Color Doppler Flow Research Articles

Which combination of different ultrasonography modalities is more appropriate to diagnose breast cancer?: A network meta-analysis (a PRISMA-compliant article).

Background:Abundant amount of literature that analyze the various detection of different ultrasound methods, no comprehensive literature that investigates the diagnostic values of breast cancer (BC) by different ultrasonography modalities through a network meta-analysis (NMA) has been made available. Each imaging diagnostic examination has its own advantages and disadvantages, and any imaging examination is not enough to make an accurate diagnosis of the disease. Thus, this study aimed to compare diagnostic values among different ultrasonography modalities, including the information of 2-dimension, stiffness and blood flow, by a network meta-analysis in the hopes of understanding which imaging methods are better and which combination of different ultrasonography modalities is more appropriate to diagnose BC.Methods:We made use of Cochrane Library, PubMed, and Embase in order to obtain literature and papers. The combination analysis of both direct and indirect evidence in terms of sensitivity, specificity, positive predictive value (PPV), negative predictive value(NPV) and accuracy was conducted so as to assess the odds ratios (ORs) and surface under the cumulative ranking curve (SUCRA) values of the 8 different ultrasound methods.Results:A total of 36 eligible diagnostic tests regarding 8 ultrasound methods were included in the study. According to this network meta-analysis, Breast Imaging Reporting and Data System (BI-RADS) 4b exhibited higher specificity, PPV, and accuracy and lower sensitivity and NPV than BI-RADS 4a. Contrast-enhanced ultrasound (CEUS) had the highest sensitivity, PPV, NPV and accuracy and superb microvascular imaging (SMI) had the highest specificity among color Doppler flow imaging (CDFI), power Doppler imaging(PDI), SMI and CEUS. There was no significant difference in diagnostic indexes between SMI and CEUS. Shear wave elastrography (SWE) had higher PPV and accuracy and lower sensitivity, specificity NPV than strain elastography (SE).Conclusion:The results of this network meta-analysis suggested more appropriate combination of different ultrasound modalities is BI-RADS 4b, SMI, and SWE for the diagnosis of breast cancer.

The application value of CDFI and SMI combined with serological markers in distinguishing benign and malignant thyroid nodules.

The purpose of this study is to explore the application value of CDFI and SMI combined with serological markers in distinguishing benign and malignant thyroid nodules. A total of 192 patients with thyroid nodules admitted to our hospital from July 2019 to December 2020 were selected as subjects. Color Doppler blood flow imaging (CDFI) and supermicro blood flow imaging (SMI) methods are used to detect the blood flow of patients and the levels of serum thyroglobulin antibody (TgAb), thyroid peroxidase antibody (TPOAb), and thyroid stimulating hormone (TSH). The receiver operating characteristic curve (ROC curve) was used to observe the sensitivity and specificity of serological markers for distinguishing benign and malignant thyroid nodules, and combined with CDFI and SMI to observe the sensitivity and specificity for distinguishing benign and malignant thyroid nodules. The levels of TgAb, TPOAb and TSH in benign thyroid nodules were lower than those of the malignant group, and the difference was statistically significant (P < 0.01). There was no statistically significant difference between benign and malignant thyroid nodules in the presence or absence of the capsule and the presence or absence of vocal halo (P > 0.05), while the differences in the nodule morphology, boundary, internal echo and internal calcification were statistically significant (P < 0.01). CDFI and SMI combined with serological index detection have higher value in the differential diagnosis of thyroid cancer, which can significantly improve the sensitivity and specificity of differential diagnosis.

Left renal vein entrapment in postural proteinuria: the diagnostic utility of the aortomesenteric angle.

Nutcracker syndrome related to the left kidney vein compression is a cause of orthostatic proteinuria during childhood. Some studies have shown that the ratios between maximum velocities and anterior-posterior diameters of hilar and aortomesenteric segments of the left kidney vein between upright and supine positions must be more than 4 in order to make a Nutcracker syndrome diagnosis. Our aim was to investigate whether the use of a decrease in aortomesenteric angle between upright and supine positions in the presence of isolated orthostatic proteinuria can be a criterion for the diagnosis of Nutcracker syndrome. Relevant patient information, which included demographic data, clinical examination findings, laboratory data, urinary system ultrasound, and kidney color flow Doppler ultrasound results, were prospectively collected. Thirty-nine pediatric patients with orthostatic proteinuria were included in the study. Left kidney vein compression findings were demonstrated in 31 patients. The ratio of maximum velocities of hilar and aortomesenteric segments of the left kidney vein between upright and supine positions was above 4 in only 7 of our patients. Ratio of aortomesenteric angle between upright and supine positions was significantly decreased for patients with left kidney vein compression findings. Conclusion: The use of a decrease in the ratio of aortomesenteric angle between upright and supine positions in the presence of orthostatic proteinuria, instead of the ratios for maximum velocities and anterior-posterior diameters of hilar and aortomesenteric segments, can be more helpful for the diagnosis of Nutcracker syndrome in the differential diagnosis of orthostatic proteinuria. What is Known: •Proteinuria may be a sign of an impending kidney disease •Nutcracker syndrome is a cause of orthostatic proteinuria. What is New: •Ratio of aortomesenteric angle between upright and supine positions > 0.6 can be used for Nutcracker syndrome diagnosis.

Fetal cardiac sectional schemas - Normal and abnormal. Part 1: Upper abdominal and thoracic sections.

A representational illustrated cardiac schema is useful for understanding and interpreting normal and abnormal fetal echocardiographic findings. Normal and abnormal fetal echocardiographic images can be better appreciated with the support of sectional schemas. An attempt is made to include normal and abnormal variations in both grayscale and color images for easy understanding with the help of the schemas. The fetal cardiac sectional schemas are drawn by the author, using Microsoft Office Word drawing canvas. It is based on the best grayscale, color Doppler, power-angio, 3-dimensional, and high definition flow ultrasound images, supported by embryological and anatomic specimens in literature. Different sections are drawn in accordance with the planes suggested by Society for Maternal-Fetal Medicine, Society of Radiologists in Ultrasound, American College of Obstetricians and Gynecologists, American Institute of Ultrasound in Medicine, American College of Radiology, and American Society of Echocardiography. Every effort has been meticulously pursued to match with the best ultrasound images with minor modifications for better clarity, understanding, and reproducibility. The drawings include normal and most of the common cardiac anomalies depicting different sectional views starting from the abdomen and upward. Each drawing complies with the ultrasound images. Users with basic computer knowledge can easily modify these images using them as templates for reference, reporting, and publications. An attempt is made to represent the fetal echocardiographic images by simplified memorable sectional schemas. These schemas will facilitate a better understanding and interpretation of various normal and abnormal fetal echocardiographic images. Being electronically transmittable, these schemas can be used as templates for further modifications.

Double Interatrial Septum and Patent Foramen Ovale in Woman With Transient Ischemic Attack.

A 47-year-old woman with a history of hypertension presented with symptoms of transient ischemic attack. Her blood pressure was normal. A 12-lead electrocardiogram and a 24-hour Holter monitor revealed sinus rhythm. Transthoracic echocardiograms showed normal left ventricular systolic function (ejection fraction, 66%), mild left ventricular hypertrophy, and a slightly enlarged left atrium. The apical 4-chamber view showed echo-free space between 2 atria in the center of the interatrial septum (IAS) with 2 parallel atrial-septal structures, raising suspicion of a persistent interatrial space (Fig. 1). With the patient in the Valsalva maneuver, we obtained a 2-dimensional transesophageal echocardiogram (TEE) with agitated saline contrast medium, which revealed a small communication from the interatrial space to the right atrium through a patent foramen ovale (PFO) at the midesophageal short-axis level of the aortic valve (Fig. 2). Real-time 3-dimensional TEE revealed a membrane, parallel to the IAS, that created a double IAS and an additional interatrial space (Figs. 3 and 4). No obstruction existed between the left atrial appendage and the normal pulmonary veins, mitral valve, or coronary sinus. A 2-dimensional TEE in color-flow Doppler mode showed flow into the additional chamber from the left atrium across the left-sided IAS. Previous reports suggest that a double IAS can cause emboli,1,2 so we considered our patient to be at high risk and the PFO to be the cause of her neurologic event. Device closure of the PFO was not attempted because of possible complications from catheter-based closure. The patient was prescribed anticoagulation therapy and was discharged from the hospital after a 5-day stay. At the 3-month follow-up visit, she had no neurologic complications; 4 years later, she remained asymptomatic.Double IAS, an extremely rare congenital cardiac anomaly, is characterized by the presence of 2 distinct interatrial septa enclosing an interatrial chamber. The accessory membrane lies parallel to the IAS, and the pulmonary veins continue to communicate freely with the mitral valve and left atrial appendage.2,3 Most patients are asymptomatic unless thromboembolic complications or cardioembolic events occur. Potential causes of double IAS are abnormal or incomplete fusion of the atrial septum primum with the septum secundum, and embryologic left venous valve derived from the embryologic sinus venosus.2,3 There is no preferred treatment or risk stratification for cardiac sources of embolism in double IAS associated with neurologic events. However, monitoring with 3-dimensional TEE is imperative.

Autoimmune and inflammatory thyroid diseases following vaccination with SARS-CoV-2 vaccines: from etiopathogenesis to clinical management.

Since the Covid-19 pandemic emerged in 2019, several adenoviral-vectored, mRNA-based and inactivated whole-virus vaccines have been developed. A massive vaccination campaign has been undertaken around the world, and an increasing number of SARS-CoV-2 vaccine-induced thyroid diseases have been described in the literature. Subacute thyroiditis has been reported in 52 patients, mean age 45.5 ± 1.8 years, mainly in women (n = 39). Graves’ disease is more frequent in women (n = 22) than in men (n = 10), mean age 46.2 ± 2.6 years, reported as new onset, recurrent or exacerbation of well-controlled hyperthyroidism. The mean time to symptoms onset is 9.0 ± 0.8 days in subacute thyroiditis, and 15.1 ± 2.6 days in Graves’ patients. Rare patients (n = 6) present silent or painless autoimmune thyroiditis. Thyroid function and autoimmune tests, inflammatory markers, thyroid echography with colour flow Doppler, radio-activity uptake on thyroid scan, medical treatment and follow-up are described and compared in patients with SARS-CoV-2 vaccine-induced thyroid diseases. The underlying pathogenic mechanisms of vaccine-induced thyroid diseases, molecular mimicry (various SARS-CoV-2 proteins sharing a genetic homology with a large heptapeptide human protein) or autoimmune/inflammatory syndrome induced by adjuvants (ASIA) are discussed in the context of predisposition or genetic susceptibility. The benefits of SARS-CoV-2 vaccination far outweigh the potential vaccine-induced adverse effects, but clinicians should be aware of possible autoimmune and inflammatory thyroid diseases, and can advise patients to seek medical assistance when experiencing anterior neck pain, fever or palpitations following SARS-CoV-2 vaccines. Further studies are warranted to investigate the etiopathogenesis and to clarify the factors which predispose patients to SARS-CoV-2 vaccine-induced thyroid diseases.

Ultrasonic Characteristics Improve Prediction of Central Lymph Node Metastasis in cN0 Unifocal Papillary Thyroid Cancer.

BackgroundPrediction of central lymph node metastasis (CLNM) is vital for clinical decision-making processes in clinically N0 (cN0) unifocal papillary thyroid carcinoma (PTC), but the sensitivity of preoperative detection of CLNM is limited. The aim of the present study was to determine whether there are ultrasonic (US) characteristics associated with CLNM.MethodsIn total, 1657 PTC patients (514 men and 1143 women) were enrolled in the present study between January 2018 and May 2021. The patients met the following inclusion criteria based on preoperative detection: suspected nodule confirmed as PTC by biopsy; the nodule was unifocal and less than 4 cm in diameter; no prior neck radiation exposure; no extrathyroidal extension; and no CLNM or distant metastases on imaging. All the enrolled patients underwent total thyroidectomy with prophylactic central lymph node dissection (CLND). A postoperative pathological diagnosis was made.ResultsCLNM was found in 58.4% of male patients and 36.9% of female patients. In univariate analysis, size, adjacent anterior capsule, distance to the lower pole and color Doppler flow imaging (CDFI) were considered risk factors for the male and female groups (p < 0.05). In multivariate analyses, size, adjacent anterior capsule, distance to the lower pole and CDFI were independent risk factors for male patients. For females, the independent risk factors included size, adjacent anterior capsule, distance to the lower pole and CDFI.ConclusionIn the present cohort, US imaging characteristics, including size, adjacent anterior capsule, distance to the lower pole and CDFI, were identified to be potentially beneficial in preoperative clinical decision-making processes for cN0 unifocal PTC patients.

Polar Vessel: A New Ultrasound Sign for Complementary Diagnosis of Major Salivary Gland Adenoid Cystic Carcinoma.

To investigate the characteristic ultrasonographic findings of adenoid cystic carcinoma (ACC) in major salivary glands and identify the value of polar vessel in color Doppler flow imaging (CDFI) for the diagnosis of ACC. From January 2017 to December 2021, 76 patients with parotid and submandibular gland tumors, including 14 patients with ACC, as confirmed by surgery and histopathology, were enrolled. Their clinicopathologic information and ultrasound (US) features were recorded and analyzed. The performance of polar vessel in CDFI for differentiating ACC from non-ACC (benign tumors and mucoepidermoid carcinoma [MEC]) was analyzed. ACC in the major salivary gland was more likely to be associated with pain symptoms (P=.027) and unclear borders and rough edges in grayscale US (P=.002, .015, respectively) than benign tumors. Compared to MEC, ACC tended to feature a homogeneous internal echo (P=.008). ACC of the major salivary gland had a significantly higher incidence of polar vessel sign than that of non-ACC (benign tumors and MEC) (P <.0001, .0001, respectively). The polar vessel sign showed good performance in distinguishing between ACC and non-ACC, with an area under the receiver operating characteristic curve of 0.857, a sensitivity of 71.4%, a specificity of 100%, and an accuracy of 94.7%. Positive predictive value and negative predictive value were calculated at 100% and 93.9%, respectively. The US sign of polar vessel has high diagnostic efficiency, and it may have important potential for use as a new complementary sign for the diagnosis of ACC in major salivary glands.

Differential diagnosis of gallbladder polypoid lesions by micro-flow imaging

To explore the value of micro-flow imaging (MFI) in evaluating blood flow characteristics and differential diagnosis of gallbladder polypoid lesions. We retrospectively analyzed the clinical data and ultrasound images of 73 patients with gallbladder polypoid lesions, including 24 patients with pathologically confirmed neoplastic polyps (n=24) and 49 with non-neoplastic polyps (n=49). All the patients underwent conventional ultrasound, MFI and contrast enhanced ultrasound (CEUS) before cholecystectomy. The blood flow characteristics of the lesions in color Doppler flow imaging (CDFI) and MFI were compared, and the consistency of the findings by these two modalities with those of CEUS were evaluated by weighted Kappa consistency test. The diagnostic performance of MFI for gallbladder polypoid lesions was assessed. There were significant differences between MFI and CDFI in the evaluation of blood flow characteristics of gallbladder polypoid lesions (χ2=37.684, P < 0.001). MFI showed better performance than CDFI in displaying the blood flow characteristics of the polyps. The consistency in the findings was 0.118 between CDFI and CEUS and 0.816 between MFI and CEUS. The sensitivity, specificity and accuracy of MFI in distinguishing neoplastic polyps from non-neoplastic polyps were 75.00%, 93.88% and 87.67%, respectively. MFI has a good consistency with CEUS in displaying the blood flow characteristics of gallbladder polypoid lesions and can accurately distinguish neoplastic polyps from non-neoplastic polyps, thus providing new ultrasound diagnostic evidence to support clinical decisions on optimal treatments of gallbladder polypoid lesions.

Комплексное исследование состояния и взаимосвязи хориоидальной и ретинальной гемодинамики при окклюзиях ретинальных вен у молодых женщин

Purpose. To study the relationship between choroidal and retinal hemodynamics of the eyes in retinal vein occlusion (RVO) in young women to determine the features of their clinical course. Material and methods. The main group included 15 women (15 eyes), whose age ranged from 35 to 45 years, averaging 39.7±4.0 years. 20 somatically healthy women of comparable age were included in the control group. In addition to standard examination methods, all women underwent a comprehensive study of chorioretinal hemodynamics. The linear velocity of blood flow (LVBF) in the posterior short ciliary arteries (PSCA) was evaluated using a multifunctional ultrasound diagnostic device Logiq e (General Electric, USA). Macular blood flow features were studied using an optical coherence tomograph in angiography mode RTVue-100 (Optovue, Inc., USA). A comparative analysis of the studied indicators between the groups was carried out. Results. The results of the study revealed the presence of an interrelated statistically significant decrease in choroidal and retinal hemodynamics in young women with RVO relative to the group of healthy women (p&lt;0.001). Conclusion. Taking into account the revealed direct relationship between choroidal and retinal hemodynamics in women with acute respiratory infections, we consider it appropriate and necessary to perform a simultaneous comprehensive study of various components of the hemodynamics of the posterior segment of the eye in the presence of this pathology: LVBF in the PSCA by color Doppler mapping and macular blood flow by OCT in angiography mode. These data can significantly expand the diagnostic capabilities of identifying the severity of the clinical course of acute respiratory infections and help predict the possible formation of neovascularization. Key words: retinal vein occlusions, young women, chorioretinal hemodynamics, color Doppler mapping, optical coherence tomography in angiography mode

Color Doppler and Microvascular Flow Imaging to Evaluate the Degree of Inflammation in a Case of Hidradenitis Suppurativa for CME credit June 2022

Color Doppler and Microvascular Flow Imaging to Evaluate the Degree of Inflammation in a Case of Hidradenitis Suppurativa for CME credit June 2022

The value of multi-modes of ultrasound in evaluating segmental mucosal healing in patients with Crohn's disease.

Mucosal healing, the result of endoscopic remission, is associated with prolonged clinical remission and delayed deterioration of Crohn's disease, which is significant and accompanied by reduced hospitalizations and surgeries. Currently, the relationship between ultrasonic parameters and mucosal healing remains controversial. To establish an ultrasonic regression model to evaluate mucosal healing, we conducted this preliminary study using multiple parameters from B-mode ultrasonography, colour Doppler flow imaging and shear wave elastography systematically. This study consisted of two single-centre investigations based on development and validation populations who received endoscopies (as the gold standard) and ultrasound. The involved bowel segments were divided into mucosal healing (MH) and nonmucosal healing (NMH) groups according to endoscopic results. Eight ultrasonic parameters were observed, including bowel wall thickness (BWT), mesenteric fat thickness (MFT), median modulus of elasticity (Emean), average shear wave velocity (SWV), Limberg scoring (LG), bowel wall stratification (BWS), ascites (AS) and lymph node enlargement (LN). We developed an ultrasonic regression model in the development phase to evaluate segmental mucosal healing and undertook prospective validation of this model. A total of 124 patients with 380 involved bowel segments from the development and validation cohorts were evaluated. Eight ultrasonic parameters were significantly different between the two groups (P<0.05) in the development phase. Four significant parameters with better AUC performance were selected to establish an ultrasonic regression model to predict mucosal healing. The AUCs of this ultrasonic model were 0.975 and 0.942 in the development and validation cohorts, respectively. The multimodal ultrasonic model has the potential to evaluate segmental mucosal healing in Crohn's disease.

Contrast-enhanced transesophageal echocardiography predicts neo-intimal coverage of device post-left atrial appendage closure.

BackgroundLeft atrial appendage (LAA) closure (LAAC) is a viable alternative to anticoagulation for stroke prevention in non-valvular atrial fibrillation. However, device-associated thrombosis (DAT) is known as a complication of LAAC as observed within the first few weeks after implantation. A noninvasive method is needed to predict the progress for endothelialization surveillance. The aim of the study was to develop a noninvasive visual contrast-enhanced transesophageal echocardiography (cTEE) method for monitoring the communication between left atrium (LA) and LAA post-LAAC by cTEE-score evaluating the contrast enhancement in LAA.MethodsA total of 29 healthy dogs were studied by LAAC at < 24 h and 1, 2, 3 and 6-months. The LAAC procedure was assessed by TEE with color Doppler flow imaging (CDFI) and contrast imaging. The cTEE score was calculated based on the differential contrast opacification of LA and LAA cavities, the CDFI on the width of peri-device color flow, and that of histology on the level of occluder surface endothelialization in postmortem histological examination. Spearman’s correlation analysis was used to correlate these scores.ResultsThe correlation between cTEE and histology scores was superior to that between CDFI and histology scores. The trend of average cTEE score was tracked with that of histology, while that of CDFI was far from that of histology. The correlation coefficient of CDFI and histology scores was not significant (p > 0.05).ConclusionsThe noninvasive visual cTEE is feasible and reliable to monitor communication between the LA and LAA post-LAAC. cTEE is superior to CDFI as a tool in predicting the progress for endothelialization surveillance.

Sincope ricorrente: attenti alla coronaria

Anomalous aortic origin of coronary artery (AAOCA) is a rare condition and the second cause of sudden cardiac death among young athletic patients. Suspicion should arise in the presence of exertional syncope without prodrome, chest pain and/or dyspnea. An accurate transthoracic echocardiogram with Doppler colour flow mapping is the best and first method to identify AAOCA, followed by cardiac CT or MRI to define the coronary anatomy that could benefit from corrective cardiac surgery.

First-Time Diagnosis and Ultrasound Features of Extranodal Lymphoma in Children.

ObjectiveTo assess the diagnostic value of ultrasound for extranodal lymphoma in children. Methods In this retrospective study, the first diagnostic clinical manifestation, ultrasound sonograms, and puncture pathology of 40 cases of pediatric lymphoma treated in Xi'an Children's Hospital from August 2018 to March 2020 were analyzed. Results The first diagnostic clinical manifestation varied from jaundice to gastrointestinal, motor, neurological, respiratory, circulatory skin, and soft tissue multisystem disorders. The intranodal ultrasound results showed abnormally enlarged lymph nodes with extranodal involvement of the liver, pancreas, spleen, kidney, ovaries, and mediastinum as hypoechoic masses with multiple plasma cavity effusions, and color Doppler flow imaging (CDFI) results showed abundant blood flow signals in the lesions. The pathological diagnosis by ultrasound-guided puncture was Hodgkin lymphoma, non-Hodgkin lymphoma, and multiple subtypes. Conclusion Routine ultrasound can provide an imaging basis for early identification and differential diagnosis of lymphoma, and ultrasound-guided puncture biopsy is simple, minimally invasive, and histopathological-based.

Feasibility of Transabdominal Real-time CDFI and HDFI Techniques for Fetal Pulmonary Vein Display in the First Trimester.

This study aimed to assess the feasibility and usefulness of transabdominal color Doppler flow imaging (CDFI) technology and the high-definition flow imaging (HDFI) technique in detecting fetal pulmonary veins (PVs) in the first trimester (11-13+6 weeks). From December 2018 to October 2019, 328 pregnant women with 328 normal singleton fetuses (crown-rump length: 45-84 mm) who had undergone CDFI and HDFI scans for fetal heart and vessel examination were enrolled in this study. The cases were divided into three groups according to the gestational age: group A, 11+0 -11+6 weeks; group B, 12+0 -12+6 weeks; and group C, 13+0 -13+6 weeks. Baseline sonograms and CDFI and HDFI images were analyzed by two senior radiologists independently and blindly. The abilities of CDFI and HDFI to display PVs were compared. Successful PV display rates via CDFI and HDFI were 2.3% and 68.2% (P<0.01), 22.4% and 82.4% (P<0.01), 41.5% and 91.2% (P<0.01) for group A, group B, and group C, respectively. The total successful display rates for the two methods were 28.9% (CDFI) and 84.8% (HDFI) (P<0.01). The HDFI technique is more valuable than CDFI for detecting PVs in early pregnancy (11-13+6 weeks). HDFI can detect at least one PV in all cases and may be used to detect pulmonary venous anomalies early.

The comparative study of color doppler flow imaging, superb microvascular imaging, contrast-enhanced ultrasound micro flow imaging in blood flow analysis of solid renal mass

PurposesTo evaluate the value of Color Doppler Flow Imaging (CDFI), Superb Microvascular Imaging (SMI) and Contrast-enhanced Ultrasound Microflow Imaging (MFI) in display the microvascular blood flow signals in renal solid lesions.Methods142 patients with 144 renal masses were examined by CDFI, SMI and MFI simultaneously. We compared the difference of blood flow grading and vascular architecture based on CDFI, SMI and MFI.ResultsThe blood flow signals detection rates of CDFI, SMI and MFI were 78.5% (113/144), 88.9% (128/144) and 93.8% (135/144), respectively. Concentrated on blood flow grading, The coincidence rates of CDFI and SMI were 64.58% (93/144) and 81.25% (117/144) referring to MFI, respectively. Blood flow grade 2–3 in CDFI is significantly lower than SMI(x2 = 5.557, P = 0.018) and MFI (x2 = 10.165, P = 0.001). Whereas there was no significant difference between SMI and MFI (x2 = 2.372, P = 0.499). Concentrated on vascular architecture, the coincidence rates of CDFI and SMI were 56.25% (81/144) and 75.69% (109/144) referring to MFI, respectively. Vascular architecture type IV and V in CDFI was significantly lower than SMI (x2 = 18.217, P < 0.001) and MFI (x2 = 29.518, P < 0.001). Whereas there was no significant difference between SMI and MFI (x2 = 3.048, P = 0.550). The sensitivity and specificity of CDFI, SMI and MFI in the diagnosis of renal mass were 61.29% and 90.20%, 79.57% and 88.24%, 88.17% and 84.31% respectively. The areas under the ROC curve of the three were 0.757, 0.839 and 0.862, respectively. There was a statistically significant difference between CDFI and MFI (Z = 3.687, P = 0.0002), while there was no statistically significant difference between SMI and MFI (Z = 1.167, P = 0.2431).ConclusionSMI and MFI are superior to CDFI in showing blood flow signals in renal solid masses, and it can perform blood flow and vascular architecture more accurately.Advances in knowledgeSMI is similar to MFI in its ability to display fine vessels and diagnostic efficiency, and has application value in the diagnosis and differential diagnosis of renal solid masses.

PO-696-04 COMPLEX IMPEDANCE ASSESSMENT OF PULMONARY VENOUS OCCLUSION DURING CRYOBALLOON ABLATION

Traditional assessment of pulmonary vein occlusion (PVO) during cryoballoon ablation (CBA) has included contrast injection, pressure waveform (PW) assessment and color doppler flow (CDF) on intracardiac echocardiography. A novel mapping system [Kodex (K), EPD Solutions, Philips] offers a unique tool to assess PVO based on differences in complex impedance with either a comparison with a free-floating CB baseline (BL), or with assessment of temporal impedance change after injection of non-contrast fluid [normal saline or 5% dextrose in water (D5W)].

Correlation between nm23-H_1 expression and transvaginal color Doppler ultrasound performance after radiotherapy for cervical cancer.

BackgroundThis study aimed to explore the correlation between nm23-H_1 gene expression and transvaginal color Doppler ultrasound performance following radiotherapy (RT) for cervical cancer.MethodsEighty patients with cervical cancer treated surgically after RT were retrospectively included in this study. Another 60 normal cervical tissue specimens from the pathology department and 30 cervical cancer tissues that did not undergo preoperative RT were included as control samples. Nm23-H_1 protein expression in cervical tissue was detected using immunohistochemistry. Color Doppler flow imaging (CDFI) was used to detect the imaging signs and resistance index (RI) of cervical cancer.Results(I) Immunohistochemical detection showed that the positive rates of the nm23-H_1 protein in cervical cancer and normal cervical tissues were 37.5% (30/80) and 70.0% (42/60), respectively, and the difference was statistically significant (χ2=14.498, P=0.000). In cervical cancer cells, nm23-H_1 was mainly localized in the cytoplasm but was also expressed in small amounts in the cell membrane. (II) We observed that the expression status of nm23-H_1 was closely correlated with the tumor diameter, lymph node metastasis status, and differentiation degree of patients (P<0.05). The positive rate of nm23-H_1 was higher in patients with cervical cancer with larger tumor diameters, presence of lymph node metastasis, and lower differentiation degree. (III) Ultrasound findings in the 80 cervical cancer patients exhibited no echogenicity in two cases, moderate echogenicity in six cases, hypoechogenicity in 36 cases, and hyperechogenicity in 36 cases. The maximum RI of the patients’ cervical tumors was 0.612, the minimum RI was 0.273, and the mean RI was 0.45. Nm23-H_1 protein expression was significantly correlated with CDFI grade and RI (P<0.05). Patients with positive nm23-H_1 expression had a significantly higher CDFI grade and RI compared to patients in the nm23-H_1 negative expression group.ConclusionsNm23-H_1 protein expression following RT for cervical cancer was significantly correlated with the clinicopathological parameters, CDFI grading, and RI index of cervical cancer patients.

Acute Acalculous Cholecystitis: Think of Hepatitis A Infection and Do Not Underestimate Pain.

A 14-year-old adolescent girl presented with severe abdominal pain, tenderness, and guarding in the right upper quadrant associated with nonbilious vomiting, scleral icterus, and fever. Laboratory tests were consistent with acute hepatitis A virus-related cholestatic hepatitis. A point-of-care ultrasound showed mild gallbladder wall thickening with increased color Doppler flow and pericholecystic fluid collection, in the absence of gallstones or biliary ducts dilatation, thus suggesting acute acalculous cholecystitis. Both the clinical symptoms and the point-of-care ultrasound findings completely resolved within 1 week after admission with conservative treatment.