Preoperative Ultrasonography Research Articles

Acute Appendicitis in Children: Evaluation of the Diagnostic Efficacy of Ultrasonography and Computed Tomography.

Acute appendicitis (AA), the most common cause of acute abdomen in childhood, can result in significant morbidity and mortality if not diagnosed and treated in a timely manner. Diagnosis of AA is more difficult in children due to the limited communication skills, in comparison to adults. The aim of this study is to evaluate the diagnostic accuracy of abdominal ultrasonography (US) and computed tomography (CT) in the diagnosis of AA in children. Pediatric patients who were operated on with the diagnosis of AA between January 2016 and December 2021 were retrospectively reviewed. Preoperative abdominal US and CT findings of the patients and postoperative pathology results were recorded. A total of 263 patients with a mean age of 11.3 years were included in the study. There were 164 (62.3%) males and 99 (37.7%) females. Histopathology revealed AA in 215 (81.7%) patients. Preoperatively, US and CT were performed in 139 (52.8%) and 137 (54.5%), respectively. Both imaging methods were applied to 13 (5.1%) patients. US had a sensitivity and specificity rate of 77.2% and 52.6%, respectively. Positive predictive value (PPV) was found to be 81.2%, whereas negative predictive value (NPV) was 46.5% for US. The diagnostic accuracy rate of US was found as 70.5%. CT had a sensitivity and specificity rate of 88.1% and 57.1%, respectively.PPV was found to be 88.8%, whereas NPV was 55.1% for CT. The diagnostic accuracy rate of CT was found as 81.8%. In case of suspicion of AA, US may be the first choice because it is inexpensiveand easily accessible. However, considering patient incompatibility and subjective factors in children, US may sometimes be insufficient. We think that CT should be performed as an advanced examination method in cases where US is not compatible with the patient's condition, not clinic.

Spontaneous recovery of underlying bony erosion following surgical removal of craniofacial dermoid cysts in periatric patients: A prospective study

This study aimed to evaluate the spontaneous recovery of bone deformity after surgical excision of craniofacial dermoid cysts in pediatrics.Pediatric patients who underwent excision of a dermoid cyst were included in the study. A prospective analysis was conducted to evaluate the amount of bone recovery by comparing the depth of bony concavity in the preoperative and postoperative (6 months) ultrasonography.In 145 of 187 patients with preoperative imaging available, the mean size of dermoid cysts was 1.4 cm3 (range, 0.1 to 9.5), and 41.4% (60/145 cases) showed cranial bone depression. In the comparison of preoperative and postoperative ultrasonography of 30 patients, the mean depth of bony cavity decreased significantly from 4.0 to 0.9 mm (p<0.001) after a mean of 6.7 months postoperatively. There was 13.3% (4/30) of mild (≤2.0 mm), 40.0% (12/30) of moderate (>2.0 to ≤4.0 mm), and 46.7% (14/30) of severe (>4.0 mm) depression, and the concavity depth significantly decreased in all groups (p = 0.028, mild; p<0.001, moderate; p<0.001 severe).Within the limitations of the study it seems that significant recovery of cranial bone depression does take place within 6 months after excision of craniofacial dermoid cysts in pediatric patients, saving the need for immediate reconstruction.

Deep learning radiopathomics based on preoperative US images and biopsy whole slide images can distinguish between luminal and non-luminal tumors in early-stage breast cancers.

For patients with early-stage breast cancers, neoadjuvant treatment is recommended for non-luminal tumors instead of luminal tumors. Preoperative distinguish between luminal and non-luminal cancers at early stages will facilitate treatment decisions making. However, the molecular immunohistochemical subtypes based on biopsy specimens are not always consistent with final results based on surgical specimens due to the high intra-tumoral heterogeneity. Given that, we aimed to develop and validate a deep learning radiopathomics (DLRP) model to preoperatively distinguish between luminal and non-luminal breast cancers at early stages based on preoperative ultrasound (US) images, and hematoxylin and eosin (H&E)-stained biopsy slides. This multicentre study included three cohorts from a prospective study conducted by our team and registered on the Chinese Clinical Trial Registry (ChiCTR1900027497). Between January 2019 and August 2021, 1809 US images and 603H&E-stained whole slide images (WSIs) from 603 patients with early-stage breast cancers were obtained. A Resnet18 model pre-trained on ImageNet and a multi-instance learning based attention model were used to extract the features of US and WSIs, respectively. An US-guided Co-Attention module (UCA) was designed for feature fusion of US and WSIs. The DLRP model was constructed based on these three feature sets including deep learning US feature, deep learning WSIs feature and UCA-fused feature from a training cohort (1467 US images and 489 WSIs from 489 patients). The DLRP model's diagnostic performance was validated in an internal validation cohort (342 US images and 114 WSIs from 114 patients) and an external test cohort (279 US images and 90 WSIs from 90 patients). We also compared diagnostic efficacy of the DLRP model with that of deep learning radiomics model and deep learning pathomics model in the external test cohort. The DLRP yielded high performance with area under the curve (AUC) values of 0.929 (95% CI 0.865-0.968) in the internal validation cohort, and 0.900 (95% CI 0.816-0.953) in the external test cohort. The DLRP also outperformed deep learning radiomics model based on US images only (AUC 0.815 [0.719-0.889], p<0.027) and deep learning pathomics model based on WSIs only (AUC 0.802 [0.704-0.878], p<0.013) in the external test cohort. The DLRP can effectively distinguish between luminal and non-luminal breast cancers at early stages before surgery based on pretherapeutic US images and biopsy H&E-stained WSIs, providing a tool to facilitate treatment decision making in early-stage breast cancers. Natural Science Foundation of Guangdong Province (No. 2023A1515011564), and National Natural Science Foundation of China (No. 91959127; No. 81971631).

Preoperative US Integrated Random Forest Model for Predicting Delphian Lymph Node Metastasis in Patients with Papillary Thyroid Cancer.

Delphian lymph node (DLN) has been considered to be a gate that predicts widespread lymph node involvement, higher recurrence and mortality rates of head and neck cancer. This study aimed to establish a preoperative ultrasonography integrated machine learning prediction model to predict Delphian lymph node metastasis (DLNM) in patients with diagnosed papillary thyroid carcinoma (PTC). Ultrasonographic and clinicopathologic variables of PTC patients from 2014 to 2021 were retrospectively analyzed. The risk factors associated with DLNM were identified and validated through a developed random forest (RF) algorithm model based on machine learning and a logistic regression (LR) model. A total of 316 patients with 402 thyroid lesions were enrolled for the training dataset and 280 patients with 341 lesions for the validation dataset, with 170 (28.52%) patients developed DLNM. The elastography score of ultrasonography, central lymph node metastasis, lateral lymph node metastasis, and serum calcitonin were predictive factors for DLNM in both models. The RF model has better predictive performance in the training dataset and validation dataset (AUC: 0.957 vs. 0.890) than that in the LR model (AUC: 0.908 vs. 0.833). The preoperative ultrasonography integrated RF model constructed in this study could accurately predict DLNM in PTC patients, which may provide clinicians with more personalized clinical decision-making recommendations preoperatively. Machine learning technology has the potential to improve the development of DLNM prediction models in PTC patients.

Evaluation of the Preoperative Slide Test in the Prediction of Intra-Abdominal Adhesions: A Single-Center, Double-Blinded, Prospective Observational Study.

To evaluate the efficacy of the preoperative ultrasonographic sliding sign in predicting intra-abdominal adhesions. This was a single-center, double-blinded, prospective observational study undertaken from March and September 2021 on 110 patients with a history of previous abdominal surgery. All patients who were scheduled for laparoscopy underwent slide test in 5 zones of abdomen: right lower quadrant, left lower quadrant, previous operation site, vesicouterine pouch, and rectovaginal pouch. Adhesions were assessed by the same gynecologic surgeon using ultrasonography before the surgery and by gynecological surgeons during surgery, and by a third gynecologic surgeon to compare the preoperative slide test findings and laparoscopic findings after the surgery. Seventy-three (66.4%) patients underwent laparoscopic surgery, and 37 (33.6%) patients underwent laparotomy. The mean age of patients was 46.9 ± 1.0years. Sensitivity, specificity, and positive and negative predictive values of preoperative ultrasonography in predicting adhesions were 89.5%, 91.7%, 97.5%, and 71.0%, respectively. The accuracy of the slide test was calculated as 90.0%. It was found that as the total number of cesarean sections increased the estimates of vesicouterine adhesions and actual adhesions increased (P = .008). Also, the prediction of intra-abdominal adhesions and actual adhesions significantly increased as the total number of surgical operations increased (P = .002). Intra-abdominal adhesions can be detected with the slide test, which is a non-invasive and well-tolerated procedure. Slide test can guide the physician before the elective operation in patients with previous abdominal surgery and may assist in counseling patients.

Allium ureteral stent for the treatment of malignant ureteral obstruction: A median term study.

This study aimed to assess the safety and efficacy of Allium ureteral stents for the maintenance therapy of malignant ureteral obstruction (MUO). Clinical data of 25 patients (27 sides) with ureteral obstruction caused by a malignant tumor from December 2018 to December 2021 were retrospectively analyzed. Preoperative ultrasonography and computed tomography urography indicated hydronephrosis and MUO. Allium ureteral stents were placed using a retrograde or antegrade approach. Therapeutic effects and complications were recorded. The Wilcoxon signed-rank test was used to compare continuous variables between the preoperative and the last follow-up. A total of 25 patients (27 sides) were included in this study. After a follow-up time of 18 (11-29) months, the width of hydronephrosis [1.6 (1.0-2.2) cm vs 2.6 (1.2-3.3) cm, P = .000], glomerular filtration rate [83.8 (58.1-86.4) mL/minutes/1.73 m2 vs 74.5 (56.8-79.1) mL/minutes/1.73 m2, P = .001] and score of ureteral stent symptoms questionnaire [77 (76-79) vs 100 (98-103), P = .000] was significantly improved. Stent migration occurred in 3 of the 25 patients within 3 months after surgery. All patients with complications were followed up for at least 6 months after stent adjustment or exchange, and no other complications were found. Two patients died because of malignant complications. The stent patency rate was 88.9% (24/27) after the first operation, and 100% (27/27) after complications were treated. The Allium ureteral stent is safe and effective for the maintenance therapy of MUO, which can dramatically relieve the symptoms of patients. Stent migration is a major complication that can be resolved by endoscopic adjustment.

Modified classifications and surgical decision-making process for chronic anterior talofibular ligament injuries based on the correlation of imaging studies and arthroscopic findings.

Surgical treatment of chronic ankle instability (CAI) typically includes ligament repair or reconstruction. Using preoperative ultrasonography or magnetic resonance imaging (MRI) to choose an appropriate arthroscopic procedure is still difficult. The aim of this study was to evaluate the correlation of imaging studies with arthroscopic findings and support the arthroscopic surgical decision-making process. One hundred twelve patients with chronic anterior talofibular ligament (ATFL) injuries were treated using the arthroscopic surgical decision-making process from November 2018 to August 2020. Preoperative imaging assessments using dynamic ultrasonography, MRI, and combined methods were applied to categorize the ATFL remnants into three quality grades ("good," "fair," and "poor"). Arthroscopic findings were classified into 6 major types (7 subtypes) and used to select an appropriate surgical procedure. Correlations between imaging studies, arthroscopic findings, and surgical methods were evaluated. Diagnostic parameters, clinical outcomes, and complications were also assessed. There was a significant interobserver agreement in the evaluation of dynamic ultrasonography (0.954, P < 0.001), MRI (0.958, P < 0.001), and arthroscopy diagnosis (0.978, P < 0.001). There was a significant correlation between the modified imaging classifications, arthroscopic diagnostic types, and surgical procedures. The mean follow-up period was 33.58 ± 8.85 months. Significant improvements were documented in postoperative ankle functions when assessed with Karlson-Peterson scores and Cumberland Ankle Instability Tool scores. The risk of complications is also very low. The modified classifications and surgical decision-making process based on dynamic ultrasonography, MRI, and arthroscopic findings, as proposed in this study, might help in selecting an appropriate arthroscopic surgical procedure for chronic ATFL injuries.

Popliteal artery injury following total knee arthroplasty due to a very rare variant of the popliteal artery: A case report of an unusual complication.

Variations of the popliteal artery are uncommon but often associated with popliteal artery injuries. Thus, in cases of popliteal artery injury, popliteal artery variations should be one of the primary differential diagnoses. Due to the poor prognosis that may result in amputation or mortality, such injuries are serious complications that can lead to medical malpractice cases. This report presents a case of a 77-year-old woman with bilateral knee osteoarthritis who sustained a popliteal artery injury during total knee arthroplasty due to the highly uncommon type II-C popliteal artery variation. In light of the current literature, the pathology, diagnosis, and treatment of this case of popliteal artery injury, as well as the necessary precautions, have been discussed. The terminal branching pattern of the popliteal artery is essential for surgical planning and the ability to treat accidental artery injuries. To reduce the risk of popliteal artery injury, it is important to discuss the need for preoperative arterial color Doppler ultrasonography and magnetic resonance imaging to reveal the branching pattern and structure (arteriosclerosis and obstruction) of the popliteal artery (arteriosclerosis and obstruction).

Can we skip technetium-99 m sestamibi scintigraphy in pediatric primary hyperparathyroidism patients with positive neck ultrasound results?

Parathyroidectomy is the only curative treatment for primary hyperparathyroidism (PHPT). Ultrasound (US) and technetium-99 m sestamibi (99mTc-MIBI) scintigraphy are recommended as the first-line localization imaging modalities for PHPT in adults, but the value of preoperative imaging in pediatric patients has not been reported. To evaluate the added value of 99mTc-MIBI scintigraphy in pediatric PHPT patients with positive ultrasound results. Pediatric patients (≤18years old) who were diagnosed with PHPT and underwent surgical treatment in Peking Union Medical College Hospital between January 2003 and January 2021 were included in this study. Demographic and clinical characteristics, preoperative localization US, 99mTc-MIBI scintigraphy and pathology results were collected. Preoperative localization results were evaluated by comparison with surgical and pathological findings. There were 32 pediatric PHPT patients with median age of 14.7 ± 2.5years who all proved to have single-gland disease without ectopic lesions. The median lesion size was 2.85cm (range 1.0-5.8cm). All patients underwent US and 99mTc-MIBI scintigraphy. Neck US demonstrated 100% sensitivity. Of 32 patients with a positive US, 99mTc-MIBI scintigraphy was concordant in 30 (93.8%). In 2 patients (6.3%), US reported suspected multigland disease, which was correctly diagnosed by 99mTc-MIBI scintigraphy as single lesions. In pediatric PHPT patients, US achieved high sensitivity for preoperative localization. 99mTc-MIBI scintigraphy for pediatric patients with positive US results would not increase the sensitivity. Implementation of 99mTc-MIBI scintigraphy could increase the specificity in pediatric patients with multigland disease suspected by US.

PREDICTION OF DIFFICULT LAPAROSCOPIC CHOLECYSTECTOMY BASED ON ULTRASONOGRAPHIC FINDINGS

Objectives: The objective of the study is to the role of pre-operative ultrasonography (USG) abdomen to find difficulty in laparoscopic cholecystectomy. Methods: It was a prospective observational study conducted in the Department of General Surgery, Government Medical College, Kottayam, for a period of 12 months after obtaining approval from the Institutional Review Board and Ethical Committee. A total of 94 patients who underwent elective laparoscopic cholecystectomy were randomly allotted and their pre-operative ultrasound was assessed. Pre-operative predictability of difficult laparoscopic cholecystectomy based on USG was studied. Results: Out of 78 difficult laparoscopic cholecystectomies, 71 cases were predicted to have intra-operative difficulty with pre-operative ultrasound as per total time taken for surgery. Out of these 78 difficult cases, 68 cases were able to predict as per difficulty in dissecting GB from GB fossa. This gives a positive predictive value of 91%, which is in agreement with earlier studies. Conversion rate in our study was 9.6% of total and 11.5% of difficult cases. Those cases that were predicted pre-operatively with ultrasound to be easy were never converted to open. Conclusion: Pre-operative USG can be used as a screening method for laparoscopic cholecystectomy as this is a valuable predictor of difficulty in laparoscopic cholecystectomy in most of the cases. It will help the surgeon to make an idea of potential difficulty that he/she can face during the intra-operative period. The most valuable assessment using the ultrasound is the gall bladder wall thickness, gall bladder contracted or not, common bile duct diameter, and stones impacted in the neck of GB.

The incidence and risk factors of occult malignancy in patients receiving vaginal hysterectomy for pelvic organ prolapse.

The aim of this study was to assess the incidence and risk factors for premalignant and malignant pathology in patients receiving vaginal hysterectomy (VH) and pelvic floor repair (PFR) for pelvic organ prolapse (POP). We performed a retrospective cohort study of pathological results after VH and PFR of 569 women at our institution from January 2011 through December 2020. Age, body mass index (BMI), POP-Q stage, and preoperative ultrasound results were evaluated as risk factors for occult malignancy. Six of the 569 patients (1.1%) had unanticipated premalignant uterine pathology and 2 (0.4%) had unanticipated malignant uterine pathology (endometrial cancer). There was no significant difference in the incidence of premalignant or malignant uterine pathology according to age, BMI, and POP-Q stage. However, if endometrial pathology is confirmed on preoperative ultrasonography, the probability of confirming malignant pathology increases (OR 4.63; 95% CI 1.84-51.4; p=0.016). The incidence of occult malignancy during VH for POP was significantly lower than that found in hysterectomy owing to benign disease. In the case of POP patients, for whom uterine-conserving surgery is not absolutely contraindicated, it can be performed. However, if endometrial pathology is confirmed by preoperative ultrasonography, uterine-conserving surgery is not recommended.

An association between gastric contents and gastric volume with gender and comorbidities: An observational study

Abstract Background and Aims: The data regarding fasting gastric contents and gastric volume in patients with comorbidity are lacking. The present study was conducted to determine an association between gender and comorbidities with gastric contents and gastric volume determined by ultrasonography in 8 h fasting patients. It was hypothesized that there is no association between gastric contents and gastric volume with gender and comorbidities. Materials and Methods: The present cross-sectional observational study was conducted in patients aged between 18 and 60 years posted for elective surgery. The patients were advised to overnight fast for a minimum of 8 h. Preoperative bedside ultrasonography was done in the right lateral decubitus position. According to the appearance on the ultrasound, the contents were identified as either empty, clear liquids, or solids. Antral cross-section area was measured and gastric volume was estimated. Statistical Package for Social Sciences for Windows, version 22, was used for analysis. Comparison of the distribution of categorical variables was done using the Chi-square test/Fisher’s exact test. Comparison of parametric and nonparametric continuous variables was done using unpaired t-test and Kruskal–Wallis test, respectively. Results: The mean gastric volume among males and females was 64.8 mL and 64.2 mL, respectively (P = 0.896). The median gastric volume and the median gastric volume in mL/kg were significantly higher in patients who had chronic kidney disease (4.53 mL/kg and 125.5 mL) as compared to other comorbidities such as diabetes mellitus (1.88 mL/kg and 52.3 mL), hypertension (2.05 mL/kg and 53.9 mL), hypothyroidism (1.69 mL/kg and 48.9 mL), and obesity (2.18 mL/kg and 65.6 mL). The percentage of patients who had no gastric content was significantly higher in males as compared to females. There was no statistically significant difference in the type of gastric contents and comorbidities. Conclusions: There was an association between gastric volume and comorbidities, but there was no association between gastric contents and comorbidities. There was an association between gastric contents and gender, but there was an association between gastric volume and gender.

PREOPERATIVE ULTRASOUND-GUIDED INFERIOR VENA CAVA COLLAPSIBILITY INDEX AS A GUIDE TO PREDICT HYPOTENSION FOLLOWING SPINAL ANESTHESIA

Objective: Post-spinal hypotension is a commonly encountered complication following spinal anesthesia. However, there is a dearth of a concrete tool to predict spinal-induced hypotension (SIH) and differentiate the cohort of patients requiring fluid boluses versus vasopressors to correct it. Thus, we aimed to determine the prognostic efficacy of ultrasonographic assessment of inferior vena caval collapsibility index (IVC-CI) to predict hypotension following spinal anesthesia and compare the requirements of crystalloids and Mephentermine among patients with IVC-Collapsibility Index &gt;50% and &lt;50%. Methods: This observational study was conducted in the Department of Anesthesiology, Government Medical College, Kottayam. Preoperative IVC Ultrasonography was performed in 74 patients of ASA Grade 1–2 scheduled for elective surgery under spinal anesthesia and their IVC-CI was determined. Spinal anesthesia procedure protocol was standardized. Mean arterial pressure, intravenous fluids, and mephentermine requirements were documented in both IVC-CI groups. Results: There was no significant difference in the demographics or pre-operative vital signs between the two groups. Significant hypotension was seen in 51.4% of patients. 97% of patients with IVC-CI&gt;50% had significant hypotension, p=0.000. IVCCI&gt;50% is 97.2% specific and 84.2% sensitive in predicting SIH with a positive predictive value of 96.97% and negative predictive value of 85.37%. Significantly, high requirement of intravenous fluids and mephentermine was noted among IVC-CI&gt;50% group, p=0.000 and 0.026, respectively. Conclusion: USG-guided IVC-CI is an easy to perform, non-invasive, time-efficient, and readily available technique to assess fluid responsiveness. Patients with IVC-CI&gt;50% are more likely to develop SIH. Furthermore, the requirement of vasopressors and IV fluids increases with IVC-CI&gt;50%. USG-guided IVC-CI is a reliable predictor of SIH.

The sonographic features of preoperative ultrasonography of metastatic tumors of thyroid cancer confirmed by surgical pathology

Abstract. This study aimed to analyze the sonographic features of metastatic tumorsin patients with thyroid cancer that underwent preoperative ultrasonogra-phy. One hundred and three thyroid cancer patients whose metastases were con-firmed by surgical pathology in The First People’s Hospital of Wenling from January 2020 toDecember 2021 were enrolled. All patients received preoperative ultra-soundexaminations, and the sonographic features were analyzed. Ultrasound ex-aminationshowed 83.50% of cervical lymph node metastasis (CLNM), 24.27% of soft tissueinvasion (STI), 3.88% of distant organ metastasis (DOM), 8.74% of CLNM + STI, 0.97% of CLNM + DOM, and 0.97% of CLNM + STI+DOM. Unilateral CLNM accounted for 72.09%, while bilateral CLNM accounted for 27.91%. The mean longdiameter of metastatic lymph nodes was (1.83±0.63) cm, and the mean short di-ameterwas (1.03±0.42) cm. Metastases to zone II, III, IV, V, VI, and VII accounted for 8.14%, 48.84%, 23.26%, 4.65%, 11.63%, and 3.49%, respectively. The L/T ratio of lymph nodes in 65 cases was lower than 2; 45 of 70 solid metastases exhibited solidhyperechoic, 15 multifocal hyperechoic, seven unifocal hyperechoic, and three diffusely distributed solid hyperechoic images. There were 25 patients with STI thatexperienced invasion of the thyroid capsule, ten patients experienced the invasion of the cervical fatty muscles, two patients had invasion of the trachea, and one pa-tienthad invasion of the thyroid cartilage. Of the four patients with DOM, one had parotidmetastasis, one had submandibular metastasis, one had axillary metastasis, and onehad uterine metastasis. The most common metastatic sites of thyroid can-cer arecervical lymph nodes. However, there were also metastases in the soft tissues anddistant organs. The ultrasonography exhibited typical sonographic features. An adequate familiarity with these sonographic features can aid in detecting suspiciousmetastases in time, which is crucial to the clinical diagnosis, treatment, and prog-nosticassessment.

Preoperative parathyroid localization. Relevance of MIBI SPECT-CT in adverse scenarios

PurposeSelective parathyroidectomy, the treatment of choice for primary hyperparathyroidism, requires precise preoperative localization. Our purpose was to compare the accuracy and concordance of pre-surgical MIBI parathyroid scintigraphy and ultrasonography, as well as to assess the relevance of hybrid acquisition (SPECT/CT) in compromised circumstances: low-weight or ectopic adenomas, coexisting thyroid disease and re-interventions. MethodsThe study included 223 patients with primary hyperparathyroidism operated in a single Surgical Unit from August 2016 to March 2021. Preoperative ultrasonography and double-phase MIBI were performed with early SPECT/CT acquisition. A minimally invasive surgical approach was initially attempted, except in patients with concomitant thyroid surgery or multiglandular parathyroid disease. ResultsSelective parathyroidectomy was accomplished in 179 patients (80.2%); cervicotomy and/or thoracoscopy in 44. Removal of the parathyroid lesion was achieved in 211 patients (94.6%), corresponding 204 (96.7%) to adenomas (37 ectopic). The cure rate was 94.2%. Preoperative MIBI SPECT/CT showed higher sensitivity and accuracy (84%; 80%) compared to ultrasound (72%; 71%), being more precise in defining the exact anatomical location (75.8% vs 68.7%). These differences reached statistical significance in ectopic glands. The existence of concomitant thyroid pathology did not decrease the sensitivity of SPECT/CT (84.2%). Mean parathyroid weight was 692.2mg (95%CI: 443.5-941) in MIBI-negative cases and 1145.9mg (95%CI: 983.6-1308.3) in MIBI-positive (p=0.001). Re-intervention was successful in the 8 patients with previous surgery. ConclusionMIBI SPECT/CT presents greater sensitivity, accuracy and anatomical precision than ultrasound for preoperative parathyroid localization, even in the case of ectopic glands or coexisting thyroid pathology. The weight of the pathological gland is a significantly limiting factor.

Correlation Between Preoperative Ultrasonography and Parkland Grading Scale in Patients Undergoing Laparoscopic Cholecystectomy

Correlation Between Preoperative Ultrasonography and Parkland Grading Scale in Patients Undergoing Laparoscopic Cholecystectomy

(101) Ultrasonography and Magnetic Resonance Imaging are Accurate for Suspected Penile Fracture

Abstract Introduction Penile fracture (PF) is a rare but potentially catastrophic injury due to the risk of erectile dysfunction (ED) and penile curvature in young, sexually active men. The diagnosis is commonly made by clinical examination only but may be inaccurate in 15% of men. Despite this, penile ultrasound (US) and magnetic resonance imaging (MRI) remains poorly utilised. Objective This study aims to correlate for the first time imaging suggestive of PF with intraoperative findings as the gold standard comparator in order to calculate the sensitivity and specificity as accurately as possible. Methods Retrospective analysis (electronic and paper records) of all men referred for imaging querying penile fracture over ten years at a single centre (January 2010 - December 2020). All men with suspected PF on US and/or MRI were included. Same day MRI was performed in equivocal cases or to further define the extent of injury. Imaging findings were correlated with intraoperative findings. Results 114 men underwent surgical exploration for PF over 10 years with a median age of 39 years (range 16-74). Pre-existing ED was reported in 9 men and 6 men reported pre-existing Peyronie’s disease. Most men had a pre-operative doppler US (92.6%, n=112) with subsequent MRI in 13 men (11.6%). Two men were surgically explored after MRI only. Table 1 summarises the strong correlation between imaging and intraoperative findings. PF was not identified on US in 8 men (7.1%). MRI upgraded equivocal US findings to PF or showed a greater extent of injury in 76.5% (n=13). All PF were identified on MRI but there was a single false positive where PF was not found on exploration. MRI may have been confounded by Peyronie’s plaque calcification. Urethral injury was identified in 24 men intraoperatively but US only identified 10 with a further 4 identified on subsequent MRI. Conclusions Penile US has a high sensitivity and PPV for PF when compared to the gold standard of intraoperative findings. MRI has excellent specificity for both PF and urethral injury and should be considered in equivocal cases. The combination of US and MRI is useful to avoid unnecessary surgery and can characterise complex/atypical injuries to guide choice of incision and surgical planning. Imaging should be routinely offered to all men prior to surgical exploration. Disclosure No

AIUM Practice Parameter for the Performance and Interpretation of Diagnostic Ultrasound of the Thyroid and Extracranial Head and Neck.

AIUM Practice Parameter for the Performance and Interpretation of Diagnostic Ultrasound of the Thyroid and Extracranial Head and Neck.

Comparative Effectiveness of MRI, 4D-CT and Ultrasonography in Patients with Secondary Hyperparathyroidism.

Accurate preoperative localization of abnormal parathyroid glands is crucial for successful surgical management of secondary hyperparathyroidism (SHPT). This study was conducted to compare the effectiveness of preoperative MRI, 4D-CT, and ultrasonography (US) in localizing parathyroid lesions in patients with SHPT. We performed a retrospective review of prospectively collected data from a tertiary-care hospital and identified 52 patients who received preoperative MRI and/or 4D-CT and/or US and/or 99mTc-MIBI and subsequently underwent surgery for SHPT between May 2013 and March 2020. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of each imaging modality to accurately detect enlarged parathyroid glands were determined using histopathology as the criterion standard with confirmation using the postoperative biochemical response. A total of 198 lesions were identified intraoperatively among the 52 patients included in this investigation. MRI outperformed 4D-CT and US in terms of sensitivity (P < 0.01), specificity (P = 0.455), PPV (P = 0.753), and NPV (P = 0.185). The sensitivity and specificity for MRI, 4D-CT, and US were 90.91%, 88.95%, and 66.23% and 58.33%, 63.64%, and 50.00%, respectively. The PPV of combined MRI and 4D-CT (96.52%) was the highest among the combined 2 modalities. The smallest diameterof the parathyroid gland precisely localized by MRI was 8×3 mm, 5×5 mm by 4D-CT, and 5×3 mm by US. MRI has superior diagnostic performance compared with other modalities as a first-line imaging study for patients undergoing renal hyperparathyroidism, especially for ectopic or small parathyroid lesions. We suggest performing US first for diagnosis and then MRI to make a precise localization, and MRI proved to be very helpful in achieving a high success rate in the surgical treatment of renal hyperparathyroidism in our own experience.

Combining primary tumor features derived from conventional and contrast-enhanced ultrasound facilitates the prediction of positive axillary lymph nodes in Breast Imaging Reporting and Data System category 4 malignant breast lesions.

To determine whether the primary tumor features derived from conventional ultrasound (US) and contrast-enhanced US (CEUS) facilitate the prediction of positive axillary lymph nodes (ALNs) in breast cancer diagnosed as Breast Imaging Reporting and Data System (BI-RADS) category 4. A total of 240 women with breast cancer who underwent preoperative conventional US, strain elastography, and CEUS between September 2016 and December 2019 were included. The multiple parameters of the primary tumor were obtained, and univariate and multivariate analyses were performed to predict positive ALNs. Then three prediction models (conventional US features, CEUS features, and the combined features) were developed, and the diagnostic performance was evaluated with receiver operating characteristic curves. On conventional US, the traits of large size and the non-circumscribed margin of the primary tumor were marked as two independent predictors. On CEUS, the features of vessel perforation or distortion and the enhanced range of the primary tumor were marked as two independent predictors for positive ALNs. Three prediction models were then developed: model A (conventional US features), model B (CEUS features), and model C (model A plus B). Model C yielded the highest area under the curve (AUC) of 0.82 [95% confidence interval (CI), 0.75-0.88] compared with model A (AUC 0.74; 95% CI, 0.68-0.81; P = 0.008) and model B (AUC 0.72; 95% CI, 0.65-0.80; P < 0.001) as per the DeLong test. CEUS, as a non-invasive examination technique, can be used to predict ALN metastasis. Combining conventional US and CEUS may produce favorable predictive accuracy for positive ALNs in BI-RADS category 4 breast cancer.