Gray-scale Ultrasonography Research Articles

The value of radiomics model based on ultrasound image features in the differentiation between minimal breast cancer and small benign breast masses.

Female breast cancer has surpassed lung cancer as the most common cancer, and is also the main cause of cancer death for women worldwide. Breast cancer <1 cm showed excellent survival rate. However, the diagnosis of minimal breast cancer (MBC) is challenging. The purpose of our research is to develop and validate an radiomics model based on ultrasound images for early recognition of MBC. 302 breast masses with a diameter of <10 mm were retrospectively studied, including 159 benign and 143 malignant breast masses. The radiomics features were extracted from the gray-scale ultrasound image of the largest face of each breast mass. The maximum relevance minimum reduncancy and recursive feature elimination methods were used to screen. Finally, 10 features with the most discriminating value were selected for modeling. The random forest was used to establish the prediction model, and the rad-score of each mass was calculated. In order to evaluate the effectiveness of the model, we calculated and compared the area under the curve (AUC) value, sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the model and three groups with different experience in predicting small breast masses, and drew calibration curves and decision curves to test the stability and consistency of the model. When we selected 10 radiomics features to calculate the rad-score, the prediction efficiency was the best, the AUC values for the training set and testing set were 0.840 and 0.793, which was significantly better than the insufficient experience group (AUC = 0.673), slightly better than the moderate experience group (AUC = 0.768), and was inferior to the experienced group (AUC = 0.877). The calibration curve and decision curve also showed that the radiomics model had satisfied stability and clinical application value. The radiomics model based on ultrasound image features has a satisfied predictive ability for small breast masses, and is expected to become a potential tool for the diagnosis of MBC, and it is a zero cost (in terms of patient participation and imaging time).

Accuracy of 2D Greyscale and 2D and 3D Color Power Doppler Ultrasound in the Diagnosis of Morbidly Adherent Placenta (MAP)

Background Prenatal diagnosis of placental accreta (PA) is essential to carry out adequate surgical planning in centers where multidisciplinary teams are in place, which improve results and reduce complications. These ideal scenarios should be developed in countries with more significant difficulties in the availability of human and technological resources, through teamwork in the different hospital centres and the adequate transfer of patients at higher risk to centres with the best interdisciplinary management skills. Objective To evaluate the diagnostic accuracy of each sign (2D grayscale US signs), 2D Doppler signs, and 3D Doppler signs modified from Collins SL in diagnosis of morbidly adherent placenta in patients with one or more previous cesarean section diagnosed as placenta previa. Methods The present study is a diagnostic test accuracy study was carried out at Ain Shams University Maternity Hospital during the period from January 2020 to March 2021. 126 women were recruited from Special Care Center of the fetus – Ain Shams University Maternity Hospital. All included women were scanned by 2D grayscale, 3D power Doppler ultrasound. Results The current study showed that cases underwent cesarean hysterectomy had significantly higher previous cesarean sections. The results of the current study showed a significant association between all criteria of the 2D grayscale, Color Doppler, 3D Power Doppler ultrasound and presence of placental adherence, considerable intraoperative blood loss, need for added surgical steps, CS hysterectomy and bladder injury with the presence of more than 4 sign or more are predictive for placental invasion with the need of emergency hysterectomy. Conclusion The result of the current study proves the diagnostic accuracy of the ultrasound concerning the prediction of difficult placental separation, considerable intraoperative blood loss, CS hysterectomy and bladder invasion.

Risk Factors and Predictors of Occlusion of Stent of Trans Jugular Intrahepatic Porto-Systemic Shunt (TIPSS) in Egyptian Patients with Primary Budd Chiari Syndrome: A Single Center Experience

Background Budd–Chiari syndrome is a heterogeneous group of disorders characterized by hepatic venous outflow obstruction at the level of the hepatic venules, the large hepatic veins, the inferior vena cava till its junction with the right atrium. The classic triad of abdominal pain, ascites, and hepatomegaly is observed in the vast majority of patients with Budd-Chiari syndrome. The diagnosis of BCS is made by clinical presentation and confirmatory investigations. Standard laboratory investigations are rarely helpful in establishing the diagnosis, because abnormal liver function tests are not specific for BCS, real time Gray-scale sonography combined with colour flow is considered by some to be the initial imaging technique. The recommended stepwise therapeutic algorithm of BCS is mainly by medical treatment with anticoagulation, angioplasty with or without stenting, TIPS of surgical shunting and liver transplantation if indicated. TIPS is a common teqnique used in BCS and TIPS stent occlusion is major complication. Objectives To identify the possible risk factors and predictors of stent occlusion in primary BCS patients who underwent TIPSS. Patients and Methods The studied patients were selected from patients presented to Budd Chiari outpatient clinic. Tropical medicine department in Ain Shams University hospitals. total number of cases during the study period was 76 cases fulfilling the inclusion criteria, they were divided in 2 groups according to patency of TIPS stent and comparing both groups regarding their pre and post TIPS data. Results The mean age of the patients was (29.29 ± 7.92) with female predominance. FVLM (69.7%) &amp; MTHFRD (67.1%) were the most common causes of BCS in the studied patients. positive and higher CRP results were found in the occluded stent patients than patent groups. also, higher TLC levels were found in the occluded TIPS stent patients. Conclusion Identifying these risk factors may help predict the outcome of TIPS stent patency.

Ultrasound identification of hepatic echinococcosis using a deep convolutional neural network model in China: a retrospective, large-scale, multicentre, diagnostic accuracy study

Ultrasonography is the most widely used technique to diagnose echinococcosis; however, challenges in using this technique and the demand on medical resources, especially in low-income or remote areas, can delay diagnosis. We aimed to develop a deep convolutional neural network (DCNN) model based on ultrasonography to identify echinococcosis and its types, especially alveolar echinococcosis. This retrospective, large-scale, multicentre study used ultrasound images from patients assessed at 84 hospitals in China, obtained between Jan 1, 2002, and Dec 31, 2021. Patients with a diagnosis of cystic echinococcosis, alveolar echinococcosis, or seven other types of focal liver lesions were included. We tested ResNet-50, ResNext-50, and VGG-16 as the backbone network architecture for a classification DCNN model and input the perinodular information from the ultrasound images. We trained and validated the DCNN model to diagnose and classify echinococcosis using still greyscale ultrasound images of focal liver lesions in four stages: differentiating between echinococcosis and other focal liver lesions (stage one); differentiating cystic echinococcosis, alveolar echinococcosis, and other focal liver lesions (stage two); differentiating cystic echinococcosis, alveolar echinococcosis, benign other focal liver lesions, and malignant focal liver lesions (stage three); and differentiating between active and transitional cystic echinococcosis and inactive cystic echinococcosis (stage four). We then tested the algorithm on internal, external, and prospective test datasets. The performance of DCNN was also compared with that of 12 radiologists recruited between Jan 15, 2022, and Jan 28, 2022, from Qinghai, Xinjiang, Anhui, Henan, Xizang, and Beijing, China, with different levels of diagnostic experience for echinococcosis and other focal liver lesions in a subset of ultrasound data that were randomly chosen from the prospective test dataset. The study is registered at ClinicalTrials.gov (NCT03871140). The study took place between Jan 1, 2002, and Dec 31, 2021. In total, to train and test the DCNN model, we used 9631 liver ultrasound images from 6784 patients (2819 [41·7%] female patients and 3943 [58·3%] male patients) from 87 Chinese hospitals. The DCNN model was trained with 6328 images, internally validated with 984 images, and tested with 2319 images. The ResNet-50 network architecture outperformed VGG-16 and ResNext-50 and was generalisable, with areas under the receiver operating characteristic curve (AUCs) of 0·982 (95% CI 0·960-0·994), 0·984 (0·972-0·992), and 0·913 (0·886-0·935) in distinguishing echinococcosis from other focal liver lesions; 0·986 (0·966-0·996), 0·962 (0·946-0·975), and 0·900 (0·872-0·924) in distinguishing alveolar echinococcosis from cystic echinococcosis and other focal liver lesions; and 0·974 (0·818-1·000), 0·956 (0·875-0·991), and 0·944 (0·844-0·988) in distinguishing active and transitional cystic echinococcosis from inactive echinococcosis in the three test datasets. Specifically, in patients with the hepatitis B or hepatitis C virus, the model could distinguish alveolar echinococcosis from hepatocellular carcinoma with an AUC of 0·892 (0·812-0·946). In identifying echinococcosis, the model showed significantly better performance compared with senior radiologists from a high-endemicity area (AUC 0·942 [0·904-0·967] vs 0·844 [0·820-0·866]; p=0·027) and improved the diagnostic ability of junior, attending, and senior radiologists before and after assistance with AI with comparison of AUCs of 0·743 (0·714-0·770) versus 0·850 (0·826-0·871); p<0·0001, 0·808 (0·782-0·832) versus 0·886 (0·864-0·905); p<0·0001, and 0·844 (0·820-0·866) versus 0·870 (0·847-0·890); p=0·092, respectively. The DCNN model was shown to be accurate and robust, and could improve the ultrasound diagnostic ability of radiologists for echinococcosis and its types for highly endemic and remote regions. National Natural Science Foundation of China and National Key Research & Development Program of China. For the Chinese translation of the abstract see Supplementary Materials section.

Diagnostic value of the dual-modal imaging radiomics model for subpleural pulmonary lesions

PurposeTo investigate the clinical value of the radiomics model of grayscale ultrasound (GUS) and contrast-enhanced ultrasound (CEUS) to diagnosis subpleural pulmonary tuberculosis and nonpulmonary tuberculosis based on GUS and CEUS images. MethodsThis study included 221 patients with 228 lesions diagnosed using the composite reference standard. The patients were randomly divided into training (n = 183) and test (n = 45) cohorts in an 8:2 ratio. The regions of interest of the GUS and CEUS images were manually segmented to extract the radiomic features. The GUS, CEUS and GUS+CEUS radiomics models were constructed via the multistep selection of highly correlated features. Receiver operating characteristic curves of the different models were plotted, and the area under the curve (AUC), accuracy, sensitivity, specificity, positive predictive value and negative predictive value (NPV) of the different models were compared. ResultsFollowing Least Absolute Shrinkage and Selection Operator dimension reduction we selected 4, 9, and 11 features to construct the GUS, CEUS, and GUS+CEUS radiomics models, respectively. The AUC values of the three groups in the test cohort were 0.689, 0.748 and 0.779, respectively, and they did not differ significantly. In the test cohort, the GUS+CEUS radiomics model exhibited the highest AUC (0.779), accuracy (75.56%), and NPV (68.7%) of the three models. ConclusionsThe GUS+CEUS radiomics model possesses good clinical value in diagnosing pulmonary tuberculosis.

Assessment of lacrimal gland involvement in primary Sjögren's syndrome using gray-scale ultrasonography and shear wave elastography.

The aim of this study was to assess lacrimal gland involvement in primary Sjögren's syndrome (pSS) using lacrimal gland gray-scale ultrasound (LGUS) and two-dimensional shear wave elastography (2D-SWE). Eighty-five pSS patients with a mean age of 51.16 ± 10.61years and 84 sex- and age-matched healthy subjects with a mean age of 50.94 ± 11.05years were included in the study. Lacrimal gland parenchymal findings and 2D-SWE values were compared between the two groups and the correlations of LGUS parameters with clinical findings, dry eye tests, and minor salivary gland biopsy (MSGB) were further investigated. LGUS parenchymal grade was 0 in 14 (16.5%), 1 in 45 (52.9%), 2 in 23 (27.1%), and 3 in 3 patients (3.5%) in the pSS group, while in the control group, parenchymal grades were 0 (57.1%) and 1 (42.9%). The mean 2D-SWE value of pSS patients was significantly higher than the control group (p < 0.05) and increased parallel with lacrimal parenchymal grade. The elasticity modulus had a high diagnostic performance in detecting lacrimal gland involvement in pSS patients (AUC 0.901, sensitivity 70.6%, specificity 97.6%), while the diagnostic performance of LGUS was much lower (AUC 0.769, sensitivity 83.5%, specificity 57.1%). LGUS and 2D-SWE values were found to be correlated with dry eye tests and MSGB results (p < 0.05). LGUS and 2D-SWE are both useful for assessing the lacrimal gland involvement in pSS patients; however, 2D-SWE has a better diagnostic performance than LGUS and found to be correlated with dry eye tests. Lacrimal gland US and two-dimensional shear wave elastography (2D-SWE) are imaging modalities that can be used to demonstrate parenchymal involvement of the lacrimal gland in primary Sjögren's syndrome (pSS). • Gray-scale US and two-dimensional shear wave elastography (2D-SWE) have been widely used in the recent decade to assess gland involvement in patients with primary Sjögren's syndrome (pSS). • The elasticity modulus had a high diagnostic performance in detecting lacrimal gland involvement in primary Sjögren's syndrome (pSS) patients. • Lacrimal gland US and two-dimensional shear wave elastography (2D-SWE) are both useful for assessing the lacrimal gland in primary Sjögren's syndrome (pSS) patients; however, two-dimensional shear wave elastography (2D-SWE) has a better diagnostic performance than lacrimal gland ultrasound (LGUS).

Placenta Accreta Spectrum: A Current Literature Review

Objective: This literature review was designed to highlight the most up-to-date and evidence-based interventions, whenever available, regarding diagnostic imaging modalities and management strategies for patients, with the placenta accreta spectrum. Materials and Methods: A comprehensive review of the literature was conducted using database searches in Science Direct, Google Scholar, and PubMed to locate the most up-to-date information, related to this topic. Results: The placenta accreta spectrum has an unclear etiology, with cesarean delivery and placenta previa being the most implicated factors. Conclusion: There is a growing global consensus that the two main risk factors for placenta accreta are placenta previa and prior cesarean delivery. Up-to-date, grayscale sonography combined with Doppler interrogation is thought to be the best first-line assistance, for the identification of abnormal placental invasion. Cesarean hysterectomy, with placenta left in situ, is the classical surgical treatment.

Diagnostic Performance of Greyscale Ultrasound in Detecting Fatty Liver Disease in a Type 2 Diabetes Population Using FibroScan as the Reference Standard.

Introduction Brightness mode ultrasound (B-mode US) and FibroScan (Echosens, Paris, France) are the two ultrasound methods often recommended for screening non-alcoholic fatty liver disease (NAFLD) in persons with type 2 diabetes mellitus (T2DM). This study assessed the diagnostic performance of B-mode US using FibroScan as the reference standard. Methods Persons with a known history of T2DM were invited to screen for NAFLD using B-mode US and FibroScan on separate days within a one-month period. Assessors of B-mode US and FibroScan were blinded to each other's findings. Both B-mode US and FibroScan independently assessed and graded each participant for the presence of NAFLD. Using the diagnostic test findings of FibroScan as a reference standard, the sensitivity and specificity of B-mode US were analyzed.The area under the receiver operating characteristic curve (AUROC) was analyzed using Jamovi (version 2.3.21). A multinomial logistic regression of the B-mode US and FibroScan in predicting NAFLD grade was also analyzed. Results A total of 171 participants were assessed. B-mode US detected NAFLD in T2DM patients with 63.6% sensitivity, 65.6% specificity, and 0.646 AUROC. Sensitivity and specificity in overweight and obese participants were 36-43% and 76-85%, respectively. Multinomial logistic regression demonstrated an insignificant statistical relationship between FibroScan and B-mode US in predicting grade 1 steatosis (p-value = 0.397), which was significantly affected by a higher BMI (p-value = 0.034) rather than a higher liver fibrosis level (p-value = 0.941). The logistic regression further showed a significant relationship between B-mode US and FibroScan in predicting steatosis grade 2 (p-value = 0.045) and grade 3 (p-value < 0.001), which was not significantly affected by BMI (p-value = 0.091). Conclusion B-mode US can replace FibroScan for severe steatosis; however, it cannot be used to screen for NAFLD in T2DM patients due to lower sensitivity for early detection in the overweight.

Sensitivity and specificity of chest ultrasound in the diagnosis of pulmonary embolism in the emergency department: A case-control study.

The present study was designed to evaluate the role of chest ultrasound in the diagnosis of acute pulmonary embolism (PE) and determine its accuracy using multi-detector CT-pulmonary angiography (MD-CTPA) as a gold standard technique for PE diagnosis. A prospective case-control study was performed with 75 patients who presented to the emergency department of Minia Cardiothoracic University Hospital with clinical suspicion of PE. All patients were evaluated clinically and by laboratory tests to assess the risk of PE. Thoracic ultrasound (TUS) was then performed for all patients for signs suggestive of PE. Finally, MD-CTPA was performed to confirm or exclude the presence of PE. Patients were subdivided into two groups according to the result of MD-CTPA; group I (patients with PE) and group II (control group without PE). In our study, PE was present in the lower lobe in 75% of cases, then in the middle in 13% and in the upper lobe in 3.8% of cases. The majority of lesions in TUS were wedge-shaped lesions. No vascular flow was detected in 83% of PE-confirmed patients. The current study revealed that TUS has 81.25% sensitivity, 95% specificity, 98.3% positive predictive value, 77.2% negative predictive value and 87% accuracy in the diagnosis of PE. Univariate regression analysis revealed that the presence of wedge-shaped pleural-based lesions in grayscale US and the absence of flow signals by colour Doppler sonography (CDS) increase the possibility of PE. Wedge-shaped pleural-based lesions increase the possibility of PE by 1.48 times (P=0.0001), and the absence of flow signals by CDS increases the possibility of PE by 92.89 times (P=0.00001). Multivariate regression analysis revealed that adding absent flow signals by CDS to wedge-shaped pleural-based lesions by grayscale US increases the possibility of a PE diagnosis by 50.28 times (P=0.001). Chest ultrasound is a simple, safe, noninvasive, inexpensive, bedside diagnostic radiological technique that can be used in the emergency department for suspected PE or as an alternative to MD-CTPA when CTPA is contraindicated. Wedge-shaped lesions and the absence of flow signals by CDS increase the diagnostic value of ultrasound for PE.

Role of Gray Scale and Color Doppler Ultrasound in Differentiating Benign from Malignant Ovaran Masses

Role of Gray Scale and Color Doppler Ultrasound in Differentiating Benign from Malignant Ovaran Masses

Use of ultrasound elastography in differentiating benign from malignant thyroid nodules: a prospective study.

Elastography is a real-time non-invasive ultrasonography modality wherein the tissue stiffness is evaluated by calculating the degree of tissue distortion in response to an external force. This study was undertaken to assess the diagnostic value of elastography in differentiating benign from malignant thyroid nodules. In this prospective comparative study, a total of 52 thyroid nodules from 44 euthyroid patients undergoing fine needle aspiration cytology were assessed. Elastography was performed by a single experienced sonologist, wherein the nodules were graded as per elastography scoring (ES), and the strain ratio (SR) for each nodule was computed. Final histopathology findings of the patients undergoing surgery were compared to elastography findings, and measures of diagnostic accuracy to differentiate between benign and malignant nodules were determined for ES and SR. Thirty (68.2%) females and 14 (31.8%) males, with a mean age of 45.18 ± 11.23years, were assessed. Fourteen (31.8%) patients underwent thyroidectomy, and histopathology was reported for 18 (34.6%) nodules. In all, nine (17.3%) nodules were malignant, and 43 (82.7%) nodules were considered benign. ES demonstrated a sensitivity of 88.9%, specificity of 88.3%, PPV of 61.5%, NPV of 97.4%, and accuracy of 88.5% to identify benign thyroid nodules. The mean SR for benign nodules was significantly lower as compared to malignant nodules (2.72 ± 0.62 vs. 4.52 ± 0.75, P < 0.0001). The optimal cut-point value for SR to differentiate benign and malignant thyroid nodules was determined to be 3.8, with the sensitivity, specificity, PPV, NPV, and accuracy being 88.9%, 95.4%, 80%, 94.6%, and 94.2%, respectively. Ultrasound elastography (ES and SR) demonstrated good diagnostic efficacy to differentiate benign thyroid nodules from the malignant ones, and can be a good supplementary tool to gray-scale ultrasonography. It can also help in reducing the rates of unnecessary fine needle-aspiration biopsy.

Histogram analysis of based on two-dimensional ultrasound images to differentiate medullary thyroid carcinoma and thyroid adenoma

Objective: To investigate the feasibility and value of histogram analysis based on two-dimensional gray-scale ultrasonography in the differential diagnosis of medullary thyroid carcinoma (MTC) and thyroid adenoma (TA). Methods: The preoperative ultrasound images of 86 newly diagnosed MTC patients and 100 TA patients treated in the Cancer Hospital of Chinese Academy of Medical Sciences from January 2015 to October 2021 were collected. Histograms were performed based on the regions of interest (ROIs) delineated manually by two radiologists, thereafter, mean, variance, skewness, kurtosis, percentiles (1st, 10th, 50th, 90th, 99th) were generated. The histogram parameters between the MTC group and the TA group were compared, and the independent predictors were screened by multivariate logistic regression analysis. Receiver operating characteristic (ROC) analysis was used to compare the individual diagnostic efficacy and joint diagnostic efficacy of independent predictors. Results: Multivariate regression analysis showed that mean, skewness, kurtosis and 50th percentile were independent factors. The skewness and kurtosis in the MTC group were significantly higher than those in the TA group, and the mean and 50th percentile were significantly lower than those in the TA group. The area under the individual ROC curve of mean, skewness, kurtosis and 50th percentile is 0.654-0.778. The area under the combined ROC curve is 0.826. Conclusion: Histogram analysis based on two-dimensional gray-scale ultrasonography is a promising tool to distinguish MTC from TA, in which the joint diagnosis value of mean, skewness, kurtosis and 50th percentile is the highest.

(123) Novel Low Intensity Shockwave Therapy Sham Delivery Method (Zero Energy) Assessed Objectively by Grayscale and Doppler Ultrasound Results

Abstract Introduction Most ED LiSWT studies use the IIEF as a primary outcome. While clinically relevant, the IIEF does not directly assess erectile tissue structure. To establish a more objective parameter, we investigated the estimation of hypoechoic area in grayscale ultrasound images of erectile tissue as an objective primary outcome for clinical trials assessing the efficacy of LiSWT. During erection, grayscale imaging of the penis demonstrates corpora cavernosa (CC) that is homogenous in healthy men and heterogeneous to varying degrees in men with ED. A critical aspect of using grayscale ultrasound is to determine that sham treatment reliably results in no significant improvement in erectile tissue structure. Other studies have used sham probes with cotton wadding or non-penetrable gel pads to dampen delivery of shockwave energy flux density, however a small amount of energy may still be delivered. We report a novel sham-controlled methodology in LiSWT RCT for ED. Objective To evaluate erectile tissue heterogeneity as an endpoint in LiSWT sham-controlled trials using grayscale analysis of percent hypoechoic regions in CC after sham delivery of zero energy flux density. Methods A single-blind, sham-controlled, randomized prospective study was performed in men with ED naïve to any kind of acoustic wave therapy. Those meeting inclusion/exclusion completed baseline assessments and were randomized to active or sham within each treatment arm. This interim sub-analysis only examined the sham group (n = 7). For each treatment, the shockwave device was already on in the exam room. When the subject was ready a curtain was suspended above his mid-section blocking the device, and noise cancelling headphones provided. When the probe was placed on the penis, a high-quality recording of shockwave sounds was activated for sham treatment. Twenty weeks after zero energy sham treatment, grayscale and DUS imaging using a 15.4 MHz probe under pharmacologic erection 3-4/4 hardness was performed before unblinding. Grayscale percent hypoechoic regions within the CC were assessed by computer-assisted histometry using Image J. (Fig 1) The IIEF was also administered to all patients at baseline and week 20. Grayscale data were analyzed by two-way repeated measures ANOVA. IIEF-EF scores and bloodflow values (PSV and EDV) were compared using the Wilcoxon matched-pairs signed rank test. Results Compared to baseline, there were no significant changes (p&amp;gt;0.7; see figure) at week 20 in hypoechoic area in the proximal, middle, and distal erect penile shaft. (Fig 2) Furthermore, there were no significant changes in PSV (p&amp;gt;0.15), EDV (p&amp;gt;0.2), or IIEF-EF (p&amp;gt;0.6) from baseline to week 20. Conclusions Using computer-assisted histometry to determine hypoechoic area in grayscale ultrasound images to assess penile erectile tissue heterogeneity, we demonstrated that a novel sham treatment protocol that ensures zero energy delivery does not change erectile tissue integrity. The lack of improvement in PSV, EDV, and IIEF-EF further support our findings with grayscale ultrasound. Future studies will assess the appropriateness of grayscale ultrasound image analysis as a primary endpoint in LiSWT clinical trials. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: TRT, Cynosure.

Rheumatoid arthritis with concomitant fibromyalgia: The role of ultrasound in assessing disease activity.

Fibromyalgia (FM) is a chronic painful condition frequently associated with rheumatoid arthritis (RA), which may falsely increase RA activity. The aim of our study was to compare clinical scoring and ultrasound (US) assessment in RA patients with concomitant FM with those without FM. A cross-sectional study including patients with RA according to the ACR/EULAR 2010 criteria was conducted. Patients were divided into two groups: RA patients meeting ACR 2016 FM criteria (cases) and RA patients not meeting FM criteria (controls). Clinico-biological and US assessments of RA activity were performed on the same day for each patient. Eighty patients distributed into 40 patients in each group were recruited. Biologic DMARD prescription was more frequent in RA with FM patients than the control group (p=0.04). DAS28 was significantly greater than DAS28 V3 in RA with FM group (p=0.002). FM group had significantly less US synovitis (p=0.035) and less Power Doppler (PD) activity (p=0.035). Grey scale US score (p=0.87) and DP US score (p=0.162) were similar in the two groups. The correlation between the clinical and the ultrasonographic scores was strong to very strong in both groups with the strongest correlation found between DAS28 V3 and US DAS28 V3 (r=0.95) in RA+FM group. Our study confirms the overestimation of disease activity by the clinical scores in RA with concomitant FM. DAS28 V3 score and US assessment would represent a better alternative.

A multiparametric clinic-ultrasomics nomogram for predicting extremity soft-tissue tumor malignancy: a combined retrospective and prospective bicentric study.

We aimed at building and testing a multiparametric clinic-ultrasomics nomogram for prediction of malignant extremity soft-tissue tumors (ESTTs). This combined retrospective and prospective bicentric study assessed the performance of the multiparametric clinic-ultrasomics nomogram to predict the malignancy of ESTTs, when compared with a conventional clinic-radiologic nomogram. A dataset of grayscale ultrasound (US), color Doppler flow imaging (CDFI), and elastography images for 209 ESTTs were retrospectively enrolled from one hospital, and divided into the training and validation cohorts. A multiparametric ultrasomics signature was built based on multimodal ultrasomic features extracted from the grayscale US, CDFI, and elastography images of ESTTs in the training cohort. Another conventional radiologic score was built based on multimodal US features as interpreted by two experienced radiologists. Two nomograms that integrated clinical risk factors and the multiparameter ultrasomics signature or conventional radiologic score were respectively developed. Performance of the two nomograms was validated in the retrospective validation cohort, and tested in a prospective dataset of 51 ESTTs from the second hospital. The multiparametric ultrasomics signature was built based on seven grayscale ultrasomic features, three CDFI ultrasomic features, and one elastography ultrasomic feature. The conventional radiologic score was built based on five multimodal US characteristics. Predictive performance of the multiparametric clinic-ultrasomics nomogram was superior to that of the conventional clinic-radiologic nomogram in the training (area under the receiver operating characteristic curve [AUC] 0.970 vs. 0.890, p = 0.006), validation (AUC: 0.946 vs. 0.828, p = 0.047) and test (AUC: 0.934 vs. 0.842, p = 0.040) cohorts, respectively. Decision curve analysis of combined training, validation and test cohorts revealed that the multiparametric clinic-ultrasomics nomogram had a higher overall net benefit than the conventional clinic-radiologic model. The multiparametric clinic-ultrasomics nomogram can accurately predict the malignancy of ESTTs.

P132 A late and rapid increase in ultrasound joint inflammation occurs when anti-CCP positive at-risk individuals with subclinical synovitis progress to inflammatory arthritis

Abstract Background/Aims Anti-CCP positive individuals with musculoskeletal (MSK) symptoms and subclinical synovitis on ultrasound (US) are at high risk of developing inflammatory arthritis (IA). Treatment initiation in these individuals is not accepted practice as they do not have clinical synovitis. We aimed to determine whether imaging characteristics change when individuals with pre-RA progress to IA in order to inform the optimal window of opportunity for therapeutic interventions. Methods Anti-CCP+ at-risk individuals with MSK symptoms from the Leeds CCP cohort were selected for having US subclinical synovitis [Grey scale (GS)≥1 and Power Doppler (PD)≥1] prior to IA development and an US scan performed at clinical synovitis onset. The US protocol included the metacarpophalangeal joints (MCPJs), proximal interphalangeal joints (PIPJs), wrists, elbows, knees, second-fifth metatarsophalangeal joints (MTPJs), extensor carpi ulnaris (ECU) and finger flexor tendons (FFTs). US PD and GS synovitis were scored semi-quantitatively (0-3) according to EULAR/OMERACT. At patient level, total GS and PD scores were compared between scans. Change on US in the joints that became clinically swollen was also assessed. Wilcoxon signed-rank tests were conducted for comparisons. Results Forty-six CCP2+ at-risk individuals were identified (Table). The median US scan interval was 3.5 months (IQR 1.25-8.75). At patient level the overall burden of PD in the joints increased at IA progression, trending towards significance [3 (IQR 1.25-5) vs 4 (IQR 2-7.25) p = 0.063]. Overall burden of GS did not increase. There was an increase in PD in the MCPJs [0 (IQR 0-2) vs 1.5 (IQR0-3) p = 0.008] and MCP and wrist joints combined [1 (IQR 0.25-3) vs 2 (IQR 1.25-4.75) p = 0.002]. GS at the elbows also significantly increased. At joint level PD [1 (IQR(0-2) vs 2 (IQR 0-3) p = 0.036] increased in joints swollen at progression and GS increased with a trend towards significance. Non-swollen joints did not change. Conclusion A marked increase in US joint inflammation is seen when CCP+ at-risk individuals with subclinical synovitis on US progress from pre-RA to clinical arthritis. This is particularly evident in the MCPJs, wrist joints and joints that become clinically swollen. Intervening when at-risk individuals have subclinical synovitis may represent a window of opportunity to prevent the rapid increase in joint inflammation which accompanies the onset of joint swelling. Disclosure K. Harnden: None. A. Di Matteo: None. D. Esperança Almeida: None. E. De Lorenzis: None. L. Duquenne: None. L. Garcia-Montoya: None. J. Nam: None. P. Emery: None. K. Mankia: None.

P173 Evaluating disease activity in established psoriatic arthritis with ultrasound

Abstract Background/Aims Early diagnosis, tight disease activity control and a treat-to-target approach are now recognised as critical factors that improve the outcome of patients with psoriatic arthritis (PsA). The traditional method used to assess disease activity is clinical examination (CE) by counting the number of tender and swollen joints. Ultrasound (US) has proven its superiority over CE for assessing the presence of synovitis in some studies. We aimed to identify the frequency and location of subclinical synovitis in a cohort of PsA patients with established disease. Methods Patients with established PsA were recruited. All gave informed, written consent and local ethical approval was obtained. All patients had a standard CE including 68/66 tender/swollen joint count. Grayscale (GS) and power doppler (PD) US of a standard set of 44 joints was performed using a GE logiq-P9 machine utilising 6-15-MHz and 8-18-MHz linear transducers. GS and PD were scored on a 0-3 semiquantitative scale for each joint. The presence of US active joints was defined as a GS-score ≥2 and/or PD-score ≥1. Results 78 patients were enrolled; 46/78 were female with a median age = 61 years (range 41-80). Median duration of PsA disease = 31.5 years (range 41-80), 40/78 were on bDMARDs and 27/78 on csDMARDs. The median TJC = 2 (range of 0-6) and mean CRP = 3.2 (SD 3.5). The most common sites for subclinical synovitis were wrists, knees, and metatarsophalangeal joints (see Table 1). 36 patients (46.2%) achieved a clinical state of minimal disease activity (MDA). 11 patients in MDA (30.5%) had a PD-score of &amp;gt; 1, suggesting they did not achieve minimal ultrasound disease activity (MUDA). Conclusion These data demonstrate that a proportion of established PsA patients deemed to have MDA actually have sonographic evidence of active disease. A previous study showed that PD-synovitis in PsA patients in clinical remission was a strong predictor of disease flare. It is unclear if subclinical synovitis in PsA is linked to radiographic progression. Combining CE and sonographic evaluation is an attractive approach to identifying subclinical disease. However, a validated ultrasound composite index, which includes the key joint areas frequently affected in PsA, is needed. Disclosure S. Sundanum: None. H. Darcy: None. P. Gallagher: None. F. Young: None. L. O'Neill: None. D. Veale: None.

Evaluation of liver stiffness in a population of client owned healthy dogs using two-dimensional shear wave elastography: intraobserver reliability

Sonoelastographic techniques can complement conventional grey-scale and Doppler ultrasonography by evaluating tissue elasticity, which has the prospect to provide differentiation between malignant and benign conditions. Both technical and patient-related confounding factors are known to influence the reliability and reproducibility of elastographic methods. Therefore, the study was designed to assess liver stiffness in a diverse population of client-owned healthy dogs, evaluate the effect of patient characteristics on the elastography measurements and to assess intraobserver reliability. A total of forty dogs underwent two-dimensional shear wave elastography (2D SWE) twice, performed by the same operator, one to six days apart. The average, median and maximum 2D SWE velocities for the linear probe were 2.50 +/- 0.067 m/s; 2.46 +/- 0.067 m/s; 3.58 +/- 0.13 m/s, respectively, and for the convex probe 0.99 +/- 0.11 m/s; 0.98 +/- 0.12 m/s and 1.34 +/- 0.21 m/s, respectively. No statistically significant effect (P&gt; 0.05) on the 2D SWVs was seen of the dog-related characteristics sex, age, body weight and body condition score. The intraobserver agreement of 2D SWE was moderate with the intraclass correlation coefficient (ICC) for the average, median and maximum 2D SWE being 0.69; 0.71 and 0.74, respectively. The moderate ICC and discrepant results obtained with different probes mandates standardization of patient-related and technical factors to overcome excessive variability in measurements in order to implement this technique in clinical practice.

Safety and efficacy of microwave ablation for abdominal wall endometriosis: A retrospective study.

This retrospective study aimed to evaluate the safety and feasibility of ultrasound-guided microwave ablation in the treatment of abdominal wall endometriosis (AWE). AWE is a rare form of endometriosis that often results in cyclic abdominal pain. The current treatment algorithm for AWE is not well established. Microwave ablation technology is a promising new thermal ablation technique for treating AWE. This was a retrospective study of nine women with pathologically proven endometriosis of the abdominal wall. All patients were treated with ultrasound-guided microwave ablation. Grey-scale and color Doppler flow ultrasonography, contrast-enhanced ultrasonography, and MRI were used to observe the lesions before and after treatment. The complications, pain relief, AWE lesion volume, and volume reduction rate were recorded 12 months after treatment to evaluate the treatment efficacy. Complications were classified according to the Common Terminology Criteria for Adverse Events and the Society of Interventional Radiology classification system. Contrast-enhanced ultrasound showed that all lesions underwent successful treatment with microwave ablation. The average initial nodule volume was 7.11 ± 5.75 cm3, which decreased significantly to 1.85 ± 1.02 cm3 at the 12-month follow-up with a mean volume reduction rate of 68.77 ± 12.50%. Periodic abdominal incision pain disappeared at 1 month after treatment in all nine patients. The adverse events and complications were Common Terminology Criteria for Adverse Events grade 1 or Society of Interventional Radiology classification grade A. Ultrasound-guided microwave ablation is a safe and effective technique for the treatment of AWE, and further study is warranted.

Evaluation of thyroid nodules by ultrasonography with cytological and histopathological correlation

Background: Nodular thyroid is a common clinical entity. The optimum diagnostic strategy for the patient with nodular thyroid is still a matter of debate. A thyroid nodule is a well-defined discrete lesion, sonographically distinct from the surrounding thyroid parenchyma. Thyroid nodules occur with relatively high frequency in the general population with prevalence of 4–7% by palpation alone, 13%–67% by sonographic evaluation, and 50% at autopsy. It is estimated that 4–8% of adult women and 1–2% of adult men have thyroid nodules that can be felt on clinical examination. However, in contrast to high prevalence of thyroid nodules, the prevalence of thyroid malignancy is low. &lt;7% of thyroid nodules are malignant. Aims and Objectives: The present study was undertaken to evaluate the diagnostic efficacy of ultrasonography (USG) and color Doppler in differentiating benign and malignant thyroid nodules and in comparing the findings with results of fine needle aspiration cytology (FNAC). Materials and Methods: A prospective study was carried out on 65 patients from 11–80 years age group of both sexes, presenting with thyroid nodules. All patients were evaluated by gray scale USG and color Doppler and then subjected to FNAC. Histopathology was done whenever required. The results of FNAC were compared with that of USG and color Doppler. Results: The majority of the cases presented were females between the age group of 21–50 years. Swelling in the anterior neck was the presenting complaint in all 65 cases (100%). The most of thyroid nodules were benign in nature. The sensitivity and specificity of US in diagnosing malignant lesions were 80% and 86%, respectively. The most common presentation was from the females in the age group of 21–50 years, with swelling in the anterior neck. Conclusion: USG with color Doppler is a safe, reliable, and cost-effective diagnostic modality with a high sensitivity and specificity and is the single best radiological investigation for non-invasive evaluation of thyroid nodules. However, a combination of FNAC and USG gives optimum results and can avoid unnecessary surgery.