Sensitivity Of Ultrasonography Research Articles

Ultracompact twisted silica taper for 20 kHz to 94 MHz ultrasound sensing.

An ultracompact twisted silica taper with an asymmetric structure is fabricated by fire-drawing two twisted single-mode fibers for broadband ultrasound sensing. A piezoelectric transducer (PZT), peaked at 3.7 MHz, is used as an ultrasound generator. A steel plate with a silica taper attached is adhered to the PZT and is used as the ultrasound propagation medium. The transmission spectrum of the silica taper has high contrast owing to multimode interference in this twisted silica structure. Specially, the taper waist length and waist diameter are optimized for the highest optical sensitivity with high contrast at high slope in the transmission spectrum. The ultrasound sensitivity is characterized by a different thickness of the steel plate from 0 to 2.36 mm to achieve the highest ultrasound frequency response. With the taper waist length of 5 mm, waist diameter of 5 µm, and steel thickness of 0 mm, a broadband ultrasound frequency of 20 kHz to 94.4 MHz can be detected at high harmonics of the PZT, verifying the high sensitivity of the compact twisted silica taper.

Breast cancer during pregnancy: matched study of diagnostic approach, tumor characteristics, and prognostic factors.

Breast cancer is one of the most frequently occurring cancers during pregnancy and its incidence is increasing. Many studies have shown poor outcomes, the causes of which remain unclear. To analyze radiologic characteristics, histology, and prognosis factors of breast cancer during pregnancy. A total of 42 patients with breast cancer diagnosed during pregnancy (BCP) were matched with 84 patients with breast cancer of similar age who were not pregnant. Sensitivity of radiology, tumor characteristics, prognosis factors, disease-free survival, and overall survival were analyzed. The sensitivity of breast ultrasound was higher than that of mammography for both groups. Ultrasound sensitivity for cancer was 95.7% in patients with BCP versus 98% in the not pregnant group, with non-statistically significant differences. Mammography sensitivity for cancer was 56.5% in patients with BCP versus 61% in the not pregnant group, with non-statistically significant differences. The stage at diagnosis according to the TNM staging system was significantly higher in patients with BCP with stage IV cancer: 16.7% in patients with BCP versus 3.7% in the not pregnant group (p = 0.03). No statistically significant differences were observed in histologic grade, Ki-67 index, or molecular subtype. Disease-free survival and overall survival were significantly lower in patients with BCP (p = 0.002 and p = 0.04). Multivariate analysis showed no difference when adjusting for stage and surrogate molecular subtype. Breast ultrasound shows a high sensitivity to detect breast cancer during pregnancy. BCP is diagnosed at a higher stage than in nonpregnant women. In our series, patients with BCP had poorer outcomes than the not pregnant group. These results were not observed when adjusting for stage.

ULTRASOUND MONITORING OF MUSCLE MASS CHANGES FOR TARGETING OF NUTRITIONAL SUPPORT IN NEUROCRITICALLY ILL PATIENTS

The main goal of this study was to identify a way to optimize nutritional support during ICU stay and obtain information about catabolic state through non-invasive and reliable methods as ultrasonography. We designed an observational case-series of 11 critically ill patients hospitalised at NEURO-ICU at IRCCS Bellaria Hospital - Bologna. The population studied shown uniform characteristics wich allowed comparison for muscle mass changes. Primary endpoint was to evaluate ultrasound sensitivity for monitoring muscle mass changes considering muscle layer thickness. Secondarly we compared ultrasonographic data and biomarkers of catabolism (sCr, nitrogen balance) in order to assess correlation between nutritional intakes (calories and protein) and changes in muscle during monitoring range of time. According to statistical index (CV<5%, ICC and Lin's Coefficient) the best reliable muscles for ultrasound monitoring resulted Rectus Femoris (RF), Vastus Intermedius (VI) and Tibialis Anterior (TA). The most statistically relevant (p<0.05) reduction of muscle layer thickness happened between Day1 and Day14 for Right VI, Right and Left TA. Significant correlation between APACHE II scored within first 24 hours of ICU admission emerged with muscle layer thickness at baseline (Day1). Muscle ultrasound resulted as a feasible method for assessing muscle changes during acute phase of critical illness. Correlation between muscle layer thickness and APACHEscore at ICU admission could represent a role of muscle mass in the prognostic response to critical illness.

Criteria for the Selection of Diagnostic Signs of Chronic Pancreatitis with Obstruction of the Main Pancreatic Duct

Introduction. Clinical outcomes of surgery for patients with chronic pancreatitis (CP), considering low rates of 10-year survival, are often unsatisfying for surgeons. Due to the absence of common diagnostic criteria, especially at an early stage of the disease, patients of young and working age undergo surgery at different periods and with different methods. The development of optimal criteria for the selection of diagnostic signs of chronic pancreatitis will improve treatment outcomes.The aim of the study is 1) to perform a comparative assessment of the informative value of methods that specify diagnostics of CP with obstruction of the main pancreatic duct; 2) to develop criteria for the selection of diagnostic signs to highlight the main types of structural changes in the pancreas in chronic pancreatitis with obstruction of the main pancreatic duct.Materials and methods. The study included radiological findings of 231 patients with CP with obstruction of the main pancreatic duct operated from 1996 to 2018 in Omsk regional surgical hospital. X-ray investigations were performed in 120 patients, ultrasound investigations were performed in 231 patients, multislice spiral computed tomography (MSCT) was performed in 226 patients, MRI was performed in 18 patients, endoscopic retrograde cholangiopancreatography (ERCP) was performed in 22 patients and angiography was performed in 5 patients. All patients were divided into two groups: control (n ​​= 88, until 2008) and case (n = 143, after 2008), where new methods of surgery were used and the structure of the applied diagnostic methods has been changed.Results. Ultrasound sensitivity was 74.5%, fistulography/virsungography sensitivity was 80%, MSCT sensitivity was 97.8%, MRI sensitivity was 88.9% and ERPC sensitivity was 95.5%. The use of invasive diagnostic methods in the main group of patients was minimized with the priority of MSCT. The main criteria for the selection of diagnostic signs of CP were determined as follows: obstruction of the main pancreatic duct (with localization at the level of the pancreatic head exclusively or along its entire length), dilatation of the main pancreatic duct (more than 3 mm), local damage to the pancreatic head with an increase in its size over 32 mm, cystic formations (more than 5 mm) in the projection of any part of the pancreas. The main types of structural changes in the pancreas were identified as follows: 1. CP with obstruction of the main pancreatic duct at the level of the pancreatic head exclusively; 2. CP with obstruction of the main pancreatic duct along its entire length with an increase in the size of the pancreatic head; 3. CP with obstruction of the main pancreatic duct along its entire length without an increase in the size of the pancreatic head.Conclusion. 1) MSCT has the highest sensitivity in CP diagnostics (98.6%). MRI (Magnetic Resonance Cholangiopancreatography (MRCP)) complements MSCT and replaces it in case of patients intolerance to contrast media. Indications for ERCP should be minimized. 2) The designed criteria for the selection of diagnostic signs of CP will optimize diagnostics of chronic pancreatitis with obstruction of the main pancreatic duct and highlight the main types of structural changes in the pancreas, the fact being important for validation of surgical treatment methods and techniques.

A case series of adult intussusception diagnosed by ultrasound in South India: an uncommon notion

Intussusception is the telescoping of one segment of the gastrointestinal tract into an adjacent one. Adult intussusception is less than 0.1% of all hospital admissions. Non-specific symptoms often delay the diagnosis with most cases diagnosed only after emergency laparotomy, hence the need for imaging as a screening investigation. The gold standard is computed tomography with the limitations of cost, radiation and contrast hazards. Our suggested initial screening tool is ultrasound. the aim of this study was to evaluate the sensitivity of ultrasound in diagnosing this rare entity. Thirteen patients (2013 to 2019) in a single tertiary care hospital diagnosed as “intussusception” were analysed. They were initially diagnosed by ultrasound and confirmed by CT or intra-op as needed. There were no exclusion criteria. The mean age was 50. There were 6 males and 7 females. Ultrasound sensitivity was 72%. Symptoms were variable. 100% had abdominal pain (1 day to 2 years duration). 69% had Intestinal obstruction. The most common type of adult intussusception observed was ileo-ileal (39%). The least common noted was gastro-jejunal (8%). The most common treatment was resection and anastomosis (77%). 3 cases were managed conservatively successfully. The biopsy was mostly benign (54%), 3 were malignant (23%) and 3 were unknown as they were not operated (23%). Our suggested initial screening is ultrasound with a fairly good sensitivity (72%). The upcoming improvement in technology can raise this sensitivity even further. The management protocols, biopsy findings, and clinical findings are however subjected to discretion.

Modern view on the issues of diagnosis and verification of axillary lymph nodes involvement in early breast cancer

The involvement of axillary lymph nodes is one of the most important prognostic factors, significantly affecting the treatment strategy for early breast cancer (BC). The risk of axillary lymph node metastases depends directly on a number of factors (age of women, size of tumor, presence of lymphovascular invasion and biological characteristics of cancer). The evaluation of regional lymph node status in patients with early BC includes the clinical examination of regional zones and the ultrasound study (US), using these methods can help to study lymph nodes shape, borders, margins and structure. The sensitivity of ultrasound in the evaluation of regional lymph nodes status directly depends on the biological subtype of the tumor; the minimum level of ultrasound sensitivity in the evaluation of lymph nodes status is detected for luminal HER2-negative cancer (less than 40%), and maximum sensitivity is detected for triple negative and HER2-positive subtypes (6871%). Clinical examination and modern ultrasound are the most accessible methods for the evaluation of regional lymph nodes status, but the possibility to misjudge metastatic process can be detected in 1/4 of patients. Verification of the diagnosis in the preoperative phase (fine-needle aspiration biopsy/core-needle biopsy under ultrasound guidance) allows minimize the number of errors for the regional staging. The sentinel lymph node biopsy (SLNB) is the gold standard of regional treatment in patients with early stage BC, nowadays. The randomized trials (NSABP B-32, ACOSOG q0011) show the safety of recession of performing regional lymph node dissection in favor of SLNB not only in case of clinically negative lymph nodes, but also in patients with metastases in 2 sentinel lymph nodes, upon condition that organ-conservative treatment and subsequent radiation therapy will be used. High-quality regional staging, the choice of the therapeutic algorithm in accordance with the biological characteristics of carcinoma, the application of the most effective modern drug regimes, the optimal radiation therapy allow not only minimize the extent of surgery, but also achieve high long-term survival results, provide excellent functional results and high quality of life in patients with the involvement of axillary lymph nodes.

SAT-398 The Use of Imaging in Primary Hyperparathyroidism

Primary hyperparathyroidism is characterized by excessive dysregulated production of parathyroid hormone (PTH) by 1 or more abnormal parathyroid glands. Preoperative localization is important for surgical planning in primary hyperparathyroidism. Previously, it had been published that ultrasound (sensitivity of 76.1%, positive predictive value of 93.2%) and nuclear scintigraphy (Sestamibi-SPECT) (sensitivity of 78.9%, and a positive predictive value of 90.7%) are first line imaging modalities1. Currently, the imaging modality of choice varies according to region and institutional protocol. The aim of this study was to evaluate the imaging modality that is associated with an improved remission rate based on concordance with operative findings. A secondary aim was to determine the effect of additive imaging on remission rates. This was an IRB-approved retrospective review of 2657 patients with primary hyperparathyroidism undergoing surgery at a tertiary referral center from 2004–2017. Analyses were performed with SAS software using a 95% confidence interval (p<0.05) for statistical significance. After excluding re-operative and familial cases, 2079 patients met study criteria. There were 422 (20.3%) male and 1657 (79.7%) female patients with a mean age of 66 (+12.2) years, of which 1723 (82.9%) of patients were white and 294 (14.1%) patients were black. Ultrasound (US) was performed in 1891 (91.9%), sestamibi with SPECT (sestamibi/SPECT) in 1945 (93.6%), and CT in 98 (4.7%) patients. Of these, 1721 (82.8%) had combined US and sestamibi/SPECT. US was surgeon-performed in 94.2% of cases and 89.9% of the patients underwent a four gland exploration. Overall, US concordance was 52.4%, sestamibi/SPECT was 45.5%, and CT was 45.9%.US and sestamibi/SPECT both had an improved remission rate if concordant with operative findings, while CT had no effect (US p=0.04; sestamibi/SPECT p=0.01; CT p=0.50). The overall remission rate was 94% (CI=0.93–0.95), however, increasing the number of imaging modalities performed did not increase the remission rate (p=0.76) or concordance with operative findings (p=0.05). Despite having low concordance rates, US and sestamibi/SPECT that agreed with operative findings were associated with higher remission rates. Therefore, when imaging is to be used for localization, our data support the use of US and sestamibi/SPECT as the initial imaging modalities of choice for preoperative localization. 1Kuzminski SJ, Sosa JA, Hoang JK. Update in Parathyroid Imaging. Magn Reson Imaging Clin N Am. 2018;26(1): 151–166.

Ultrasonography in diagnosis of appendicitis and its complications in pediatric patients: a cross-sectional study

BackgroundAppendicitis is a common cause of acute abdomen in pediatrics. Although various criteria have been suggested in early diagnosis of appendicitis, these criteria are not as applicable for pediatric patients. Because of this, imaging has an important role in the diagnosis of appendicitis in pediatric patients. The present study was conducted on 121 pediatric patients with possible diagnosis of appendicitis. All of the patients underwent initial evaluation and then underwent sonographic imaging. Sonography was used to assess the existence of signs associated with appendicitis, or its complications. Imaging findings were compared in patients with complications with those with complications. True false positive, false negative, true positive, and true negative values were calculated. Sensitivity and specificity of ultrasonography in determining appendicitis was evaluated.ResultsThe mean age of children was 8.08 ± 3.25 years, with ages ranging from 3 to 14 years. Of the 121 children, 74(61.2%) were male and 47(38.8%) were female. In total, there were 3(2.4%) false positives and 2(1.6%) false negatives based on sonographic findings. There were also 54(44.6%) true positive and 62(51.2%) true negative based on sonographic findings. Based on the findings of ultrasound in this study, ultrasound sensitivity was 96.4%, specificity was 95.3%, positive predictive value was 94.7%, and negative predictive value was 96.8%.ConclusionUltrasonography is indicated in the diagnosis of appendicitis in pediatric patients and has optimal sensitivity and specificity in the diagnosis. Furthermore, it is a suitable diagnostic method for evaluating complications of appendicitis.

Method developed for creating foam-free monodisperse bubbles as ultrasound contrast agents

The efficient creation of uniform, ready-to-use bubbles improves ultrasound imaging sensitivity 15-fold.

Clinical Value of the Carotid Ultrasound in Evaluation of Plaque Composition as Compared to the Carotid MRI

Abstract Background: The main aim of carotid imaging studies is the assessment of the carotid plaque morphology with the detection of vulnerable plaques which is associated with increased risk of cerebrovascular insult, hence proper deline-ation of plaque composition is a crucial step for further management of brain ischemic insult. Aim of Study: To define the inter method agreement between the carotid ultrasound and carotid MRI for charac-terization of vulnerable plaques with further assessment of carotid ultrasound sensitivity and specificity. Material and Methods: The study was conducted over 60 patients. The modified G-W classification was used to assess the sonographic features of the carotid plaques, and compared with the plaque composition using carotid MRI. Results: Our study included 60 patients, their ages ranged between 53 and 78 years with a mean age of 60.3±9.8 years. 56.7% of patients was male. The agreement between carotid ultrasound and carotid MRI was good with k=0.734, sensitivity of the carotid ultrasound to detect the vulnerable plaque was 88.1% with an overall accuracy of 88.3%. Conclusion: The carotid ultrasound examination is con-sidered the first-line modality for assessment of the carotid plaque composition, with good agreement with carotid MRI and acceptable sensitivity and accuracy for characterization of vulnerable plaques.

Imaging features and pathological comparison of carotid web

Objective To analyze the ultrasound examination and computed tomography angiography (CTA) features of carotid web(CAW), and compare with the pathology after carotid endarterectomy, and then compare diagnostic efficacies of the two methods. Methods From June 2018 to July 2019, 159 patients underwent carotid endarterectomy(CEA) in Beijing Tian Tan Hospital were collected, ultrasound examination and CTA were performed preoperatively. The presence or absence of CAW and whether there were thrombosis or atherosclerotic plaques associated with it were identified. The location length, thickness, direction in the lumen, echo characteristics of CAW, and complicated with or without thrombosis or atherosclerotic plaques were recorded. The postoperative specimens were observed, and the pathological analysis was performed. Results Among the 159 cases of CEA, 22 cases were confirmed to have CAW structure by pathology, and HE staining showed extensive intimal fibrohyperplasia and mucoid degeneration, among which 18 cases had plaque formation at the bottom of the carotid web, and 4 cases associated with thrombosis. There were 17 cases of CAW structure diagnosed by ultrasound, 5 cases were misdiagnosed or missed, the sensitivity and specificity of ultrasound in the diagnosis of CAW were 77% (17/22) and 98% (135/137), and the accuracy was 75%. Eleven cases of CAW were diagnosed by preoperative CTA, and 11 cases were misdiagnosed and missed diagnosis, the sensitivity and specificity of CTA in the diagnosis of CAW were 50%(11/22) and 97%(134/137), and the accuracy was 47%. Conclusions The sensitivity of ultrasound in the diagnosis of CAW is higher than that of CTA, which can better display the structure of CAW and whether it is associated with plaque or thrombosis. Key words: Ultrasonography; Carotid artery web; Atherosclerosis plaque; Thrombosis; Computed tomographic angiography

Comparison of accuracy of computed tomography scan and ultrasonography in the diagnosis of mandibular fractures

Ultrasonography (USG) allows to the examination of soft tissue and osseous tissues in the head-and-neck region. This study compared the accuracy of USG and computed tomography (CT) scan in the diagnosis of mandibular fractures. In this prospective observational study, spiral CT scan was prescribed for the lower face and, if necessary, midface and upper face in 42 trauma patients suspected of mandibular fractures, referring to Imam Reza Hospital in Tabriz. Two radiologists evaluated the CT scans. Then, another radiologist examined all the patients with USG with a frequency of 7-12 MHz. Ultrasonographic diagnostic results were recorded and compared with the results of the CT scan examinations. The results were reported using descriptive statistical methods. The specificity and sensitivity of USG were 100% and 91.1%, respectively. The USG sensitivities in the angle, condyle, condylar neck, and symphysis fractures were 100%, 91.6%, 85.7%, and 80%, respectively, and the specificity was 100% in all that anatomical regions. Among the confounding factors, the sensitivity of the USG (84.6%) was the lowest in the presence of hematoma; however, its specificity remained 100%. One case of symphysis fracture was not detected in the absence of any confounding factors in USG examination. Although the sensitivity, specificity, and diagnostic accuracy of the USG were at high levels, there were some limitations, making it difficult to definitively replace USG with CT scans, especially in the case of condylar fractures and in the presence of confounding factors such as hematoma and swelling.

Multimodality imaging approach to blunt abdominal trauma in a tertiary care center in North India

Background: Evaluating patients who have sustained blunt abdominal trauma (BAT) remains one of the most challenging and resource-intensive aspects of acute trauma care. This study was conducted to evaluate the correlation of ultrasonography (USG) and computed tomography (CT) in detecting the visceral injuries with the assessment of their diagnostic indices. X-ray was done in cases of suspected bowel injuries. Materials and Methods: This prospective cross-sectional study was conducted in the Department of Radiodiagnosis, Imaging and Interventional Radiology, at CSS Hospital, Subharti Medical College, Meerut, Uttar Pradesh, India, for 2 years. Eighty-two patients of BAT were evaluated using investigations such as X-ray (wherever required), USG, and CT scan during the study. Results: Majority of the patients were from the age group of 21 to 40 years with predominance of male (69.5%). Hemoperitoneum associated with visceral injuries were the major findings detected by both USG (70.7%) and CT (81.7%). Sensitivities of USG for the detection of spleen, liver, kidney, and pancreatic injuries were 95%, 94%, 66.6%, and 40%, respectively, while the sensitivity of CT for the detection of liver, spleen, kidney, and pancreas was 100%. Conclusion: CT is highly sensitive, specific, and accurate in detecting the presence or absence of injury in BAT and defining its extent. However, USG still remains the initial investigation of choice.

Diagnostic Accuracy of Carotid Doppler Ultrasound for the Detection of Right-to-Left Cardiac Shunt.

Background:Right-to-left cardiac shunt is a condition anatomically related to patent foramen ovale (PFO) and potentially related to cryptogenic cerebrovascular events. As recent studies demonstrated a reduction of recurrent stroke in patients undergoing percutaneous PFO closure after a cryptogenic cerebrovascular event, it is now of pivotal importance to screen these patients for Right-to-left shunt(RLS) presence. At this regard, transcranial color Doppler (TCCD) with contrast has a good sensitivity (97%) and specificity (93%) compared to transesophageal echocardiography and became the test of choice to assess RLS presence, thanks to its noninvasive nature. However, temporal bone window is not accessible in 6%–20% patients. Several approaches have been explored to overcome this limitation with encouraging but not definitive results for extracranial internal carotid artery (ICA) approach, proposed in previous pivotal studies. Aims of this study were to further assess the diagnostic accuracy of ICA Doppler ultrasound with contrast for RLS detection compared to TCCD, with the two tests performed simultaneously.Materials and Methods:Sixty-four patients underwent simultaneously to TCCD and ICA Doppler ultrasound, both performed at rest and after Valsalva maneuver. Diagnosis of RLS was made, both for TCCD and ICA ultrasound, if=1 microembolic signals (MES) were detected during the examination (either at rest or after Valsalva maneuver).Results:ICA Doppler ultrasound sensitivity and specificity resulted respectively of 97% (confidence interval [CI] 95%) and 100% ([CI] 95%), while negative likelihood ratio was 0.03 (CI 95%).Conclusions:ICA Doppler ultrasound represents a valid alternative to TCCD for RLS screening in patients without adequate transcranial acoustic window.

Ultrasound-Sensitive Liposomes for Triggered Macromolecular Drug Delivery: Formulation and In Vitro Characterization.

Mistletoe lectin-1 (ML1) is a nature-derived macromolecular cytotoxin that potently induces apoptosis in target cells. Non-specific cytotoxicity to normal cells is one of the major risks in its clinical application, and we therefore propose to encapsulate ML1 in a nanocarrier that can specifically release its cargo intratumorally, thus improving the efficacy to toxicity ratio of the cytotoxin. We investigated the encapsulation of ML1 in ultrasound-sensitive liposomes (USL) and studied its release by high-intensity focused ultrasound (HAccessedIFU). USL were prepared by entrapment of perfluorocarbon nanodroplets in pegylated liposomes. The liposomes were prepared with different DPPC/cholesterol/DSPE-PEG2000 lipid molar ratios (60/20/20 for USL20; 60/30/10 for USL10; 65/30/5 for USL5) before combination with perfluorocarbon (PFC) nanoemulsions (composed of DPPC and perfluoropentane). When triggered with HIFU (peak negative pressure, 2–24 MPa; frequency, 1.3 MHz), PFC nanodroplets can undergo phase transition from liquid to gas thus rupturing the lipid bilayer of usl. Small unilamellar liposomes were obtained with appropriate polydispersity and stability. ML1 and the model protein horseradish peroxidase (HRP) were co-encapsulated with the PFC nanodroplets in USL, with 3% and 7% encapsulation efficiency for USL20 and USL10/USL5, respectively. Acoustic characterization experiments indicated that release is induced by cavitation. HIFU-triggered release of HRP from USL was investigated for optimization of liposomal composition and resulted in 80% triggered release for USL with USL10 (60/30/10) lipid composition. ML1 release from the final USL10 composition was also 80%. Given its high stability, suitable release, and ultrasound sensitivity, USL10 encapsulating ML1 was further used to study released ML1 bioactivity against murine CT26 colon carcinoma cells. Confocal live-cell imaging demonstrated its functional activity regarding the interaction with the target cells. We furthermore demonstrated the cytotoxicity of the released ML1 (I.E., After USL were treated with HIFU). The potent cytotoxicity (IC50 400 ng/ml; free ML1 IC50 345 ng/ml) was compared to non-triggered USL loaded with ML1. Our study shows that USL in combination with HIFU hold promise as trigger-sensitive nanomedicines for local delivery of macromolecular cytotoxins.

Comparision between Low-Dose CT and Ultrasound in Diagnosis of Renal and Uretral Stones in Adults

AbstractBackground: Non-contrast computed tomography of the kidneys, ureters, and bladder (CT KUB) is the examination of decision for renal colic when compared to ultrasonography; be that as it may, radiation presentation can be a worry.Aim of Study: Comparison between low dose CT and ultrasound in diagnosis of renal and uretral stones in adults.Patients and Methods: This prospective study was con-ducted on fifty Egyptian adults meeting the inclusion criteria of hading flank pain, suspected to have urinary tract calculi and recruited from Urology Department of Tanta University to Radiology Department at Tanta University Hospitals. All patients were applied to careful history taken, clinical and laboratory examination then underwent imaging studies which include renal ultrasound examination and MDCT-KUB using low dose protocol. Each depicted stone was documented whether it is renal or uretric. All the stones were also defined as single or multiple, unilateral or bilateral and the maximum diameter of them. In case of upper urinary tract calculi reliable secondary signs of obstructing calculi were demonstrated. These include hydronephrosis, hydroureter, ipsilateral renal enlargement and ureter rim sign. The findings were confirmed by comparing to the previous standard CT scans that were done and detected in the medical records for 20 patients, uretroscopy in 12 patients, percutenous nephro lithotomy in 8 patients, medical treatment and more follow-up for 10 patients. The sensitivity, specificity and size accuracy of US was determined using low dose CT as the standard.Results: Low dose CT showed number of renal and ureteral stones more than ultrasound with statistical significant p-value <0.001 with overall stones detected by ultrasound is 43 stones (5 ureteral and 38 renal) while low dose CT showed 96 stones (40 ureteral and 56 renal). The ultrasound missed 12 stones with 80% with mean size 4mm at uretrovesical junction and 10 stones with 83.8% with mean size 6mm at upper third of ureter. The ultrasound missed 100% of the ureteral stones in middle or distal ureter due to abdominal gases. The ultrasound overestimate the size in size group [4 to 1 0mm] by 3.3mm with statistically significant p-value detected. The ultrasound sensitivity, specificity, accuracy for renal stones detection were 67.8%, 100% and 81.2% respectively when compared to low dose ct and the ultrasound sensitivity, specificity, accuracy for ureteral stones detection were 6.90%, 100% and 43.75% respectively when compared to low dose.Conclusion: Low dose CT shows up as preferred imaging modality for uorolithiasis over ultrasound because of its high sensitivity and accuracy in identifying renal and ureteral stones.

Multiparametric Ultrasound for Prostate Cancer Detection and Localization: Correlation of B-mode, Shear Wave Elastography and Contrast Enhanced Ultrasound with Radical Prostatectomy Specimens.

Similar to multiparametric magnetic resonance imaging, multiparametric ultrasound represents a promising approach to prostate cancer imaging. We determined the diagnostic performance of B-mode, shear wave elastography and contrast enhanced ultrasound with quantification software as well as the combination, multiparametric ultrasound, for clinically significant prostate cancer localization using radical prostatectomy histopathology as the reference standard. From May 2017 to July 2017, 50 men with biopsy proven prostate cancer underwent multiparametric ultrasound before radical prostatectomy at 1 center. Three readers independently evaluated 12 anatomical regions of interest for the likelihood of clinically significant prostate cancer on a 5-point Likert scale for all separate ultrasound modalities and multiparametric ultrasound. A logistic linear mixed model was used to estimate diagnostic performance for the localization of clinically significant prostate cancer (any tumor with Gleason score 3 + 4 = 7 or greater, tumor volume 0.5 ml or greater, extraprostatic extension or stage pN1) using a Likert score of 3 or greater and 4 or greater as the threshold. To detect the index lesion the readers selected the 2 most suspicious regions of interest. A total of 48 men were included in the final analysis. The region of interest specific sensitivity of multiparametric ultrasound (Likert 3 or greater) for clinically significant prostate cancer was 74% (95% CI 67-80) compared to 55% (95% CI 47-63), 55% (95% CI 47-63) and 59% (95% CI 51-67) for B-mode, shear wave elastography and contrast enhanced ultrasound, respectively. Multiparametric ultrasound sensitivity was significantly higher for Likert thresholds and all different clinically significant prostate cancer definitions (all p <0.05). Multiparametric ultrasound improved the detection of index lesion prostate cancer. Multiparametric ultrasound of the prostate, consisting of B-mode, shear wave elastography and contrast enhanced ultrasound with parametric maps, improved localization and index lesion detection of clinically significant prostate cancer compared to single ultrasound modalities, yielding good sensitivity.

Quantitative sonographic evaluation of muscle thickness and fasciculation prevalence in healthy subjects.

In the current study, we aimed to determine normative values for muscle thickness and fasciculation prevalence in healthy subjects. We performed a prospective study from October to December 2018 in 65 healthy subjects. All subjects underwent quantitative sonographic evaluation of muscle thickness and fasciculation prevalence in the following 8 muscles: Biceps brachii, abductor pollicis brevis, first dorsal interosseous, abductor digiti minimi, quadriceps, tibialis anterior, extensor digitorum brevis, and abductor hallucis brevis. Subject ages ranged from 21 to 82 years, with 63% women. Normative values for muscle thickness were determined using the fifth percentile. Multivariate regression analysis showed that sex, age, body mass index, and hand dominance affected muscle thickness. Fasciculations were observed frequently only in distal muscles. Normal values for muscle thickness were determined, and may enhance neuromuscular ultrasound sensitivity and serve as a basis for future studies. Larger series are needed to confirm these values.

Sensitivity of Radial Endobronchial Ultrasound-Guided Bronchoscopy for Lung Cancer in Patients With Peripheral Pulmonary Lesions: An Updated Meta-analysis

Registry trials have found radial endobronchial ultrasound (r-EBUS) sensitivity to vary between institutions, suggesting that in clinical practice, r-EBUS sensitivity may be lower than reported in clinical trials. We performed a meta-analysis to update the estimates of r-EBUS sensitivity and to explore factors contributing to heterogeneity of results. A systematic review using PubMed was performed through July 2018 to determine the sensitivity of r-EBUS for lung cancer, and to construct a summary receiver operating characteristic curve. The DerSimonian and Laird method was used to weight results. Subgroup analysis and meta-regression was used to identify sources of heterogeneity. Study quality was assessed using the QUADAS tool, and publication bias was tested using funnel plots. Fifty-one studies with a total of 7,601 patients were included. r-EBUS pooled sensitivity was 0.72 (95%CI, 0.70-0.75), and area under the sROC curve was 0.96 (95%CI, 0.94-0.97). Significant heterogeneity was observed (I2= 76%; heterogeneity P< .01). We failed to demonstrate an association between sensitivity and air bronchus sign, average nodule size, use of fluoroscopy, virtual bronchoscopy, guide sheath, cancer prevalence, multicenter status, or consecutive enrollment. Rapid onsite cytology was associated with increased sensitivity (P= .01). The pooled pneumothorax rate was 0.7%(95%CI, 0.3%-1.1%). Funnel plots were asymmetrical, demonstrating sample size-related effects and possible publication bias. r-EBUS has an excellent safety profile, but there is significant between-study heterogeneity. Sample size-related effects and possibly publication bias have led to overly optimistic estimates of the sensitivity of r-EBUS.

EP11.03: Cardiac anomaly screening in the first trimester: a systematic review and meta‐analysis of ultrasound sensitivity and factors impacting detection

EP11.03: Cardiac anomaly screening in the first trimester: a systematic review and meta‐analysis of ultrasound sensitivity and factors impacting detection