation, hypoxia, necrosis, D-luciferin kinetics, luciferase expression, immune response, etc.). As a result, researchers often include an anatomical modality such as magnetic resonance (MR) or ultrasound (US). MR imaging is the gold standard but suffers from long and expensive acquisitions, while conventional US is fast but requires skilled users and lacks repeatability. Here, we compare BLI tumor cell viability measurements with volume measurements from robotic US and MRI and highlight the value of tracking both anatomical and molecular readouts for therapeutic efficacy assessment. Pancreatic tumor cells (KPC 4662) were injected into the pancreas tail of 10 C57BL/6 female mice and imaged weekly with BLI, US, and MRI starting 7 days after injection. Robotic US and BLI images were acquired with a Strata (SonoVol, Inc.) system, and MRI images with the 9.4 Tesla BioSpec MR scanner (Bruker Biospin). US and MR images were digitally segmented for volume and BLI signal was quantified using SonoEQ (SonoVol, Inc.). Tumor volumes obtained via robotic US and MRI had a strong correlation (R2 = 0.95). Bland-Altman analysis showed an insignificant mean bias of 12 mm3 (p = 0.28). The limits of agreement and coefficient of variation were 130 mm3 and 26%, respectively. BLI signal was detected on the first timepoint (7d), while tumors were not resolvable anatomically until 9d. BLI signal increased rapidly for the first 2 timepoints but remained stable after that. In comparison, tumor volume increased throughout the study and so, there was a poor correlation between molecular BLI and volumetric anatomical US measurements (R2 = 0.69). This work demonstrates the importance of multimodality imaging of tumor growth. BLI signal plateaus because dead tumor cells at the core do not produce light so while BLI is a valuable and highly sensitive tool for cell viability, initial growth, and drug efficacy, limitations mentioned above may bias assessment of response to therapy. Hence, a combined BLI signal and volume readout in orthotopic models may offer a more complete picture of tumor development and treatment efficacy. Robotic US provides similar measurements of orthotopic tumors to MRI while allowing faster scan times at a reduced cost. Therefore, robotic ultrasound with integrated BLI allows for a more holistic assessment of tumor development and response to therapy. Citation Format: Juan Rojas, Jordan Joiner, Brian Velasco, Alexandra De Lille, Tomek J. Czernuszewicz, Yuliya Pylayeva-Gupta, Paul A. Dayton. A multi-modality robotic ultrasound and bioluminescence system provides a low-cost alternative to magnetic resonance imaging for measurement of orthotopic pancreatic tumors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2812.

Can contrast enhanced ultrasound (CEUS) be useful in the diagnosis of ovarian torsion in pediatric females? A preliminary monocentric experience.

To describe contrast enhanced ultrasound (CEUS) characteristics of ovarian torsion in pediatric females, assessing the potential diagnostic advantages of method as well as its limitations. A retrospective study design was used. Between January 2018 and December 2020 we analyzed all pediatric females who underwent explorative surgery with a suspected diagnosis of ovarian torsion, and who were previously evaluated by conventional ultrasound (US), color-Doppler ultrasound (CDUS) and CEUS. We examined twenty pediatric females with a median age of 12years. US identified 9/20 ovarian complex masses against 13/20 by CEUS. At US abdominal free fluid was shown in 13/20 patients and in 18/20 cases with CEUS. In our case series the evaluation of contrast enhancement at CEUS in the detection of ovarian torsions revealed a sensitivity of 94.1%, a specificity of 100% and an overall accuracy of 95%. Although there is a known ultrasound semeiotics suggestive of ovarian torsion, it is not always possible to obtain a diagnosis of certainty with conventional US even with CDUS. The study reports that complementation with CEUS showed excellent agreement with surgery obtaining a diagnosis in almost all the pediatric females examined.

Conventional ultrasound for diagnosis of hepatic steatosis is better than believed.

Hepatic steatosis is a condition frequently encountered in clinical practice, with potential progression towards fibrosis, cirrhosis, and hepatocellular carcinoma. Detection and staging of hepatic steatosis are of most importance in nonalcoholic fatty liver disease (NAFLD), a disease with a high prevalence of more than 1 billion individuals affected. Ultrasound (US) is one of the most used noninvasive imaging techniques used in the diagnosis of hepatic steatosis. Detection of hepatic steatosis with US relies on several conventional US parameters, which will be described. US is the first-choice imaging in adults at risk for hepatic steatosis. The use of some scoring systems may add additional accuracy especially in assessing the severity of hepatic steatosis. In the presented paper, we discuss screening and risk stratification, ultrasound features for diagnosing hepatic steatosis, B-mode criteria, focal fatty patterns and Doppler features of the hepatic vessels, and the value of the different US signs for the diagnosis of liver steatosis including classifying the severity of steatosis using different US scores. Limitations of conventional B-mode and Doppler features in the evaluation of hepatic steatosis are also discussed, including those in grading and assessing the complications of steatosis, namely fibrosis and nonalcoholic steatohepatitis. Ultrasound is the first-line imaging examination for the screening and follow-up of patients with liver steatosis. The use of some scoring systems may add additional accuracy in assessing the severity of steatosis. Conventional B-mode and Doppler ultrasound have limitations in grading and assessing the complications of steatosis.

Evaluation of whole axillary status with lymphatic contrast-enhanced ultrasound in patients with breast cancer.

This study aims to evaluate the whole axillary status of patients with breast cancer by lymphatic contrast-enhanced ultrasound (LCEUS). LCEUS was applied for 169 patients with suspected breast cancer. Abnormal patterns in lymphatic channels, sentinel lymph nodes (SLNs), and non-enhanced but abnormal lymph nodes were investigated. The signs of distorted, attenuated, netted, or interrupted lymphatic channels, defective-filling or no-filling SLNs, and the appearance of non-enhanced but abnormal lymph nodes were designated as features of axillary metastasis. A positive outcome was given when any of the abnormal patterns was found in the LCEUS. The diagnostic efficiencies were calculated to differentiate the axillary lymphatic status using LCEUS for the whole axilla, compared with conventional ultrasound (US) and LCEUS for SLNs. The LCEUS procedure was successfully performed for 157 breast cancer patients with axillary dissection. Compared to normal axillae, abnormal patterns had a significantly higher frequency in metastatic axillae (p = 0.000). Using conventional US to evaluate the whole axillae, the diagnostic sensitivity, specificity, and accuracy were 69.1%, 71.9%, and 70.7%, respectively. When LCEUS was used for SLN evaluation to predict the whole axilla, the diagnostic sensitivity, specificity, and accuracy were 66.2%, 89.9%, and 79.6%, respectively. When LCEUS was used as the whole axillary evaluation method, the diagnostic sensitivity, specificity, and accuracy were 76.5%, 86.5%, and 82.2%, respectively. LCEUS can be an accurate method to observe the whole axillae in breast cancer patients. Lymphatic channels, SLNs, and non-enhanced but abnormal lymph nodes constitute the LCEUS for whole axillary evaluation. • LCEUS can be an accurate method to observe the whole axillae in breast cancer patients. • Three aspects in the LCEUS for whole axillary evaluation are the lymphatic channels, sentinel lymph nodes (SLNs), and non-enhanced but abnormal lymph nodes. • Signs of distorted, attenuated, netted, or interrupted lymphatic channels, defective-filling or no-filling SLNs, and the appearance of non-enhanced but abnormal lymph nodes were considered as features of axillary metastasis.

Contrast-Enhanced Ultrasound Imaging Features of Focal Splenic Tuberculosis.

BackgroundThe aim of this study was to characterize the contrast-enhanced ultrasound imaging features of focal splenic tuberculosis.Material/MethodsWe retrospectively analyzed the conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS) imaging features of 22 patients with splenic TB confirmed by surgical histopathology or biopsy.ResultsConventional US demonstrated that 15 of the 22 patients had a single lesion, while 7 had multiple lesions. The maximum diameter of the lesions ranged from 1.0 to 3.7 cm. Of the 22, 17 were detected with hypoecho and 5 were detected with complex echo by conventional US. Seven (7/22) were detected with blood flow signals by color Doppler flow image (CDFI). CUES demonstrated that 18 cases (81.8%, 18/22) began to enhance in the arterial phase, mostly followed by slow wash-out in the intermediate or late parenchymal phase, and 4 (18.2%, 4/22) presented with non-enhancement during all phases. The enhancement patterns were categorized into 4 types: Type I, homogeneous enhancement (2/22); Type II, rim-like enhancement (12/22); Type III, septation-like enhancement (4/22); and Type IV, non-enhancement (4/22).ConclusionsCEUS showed that splenic TB lesions were enhanced in the arterial phase, followed by slow washed out or persistent enhancement in the intermediate and late parenchymal phases. The rim- or septation-like enhancement may be helpful for diagnosing splenic TB. The splenic lesions presenting round hypoecho by conventional US and complete non-enhancement by CEUS are highly suspicious of splenic TB.

Value of Conventional Ultrasonography with Contrast-Enhanced Ultrasonography in the Differential Diagnosis of Partial Cystic Thyroid Nodules

The value of contrast-enhanced ultrasonography (CEUS) in the diagnosis of malignant partial cystic thyroid nodules (PCTNs) remains unclear. Thus, in the present study, the data of patients with pathologically proven PCTNs who underwent CEUS in the Chinese PLA General Hospital from January 2016 to February 2019 were retrospectively reviewed, and the imaging characteristics of benign and malignant PCTNs were compared. A total of 177 PCTNs were enrolled in this study, including 58 (32.7%) malignant nodules and 119 (67.2%) benign nodules. Six characteristics significantly differed between malignant PCTNs and benign PCTNs in univariate comparison: position of the solid portion (χ2 = 17.937, p < 0.001), microcalcifications (χ2 = 81.382, p < 0.001), boundaries (χ2 = 45.486, p < 0.001), echogenicity (χ2 = 11.152, p = 0.004), intensity of enhancement (χ2 = 40.656, p < 0.001) and uniformity of enhancement (χ2 = 19.933, p < 0.001). Among these, microcalcifications, boundaries, position of the solid portion, and uniformity of enhancement were independent risk factors in the multivariate comparison. A logistic regression model for predicting benign and malignant PCTNs was established with a sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 89.0% (95% confidence interval [CI]: 0.788–0.961), 91.0% (95% CI: 0.830–0.946), 81.0% (95% CI: 0.715–0.881), 95.0% (95% CI: 0.892–0.974) and 90.0% (95% CI: 0.844–0.938), respectively. The area under the receiver operating characteristic curve was 0.967 (95% CI: 0.944–0.990), which was significantly higher than that of conventional ultrasound only (0.747, 95% CI: 0.663–0.831, Z = 2.090, p = 0.0366). CEUS can be used in the diagnosis of PCTNs, and the four characteristics of malignant PCTNs proven by our study were microcalcifications, unclear boundaries, eccentric distributions of the solid parts and heterogeneous enhancement.