Gray-scale Ultrasonography Research Articles

Diagnostic value of radiomics model based on gray-scale and contrast-enhanced ultrasound for inflammatory mass stage periductal mastitis/duct ectasia.

ObjectiveThe present study aimed to investigate the clinical application value of the radiomics model based on gray-scale ultrasound (GSUS) and contrast-enhanced ultrasound (CEUS) images in the differentiation of inflammatory mass stage periductal mastitis/duct ectasia (IMSPDM/DE) and invasive ductal carcinoma (IDC).MethodsIn this retrospective study, 254 patients (IMSPDM/DE: 129; IDC:125) were enrolled between January 2018 and December 2020 as a training cohort to develop the classification models. The radiomics features were extracted from the GSUS and CEUS images. The least absolute shrinkage and selection operator (LASSO) regression model was employed to select the corresponding features. Based on these selected features, logistic regression analysis was used to aid the construction of these three radiomics signatures (GSUS, CEUS and GSCEUS radiomics signature). In addition, 80 patients (IMSPDM/DE:40; IDC:40) were recruited between January 2021 and November 2021 and were used as the validation cohort. The best radiomics signature was selected. Based on the clinical parameters and the radiomics signature, a classification model was built. Finally, the classification model was assessed using nomogram and decision curve analyses.ResultsThree radiomics signatures were able to differentiate IMSPDM/DE from IDC. The GSCEUS radiomics signature outperformed the other two radiomics signatures and the AUC, sensitivity, specificity, and accuracy were estimated to be 0.876, 0.756, 0.804, and 0.798 in the training cohort and 0.796, 0.675, 0.838 and 0.763 in the validation cohort, respectively. The lower patient age (p<0.001), higher neutrophil count (p<0.001), lack of pausimenia (p=0.023) and GSCEUS radiomics features (p<0.001) were independent risk factors of IMSPDM/DE. The classification model that included the clinical factors and the GSCEUS radiomics signature outperformed the GSCEUS radiomics signature alone (the AUC values of the training and validation cohorts were 0.962 and 0.891, respectively). The nomogram was applied to the validation cohort, reaching optimal discrimination, with an AUC value of 0.891, a sensitivity of 0.888, and a specificity of 0.750.ConclusionsThe present study combined the clinical parameters with the GSCEUS radiomics signature and developed a nomogram. This GSCEUS radiomics-based classification model could be used to differentiate IMSPDM/DE from IDC in a non-invasive manner.

The role of ultrasonographic synovial assessment in rheumatoid arthritis patients with concomitant fibromyalgia.

This study aimed to compare the prevalence and musculoskeletal ultrasonography (US) findings of rheumatoid arthritis (RA) patients with concomitant fibromyalgia (FM) according to the 1990 American College of Rheumatology (ACR) FM classification criteria or the 2016 ACR FM diagnostic criteria. This cross-sectional study included 63 patients (17 males, 46 females; mean age: 48.2±7.1 years; range, 18 to 62 years) with RA. Medical history and laboratory data were obtained from electronic records. Clinical examination, composite disease activity measures, functional status, and the German 7-joint ultrasound score were assessed to evaluate disease activity and synovial inflammation. The patients were divided into three groups: patients who met only the 2016 ACR criteria, patients who met only the 1990 ACR criteria, and patients who met both criteria. In patients with RA, concomitant FM prevalence was 34.9% according to the 2016 ACR FM diagnostic criteria versus 23.8% according to the 1990 ACR FM classification criteria. Rheumatoid arthritis patients with FM had high tender joint count and disease activity scores, while musculoskeletal US findings were similar. Patients who met only the 2016 ACR FM diagnostic criteria had significantly higher gray-scale US and power Doppler US synovitis scores than patients who satisfied only ACR 1990 FM classification criteria (p=0.03 and p=0.02, respectively). Synovial inflammation is a prominent sign in RA patients diagnosed with FM according to the 2016 ACR FM diagnostic criteria. The higher disease activity seen in the presence of FM in RA patients is associated with FM rather than synovitis.

Using ultrasound radiomics analysis to diagnose cervical lymph node metastasis in patients with nasopharyngeal carcinoma.

This study aimed to explore the clinical value of ultrasound radiomics analysis in the diagnosis of cervical lymph node metastasis (CLNM) in patients with nasopharyngeal carcinoma (NPC). A total of 205 cases of NPC CLNM and 284 cases of benign lymphadenopathy with pathologic diagnosis were retrospectively included. Grayscale ultrasound (US) images of the largest section of every lymph node underwent feature extraction. Feature selection was done by maximum relevance minimum redundancy (mRMR) algorithm and multivariate logistic least absolute shrinkage and selection operator (LASSO) regression. Logistic regression models were developed based on clinical features, radiomics features, and the combination of those features. The AUCs of models were analyzed by DeLong's test. In the clinical model, lymph nodes in the upper neck, larger long axis, and unclear hilus were significant factors for CLNM (p < 0.001). MRMR and LASSO regression selected 7 significant features for the radiomics model from the 386 radiomics features extracted. In the validation dataset, the AUC value was 0.838 (0.776-0.901) in the clinical model, 0.810 (0.739-0.881) in the radiomics model, and 0.880 (0.826-0.933) in the combined model. There was not a significant difference between the AUCs of clinical models and radiomics models in both datasets. DeLong's test revealed a significantly larger AUC in the combined model than in the clinical model in both training (p = 0.049) and validation datasets (p = 0.027). Ultrasound radiomics analysis has potential value in screening meaningful ultrasound features and improving the diagnostic efficiency of ultrasound in CLNM of patients with NPC. • Radiomics analysis of gray-scale ultrasound images can be used to develop an effective radiomics model for the diagnosis of cervical lymph node metastasis in nasopharyngeal carcinoma patients. • Radiomics model combined with general ultrasound features performed better than the clinical model in differentiating cervical lymph node metastases from benign lymphadenopathy.

Ultrasomics prediction for cytokeratin 19 expression in hepatocellular carcinoma: A multicenter study.

ObjectiveThe purpose of this study was to investigate the preoperative prediction of Cytokeratin (CK) 19 expression in patients with hepatocellular carcinoma (HCC) by machine learning-based ultrasomics.MethodsWe retrospectively analyzed 214 patients with pathologically confirmed HCC who received CK19 immunohistochemical staining. Through random stratified sampling (ratio, 8:2), patients from institutions I and II were divided into training dataset (n = 143) and test dataset (n = 36), and patients from institution III served as external validation dataset (n = 35). All gray-scale ultrasound images were preprocessed, and then the regions of interest were then manually segmented by two sonographers. A total of 1409 ultrasomics features were extracted from the original and derived images. Next, the intraclass correlation coefficient, variance threshold, mutual information, and embedded method were applied to feature dimension reduction. Finally, the clinical model, ultrasonics model, and combined model were constructed by eXtreme Gradient Boosting algorithm. Model performance was assessed by area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and accuracy.ResultsA total of 12 ultrasomics signatures were used to construct the ultrasomics models. In addition, 21 clinical features were used to construct the clinical model, including gender, age, Child-Pugh classification, hepatitis B surface antigen/hepatitis C virus antibody (positive/negative), cirrhosis (yes/no), splenomegaly (yes/no), tumor location, tumor maximum diameter, tumor number, alpha-fetoprotein, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, glutamyl-transpeptidase, albumin, total bilirubin, conjugated bilirubin, creatinine, prothrombin time, fibrinogen, and international normalized ratio. The AUC of the ultrasomics model was 0.789 (0.621 – 0.907) and 0.787 (0.616 – 0.907) in the test and validation datasets, respectively. However, the performance of the combined model covering clinical features and ultrasomics signatures improved significantly. Additionally, the AUC (95% CI), sensitivity, specificity, and accuracy were 0.867 (0.712 – 0.957), 0.750, 0.875, 0.861, and 0.862 (0.703 – 0.955), 0.833, 0.862, and 0.857 in the test dataset and external validation dataset, respectively.ConclusionUltrasomics signatures could be used to predict the expression of CK19 in HCC patients. The combination of clinical features and ultrasomics signatures showed excellent effects, which significantly improved prediction accuracy and robustness.

A deep learning-based diagnostic pattern for ultrasound breast imaging: can it reduce unnecessary biopsy?

BackgroundEarly studies have demonstrated the potential of deep learning in bringing revolutionary changes in medical analysis. However, it is unknown which deep learning based diagnostic pattern is more effective for differentiating malignant and benign breast lesions (BLs) and can assist radiologists to reduce unnecessary biopsies.MethodsA total of 506 malignant BLs and 557 benign BLs were enrolled in this study after excluding incomplete ultrasound images. 396 malignant BLs and 447 benign BLs were included in the training cohort while 110 malignant and 110 benign BLs were included in the validation cohort. All BLs in the training and validation cohort were biopsy-proven. The most common convolutional neural networks (VGG-16 and VGG-19) were applied to identify malignant and benign BLs using grey-scale ultrasound images. Two radiologists determined the malignant (suggestion for biopsy) and benign (suggestion for follow-up) BLs with a 2-step reading session. The first step was based on conventional ultrasound (US) images alone to make a biopsy or follow-up decision. The second step was to take deep learning results into account for the decision adjustment. If a deep learning result of a first-classified benign BL was above the cut-off value, then it was re-classified as malignant.ResultsIn terms of area under the curve (AUC), the VGG-19 model yielded the best diagnostic performance in both training [0.939, 95% confidence interval (CI): 0.924–0.954] and testing dataset (0.959, 95% CI: 0.937–0.982). With the aid of deep learning models, the AUC of radiologists improved from 0.805 (95% CI: 0.744–0.865) to 0.827 (95% CI: 0.771–0.875, VGG-16) and 0.914 (95% CI: 0.871–0.957, VGG-19). The unnecessary biopsies decreased from 10.0% (11/110) to 8.2% (9/110) (assisted by VGG-16) and 0.9% (1/110) (assisted by VGG-19).ConclusionsThe application of deep learning patterns in breast US may improve the diagnostic performance of radiologists by offering a second opinion. And thus, the assist of deep learning algorithm can considerably reduce the unnecessary biopsy rate in the clinical management of breast lesions.

INFERIOR THYROID ARTERY DOPPLER: A NEW TOOL IN DIFFERENTIATION OF GRAVE'S DISEASE AND HASHIMOTO'S THYROIDITIS. A NOVEL RADIOLOGICAL-PATHOLOGICAL CORRELATION STUDY

Background: Autoimmune thyroid diseases are characterized by diffuse involvement of thyroid gland with hypoechogenicity and altered echotexture at gray scale ultrasound being a characteristic feature. An overlap of this pattern in patients affected by Graves' disease or Hashimoto's thyroiditis. Differentiation between causes of thyrotoxicosis at time of diagnosis, either hyperthyroidism due to Graves' disease or destructive thyrotoxicosis due to thyroiditis, is very important as management of each is completely different. Comparison of Doppler indices Aims and Objectives: in patients of Diffuse thyroid disease ( Graves' and Hashimoto's) on ultrasound with normal study population. Participants w Material &amp; Methods ere recruited in the ultrasound unit at the Victoria hospital, Bangalore medical college and research institute. We conducted a prospective study on a group of 20 Normal individuals and 40 patients with Diffuse thyroid disease on Ultrasonography (20 cases of Hashimoto's thyroiditis and 20 cases of Graves disease). The thyroid glands of all patients were evaluated by gray scale ultrasonography for size, shape and echotexture. Color-ow Doppler ultrasonography of the thyroid tissue was performed and spectral ow analysis of both inferior thyroid arteries was assessed. Inferior thyroid artery Doppler parameters were calculated in all patients. Mean PSV of normal indivi Results duals was 16.4. Hashimoto's patients who had their mean PSV was 36.2 and Graves patients who had their mean PSV 86.4. On applying unpaired t test, the two tailed p value was less than 0.05 (0.001 and 0.0001 respectively), which found statistically highly signicant. The comparison of Doppler indices of Hashimotos disease and Graves diseases - On applying unpaired t test, the two tailed p value was less than 0.05 (0.0001) which was found statistically highly signicant. Blood Conclusion ow is a useful marker in initial diagnosis of diffuse thyroid. The high correlation between Doppler indices with pathological diagnosis establishes this modality as an acceptable alternative to Nuclear imaging. Its role in pregnancy and lactation where nuclear imaging is contraindicated needs to be emphasised.

Correlation of Clinical Disease Activity Score with Ultrasound Disease Activity Score in Rheumatoid Arthritis Patients of Kashmir Valley

Abstract Background: Musculoskeletal ultrasound can aid in assessing disease activity and deciding to taper off disease-modifying antirheumatic drugs in patients of rheumatoid arthritis (RA). With this background, we conducted a study to compare Clinical Disease Activity Score 28 C-reactive protein (DAS28 CRP) with Ultrasound Disease Activity Score 28 CRP (USDAS28 CRP) and its correlation with disease parameters in RA patients. Materials and Methods: Forty-eight RA patients were subjected to clinical and ultrasound assessment of disease activity after subjecting them to history, clinical, and laboratory investigations. The clinical assessment was done by DAS28 CRP and the US assessment was done by USDAS28 CRP score. The swollen joint count and the tender joint count were replaced by GSUS (grayscale ultrasound) score and power Doppler ultrasound score, respectively, in USDAS28 CRP score. Results: The mean age of the patients was 46.31 ± 13.90 years, with a mean duration of illness being 98.3 months. Nineteen patients had inactive disease and 29 patients had active disease on clinical examination. Six out of 19 (31.6%) patients with the inactive disease on clinical assessment had activity (subclinical synovitis) on US assessment. Two out of 29 (6.89%) patients with the active disease on clinical assessment had inactive disease on US assessment. Patients with subclinical synovitis had a longer disease duration (154 ± 114.2 vs. 73.38 ± 54.9 months, P = 0.05) and higher erythrocyte sedimentation rate (28.5[23] vs. 15[5] mm/H, P = 0.017) as compared to RA patients with the inactive disease on US assessment. Correlations between clinical scales and ultrasound scales were good (Pearson’s r = 0.832, P = 0.01). Conclusion: US scoring for disease assessment is a plausible method to assess subclinical activity in RA patients with inactive disease.

Ultrasound Radiomics-Based Logistic Regression Model to Differentiate Between Benign and Malignant Breast Nodules.

To explore the potential value of ultrasound radiomics in differentiating between benign and malignant breast nodules by extracting the radiomic features of two-dimensional (2D) grayscale ultrasound images and establishing a logistic regression model. The clinical and ultrasound data of 1000 female patients (500 pathologically benign patients, 500 pathologically malignant patients) who underwent breast ultrasound examinations at our hospital were retrospectively analyzed. The cases were randomly divided into training and validation sets at a ratio of 7:3. Once the region of interest (ROI) of the lesion was manually contoured, Spearman's rank correlation, least absolute shrinkage and selection operator (LASSO) regression, and the Boruta algorithm were adopted to determine optimal features and establish a logistic regression classification model. The performance of the model was assessed using the area under the receiver operating characteristic curve (AUC), and calibration and decision curves (DCA). Eight ultrasound radiomic features were selected to establish the model. The AUC values of the model were 0.979 and 0.977 in the training and validation sets, respectively (P=.0029), indicating good discriminative ability in both datasets. Additionally, the calibration and DCAsuggested that the model's calibration efficiency and clinical application value were both superior. The proposed logistic regression model based on 2D grayscale ultrasound images could facilitate differential diagnosis of benign and malignant breast nodules. The model, which was constructed using ultrasound radiomic features identified in this study, demonstrated good diagnostic performance and could be useful in helping clinicians formulate individualized treatment plans for patients.

Development of an ultrasound-based radiomics nomogram to preoperatively predict Ki-67 expression level in patients with breast cancer.

ObjectiveTo develop and validate a radiomics nomogram that could incorporate clinicopathological characteristics and ultrasound (US)-based radiomics signature to non-invasively predict Ki-67 expression level in patients with breast cancer (BC) preoperatively.MethodsA total of 328 breast lesions from 324 patients with BC who were pathologically confirmed in our hospital from June 2019 to October 2020 were included, and they were divided into high Ki-67 expression level group and low Ki-67 expression level group. Routine US and shear wave elastography (SWE) were performed for each lesion, and the ipsilateral axillary lymph nodes (ALNs) were scanned for abnormal changes. The datasets were randomly divided into training and validation cohorts with a ratio of 7:3. Correlation analysis and the least absolute shrinkage and selection operator (LASSO) were used to select the radiomics features obtained from gray-scale US images of BC patients, and each radiomics score (Rad-score) was calculated. Afterwards, multivariate logistic regression analysis was used to establish a radiomics nomogram based on the radiomics signature and clinicopathological characteristics. The prediction performance of the nomogram was assessed by the area under the receiver operating characteristic curve (AUC), the calibration curve, and decision curve analysis (DCA) using the results of immunohistochemistry as the gold standard.ResultsThe radiomics signature, consisted of eight selected radiomics features, achieved a nearly moderate prediction efficacy with AUC of 0.821 (95% CI:0.764-0.880) and 0.713 (95% CI:0.612-0.814) in the training and validation cohorts, respectively. The radiomics nomogram, incorporating maximum diameter of lesions, stiff rim sign, US-reported ALN status, and radiomics signature showed a promising performance for prediction of Ki-67 expression level, with AUC of 0.904 (95% CI:0.860-0.948) and 0.890 (95% CI:0.817-0.964) in the training and validation cohorts, respectively. The calibration curve and DCA indicated promising consistency and clinical applicability.ConclusionThe proposed US-based radiomics nomogram could be used to non-invasively predict Ki-67 expression level in BC patients preoperatively, and to assist clinicians in making reliable clinical decisions.

Role of shear wave elastography in the diagnostic evaluation of plantar fasciitis: a prospective case-control study.

To assess the advantage of the addition of shear wave elastography (SWE) to gray-scale sonography in the diagnosis of plantar fasciitis. 30 subjects between 18-60years of age with unilateral heel pain who were clinically suspected of having plantar fasciitis were included in this study. Their affected feet were taken as cases; while their contralateral feet served as controls. On gray-scale ultrasound, the thickness of plantar fascia, its echopattern, presence of hypoechoic areas, and perifasicular collections were recorded. SWE was done by placing seven ROIs within the plantar fascia; and the mean of their Young's modulus was taken in kPa. Plantar fascial thickening more than 4mm had 70% sensitivity and 66.7% specificity, echopattern had 90% sensitivity and 96.7% specificity, hypoechoic areas had 80% sensitivity and 96.7% specificity, and perifascial edema had 26.7% sensitivity and 100% specificity for diagnosing plantar fasciitis. Using the ROC curve, the cut-off value of Young's modulus for the diagnosis of plantar fasciitis was found to be ≤ 99.286kPa. This predicted plantar fasciitis with 97% sensitivity and 100% specificity. The primary diagnostic feature of ultrasound of plantar fascia thickness more than 4mm detected 21 out of 30 cases of plantar fasciitis; whereas elastography detected an additional 8 cases which would have been missed on B-mode ultrasound alone. SWE is a useful supplement and improves the diagnostic accuracy of gray-scale ultrasound in plantar fasciitis.

Uterine Evaluation Using Morphological Uterus Sonographic Assessment Diagnostic Protocol: A Literature Review

Background: Myometrial lesion is one of the major causes of the need for gynecologic surgeries. Ultrasonography (USG) is the primary modality in myometrial radiological examination. Thus a consistent procedure for reporting evaluation findings is needed. &#x0D; Method: We reviewed literature from textbooks and journals from 2000 to 2019 containing information about myometrial sonographic evaluation. &#x0D; Results: MUSA (Morphological Uterus Sonographic Assessment) is a consensus statement on terms, definitions, and measurements that may be used to describe findings and report the sonographic features of the myometrium using gray-scale sonography, colour/power Doppler and three-dimensional (3D) ultrasound imaging. The procedure consists of reports on the sonographic features of the uterine corpus, myometrium, and myometrial lesion. &#x0D; Conclusion: The need for a standardized terminology to describe sonographic findings of the myometrium, both normal and pathological, has given this protocol an advantage to show its benefit, that is not only just for a clinical background but also research purposes. We suggest researchers and clinicians continue to develop further and study the relevance and use of the consensus, especially the correlation of sonographic findings with clinical and histological features.

Second-Generation Differential Tissue Harmonic Imaging Improves the Visualization of Renal Lesions.

To compare to three nonlinear imaging techniques to conventional, grayscale ultrasound imaging of renal lesions. Twenty adults with a known renal lesion and a body mass index >25 kg/m2 were enrolled in this prospective, institutional review board approved study. Each subject was imaged with an Aplio 500 scanner (Canon Medical Systems, Tokyo, Japan) using grayscale ultrasound, tissue harmonic imaging (THI) and two dual-frequency, differential tissue harmonic imaging modes (DTHI and DTHI-II, respectively). In total 184 images were scored by three independent and blinded observers for detail resolution, image quality, margin delineation, and depth penetration. Quantitative contrast-to-noise ratios (CNRs) were also calculated. Readers and CNR values showed that nonlinear imaging was superior to grayscale ultrasound (P < .0014). DTHI-II outperformed DTHI, THI, and grayscale ultrasound with respect to detail resolution, image quality, and margin delineation (P < .012). The depth penetration of DTHI and DTHI-II was similar (P=.16), but superior to grayscale ultrasound and THI (P < .001). Two observers saw improvements in detail resolution with DTHI-II over DTHI (P < .05), while image quality and margin delineation were considered similar by two readers (P > .07) and improved with DTHI-II by one (P < .017). DTHI-II improves the imaging of renal lesions compared to DTHI, THI, and grayscale ultrasound, albeit based on a limited sample size.

Ultrasonographic assessment of rheumatoid arthritis: A systematic review.

Objective: To evaluate the reliability of ultrasound for the detection of rheumatoid arthritis (RA). Study Design: Systematic Review. Setting: The University of Lahore. Period: 2001 to 2021. Material &amp; Methods: A systematic exploration of the literature was achieved by collecting articles related to our topic. Articles reporting the reliability result for the assessment of rheumatoid arthritis by ultrasonography were included in this study. Exclusion criteria were articles reporting large joints including shoulder and knees as well as that articles which were not reporting sufficient information of sensitivity and specificity of US regarding RA. These articles were provided by an online source of PubMed, google scholar, research gate, Embase, Wiley online library, BMJ Journal, AJR, Springer, and Elesvier link. Results: Results shows that the specificity and sensitivity of gray-scale US for synovitis assessment ranged from 50% to 90.9% and 47.4% to 100% respectively, specificity and sensitivity of Power Doppler ultrasonography for the evaluation of synovitis hypervascularity ranged from 60% to 98% and 21% to 92% respectively, and specificity and sensitivity of ultrasonography to assess the bone erosion in rheumatoid arthritis patients ranged from 69% to 98.7% and 35.9% to 83% respectively. Conclusion: This systematic review concluded that ultrasound is a vital diagnostic tool as compared to X-ray, CT, MRI, clinical and laboratory examination for the evaluation of bone erosion, synovitis, and synovial hypervascularity.

Ultrasonographic Identification of the Parotid Cystadenolymphoma (Warthin’s Tumor) by Oral and Maxillofacial Surgeons: Supplement to the Matsuda and Colleagues’ Classification

Warthin’s tumor (WT), which is also known as papillary cystadenoma lymphomatosum, monomorphic parotid adenoma, adenolymphoma, cystadenolymphoma, and branchiogenic adenoma, is to be differentiated (in surgical practice) from other parotid masses. The purposes of our retrospective case series study are: (1) to describe ultrasound morphology (sonomorphology) of the WT in patients referred to our hospital, (2) based on the presented cases to propose a supplement to the Matsuda and colleagues’ classification (2017) of anechoic area patterns of the WT, and (3) to expand the knowledge of oral and maxillofacial surgeons for the preoperative ultrasonographic verification of the WT and for choosing the most appropriate surgical technique. Over three years, 5 patients (mean age, 65.4 years) with parotid WT had been examined with gray-scale, color, and power Doppler ultrasonography. Cystic components are visualized in all five WT cases but in different proportions. Case 1 and 4 showed the presence of septations. According to Matsuda and colleagues’ (2017) classification of anechoic area patterns, in our cases the US patterns of the WTs belong only to Group 3 (i.e., with large anechoic areas) (n = 4) and Group 4 (multiple and sponge-like anechoic areas) (n = 1). Moreover, based on the presented five cases, we offer an addition to the classification of Japanese authors. In conclusion, our supplement to Matsuda and colleagues’ classification of anechoic area patterns of the WT can help surgeons around the globe to be more accurate in preoperative verification of cystadenolymphoma. This case series illustrate the growing importance of ultrasonography in the professional life of oral and maxillofacial and head and neck surgeons. Based on the cystic structure of this benign tumor and the ultrasound appearance presented in our case series, we propose to continue using the term “cystadenolymphoma” with a purpose to emphasize the tumor`s structure.

Ultrasound gray scale ratio for differential diagnosis of papillary thyroid microcarcinoma from benign micronodule in patients with Hashimoto’s thyroiditis

BackgroundTo investigate the diagnostic value of ultrasound gray scale ratio (UGSR) in differentiating papillary thyroid microcarcinomas (PTMCs) from benign micronodules (BMNs) in patients with Hashimoto’s thyroiditis (HT).MethodsThe ultrasound images of 285 PTMCs (from 247 patients) and 173 BMNs (from 140 patients) in the HT group, as well as 461 PTMCs (from 417 patients) and 234 BMNs (from 197 patients) in the non-HT group were retrospectively analyzed. The diagnosis of all cases was confirmed by histopathological examinations. The gray scale values of the nodules and surrounding thyroid tissues were measured and subsequently the UGSRs were calculated. Receiver operating characteristic curve analysis was used to determine the area under the curve (AUC), optimal UGSR threshold, sensitivity and specificity in differentiating PTMCs and BMNs in the two groups.ResultsThe UGSR of PTMC and BMN was 0.52 ± 0.12 and 0.85 ± 0.24 in the HT group (P < 0.001), and 0.57 ± 0.13 and 0.87 ± 0.20 in the non-HT group (P < 0.001), respectively. The difference in PTMC-UGSR was significant between the two groups (P < 0.001), whereas BMN-UGSR did not differ between the two groups (P = 0.416). The AUC, optimal UGSR threshold, sensitivity and specificity of UGSR for differentiating PTMC and BMN in the HT and non-HT group were 0.890 versus 0.901, 0.68 versus 0.72, 91.23% versus 90.67%, and 77.46% versus 82.05%, respectively.ConclusionsThe USGR of the HT group was lower than that of the non-HT group.Moreover, UGSR exhibited important diagnostic value in differentiating PTMC from BMN in both HT and non-HT groups.

Feasibility of Ultrasound Attenuation Imaging for Assessing Pediatric Hepatic Steatosis.

Simple SummaryHepatic steatosis is associated with cardiovascular disease, diabetes mellitus, and liver cirrhosis. The increasing prevalence of hepatic steatosis among children has become a public health concern. Although liver biopsy is the gold standard for the diagnosis of hepatic steatosis, it has limited value because of invasiveness. Among imaging studies, ultrasonography is readily accessible and can be used to exclude other pathology, but its accuracy is limited by low sensitivity and specificity. Although magnetic resonance imaging is highly accurate for liver steatosis and fibrosis, its application is curbed in children as it requires sedation and longer scan time. Recently, attenuation imaging (ATI) has emerged as a new modality for quantifying fat deposition in the liver in real time. However, investigations of ATI for pediatric hepatic steatosis are still in their preliminary stages. Thus, we investigated the feasibility of ultrasound attenuation imaging (ATI) for assessing pediatric hepatic steatosis. This study demonstrated that ATI can differentiate fatty liver from normal liver as well as moderate to severe fatty liver from mild fatty liver. Thus, ATI may be useful for identifying children who require liver biopsy and early treatment.We investigated the feasibility of ultrasound attenuation imaging (ATI) for assessing pediatric hepatic steatosis. A total of 111 children and adolescents who underwent liver ultrasonography with ATI for suspected hepatic steatosis were included. Participants were classified into the normal, mild, or moderate–severe fatty liver group according to grayscale US findings. Associations between clinical factors, magnetic resonance imaging proton density fat fraction, steatosis stage and ATI values were evaluated. To determine the cutoff values of ATI for staging hepatic steatosis, areas under the curve (AUCs) were analyzed. Factors that could cause measurement failure with ATI were assessed. Of 111 participants, 88 had successful measurement results. Median ATI values were significantly increased according to steatosis stage (p < 0.001). Body mass index (BMI) was a significant factor for increased ATI values (p = 0.047). To differentiate fatty liver from normal liver, a cutoff value of 0.59 dB/cm/MHz could be used with an AUC value of 0.853. To differentiate moderate to severe fatty liver from mild fatty liver, a cutoff value of 0.69 dB/cm/MHz could be used with an AUC value up to 0.91. ATI can be used in children as an effective ultrasonography technique for quantifying and staging pediatric hepatic steatosis.

Role of contrast-enhanced ultrasound with Perfluorobutane in lesion detection, guidance for microwave ablation, and response assessment of hepatocellular carcinoma.

To evaluate role of perfluorobutane in guiding microwave ablation of HCC and to compare treatment response at 3h of ablation using contrast-enhanced US (CEUS) with Sonazoid with 1-month follow-up contrast-enhanced CT/MRI. This was a single center prospective study and consecutive patients planned for microwave ablation of HCC from October to November 2021 were enrolled. Pre-procedure CEUS were performed using Sonazoid in both vascular and Kupffer phase and number of Kupffer defects compared with gray scale US. Precise needle placement of microwave applicator was done in the Kupffer phase. 3hours post ablation CEUS was repeated to evaluate response assessment using Liver Imaging Reporting and Data System Treatment Response criteria (LR TR). One-month follow-up imaging was done using multiphasic CECT/dynamic CEMRI and comparison was done with post procedure CEUS.Please confirm if the author names are presented accurately and in the correct sequence (given name, middle name/initial, family name). Author 5 Given name: [Manoj Kumar] Last name [Sharma]. Author 6 Given name: [Shiv Kumar] Last name [Sarin]. Also, kindly confirm the details in the metadata are correct. all the names and affiliations are correct RESULTS: A total of 26 patients (24 males and 2 females, mean age 61.38 ± 9.76years) having 40 lesions, of mean tumor diameter 21.4 ± 7.7mm, underwent CEUS and ablation. Most common etiology for cirrhosis was viral hepatitis, followed by non-alcoholic steatohepatitis (NASH). Four (10%) additional lesions (which were seen on pre-procedure imaging) were detected in Kupffer phase over gray scale US. All lesions showed complete response in the immediate post procedure CEUS. Technique efficacy at 1-month was 95% according to the LR TR criteria.Please check the edit made in article title and amend if necessary.The edit is correct and appropriatePlease check and confirm that the authors and their respective affiliations have been correctly identified and amend if necessary.All the names and their respective affiliations are correct CONCLUSION: CEUS with Sonazoid is an excellent modality for precise needle placement for ablation due to stable nature and excellent lesion visibility of Kupffer phase.

Intraoral ultrasonography for gingival squamous cell carcinoma: Tumor thickness and bone invasion

AbstractPurposeThe aim of this study was to evaluate the accuracy of intraoral ultrasonography (US) for gingival squamous cell carcinoma (SCC) thickness and bone invasion compared with computed tomography (CT).Materials and MethodsThis study assessed eight gingival squamous cell carcinoma patients who underwent US and CT at our hospital from April 2021 to November 2021. Grayscale and color Doppler US were performed using a liner 14 MHz transducer. Computed tomography imaging was undergone with a 16‐multidetector CT scanner using the oral and maxillofacial protocol. The relationship between US and CT on tumor thickness of gingival SCC was assessed by Pearson's rank correlation test. A p value lower than 0.05 was considered as statistically significant.ResultsPresence or absence of bone invasion was consistent in CT and US. We plotted tumor thickness of gingival SCC and observed a significant correlation between tumor thickness using CT and US.ConclusionWe showed the usefulness of to evaluate of tumor thickness and bone invasion using intraoral US is useful with gingival SCC.

A Comparative Study of Multiple Deep Learning Models Based on Multi-Input Resolution for Breast Ultrasound Images.

PurposeThe purpose of this study was to explore the performance of different parameter combinations of deep learning (DL) models (Xception, DenseNet121, MobileNet, ResNet50 and EfficientNetB0) and input image resolutions (REZs) (224 × 224, 320 × 320 and 488 × 488 pixels) for breast cancer diagnosis.MethodsThis multicenter study retrospectively studied gray-scale ultrasound breast images enrolled from two Chinese hospitals. The data are divided into training, validation, internal testing and external testing set. Three-hundreds images were randomly selected for the physician-AI comparison. The Wilcoxon test was used to compare the diagnose error of physicians and models under P=0.05 and 0.10 significance level. The specificity, sensitivity, accuracy, area under the curve (AUC) were used as primary evaluation metrics.ResultsA total of 13,684 images of 3447 female patients are finally included. In external test the 224 and 320 REZ achieve the best performance in MobileNet and EfficientNetB0 respectively (AUC: 0.893 and 0.907). Meanwhile, 448 REZ achieve the best performance in Xception, DenseNet121 and ResNet50 (AUC: 0.900, 0.883 and 0.871 respectively). In physician-AI test set, the 320 REZ for EfficientNetB0 (AUC: 0.896, P < 0.1) is better than senior physicians. Besides, the 224 REZ for MobileNet (AUC: 0.878, P < 0.1), 448 REZ for Xception (AUC: 0.895, P < 0.1) are better than junior physicians. While the 448 REZ for DenseNet121 (AUC: 0.880, P < 0.05) and ResNet50 (AUC: 0.838, P < 0.05) are only better than entry physicians.ConclusionBased on the gray-scale ultrasound breast images, we obtained the best DL combination which was better than the physicians.

Evaluation of Placental Grading in 2nd and 3rd Trimester Using Gray Scale Ultrasound

Background: The use of ultrasound has asignificant role in assessment of placental grading during antenatal treatment. With the help of ultrasound one can know about the gestational age, riskevaluation and it also describes about placental maturity, grading, fetal health, andprognosis. Any abnormality in placental maturity can lead towards poor pregnancy outcomes and fetus intrauterine growth restriction (IUGR). Objective: The objective of this study is to determine the evaluation of placental grading in 2nd and 3rd trimester using gray scale ultrasound for prediction of fetal outcomes. Material and Method: This study was conducted atgynecology and obstetrics department of two Hospitals (Sajida Khalil Hospital and Robina Sajid Hospital Gujrat) respectively. The duration of study was 4 months i.e. 14 January 2022 to 14 May 2022. Total number of participants was 200 pregnant ladies. These all were coming for their regular antenatal follow up in gynecology and obstetrics department of both hospitals. Results: Total 200 pregnant females with gestational age of 13 weeks and onwardi.e. 2nd and 3rd trimester in order to see the placental grading in 2nd and 3rd trimester were taken as sample population for the present study.Out of the total 200, women 62 (31.0%) were of second trimester and 138 (69.0%) were of third trimester. The results for placental grading by statistical analysis showed out of 200, 74 (37.0%) showed Placenta with Grade-I, 75 (37.5%) showed placenta with Grade-II maturity and 51(25.5%) showed placental maturity of Grade-III. Conclusion: Sonographic appearance of placental Grading gives us information about the well being and the information about placental appearance (hypoechoic, hyperechoic or echogencity).