Gray-scale Ultrasonography Research Articles

Deep Learning Prediction of Ovarian Malignancy at US Compared with O-RADS and Expert Assessment.

Background Deep learning (DL) algorithms could improve the classification of ovarian tumors assessed with multimodal US. Purpose To develop DL algorithms for the automated classification of benign versus malignant ovarian tumors assessed with US and to compare algorithm performance to Ovarian-Adnexal Reporting and Data System (O-RADS) and subjective expert assessment for malignancy. Materials and Methods This retrospective study included consecutive women with ovarian tumors undergoing gray scale and color Doppler US from January 2019 to November 2019. Histopathologic analysis was the reference standard. The data set was divided into training (70%), validation (10%), and test (20%) sets. Algorithms modified from residual network (ResNet) with two fusion strategies (feature fusion [hereafter, DLfeature] or decision fusion [hereafter, DLdecision]) were developed. DL prediction of malignancy was compared with O-RADS risk categorization and expert assessment by area under the receiver operating characteristic curve (AUC) analysis in the test set. Results A total of 422 women (mean age, 46.4 years ± 14.8 [SD]) with 304 benign and 118 malignant tumors were included; there were 337 women in the training and validation data set and 85 women in the test data set. DLfeature had an AUC of 0.93 (95% CI: 0.85, 0.97) for classifying malignant from benign ovarian tumors, comparable with O-RADS (AUC, 0.92; 95% CI: 0.85, 0.97; P = .88) and expert assessment (AUC, 0.97; 95% CI: 0.91, 0.99; P = .07), and similar to DLdecision (AUC, 0.90; 95% CI: 0.82, 0.96; P = .29). DLdecision, DLfeature, O-RADS, and expert assessment achieved sensitivities of 92%, 92%, 92%, and 96%, respectively, and specificities of 80%, 85%, 89%, and 87%, respectively, for malignancy. Conclusion Deep learning algorithms developed by using multimodal US images may distinguish malignant from benign ovarian tumors with diagnostic performance comparable to expert subjective and Ovarian-Adnexal Reporting and Data System assessment. © RSNA, 2022 Online supplemental material is available for this article.

Prediction of programmed cell death protein 1 in hepatocellular carcinoma patients using radiomics analysis with radiofrequency-based ultrasound multifeature maps

BackgroundThis study explored the feasibility of radiofrequency (RF)-based radiomics analysis techniques for the preoperative prediction of programmed cell death protein 1 (PD-1) in patients with hepatocellular carcinoma (HCC).MethodsThe RF-based radiomics analysis method used ultrasound multifeature maps calculated from the RF signals of HCC patients, including direct energy attenuation (DEA) feature map, skewness of spectrum difference (SSD) feature map, and noncentrality parameter S of the Rician distribution (NRD) feature map. From each of the above ultrasound maps, 345 high-throughput radiomics features were extracted. Then, the useful radiomics features were selected by the sparse representation method and input into support vector machine (SVM) classifier for PD-1 prediction.Results and conclusionAmong all the RF-based prediction models and the ultrasound grayscale comparative model, the RF-based model using all of the three ultrasound feature maps had the highest prediction accuracy (ACC) and area under the curve (AUC), which were 92.5% and 94.23%, respectively. The method proposed in this paper is effective for the meaningful feature extraction of RF signals and can effectively predict PD-1 in patients with HCC.

Development and External Validation of a Simple-To-Use Dynamic Nomogram for Predicting Breast Malignancy Based on Ultrasound Morphometric Features: A Retrospective Multicenter Study

BackgroundWith advances in high-throughput computational mining techniques, various quantitative predictive models that are based on ultrasound have been developed. However, the lack of reproducibility and interpretability have hampered clinical use. In this study, we aimed at developing and validating an interpretable and simple-to-use US nomogram that is based on quantitative morphometric features for the prediction of breast malignancy.MethodsSuccessive 917 patients with histologically confirmed breast lesions were included in this retrospective multicentric study and assigned to one training cohort and two external validation cohorts. Morphometric features were extracted from grayscale US images. After feature selection and validation of regression assumptions, a dynamic nomogram with a web-based calculator was developed. The performance of the nomogram was assessed with respect to calibration, discrimination, and clinical usefulness.ResultsThrough feature selection, three morphometric features were identified as being the most optimal for predicting malignancy, and all regression assumptions of the prediction model were met. Combining all these predictors, the nomogram demonstrated a good discriminative performance in the training cohort and in the two external validation cohorts with AUCs of 0.885, 0.907, and 0.927, respectively. In addition, calibration and decision curves analyses showed good calibration and clinical usefulness.ConclusionsBy incorporating US morphometric features, we constructed an interpretable and easy-to-use dynamic nomogram for quantifying the probability of breast malignancy. The developed nomogram has good generalization abilities, which may fit into clinical practice and serve as a potential tool to guide personalized treatment. Our findings show that quantitative morphometric features from different ultrasound machines and systems can be used as imaging surrogate biomarkers for the development of robust and reproducible quantitative ultrasound dynamic models in breast cancer research.

Value of Histogram of Gray-Scale Ultrasound Image in Differential Diagnosis of Small Triple Negative Breast Invasive Ductal Carcinoma and Fibroadenoma.

ObjectiveTo investigate the value of gray-scale ultrasound (US) image histogram in the differential diagnosis between small (≤2.00 cm), oval, or round triple negative breast invasive ductal carcinoma (TN-IDC) and fibroadenoma (FA).MethodsFifty-five cases of triple negative breast invasive ductal carcinoma (TN-IDC group) and 57 cases of breast fibroadenoma (FA group) confirmed by pathology in Hubei cancer hospital from September 2017 to September 2021 were analyzed retrospectively. The gray-scale US images were analyzed by histogram analysis method, from which some parameters (including mean, variance, skewness, kurtosis and 1st, 10th, 50th, 90th and 99th percentile) can be obtained. Intraclass correlation coefficient (ICC) was used to evaluate the inter observer reliability of histogram parameters. Histogram parameters between the TN-IDC and FA groups were compared using independent Student’s t-test or Mann-Whitney U-test, respectively. In addition, the receiver operating characteristic (ROC) curve analysis was used for the significant parameters to calculate the differential diagnosis efficiency.ResultsAll the histogram parameters showed excellent inter-reader consistency, with the ICC values ranged from 0.883 to 0.999. The mean value, 1st, 10th, 50th, 90th and 99th percentiles of TN-IDC group were significantly lower than those of FA group (P < 0.05). The area under ROC curve (AUC) values of mean and n percentiles were from 0.807 to 0.848. However, there were no significant differences in variance, skewness and kurtosis between the two groups (P > 0.05).ConclusionHistogram analysis of gray-scale US images can well distinguish small, oval, or round TN-IDC from FA.

The ultrasound elastography findings in lateral epicondylitis in comparison with healthy individuals

Objectives: To evaluate the ability of strain sonoelastography (SEL) in diagnosing lateral epicondylitis (LE) and to asses clinical and diagnostic efficacy of strain SEL in patients with clinically confirmed LE and in healthy volunteers. Methods: Strain SEL was performed on 110 patients with clinical symptoms of LE and on 56 healthy participants. The common extensor tendon (CET) was evaluated with gray-scale and color Doppler ultrasonography (CDUS). The stiffness and the elasticity of the CET was divided into 2 main types and 2 subtypes as a spectrum ranging from hard for 1a to soft for 2b. Results: The thickness of the CET in patients with LE (6.3±1.06 mm) were remarkably thicker than in healthy participants (3.8±0.62 mm) (p&lt;0.001). There were negative significant correlations between the thickness of the CET and lower and mean strain ratios (SR) (rs= [–0.666], p&lt;0.001 for lower SR and rs= [–0.358], p&lt;0.001 for mean SR). Thickness of the CET varied between the groups of elastographic patterns (p&lt;0.001). The SR of tendon in patients with LE (6.68±2.49 mm) were remarkably lower than in healthy participants (11.16±4.88 mm) (p&lt;0.001). The SR of tendon in patients with LE also varied significantly between the groups of elastographic patterns (p&lt;0.001). Conclusion: Strain SEL is a promising sonographic technique for musculoskeletal imaging to differentiate thickening and softening of CET in LE. SR and SEL pattern findings are compatible with gray scale ultrasound and CDUS findings.

Relationship Between Greyscale Ultrasound Grading of Hepatic Steatosis and Attenuation Imaging.

BackgroundNon-alcoholic fatty liver disease (NAFLD) has been rising worldwide due to the rising public health threat of metabolic syndrome. Because non-alcoholic steatohepatitis can proceed to liver fibrosis and cirrhosis, early identification and monitoring are critical for management. For the examination of NAFLD, greyscale ultrasound has been frequently employed. A relatively new technique, attenuation imaging (ATI), can quantitatively evaluate and compute the attenuation coefficient (AC). Our goal was to evaluate the performance and cutoff values of attenuation imaging to identify hepatic steatosis. As a reference standard, greyscale ultrasound was employed.MethodA total of 207 patients were assessed from June to November 2021 after getting informed consent. The association between ATI values and greyscale grading to diagnose hepatic steatosis was investigated, and the Statistical Package for the Social Sciences (SPSS) version 21 (IBM Corp., Armonk, NY, USA) was used to analyze the data. In the analysis, the Spearman correlation and area under the receiver operating characteristic curve (AUROC) tests were performed. Receiver operating characteristic curve analysis was also used to assess ATI’s diagnostic capability and cutoff values.ResultThe correlation between ATI values and hepatic steatosis grades on greyscale was statistically significant (p < 0.05). Greyscale grading and ATI levels have a correlation coefficient (r) of 0.85, indicating a strong association. Steatosis grades 1, 2, and 3 had threshold ATI values of 0.65, 0.73, and 0.96 dB/cm/MHz, respectively. According to greyscale, the diagnostic ability of ATI for steatosis grades 1, 2, and 3 were 0.948 (95% CI: 0.917-0.979), 0.978 (95% CI: 0.961-0.995), and 1.000 (95% CI: 1.000-1.000), respectively.ConclusionsAttenuation imaging is a reliable method for identifying liver steatosis, with great performance and a strong association with the greyscale ultrasound.

Ultrasound grayscale ratio: a reliable parameter for differentiating between papillary thyroid microcarcinoma and micronodular goiter

BackgroundThe present study aimed to quantify and differentiate the echo levels of papillary thyroid microcarcinomas (PTMCs) and micronodular goiters (MNGs) using the ultrasound grayscale ratio (UGSR) and to investigate the repeatability of UGSR.MethodsThe ultrasound (US) data of 241 patients with 265 PTMCs and 141 patients with 168 MNGs confirmed by surgery and pathology were retrospectively analyzed. All patients had received outpatient ultrasonic examination and preoperative ultrasonic positioning. The RADinfo radiograph reading system was used to measure the grayscales of PTMC, MNG, and thyroid tissues at the same gain level, and the UGSR values of the PTMC, MNG, and thyroid tissue were calculated. The patients were divided into outpatient examination, preoperative positioning, and mean value groups, and the receiver operating characteristic (ROC) curves were calculated to obtain the optimal UGSR threshold to distinguish PTMC from MNG. The interclass correlation coefficient (ICC) was used to assess the consistency of UGSR measured in three groups.ResultsThe UGSR values of the PTMC and MNG were 0.56 ± 0.14 and 0.80 ± 0.19 (t = 5.84, P < 0.001) in the outpatient examination group, 0.55 ± 0.14 and 0.80 ± 0.19 (t = 18.74, P < 0.001) in the preoperative positioning group, and 0.56 ± 0.12 and 0.80 ± 0.18 (t = 16.49, P < 0.001) in the mean value group. The areas under the ROC curves in the three groups were 0.860, 0.856, and 0.875, respectively. When the UGSR values for the outpatient examination, preoperative positioning, and mean value groups were 0.649, 0.646, and 0.657, respectively, each group obtained its largest Youden index. A reliable UGSR value was obtained between the outpatient examination and preoperative positioning groups (ICC = 0.79, P = 0.68).ConclusionUGSR is a simple and repeatable method to distinguish PTMC from MNG, and hence, can be widely applicable.

Exploratory study on the predictive value of ultrasound radiomics for cervical tuberculous lymphadenitis

PurposeTo investigate the predictive values of gray-scale ultrasound (G-US) and strain elastic ultrasound (SE-US) radiomic features for cervical tuberculous lymphadenitis (CTL). Material and methodsThe G-US and SE-US images of 147 patients with pathologically confirmed CTL and 69 non-CTL patients were retrospectively analyzed. A total of 851 imaging features were extracted. The patients were divided into the training set and test set in 7:3 ratio. In the training set, the minimum redundancy maximum relevance (mRMR) and the least absolute shrinkage and selection operator (LASSO) were used for feature selection and modeling. The diagnostic power of G-US and SE-US ultrasound radiomics in identifying CTL was evaluated in test set. ResultsThe G-US and SE-US have finally selected 10 and 14 features, respectively. In the G-US group, the diagnostic sensitivity, specificity and accuracy of the training set were 69.7%, 85.7% and 70.0%, respectively, and those values in the test set were 81.3%, 70.0% and 86.4%, respectively. The SE-US group had a sensitivity of 71.7%, a specificity of 81.6%, and an accuracy of 67.0% in the training set, and those parameters in the test set were 81.0%, 75.0%, and 83.7%, respectively. In the G-US group, the positive and negative predictive value of the training set were 0.519 and 0.901, respectively, and those values in the test set were 0.700 and 0.864, respectively. The SE-US group had a positive predictive value of 0.541, and a negative predictive value of 0.885 in the training set, and those parameters in the test set were 0.682 and 0.878, respectively. By Delong test, G-US and SE-US groups showed no significant differences in diagnostic performance between the training and test sets. ConclusionsThe ultrasound radiomic features of G-US and SE-US exhibited certain predictive potential in detecting CTL, providing a new non-invasive method for clinicians to more accurately evaluate patients with CTL.

A sonographic software program, Fluctuational Imaging, for diagnosis of hepatic hemangioma

Hepatic hemangioma is the most common benign solid lesion of the liver. Contrast-enhanced computed tomography or magnetic resonance imaging is recommended for definitive diagnosis of hepatic hemangioma. However, these modalities have drawbacks in terms of radiation exposure, invasiveness, and high cost for examination. “Fluttering sign” is one of the candidate findings considered specific for hepatic hemangioma that can be useful for diagnosis of hepatic hemangioma using grayscale US alone. However, the assessment is subjective and the findings are weak and likely to be overlooked in some cases. We developed a software program, Fluctuational Imaging, for objective detection and depiction of “fluttering sign”. Here, we evaluated the ability of Fluctuational Imaging software to depict “fluttering sign” in hepatic hemangioma. Presence or absence of “fluttering sign” was evaluated in the grayscale US videos and Fluctuational Imaging software analysis results of patients with hepatic hemangioma. The Cohen’s kappa test showed very good agreement (0.95). Fluctuational Imaging software can detect and depict the phenomenon of “fluttering sign” well and may be a useful tool for diagnosis of hepatic hemangioma.

Morphological Uterus Sonographic Assessment Criteria for Adenomyosis Diagnostic: A Case Report

BACKGROUND : The MUSA (Morphological Uterus Sonographic Assessment) statement is a consensus statement on terms, definitions and measurements that may be used to describe and report the sonographic features of the myometrium using gray-scale sonography, color/power Doppler and three-dimensional ultrasound imaging. MUSA Adenomyosis ultrasound features : Asymmetrical thickening, fan shape shadowing, cyst, hyperechoic island, Echogenic sub endometrial lines and buds, trans lesion vascularity, Irregular junctional zone, Interrupted junctional zone. Classification and descriptions of the MUSA criteria for adenomyosis are presented : location, classification (diffuse/focal), cystic, layer involvement (type), extent, size of the lesion.

Prevalence of ovarian mass and diagnostic performance of ultrasonography pattern recognition among women at the Gynaecologic Ultrasonography Unit at University Hospital in Thailand

The aim of this retrospective study was to determine the prevalence of ovarian masses and calculate the diagnostic performance of the pattern recognition approach in ovarian pathology. A total of 1001 patients diagnosed with ovarian mass were included, of which 92.6% were diagnosed with ovarian pathology and the presence of a pathological result, while 7.4% of cases were diagnosed with functional ovarian cyst. The prevalence of ovarian malignancy was 15%. A specific ultrasound diagnosis was suggested in 62.9% of all cases, while sonographers did not explicitly provide a diagnosis in remaining cases. A subjective assessment showed 80.3% sensitivity (95% confidence interval (CI) 68.7–89.1) and 97.6% specificity (95% CI 96–98.6) in differentiating between benign and malignant ovarian masses. The sensitivity and specificity for the diagnosis of endometriotic cyst were 77.03% and 90.63% and 63.19% and 94.3% for mature cystic teratoma, respectively. In conclusion, assessment showed good performance in differentiating between benign and malignant ovarian mass and it was possible to diagnose several specific ovarian tumours. Impact Statement What is already known on this subject? Pattern recognition is an acceptable method for classifying ovarian mass, which exhibits specific morphological features on grey-scale ultrasonography, and can be used to predict nature and histological type. What do the results of this study add? Even in the hands of an expert examiner, there were a number of cases in which the diagnoses could not be specifically stated. Pattern recognition correctly classified 90.3% of ovarian masses as either benign or malignant and correctly provided specific histologic diagnoses after exclusion of unspecified diagnosis in 80.6% of all cases. The diagnostic performance of this approach was high in differentiating between benign and malignant ovarian mass and in diagnosing some specific ovarian pathologies. What are the implications of these findings for clinical practice and/or further research? A subjective assessment is simple and easy to use in clinical practice and has shown promising results in classifying benign and malignant ovarian mass. Moreover, it can also be used to make some specific diagnoses. However, specialised and experienced gynaecological ultrasound examiners are required to provide the most accurate diagnosis. Therefore, criteria to describe ultrasound features and convincing operators to make a definite diagnosis as often as possible should be encouraged. A prospective study to verify diagnostic performance of pattern recognition or comparing with other ultrasonographic diagnostic tools should be considered.

Prospective evaluation of impact of post‐Cesarean section uterine scarring in perinatal diagnosis of placenta accreta spectrum disorder

ABSTRACTObjectiveStandardized ultrasound imaging and pathology protocols have recently been developed for the perinatal diagnosis of placenta accreta spectrum (PAS) disorders. The aim of this study was to evaluate prospectively the effectiveness of these standardized protocols in the prenatal diagnosis and postnatal examination of women presenting with a low‐lying placenta or placenta previa and a history of multiple Cesarean deliveries (CDs).MethodsThis was a prospective cohort study of 84 consecutive women with a history of two or more prior CDs presenting with a singleton pregnancy and low‐lying placenta/placenta previa at 32–37 weeks' gestation, who were referred for perinatal care and management between 15 January 2019 and 15 December 2020. All women were investigated using the standardized description of ultrasound signs of PAS proposed by the European Working Group on abnormally invasive placenta. In all cases, the ultrasound features were compared with intraoperative and histopathological findings. Areas of abnormal placental attachment were identified during the immediate postoperative gross examination and sampled for histological examination. The data of a subgroup of 32 women diagnosed antenatally as non‐PAS who had complete placental separation at birth were compared with those of 39 cases diagnosed antenatally as having PAS disorder that was confirmed by histopathology at delivery.ResultsOf the 84 women included in the study, 42 (50.0%) were diagnosed prenatally as PAS and the remaining 42 (50.0%) as non‐PAS on ultrasound examination. Intraoperatively, 66 (78.6%) women presented with a large or extended area of dehiscence and 52 (61.9%) with a dense tangled bed of vessels or multiple vessels running laterally and craniocaudally in the uterine serosa. A loss of clear zone was recorded on grayscale ultrasound imaging in all 84 cases, while there was no case with bladder‐wall interruption or with a focal exophytic mass. Myometrial thinning (< 1 mm) in at least one area of the anterior uterine wall was found in 41 (97.6%) of the 42 cases diagnosed as non‐PAS on ultrasound and 37 (88.1%) of the 42 diagnosed antenatally as PAS. Histological samples were available for all 48 hysterectomy specimens with abnormal placental attachment and for the three cases managed conservatively with focal myometrial resection and uterine reconstruction. Villous tissue was found directly attached to the superficial myometrium (placenta creta) in six of these cases and both creta villous tissue and deeply implanted villous tissue within the uterine wall (placenta increta) were found in the remaining 45 cases. There was no evidence of percreta placentation on histology in any of the PAS cases. Comparison of the main antenatal ultrasound signs and perioperative macroscopic findings between the two subgroups correctly diagnosed antenatally (32 non‐PAS and 39 PAS) showed no significant difference with respect to the distribution of myometrial thinning and the presence of a placental bulge on ultrasound and of anterior uterine wall dehiscence intraoperatively. Compared with the non‐PAS subgroup, the PAS subgroup showed significantly higher placental lacunae grade (P < 0.001) and more often hypervascularity of the uterovesical/subplacental area (P < 0.001), presence of bridging vessels (P = 0.027) and presence of lacunae feeder vessels (P < 0.001) on ultrasound examination, and increased vascularization of the anterior uterine wall intraoperatively (P < 0.001).ConclusionsRemodeling of the lower uterine segment following CD scarring leads to structural abnormalities of the uterine contour on both ultrasound examination and intraoperatively, independently of the presence of accreta villous tissue on microscopic examination. These anatomical changes are often reported as diagnostic of placenta percreta, including cases with no histological evidence of PAS. Guided histological examination could improve the overall diagnosis of PAS and is essential to obtain evidence‐based epidemiologic data. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Comparison of Placental Elasticity and Different Spectral Doppler Indices in Normal and Intrauterine Growth Restricted Fetuses

Objective: Comparison of Placental Elasticity and different spectral Doppler indices in normal and intrauterine growth restricted fetuses to establish efficacy of shear wave elastography in early detection of Intrauterine Growth Restricted (IUGR). Design: Cross sectional comparative. 290 pregnant women previously diagnosed by ultrasound as normal and intrauterine growth restriction fetuses which were included in this study, placental elasicity in both groups was evalauted by SWE (shearwave elastography) and compared. Methods: Primarily both groups were scanned for grayscale and Color Doppler ultrasonography in which we took the measurements of resistivity and pulsatility indices of umbilical artery (UA), uterine artery and MCA (middle cerebral artery). In these groups placental elasticity was evaluated by SWE .The ratios of strain were compared between both groups. Statistical study was carried out by using Mann-Whitney test. Cut-off values for elasticity were analyzed by plotting receiver operative characteristic curve (ROC), sensitivity. Specificity and DA&#x0D; (diagnostic accuracy) for IUGR were designed established on Shear wave elastography measurements. Results: The mean placental elasticity in intrauterine growth restriction (IUGR) and in normal groups was 28.71+7.28 and 5.64+1.53, respectively while in the IUGR group median placental elasticity was 27+7 and 5.50+2 with statistically elevated median among patients in the IUGR group (P

Deep learning based sarcopenia prediction from shear-wave ultrasonographic elastography and gray scale ultrasonography of rectus femoris muscle

We aim to evaluate the performance of a deep convolutional neural network (DCNN) in predicting the presence or absence of sarcopenia using shear-wave elastography (SWE) and gray-scale ultrasonography (GSU) of rectus femoris muscle as an imaging biomarker. This retrospective study included 160 pair sets of GSU and SWE images (n = 160) from December 2018 and July 2019. Two radiologists scored the echogenicity of muscle on GSU (4-point score). Among them, 141 patients underwent CT and their L3 skeletal muscle index (SMI) were measured to categorize the presence or absence of sarcopenia. For DCNN, we used three CNN architectures (VGG19, ResNet-50, DenseNet 121). The accuracies of DCNNs for sarcopenia classification were 70.0–80.0% (based on SWE) and 65.0–75.0% (based on GSU). The DCNN application to SWE images highlights the utility of deep-learning base SWE for sarcopenia prediction. DCNN application to SWE images might be a potentially useful biomarker to predict sarcopenic status.

Ultrasonographic index for the diagnosis of non-alcoholic steatohepatitis in patients with non-alcoholic fatty liver disease.

Liver biopsy is a gold standard for the diagnosis of non-alcoholic steatohepatitis (NASH), but has several disadvantages including invasiveness, high cost, and sampling error. Ultrasonography (US) is a noninvasive imaging modality widely used in non-alcoholic fatty liver disease (NAFLD) patients. This study aimed: (I) to assess the feasibility of US in the prediction of NASH and (II) to develop various US indices combining US parameters and laboratory data for the detection of NASH in NAFLD patients and to compare the diagnostic performance of them. Sixty patients who underwent liver biopsy, gray-scale US [hepatorenal index (HRI) and shear-wave elastography (SWE)], and Fibroscan [controlled attenuation parameter (CAP) and transient elastography (TE)] for the evaluation of NASH were included. Patients were classified according to the NAFLD Activity Score (NAS) into the NASH (NAS ≥5) and non-NASH (NAS <5) groups. The diagnostic performance of HRI, CAP, SWE, TE, and laboratory data for grading steatosis, lobular inflammation, ballooning degeneration, and fibrosis was evaluated. After the identification of laboratory data that were independently associated with NASH through univariable and multivariable logistic regression analyses, various US indices were developed by combining US parameters with or without these laboratory data. The diagnostic performance of the US indices was assessed with obtaining area under the curve (AUC) and compared using DeLong test. Twenty-five NASH and 35 non-NASH patients were included. The mean AUCs for grading steatosis were 0.871 using HRI and 0.583 using CAP. The mean AUCs for grading fibrosis and ballooning degeneration were 0.777 and 0.729 using SWE and 0.830 and 0.708 using TE, respectively. Aspartate aminotransferase (AST) was the only significant laboratory data associated with NASH (OR, 1.019; P=0.032). Using AST, the mean AUCs for grading lobular inflammation and ballooning degeneration were 0.712 and 0.775, respectively. Among various US indices, the index consisting of gray-scale US parameters (SWE and HRI) and AST showed the best diagnostic performance for the detection of NASH in NAFLD patients (AUC =0.806). The index combining gray-scale US parameters and AST is useful for the detection of NASH and may be used to exclude the need for liver biopsy in NAFLD patients.

Ultrasound Imaging Acquisition Procedures for Evaluating the First Metatarsophalangeal Joint: A Scoping Review.

The aim of this scoping review was to investigate ultrasound imaging (USI) acquisition procedures and guidelines used to assess the first metatarsophalangeal joint (MTPJ). MEDLINE, CINAHL, AMED and SPORTDiscus were systematically searched in May 2021. Studies were included if they used grey-scale USI or power Doppler and reported a USI procedure to assess the first MTPJ. Screening and data extraction were performed by two independent assessors. The scoping review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping reviews (PRISMA-ScR). A total of 403 citations were identified for screening, with 36 articles included in the final analysis. There was wide variation in USI acquisition procedures used to evaluate the first MTPJ. Inconsistencies in reporting may be attributable to the number of elements the USI acquisition procedure encompasses, which include the model of the USI device, the type of transducer, USI modalities and settings, patient position, transducer orientation, surfaces scanned and the scanning technique used. The review found inconsistencies against international guidelines and limited implementation of consensus-based recommendations to guide image acquisition. Current guidelines require further refinement of anatomical reference points to establish a standardised USI acquisition procedure, subsequently improving interpretability and reproducibility between USI studies that evaluate the first MTPJ.

Prevalence and Risk Factors Analysis of Carotid Stenosis Among Ischaemic Heart Diseases Patient in Bangladesh: A Cross-Sectional Study.

PurposeThis study aimed to evaluate the prevalence of carotid stenosis among ischaemic heart disease (IHD) patients undergoing coronary artery bypass graft (CABG) surgery and identify risk factors associated with carotid stenosis at a tertiary-level hospital in Bangladesh.Patients and MethodsThis cross-sectional study examined 200 IHD patients scheduled for isolated and elective CABG surgery, and multivariate regression analysis was used to determine the impact of independent variables on carotid stenosis with coronary artery disease. A vascular surgeon and sonographer assessed carotid stenosis, and the severity of stenosis was classified according to the current Grayscale and Doppler US diagnosis models.ResultsWe observed that the prevalence of carotid artery stenosis was 13.5%, and the male was significantly higher (85.2%) in the carotid stenosis group. A multivariate regression analysis observed that age (OR 1.79), dyslipidaemia (OR 2.19), uncontrolled hypertension (OR 2.38), uncontrolled DM (OR 2.51), multivessel coronary artery disease (OR 3.79), and multiple comorbidities (OR 4.46) are potential predictors of having significant carotid stenosis in a patient undergoing CABG surgery.ConclusionIn Bangladesh, multivessel coronary artery disease, especially in elderly patients with multiple comorbidities, are 4 (four) times higher risk to have significant carotid artery stenosis. Preoperative carotid duplex screening should be performed to curtail the risk of postoperative adverse cerebrovascular events, particularly those who have carotid stenosis associated potential risk factors.

Quantitative analysis of thyroid gland blood supply in children and adolescents

Aim &#x0D; This study aims to determine the reference vascularization index (VI) values for the thyroid gland in healthy children and adolescents using Super microvascular imaging (SMI). It was also investigated the correlation between thyroid vascularity and thyroid lobe volumes, age, sex, weight, height, and body mass index (BMI). &#x0D; Material and Methods&#x0D; One hundred and twenty-four children and adolescents without a thyroid gland, systemic disease, and medical history affecting the thyroid gland were included in the study. Participants with abnormal thyroid function tests were excluded from the study. Age, gender, height, and weight were recorded before ultrasonography and SMI examinations. After the grayscale ultrasonography, VI values for each participant were obtained using SMI. The association between the VI and thyroid lobe volumes, age, sex, weight, height, and BMI values were analyzed.&#x0D; Results&#x0D; Median values of the age, height, weight, and BMI of 124 participants were 10 (6-12) years, 1.3 (1.2-1.52) m, 30.5 (21-47) kg, 17.55 (15.37-21.14) kg/m2, respectively. Median (IQR) values of the left and right thyroid lobe volumes were 1.4 (0.9-2.07) mL and 1.9 (1.2-3.07) mL, respectively, and the mean VI value was 5.31±1.84%. There was no significant association of VI values with the thyroid lobe volume. Also, there was no relation between the mean VI values and the auxological parameters.&#x0D; Conclusion&#x0D; This study defines the VI values of thyroid glands in healthy adolescents and children. It also demonstrated no correlation between VI values of the thyroid gland and thyroid lobe volume, sex, age, weight, height, and BMI.

Advanced ultrasound techniques in arterial diseases.

Ultrasound (US) remains a valuable modality for the assessment of vascular diseases, with conventional sonographic techniques such as grayscale and Doppler US used extensively to assess carotid atherosclerosis and abdominal aortic aneurysms. However, conventional US techniques are inherently limited by factors such as operator dependency and limited field of view. There is an increasing interest in the use of advanced sonographic techniques such as contrast-enhanced US (CEUS) and 3-dimensional (3D) US to mitigate some of these limitations. Clinical applications of advanced sonographic techniques include surveillance of abdominal aortic aneurysm, post-endovascular aortic repair, and carotid atherosclerotic plaques. Recently published studies have demonstrated that CEUS and 3D US are superior to conventional US and comparable to computed tomography for certain vascular applications. Further research is required to fully validate the application of advanced sonographic techniques in evaluating various atherosclerotic diseases.

Features of ultrasound and contrast enhanced ultrasound in superficial desmoid-type fibromatosis: A series of 19 cases

This study aimed to describe the characteristics of superficial desmoid fibromatosis (DF) using two-dimensional and contrast-enhanced ultrasonography, intending to improve diagnostic accuracy. We retrospectively analyzed 19 cases of superficial DF confirmed by surgery or core-needle biopsy in our hospital from January 2018 to August 2020. All patients underwent two-dimensional and contrast-enhanced ultrasound (CEUS) examination. Nineteen patients included 15 women and 4 men, with an average age of 33.37±12.13 years old. The mean size of lesions was 4.78±1.99 cm. On ultrasound, all lesions presented as solitary heterogeneous hypoechoic masses; 13 presented with ill-defined margins. Ten lesions (52.63%) presented with fusiform shapes, and 11 lesions (57.89%) presented with the “fascial tail” sign. CEUS suggested the tumors were hyperenhanced, with an enhanced pattern of rapid wash-in and slow wash-out. Four lesions (21.05%) showed an enlarged scope in the CEUS image compared with the grayscale ultrasound image. In conclusion, an ill-defined heterogeneous hyperechoic appearance with fusiform-shaped and “fascial tail” signs on US and heterogeneous hyperenhancement with an enlarged scope on CEUS are valuable clues in the diagnosis and treatment of superficial DF.