Gray-scale Ultrasonography Research Articles

Application of decision tree algorithms to predict central lymph node metastasis in well-differentiated papillary thyroid carcinoma based on multimodal ultrasound parameters: a retrospective study.

Prophylactic central neck dissection (pCND) in patients with well-differentiated primary papillary thyroid carcinoma (PTC) has become controversial. Several attempts have been made to predict central compartment lymph node metastasis (CLNM) based on clinical and conventional ultrasonic parameters. This study aimed to develop a decision tree (DT) model for predicting the risk of CLNM in patients with PTC based on clinical and preoperative multimodal ultrasound (US) characteristics. A total of 148 PTC nodules confirmed by surgical pathology at Beijing Tiantan Hospital were retrospectively analyzed. All nodules underwent multimodal US examinations preoperatively from January 2020 to September 2021. Correlation analysis of CLNM with clinical characteristics as well as multimodal US parameters of PTC lesions based on gray-scale US, color Doppler flow imaging (CDFI), superb microvascular imaging (SMI), contrast-enhanced ultrasound (CEUS), and shear wave elastography (SWE) technology was carried out. Finally, the chi-squared automatic interaction detector (CHAID) with a 10-fold cross-validation was used to establish DTs for CLNM prediction. The area under the curve was calculated to compare the predictive performance. Univariate analysis indicated that CLNM was positively correlated with thyroglobulin level, maximum size, taller-than-wide, the number of microcalcifications greater than or equal to 5, contact capsule, abnormal cervical lymph node on conventional US, noncentripetal perfusion, delayed clearance, the average shear wave velocity (SWV mean), and the SWV ratio (P<0.05). The multimodal US DT based on taller-than-wide, contact capsule, abnormal cervical lymph node on conventional US, and centripetal enhancement as independent variables showed good discrimination: the sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve were 80.0%, 76.7%, 78.4%, and 0.837 [95% confidence interval (CI): 0.771-0.902]. There was a significant difference between the multimodal and conventional US DTs (P=0.009). Our results indicated that the DT based on the preoperative multimodal US characteristics of PTCs has a reasonable predictive ability for CLNM and can be conveniently used for clinical decision-making of individualized treatment in patients with well-differentiated PTC.

Ultrasound image-based deep learning to assist in diagnosing gross extrathyroidal extension thyroid cancer: a retrospective multicenter study

The presence of gross extrathyroidal extension (ETE) in thyroid cancer will affect the prognosis of patients, but imaging examination cannot provide a reliable diagnosis for it. This study was conducted to develop a deep learning (DL) model for localization and evaluation of thyroid cancer nodules in ultrasound images before surgery for the presence of gross ETE. From January 2016 to December 2021 grayscale ultrasound images of 806 thyroid cancer nodules (4451 images) from 4 medical centers were retrospectively analyzed, including 517 no gross ETE nodules and 289 gross ETE nodules. 283 no gross ETE nodules and 158 gross ETE nodules were randomly selected from the internal dataset to form a training set and validation set (2914 images), and a multitask DL model was constructed for diagnosing gross ETE. In addition, the clinical model and the clinical and DL combined model were constructed. In the internal test set [974 images (139 no gross ETE nodules and 83 gross ETE nodules)] and the external test set [563 images (95 no gross ETE nodules and 48 gross ETE nodules)], the diagnostic performance of DL model was verified based on the pathological results. And then, compared the results with the diagnosis by 2 senior and 2 junior radiologists. In the internal test set, DL model demonstrated the highest AUC (0.91; 95% CI: 0.87, 0.96), which was significantly higher than that of two senior radiologists [(AUC, 0.78; 95% CI: 0.71, 0.85; P<0.001) and (AUC, 0.76; 95% CI: 0.70, 0.83; P<0.001)] and two juniors radiologists [(AUC, 0.65; 95% CI: 0.58, 0.73; P<0.001) and (AUC, 0.69; 95% CI: 0.62, 0.77; P<0.001)]. DL model was significantly higher than clinical model [(AUC, 0.84; 95% CI: 0.79, 0.89; P=0.019)], but there was no significant difference between DL model and clinical and DL combined model [(AUC, 0.94; 95% CI: 0.91, 0.97; P=0.143)]. In the external test set, DL model also demonstrated the highest AUC (0.88, 95% CI: 0.81, 0.94), which was significantly higher than that of one of senior radiologists [(AUC, 0.75; 95% CI: 0.66, 0.84; P=0.008) and (AUC, 0.81; 95% CI: 0.72, 0.89; P=0.152)] and two junior radiologists [(AUC, 0.72; 95% CI: 0.62, 0.81; P=0.002) and (AUC, 0.67; 95 CI: 0.57, 0.77; P<0.001]. There was no significant difference between DL model and clinical model [(AUC, 0.85; 95% CI: 0.79, 0.91; P=0.516)] and clinical+DL model [(AUC, 0.92; 95% CI: 0.87, 0.96; P=0.093)]. Using DL model, the diagnostic ability of two junior radiologists was significantly improved. The DL model based on ultrasound imaging is a simple and helpful tool for preoperative diagnosis of gross ETE thyroid cancer, and its diagnostic performance is equivalent to or even better than that of senior radiologists. Jiangxi Provincial Natural Science Foundation (20224BAB216079), the Key Research and Development Program of Jiangxi Province (20181BBG70031), and the Interdisciplinary Innovation Fund of Natural Science, Nanchang University (9167-28220007-YB2110).

Detection of joint involvement in patients with systemic lupus erythematosus using musculoskeletal ultrasound and its correlation with disease activity

BackgroundMusculoskeletal symptoms are common and could be the first presenting symptom in up to 50% of systemic lupus erythematosus patients, and they affect more than 95% of patients during the clinical course. The present study aimed to assess joint involvement in the wrists, hands, and knees of SLE patients using musculoskeletal ultrasonography and to correlate these findings with disease activity.The study enrolled 40 Patients with SLE who were attending the Immunology outpatient clinic and internal medicine department of Beni-Suef University Hospital and 20 age and sex nearly matched healthy controls who have no rheumatological complaints. Participants had a comprehensive physical examination, series of laboratory tests, functional assessment by Health Assessment Questionnaire score, disease activity assessment of by European Consensus Lupus Activity score, and radiological examination by high-resolution Ultrasound machine called (LOGIC P 9) using a gray-scale US mode (13–18 MHz) with Power Doppler to detect joint synovitis, synovial hypertrophy, bone erosions and or tenosynovitis.ResultsThere was a statistically significant prevalence of US abnormality of knee joints in both asymptomatic and symptomatic cases versus controls contrary to the wrist and hand US abnormality. The presence of SLE increases the risk of US abnormalities in knee joints 28 times more than controls also increasing the age of the patient one year increase the probability of getting abnormal findings in the knee joint by 1.156 times. While the only independent variable that can affect US abnormal findings in the wrist joint is the increase in Systolic Blood Pressure 1 mmHg with 1.06 times.ConclusionMusculoskeletal Ultrasound with applied Power Doppler is a good tool for the detection of early affection of joints either in symptomatic or asymptomatic SLE patients.

Quantitative evaluation of gastrocnemius medialis mass in patients with chronic heart failure by gray-scale ultrasound and shear wave elastography.

To assess the usefulness of gray-scale ultrasound (US) and shear wave elastography (SWE) in assessing the condition of the skeletal muscles in patients with chronic heart failure (CHF). We prospectively compared 20 patients with clinically diagnosed CHF and a control population of 20 normal volunteers. The gastrocnemius medialis (GM) of each individual in the rest and the contraction position was assessed using gray-scale US and SWE. The quantitative US parameters including the fascicle length (FL), pinnation angle (PA), echo intensity (EI), and Young's modulus of the muscle were measured. In the CHF group compared with the control group, in the rest position, there was a significant difference in EI, PA, and FL of the GM (P < 0.001), but no statistically significant difference in Young's modulus values (P > 0.05); however, in the contraction position, all parameters were statistically different between the two groups (P < 0.001). In the different subgroups of the CHF group grouped according to New York Heart Association staging (NYHA) or left ventricular ejection fraction (LVEF), there were no significant differences in ultrasound parameters in the rest position. However, during the contraction of GM, the smaller the FL and Young's modulus, the larger the PA and EI with the increase of NYHA grade or the decrease of LVEF (P < 0.001). The gray-scale US and SWE can provide an objective assessment of skeletal muscle status for CHF patients and are expected to be used to guide their early rehabilitation training and improve their prognosis.

Value of Hands Ultrasonography in the Differential Diagnosis Between Psoriatic Arthritis and Rheumatoid Arthritis.

Psoriatic arthritis (PsA) can mimic rheumatoid arthritis (RA) at an early stage, especially when psoriasis is lacking. In the absence of specific radiological and immunological markers, the differential diagnosis between these two diseases can be challenging. We aimed to determine whether hands ultrasonography (US) may be useful in the differential diagnosis between PsA and RA. We conducted a cross-sectional study including patients with PsA and RA. All wrists and small joints of the hands were examined using gray-scale and Power Doppler US. The evaluated US lesions were: synovitis, tenosynovitis of extensor carpi ulnaris, extensor communis and flexor tendons, enthesitis of extensor tendons at distal interphalangeal joints, peritendon inflammation of extensor tendons, and soft tissue edema. Six hundred joints in 20 PsA patients and 900 joints in 30 RA patients were assessed. Extensor enthesitis was significantly more observed in PsA compared with RA (39.4 vs 26.3%, P=.006) with a significant higher frequency of enthesophytes and calcifications (P=.022 and P=.002, respectively). Peritendon inflammation of extensor digitorum tendons was observed in 13% of metacarpophalangeal joints in PsA patients versus 3% in RA patients with a significant difference (P < .001). Soft tissue edema was exclusively observed in PsA (1.5 vs 0%, P=.033). Power Doppler synovitis was significantly more frequent in RA (9.2 vs 5%, P=.002). Extensor carpi ulnaris tenosynovitis was significantly more frequent in RA (18.3 vs 2.5%, P=.017). Extrasynovial US findings may be helpful to distinguish PsA from RA especially in patients with immunonegative polyarthritis and no evidence of psoriasis.

Machine learning analysis of breast ultrasound to classify triple negative and HER2+ breast cancer subtypes.

Early diagnosis of triple-negative (TN) and human epidermal growth factor receptor2 positive (HER2+) breast cancer is important due to its increased risk of micrometastatic spread necessitating early treatment and for guiding targeted therapies. This study aimed to evaluate the diagnostic performance of machine learning (ML) classification of newly diagnosed breast masses into TN versus non-TN (NTN) and HER2+ versus HER2 negative (HER2-) breast cancer, using radiomic features extracted from grayscale ultrasound (US) b-mode images. A retrospective chart review identified 88 female patients who underwent diagnostic breast US imaging, had confirmation of invasive malignancy on pathology and receptor status determined on immunohistochemistry available. The patients were classified as TN, NTN, HER2+ or HER2- for ground-truth labelling. For image analysis, breast masses were manually segmented by a breast radiologist. Radiomic features were extracted per image and used for predictive modelling. Supervised ML classifiers included: logistic regression, k-nearest neighbour, and Naïve Bayes. Classification performance measures were calculated on an independent (unseen) test set. The area under the receiver operating characteristic curve (AUC), sensitivity (%), and specificity (%) were reported for each classifier. The logistic regression classifier demonstrated the highest AUC: 0.824 (sensitivity: 81.8%, specificity: 74.2%) for the TN sub-group and 0.778 (sensitivity: 71.4%, specificity: 71.6%) for the HER2 sub-group. ML classifiers demonstrate high diagnostic accuracy in classifying TN versus NTN and HER2+ versus HER2- breast cancers using US images. Identification of more aggressive breast cancer subtypes early in the diagnostic process could help achieve better prognoses by prioritizing clinical referral and prompting adequate early treatment.

Testicular torsion: an avascular testis at color Doppler ultrasound is not enough to prove the diagnosis.

A Doppler ultrasound (US) of the scrotum is commonly used to improve the diagnostic confidence for testicular torsion in an emergency setting. However, the sensitivity of this investigation to identify torsion varies largely. This is due, in part, to a lack of guidelines on how-to perform the US and therefore training is necessary. The Scrotal and Penile Imaging Working Group of the European Society of Urogenital Radiology (ESUR-SPIWG) and the Section of Urological Imaging of the European Association of Urology (ESUI) established a joint panel of experts to standardize Doppler US investigation of patients with testicular torsion. The panel reviewed the available literature, identified accumulated knowledge and limitations, and released recommendations on how-to perform Doppler US in patients with acute scrotal pain. Diagnosis of testicular torsion is based on clinical evaluation and investigation of the cord, the testis, and the paratesticular structures. A preliminary clinical evaluation, including history and palpation, is necessary. Grey scale US, color Doppler US and spectral analysis must be performed by a sonologist with at least level 2 competence. Modern equipment with adequate grey-scale and Doppler capabilities are required. Standardization of Doppler US in suspicious testicular torsion is presented, with the aim to obtain comparable results among different centres, prevent unnecessary operations, and improve patient management.

Transport-Based Anatomical-Functional Metric Learning for Liver Tumor Recognition Using Dual-View Dynamic CEUS Imaging.

Hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) are the most common malignancy arising from primary liver cancer (PLC). Liver ultrasound (US) has been the main approach for the early screening and differential diagnosis. Since ultrasonic findings of PLC are closely associated with tumor growth pattern, histological morphology, tumor staging, and other factors, ultrasonic imaging findings overlap partially. Besides, qualitative assessment is highly dependent on expertise. To improve the diagnostic objectiveness, we propose a novel transport-based anatomical-functional metric learning (T-AFML) method to quantify imaging similarity of both the gray-scale US and dynamic contrast-enhanced US view. Considering that the hemodynamic changes vary with individuals, we introduce a temporally regularized optimal transport to align the local enhancement patterns automatically. To sufficiently exploit ultrasonic findings similarity from different modalities, a selector-based metric integration mechanism is adopted to adaptively select a dominant modality accounting for the similarity measure. In this retrospective study, we collected a total of 174 liver cancer patients consists of 105 HCC and 69 ICC, and our method achieves the superior diagnostic accuracy and sensitivity of 88.41% and 86.16%, respectively, demonstrating its efficacy in quantifying multi-modal ultrasonic findings similarity for PLC diagnosis.

Artifacts and Technical Considerations at Contrast-enhanced US

Contrast-enhanced US (CEUS), similar to other radiologic modalities, requires specific technical considerations and is subject to image artifacts. These artifacts may affect examination quality, negatively impact diagnostic accuracy, and decrease user comfort when using this emerging technique. Some artifacts are related to commonly known gray-scale US artifacts that can also appear on the contrast-only image (tissue-subtracted image obtained with the linear responses from background tissues nulled). These may include acoustic shadowing and enhancement; reverberation, refraction, and reflection; and poor penetration. Other artifacts are exclusive to CEUS owing to the techniques used for contrast mode image generation and the unique properties of the microbubbles that constitute ultrasound-specific contrast agents (UCAs). UCA-related artifacts may appear on the contrast-only image, the gray-scale image, or various Doppler mode images. Artifacts related to CEUS may include nonlinear artifacts and unintentional microbubble destruction resulting in pseudowashout. The microbubbles themselves may result in specific artifacts such as pseudoenhancement, signal saturation, and attenuation and shadowing and can confound the use of color and spectral Doppler US. Identifying and understanding these artifacts and knowing how to mitigate them may improve the quality of the imaging study, increase user confidence, and improve patient care. The authors review the principles of UCAs and the sound-microbubble interaction, as well as the technical aspects of image generation. Technical considerations, including patient positioning, depth, acoustic window, and contrast agent dose, also are discussed. Specific artifacts are described, with tips on how to identify and, if necessary, apply corrective measures, with the goal of improving examination quality. © RSNA, 2022 Online supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article.

ROLE OF ULTRASOUND TO DIFFERENTIATE BETWEEN BENIGN AND MALIGNANT THYROID NODULES WITH HISTOPATHOLOGICAL CORRELATION

Background: The only endocrine gland that may be directly examined because to its supercial placement and size is the thyroid gland, which is the largest of all endocrine glands. High resolution real-time gray-scale sonography with the thyroid gland's supercial position enables good visibility and assessment of both its pathologic status and normal structure. The goal was to l Aim: ink histopathology results with sonographic criteria to distinguish between benign and malignant thyroid nodules. From April 2022 to November 2 Materials and Methods: 022, based on criteria for inclusion and exclusion, 50 cases with thyroid nodules were included in the study. Each nodule's sonographic features were identied. After that, the outcomes were contrasted with histopathological diagnosis. 40 Results: benign and 10 malignant solitary thyroid nodules assessed by ultrasound out of 50 total cases were determined, 43 out of 50 instances were benign and 7 were malignant, according to histopathological analysis. To distinguish between benign and malignant etiologies, ultrasound is a relatively safe and accurate investigation with sensitivity of 85.7 % and specicity of 90.7%. In order to distinguish between benign and malignant lesions, USG has proven to possess greater sensitivity. Conclusion: Thyroid nodules were prevalent in women between the ages of 31 and 45. With a sensitivity of 85.7% and a specicity of 90.7%, ultrasound is a relatively safe and accurate test to distinguish between benign and malignant etiologies.

Sonoelastographic evaluation of salivary gland lesions with clinicopathological association

Sonoelastography is a comparatively new and developing technology in the field of salivary gland imaging. Nevertheless, it has the potential to distinguish between various types of lesions by calculating the degree of strain-related deformation under the externally applied force. With this background, the present study was undertaken to evaluate the role of sonoelastography in characterising salivary gland lesions as benign or malignant.&#x0D; The aim: To evaluate and characterize salivary Gland lesions on the Gray scale and Colour doppler ultrasonography and sonoelastography and to correlate these findings with the clinico-pathological diagnosis.&#x0D; Methodology: This prospective cross-sectional study was conducted in the Department of Radiodiagnosis, Teerthanker Mahaveer Medical College &amp; Research Centre, Moradabad (U.P.), from Aug 2021 to Nov 2022. All patients referred to the radiology department for imaging with clinical suspicion of having salivary gland lesions were enrolled in the study and evaluated on the SIEMENS ACUSON S3000 machine. Gray scale USG was done first to assess various morphological features of lesions, and then a Doppler assessment was done to determine vascularity within the lesion. Subsequently, real-time strain elastography (eSie touch) was performed to assess the tissue stiffness. The elastogram image of the detected lesions was evaluated using colour coding ranging from blue (soft) through green (intermediate/average hardness) and red (hard). After strain elastography, shear wave elastography of the lesion was also performed using Virtual Touch Quantification (VTQ) and Virtual Touch Imaging Quantification (VTIQ) software. The sonographic findings were correlated with histopathological diagnosis. The acquired data were subjected to statistical analysis using the software SPSS version 20. Sensitivity, specificity, PPV and NPV were calculated for conventional ultrasound techniques alone &amp; in combination with elastography.&#x0D; Results: Out of the 50 salivary gland lesions included in the study, 44 (88 %) were benign, whereas 6 (12 %) were malignant on cytology. The age of the study population ranged from 16 to 75 years, with a mean age of 38.82 years. Pleomorphic adenoma (60 %) was the most frequent lesion, followed by Warthin's tumour (28 %). The Conventional USG showed 66.67 %, sensitivity, 52.27 %, specificity, 16.00 %, PPV, 92.00 % NPV and 54.00 % accuracy in differentiating benign from malignant lesions while USG- Elastography combined showed higher diagnostic performance with 83.33 %, sensitivity, 79.55 %, specificity, 35.71 % PPV, 97.22 % NPV and 80.00 %, accuracy. The specific cut-off scores for the sonoelastography score, eSie touch, VTQ, and VTIQ were also determined to diagnose a lesion as malignant or benign, and the difference was found to be statistically significant.&#x0D; Conclusions: Sonoelastography alone cannot be solely relied upon to distinguish between malignant &amp; benign salivary gland abnormalities. However, it can be combined with conventional USG for better differentiation and characterization of these lesions

Comparison of shear wave elastography with gray-scale USG and CT for quantitative evaluation of rectus femoris muscle.

The purpose of this study was to compare the measurement of shear wave elastography (SWE) and gray scale ultrasonography (GSU) and CT attenuation of mid-rectus femoris (RF) muscle in healthy adults. This prospective study included 70 participants with a healthy body mass index (<25 kg/m2 ) between June 2019 and January 2020. Echo intensity (EI) grading of RF on GSU was performed. SWE was performed for the three levels of the RF. Measurements were repeated 10min after the first measurement. The mid-RF attenuation on CT was also measured. Interobserver agreement of EI grade among three readers was assessed using weighted-kappa statistics. The reliability of SWE was assessed using intraclass correlation coefficient. The correlations between the SWE and CT/GSU measurements were analyzed. Interobserver agreement of EI grade on GSU by the three radiologists was moderate to substantial (k=0.562-0.767). The inter-session agreements for SWE were almost perfect for mid RF (k=0.822-0.829) and substantial for proximal and distal RF (k=0.767-0.795). There were significant correlations between SWE-EI and SWE-CT attenuation (p < 0.001, respectively) at the mid-RF. SWE measurements on mid-RF demonstrated the highest reliability. SWE parameters showed a strong correlation with EI on GSU and attenuation on CT.

Evaluation of the Relationship Between Quantitative Ultrasound Findings and Morbidly Adherent Placenta.

The accuracy of ultrasound findings in predicting the incidence of morbidly adherent placenta has been evaluated previously. In this study, we assessed the sensitivity and specificity of different quantitative findings of color Doppler and grayscale ultrasonography in predicting morbidly adherent placenta. In this prospective cohort study, all pregnant women over 20 weeks of gestational age with anterior placenta and a history of previous cesarean section were evaluated for inclusion. Various ultrasound findings were measured. The non-parametric receiver operating characteristic curves, the area under the curve, and the cut-off values were assessed. A total of 120 patients were ultimately included for analysis, of whom 15 had morbidly adherent placenta. The two groups were significantly different regarding the number of vessels. Based on color Doppler ultrasonography, in predicting the morbidly adherent placenta, more than two intraplecental echolucent zones with color flow had 93% and 98% sensitivity and specificity, respectively. According to grayscale ultrasonography, more than thirteen intraplacental echolucent zones had the sensitivity and specificity of 86% and 80% in predicting morbidly adherent placenta, respectively. Echolucent zone >11 mm at non-fetal surface had a sensitivity of 93% and a specificity of 66% in detecting morbidly adherent placenta. According to the results, the quantitative findings of color Doppler ultrasound have considerable sensitivity and specificity in detecting morbidly adherent placenta. More than two echolucent zones with color flow are recommended as the main diagnostic parameter indicating the presence of morbidly adherent placenta with a sensitivity of 93% and a specificity of 98%.

Multiparametric ultrasound for the assessment of testicular lesions with negative tumoral markers.

The purpose of this study was to evaluate the diagnostic performance of multiparametric ultrasound (mpUS; grayscale US, color Doppler US, strain elastography, and contrast-enhanced US) in the assessment of testicular lesions with negative tumoral markers. MpUS imaging data, patient age, serum tumor markers, scrotal pain, cryptorchidism, and related clinical information were retrospectively collected for patients who underwent mpUS examination between January 2013 and December 2019. Histologic results or follow-up examinations were used as the reference standard. In total, 83 lesions from 79 patients were included in the analysis. Fifty-six patients were finally diagnosed with benign tumors, and 23 patients were ultimately diagnosed with malignant tumors. Chi-square tests or Fisher's exact tests were used to assess the difference between the two groups. Stepwise multivariate logistic regression analysis showed that lesion diameter (odds ratio [OR] = 1.072, P = 0.005), vascularization on color Doppler US (OR = 4.066, P = 0.001), and hyperenhancement during the early phase (OR = 6.465, P = 0.047) were significant independent risk factors for malignancy; however, when compared with neoplastic lesions, pain (OR = 0.136, P < 0.001), absence of vascularization on color Doppler US (OR = 1.680, P = 0.042), and nonenhancement during the late phase (OR = 3.461, P = 0.031) were strongly associated with nonneoplastic lesions. MpUS features are useful for differentiating testicular lesions with negative tumoral markers and improving the preoperative diagnosis, which may avoid inappropriate radical orchiectomy.

Role of High-Resolution Grey Scale and Power Doppler Ultrasonography in Assessment of Ankle Joints of Symptomatic and Asymptomatic Rheumatoid Arthritis Patients

Role of High-Resolution Grey Scale and Power Doppler Ultrasonography in Assessment of Ankle Joints of Symptomatic and Asymptomatic Rheumatoid Arthritis Patients

Role of Gray Scale and Color Doppler Ultrasound in Diagnosis of Parotid and Submandibular Gland Diseases

Role of Gray Scale and Color Doppler Ultrasound in Diagnosis of Parotid and Submandibular Gland Diseases

Sonoelastographic Evaluation of Pelvic Adnexal Masses and its Association with Clinicopathological Findings at a Tertiary Care Centre in Western Uttar Pradesh, India

Introduction: Despite advancements in cross-sectional aging techniques, ultrasonography continues to remain the first-line imaging modality for the preoperative assessment of pelvic adnexal masses. Ultrasound strain elastography is a novel technique that can characterise adnexal lesions based on their tissue stiffness and when used in conjunction with conventional USG, it may increase the precision of diagnosis and can act as a cost-effective viable ancillary tool. Aim: To assess the role of strain sonoelastography in characterising the adnexal lesion as benign or malignant. Materials and Methods: This cross-sectional study was conducted in the Department of Radiodiagnosis, Teerthankar Mahaveer Medical College and Research Centre (TMMC&amp;RC), Moradabad, Uttar Pradesh, India, for a period of 18 months (January 2020 to June 2021) and consisted of 110 patients with clinical suspicion of adnexal mass, who were evaluated on SIEMENS Acuson S 3000 scanner (from the total of 130 cases). Various morphological features of mass (size, laterality, consistency, echogenicity and internal contents) were assessed on Gray scale and vascularity was assessed on colour doppler Ultrasonography (USG). Subsequently, real time strain elastography (eSie touch) was performed to assess the tissue stiffness. Elasticity was indicated on a colour-coded elastogram map, with blue areas denoting hard tissue, green areas suggesting intermediate tissue, and red portions denoting soft tissues. The sonographic findings were compared with histopathological diagnosis. Sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) were calculated for Gray scale sonography in combination with Doppler (conventional ultrasound techniques) and in conjunction with elastography. The Chi-square test was applied for comparing the frequency and p-value less than 0.05 was considered to be significant. Results: The mean age of study population was 36.35±14.82 years. On histopathology out of 110 patients, 95 (86.36%) had benign adnexal lesions and 15 (13.64%) had malignant adnexal lesions. The youngest patient was 16-year-old and eldest was 70 years and the mean age of the study population was 36.35 years. When conventional ultrasound technique was used alone for differentiating benign and malignant adnexal masses the sensitivity was 96.7%, specificity was 83%, PPV was 96.7% and NPV was 83% while on addition of sonoelastography the sensitivity increased to 98.9%, specificity increased to 93%, PPV increased to 98.9% and NPV increased to 93.7%. Conclusion: Conventional ultrasound techniques should be combined with sonoelastography in a diagnostic system to achieve better characterisation and differentiation of benign and malignant adnexal masses.

Echocardiographic characterization of cardiac chambers and vasculatures in buffaloes (Bubalus bubalis) during diastolic and systolic phases.

Ultrasonography had diagnostic importance in the evaluation of different diseases in buffaloes, including cardiovascular diseases. The current work describes the normal echocardiographic findings in healthy buffaloes, along with establishing reference values for echocardiographic dimensions for both sides of the heart, i.e., left and right ones. About 30 healthy adult buffaloes that belonged to private farms in Assiut, Egypt, were included in this study. Each animal underwent a complete clinical evaluation as well as hematological analyses, lipid profile indices, liver functions, cardio-thoracic radiography, and echocardiography to confirm no diseased conditions were detected. The study was conducted on healthy buffaloes (n = 30) in Assiut Governorate, Egypt. The obtained results reported healthy buffaloes with normal clinical findings as well as indices of blood pictures and serum biochemicals that were within the reference intervals. Radiography revealed a free reticulum and a well-defined diaphragm. The heart was seen as a typical radio-opaque organ. Ultrasonographically, using grayscale B-mode and M-mode, the heart was commonly imaged from the left fourth intercostal space. Different echocardiographic views were described, including the four chamber view, i.e., right atrium (RA), right ventricle (RV), tricuspid valve (TCV), left atrium, left ventricle, mitral valve, and interventricular septum (IVS), and the right ventricular outflow tract, i.e., RA, TCV, RV, pulmonary artery (PA), and pulmonary valve. Cross sections in each of the apex and base of the heart were described. Echocardiographic dimensions during cardiac diastole and systole, including diameters and wall thickness of each of the atria and ventricles, were demonstrated. Interventricular septal thickness wall thickness as well as diameters of the aorta and PA, were stated. The work tried to put reference values on the normal echocardiographic dimensions using 2-D B-mode gray scale ultrasonography in healthy adult buffaloes. These echocardiographic reference dimensions with normal echocardiographic imaging will be very helpful in enhancing the diagnostic efficacy of ultrasounds for recognizing abnormal findings related to cardiac disorders.

Diagnosis of Hepatoma Using Grey Scale and Doppler Ultrasound in Patient with Chronic Liver Disease

Aim: To assess the efficacy of the greyscale and Doppler ultrasound in the diagnosis of hepatoma in chronic liver disease patients. Study Design: Prospective study. Place and duration of study: Department of Radiology, Jinnah Postgraduate Medical Centre Karachi from 1st October 2021 to 30th June 2022. Methodology: One hundred and twenty patients who were diagnosed with chronic liver diseases and were suspected of hepatocellular carcinoma were included in this study. Ultrasonography was conducted under grey scale Doppler scanning in each patient after 6 hours of fasting at 3-6 megahertz with a curvilinear probe in supine as well as oblique position. Sensitivity, specificity as well as the predictive value of the image formed through the ultrasonography machine was assessed. Results: The age of the patients was 46.5±6.5 years and there were 78 (65%) males whereas 42 (35%) were females. On the grey scale Doppler scan, there was 53% of cases seen confirmed for the presence of hepatoma. The sensitivity and specificity were observed in 65% and 85% of the grey scale Doppler ultrasonography while the positive predictive value was 92% respectively. Conclusion: Greyscale Doppler scan is an efficient and reliable method for the detection of hepatoma and can be used in clinically confirmed cases of chronic liver disease as a screening tool. Keywords: Hepatoma, Greyscale, Doppler ultrasound, Chronic liver disease

Application value of shear-wave elastography combined with monochrome superb microvascular imaging in renal allograft chronic rejection.

Conventional ultrasound (US), which include gray scale US and Doppler US, is the first-line imaging modality for the evaluation of renal allograft; however, conventional US indicators have limitations. To explore the application value of shear-wave elastography (SWE) combined with monochrome superb microvascular imaging (mSMI) in renal allograft chronic rejection (CR). From November 2021 to February 2022 in the Lanzhou University Second Hospital, the US features of 54 patients with renal allograft were retrospectively analyzed. Patients were categorized into two groups: stable group(n = 44) and CR group(n = 10), with clinical diagnosis as reference standard. The vascular index (VI) on mSMI and parenchymal stiffness were measured in the middle cortex of all renal allografts and receiver operating characteristic (ROC) curves were drawn to evaluate the feasibility of differentiation. Statistically significant US features and biochemical indicators such as creatinine were scored, and the results of the scores were analyzed by ROC curve. The VI on mSMI of the stable group (49.5±2.0) was significantly greater than that of the CR group (33.8±5.9) (P = 0.028). There was a statistically significant difference in parenchymal stiffness between stable group (16.2kPa±1.2) and CR group (33.9kPa±6.6) (P = 0.027). The sensitivity was 90% and specificity was 81.8% of the scores in the differentiation of stable group from CR group (cut-off value, 2; P = 0.000). SWE combined with mSMI may help differentiate stable renal allograft from renal allograft CR and have the potential application value in the diagnosis of renal allograft CR.