Conventional Ultrasound Examination Research Articles

Two-dimensional shear wave elastography of the perirenal fat: Can sticky fat be predicted?

To evaluate whether two-dimensional (2D) shear wave elastography (SWE) can predict the presence of perirenal sticky fat (PSF) by showing increased perirenal fat stiffness. We prospectively enrolled 28 patients with 31 renal tumors and 10 donor cases. Conventional renal ultrasound (US) and 2D-SWE examination of the perirenal fat were performed. Patient age, gender, body mass index (BMI), largest mass size, PF shear wave velocity (SWV) on both sides were recorded. During surgery, presence of PSF and perirenal fat dissection time (PFDT) were recorded. Twenty three renal masses were malignant and eight were benign. There were 13 clear cell carcinomas and 10 nonclear cell carcinomas. Eight patients had PSF. Mean PFDT was 13 minutes. PFDT and BMI were significantly increased in the PSF group (p < .05). No statistically significant differences were found in SWVs in patients with and without PSF. There were no significant differences with regard to SWVs between donor cases and patients, tumor side and nontumor side, benign masses and malignant masses, clear cell and nonclear cell tumors. No significant correlations were detected between SWVs and PFDT, mass size, Fuhrman grade and BMI (p > .05). 2D-SWE cannot detect PSF.

Evaluating the Efficacy of Atorvastatin on Patients with Carotid Plaque by an Innovative Ultrasonography

Background: The present study aimed to explore the efficacy of atorvastatin on patients with carotid plaque, applying superb microvascular imaging (SMI), and contrast-enhanced ultrasound (CEUS) for evaluating carotid intraplaque neovascularization. Methods: A total of 82 patients (82 carotid plaques) who were randomized into treatment group and control group underwent conventional ultrasound, CEUS, and SMI examinations. Patients in treatment group received a dose of 20 mg atorvastatin per day for 6 months while those in control group received placebo instead. Lipid parameters were assessed and intraplaque neovascularization were evaluated by CEUS and SMI before and 6 months after atorvastatin treatment. Results: No significant differences were found between the 2 groups at the study entry. Patients with atorvastatin treatment received marked improvement in total cholesterol, triglyceride, and LDL-cholesterol compared with those in control group (P < .001). In treatment group, SMI-detected intraplaque neovascularization reduced from 69.23% to 48.72% while CEUS-detected ones reduced from 76.92% to 69.23%. By contrast, the percentage of intraplaque neovascularization in control group did not change too much either by SMI (65.12%, 67.44%) or CEUS (74.41%, 74.41%). The consistency between CEUS and SMI was above .75 at all assessments (P < .001). Conclusions: Atorvastatin treatment works for patients with carotid plaque by reducing LDL-cholesterol and improving plaque regression. Second, the consistency between SMI and CEUS in visualizing intraplaque neovascularization is good. That indicates a high possibility to identify carotid plaque instability by a safer and cheaper ultrasonography without contrast agent.

Ultrasonographic Multimodality Diagnostic Model of Thyroid Nodules.

The aim of this study was to identify independent risk factors for thyroid cancer, establish an ultrasonographic multimodality diagnostic model for thyroid nodules, and explore the diagnostic value of the model. From November 2011 to February 2015, 307 patients with a total of 367 thyroid nodules underwent conventional ultrasound, contrast-enhanced ultrasound (CEUS), and ultrasound elastography examinations before surgery. A binary logistic regression analysis was performed to identify independent risk factors for thyroid cancer and to establish a multimodality diagnostic model for thyroid nodules. The diagnostic performance of conventional ultrasound, CEUS, ultrasound elastography, and the multimodality diagnostic model was assessed and compared. The following seven independent risk factors were included in the logistic regression models: age, irregular shape, hypoechoic pattern, marked hypoechoic pattern, irregular blood flow distribution, heterogeneous enhancement, and an elastic score of 3/4. The multimodality diagnostic model had a diagnostic accuracy of 86.9%, with a sensitivity of 93.5% and a specificity of 77.3%. The multimodality diagnostic model improved the diagnostic accuracy compared with that of conventional ultrasound, CEUS, and ultrasound elastography. Independent risk factors for thyroid cancer included age, irregular shape, hypoechoic pattern, marked hypoechoic pattern, irregular blood flow distribution, heterogeneous enhancement, and an elastic score of 3/4. The multimodality diagnostic model was demonstrated to be effective in the diagnosis of thyroid nodules.

OP22.03: First trimester diagnostic accuracy of two‐dimensional ultrasound technique in congenital heart diseases and great arteries anomalies

To assess the accuracy of a standard first-trimester (FT) conventional two-dimensional ultrasound (2DUS) examination protocol in detecting congenital heart diseases (CHDs) and great arteries anomalies, in an unselected population. This is an eight-year single centre study, performed in a FT screening for aneuploidies program. We stored the cardiac sweep digital video clips, in duplex two-dimensional/two dimensional colour, from an oblique lateral insonation from the right shoulder. We used 2DUS re-examination by a team of specialists, pathological examination, and subsequent re-examination as the reference standard methods. In 20015 FT scanned fetuses, positive 2DUS diagnosed both major and minor CHDs with high accuracy (specificity 99.9%). Positive likelihood ratios were1896.83 for major and 920 for minor heart anomalies. Sensitivity was lower for minor defects than for major CHDs (40% vs 55.17%) with discrepancies between positive predictive values (40% vs 88.89%). The detection rates varied widely being: 88.25% (15/17) for complete atrioventricular septal defect, 87.5% (7/8) for hypoplastic left heart syndrome, 88.88% (8/9) for isolated great arteries transposition, 43.75% (7/16) for tetralogy of Fallot, 25% (2/8) for isolated aortic coarctation and 66.66% (2/3) for isolated aortic arch anomalies (normal heart) cases. In late FT the 2D ultrasound is an accurate tool in screening for some of the major CHDs. Using a standardised and low time-consuming technique will probably raise detection rates in this specific group of diseases. It will lower the operator-dependency and will eliminate the fetal position-dependency, two main reasons for the delayed diagnosis in certain CHDs cases. Despite the extremely low number of false positive cases, the overall accuracy of the method is too low for introducing it in national screening programs. This is mainly due to the spectrum bias of CHDs, with poor FT ultrasound markers in some cases and an evolving pattern in others. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Strain Elastography: A Valuable Additional Method to BI-RADS?

Breast lesions classified as BI-RADS-US 3 are probably benign and observation was recommended, while a considerable number of BI-RADS-US 4 lesions were benign, resulting in excessive biopsies. We focus exclusively on BI-RADS-US 3 and 4 lesions and hypothesize that improved diagnostic performance can be achieved by integrating real-time elastography (strain ratio) into the BI-RADS-US classification system. From April 2010 to September 2015, 1071 lesions were included in the final analysis. After the conventional ultrasound examination, the BI-RADS-US (2013) classification was used to evaluate the lesions. Then the strain ratios were calculated, and the final diagnosis was made on the basis of histological results. The sensitivity, specificity, accuracy, PPV and NPV were calculated and the AUCs were compared. Additionally, an analysis of the diagnostic performance expressed by the pretest and posttest probability of disease (POD) was performed in BI-RADS-US 3 and 4A lesions. With the cutoff point of 2.98, the sensitivity, specificity and accuracy of the strain ratio method were 86.9 %, 86.6 % and 82.6 %, respectively. In BI-RADS-US 3 lesions, a suspicious strain ratio significantly modified the POD from 1.3 % to a posttest POD of 29.8 %. In BI-RADS-US 4A lesions, a suspicious strain ratio significantly modified the POD from 8.5 % to a posttest POD of 48.7 %. Ultrasonographic elastography (strain ratio) yields additional diagnostic information in the evaluation of BI-RADS-US 3 and 4 breast lesions. The strain ratios should be integrated into the BI-RADS-US classification system and into daily practice.

A study of the application of TAP combined with transvaginal ultrasound in the diagnosis of early-stage endometrial cancer.

The aim of the study was to investigate the application of tumor abnormal protein (TAP) combined with transvaginal ultrasound in the diagnosis of early-stage endometrial cancer. A total of 248 patients with suspected endometrial cancer who were admitted to the Gynecology Department of the Second People's Hospital of Liaocheng from September 2013 to September 2015 were selected and randomly divided into the control (n=124) and the observation group (n=124). The control group received conventional ultrasound examination, while the observation, underwent TAP combined with conventional ultrasound examination. Differences in the definite diagnostic results of the two diagnostic methods and curettage were compared, and the application of TAP combined with transvaginal ultrasound in the diagnosis of early-stage endometrial cancer was studied. Among 248 patients receiving hysteroscopy and diagnostic curettage examination, there were 75 patients with early-stage endometrial cancer, and 173 benign patients. The total diagnostic accordance rate of conventional ultrasound for endometrial lesions was 87.90% (n=218), and the accordance rate for early-stage endometrial carcinoma was 90.67% (n=68); the total diagnostic accordance rate of TAP combined with vaginal ultrasound for endometrial lesions was 94.35% (n=234), and for early-stage endometrial cancer was 94.67% (n=71); of TAP combined with conventional ultrasound for endometrial lesions and endometrial cancer were higher than those of simple conventional ultrasound (P<0.05). The area under the curve (AUC) of conventional ultrasound in the diagnosis of endometrial cancer was 0.754 [95% confidence interval (CI): 0.211–2.534]. The AUC of TAP combined with vaginal ultrasound in the diagnosis of endometrial cancer was 0.814 (95% CI: 0.517–0.932), and a comparison between the two groups was statistically significant (P=0.011). The accuracy rate of TAP combined with transvaginal ultrasound in the diagnosis of early-stage endometrial cancer is relatively high, and it is worthy promoting and applying in clinical practice.

Role of Ultrasound Elastography in Characterization of Indeterminate Breast lesions (BIRADS 3&amp;4 lesions).

With the expanded role of screening breast ultrasonography and accumulating clinical experience, the American College of Radiology (ACR) has established the Breast Imaging Reporting and Data System (BI-RADS) ultrasonography lexicon to standardize terminology for description and management recommendations according to stratified risks. It has been established that probably benign (BI-RADS category 3) lesions having a malignancy rate of less than 2% require short-term imaging follow-up rather than immediate biopsy. The BI-RADS 4 category is assigned to suspicious lesions for which biopsy is recommended. Routine screening methods such as mammography and breast ultrasound are valuable methods for managing breast masses. Breast ultrasound is the preferable screening method as it provides high sensitivity for detecting breast cancer in women with dense breast tissue and can detect cancers not identified on mammography in asymptomatic women with dense breast tissue. In our study we included 46 patients with different breast lesions. All patients had a conventional B-mode ultrasound examination and were evaluated according to the BIRADS categories, then real time free-hand ultrasound elastography was performed in the same session and images were evaluated using both the Tsukuba elasticity score and the strain ratio method. Finally, the results were compared to the histopathologic results of those lesions. It was found that conventional B-mode ultrasound examination had a sensitivity of 72.73% and specificity of 83% While, elastography scoring alone turned out to have sensitivity of 65.5%, specificity of 83.4% using the Tsukuba score system. The additional of Strain ratio parameter for evaluating the elastography images showed the highest sensitivity 98.4% and specificity 85.68% at a best cutoff point of 3.47. So we have found that elastography is an easy procedure with high diagnostic performance which can be easily integrated with the B-mode ultrasound examination in the same session and improves its specificity. That has proven benefit in minimizing the number of unnecessary biopsies especially in the assessment of BIRADS 3 and 4 lesions

Correlation between the maximum elastic modulus(Emax) shear-wave elastography and immunohistochemical profiles in breast cancer

Objective To investigate the correlation between the maximum elastic modulus(Emax) of breast cancer obtained by shear-wave elastography (SWE) and immunohistochemical profiles. Methods One hundred and sixty patients with 171 pathologically proven breast lesions were included in this study. All of them underwent conventional ultrasound and SWE examination before surgery. The Emax and maximum diameter were obtained. Histologic grade, immunohistochemical profiles ER, PR, HER-2, Ki-67 and molecular subtypes were recorded according to pathological results after surgery. The correlation between Emax and tumor size, histological grade, ER, PR, HER-2, Ki-67 and molecular subtypes were analyzed. Results ①There was a positive correlation between the tumor size with Emax(r=0.510, P<0.05); ②The Emax of tumors with HER-2 positive expression were higher than that with HER-2 negative expression(P<0.05), the Emax of tumors with Ki67 high expression were higher than that with Ki67 low expression (P<0.05); ③There were significant differences in Emax between different molecular subtypes(P<0.05), the Emax of HER-2 positive tumor was the highest, followed by those of Luminal B tumor, triple-negative and Luminal A tumor; ④Multiple linear regression indicated that tumor size was the strongest pathologic determinate of Emax value(P<0.05), its standardized partial regression coefficient was 0.500, and HER-2 also had significant influence on Emax value of tumor(P<0.05), the standardized partial regression coefficient was 0.237. Conclusions Some prognosis immunohistochemical feature of breast cancer showed association with the Emax. Breast cancers with higher Emax at shear-wave elastography had poor prognostic features. To some extend, the value of Emax can reflect the biological characteristics of breast cancer, SWE may provide a certain imaging basis for the prognosis of breast cancer and the choice of treatment plan. Key words: Ultrasonography; Breast Neoplasms; Elasticity imaging techniques; Immunohistochemical profiles

Ultrasound-based scoring system for differential diagnosis of polypoid lesions of the gallbladder.

Polypoid lesions of the gallbladder may be neoplastic or non-neoplastic. Correct diagnosis would help reduce unnecessary cholecystectomies. This study aimed to determine the predictive value of individual ultrasound characteristics for diagnosis of neoplastic polyps and to build a scoring system based on these characteristics. A total of 109 patients with gallbladder polyps ≥6mm underwent conventional ultrasound examination and received finally diagnosis by pathological examination. All images were analyzed to determine characteristics of the lesions. Univariate and multivariate analyses were used to identify the predictors of neoplastic polyps, and a scoring system was built based on multivariate analysis. Maximum diameter, height/width ratio, base width, presence of hyper-echoic spots, and intralesional blood flow were statistically significant (P=0.011, P=0.016, P=0.003, P=0.031, and P=0.022, respectively) predictors of neoplastic lesions. The total score=(Maximum diameter, ≥13.9mm=1, <13.9=0)+(Base width, ≥3.5mm=1, <3.4=0)+(Height/width ratio, ≤1.05=1, >1.05=0)+(Hyper-echoic spots, presence=0, absence=1)+(Blood flow, presence=1, absence=0). Receiver operating characteristic curve showed that the sensitivity, specificity, and accuracy for the risk of neoplastic polyps with scores of 3 or higher were 81.6%, 86.7%, and 84.4%, respectively. This ultrasound-based scoring system could be a useful means for differentiating between neoplastic and non-neoplastic gallbladder polyps in the clinic.

Diagnosis and treatment of submucous myoma of the uterus with interventional ultrasound.

The value of interventional ultrasound in the diagnosis and treatment of submucous myoma of the uterus was assessed to study the ultrasonographic features of modified sonohysterography for submucous polyp of uterus. A total of 25 patients diagnosed preliminarily as submucous myoma of the uterus via conventional ultrasound examination from June 2014 to December 2016 were enrolled in the study. The diagnosis was made via the comprehensive analysis of ultrasound-guided modified SHG, followed by ultrasound-guided needle biopsy and sclerotherapy of tumor. After modified SHG and ultrasound-guided needle biopsy, 96% (24/25) cases were confirmed pathologically as submucous myoma of the uterus. After treatment, the maximum diameter of myoma in patients with submucous myoma of uterus was significantly different, and the volume of myoma was significantly reduced. After treatment, the clinical symptoms of patients with submucous myoma of the uterus were obviously improved compared to before treatment (P<0.05). It was found in the follow-up after treatment that a small number of patients suffered from mild abdominal pain, increased secretion, slight vaginal bleeding, cold sweat, pale complexion, dizziness and other symptoms, which, however, disappeared after treatment for about 1 week. The score of 36 item Short-Form Health Survey Questionnaire of patients with submucous myoma of the uterus was significantly different before and after treatment (P<0.05). Interventional ultrasonography can effectively diagnose the submucous myoma of uterus. The treatment of submucous myoma of uterus with ultrasound-guided intratumor injection of lauromacrogol is characterized by simple operation, which can effectively reduce the tumor diameter and volume, improve the blood flow in patients, reduce the postoperative adverse reactions and alleviate the patient's pain, so it is a new type of minimally invasive treatment method of submucous myoma of the uterus, and it is worthy of clinical promotion and application.

Three-Dimensional Shear Wave Elastography for Differentiating Benign From Malignant Thyroid Nodules.

To prospectively evaluate the diagnostic performance of 3-dimensional (3D) shear wave elastography (SWE) for assessing thyroid nodules. A total of 176 surgically or cytologically confirmed thyroid nodules (63 malignant and 113 benign) in 176 patients who had undergone conventional ultrasound (US), 2-dimensional (2D) SWE, and 3D SWE examinations were included in this study. Quantitative elasticity values (mean elasticity, maximum elasticity, and standard deviation of elasticity of a large region of interest and mean elasticity of a 2-mm region of interest) were measured on 2D and 3D SWE. Diagnostic performances of conventional US, 2D SWE, and 3D SWE were assessed. The role of 2D and 3D SWE in reducing unnecessary fine-needle aspiration (FNA) for nodules with low suspicion was also evaluated. The diagnostic performances in terms of the area under the receiver operating characteristic curve were 0.612 for conventional US, 0.836 for 2D SWE (P < .001 in comparison with conventional US), and 0.839 for 3D SWE (P < .001 in comparison with conventional US). The mean elasticity achieved the highest diagnostic performance in 2D SWE, whereas the standard deviation of elasticity achieved the highest performance in 3D SWE, although no significant difference was found between them (P > .05). Three-dimensional SWE increased the specificity in comparison with 2D SWE (88.5% versus 82.3%; P = .039). For the 37 nodules with low suspicion on conventional US imaging, 2D SWE was able to avoid unnecessary FNA in 77.1% (27 of 35) of benign nodules, and 3D SWE further increased the number to 88.6% (31 of 35). Three-dimensional SWE is a useful tool for predicting thyroid nodule malignancy and reducing unnecessary FNA procedures in thyroid nodules with low suspicion of malignancy.

Assessment of Virtual Touch Tissue Imaging Quantification and the Ultrasound Thyroid Imaging Reporting and Data System in Patients With Thyroid Nodules Referred for Biopsy.

To evaluate the diagnostic performance of Virtual Touch tissue imaging quantification (VTIQ; Siemens Medical Solutions, Mountain View, CA) in combination with the Thyroid Imaging Reporting and Data System (TI-RADS) for assessing thyroid nodules referred for biopsy. A total of 197 surgically or cytologically proven thyroid nodules in 187 patients were included. Nodules evaluated by conventional ultrasound (US) and VTIQ examinations were classified into US TI-RADS categories. The shear wave velocity (SWV) on VTIQ was assessed, and the cutoff value was obtained from a receiver operating characteristic curve analysis. Diagnostic performances of conventional US, VTIQ, and their combination were compared. There were 134 benign and 63 malignant nodules. The sensitivity and specificity for the US TI-RADS were 98.4% and 20.1%, respectively. The areas under the receiver operating characteristic curves for the mean, maximum, minimum, and ratio of the SWV were 0.818, 0.805, 0.799, and 0.728. With a cutoff value of 2.90 m/s, the sensitivity and specificity of the mean SWV were 71.4% and 82.8%. By applying this value or less as a standard for downgrading TI-RADS category 4a to category 3 lesions, the specificity significantly rose from 20.1% to 47.0% (P < .001) without a loss of sensitivity. The additional application of VTIQ can improve the specificity of the TI-RADS for evaluating thyroid nodules without a loss of sensitivity.

Role of ultrasound in the assessment of percutaneous laser ablation of cervical metastatic lymph nodes from thyroid carcinoma.

Background Few studies have examined the feasibility and efficiency of performing ultrasound and contrast-enhanced ultrasound (CEUS) after percutaneous laser ablation (PLA) of cervical metastatic lymph nodes from thyroid cancer. Purpose To investigate and describe the use of conventional ultrasound and CEUS in evaluating PLA of metastatic lymph nodes. Material and Methods PLA was performed in a small, prospective, observational study of 21 metastatic lymph nodes in 17 thyroid cancer patients who underwent radical thyroid resection. CEUS was conducted prior to PLA and 1 h and seven days after ablation. Conventional ultrasound examination of all nodes was performed during follow-up after ablation. We observed contrast agent perfusion in the lymph nodes, calculated perfusion defect volumes using CEUS and determined the rates of reduction for metastatic lymph nodes for a mean duration of 17.86 ± 4.704 months (range = 12-27 months). Results CEUS demonstrated that the perfusion defect volume was larger on day 7 than on day 1 post-ablation in 47% of the ablated nodes. Compared to the largest diameters and volumes pre-PLA, the corresponding post-PLA values significantly decreased ( P < 0.05 versus baseline). No statistically significant change in thyroglobulin (Tg) levels before and after PLA was observed in this study ( P > 0.05 versus baseline). Conclusion CEUS can be effectively used to distinguish the margins of ablated regions, assess the accuracy of PLA, and monitor short-term changes in necrotic areas. However, long-term follow-up assessments of the curative effect of PLA will predominantly rely on conventional ultrasonography.

Application value of tissue dispersion quantitative analysis technique in different stages of SAT

Objective To investigate the application value of the ultrasonic elastic tissue dispersion quantitative analysis technique in different stages of subacute thyroiditis (SAT). Methods One hundred and forty-four SAT lesions detected from 81 patients were enrolled in the patient group. They were further divided into three subgroups, including acute group (group Ⅰ), medium group (group Ⅱ) and recovery group (group Ⅲ). Another 59 healthy volunteers were collected as control group. All the participants accepted conventional ultrasound and elastographic examinations. Eleven parameters were obtained by the tissue dispersion quantitative analysis software. These parameters were compared between groups and among subgroups by ANOVA. The correlation between all the parameters and the course of SAT were analyzed by Spearman and Multiple linear regression methods. Results Between groups and among subgroups, the complexity (COMP) and correlation (CORR) were not statistically different(all P>0.05). Differences of kurtosis (KURT) and angular secon moment (ASM) among the three subgroups were not significant (all P>0.05). Differences between groups and among subgroups were significantly different among the value of all the other seven indexes (all P<0.01). Moreover, they were all correlated with the clinical staging, with the highest coefficient in area ration of low-strain region (%AREA)(r=-0.881). Regression model was constructed and only %AREA was selected into the regression equation. ROC curves were constructed to estimate the clinic value of %AREA in staging patients of SAT, the areas under ROC curves were 0.986(group Ⅰ vs group Ⅱ-Ⅲ) and 0.988 (group Ⅰ-Ⅱ vs group Ⅲ) for %AREA, respectively. Conclusions The tissue dispersion quantitative analysis technique is helpful in estimating the stiffness of thyroid in patients with SAT. Key words: Ultrasonography; Thyroiditis, subacute; Tissue dispersion quantitative analysis technique

Improvement of diagnostic efficiency in distinguishing the benign and malignant thyroid nodules via conventional ultrasound combined with ultrasound contrast and elastography.

We aimed to evaluate the diagnostic values of conventional ultrasound (US), ultrasound contrast (UC) and ultrasound elastography (UE) in distinguishing the benign and malignant thyroid nodules. A total of 100 patients with thyroid nodules receiving operative treatment were selected; they underwent the conventional US, UE and UC examinations before operation, respectively. The nodules received pathological examination after operation to distinguish benign from malignant lesions. The sensitivity, specificity and diagnostic accordance rate of each diagnostic method was evaluated by receiver operating characteristic (ROC) curve, and the area under the curve (AUC) of ROC was calculated. The manifestations of malignant thyroid nodules in conventional US examination were mostly the hypoecho, heterogeneous echo, irregular shape, unclear boundary, aspect ratio <1, microcalcification and irregular peripheral echo halo, and there were statistically significant differences compared with the benign nodules (P<0.05). UE showed that the differences between benign and malignant nodules in 2, 3 and 4 points were statistically significant (P<0.05). The manifestations of malignant nodules in UC were mostly the irregular shape, obscure boundary, no obvious enhancement, heterogeneous enhancement and visible perfusion defects, and there were statistically significant differences compared with the benign nodules (P<0.05). ROC curve showed that both sensitivity and specificity of UE and UC were superior to those of conventional US. AUC was the largest (AUC = 0.908) and the diagnostic value was the highest in the conventional US combined with UE and UC. Conventional US combined with elastography and UC can significantly improve the sensitivity, specificity and accuracy of diagnosis of benign and malignant thyroid nodules.

Calcifications of the parotid space. A review

Parotid lithiasis is the main cause of calcifications in the parotid space. However, there are many other less known causes. The aim of our study was to point out the non-lithiasic causes of calcifications in the parotid space. We conducted an exhaustive review of the literature by mean of PubMed, using the keywords "parotid" and "calcification" and limiting our analysis to the original articles in humans published in English and in French. Articles reporting about microscopic calcifications and who were not dealing with parotid calcifications were excluded. Twenty articles met the inclusion criterions. Tumoral and non-tumoral local causes and systemic causes of parotid calcification were found. The way they revealed was variable. The main tumoral local causes were pleomorphic adenomas, salivary duct carcinomas and adenocarcinomas. The main non-tumoral local causes included vascular malformations and calcified parotid lymph nodes. The main systemic causes were chronic kidney diseases, HIV infection, chronic alcoholism, elevated levels of alkaline phosphatase and auto-immune diseases. Eighteen different etiologies of parotid space calcifications could be identified. First line exploration of these lesions relies mainly on conventional radiography and ultrasound examination that are easily available. CT scan remains the reference examination.

What Help Could Ultrasound Elastography Give to the Diagnosis of Breast Papillary Lesions?

On the basis of results of our previous studies and the findings of other scholars, the most common histologic type of false-positive diagnosis with strain elastography (SE) was papilloma. The objectives of our study were to evaluate whether SE could contribute to conventional ultrasound differentiation between benign and malignant papillary lesions and between papillary lesions and other common benign breast lesions. Data on 89 papillary lesions at our hospital, including 74 benign and 15 malignant papillary lesions, were included in our study. In addition, 198 non-papillary benign tumors were selected as the control group, including 126 fibroadenomas and 72 cases of fibrocystic mastopathy. All patients gave written informed consent. All patients with breast lesions underwent conventional ultrasound and SE examination. Breast Imaging Recording and Data System (BI-RADS) category and SE score were compared with respect to sensitivity, specificity and accuracy in differentiating between benign and malignant papillary lesions. We then explored the possibility of using BI-RADS combined with SE to differentiate papillary lesions from non-papillary benign tumors. For differentiating between benign and malignant papillary lesions, the area under the receiver operating characteristic curve (AUC) of BI-RADS was 0.568, whereas the AUC values of SE score, strain ratio and BI-RADS combined with SE were 0.517, 0.584 and 0.509, respectively (p > 0.05). For differentiating between papillary lesions and non-papillary benign lesions, the AUC of BI-RADS combined with SE was 0.835, which was higher than the values for BI-RADS (0.775) and SE (SE score: 0.648, strain ratio: 0.661) (p < 0.001). The specificity and accuracy of BI-RADS combined with SE were significantly higher than those for BI-RADS alone without a decrease in sensitivity (p < 0.05). SE could not improve the diagnostic efficiency of BI-RADS in differentiating between benign and malignant papillary lesions. However, BI-RADS combined with SE could improve the specificity of BI-RADS without decrease in sensitivity for differentiating breast papillary lesions from non-papillary benign lesions.

Smoking and alcohol use are associated with structural and inflammatory hand osteoarthritis features

Objectives: To explore whether smoking and alcohol use are associated with hand osteoarthritis (OA) features in two different OA cohorts.Method: We studied 530 people with radiographic hand OA from the Musculoskeletal pain in Ullensaker STudy (MUST) and 187 people from the Oslo hand OA cohort [mean (sd) age 65 (8.0) and 62 (5.7) years, 71% and 91% women, respectively]. Smoking, alcohol use and hand pain were self-reported. Participants underwent conventional hand radiographs and ultrasound examination of 30 hand joints. The Kellgren–Lawrence sum score for radiographic OA severity (0–120 scale) and the proportion of participants having at least one joint with grey-scale synovitis (grade ≥1) were calculated. We studied whether smoking and alcohol use were cross-sectionally associated with radiographic OA, synovitis, and pain using adjusted linear and logistic regression analyses.Results: Smoking was associated with less radiographic OA in both cohorts [β = −4.71, 95% confidence interval (CI) −8.36 to −1.06 for current smoking in MUST and β = −0.15, 95% CI −0.29 to −0.02 for smoking pack-years in the Oslo hand OA cohort]. Stratified analyses indicated that the association was present in men only. Being a monthly drinker (examined in MUST only) was significantly associated with present synovitis compared to never drinkers (odds ratio = 2.35, 95% CI 1.27 to 4.34) (no gender differences). Neither smoking nor alcohol was associated with hand pain.Conclusions: Smoking was associated with less radiographic hand OA whereas alcohol consumption was associated with present joint inflammation in hand OA. Future longitudinal studies are needed to explore the causal associations and explanatory mechanisms behind gender differences.

Qualitative and quantitative analysis with a novel shear wave speed imaging for differential diagnosis of breast lesions

To evaluate the diagnostic performance of a new two-dimensional shear wave speed (SWS) imaging (i.e. Toshiba shear wave elastography, T-SWE) in differential diagnosis of breast lesions. 225 pathologically confirmed breast lesions in 218 patients were subject to conventional ultrasound and T-SWE examinations. The mean, standard deviation and ratio of SWS values (m/s) and elastic modulus (KPa) on T-SWE were computed. Besides, the 2D elastic images were classified into four color patterns. The area under the receiver operating characteristic (AUROC) curve analysis was performed to evaluate the diagnostic performance of T-SWE in differentiation of breast lesions. Compared with other quantitative T-SWE parameters, mean value expressed in KPa had the highest AUROC value (AUROC = 0.943), with corresponding cut-off value of 36.1 KPa, sensitivity of 85.1%, specificity of 96.6%, accuracy of 94.2%, PPV of 87.0%, and NPV of 96.1%. The AUROC of qualitative color patterns in this study obtained the best performance (AUROC = 0.957), while the differences were not significant except for that of Eratio expressed in m/s (AUROC = 0.863) (P = 0.03). In summary, qualitative color patterns of T-SWE obtained the best performance in all parameters, while mean stiffness (36.05 KPa) provided the best diagnostic performance in the quantitative parameters.

Role of real-time elastography in assessing the stage of thrombus.

Due to major complication that acute thrombosis can occur, we aim to observe the value of real-time tissue elastography (RTE) in assessing the stage of thrombi. We prospectively analyzed 132 patients with deep venous thrombosis confirmed by clinical symptoms and conventional ultrasound examination. RTE imaging of thrombosis were estimated according Itoh's 5-point scale and we also calculated the strain ratio (reference/clot ratio). Differences in thrombus displacement have been presented as different color maps. In the group of acute thrombosis, 70.9% (39/55) showed red color. In the group of subacute thrombosis, 62.8% (27/43) showed green color. In the group of chronic thrombosis, 67.6% (23/34) showed blue color. The strain ratio of the chronic thrombosis group and the subacute thrombosis group were higher than that of the acute thrombosis group (P<0.001, P<0.05). The strain ratio of the chronic thrombosis group was higher than that of the acute and subacute thrombosis group (P<0.05). RTE has good diagnostic value for assessing the stage of thrombi.