Efficacy Of Ultrasound Research Articles

The accuracy of fine-needle aspiration cytology and ultrasonography in assessing thyroid nodules in correlation with histopathology: a retrospective study.

Accurately diagnosing thyroid nodules is vital for preventing unnecessary surgeries and providing prompt therapy. Although fine-needle aspiration cytology (FNAC) and ultrasonography (US) are widely used diagnostic methods, their reliability is questioned. This study investigates the effectiveness of US and FNAC in thyroid nodule diagnosis and differentiates benign from malignant nodules in relation to final histopathological diagnosis. A retrospective study including 307 adult patients with thyroid diseases who underwent neck US and FNAC before surgery was conducted between April 2019 and May 2023. The diagnostic efficacy of US, FNAC, and their combination usage was compared to histopathological results. Histopathological findings revealed that 187 (61%) cases were benign, while 120 (39%) were malignant. The US features of 'taller-than-wider' forms and hypoechoic appearance had the highest diagnostic accuracy in characterizing malignant thyroid nodules, with 83 and 73% accuracy, respectively. The combination of US parameters demonstrated high sensitivity, specificity, positive predictive value, and negative predictive value (NPV) of 88.33, 63.10, 60.6, and 89.4%, with a statistically significant area under the ROC curve (AUC: 0.828, P<0.001) than individual parameters. FNAC's sensitivity, specificity, PPV NPV, and accuracy in detecting malignant lesions were 50, 95, 86, 75, and 77%, respectively, with acceptable discrimination and statistical significance (AUC: 0.723, P<0.0001). The combination of US parameters and FNAC significantly improved the AUC value (AUC: 0.878, P<0.0001), sensitivity (83.33%), and specificity (79.14%). Univariate analysis showed that hypoechoic appearance, heterogenicity, large mass size (>4cm), 'taller-than-wider', infiltrative margins, and microcalcifications were risk factors for malignancy in thyroid nodules and were statistically significant (all P-values <0.05). Combining US characteristics with FNAC results can afford the maximum analytical accuracy in distinguishing benign from malignant thyroid nodules. This strategy is practical due to its simplicity, minimal invasiveness, and cost-effectiveness, enabling robust management regimens and avoiding additional surgical procedures.

Efficacy of ultrasonography and color-Doppler for early prediction of hemodialysis arteriovenous fistula unassisted maturation.

Arteriovenous fistula (AVF) failure is a prevalent concern for patients with end-stage kidney disease on hemodialysis. Recognizing the efficacy of ultrasound Doppler in post-operative AVF evaluation, this study sought to discern the predictive capabilities of various ultrasonographic and color-Doppler metrics for early AVF outcomes. This single-center, prospective cohort study spanned 1 year and, post ethical clearance, included all patients who underwent native AVF creation surgery and were subsequently referred for standard post-operative ultrasound Doppler assessment. Parameters such as fistula size, cephalic vein area and diameter, and AVF flow velocity and rates were assessed on post-operative day 2, week 2, and week 6. These initial findings were juxtaposed with later outcomes to determine unassisted AVF results. Of the initial cohort of 40 patients, 75% encountered AVF failure, whereas 25% realized successful unassisted AVF maturation. A notable observation was the significant variance in AVF flow rates as early as post-operative day 2. A threshold of >246 ml/min was indicative of successful unassisted AVF maturation, leading to a sensitivity of 80% and a specificity of 70%. Although the cephalic vein diameter on post-operative day 2 lacked a robust association with AVF outcomes, a cut-off of >3.4 mm, when combined with flow rate testing, augmented the cumulative sensitivity to 92%. Ultrasound Doppler stands out as a valuable quantitative imaging modality, adept at prognosticating AVF outcomes from as early as post-operative day 2. In particular, a flow rate exceeding 246 ml/min and a cephalic vein diameter surpassing 3.4 mm are salient indicators for the early prediction of successful AVF outcomes.

Best Practices: Ultrasound Versus MRI in the Assessment of Pelvic Endometriosis.

Endometriosis is a common yet morbid disease. Imaging plays an important role in diagnosis and treatment planning. Both ultrasound (US) and MRI are used to detect disease. We performed a literature review to assess whether one is superior. A total of 33 studies from the 4482 identified in the initial search were found to assess the efficacy of US and/or MRI in detecting pelvic endometriosis. Most studies were performed at centers with extensive experience with endometriosis, using dedicated US and MRI protocols. A wide range of sensitivities and specificities was reported, but overall weighted means of diagnostic statistics between US and MRI were similar. The choice of dedicated US versus MRI in evaluation of endometriosis should therefore be based on the expertise in the region. The data also showed US had better accuracy for identifying depth of wall invasion in bowel wall disease, whereas MRI better visualized pelvic wall and extraperitoneal disease. Routine US and MRI protocols performed worse than dedicated US and MRI protocols, which may account for delays in diagnoses. Clinical and research efforts directed at improving the sensitivity of routine imaging for diagnosing deep endometriosis could improve patient access to appropriate care.

Determination of strain variability and kinetics of food-associated microorganisms following ultrasound treatment

Ultrasound is a promising emerging technology known for its antimicrobial efficacy. However, existing studies have not fully addressed the impact of strain variability and inactivation kinetics on US efficacy. Ten strains of Listeria monocytogenes, Lactiplantibacillus plantarum, Saccharomyces cerevisiae and Escherichia coli were exposed to US treatment (26 kHz, 200 mL, 100 % amplitude, 200 W, 65–71 W/cm2) under dynamic conditions to investigate their resistance profile. Furthermore, the inactivation kinetics of selected resistant/sensitive strains were assessed. The result showed significant intra-species variability in resistance (p < 0.05) for the four target microorganisms evaluated in this study. L6 and NCTC 10357 were the most resistant and sensitive L. monocytogenes strains respectively, having a reduction difference of ∼3.4 log CFU/mL. Regarding L. plantarum, FBR04 emerged as the most resistant strain (4.4 log reduction), while E. coli FAM21845, FAM21805 and FAM21843 (∼2 log reduction) emerged as the most resistant strains. On the other hand, the most resistant strains of S. cerevisiae were CBS 1544, AD 1890 and 077.0001 (<1 log reduction) while S. cerevisiae AD 2913, 028.0404 and 028.0315 were the most sensitive (>5 log reduction). The survival curves of most of the strains exhibited an initial phase of insignificant microbial inactivation followed by a relatively fast log-linear inactivation period. The estimated D-value showed that L. monocytogenes strains exhibited higher resistance to US treatment than any other species, while other species displayed comparable resistance. The findings on strain variability resistance and inactivation kinetics following US treatment are essential for food safety and will pave the way for further research on microbial response to US stress, risk assessment and optimisation studies.

Effectiveness of ultrasonography in the diagnosis of temporomandibular joint disorders: A systematic review and meta-analysis.

Temporomandibular disorders (TMDs) pose diagnostic challenges, and selecting appropriate imaging modalities is crucial for accurate assessment. This study aimed to compare the diagnostic accuracy and efficacy of ultrasonography (US) and magnetic resonance imaging (MRI) in identifying TMDs. A comprehensive meta-analysis was conducted, including studies that compared US and MRI for TMJ disorder assessments. Fixed-effects models were utilized to calculate pooled odds ratios (ORs) and relative risks (RRs) with 95% confidence intervals (CIs). Heterogeneity was assessed using the chi-squared test and I2 statistic. Newcastle-Ottawa scale was used to assess the methodological quality of the studies included. Six studies were included, involving a total of 281 participants. The meta-analysis demonstrated that MRI was statistically somewhat better than US in identifying TMJ disorders. The summary OR was 0.64 (95% CI: 0.46-0.90), and the summary RR was 0.80 (95% CI: 0.68-0.95). Heterogeneity among the studies was low (χ2 = 2.73, df = 5, p = .74; I2 = 0%). Demographic variables revealed variations in sample size, gender ratio and mean age across the studies. This meta-analysis provides evidence that MRI may be more effective than US in diagnosing TMDs. However, the study is limited by the small number of included studies and variations in demographic variables and study designs. Future research with larger samples and standardised protocols is essential to confirm and strengthen these findings. Understanding the diagnostic accuracy of MRI and US for TMJ disorders will aid clinicians in making informed decisions for effective TMJ disorder assessments and patient management.

The usefulness of ultrasonography for the early diagnosis of polyneuropathy in patients with type II diabetes mellitus

Background: Diabetic neuropathies, affecting over 50% of diabetes patients, present varied forms of polyneuropathy impacting somatic and autonomic nerves. Clinical assessments, laboratory findings, and nerve conduction studies (NCSs) aid in precise diagnosis, while recent technological advances highlight ultrasonography (US) as a promising, cost-effective diagnostic tool. Aims and Objectives: This study aims to assess the efficacy of US in early polyneuropathy diagnosis in type II diabetes, exploring its potential as an alternative to NCS. Materials and Methods: In this prospective observational study, we enrolled 30 adult patients with type II non-controlled diabetes and 30 age-matched controls, comprising 15 controlled diabetic patients and 15 normal individuals. The comprehensive assessments encompassed history-taking for diabetes duration, hypertension, and diabetic complications, along with clinical examinations and investigations involving nerve electrophysiology and US on one upper limb based on patient complaints. Results: Significant increases in the cross-sectional area (CSA) of the median nerve were observed in diabetic peripheral neuropathy groups compared to controls, with a P&lt;0.001. Similarly, at the level behind the medial epicondyle, the ulnar nerve CSA exhibited a significant increase in the diabetic peripheral neuropathy group (11.7 mm2) compared to controls (6.7 mm2) with a P&lt;0.002. In addition, a significant difference in cross-sectional values was found in the median nerve proximal to the carpal tunnel between the two groups (P&lt;0.05). In contrast, no significant differences were observed at other sites. Regarding the relationship between sonography and NCSs, NCSs showed higher sensitivity, but sonography demonstrated comparable specificity in evaluating diabetic peripheral neuropathy. Conclusion: Peripheral nerve US in the upper limb can be a valuable diagnostic tool for identifying and diagnosing diabetic peripheral neuropathy.

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 &amp; 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

Pulsed-control plasma-activated water: An emerging technology to assist ultrasound for fresh-cut produce washing

In this study, we explored the use of plasma-activated water (PAW) in combination with ultrasound (US) for food disinfection. Our research introduces a novel approach that utilizes a pulsed-control (PC) method to modify the PAW. The resulting PCPAW exhibits significantly higher concentrations of key reactive oxygen and nitrogen species (RONS) compared to conventional PAW. The disinfection efficacy of US–PCPAW against fresh-cut lettuce was compared to that of US-PAW, US, and PCPAW. The combination of US and PCPAW was highly effective in reducing food-borne pathogens, surpassing single treatments in count reduction and minimizing cross-contamination. Furthermore, our study demonstrates that US–PCPAW effectively controls browning appearance without compromising sensory attributes. These findings suggest that PCPAW, as a novel disinfectant, can be a valuable addition to US to enhance the quality and safety of fresh-cut produce.

The value of ultrasonography in predicting the outcomes of simple long bone fractures treated by closed intramedullary nail fixation

PurposeUltrasonography has been used increasingly in orthopaedic practice credited to its low cost, easy accessibility, non-invasiveness, reproducibility, and safety from radiation. The purpose of this study was to test the validity and efficacy of ultrasonography as an adjunct in the assessment of fracture healing in long bones treated with intramedullary interlocking devices and its predictive value in determining the need for a secondary surgical procedure. MethodsThis was a descriptive longitudinal study of 40 skeletally mature patients who sustained long bone fractures of the tibia or femur treated using intramedullary interlocking nails. Patients with comminuted and segmental fracture patterns were excluded from the study. Each patient was evaluated at 6- and 12-week post-surgery using standard orthogonal radiographs and ultrasonography to assess fracture healing. Patients were then followed up until fracture union. Quantitative data was analyzed using frequency statistics and descriptive data with inferential statistics. ResultsUltrasonography predicted 87.5% union and 12.5% delayed or non-union as early as 6 weeks after surgery, while radiographs predicted 22.5% union as late as 3 months of follow-up. The sensitivity and specificity of ultrasonography in assessing fracture healing were 100% and 97.2%, respectively, with a positive predictive value of 80.0%. Vascular resistance index was less than 0.5 in all patients who developed delayed or non-union. ConclusionUltrasonography is able to predict fracture outcomes much earlier than standardized radiographs with comparable sensitivity and specificity. Vascular resistance index is an objective parameter in assessing callus quality and predicting fracture outcomes.

Efficacy of ultrasound versus short wave diathermy in the treatment of chronic low back pain in patients with lumbar disk herniation: a prospective randomized control study

BackgroundLumbar disk herniation (LDH) is a cause of chronic low back pain (CLBP) treated using physical therapy (PT), including exercise and physical modalities such as ultrasound (US) and short wave diathermy (SWD). Despite the use of US and SWD, there is inconclusive evidence on their efficacy. The aim of this study was to investigate the efficacy of US and SWD in the treatment of CLBP in patients with LDH.MethodsA prospective randomized control clinical study. Individuals with radicular CLBP and LDH on magnetic resonance imaging, presenting to the Physical and Rehabilitation Medicine Department were randomized into 3 treatment groups. All participants received 10 sessions of hotpack, transcutaneous nerve stimulation (TENS) and therapeutic exercises. In addition, Group 1 received 10 sessions of therapeutic US (1 MHz, 1.5W/cm2, 10 min), Group 2 SWD (27.12 MHz, wavelength 11.06 m, induction technique, 20 min) to the lower back. Group 3 (control group) received hotpack, TENS and therapeutic exercises alone. Visual analogue scale (VAS) for LBP, Modified Oswestry Disability Index (MODI) and Short Form 36 (SF-36) were evaluated pre and post treatment and at one and three months follow up.ResultsIn all groups, VAS for LBP and MODI improved with treatment and at the one and three month follow up (p < 0.001). In Groups 1 and 2, MODI scores continued to reduce at 1 and 3 months (p < 0.001 and p = 0.012 respectively). SF-36 physical, social function and pain parameters reduced in all groups (p < 0.05). Role limitation due to physical and emotional problems, emotional well-being, vitality and mental health improved in Groups 1 and 2 (p < 0.05).ConclusionsDeep heating agents can be used as part of the physical therapy for CLBP in those with LDH with positive mid-term effects.Trial registrationNCT03835182, 02/04/2019.

The combined effects of ultrasound and plasma-activated water on microbial inactivation and quality attributes of crayfish during refrigerated storage

In this study, a decontamination technology combining ultrasound (US) and plasma-activated water (PAW) was developed to better preserve crayfish. First, the decontamination efficacy of US, PAW and their combinations (UP) on crayfish was quantified after 0, 20, 40, or 60 min of treatments. The total viable count (TVC) was reduced by 0.27–0.77 Log CFU/g after individual US or PAW treatments, while a TVC reduction of 1.17 Log CFU/g was achieved after 40 min of UP treatment. Besides, the changes in psychrotrophic bacteria, lactic acid bacteria, yeasts and molds followed a similar trend to TVC. UP treatments normally resulted in more significant reductions in the natural microbiota of crayfish than US or PAW treatments. Furthermore, the microbial quality, physicochemical properties and sensory properties of crayfish after different treatments were assessed during storage at 4 °C for 12 days. According to TVC and total volatile basic nitrogen (TVB-N) values, the control group became unacceptable from 4 days, US or PAW groups became unacceptable from 6 days, while UP group extended the storage time to 8–10 days. During storage, thiobarbituric acid reactive substances (TBARS) values of all the groups were maintained below 0.5 mg/kg, among which the control group exhibited the highest value (0.39 mg/kg). Moreover, UP treatment effectively retarded the deterioration in color and texture properties of crayfish. Fourier transform infrared (FTIR) spectroscopy analysis indicated that UP treatment decreased the α-helix contents and increased the β-sheet contents of crayfish proteins, while the structural changes were not evident at the end of storage. Low-field nuclear magnetic resonance (LF-NMR) analysis revealed that UP treatment reduced the water migration and enhanced the stability of bond water in crayfish. In addition, E-nose analysis revealed the protection of UP treatment on the sensory properties of crayfish during storage. This study demonstrated that the combinations of US and PAW treatments effectively accelerated the decontamination of crayfish and contributed to better storage quality.

Qualitative and semi-quantitative ultrasound assessment in delta and Omicron Covid-19 patients: data from high volume reference center

Objective: to evaluate the efficacy of US, both qualitatively and semi-quantitatively, in the selection of treatment for the Covid-19 patient, using patient triage as the gold standard. Methods: Patients admitted to the Covid-19 clinic to be treated with monoclonal antibodies (mAb) or retroviral treatment and undergoing lung ultrasound (US) were selected from the radiological data set between December 2021 and May 2022 according to the following inclusion criteria: patients with proven Omicron variant and Delta Covid-19 infection; patients with known Covid-19 vaccination with at least two doses. Lung US (LUS) was performed by experienced radiologists. The presence, location, and distribution of abnormalities, such as B-lines, thickening or ruptures of the pleural line, consolidations, and air bronchograms, were evaluated. The anomalous findings in each scan were classified according to the LUS scoring system. Nonparametric statistical tests were performed. Results: The LUS score median value in the patients with Omicron variant was 1.5 (1–20) while the LUS score median value in the patients with Delta variant was 7 (3–24). A difference statistically significant was observed for LUS score values among the patients with Delta variant between the two US examinations (p value = 0.045 at Kruskal Wallis test). There was a difference in median LUS score values between hospitalized and non-hospitalized patients for both the Omicron and Delta groups (p value = 0.02 on the Kruskal Wallis test). For Delta patients groups the sensitivity, specificity, positive and negative predictive values, considering a value of 14 for LUS score for the hospitalization, were of 85.29%, 44.44%, 85.29% and 76.74% respectively. Conclusions: LUS is an interesting diagnostic tool in the context of Covid-19, it could allow to identify the typical pattern of diffuse interstitial pulmonary syndrome and could guide the correct management of patients.

Preprocedural ultrasonography as an adjunct to landmark technique for identification of epidural space in parturients for labor analgesia.

Pregnancy-induced softening of tissues and ligaments may increase the false-positive rates when identifying the epidural space in parturients by the landmark technique. To mitigate these problems, Ultrasonography (USG), which has now become the eye of anesthesiologists, can be used as a reliable tool to facilitate more accurate epidural needle placement in parturients. This study was conducted to know the efficacy of USG when compared to the traditional landmark method. After the approval from the institutional ethics committee and CTRI registration, 62 parturients of ASA-2 requesting labor analgesia were randomized into 2 groups of 31 each: Group-L (conventional landmark technique) and Group-U (preprocedural USG done before epidural). In group-U, Tuohy's needle was introduced through the USG predetermined insertion point and epidural space was located using the LOR technique. USG increased the success rate of epidural at first attempt from 51.6% in group "L" to 87% in group "U." Fewer needle attempts (P-value - 0.001) were required in group "U" as compared to group "L." No accidental dural puncture in group-U, compared to 2 in group-L. Mean Depth of epidural space (cm) ultrasound depth (UD) = 3.89 ± 0.45 cm and needle depth (ND) = 4.05 ± 0.37 cm. Side effects profile in the ultrasound group was better. Preprocedural ultrasonography is a simple safe, accurate tool with less number of attempts to determine the needle insertion site, decrease the incidence of accidental dural punctures, and assess epidural space depth in parturients.

Efficacy of Ultrasonography and Fibroblast Growth Factor 21 for Early Diagnosis of Non-Alcoholic Fatty Liver Disease

Efficacy of Ultrasonography and Fibroblast Growth Factor 21 for Early Diagnosis of Non-Alcoholic Fatty Liver Disease

Is Ultrasound-guided Bedside Percutaneous Transhepatic Biliary Drainage Safe and Feasible in Critically Ill Patients with Severe Cholangitis? A Preliminary Single-center Experience.

Severe cholangitis secondary to biliary obstruction carries high mortality unless biliary drainage is performed urgently. Owing to various patient-related and logistical issues, bedside biliary drainage is considered a salvage therapeutic option. This study aims to evaluate the safety and efficacy of ultrasonography (USG)-guided biliary drainage at the bedside in patients with severe cholangitis admitted to the intensive care unit (ICU). A total of 20 patients with severe cholangitis admitted to ICU who underwent bedside percutaneous transhepatic biliary drainage (PTBD) under USG guidance were retrospectively evaluated. Clinical outcomes, details about the PTBD procedure, and complications were recorded and analyzed. Among 20 patients, 13 were male and 7 were female with a mean age of 50.5 years. The most common cause of biliary obstruction was gall bladder malignancy (45%, n = 9) followed by cholangiocarcinoma (25%, n = 5). Left- and right-sided PTBD was performed in 40% (n = 8) and 35% (n = 7) patients, respectively, while 25% (n = 5) of patients underwent bilateral PTBD. The technical success rate was 100%. A total of 65% (n = 13) of patients were discharged from ICU upon improvement while the remaining 35% (n = 7) died despite bedside PTBD. None of the patients had any major procedure-related complications. Ultrsound-guided bedside PTBD seems to be a safe and effective option in critically ill patients with severe cholangitis when shifting of patients is not feasible. Singh J, Tripathy TP, Patel R, Chandel K. Is Ultrasound-guided Bedside Percutaneous Transhepatic Biliary Drainage Safe and Feasible in Critically Ill Patients with Severe Cholangitis? A Preliminary Single-center Experience. Indian J Crit Care Med 2023;27(1):16-21.

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.

Classification of acute diverticulitis in the left colon with ultrasonography and computed tomography: Value of current severity classification schemes

Background and aimsThe current management of acute diverticulitis of the left colon (ADLC) requires tests with high prognostic value. This paper analyzes the usefulness of ultrasonography (US) in the initial diagnosis of ADLC and the validity of current classifications schemes for ADLC. PatientsThis retrospective observational study included patients with ADLC scheduled to undergo US or computed tomography (CT) following a clinical algorithm. According to the imaging findings, ADLC was classified as mild, locally complicated, or complicated. We analyzed the efficacy of US in the initial diagnosis and the reasons why CT was used as the first-line technique. We compared the findings with published classifications schemes for ADLC. ResultsA total of 311 patients were diagnosed with acute diverticulitis; 183 had ADLC, classified at imaging as mild in 104, locally complicated in 60, and complicated in 19. The diagnosis was reached by US alone in 98 patients, by CT alone in 77, and by combined US and CT in 8. The main reasons for using CT as the first-line technique were the radiologist’s lack of experience in abdominal US and the unavailability of a radiologists on call. Six patients diagnosed by US were reexamined by CT, but the classification changed in only three. None of the published classification schemes included all the imaging findings. ConclusionsUS should be the first-line imaging technique in patients with suspected ADLC. Various laboratory and imaging findings are useful in establishing the prognosis of ADLC. New schemes to classify the severity of ADLC are necessary to ensure optimal clinical decision making.

The efficacy of ultrasound and low-intensity laser therapy in carpal tunnel syndrome

Aim: The most frequent type of peripheral entrapment neuropathy is carpal tunnel syndrome (CTS), which is caused by compression of the median nerve at the wrist level. Ultrasound (US) and low-intensity laser therapy (LILT) are among the most commonly used physical therapy methods in the treatment of CTS. The aim of this study is to examine the efficacy of US and LILT in the treatment of CTS and their superiority to each other.&#x0D; Material and Method: Patients who were admitted to the physical therapy program with the diagnosis of CTS in our clinic were retrospectively examined. A total of eleven patients (18 wrists) diagnosed with mild and moderate CTS were included in our study with the G-Power program with a 5 % margin of error and 80 % power. Patients were divided into US and LILT groups using a simple randomization method. The patients were evaluated in terms of clinical and electrophysiological parameters before and after treatment.&#x0D; Results: A total of 18 wrists were included in our study, of which eight patients were diagnosed with mild CTS and the rest (n=10) with moderate CTS. The mean age of the patients was 49.66±10.68 years. When the post-treatment clinical (Boston Carpal Tunnel Syndrome Questionnaire (BCTQ), hand and pinch grip strength, measurement of wrist joint range of motion) and electrophysiological parameters were evaluated between the US and LILT groups, no significant difference was found in terms of their superiority over each other (p&gt;0.05). When the LILT group was compared before and after treatment, a statistically significant difference was found in the degree of wrist extension, handgrip strength and BCTQ parameters. (p