Conventional Ultrasonography Research Articles

Shear wave elastography versus strain elastography to identify benign superficial lymph nodes: sonographic assessment with histopathological confirmation

BackgroundDifferentiation between benign and malignant superficial lymph nodes (LNs) presents clinical dilemma. No specific criteria are established with conventional ultrasound to make a distinction. We aimed to study the added value of shear wave velocity (SWV) measurement with acoustic radiation force impulse (ARFI) and strain elastography (SE) to identify benign superficial LNs. The study included 115 superficial LNs subjected to conventional ultrasonography, 4-scale strain elastography and shear wave velocity measurement using ARFI. Histopathological analysis was obtained for all examined nodes.ResultsSE correctly diagnosed 89.3% of the reactive and 92.2% of the metastatic LNs and erroneously diagnosed 72.7% of the lymphoma LNs as being benign. Overall sensitivity, specificity, PPV, NPV and accuracy were 74.4%, 73%, 85.3%, 57.4% and 73.9%, respectively. The receiver operating curve analysis of SWV measurement using ARFI revealed a cut-off value of ≥ 2.70 m/sec to recognize malignant LNs and to obtain best sensitivity (88.5%) and specificity (89.2%) (Area under the curve: 0.819, 95% confidence interval (CI): 0.744 and 0.894). The PPV, NPV and accuracy were 94.5%, 78.6% and 88.7%, respectively. As compared to SE, ARFI boosted the diagnostic accuracy of lymphoma LNs from 27.3 to 68.2% and showed better specificity and NPV to identify benign LN as contrasted to SE.ConclusionsSE could be adequate to differentiate reactive from metastatic LN but not from Lymphomas. Shear wave elastography is a reasonable imaging modality to identify benign lymph nodes. ARFI at a cut-off value of < 2.7 m/sec was superior to SE and the best B-mode features.

Application of Color Doppler with 3- and 4-Dimensional Ultrasonography in the Prenatal Evaluation of Fetal Extracardiac and Placental Abnormalities

Using color Doppler flow imaging or high-definition flow imaging with three-dimensional volume or spatio-temporal image correlation (STIC) in the glass-body mode allows displaying both gray-scale and color information of the heart cycle-related flow events and vessel spatial relationship. Conventionally, STIC in the glass-body mode has been used to examine the fetal heart and assess heart defects. Recently, a novel application of STIC in the visualization of abdominal precordial veins and intraplacental vascularization in singleton pregnancies has been reported. The aim of this present review is to discuss the use of color Doppler with three- and four-dimensional ultrasonography in the evaluation of extracardiac, placental, umbilical cord and twin abnormalities with examples. The glass-body mode is complementary to conventional 2D ultrasonography. Further studies are required to investigate use of the glass-body mode in the assessment of intraplacental vascularization in singleton and twin pregnancies.

Imaging of Central Nervous System Autoimmune, Paraneoplastic, and Neuro-rheumatologic Disorders.

This article provides an overview of the imaging modalities used in the evaluation of central nervous system (CNS) autoimmune, paraneoplastic, and neuro-rheumatologic disorders. An approach is outlined for interpreting imaging findings in this context, synthesizing a differential diagnosis based on certain imaging patterns, and choosing further imaging for specific diseases. The rapid discovery of new neuronal and glial autoantibodies has revolutionized the autoimmune neurology field and has elucidated imaging patterns characteristic of certain antibody-associated diseases. Many CNS inflammatory diseases, however, lack a definitive biomarker. Clinicians should recognize neuroimaging patterns suggestive of inflammatory disorders, as well as the limitations of imaging. CT, MRI, and positron emission tomography (PET) modalities all play a role in diagnosing autoimmune, paraneoplastic, and neuro-rheumatologic disorders. Additional imaging modalities such as conventional angiography and ultrasonography can be helpful for further evaluation in select situations. Knowledge of imaging modalities, both structural and functional, is critical in identifying CNS inflammatory diseases quickly and can help avoid invasive testing such as brain biopsy in certain clinical scenarios. Recognizing imaging patterns suggestive of CNS inflammatory diseases can also facilitate the early initiation of appropriate treatments to diminish morbidity and future disability.

Yapay Zekâ ile Entegre Ultrasonografi Cihazı Kullanımının Periferik Sinir Bloğu Uygulamalarında Enjeksiyon Alanını Görüntülemeye Olan Etkisi

Objective: New devices and software have brought about benefits such as easing the burden of clinicians, preventing time losses and increasing their professional satisfaction. In this study, we aimed to present the effect of the use of artificial intelligence integrated ultrasonography (USG) on the imaging of the injection site in peripheral nerve block applications and the point of view of the clinicians. Methods: In the study, following ethics committee’s approval, 40 volunteer Anesthesiology and Reanimation doctors working in Health Sciences University Dışkapı Yıldırım Beyazıt Education and Training Hospital performed selected regional blocks (infraclavicular and PECS) accompanied by conventional USG and artificial intelligence integrated-USG (Nerveblox), and the block area imaging times were recorded. Subsequently, questionnaires about these experiences were distributed and 14 closed-ended questions were asked. In the comparison made according to the physicians’ imaging times of the determined block areas, the t test for independent samples was used, and the statistical significance level was established as p&lt;0.001. Results: There is a significant difference in favor of the use of artificial intelligence integrated-USG in the comparison of the time taken by the physicians participating in the survey to find infraclavicular and PECS blocks reference area with conventional and artificial intelligence integrated-USG (p&lt;0.001). Conclusion: It has been proven in our study that artificial intelligence algorithms will continue to increase and will be one of the important components of diagnostic USG in the coming years. Keywords: Peripheral nerve blocks, ultrasonography, artificial intelligence

P295 Hocus Pocus: The Role Of Hand-Held Ultrasonography In Predicting Disease Extension And Endoscopic Activity In Ulcerative Colitis

Abstract Background Ulcerative colitis (UC) diagnosis and monitoring still require ileo-colonoscopy (IC) as the reference standard. Bowel sonography (BS) has recently emerged as a non-invasive assessment tool, and Milan Ultrasound Criteria (MUC) score has been validated to estimate and predict UC disease activity. Recently, hand-held BS (HHBS) has been used effectively in several clinical settings (e.g. cardiology, orthopedy, gynaecology), while data about its use in UC are still limited. We aimed to evaluate the diagnostic accuracy of HHBS compared to conventional bowel sonography (BS) in predicting UC extension and activity compared to endoscopy. Methods From November 2021 to September 2022, we prospectively enrolled consecutive UC patients afferent to our third-level IBD Unit for IC evaluation. Patients underwent IC, HHBS, and BS, and the operators were blinded by the other procedure results. Endoscopy was considered the reference standard for UC extension. Cohen’s k test was applied after MUC dichotomization to test the concordance between BS-MUC and HHBS-MUC following Allocca et al. (MUC &amp;gt;6.2: yes/no). Results At the end of the study, 86 patients with UC were examined. No significant difference was recorded between BS and HHBS in terms of UC at the per-segment extension (p: N.S.) (table 1), and both procedures were comparable regarding colonic wall thickness (CWT) and colonic wall pattern (CWP) assessment (figure 1 and 2). Regarding the prediction of endoscopic activity, BS and HHBS displayed excellent agreement when applying the MUC score system (k = 0.86, p&amp;lt;0.01) (figure 3). Conclusion Hand-held bowel sonography and BS are comparable in defining UC extension and MUC evaluation in the UC setting. HHBS could be reliable for detecting disease activity and estimating its extension, providing close monitoring of the treat-to-target paradigm. It also represents a non-invasive, easily practicable investigation during a physical examination, allowing immediate medical decisions with significant time and cost advantages.

5G-Based Telerobotic Ultrasound System Improves Access to Breast Examination in Rural and Remote Areas: A Prospective and Two-Scenario Study.

Ultrasound (US) plays an important role in the diagnosis and management of breast diseases; however, effective breast US screening is lacking in rural and remote areas. To alleviate this issue, we prospectively evaluated the clinical availability of 5G-based telerobotic US technology for breast examinations in rural and remote areas. Between September 2020 and March 2021, 63 patients underwent conventional and telerobotic US examinations in a rural island (Scenario A), while 20 patients underwent telerobotic US examination in a mobile car located in a remote county (Scenario B) in May 2021. The safety, duration, US image quality, consistency, and acceptability of the 5G-based telerobotic US were assessed. In Scenario A, the average duration of the telerobotic US procedure was longer than that of conventional US (10.3 ± 3.3 min vs. 7.6 ± 3.0 min, p = 0.017), but their average imaging scores were similar (4.86 vs. 4.90, p = 0.159). Two cases of gynecomastia, one of lactation mastitis, and one of postoperative breast effusion were diagnosed and 32 nodules were detected using the two US methods. There was good interobserver agreement between the US features and BI-RADS categories of the identical nodules (ICC = 0.795-1.000). In Scenario B, breast nodules were detected in 65% of the patients using telerobotic US. Its average duration was 10.1 ± 2.3 min, and the average imaging score was 4.85. Overall, 90.4% of the patients were willing to choose telerobotic US in the future, and tele-sonologists were satisfied with 85.5% of the examinations. The 5G-based telerobotic US system is feasible for providing effective breast examinations in rural and remote areas.

Diagnostic Value and Misdiagnosis Analysis of Conventional Ultrasonography Combined with Contrast-Enhanced Ultrasonography in Thyroid Nodules

Objective: To explore the diagnostic value of conventional ultrasonography combined with contrast-enhanced ultrasonography in thyroid nodules. Methods: From June 2021 to July 2022, 163 patients with thyroid nodules enrolled in our hospital were selected as research subjects. After pathological diagnosis, 24 cases were malignant thyroid nodules, and 139 cases were benign thyroid nodules. The diagnosis rate of malignant and benign thyroid nodules was observed and analyzed, with 95% CI. Results: Among them, the malignant and benign detection rates of routine ultrasound were 88.63% and 75.00%, respectively, and the malignant and benign detection rates of contrast-enhanced ultrasound were 81.82% and 81.25%, respectively. The malignant and benign detection rates of conventional ultrasound combined with contrast-enhanced ultrasound were 93.18% and 87.50%, respectively, and the 95% CI was greater than 0.7. Conclusion: Conventional ultrasound combined with contrast-enhanced ultrasound can help improve the diagnostic accuracy of benign and malignant thyroid nodules and reduce the misdiagnosis rate.

Comparison of automated breast volume scanning with conventional ultrasonography, mammography, and MRI to assess residual breast cancer after neoadjuvant therapy by molecular type

To compare the accuracy of hand-held ultrasonography (US), mammography (MG), magnetic resonance imaging (MRI), and automated breast volume scanning (ABVS) in defining residual breast cancer tumour size after neoadjuvant therapy (NAT). Patients diagnosed breast cancer and who received NAT at the Breast Center, Peking University People's Hospital, were enrolled prospectively. Imaging was performed after the last cycle of NAT. The residual tumour size, intraclass correlation coefficients (ICCs), and receiver operating characteristic (ROC) to predict pathological complete response (pCR) were analysed. A total of 156 patients with 159 tumours were analysed. ABVS had a moderate correlation with histopathology residual tumour size (ICC=0.666), and showed high agreement among triple-positive tumours (ICC=0.797). With 5 mm as the threshold, the coincidence rate reached 64.7% between ABVS and pathological size, which was significantly higher than that between US, MG, MRI, and pathological size (50%, 45.1%, 41.4%; p=0.009, p=0.001, p<0.001, respectively). For ROC analysis, ABVS demonstrated a higher area under the ROC curve, but with no statistical difference, except for MG (0.855, 0.816, 0.819, and 0.788, respectively; p=0.183 for US, p=0.044 for MG, and p=0.397 for MRI, with ABVS as the reference). The longest tumour diameter on ABVS had a moderate correlation with pathological residual invasive tumour size. ABVS was shown to have good ability to predict pCR and would appear to be a potential useful tool for the assessment after NAT for breast cancer.

Hybrid reflected-ultrasound computed tomography versus B-mode-ultrasound for muscle scoring in spinal muscular atrophy.

Novel light- and sound-based technologies like multispectral optoacoustic tomography (MSOT) with co-registered reflected-ultrasound computed tomography (RUCT) could add additional value to conventional ultrasound (US) for disease phenotyping in pediatric spinal muscular atrophy (SMA). The aim of this study was to investigate the quality of RUCT compared to US for qualitative and quantitative assessment of imaging neuromuscular disorders. Subanalyzing the MSOT SMA study, 288 RUCT and 276 US images from 10 SMA patients (mean age 9.0±3.7) and 10 gender- and age-matched healthy volunteers (HV; mean age 8.7±4.3) were analyzed for quantitative (grayscale levels [GSLs]) and qualitative (echogenicity, distribution pattern, Heckmatt scale, and muscle texture) muscle changes. RUCT and US measures were further correlated with clinical standard motor outcomes. Quantitative agreement using GSLs revealed significantly higher GSLs in muscles of SMA patients compared to healthy muscles in both techniques (US mean GSL [SD] SMA vs. HV: 110.70 [27.8] vs. 68.85 [19.2], p<.0001; RUCT mean GSL [SD] SMA vs. HV: 91.81 [21.8] vs. 59.86 [8.2], p<.0001) with good correlation with motor outcome tests, respectively. Qualitative agreement between methods for muscle composition was excellent for differentiation of pathological versus healthy muscles, echogenicity, and distribution pattern, moderate for Heckmatt scale, and poor for muscle texture. The data suggest that RUCT may allow the assessment of basic qualitative and quantitative measures for muscular diseases with comparable results to conventional US.

Handheld Ultrasound or Conventional Ultrasound Devices in Patients Undergoing HCT: A Validation Study.

Abdominal ultrasound exams play a major role in the diagnosis of sinusoidal obstruction syndrome/veno-occlusive disease (SOS/VOD). The development of portable hand-held ultrasound devices (HHUS) has been shown to facilitate the diagnosis of many diseases, but little data on the value of HHUS in the diagnosis of SOS/VOD are available. We performed a study aimed at validating portable ultrasound (US) devices in the setting of hematopoietic stem cell transplant (HCT). Sixteen evaluable patients undergoing allogeneic HCT were studied using conventional US and HHUS during the first 3 weeks after transplant. The results obtained demonstrate that there is a close correlation between conventional and handheld ultrasound examination in the measurement of the right hepatic lobe (r = 0.912, p &lt; 0.0001), the left hepatic lobe (r = 0.843, p &lt; 0.0001), the portal vein (PV) (r = 0.724, p &lt; 0.0001), and the spleen (r = 0.983, p &lt; 0.0001) based on Pearson's correlation. The same data, analyzed through Lin's concordance correlation coefficient, evidenced a substantial level of agreement in the comparison of the spleen and right hepatic lobe, while a lower grade of agreement in the measurement of the portal vein and left hepatic lobe. Moreover, there was good agreement between results obtained by the two types of ultrasound devices in assessing ascites (p &lt; 0.0001), gallbladder thickening (p &lt; 0.0001), and the direction of PV flow (p &lt; 0.0001). HHUS device allows the study of HokUs-10 parameters with an excellent agreement with conventional US, and may contribute to SOS/VOD diagnosis.

Conventional ultrasonography and elastosonography in diagnosis of malignant thyroid nodules: A systematic review and meta-analysis.

To evaluate the diagnostic value of conventional ultrasound and elastosonography in malignant thyroid nodules by meta-analysis. The literature included in the Cochrane Library, PubMed, and Embase were searched by using "elastosonography, ultrasonography, thyroid nodules" as the keywords. The clinical studies using elastosonography and conventional ultrasound to diagnose thyroid nodules were selected, and histopathology of thyroid nodules was used as reference standards. The quality evaluation and heterogeneity test were performed on the literature that met the requirements, the combined specificity and sensitivity were pooled, and a comprehensive ROC curve analysis was performed. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool was utilized to evaluate the quality of each included study. Meta-DiSc version 1.4, StataSE 12 and Review Manager 5.4 were used. A total of nine studies assessed 3066 thyroid nodules (2043 benign and 1023 malignant). The pooled sensitivity, specificity, PLR, NLR, and DOR of conventional ultrasound for the diagnose of malignant thyroid nodules were 0.833 (95% CI 0.809-0.855), 0.818 (95% CI 0.801-0.835), 4.85 (95% CI 4.36-5.39), 0.20 (95% CI 0.17-0.23), and 29.38 (95% CI 23.28-37.08), respectively, with an AUC of 0.9068. Also, the pooled sensitivity, specificity, PLR, NLR, and DOR of elastosonography were 0.774 (95% CI 0.741-0.804), 0.737 (95% CI 0.715-0.758), 3.14(95% CI 2.85-3.47), 0.29 (95% CI 0.25-0.34), and 9.35 (95% CI 7.63-11.46), respectively, with an AUC of 0.8801. Three studies provided data regarding the conventional ultrasound and elastosonography. The pooled sensitivity, specificity, PLR, NLR, DOR, and AUC were 0.902 (95% CI 0.870-0.928), 0.649 (95% CI 0.616-0.681), 2.72 (95% CI 2.46-3.00), 0.14 (95% CI 0.11-0.19), 25.51 (95%CI 17.11-38.03), and 0.9294. The existing evidence shows that elastosonography cannot completely replace conventional ultrasound in the diagnosis of malignant thyroid nodules, and the combination of elastosonography and conventional ultrasound gives a better diagnostic precision. www.crd.york.ac.uk, identifier PROSPERO CRD42022375808.

Comparison of telerobotic and conventional ultrasonography in children: a crossover bicentric pilot study.

The MELODY system allows for performing ultrasonography on a patient remotely and has been proposed to assess disease characteristics in the context of the coronavirus disease 2019 (COVID-19) pandemic. The aim of this interventional crossover study was to address the feasibility of the system in children aged 1 to 10 years old. Children underwent ultrasonography with a telerobotic ultrasound system followed by a second conventional examination by a different sonographer. In total, 38 children were enrolled, and 76 examinations were performed, with 76 scans analyzed. The mean [standard deviation (SD)] age of participants was 5.7 (2.7) years (range, 1-10 years). We found substantial agreement between telerobotic and conventional ultrasonography [κ=0.74 (95% CI: 0.53-0.94), P<0.005]. The mean (SD) duration was longer for telerobotic than conventional examinations [26.0 (2.5) vs. 13.9 (11.2) min, P<0.0001]. Abdominal organs and abnormalities were similarly visualized on telerobotic and conventional ultrasonography. Cardiac echocardiography provided reliable diagnoses, with non-significantly different measurements with both techniques, although the visualization score was significantly higher with conventional than telerobotic ultrasonography (P<0.05). On lung analysis, both examinations identified consolidations and pleural effusion, whereas visualization and total lung score were similar with the 2 techniques. Overall, 45% of parents reported that their children felt less pressure with the telerobotic system. Telerobotic ultrasonography may be effective, feasible, and well-tolerated in children.

Sonoelastographic Evaluation of Pelvic Adnexal Masses and its Association with Clinicopathological Findings at a Tertiary Care Centre in Western Uttar Pradesh, India

Introduction: Despite advancements in cross-sectional aging techniques, ultrasonography continues to remain the first-line imaging modality for the preoperative assessment of pelvic adnexal masses. Ultrasound strain elastography is a novel technique that can characterise adnexal lesions based on their tissue stiffness and when used in conjunction with conventional USG, it may increase the precision of diagnosis and can act as a cost-effective viable ancillary tool. Aim: To assess the role of strain sonoelastography in characterising the adnexal lesion as benign or malignant. Materials and Methods: This cross-sectional study was conducted in the Department of Radiodiagnosis, Teerthankar Mahaveer Medical College and Research Centre (TMMC&amp;RC), Moradabad, Uttar Pradesh, India, for a period of 18 months (January 2020 to June 2021) and consisted of 110 patients with clinical suspicion of adnexal mass, who were evaluated on SIEMENS Acuson S 3000 scanner (from the total of 130 cases). Various morphological features of mass (size, laterality, consistency, echogenicity and internal contents) were assessed on Gray scale and vascularity was assessed on colour doppler Ultrasonography (USG). Subsequently, real time strain elastography (eSie touch) was performed to assess the tissue stiffness. Elasticity was indicated on a colour-coded elastogram map, with blue areas denoting hard tissue, green areas suggesting intermediate tissue, and red portions denoting soft tissues. The sonographic findings were compared with histopathological diagnosis. Sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) were calculated for Gray scale sonography in combination with Doppler (conventional ultrasound techniques) and in conjunction with elastography. The Chi-square test was applied for comparing the frequency and p-value less than 0.05 was considered to be significant. Results: The mean age of study population was 36.35±14.82 years. On histopathology out of 110 patients, 95 (86.36%) had benign adnexal lesions and 15 (13.64%) had malignant adnexal lesions. The youngest patient was 16-year-old and eldest was 70 years and the mean age of the study population was 36.35 years. When conventional ultrasound technique was used alone for differentiating benign and malignant adnexal masses the sensitivity was 96.7%, specificity was 83%, PPV was 96.7% and NPV was 83% while on addition of sonoelastography the sensitivity increased to 98.9%, specificity increased to 93%, PPV increased to 98.9% and NPV increased to 93.7%. Conclusion: Conventional ultrasound techniques should be combined with sonoelastography in a diagnostic system to achieve better characterisation and differentiation of benign and malignant adnexal masses.

Quantification of Portal Vein Vascularization Using an Automated Post-Processing Video Analysis Tool.

Purpose Blood flow dynamics represent a diagnostic criterion for many diseases. However, no established reference standard is available. In clinical practice, ultrasound pulsed-wave Doppler (PW-Doppler) is frequently used to assess visceral blood flow, despite its well-known limitations. A quantitative analysis of conventional color Doppler patterns can be performed using an innovative ultrasound-based algorithm (pixel flow analysis, PFA). This tool already shows promising results in obstetrics, but the technique has not yet been evaluated for portal venous blood flow assessment. Methods This prospective exploratory research study evaluated the applicability of PFA in the portal venous system. Measurements of portal venous flow using PFA and PW-Doppler were compared in healthy volunteers (n=20) and in patients with hepatic steatosis (n=10) and liver cirrhosis (n=10). Results In healthy volunteers (60% female, mean age 23 years, BMI 21.5 kg/m 2 [20.4-23.8]), PFA and PW-Doppler showed a strong positive correlation in fasting conditions (r=0.69; 95% CI 0.36-0.87), recording a median blood flow of 834 ml/min (624-1066) and 718 ml/min (620-811), respectively. PFA was also applicable in patients with chronic liver diseases (55% female, age 65 years (55-72); BMI 27.8 kg/m 2 (25.4-30.8)), but the correlation between PFA and PW-Doppler was poor (r=- 0.09) in the subgroup with steatosis. A better correlation (r=0.61) was observed in patients with liver cirrhosis. Conclusion PFA and PW-Doppler assessment of portal venous vascularization showed high agreement in healthy volunteers and patients with liver cirrhosis. Therefore, PFA represents a possible alternative to conventional PW-Doppler sonography for visceral blood flow diagnostics and merits further evaluation.

Diagnostic potential of conventional ultrasonography combined with elastography in assessing the properties of axillary lymph nodes in breast cancer

Diagnostic potential of conventional ultrasonography combined with elastography in assessing the properties of axillary lymph nodes in breast cancer

Cranial Ultrasound: A Novel Approach of Neuroimaging in Preterm Infants Suffering from Perinatal Birth Injury

Introduction: Preterm birth is a common cause of neonatal mortality with an additional burden of adverse neurodevelopmental outcomes. It is caused by different factors that can be either perinatal, natal or postnatal leading to white matter injury/intracranial hemorrhages. These lesions can be readily assessed by cranial ultrasound which provides cost-effective, radiation-free, bedside imaging. Conclusion: Cranial ultrasound is an innovative method to assess brain injury in preterm infants. Ultrasonographic evaluation of preterm brain is recommended as early as possible after birth with interval follow up. Three distinct patterns of brain injury can be seen in preterm infants: Periventricular leukomalacia (PVL), Germinal Matrix-Intraventricular hemorrhage (GMH-IVH) and cerebellar hemorrhages. Germinal matrix hemorrhage is found to be most common pattern with cystic PVL being next among three patterns of brain injury. Ultrasound is an operator-dependent technique with poor visualization of few abnormalities on two-dimensional images. The limitation of conventional ultrasonography opens up new aspects of 3 D scanning with better imaging outcomes

Application value of shear-wave elastography combined with monochrome superb microvascular imaging in renal allograft chronic rejection.

Conventional ultrasound (US), which include gray scale US and Doppler US, is the first-line imaging modality for the evaluation of renal allograft; however, conventional US indicators have limitations. To explore the application value of shear-wave elastography (SWE) combined with monochrome superb microvascular imaging (mSMI) in renal allograft chronic rejection (CR). From November 2021 to February 2022 in the Lanzhou University Second Hospital, the US features of 54 patients with renal allograft were retrospectively analyzed. Patients were categorized into two groups: stable group(n = 44) and CR group(n = 10), with clinical diagnosis as reference standard. The vascular index (VI) on mSMI and parenchymal stiffness were measured in the middle cortex of all renal allografts and receiver operating characteristic (ROC) curves were drawn to evaluate the feasibility of differentiation. Statistically significant US features and biochemical indicators such as creatinine were scored, and the results of the scores were analyzed by ROC curve. The VI on mSMI of the stable group (49.5±2.0) was significantly greater than that of the CR group (33.8±5.9) (P = 0.028). There was a statistically significant difference in parenchymal stiffness between stable group (16.2kPa±1.2) and CR group (33.9kPa±6.6) (P = 0.027). The sensitivity was 90% and specificity was 81.8% of the scores in the differentiation of stable group from CR group (cut-off value, 2; P = 0.000). SWE combined with mSMI may help differentiate stable renal allograft from renal allograft CR and have the potential application value in the diagnosis of renal allograft CR.

The Role of a Deep Learning-Based Computer-Aided Diagnosis System and Elastography in Reducing Unnecessary Breast Lesion Biopsies

ObjectivesUltrasound examination has inter-observer and intra-observer variability and a high false-positive rate. The aim of this study was to evaluate the value of the combined use of a deep learning-based computer-aided diagnosis (CAD) system and ultrasound elastography with conventional ultrasound (US) in increasing specificity and reducing unnecessary breast lesions biopsies. Materials and MethodsConventional US, CAD system, and strain elastography (SE) were retrospectively performed on 216 breast lesions before biopsy or surgery. The area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and biopsy rate were compared between conventional US and the combination of conventional US, SE, and CAD system. ResultsOf 216 lesions, 54 were malignant and 162 were benign. The addition of CAD system and SE to conventional US increased the AUC from 0.716 to 0.910 and specificity from 46.9% to 85.8% without a loss in sensitivity while 89.2% (66 of 74) of benign lesions in Breast Imaging Reporting and Data System (BI-RADS) category 4A lesions would avoid unnecessary biopsies. ConclusionThe addition of CAD system and SE to conventional US improved specificity and AUC without loss of sensitivity, and reduced unnecessary biopsies.

Contrast-enhanced ultrasound targeted versus conventional ultrasound guided systematic prostate biopsy for the accurate diagnosis of prostate cancer: A meta-analysis.

Conventional transrectal ultrasonography (TRUS) guided prostate biopsy is the standard method for accurate diagnosis of prostate cancer (PCa). However, the limitations of this technique in terms of missed diagnosis cannot be ignored. Based on previous studies, contrast-enhanced ultrasound (CEUS) may be able to more distinctly detect malignant lesions with increased microvessels. Therefore, to evaluate the diagnostic efficiency and clinical application prospects of CEUS-guided prostate biopsy for patients with suspected PCa, we performed a meta-analysis comparing CEUS-targeted with TRUS-guided systematic biopsy. A systematic search of PubMed, Web of Science, Embase and CNKI was performed up to March, 2022 for the relevant published studies. After data extraction and quality assessment, meta-analysis was performed using the RevMan 5.3 software. The results showed that the overall sensitivity was higher for CEUS targeted biopsy than systematic biopsy (P = .03), so was the accuracy (P = .03). However, significant heterogeneity and inconsistent results from certain subgroup analyses challenged the validity of the results. Meanwhile, CEUS yielded a much higher sensitivity in patients with prostate specific antigen (PSA) level of 4 to 10 ng/mL (P = .007). On the other hand, the positive rate of each core (P < .001) and the detection rate of clinically significant PCa (P = .006) were significantly improved using CEUS. CEUS showed the advantage of a higher detection rate of clinically significant PCa, which might provide more specific indications for subsequent treatment. More feasible, real-time data are required to confirm our findings.

The value of contrast-enhanced ultrasonography in the diagnosis of primary testicular non-neoplastic and neoplastic lesions in adults

BackgroundDifferent pathological types of testicular tumors are treated differently. Malignant germ cell tumors require radical orchiectomy, while benign tumors may only need mass enucleation. Contrast-enhanced ultrasonography (CEUS) is more sensitive than conventional ultrasonography in displaying tumor microvessels, which helps distinguish between benign and malignant tumors.MethodsThis was a retrospective analysis of 35 patients with pathological-confirmed primary testicular non-neoplastic and neoplastic lesions in our hospital from February 2017 to February 2022. Conventional ultrasonography and CEUS imaging findings of included lesions were retrospectively analyzed and their diagnostic values were compared with the pathological results.ResultsThere were 13 cases of benign testicular lesions (including 1 case of spontaneous hematoma, 2 cases of segmental infarctions, 5 cases of epidermoid cysts, 2 cases of Sertoli cell tumors, and 3 cases of Leydig cell tumors) and 23 cases of malignant testicular lesions (including 10 cases of seminomas, 1 case of embryonal carcinoma, 2 cases of mixed germ cell tumors, 2 cases of spermatocytic tumors, and 8 cases of lymphomas). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy rates of conventional ultrasound in diagnosing benign testicular tumors by "onion skin-like" echo (epidermoid cysts) and peripheral annular blood flow were 30.8%, 100.0%, 100.0%, 71.9% and 75.0%, respectively. All testicular non-neoplastic lesions and epidermoid cysts showed no enhancement by CEUS. All Sertoli-Leydig cell tumors (SLCTs)’ CEUS imaging showed uniform high enhancement (no necrosis area), fast forward, and slow backward. 80.0% (12/15) malignant germ cell tumors showed heterogeneous enhancement and fast forward and fast backward in CEUS. All lymphomas showed fast forward and fast backward, and 87.5% (7/8) of them showed uniform high levels of enhancement in CEUS. According to CEUS without enhancement (non-neoplastic lesions and epidermoid cysts) and uniform high enhancement with fast forward and slow backward (SLCT), the sensitivity, specificity, positive predictive value, negative predictive value and accuracy rates for diagnosing benign testicular tumors were all 100.0%. Compared with conventional ultrasound, the difference was statistically significant (p = 0.004).ConclusionsCEUS could accurately distinguish between benign and malignant testicular tumors, as well as differentiate specific pathological types (testicular focal infarction, epidermoid cysts, spermatocytic tumors, SLTC and lymphoma). Accurate preoperative diagnosis is critical for guiding the selection of appropriate treatment plans for different pathological types of testicular tumors.