Negative Predictive Value Of Ultrasound Research Articles

Comparison of Ultrasound and MRI in Detecting Breast Cancer: A Retrospective Study in Mumbai Hospitals, India

Introduction: Breast cancer is the most common cancer in women throughout the world. Early detection of breast cancer is very important to increase the chances of cure. Ultrasonography (USG) and magnetic resonance imaging (MRI) are two imaging methods commonly used to detect breast cancer. The aim of this study was to compare the accuracy of ultrasound and MRI in detecting breast cancer in female patients at Mumbai Hospital, India.
 Methods: A retrospective study was conducted on 2435 female patients who underwent ultrasound and MRI examinations at Mumbai Hospital, India between 2018 and 2023. Patient data was collected from electronic medical records and analyzed to compare the accuracy of ultrasound and MRI in detecting breast cancer.
 Results: The research results show that MRI is more accurate than ultrasound in detecting breast cancer. MRI sensitivity was 95.2%, while ultrasound sensitivity was 78.3%. The specificity of MRI was 98.7%, while the specificity of USG was 94.3%. The positive predictive value of MRI was 95.2%, while the positive predictive value of USG was 87.5%. The negative predictive value of MRI was 98.7%, while the negative predictive value of USG was 94.3%.
 Conclusion: MRI is recommended as the primary imaging method for detecting breast cancer in female patients. Ultrasound can be used as a complementary method to MRI.

A retrospective analysis of 350 cases of parotid gland tumors and the value of ultrasound in the diagnosis of benign and malignant parotid gland tumors

AbstractObjectiveTo retrospective analysis of the epidemiological and clinical characteristics of parotid gland tumors, and to explore the value of ultrasound in the differentiation of benign and malignant parotid gland tumors.MethodsThe clinical data of 350 patients with parotid gland tumors in our hospital from 2002 to 2022 were retrospectively analyzed. These patients were examined by ultrasound. The postoperative pathological test results were used as the “gold standard” to verify and analyze the value of color Doppler ultrasound in the differential diagnosis of benign and malignant parotid tumors (PT).ResultsThe male‐to‐female ratio of 350 patients with parotid gland tumors was 1.16:1. The age of patients ranged from 12 to 87 years old. Patients aged 40–65 years accounted for 54.6%, which was the most common age of parotid gland tumors. Among 350 cases, 259 were benign and 91 were malignant. The top three benign PTs were pleomorphic adenoma, Warthin tumor, and basal cell adenoma. The top three malignant tumors were mucoepidermoid carcinoma, acinar cell carcinoma, and adenoid cystic carcinoma. The specificity, sensitivity, accuracy, positive predictive value, and negative predictive value of ultrasonography in the diagnosis of benign and malignant parotid masses were 96.53%, 69.23%, 89.43%, 87.50%, and 87.72%, respectively.ConclusionThe pathological types of parotid gland tumors are complex and diverse. Ultrasonography has high accuracy in the diagnosis of PT, which can provide important evidence for the differentiation of benign and malignant PT, and then assist in the clinical selection of individualized surgical programs.

Role of computed tomography in the evaluation of regional metastasis in well-differentiated thyroid cancer.

Accurate neck staging is essential for performing appropriate surgery and avoiding undue morbidity in thyroid cancer. The modality of choice for evaluation is ultrasonography (US), which has limitations, particularly in the central compartment, that can be overcome by adding a computed tomography (CT). A total of 314 nodal levels were analyzed in 43 patients with CT, and US; evaluations were done between January 2013 and November 2015. The images were reviewed by two radiologists independently who were blinded to histopathological outcomes. The sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and accuracy of US, CT, and US + CT were calculated using histology as the gold standard. The overall sensitivity, specificity, PPV, and NPV for US, CT, and US + CT were 53.9%, 88.8%, 74.1%, and 76.4%; 81.2%, 68.0%, 60.1%, and 85.9%; and 84.6%, 66.0%, 59.6%, and 87.8%, respectively. The overall accuracy of the US was 75.80%, the CT scan was 72.93%, and the US + CT scan was 72.93%. For the lateral compartment, the sensitivity, specificity, PPV, and NPV for the US, CT, and US + CT were 56.6%, 91.4%, 77.1%, and 80.5%; 80.7%, 70.6%, 58.3%, and 87.8%; and 84.3%, 68.7%, 57.9%, and 89.6%, respectively. The accuracy of the US was 79.67%, the CT scan was 73.98%, and the US + CT scan was 73.98% for the lateral compartment. For the central compartment, the sensitivity, specificity, PPV, and NPV for the US, CT, and US + CT were 47.1%, 76.5%, 66.7%, and 59.1%; 82.4%, 55.9%, 65.1%, and 76.0%; and 85.3%, 52.9%, 64.4%, and 78.3%, respectively. The accuracy of the US was 61.76%, the CT scan was 69.12%, and the US + CT scan was 69.12% for the central compartment. This study demonstrated that CT has higher sensitivity in detecting nodal metastasis; however, its role is complementary to US due to low specificity.

THE SIGNIFICANCE OF MAGNETIC RESONANCE CHOLANGIOPANCREATOGRAPHY (MRCP) IN THE DETECTION OF SUSPECTED CHOLEDOCHOLITHIASIS.

Background: Magnetic resonance cholangiopancreatography (MRCP) is a radiation-free test that can be performed quickly and does not expose patients to ionizing radiation or iodinated contrast material. The present study is intended to evaluate the role of MRCP in the detection of Common Bile Duct (CBD) stones in patients with suspected choledocholithiasis. Thi Materials and Methods: s prospective study included 64 patients with suspected choledocholithiasis which was based on clinical evaluation and biochemical or ultrasonographic examination. MRCP was done in all patients. All presenting patients underwent open surgery after proper investigation. CBD exploration was performed in all patients, either due to the presence of palpable stones or due to the presence of dilated CBD (≥8 mm). Demonstration of CBD stones intra-operatively was considered the gold standard' for their presence, dened as stones visualized and extracted or attempted for extraction during surgical CBD exploration. Results: Intraoperatively, 45 (70.3%) out of 64 patients had cholelithiasis. 55 (85.93%) out of 64 patients had dilated CBDs. In 43 (67.18%) out of 64 patients, choledocholithiasis was detected intraoperatively. The sensitivity, specicity, and positive and negative predictive value of ultrasonography in detecting CBD stones in the present study were found to be 65.11%, 61.9%, 77.77% and 46.43% respectively. The sensitivity, specicity, positive predictive value and negative predictive value of MRCP in the diagnosis of CBD stones in the present study were 95.35%, 90.47%, 95.35% and 90.48% respectively. MRCP is a non–invasive and uncomplicated investigation w Conclusion: ith high sensitivity, specicity, and positive and negative predictive values for the detection of CBD stones. Hence MRCP is advised in all cases with a suspicion of CBD stones, where facilities and expertise are available.

Ultrasonography performed by an infectiologist in hip and knee prosthetic joint and native joint infections

IntroductionClinical ultrasonography (US) by infectiologists has only recently been developing, and as now there is little literature on the subject. Our study focuses on the conditions and diagnostic performance of clinical ultrasound imaging by infectiologists in cases of hip and knee prosthetic and native joint infection. MethodsA retrospective study carried out between June 1st 2019 and March 31st 2021 in the University Hospital of Bordeaux, South-Western France. We measured US sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV), combined or not with the analysis of articular fluid, compared to the MusculoSketetal Infection Society (MSIS) score in prosthetic joints, or to expert diagnosis in native joints. ResultsFifty-four patients underwent US by an infectiologist in an infectious disease ward, including 11 (20.4%) for native joint and 43 (79.6%) for prosthetic joint. Joint effusion and/or periarticular collection were highlighted in 47 (87%) patients, and US led to 44 punctures. In all patients (n = 54), Se, Sp, PPV and NPV of US alone were 91%, 19%, 64% and 57%, respectively. When US was combined with fluid analysis, Se, Sp, PPV, NPV were 68%, 100%, 100%, 64% in all patients (n = 54), 86%, 100%, 100%, 60% in acute arthritis (n = 17) and 50%, 100%, 100% and 65% respectively in non-acute arthritis (n = 37). ConclusionThese results suggest that US by infectiologists effectively diagnoses osteoarticular infections (OAIs). This approach has many applications in infectiology routines. Consequently, it would be interesting to define the contents of a first level of infectiologist competence in US clinical practice.

Role of Ultrasonography and Conventional Radiography in the Detection of Maxillofacial Fractures: A Comparative Study

Objective: With the collaboration of the trauma department, our study was designed to compare the effectiveness of ultrasonography (USG) and conventional radiography in the detection of bony fractures related to oral and maxillofacial regions.
 Methodology: This comparative study was conducted from March 2020 to March 2021 by the Radiology department of Sarghoda medical college hospital with the collaboration of the trauma department. Ultrasonography was performed by using GE- USG machine along with a linear extraoral transducer (frequency range 7-15 MHZ). Patients were asked to sit in a seated position facing the sinologist. Transducers were placed over the site by applying the sterile gel.
 Results: The overall sensitivity and specificity rate of ultrasonography was reported as 83.33% and 98.88% respectively in all sites whereas the sensitivity and specificity rate of conventional radiographs were reported as 70.24%, 100%. The negative predictive value of USG was reported as 96.17% along with 94.59% positive predictive value. In the contrast, conventional radiography gave a better positive predictive value (100%) than USG In our study we found better results of ultrasonography in terms of sensitivity and negative predictive value.
 Conclusion: In conclusion, our study depicts that ultrasonography is an economical, useful diagnostic tool for examining the bony fractures of facial trauma with a better sensitivity rate when compared to conventional radiographs.

The Accuracy of Shear Wave Elastography in the Assessment of Placental Invasion in Women with Placenta Previa

Background: Placenta accreta spectrum is a term which describes abnormal invasion of the placenta into the uterine myometrium. The first line in diagnosis is ultrasonography and magnetic resonance imaging may complement the diagnosis. Aim: The aim of the work is to assess the accuracy of shear wave elastography in predication of placental invasion in women with placental previa.Materials and Methods: This is a prospective cohort study which was conducted in Ain Shams University on 50 women with a diagnosis of anterior placenta previa and history of previous cesarean section who were pregnant at 32 weeks or more and were planned for delivery by elective cesarean section. They were subjected to ultrasonography and elastography study and the diagnosis of placenta accreta spectrum was confirmed/ excluded intraoperatively.Results: Placental separation was normal in 36% of cases, delayed in 46 % of cases, partial in 6% of cases only whereas non separation occurred in 12% of cases. elastrgraphy had a sensitivity of 73.7%, specificity of 90.3%, positive predicting value of 82.4% and negative predictive value of 84.8% in diagnosing cases with abnormal placental invasion while sensitivity, specificity positive and negative predictive value of ultrasonography in diagnosing abnormal placental invasion was 89.5%, 96.8%, 94.4% and 93.8% respectively.Conclusion: Elastography is sensitive and specific but inferior to ultrasonography in evaluating women with suspected placenta accreta spectrum but it may be useful in diagnosis of focal invasion.

A clinico-pathological study of acute appendicitis with management and the role of ultrasound in diagnosis of appendicitis

Background: Acute appendicitis is the most common cause of acute surgical abdomen and appendicectomy is the most commonly done emergency surgery. Its diagnosis remains an enigmatic challenge, plagued by a high rate of negative explorations. There is no single reliable test with satisfactory, sensitivity and specificity. Aim and Objective: The objective of the study is to evaluate the clinical presentations, signs of acute appendicitis and its management. The role of USG in diagnosing acute appendicitis and reducing the rate of negative appendicectomies. Methodology: The present study was conducted in 100 patients who have been clinically diagnosed of having Acute Appendicitis and posted for emergency appendicectomy in General Surgery, Department of MGM, attached to Kakatiya Medical College, Warangal, during the period from January 2018 to June 2020. Preoperatively blood for WBC count, DC and USG abdomen were done. All patients were subjected to histopathological examination postoperatively which was taken as gold standard. Results of Ultrasound were correlated with HPE reports to evaluate their role in diagnosis of acute appendicitis. Results and Observations: In the present study we had 100 cases of which 61 (61%) were males and 39 (39%) were females. The number of patients was highest in the age group 20 to 29years (33%). Migrating Pain to RIF was found in 76% of patients, Anorexia in 87% of patients. Nausea/vomiting were present in 79% patients. Right iliac fossa tenderness was found in 98% of cases. Rebound tenderness was found in 68% of patients. Fever was present in 45% of cases. Total leucocyte count was elevated in 80% of cases in our present study. Shift to let was seen in 42% cases. In our study all the patients were subjected to abdominal ultrasound examination. The sensitivity and specificity of Ultrasonography for acute appendicitis is 94.8% and 80% respectively. Accuracy was 93%. The positive predictive value and negative predictive value of Ultrasonography for acute appendicitis is 98% and 44% respectively. Negative appendectomy rate in this study 5.5%.The majority (60%) is seen in females. Conclusion: Ultrasound is a fast, simple, reliable, non-invasive, repeatable and safe diagnostic modality without any complications. It has greater sensitivity and positive predictive value in diagnosing acute appendicitis and it reduces the rate of negative appendicectomy.

The Utility of Ultrasonography in the Diagnosis of Cervical Lymph Nodes after Chemoradiotherapy for Head and Neck Squamous Cell Carcinoma.

Background and Objectives: There is evidence or consensus on the use of 18F-2-fluorodeoxyglucose-positron emission tomography with computed tomography (PET-CT) in evaluating the effects of treatment at 12 weeks after chemoradiotherapy for head and neck squamous cell carcinoma with cervical lymph node metastasis. However, the use of imaging to evaluate the effects of treatment within 12 weeks after chemoradiotherapy is controversial. The aim of this study was to evaluate the usefulness of ultrasonography in the diagnosis of lymph nodes metastasis after chemoradiotherapy according to the criteria of the “Evaluation of the effects of treatment on metastatic cervical lymph nodes using ultrasonography”, which evaluated lymph nodes metastasis based on size change and presence of degeneration. Materials and methods: This prospective study included 34 head and neck squamous cell carcinoma patients with cervical lymph nodes metastasis. Thirty-two patients who completed treatment were analyzed. Ultrasonography was performed at 4 and 8 weeks after chemoradiotherapy and we judged whether a favorable prognosis could be expected or whether additional treatments should be considered. Ultrasonography and PET-CT were performed at 12 weeks after chemoradiotherapy. Neck dissection was performed if residual disease was suspected based on the PET-CT findings. Results: The accuracy and negative predictive value of ultrasonography were 81.3% and 96.3%, respectively. According to the Ultrasonography findings, the size of lymph nodes metastasis after chemoradiotherapy was significantly smaller than those before chemoradiotherapy (p < 0.05). The fluid and blood flow of lymph nodes metastasis showed a significantly reduced at 12 weeks after chemoradiotherapy (p < 0.05, p < 0.05, respectively). The echo density significantly changed from low to high echoic density after chemoradiotherapy (p < 0.05). Conclusions: Ultrasonography was useful for evaluating cervical lymph nodes metastasis after chemoradiotherapy for head and neck squamous cell carcinoma.

Ultrasound can differentiate complicated and noncomplicated acute colonic diverticulitis: a prospective comparative study with computed tomography.

To prospectively assess the diagnostic value of intestinal ultrasound (US) compared to computerized tomography (CT) in differentiating uncomplicated and complicated acute colonic diverticulitis (ACD). During a period of 14months patients referred to the department of Radiology with clinical suspicion of ACD underwent an US examination. All confirmed US ACD diagnosis were included and subsequently underwent an emergency abdominal CT, used as gold standard. The WSES (World Society for Emergent Surgery) classification of diverticulitis was used. Diverticulitis was prospectively classified as either uncomplicated or complicated. Sensitivity, specificity, positive predictive value, and negative predictive values of US were evaluated. Before CT scan, the radiologist indicated whether they would have required or not a complementary CT scan, based on US findings. Of the 240 patients included in our study, 71 (29.6%) were Stage 0, 127 (53%) Stage 1A, and 42 (17.5%) were moderate-severe ACD (stages 1B, 2A, 2B, 3 and 4). The sensitivity of US for diagnosing complicated ACD was 84% and specificity of 95.8%. Most patients (24 of 27) misclassified by US as uncomplicated diverticulitis were classified on CT as stage 1A. From the 148 cases in which the radiologist considered CT unnecessary, only 3 of these revealed signs of complicated ACD on CT; none of them required emergency surgery. US is an effective technique to differentiate complicated from uncomplicated ACD. Our results suggest that US, may be a valuable alternative to CT for the initial radiologic evaluation in patients with clinical suspicion of ACD.

A Comparison of the Diagnostic Value of Positron Emission Tomography/Computed Tomography and Ultrasound for the Detection of Metastatic Axillary Nodal Disease in Treatment-Naive Breast Cancer.

The objective of this study was to describe the diagnostic value of positron emission tomography/computed tomography (PET/CT) and ultrasound (US) for identifying metastatic axillary disease in primary breast cancer. This is a retrospective review of 240 patients with treatment-naive unilateral primary breast cancer of at least stage T2. Eighty-five patients met our inclusion criteria. Initial whole-body PET/CT and axillary US examinations were reviewed and compared with the criterion standard of fine-needle aspiration cytology. Sensitivity, accuracy, and positive predictive value (PPV) for each modality were computed. Because of all positive US cases, specificity and negative predictive value of US were not determined. Sensitivity and accuracy between modalities were compared using McNemar test. The majority of the patients were White women with clinical inflammatory breast cancer and with histologically invasive ductal carcinoma. The most common tumor and nodal stage was T4N3. The tumors were predominantly estrogen receptor positive, progesterone receptor negative, and human epidermal growth factor receptor 2 negative. The sensitivities of PET/CT and US were 96.2% and 100%, respectively. The accuracies for PET/CT and US were 91.8% and 94.1%, respectively. The PPV for PET/CT was 95.1%, and for US, the PPV was 94.1%. No significant difference in sensitivity or accuracy was shown between PET/CT and US for the diagnosis of metastatic axillary nodal disease. Three of 85 cases showed discordance between negative PET/CT and positive US and fine-needle aspiration cytology.

Diagnosis of liver tumors by multimodal ultrasound imaging.

To investigate the diagnostic value of multimodal ultrasound imaging composed of conventional ultrasonography (US), contrast-enhanced ultrasonography (CEUS), and shear wave elastography (SWE) for liver tumors.Between October 2017 and October 2019, US, CEUS, and SWE examinations of a total of 158 liver tumors in 136 patients at The First Affiliated Hospital of Nanchang University were performed. The histopathological or imaging diagnostic results were used as controls to evaluate the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of US, CEUS, SWE, and multimodal ultrasound imaging, which combines these 3 modes, in the differential diagnosis of benign and malignant liver tumors.Among the 158 tumors, there were 64 benign tumors, including 55 cases of hepatic hemangioma, 3 cases of focal nodular hyperplasia of the liver, 4 cases of hepatic cyst, and 2 cases of focal nonuniform distribution of fat in the liver. There were 94 malignant tumors, including 32 cases of hepatocellular carcinoma, 22 cases of intrahepatic cholangiocellular carcinoma, 29 cases of metastatic liver cancer, and 11 cases of dysplastic nodules in cirrhotic liver. In the diagnosis of benign and malignant liver tumors, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 82.56%, 68.06%, 75.96%, 75.53%, and 76.56% for US; 92.39%, 86.36%, 89.87%, 90.43%, and 89.06% for CEUS; 87.14%, 76.81%, 82.91%, 82.98%, and 82.81% for SWE; and 97.85%, 95.38%, 96.83%, 96.81%, and 96.88% for multimodal ultrasound imaging, respectively. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were all significantly higher for multimodal ultrasound imaging than those values for US, CEUS, and SWE (all P < .05). The areas under the receiver operating characteristic curve for US, CEUS, SWE, and multimodal ultrasound imaging in the diagnosis of benign and malignant liver tumors were 0.760, 0.897, 0.829, and 0.968, respectively.US, CEUS, and SWE all have diagnostic value in the diagnosis of benign and malignant liver tumors. Multimodal ultrasound imaging could significantly increase the accuracy of the diagnosis of benign and malignant liver tumors and has higher value for clinical application.

Ultrasonic assessment has high sensitivity for pregnant women with previous cesarean section occurring uterine dehiscence and rupture: A STARD-compliant article.

To investigate the diagnostic performance of ultrasound (US) for pregnant women with previous caesarean section (CS) occurring lower uterine segment (LUS) dehiscence and rupture.107 pregnant women with previous CS and LUS thickness of 1.0 mm or less were recruited, the LUS and myometrium was measured, and US findings suggestive of uterine rupture were compared with findings at laparotomy. The included pregnant women were assigned into 2 groups, including 64 pregnant women had vaginal delivery at full-term and 43 pregnant women underwent repeat CS at preterm.US findings suggestive of uterine rupture and dehiscence occurred in 18 women and 89 women, respectively; ten of them developed uterine rupture, and the incidence of uterine rupture was 9.34% (10/107). The sensitivity, specificity, accuracy, positive, and negative predictive values of US for the evaluation of LUS dehiscence and rupture were 100.0%, 91.8%, 92.5%, 55.6%, and 100.0%, respectively. There was no severe maternal obstetric complication, 1 fetus died, and the other fetuses were born with a 5-minute Apgar score of 7 to 10.US has high sensitivity and specificity for pregnant women with previous CS occurring LUS dehiscence and rupture.

Making the diagnosis of midgut volvulus: Limited abdominal ultrasound has changed our clinical practice

PurposeTo assess the diagnostic accuracy of limited abdominal ultrasound (US) examination for midgut volvulus (MGV) and to evaluate how clinical practice has changed in a free-standing children's hospital leading to the near obsolescence of upper GI (UGI) studies for the diagnosis of MGV. Materials and methodsAll patients with suspected MGV who underwent abdominal US during 2016–2017 were identified using keyword search tools in the radiology information system. Retrospective, blinded image review was performed by a certificate of added qualification (CAQ), board certified pediatric radiologist. US images were evaluated for the presence of the superior mesenteric artery (SMA) cutoff sign and twisting of the bowel and mesentery around the SMA (whirlpool sign). The results were compared with the operative reports. Results195 US studies were performed from 2016 to 2017. The most common presentations were vomiting (44%), abdominal pain (7%), and suspected malrotation (10%) 195 US studies were reviewed, of which 16 were nondiagnostic. The remaining 179 diagnostic studies showed MGV in 14 patients. Those 14 patients were surgically explored and confirmed to have midgut volvulus. 7 of the 16 nondiagnostic US studies were further evaluated with UGI examination with 1 patient demonstrating malrotation without volvulus, which was confirmed at surgery. 2 had CT exams which were normal. 4 were followed clinically. The remaining 3 patients went to surgery, all of which did not show MGV. There were 164 negative US, none of whom went to surgery. US was diagnostic in 92% of patients and when diagnostic the positive and negative predictive values of US were 100%. ConclusionLimited abdominal US is a highly accurate examination for the diagnosis of midgut volvulus. UGI exposes patients to ionizing radiation and should be reserved for patients in whom US is nondiagnostic or inconclusive. Type of studyRetrospective review. Level of evidenceLevel 3.

Diagnosis of avulsion fractures of the distal fibula after lateral ankle sprain in children: a diagnostic accuracy study comparing ultrasonography with radiography

BackgroundThe purpose of this study was to determine the diagnostic accuracy of ultrasonography for the diagnosis of avulsion fractures of the distal fibula for lateral ankle sprain in children and compare it to that of radiography.MethodsChildren who sustained lateral ankle sprain were prospectively surveyed. They underwent both ultrasonography and radiography at the first clinic visit to diagnose any concomitant avulsion fractures of the distal fibula. The patients underwent follow-up radiography 4 weeks later to obtain the reference standard diagnosis. The measures of diagnostic accuracy (i.e., sensitivity, specificity, positive predictive value, and negative predictive value) of the initial ultrasonography and radiography were calculated; they were then compared using the McNemar test. Totally, 52 patients (with a median age of 9 years) were analyzed.ResultsOn the reference standard (follow-up) radiographs, 32 patients (62%) were found to have avulsion fractures of the distal fibula. The sensitivity, specificity, positive predictive value, and negative predictive value for ultrasonography were 94, 85, 91, and 89% respectively; and 81, 100, 100, and 77% respectively for radiography at the first visit. There were no significant differences in sensitivity and specificity between the two diagnostic methods (P = 0.22, 0.25).ConclusionsUltrasonography has a high diagnostic accuracy, which is comparable to that of radiography, for the diagnosis of avulsion fracture of the distal fibula. Ultrasonography may be used as an option of imaging modality for lateral ankle sprain in children.

Correlations of neck ultrasound and pathology in cervical lymph node of papillary thyroid carcinoma

Background: High-resolution sonography is becoming a method of choice for the detection and diagnosis of cervical lymph node metastasis in patients with papillary thyroid carcinoma (PTC). The purpose of this study is to assess the diagnostic accuracy of neck ultrasound (US) in the detection of lymph node metastases from PTC.Methods: Data for all patients with papillary thyroid cancers and preoperative neck US were reviewed retrospectively. The diagnostic accuracy of US was determined according to whether histologically confirmed cancer was present in surgical cervical lymph node specimens.Results: A total of 206 patients (149 central and 57 central and lateral lymph nodes dissection) were included. Their mean age was 56 years (14–88 years). Central and lateral lymph nodes were involved in 68% (n = 141 patients; 141/206) and 60% (n = 34 patients; 34/57) of cases, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of US in predicting papillary thyroid carcinoma (PTC) metastasis in the central neck were 69%, 71%, 84% and 51% respectively, and in the lateral neck were 85%, 65%, 78% and 75% respectively.Conclusions: Preoperative neck US is a valuable tool in the detection of cervical lymph node metastases from papillary thyroid cancer and can provide reliable information to assist in surgical management.

Value of Additional Ultrasound Examination in Patients with Equivocal Computed Tomography Findings of Acute Appendicitis: Comparison with Computed Tomography Reassessment.

Objectives:The objective of this study was to find the diagnostic values of additional ultrasound (US) in patients with equivocal computed tomography (CT) findings of acute appendicitis, compared to CT reassessment.Materials and Methods:Patients with equivocal CT findings of acute appendicitis (n = 115), who underwent the US, were included in the study. Two abdominal radiologists reviewed CT scans independently. They analyzed CT findings and made a diagnosis of acute appendicitis. The patients were categorized into positive and negative appendicitis based on the previous US reports. The diagnostic performance, interobserver agreement of CT findings, and appendicitis likelihood were calculated.Results:The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of US (100%, 92.1%, 79.5%, and 100%, respectively) were higher than those of CT reassessment (reviewer 1: 51.9%, 87.5%, 56.1%, and 85.6%; reviewer 2: 66.7%, 85.2%, 58.1%, and 89.3%, respectively). In the coexistent inflammation group, the sensitivity, specificity, PPV, and NPV of US (reviewer 1: 100%, 98%, 91.5%, and 100%; reviewer 2: 100%, 98%, 87.7%, and 100%, respectively) were higher than those of CT reassessment (reviewer 1: 27.3%, 94.1%, 49.9%, and 85.8%; reviewer 2: 14.3%, 98.0%, 50.5%, and 88.9%, respectively).Conclusion:In patients with equivocal CT findings of acute appendicitis, US shows better diagnostic performance than CT reassessment, and helps differentiate with periappendicitis.

Accuracy of ultrasound in verifying endotracheal tube position in neonates

Objective To evaluate the accuracy of ultrasound in verifying endotracheal tube (ETT) position in neonates. Methods Sixty neonates of both sexes, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ , aged 2-28 days, weighing 2.5-4.8 kg, scheduled for urachal fistula/urachal resection or inguinal hernia repair under general anesthesia, were divided into 2 groups (n=30 each) using a random number table method: auscultation group and ultrasound group.Confirmation of ETT position was performed in two stages.In the first stage, misplacement of ETT into esophagus was identified using auscultation and ultrasound techniques after intubation, and end-tidal carbon dioxide pressure was considered as the gold standard for identification of esophageal intubation.In the second stage, misplacement of ETT into bronchus was identified using auscultation and ultrasound after confirming ETT position was within the trachea, and electronic bronchoscope served as the gold standard for identification of bronchial intubation. Results Compared with auscultation group, the accurate rate of identification of bronchial intubation was significantly increased in ultrasound group (P<0.05). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of auscultation for identification of esophageal intubation was 100%, 96.3%, 75% and 100%, respectively.The sensitivity, specificity, PPV and NPV of auscultation for identification of bronchial intubation was 33.3%, 95.8%, 66.7% and 85.2%, respectively.The sensitivity, specificity, PPV and NPV of ultrasound for identification of esophageal or bronchial intubation were all 100%. Conclusion Ultrasound can verify ETT position accurately in neonates. Key words: Ultrasonography; Intubation, intratracheal; Infant, newborn

Real-time Tracheal Ultrasound for the Confirmation of Endotracheal Intubations in the Intensive Care Unit: An Observational Study.

Current methods to confirm endotracheal tube (ETT) placement have varying degrees of effectiveness and time to completion. We aimed to study the accuracy of real-time tracheal ultrasound (US) to confirm ETT placement in the intensive care unit (ICU) setting. This work was a prospective study completed at 2 academic tertiary care centers. Patients in the adult ICU requiring emergent intubation were enrolled in the trial. During the intubation process, a US team performed a tracheal US examination to determine, in real time, whether the ETT was placed into the trachea or the esophagus. A total of 75 patients were enrolled in the study and were available for analysis. There were 12 (16%) esophageal intubations and 63 (84%) tracheal intubations. One hundred percent of the tracheal intubations and 83% of the esophageal intubations were correctly identified. The positive and negative predictive values of US to detect an esophageal intubation were 100% and 97%, respectively. Tracheal US can be highly accurate in identifying the location of the ETT, in real time, in ICU patients undergoing emergent intubation. Although our study shows a great potential of real-time US use during emergent intubations, larger studies would be needed to further evaluate the accuracy of this technique.

US and MRI in the evaluation of mammographic BI-RADS 4 and 5 microcalcifications.

The aim of this study was to assess diagnostic accuracies of ultrasonography (US) and magnetic resonance imaging (MRI) in lesions that manifest as mammographic BI-RADS 4 and 5 microcalcifications, in the setting of conjoined use of mammography, US, and MRI. Patients with mammographic BI-RADS 4 or 5 microcalcifications, without additional findings, were included in this prospective study. All patients subsequently underwent breast US and MRI. Histopathologic diagnosis, obtained by US-guided core-needle biopsy or surgical excision, served as a reference standard. Diagnostic accuracies of US and MRI were calculated, and positive predictive value for different MRI BI-RADS imaging features were determined. The study group consisted of 113 women with 125 areas of suspicious microcalcifications. MRI reached sensitivity, specificity, positive predictive value 3 (PPV3), and negative predictive value (NPV) of 100%, 70.1%, 67.6%, and 100%, respectively. Statistically significant differences in MRI morphologic features and kinetic enhancement curves were observed between malignant and benign microcalcifications. Sensitivity, specificity, PPV3, and NPV for US were: 85.4%, 66.2%, 61.2%, and 87.9%. There was statistically significant difference in presentation of malignant and benign microcalcifications at US. In the setting of conjoined use of mammography, US, and MRI, MRI can reliably exclude malignancy in suspicious microcalcifications. Thus, negative MRI findings may influence the decision to biopsy the microcalcifications.