Diagnostic Accuracy Of Ultrasound Research Articles

Factors Influencing the Result of Sonographic Diagnosis of Acute Appendicitis in a Large Hospital in the Netherlands

Objective: Appendicitis is a common surgical emergency, for which sonography is widely used to assess the presence of absence of appendicitis. The objective of this study was to identify factors associated with the diagnostic accuracy of sonography in patients with a suspected case of acute appendicitis. Methods: A retrospective review was conducted in all patients who were assessed for acute appendicitis (with sonography) in two emergency rooms of a large hospital. The sonography result was compared with the pathological report in patients who underwent surgery under suspicion of an acute appendicitis. Results: A multivariate analysis revealed that operator (radiologist or resident), time of the sonogram, site (hospital), and body mass index were independent variables significantly influencing the sonographic result. Correctly diagnosing suspected appendicitis with sonography is 2.2 times more likely when performed by a radiologist compared to a resident. Conclusions: Sonography is widely used in diagnosing appendicitis in the emergency room. In this study, the probability of sonography being correctly diagnosed decreases during on-call hours or when conducted by a resident in patients with suspected appendicitis. Furthermore, increasing body mass index decreases the probability of a sonogram being correct when conducted by a resident compared to a radiologist.

EP34.13: Ultrasound diagnostic accuracy for ovarian borderline tumours in a tertiary centre using IOTA simple rules and ADNEX models

EP34.13: Ultrasound diagnostic accuracy for ovarian borderline tumours in a tertiary centre using IOTA simple rules and ADNEX models

Evaluating the preoperative breast cancer characteristics affecting the accuracy of axillary ultrasound staging

We evaluate the preoperative breast cancer (BC) characteristics that affect the diagnostic accuracy of axillary ultrasound (US) and determine the reliability of US in the different subgroups of BC patients. Axillary US assessments in women with invasive BC diagnosed between 2009 and 2016 in a single institution were retrospectively reviewed. The diagnostic accuracy of axillary US was obtained using surgical nodal histology as the gold standard. Preoperative breast tumor sonographic and histological factors affecting axillary US diagnostic accuracy were examined. Of the 605 newly diagnosed invasive BC cases reviewed, 251 (41.5%) had nodal metastases. Axillary US sensitivity was 75.7%, specificity 92.9%, positive predictive value 88.4%, negative predictive value 84.4%, and false-negative rate 24.3%. Lower US sensitivity was seen with invasive lobular cancer (ILC) (P=.043), grade I/II, (P=.021), unifocal (P=.039), and smaller tumors (P<.001). US specificity was lower in grade III (P<.001), estrogen receptor (ER)-negative (P<.001), progesterone receptor (PR)-negative (P=.004), HER2-positive (P=.015), triple-negative (P=.001), and larger breast tumors (P<.001). US has moderate sensitivity and good specificity in detecting metastatic axillary lymph nodes. Based on preoperative cancer characteristics, US was less sensitive for nodal metastases from ILC, unifocal, lower grade, and smaller breast tumors. It was also less specific in grade III, ER-negative, PR-negative, HER2-positive, triple-negative, and larger breast tumors. Caution is suggested in interpreting the US axillary findings of patients with these preoperative tumor features.

Point of Care Ultrasound in Detection of Brain Hemorrhage and Skull Fracture Following Pediatric Head Trauma; a Diagnostic Accuracy Study.

Head trauma is a common reason for emergency department visits worldwide; many of which involve young children. We sought to determine if head ultrasound (US), as a portable, fast and safe modality, can guide diagnosis and treatment of children in emergency settings. In this cross-sectional study, brain computed tomography (CT) scan and emergency head US were performed on head trauma children who were referred to the emergency departments of Firouzgar and Besat Hospitals, Tehran, Iran, from September 2018 to May 2019. The findings of the two modalities were separately evaluated, and used to estimate the diagnostic accuracy of US. 538 patients with the mean age of 5.6 ± 4.9 (0-18) years were studied (54.8% male). Sensitivity and specificity of bedside US in detection of hemorrhage were 85.71% (42.13%-99.64%) and 97.99% (94.23%-99.58%) for children below the age of 2. These measures were 80.00% (51.91%-95.67%) and 97.97% (94.88%-99.44%), respectively, for those between 2 and 6 years old and 46.67% (21.27%-73.41%) and 92.90% (87.66%-96.40%), respectively, for those above the age of 6. Sensitivity and specificity were 92.31% (84.01%-97.12%) and 95.87% (93.62%-97.50%), respectively, in diagnosing skull fractures. Cohen's kappa coefficient varied greatly for different findings, ranging from 0.363 to 0.825, indicating different agreement rates for each. Based on our findings, emergency US can play a greater role in the initial management of head trauma children, especially as a triage test.

Valvular and/or Non-valvular Aortic Pathology Can Bias the Ultrasonographic Diagnosis of Renal Artery Stenosis

Renal artery stenosis (RAS) has been shown to cause a reduction in the index of maximal systolic acceleration (AImax: the maximal acceleration of flow waveform in early systole divided by the peak systolic velocity) of blood in the renal interlobar arteries, caused by local dampening of the pulse wave. In previous studies, AImax demonstrated diagnostic accuracy in terms of negative predictive value, which is useful for screening, but had a relatively low specificity. We hypothesized that an upstream focal resistance, such as an aortic stenosis or aneurysm, could act in the same way as RAS, thus generating false positives in non-stenotic kidneys. We studied 226 patients who underwent a complete protocol for RAS screening. AImax was 6.2 ± 2.9 s–1 and 13.4 ± 3.5 s–1 (mean ± standard deviation) in stenotic and non-stenotic kidneys, respectively. Diagnostic accuracy of ultrasonography with respect to the benchmark of renal computed tomography or magnetic resonance angiography (significant RAS cutoff ≥50%) resulted in 97% sensitivity, 94% specificity and a negative and positive predictive value of 99% and 55%, respectively. Using logistic regression for unexpectedly low AImax in non-stenotic kidneys (AImax cutoff ≤ 9.0 s–1), aortic pathology, such as aortic valve stenosis or aortic arch dilation (as assessed by echocardiography), was found to be the only significant predictor (Χ2 = 33.8, p < 0.0001) of false positive cases compared with clinical and hemodynamic variables. We concluded that the aortic valvular and non-valvular pathology can act as a proximal resistance that can attenuate the Doppler flowmetric parameters, which explore the flow waveform in the renal parenchymal arterial circulation, thus mimicking the presence of a focal resistance in the peripheral vascular region explored.

Diagnostic Accuracy of Ultrasonography in Diagnosis of Metatarsal Bone Fracture; a Cross Sectional Study.

Metatarsus is one of the most common sites in the sole of foot bones fractures. The aim of this study was to determine the diagnostic accuracy of ultrasound in diagnosis of metatarsal bone fractures following foot trauma. This cross-sectional study was carried out on patients with blunt foot trauma admitted to emergency department of a hospital in Mashhad, Iran from January to September 2016. All patients were evaluated with bedside ultrasound for the presence of first to fifth metatarsal fractures and screening performance characteristics of ultrasonography in detection of metatarsal fractures were calculated considering foot radiography as the reference test. The study was conducted on 102 patients with a mean age of 35.14±14.32 years (56.8% male). The most common signs of trauma in physical examination were pain and tenderness (100%), swelling (96.1%), ecchymosis (14.7%) and deformity (1.9%). Sensitivity, specificity, and positive and negative likelihood ratio of ultrasonography in detection of metatarsal bone fracture were 96.7% (95% CI: 0.83-0.99), 84.5% (95% CI: 0.73-0.92), 73.1% (95% CI: 0.57-0.85), and 98.3% (95% CI: 0.91-0.99), respectively. The overall accuracy of ultrasonography was 0.906 (95% CI: 0.844 - 0.969) based on area under the receiver operating characteristic (ROC) curve. Considering the excellent diagnostic accuracy, ultrasonography can be used as an alternative means in diagnosis of metatarsal bone fractures.

Diagnostic Accuracy of Ultrasound in the Diagnosis of Small Bowel Obstruction.

Introduction: Small bowel obstruction (SBO) is a common presentation to the Emergency Department (ED). This study aimed to analyze the accuracy of ultrasound (US) in diagnosing and staging SBO. Objectives: The main object of this study was to analyze the accuracy of ultrasound in diagnosing and staging SBO compared to CT. Methods: Retrospectively, stable patients with an ultrasonographic diagnosis of SBO who underwent abdominal CT immediately after US and before receiving naso-intestinal decompression, were included. US criteria for the diagnosis of SBO were related to morphological and functional findings. US diagnosis of obstruction was made if fluid-filled dilated small bowel loops were detected, peristalsis was abnormal and parietal abnormalities were present. Morphologic and functional sonographic findings were assigned to three categories: simple SBO, compensated SBO and decompensated SBO. US findings were compared with the results of CT examinations: Morphologic CT findings (divided into loop, vascular, mesenteric and peritoneal signs) allowed the classification of SBO in simple, decompensated and complicated. Results: US diagnostic accuracy rates in relation to CT results were calculated: ultrasound compared to CT imaging, had a sensitivity of 92.31% (95% CI, 74.87% to 99.05%) and a specificity of 94.12% (95% CI, 71.31% to 99.85%) in the diagnosis of SBO. Conclusions: This study, similarly to the existing literature, suggests that ultrasound is highly accurate in the diagnosis of SBO, and that the most valuable sonographic signs are the presence of dilated bowel loops ad abnormal peristalsis.

Imaging Surveillance of Invasive Bladder Cancer with Bladder Preservation

Purposes: To evaluate the diagnostic accuracy of abdominopelvic ultrasound (US), virtual cystoscopy (VC) and MRI diffusion (MRI DWI) with conventional cystoscopy (CC), in the detection and characterization of bladder lesions after transurethral resection (TURT). Methods: Forty-five patients with a history of high-grade T1 or T2-T4a bladder cancer who underwent TURT and received chemoradiation schedule. They were followed-up by serial cystoscopies. Before each cystoscopy, the patients underwent bladder ultrasound, CT-based virtual cystoscopy, and diffusion-weighted MRI. The results of these three non-invasive modalities are compared with those of cystoscopy and with histological findings obtained by (repeat) transurethral resection. Sensitivity, specificity, positive and negative predictive values, and accuracy were calculated and compared to CC and histopathology as the gold standard. Results: After median 24 months of follow up, US, CT VC, and MRI DWI detected 23,28 and 29 lesions respectively of the 30 lesions detected at CC. pathology confirmed local recurrence in 18 lesions (40%) and benign changes in 12 lesions (27%), while remaining 15 patients were negative. Eighteen lesions (60 %) were larger than 1 cm, twenty-three lesions showed polypoidal morphology (77 %). The diagnostic accuracy of US, CT VC, MRI DWI was 73%, 93%, and 93 % respectively. (P>0.10). MRI DWI had highest NPV of 93%. Conclusion: Imaging surveillance in bladder cancer preservation should include MRI DWI as part of the surveillance programme to reduce the frequency of cystoscopy. MRI and CT VC were of comparable accuracy, US had the lowest sensitivity, however, it is still can be used as the first step of surveillance. Funding Statement: No funding received. Declaration of Interests: Authors declare no conflict of interest. Ethics Approval Statement: Written consent was taken from patients participating in the study. The study protocol was approved by the local institutional review board (IRB:IORG0006563)

Diagnostic Accuracy of Ultrasound for the Directionality of Testicular Rotation and the Degree of Spermatic Cord Twist in Pediatric Patients With Testicular Torsion.

To evaluate the diagnostic accuracy of ultrasound (US) to diagnose the directionality of testicular rotation and the degree of spermatic cord twist in pediatric patients with testicular torsion. A retrospective review of 14 pediatric patients with testicular torsion was conducted. The directionality of testicular rotation was classified as an inner or outer direction (inner, counterclockwise in the left testis [viewed from below] and clockwise in the right testis; and outer, counterclockwise in the right testis and clockwise in the left testis). The Clopper-Pearson method and the Fisher exact, Mann-Whitney U, and Wilcoxon signed rank sum tests were used for the statistical analyses. The diagnostic accuracy of US in the directionality of testicular rotation and the degree of spermatic cord twist were 78.6% (11 of 14; 95% confidence interval, 49.2%-95.3%) and 36.4% (4 of 11; 95% confidence interval, 10.9%-69.2%), respectively. Outer rotation was seen in 50.0% of the cases. The directionality of testicular rotation and the degree of spermatic cord twist as determined by US were not significantly different between the patients with salvaged testis and those with testicular loss (inner/outer direction, 4/2 versus 4/4; P = .627; mean twist ± SD, 330.0° ± 73.5° versus 337.5° ± 115.4°; P > .999). There was no significant difference in the degree of spermatic cord twist determined by US and surgical results (343.0° ± 97.1° versus 458.2° ± 168.2°; P = .063). The accuracy of US in determining the directionality of testicular rotation was relatively high in our small cohort. This information may be useful for pediatric surgeons and urologists when performing early manual reduction for testicular torsion.

Diagnostic accuracy of ultrasound vs. MRI in evaluation of rotator cuff injuries

Background: Rotator cuff pathology accounts for 10% causes of shoulder pain. A gamut of imaging techniques comprising of ultrasonography (USG), Magnetic Resonance Imaging (MRI) and MR arthrography (MRA) have been commonly used for the characterisation of rotator cuff (RC) disorders. With the advent of high-end USG machines, accuracy rates of USG is comparable to that of MRI in evaluation of rotator cuff pathologies. Materials and Methods: 50patients who had presented with symptoms of rotator cuff injuries and were referred to Department of Radiodiagnosis JSS Medical College and Hospital, Mysuru during the period August 2017 to September 2019 for Ultrasound and MRI of the shoulder. Results: Diagnostic accuracy of USG in correlation to MRI showed 93% sensitivity and 97% specificity for supraspinatus, 88% sensitivity and 96% specificity for detecting the infraspinatus tears; 74% sensitivity and 86%specificity for subscapularis indicating detection of supraspinatus was comparatively easier than subscapularis in ultrasound. Conclusion: MRI was more superior and sensitive tool than ultrasound in detecting and delineating the musculoskeletal injury in terms of grading the partial tear & tendinopathy, however accuracy of ultrasound in initial evaluation of rotator cuff injuries is comparable to MRI. Anatomical delineation of the rotator cuff injury which is of prime value for treating surgeon is better visualized by MRI.

Comparison of Mammography and Ultrasonography in Evaluation of Breast Masses

Introduction: Breast cancer is the most common cancer and second leading cause of cancer deaths in women. Early detection, efficient and accurate diagnosis can reduce the mortality rate.&#x0D; Objectives: To compare the screening accuracy of mammography (MMG) and ultrasonography (USG) in suspected cases of breast masses.&#x0D; Material and Methods: This cross-sectional analytical study was carried out in the Department of Radiology and Imaging, Combined Military Hospital, Dhaka from June 2016 to July 2017. A total of 100 clinically suspected case of breast masses aged from 20 to 75 years referred for MMG and USG was selected. Each patient underwent USG and MMG followed by a histopathological examination of the biopsy material taken from the lump lesion. Two cases histopathological report was not found. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of USG and MMG were compared with histopathology as the gold standard. In order to determine the agreement of diagnoses between USG and MMG, consistency analysis was performed using Kappa-statistics.&#x0D; Results: Sensitivity, specificity, PPV, NPV and diagnostic accuracy of USG was 58.8%, 98.4%, 77.8%, 85.0% and 83.6% and for MMG 92.0%, 84.5%, 67.6%, 96.8% and 84.7% respectively. Kappa-statistics shows that the two diagnostic modalities had a test agreement in 39.8% cases to differentiate malignant breast tumour from the benign one (k-value = 0.398, p &gt; 0.05).&#x0D; Conclusion: Two diagnostic modalities USG and MMG had a fair agreement in the differentiation of malignant breast tumour from the benign.&#x0D; Journal of Armed Forces Medical College Bangladesh Vol.13(2) 2017: 22-24

OR27-3 A Novel Risk Stratification System for Thyroid Nodules with Indeterminate Cytology: A Pilot Cohort Study

Background Thyroid ultrasound (US) and US-guided fine needle aspiration biopsy (FNAB) have been widely used to stratify the risk of malignancy in thyroid nodules (TN). Cytology material characterized as category III and IV by the Bethesda System for Reporting Thyroid Cytopathology is associated with thyroid cancer (TC) risk ranging between 5-30%. The use of molecular markers may help defining the management strategy in these indeterminate nodules. The goal of this study was to create a risk stratification system based on US features and the results of molecular profiling of cytologically indeterminate TN and to assess its diagnostic accuracy. Methods We performed a cohort study including patients with TN who underwent thyroid US and FNAB revealing indeterminate cytology (Bethesda III, IV). Final pathology diagnosis was available for all patients. DNA and RNA were extracted from pathology material and subjected to Ion Torrent™ Oncomine™ Comprehensive Assay v3 (OCAv3) next-generation sequencing, analyzing single nucleotide variants (SNV), small insertions and deletions (INDEL), copy number variants (CNV) and gene fusions (GF) from 161 cancer driver genes. Each genetic alteration was annotated (X) based on its strength of association with TC per TCGA and COSMIC database. US features of TN were similarly categorized (Xus) by two independent clinicians, blinded to pathology report. The total risk score (TRS) was estimated based on the following formula TRS= (XSNV/INDEL)*n + XGF + XCNV + XUS , where X is the annotated score and n is the number of SNVs/INDELs. ROC curve was performed to assess the diagnostic accuracy of US alone, OCAv3 alone and TRS. Results We analyzed 84 TN in 50 patients (39 females and 11 males), age 47.2 ± 14.8 years. Thirty-four patients (68%) were diagnosed with TC: 21 papillary (PTC), 6 follicular variant of PTC (FVPTC), 1 noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), 2 Hürthle cell (HTC), 1 poorly differentiated carcinoma (PD) and 3 medullary TC (MTC). The molecular signature revealed the BRAF V600E mutation as the most common in PTC, while KRAS and NRAS mutations were associated with FVPTC. A NIFTP showed a PAX8-PPARG fusion. HTC had pathogenic variants of SLX4, ATM and NRAS genes, PD was associated with HRAS mutation, and MTC with RET pathogenic variants. Benign lesions were characterized by either no mutations or the presence of GNAS, HRAS, NRAS and ESR1 variants. The diagnostic accuracy of US alone was 68% (sensitivity 41.2%, specificity 93.8%), while for OCAv3 alone it was 79% (sensitivity 65%, specificity 93.8%). TRS was associated with the highest diagnostic accuracy of 83.5% (sensitivity 79.4%, specificity 88%). Conclusions Combining risk stratification based on thyroid US and molecular signature improves diagnostic accuracy of TC in patients with indeterminate TN. Our pilot study requires validation in independent larger cohorts.

Correlations of neck ultrasound and pathology in cervical lymph node of papillary thyroid carcinoma

Background: High-resolution sonography is becoming a method of choice for the detection and diagnosis of cervical lymph node metastasis in patients with papillary thyroid carcinoma (PTC). The purpose of this study is to assess the diagnostic accuracy of neck ultrasound (US) in the detection of lymph node metastases from PTC.Methods: Data for all patients with papillary thyroid cancers and preoperative neck US were reviewed retrospectively. The diagnostic accuracy of US was determined according to whether histologically confirmed cancer was present in surgical cervical lymph node specimens.Results: A total of 206 patients (149 central and 57 central and lateral lymph nodes dissection) were included. Their mean age was 56 years (14–88 years). Central and lateral lymph nodes were involved in 68% (n = 141 patients; 141/206) and 60% (n = 34 patients; 34/57) of cases, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of US in predicting papillary thyroid carcinoma (PTC) metastasis in the central neck were 69%, 71%, 84% and 51% respectively, and in the lateral neck were 85%, 65%, 78% and 75% respectively.Conclusions: Preoperative neck US is a valuable tool in the detection of cervical lymph node metastases from papillary thyroid cancer and can provide reliable information to assist in surgical management.

Ultrasound vs Endoscopy, Surgery, or Pathology for the Diagnosis of Small Bowel Crohn's Disease and its Complications.

In patients with inflammatory bowel disease, we strive to achieve mucosal healing, as this has been shown to decrease the risk of disease flares, hospitalization, and surgery. For this reason, we must use objective measures of mucosal healing to inform our clinical decision-making and can no longer rely on patient symptoms alone. Assessment of small bowel Crohn's disease (SBCD) is particularly challenging given its lack of accessibility via standard endoscopic techniques. Ultrasound (US) represents a readily available, cost-effective, minimally invasive, radiation-free alternative for the assessment of small bowel disease. In this study, we performed a systematic review to determine the accuracy of ultrasound in diagnosing SBCD and its complications as compared with endoscopic visualization, surgery, and/or pathology. We searched MEDLINE, EMBASE, and CENTRAL. Prospective cohort studies published up to March 2017 were reviewed. References meeting all eligibility criteria were assessed at the full-text level by 2 independent reviewers. Sensitivity and specificity were collected where available. A total of 2817 unique references were identified. Twenty-two studies were included. All studies were at low-moderate risk of bias based on the Quality Assessment of Diagnostic Accuracy Studies criteria. Transabdominal US (TAUS) yielded moderately high sensitivity and specificity for the diagnosis of SBCD and its postoperative recurrence. Detection was more accurate for severe postoperative recurrence. The diagnostic accuracy of US in stricture and abscess detection was high. Contrast enhancement improved the detection of abscess. Diagnostic detection of fistulas was of moderate accuracy. Entero-enteric fistulization and entero-mesenteric fistulization were most clearly identified. Ultrasound can be used to diagnose SBCD in those with known or suspected Crohn's disease. It can be used to detect postoperative recurrence and can accurately identify abscesses and fistulas, especially with the aid of contrast enhancement.

Contrast-enhanced ultrasound of hepatocellular carcinoma: where do we stand?

Contrast-enhanced ultrasound (CEUS) represents a significant breakthrough in ultrasonography (US), and it is being increasingly used for the evaluation of focal liver lesions (FLLs). CEUS is unique in that it allows non-invasive assessment of liver perfusion in real time throughout the vascular phase, which has led to dramatic improvements in the diagnostic accuracy of US in the detection and characterization of FLLs, the choice of therapeutic procedures, and the evaluation of response. Currently, CEUS is included as a part of the suggested diagnostic work-up of FLLs, including in cirrhotic patients with hepatocellular carcinoma, resulting in better patient management and cost-effective delivery of therapy.

Sonoelastographic Evaluation of Uterine Fibroids – Our Initial Experience

Context: Real-time elastography is a novel and dynamic imaging technique that is based on the softness or hardness of tissues or organs of interest under the appropriate compression and can be used with conventional ultrasonography(US) probes after performing grayscale imaging and Doppler US. Aims: It was to find out the diagnostic ability of sonoelastography in evaluation of uterine fibroids and whether evaluation with computed tomography (CT) or magnetic resonance imaging (MRI) can be avoided. Subjects and Methods: A prospective study was conducted from August 2017 to August 2018. A total of 87 females were included and underwent sonographic examination and a diagnosis was made, and later, elastogram was obtained and strain ratios were calculated and the final diagnosis was compared to histopathological diagnoses to evaluate the diagnostic accuracy of ultrasound with and without elastography. Statistical Analysis Used:Statistical analysis was done using descriptive and inferential statistics using Chi-square test, Student's unpaired test, sensitivity, and specificity, and software used in the analysis was SPSS 22.0 version and GrafhPad Prism 6.0 version. Results: Out of the total 87 patients, 10 cases were misdiagnosed on ultrasonography compared to 7 on elastography, of which the major pathology was adenomyosis and 1 case submucosal fibroid. Sensitivity, specificity, and diagnostic accuracy of ultrasound were found to be 90.28%, 80%, and 88.5%, respectively. Sensitivity, specificity, and diagnostic accuracy of sonography with elastography were 93.06%, 86.67%, and 91.95%, respectively, showing better results. Conclusions: Sonography coupled with elastography showed better results and can be used to avoid dependency on CT and MRI avoiding radiation exposures and increase cost, especially in a developing country such as India.

Evaluation of oral and maxillofacial swellings using ultrasonographic features.

PurposeThe aim of this study was to evaluate the characteristic features of oral and maxillofacial swellings that could be seen on ultrasonographic examinations.Materials and MethodsFifty patients with oral and/or maxillofacial swellings were randomly selected, thorough case histories and clinical examinations were done, ultrasonographic examinations with Doppler imaging were performed, and the features of every group were studied. Finally, histopathological evaluations were performed to identify the final diagnosis, according to which patients were classified into 5 groups; group I: inflammatory/space infection and abscess swellings, group II: cystic swellings, group III: lymph node swellings, group IV: benign swellings, and group V: malignant neoplastic swellings.ResultsA significant association (P<0.05), with a contingency coefficient of 0.88, was found between the histopathological and ultrasonographic diagnoses, with ultrasonography having a diagnostic accuracy of 89% in diagnosing maxillofacial swellings. The diagnostic accuracy of ultrasonography was 100% for lymph node and malignant swellings, followed by 98% for inflammatory and cystic swellings and 92% for benign swellings. The sensitivity of the ultrasonographic diagnosis was 100% for cystic, lymph node, and malignant swellings, followed by 91% for inflammatory swellings and 86% for benign swellings.ConclusionUltrasonographic features with Doppler imaging greatly aid in obtaining accurate diagnoses of oral and maxillofacial swellings. Ultrasonography is a recommended imaging tool for differentiating maxillofacial swellings and classifying them accurately.

Role of sonoelastography in diagnosing endometrial lesions: Our initial experience

Context: Real-time elastography is a novel and dynamic imaging technique that is based on the softness or hardness of tissues or organs of interest under the appropriate compression and can be used with conventional ultrasonography (USG) probes after performing grayscale imaging and Doppler USG. Aims: The aim was to analyze the role of sonoelastography in diagnosing endometrial lesions. Subjects and Methods: A prospective study was conducted from August 2016 to 2018. 30 females were included who underwent sonographic examination. Diagnoses were made and later elastograms were obtained. Strain ratios were calculated and the final diagnosis was compared to histopathological diagnoses to evaluate the role of sonoelastography in diagnosing endometrial pathologies. Statistical Analysis Used: Statistical analysis was done be using descriptive and inferential statistic's using chi square test, students unpaired test, sensitivity and specificity and software used in the analysis were SPSS 22.0 version and graft pad prism 6.0 version. Results: Of the total 30 patients, 5 cases were misdiagnosed on USG compared to 1 on elastography which was of atypical endometrial hyperplasia. Sensitivity, specificity, and diagnostic accuracy of ultrasound were found to be 90.28%, 80%, and 88.5%, respectively. Sensitivity, specificity, and diagnostic accuracy of sonography with elastography were 93.06%, 86.67%, and 91.95%, respectively, showing better results. Conclusions: Sonography coupled with elastography showed better results and can be used to avoid dependency on computed tomography and magnetic resonance imaging avoiding radiation exposures and high cost, especially in a developing country like India, or unnecessary surgical interventions can also be avoided.

Accuracy of ultrasonography in the evaluation of abdominal masses in children in Nigeria.

Introduction:Abdominal masses in children constitute a spectrum of lesions of diverse origin, nature and significance. In a low-income setting with limited investigative facilities, accurate diagnosis of abdominal masses can be very challenging. However, ultrasound has been used preferentially as a diagnostic tool in evaluating abdominal masses in children. This study aimed to determine the accuracy of ultrasound evaluation of abdominal masses in children.Materials and Methods:This was a prospective descriptive study of 135 consecutive children presenting with palpable and/or suspected abdominal masses over a 1-year period at a tertiary hospital. Data analyses were done using SPSS version 17 software and level of significance was set at P < 0.05.Results:Abdominal mass was located in the kidney in 40 (32.3%) patients. Definitive diagnoses of abdominal masses were confirmed intraoperatively in 33 (24.4%) and by histopathological examination in 102 (75.6%) cases. Abdominal masses were detected in 124/135 (91.9%) of the participants. Ultrasound (US) correctly identified 109/124 (87.9%) of the pathologies. The sensitivity and specificity of USS were 87.9% and 81.8%, respectively. Positive predictive value (PPV) and negative predictive value (NPV) were 97.2%–98.2% and 37.5%–45.7%, respectively. The overall US diagnostic accuracy was 87.4%. The predictive value of US for intussusceptions, Wilms' tumour and hydronephrosis was high (sensitivity was 92.0%, 95.8% and 81.1% and PPV was 90.0%, 83.0% and 93.8%, respectively). On the other hand, the sensitivity indices for appendiceal mass/abscess, lymphoma and neuroblastoma were low (28.6%, 66.7% and 57.1%, respectively), while their PPV was low too (66.7%, 42.9% and 77.7%, respectively). The PPV was especially poor for lymphoma. The specificity and NPV indices for these six disease conditions were good.Conclusion:Ultrasound is a reliable tool in the evaluation of abdominal masses in children in this setting.

The Potential Role of Ultrasound in the Work-up of Appendicitis in the Emergency Department

BackgroundAcute appendicitis is common in the adult emergency department (ED). Computed tomography (CT) scan is frequently used to diagnose this condition, but ultrasound (US)—commonly used in pediatric diagnosis—may also have a role. ObjectivesReview the clinical utility and define the frequency and diagnostic accuracy of US to diagnose appendicitis in an adult population in the ED setting. MethodsRetrospective cohort study of patients who underwent appendiceal US in an academic, tertiary ED from July 2013–October 2015. ResultsThere were 174 patients included, of which 39 (22%) had pathology-confirmed appendicitis. There were 25 patients who had an US scan that was positive for appendicitis, 146 (84%) were indeterminate, and 3 (1.7%) were negative. Among patients with a positive US, 25/25 (100%, 95% confidence interval [CI] 84–100%) had appendicitis, 32/146 (22%, 95% CI 16–29%) with an indeterminate US had appendicitis, and 0/3 (0%, 95% CI 0–6.2%) with a negative US had appendicitis. In the 28 definitive cases, US had a sensitivity of 64%, specificity of 2%, positive predictive value of 100%, and negative predictive value of 100%. The likelihood ratio positive and negative were 173 and 0, respectively. ConclusionOur initial data suggest that an US that shows appendicitis seems to be reliable; however, a high prevalence of indeterminate studies limits the diagnostic utility as a universal approach in adult patients in the ED setting. Larger studies are needed to identify which patient populations would benefit from US as the initial imaging modality, what factors contribute to the large numbers of indeterminate results, and if any interventions may reduce the number of indeterminate results.