Diagnostic Efficacy Of Ultrasound Research Articles

WITHDRAWN: Detection of myofascial trigger points in the masseter muscle using ultrasonography in patients with myogenous temporomandibular disorder

We aimed to investigate the diagnostic efficacy of ultrasonography (US) using gray scale B-mode and ultrasound elastography (UE) in detecting myofascial trigger points (MTPs) in the masseter muscles of patients with myogenous temporomandibular disorder (TMD). A diagnostic cross-sectional study of patients with MTPs in the masseter muscles using US was conducted. The diagnostic results from the US examinations were compared with the clinical examination reference standard to determine the diagnostic efficacy of US. MTPs were detected as band-like hypoechoic localized areas with reduced vibration amplitude (stiffer) under US B-mode and UE imaging. In total, 116 sites from 29 patients (3 males, 26 females) with a mean age of 39.4 years were examined. US exhibited sensitivity of .946 (95% CI: .851-.989) and specificity of .900 (95% CI: .795-.962) in detecting MTPs when compared to the clinical examination. Diagnostic accuracy ranged from .902 to .950 when assuming 3 levels of myogenous TMD prevalence. US B-mode and UE imaging exhibited diagnostic accuracy comparable to the standard clinical examination carried out by a trained specialist. It can be a reliable technique in the detection and localization of MTPs for the diagnosis of myogenous TMD and localization of MTPs for therapeutic purposes.

EVALUATION OF DIAGNOSTIC EFFICACY OF ULTRASONOGRAPHY AND COMPUTED TOMOGRAPHY IN NECK MASSES

INTRODUCTION A neck mass can be frequently seen in clinical practice. The close proximity of various structures in the neck creates a diagnostic problem. The precise anatomical location and imaging appearances are important for accurate diagnosis and formulating the differential diagnoses of neck masses. The present study was undertaken to evaluate diagnostic efficacy of ultrasonography and computed tomography in neck masses. AIM To assess the efficacy of Ultrasonography and Computed Tomography in the evaluation of neck masses. MATERIAL AND METHODS This study was conducted in the department of E.N.T. in co-ordination with the department of Radiodiagnosis, Oncology and Pathology at LLR & Associated Hospital, GSVM, Medical College, Kanpur.Total number of patients included were 50. RESULT Of the 50 patients of age group 3-70 years who presented with neck masses, majority of patients belonged to 20-30 years of age group (10 patients , 20% ) with male dominance 62% ( 31 out of 50 patients).Maximum number of neck swelling were of lymph node origin14(28%). Out of those lymph nodes maximum were malignant. Out of the non nodal masses 36(72%), maximum were benign. CONCLUSION High resolution sonography and color Doppler is a useful modality for diagnostic evaluation of neck masses in every age group. It is simple, noninvasive and inexpensive diagnostic tool. CT ensures accurate anatomical localization and lesion characterization in benign lesions. In malignant tumors, it is useful for staging and provides essential information about the tumor extent that directly affects the surgical approach necessary for curative resection. Ke y w o r d s : U l t r a s o n o g r a p h y, C o m p u t e d Tomography, Neck Masses

Malignant and Benign Peripheral Nerve Sheath Tumors in a Single Center: Value of Clinical and Ultrasound Features for the Diagnosis of Malignant Peripheral Nerve Sheath Tumor Compared With Magnetic Resonance Imaging.

This study aimed to investigate the combined use of ultrasonography and clinical features for the differentiation of malignant peripheral nerve sheath tumors (MPNST) from benign peripheral nerve sheath tumors (BPNST) and to compare the efficacy of ultrasonography with that of magnetic resonance imaging (MRI). This retrospective study included 28 MPNSTs and a control group of 57 BPNSTs. All patients underwent an ultrasound scan using the Logiq E9 (GE Health Care, Milwaukee, WI) or EPIQ7 equipment (Philips Medical System, Bothell, WA). A 3.0-T MRI machine (Ingenia; Philips Healthcare, Best, the Netherlands) was used for scanning, and conventional MRI was performed on different regions based on the patient's clinical situation. The following variables were evaluated: palpable mass, pain, nerve symptoms, maximum diameter, location, shape, boundary, encapsulation, echogenicity, echo homogeneity, presence of a cystic component, calcification, target sign, posterior echo, and intertumoral vascularity of the tumors. The diagnostic efficacy of ultrasonography and clinical factors was compared with that of MRI. Independent factors for predicting MPNST versus BPNST were also assessed. The parameters of location, shape, boundary, encapsulation, and vascularity were significantly different between MPNSTs and BPNSTs. Multiple logistic regression analysis showed that shape, boundary, and vascularity were independent predictors of MPNSTs. The sensitivity, specificity, and Youden index of the three clinical and ultrasound factors (shape, boundary, and vascularity) were 0.89, 0.81, and 0.69, respectively, whereas those of MRI were 0.71, 0.89, and 0.61, respectively. No significant differences in the area under the curve (AUC) of the three combined clinical and ultrasound factors and those of MRI were found (P > .05). MRI was useful in the differential diagnosis between MPNSTs and BPNSTs. However, the combination of clinical and ultrasound diagnoses can achieve the same effect as MRI, including shape, boundary, and vasculature.

Diagnostic Efficacy of Ultrasonography, Doppler Ultrasonography and Elastography in the Evaluation of Suspected Malignant Lymph Nodes.

In this prospective study, the efficiency of imaging findings was investigated by comparing the histopathological results of lymph nodes with Doppler and ultrasound features and elasticity scores. A total of 100 cervical or axillary lymph nodes with a suspected malignancy or whose size did not decrease after treatment were examined. In addition to the demographic data of the patients, B-mode ultrasound, Doppler ultrasound, and elastography features of the lymph nodes were evaluated prospectively. The irregular shape, increased size, pronounced hypoechogenicity, presence of micro/macro calcification, short axis/long axis ratio >2, increased size of the short axis, increased cortex thickness, obliterated hilus or increased cortex thickness >3.5 mm were evaluated on ultrasound. Resistivity index, pulsatility index, acceleration rate and time were evaluated for intranodal arterial structures on color. Doppler ultrasound, strain ratio value and elasticity score were recorded on ultrasound elastography. After sonographic examination, patients underwent ultrasound-guided fine needle aspiration cytology or tru-cutting needle biopsy. Histopathological examination results of the patients were compared with the B-mode ultrasound, Doppler ultrasound, and ultrasound elastography. When the individual and combined effects of the ultrasound, Doppler ultrasound, and ultrasound elastography were evaluated, the combination of all three imaging methods was found to have the highest sensitivity and the highest overall accuracy (90.4% and 73.9%). As an individual method Doppler ultrasound had the highest specificity (77.8%). B-mode ultrasound was found to have the lowest accuracy (56.7%) both in individual and combined evaluations. Addition of ultrasound elastography to the combination of B-mode and Doppler ultrasound findings increases diagnostic sensitivity and accuracy in the differentiation of benign and malignant lymph nodes.

Evaluation of diagnostic efficacy of multimode ultrasound in BI-RADS 4 breast neoplasms and establishment of a predictive model.

To explore the diagnostic efficacy of ultrasound (US), two-dimensional and three-dimensional shear-wave elastography (2D-SWE and 3D-SWE), and contrast-enhanced ultrasound (CEUS) in breast neoplasms in category 4 based on the Breast Imaging Reporting and Data System (BI-RADS) from the American College of Radiology (ACR) and to develop a risk-prediction nomogram based on the optimal combination to provide a reference for the clinical management of BI-RADS 4 breast neoplasms. From September 2021 to April 2022, a total of 104 breast neoplasms categorized as BI-RADS 4 by US were included in this prospective study. There were 78 breast neoplasms randomly assigned to the training cohort; the area under the receiver-operating characteristic curve (AUC), 95% confidence interval (95% CI), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 2D-SWE, 3D-SWE, CEUS, and their combination were analyzed and compared. The optimal combination was selected to develop a risk-prediction nomogram. The performance of the nomogram was assessed by a validation cohort of 26 neoplasms. Of the 78 neoplasms in the training cohort, 16 were malignant and 62 were benign. Among the 26 neoplasms in the validation cohort, 6 were malignant and 20 were benign. The AUC values of 2D-SWE, 3D-SWE, and CEUS were not significantly different. After a comparison of the different combinations, 2D-SWE+CEUS showed the optimal performance. Least absolute shrinkage and selection operator (LASSO) regression was used to filter the variables in this combination, and the variables included Emax, Eratio, enhancement mode, perfusion defect, and area ratio. Then, a risk-prediction nomogram with BI-RADS was built. The performance of the nomogram was better than that of the radiologists in the training cohort (AUC: 0.974 vs. 0.863). In the validation cohort, there was no significant difference in diagnostic accuracy between the nomogram and the experienced radiologists (AUC: 0.946 vs. 0.842). US, 2D-SWE, 3D-SWE, CEUS, and their combination could improve the diagnostic efficiency of BI-RADS 4 breast neoplasms. The diagnostic efficacy of US+3D-SWE was not better than US+2D-SWE. US+2D-SWE+CEUS showed the optimal diagnostic performance. The nomogram based on US+2D-SWE+CEUS performs well.

Real-World Evidence on the Sensitivity of Preoperative Ultrasound in Evaluating Central Lymph Node Metastasis of Papillary Thyroid Carcinoma.

IntroductionGuidelines for prophylactic dissection in clinical central negative node (cN0) of papillary thyroid carcinoma vary among different countries due to the uncertainty on the benefit of dissection. The Chinese guidelines recommend prophylactic central compartment lymph node dissection (pCLND) under professional technology. Preoperative ultrasound (US) evaluation of central lymph node determines the surgical strategy used. Sensitivity differs significantly when US is conducted by different physicians even in diverse hospitals. In this study, the aim was to explore why the Chinese guidelines were different from the America Thyroid Association (ATA) guidelines through the real-world evidence on the preoperative diagnosis of cN0.MethodsPreoperative US and surgical pathology data for 1,015 patients with PTC attending 13 Grade-A tertiary hospitals in 2017 were collected. A retrospective analysis using US assessment of CLNM was the conducted to explore the benefits of this approach in China. US physicians in our hospital were trained on scanning the thyroid gland and its regional lymph nodes in normalization. Data of 1,776 patients were collected under the same condition from 2012 to 2017, whose ultrasonography was performed by diverse physicians and doctors. Further, data of 339 patients evaluated by the same sonographer and operated by the same surgical team was collected between 2015 and 2017. In this set of data, US combined CT versus US alone was compared. Patients were grouped into metastasis group and non-metastasis group based on postoperative pathological diagnosis of CLNM. Diagnostic efficacy of US was evaluated.ResultsA total of 925 patients who underwent preoperative ultrasonography in central lymph node, including 825 cases who underwent thyroidectomy and central lymph node dissection were included in this study. The sensitivity of ultrasonography in detecting CLNM was 23.18%, with occult metastasis rate of 40.8%. Data for 1,776 patients comprising paired ultrasonic report and pathological report were collected in our hospital, whose physicians underwent standardized training. The sensitivity was 37.58%. Furthermore, specialized evaluation showed high sensitivity in US/CT (84.58%) than US (58.21%) alone.ConclusionAlthough the sensitivity of US could be enhanced by standardized training and combination with CT, the prevalence of low sensitivity of US in real-world multicenter data and the high occult metastasis rate indicated that the Chinese guidelines were based on the current conditions.

Diagnostic Efficacy of Ultrasonography and Fine-needle Aspiration Cytology in Correlation with Histopathology in Euthyroid Patients Having Solitary Thyroid Nodule

Objective: In patients with solitary thyroid nodules, first approach is to confirm whether the nodule is benign or malignant. Commonly available investigations used in the evaluation include thyroid hormone assays, fine needle aspiration cytology (FNAC) and ultrasonography (USG) among others. These procedures are not without drawbacks. The present study was undertaken to compare the diagnostic efficacy of USG and FNAC in correlation with histopathology in euthyroid patients having solitary thyroid nodule. Study Design: A prospective study was carried out on 48 euthyroid cases of solitary thyroid nodule attending the Department of ENT, SMS Medical College & Hospital, Jaipur, during the period of March 2016 to November 2017. All patients underwent ultrasonography and fine-needle aspiration cytology. The results of FNAC and USG were correlated with post surgical histopathogical examination (HPE) of the specimens to evaluate their sensitivity and specificity by statistical methods. Results: Ultrasound was 87.5% sensitive & 92.50% specific in the detection of malignancy in solitary thyroid nodules while the fine needle aspiration cytology had a sensitivity of 87.50% & specificity of 100% in the same regard. Conclusion: It was found that FNAC is a safe, reliable and cost effective diagnostic modality with a high sensitivity and specificity and is the single best investigation for preoperative evaluation of solitary thyroid nodule to differentiate between benign and malignancy nodules.

Spectrum of diseases and diagnostic values of ultrasound in adult patients with nontraumatic acute abdomen in a nigerian tertiary health facility.

Aim and Objective:The purpose of this study was to determine the spectrum of disease on abdominal ultrasound (US) and the diagnostic efficacy of US in adult patients with nontraumatic acute abdomen at Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife.Materials and Methods:The study population included consecutive 150 adult patients aged 15 years and above presenting with nontraumatic acute abdomen via the adult emergency unit or as inpatients referred to the Radiology Department of OAUTHC, Ile-Ife for abdominal US. MINDRAY D.C-6 real-time US scanner with 3.5, 5.0, and 7.5 MHz probes and Doppler facilities were used to assess the intra-abdominal organs and the findings were compared with the clinical and surgical findings in those cases that were operated.Results:The common spectrum of diseases encountered on US in this study included appendicitis (66 [44%]), ectopic pregnancy (34 [22%]), intestinal obstruction (13 [8.7%]) while the least finding was renal abscess 1 (0.7%). The correlation of US findings with surgical findings in this study showed sensitivity, specificity, and kappa agreement for appendicitis of 83.3%, 100.0%, and 0.808; ectopic pregnancy of 100.0%, 97.8%, and 0.958; acute cholecystitis of 100.0%, 100.0%, and 1.0. However, perforated viscus showed the least sensitivity (60.0%), specificity (99.2%), and kappa agreement 0.654. All the disease entities showed good kappa agreement beyond chance, and they were all statistically significant (P < 0.001).Conclusions:This study has shown a relatively high sensitivity, specificity and diagnostic accuracy of US in cases of nontraumatic acute abdomen in a careful hand. We, therefore, recommended that these advantages of US should be capitalized upon in settings where other advanced diagnostic modalities are not available.

Diagnostic efficacy of ultrasonography in acute appendicitis

Introduction: Acute appendicitis is the most common acute condition of the abdomen requiring surgery in both adults 1,2 and children. 3.5 The overall frequency of appendicitis for symptomatic patients younger than 20 years is 41%; the frequency for those older than 20 years is 59%. Methods: This was a prospective cross sectional study involving 104 patients aged between 8 and 68 years with clinical suspicion of acute appendicitis. Patients with suspected acute appendicitis were evaluated with high frequency linear transducer using graded compression technique. Peroperative findings were noted and histopathological examination were carried out in all the cases for confirmation of acute appendicitis. Sensitivity, specificity, negative predictive value, positive predictive value and accuracy of ultrasonography were calculated by using statistical method. Results: Among 104 patients (61 males and 43 females) with clinical diagnosis of acute appendicitis, ultrasonography was positive for acute appendicitis in 79 patients (75.96%). On histopathological examination, 94 appendices (90.38%) were acutely inflamed. The sensitivity of ultrasonography for the diagnosis of acute appendicitis was 78.72% with specificity of 60%. Positive predictive value, negative predictive value and accuracy of ultrasonography were 94.87%, 23.07% and 76.92% respectively. Conclusion: Ultrasonography is a useful method of diagnosing clinically suspected acute appendicitis especially in doubtful cases. DOI: http://dx.doi.org/10.3126/joim.v34i3.8908 Journal of Institute of Medicine, December, 2012; 34:8-11

Diagnostic efficacy of ultrasonography in acute appendicitis

Introduction: Acute appendicitis is the most common acute condition of the abdomen requiring surgery in both adults 1,2 and children. 3.5 The overall frequency of appendicitis for symptomatic patients younger than 20 years is 41%; the frequency for those older than 20 years is 59%. Methods:&nbsp; This was a prospective cross sectional study involving 104 patients aged between 8 and 68 years with clinical suspicion of acute appendicitis. Patients with suspected acute appendicitis were evaluated with high frequency linear transducer using graded compression technique. Peroperative findings were noted and histopathological examination were carried out in all the cases for confirmation of acute appendicitis. Sensitivity, specificity, negative predictive value, positive predictive value and accuracy of ultrasonography were calculated by using statistical method. Results: Among 104 patients (61 males and 43 females) with clinical diagnosis of acute appendicitis, ultrasonography was positive for acute appendicitis in 79 patients (75.96%). On histopathological examination, 94 appendices (90.38%) were acutely inflamed. The sensitivity of ultrasonography for the diagnosis of acute appendicitis was 78.72% with specificity of 60%. Positive predictive value, negative predictive value and accuracy of ultrasonography were 94.87%, 23.07% and 76.92% respectively. Conclusion: Ultrasonography is a useful method of diagnosing clinically suspected acute appendicitis especially in doubtful cases. DOI: http://dx.doi.org/10.3126/joim.v34i3.8908 &nbsp; Journal of Institute of Medicine, December, 2012; 34:8-11

Diagnostic significance of ultrasonography in investigations of swellings of head and neck region – A clinico-imaging study

ObjectivesA study was conducted with an aim to evaluate the reliability, diagnostic efficacy of ultrasonography in head and neck swelling and familiarize with the clinical application of ultrasonography as an investigative modality for diagnosis of head and neck swellings. Methodology90 randomly selected volunteering patients with obvious head and neck swellings of both gender and any age group who reported to the Dept. of Oral Medicine and Radiology, A.B. Shetty Memorial Institute of Dental Sciences, Deralakatte were included in the study. After a clinical diagnosis, they were subjected to ultrasonographic investigation and a diagnosis was arrived at. These findings were compared with final diagnosis. The data obtained were statistically analysed using sensitivity and specificity tests. ResultsThe sensitivity and specificity of ultrasonography in inflammatory swellings was 96.5%. For cystic, swellings of muscular origin, lymph node swellings and malignant neoplasms it was 100%. In addition, for benign neoplasms it was 92.86%. ConclusionUltrasonography is a valuable and accurate diagnostic tool in diagnosis of head and neck swellings. Even though ultrasonographic pictures were consistent and are, reliable they should be used only as an added informative investigation tool in diagnosing benign neoplasms, malignant neoplasms and swellings of lymph node origin.

MR Imaging in the Evaluation of Placental Abruption: Correlation with Sonographic Findings

To evaluate the accuracy of magnetic resonance (MR) imaging and color Doppler ultrasonography (US) in the diagnosis of abruption, to assess the accuracy of the different MR imaging sequences in the visualization of clots, and to evaluate the correlation between MR imaging findings and clinical outcome. This study protocol was approved by the institutional review board, and written informed consent was obtained from all patients. Between March 2008 and June 2010, 60 consecutive patients (mean gestational age, 30.7 weeks [range, 27-38 weeks]; mean age, 29 years [range, 20-38 years]) who were referred for US and MR imaging owing to a putative diagnosis of abruption were assessed. Multiplanar half-Fourier rapid acquisition with relaxation enhancement, true fast imaging with steady-state precession, three-dimensional T1-weighted gradient-echo MR imaging, and sagittal diffusion-weighted MR imaging were performed. Two radiologists independently reviewed each case, resolving by consensus any diagnostic discrepancy. During a second imaging analysis, the same readers randomly and independently assessed the single sequences. The signal intensity of hematoma was correlated with clinical outcome. The reference standard for abruption was the presence of clots and/or fibrin at inspection of the placenta after delivery. The diagnostic efficacy of US and MR imaging was calculated with 95% confidence intervals. Interobserver agreement was assessed by using the Cohen κ test. The performance of US and MR imaging was calculated in 39 patients who gave birth less than 10 days after MR imaging; these women were considered to have an adequate reference standard. Abruption was found at delivery in 19 patients. Abruption was identified in 10 of the 19 patients (52%) with US and in all 19 (100%) with MR imaging (P = .002), with an interobserver agreement of 0.949. Diffusion- and T1-weighted sequences helped identify 19 (100%) and 18 (95%) of the 19 abruptions, respectively; interrater agreement was very good for all sequences (κ = 0.892-1.0). Hematomas classified as hyperacute or acute worsened to abruption grade II, with the mother being symptomatic or the fetus distressed. MR imaging can accurately depict placental abruption, with excellent interobserver agreement, and should be considered after negative US findings in the presence of late pregnancy bleeding if the diagnosis of abruption would change management.

Rapid detection of pneumothorax by ultrasonography in patients with multiple trauma

IntroductionEarly detection of pneumothorax in multiple trauma patients is critically important. It can be argued that the efficacy of ultrasonography (US) for detection of pneumothorax is enhanced if it is performed and interpreted directly by the clinician in charge of the patients. The aim of this study was to assess the ability of emergency department clinicians to perform bedside US to detect and assess the size of the pneumothorax in patients with multiple trauma.MethodsOver a 14 month period, patients with multiple trauma treated in the emergency department were enrolled in this prospective study. Bedside US was performed by emergency department clinicians in charge of the patients. Portable supine chest radiography (CXR) and computed tomography (CT) were obtained within an interval of three hours. Using CT and chest drain as the gold standard, the diagnostic efficacy of US and CXR for the detection of pneumothorax, defined as rapidity and accuracy (sensitivity, specificity, positive predictive value, negative predictive value), were compared. The size of the pneumothorax (small, medium and large) determined by US was also compared to that determined by CT.ResultsOf 135 patients (injury severity score = 29.1 ± 12.4) included in the study, 83 received mechanical ventilation. The time needed for diagnosis of pneumothorax was significantly shorter with US compared to CXR (2.3 ± 2.9 versus 19.9 ± 10.3 minutes, p < 0.001). CT and chest drain confirmed 29 cases of pneumothorax (21.5%). The diagnostic sensitivity, specificity, positive and negative predictive values and accuracy for US and radiography were 86.2% versus 27.6% (p < 0.001), 97.2% versus 100% (not significant), 89.3% versus 100% (not significant), 96.3% versus 83.5% (p = 0.002), and 94.8% versus 84.4% (p = 0.005), respectively. US was highly consistent with CT in determining the size of pneumothorax (Kappa = 0.669, p < 0.001).ConclusionBedside clinician-performed US provides a reliable tool and has the advantages of being simple and rapid and having higher sensitivity and accuracy compared to chest radiography for the detection of pneumothorax in patients with multiple trauma.

Imaging methods for medullary thyroid cancer.

Imaging of multiple endocrine neoplasia (MEN) syndromes is a challenge not only for the radiologist but for every physician engaged in ultrasonography (US), conventional radiology, computerized tomography (CT), magnetic resonance imaging (MRI), and scintigraphy (SC). Doppman (1985) called the MEN syndromes “a nightmare” for the diagnostician because of the difficulty of detecting and localizing small tumors or even only hyperplasia of endocrine organs. Nevertheless, the primary aim of allefforts is detection of preclinical stages of organ involvement, as it is only in those early stages that curative therapy of medullary thyroid cancer (MTC) may be possible. On the other hand, sensitive imaging methods are needed for follow-up to localize suspected recurrences or metastases of MTC in patients with elevated serum tumor markers. In this context, the diagnostic efficacy of US, SC, CT, and MRI must be discussed. Additionally, the clinical value of fine needle aspiration (FNA) biopsy has to be considered.KeywordsThyroid CancerMedullary Thyroid CarcinomaMedullary ThyroidMultiple Endocrine NeoplasiaMedullary Thyroid CancerThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.