Sensitivity Of Ultrasonography Research Articles

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

Diagnostic imaging for acute abdominal pain in an Emergency Department in Italy

Imaging plays a key role in the diagnostic work-up of patients with non-traumatic acute abdominal pain (AAP) in emergency department (ED). We aimed to evaluate the use and diagnostic performance of imaging techniques in adult patients with AAP in an ED in Italy. Patients with non-traumatic AAP admitted at the ED of S. Orsola-Malpighi University Hospital of Bologna (Italy) from the 1st to the 30th November 2016 were included. Demographic and clinical data, data on radiological procedures and discharge diagnosis were collected. Sensitivity and specificity for detecting acute diseases were assessed using the discharge diagnosis from the ED as reference standard. Of the 578 patients (female 52.8%, mean age 51.3years) admitted to the ED for AAP, 433 (74.9%) underwent abdominal imaging. The most frequent techniques used were abdominal plain radiography and ultrasonography (US), performed in 38.4% and 37.9% of patients, respectively, followed by computed tomography (CT) in 28% of patients. Plain radiography yielded a sensitivity of 28% and specificity of 91.1%; the sensitivity increased to 79.4% in patients with small bowel obstruction. Ultrasonography's sensitivity and specificity were 61.8% and 98.4%, respectively; the sensitivity of US reached 85.2% and 90% in patients with acute cholecystitis/biliary colic and urolithiasis, respectively. The sensitivity and specificity of CT were 87.8% and 92.9%, respectively. Plain radiography is still overused in the diagnostic work-up of AAP in ED in Italy, despite its unsatisfactory sensitivity. Ultrasonography and CT has a higher sensitivity and should be used as first-level imaging in most patients.

Clinical value of echocardiography in differential diagnosis of segmental wall motion abnormalities in coronary heart disease

Objective To explore the clinical value of echocardiography in differential diagnosis of segmental wall motion abnormalities in coronary heart disease(CHD), and to provide help for clinical treatment. Methods From January 2017 to November 2018, 56 patients with segmental abnormal wall motion of CHD in Yuyao People's Hospital of Zhejiang Province were selected in the study.All patients were diagnosed by echocardiography and coronary angiography.The diagnostic coincidence rate, specificity, sensitivity, false negative rate, false positive rate and accuracy of echocardiography were evaluated. Results Coronary angiography showed abnormal segmental wall motion in 56 patients, with 100.00% anastomosis rate.Echocardiography revealed abnormal segmental wall motion in 54 patients with CHD, 2 patients showed normal segmental wall motion, anastomosis rate was 96.43%.There was no statistically significant difference between the two diagnostic methods(χ2=0.635, P=0.152), but the specificity of ultrasound diagnosis(80.36%), sensitivity(78.57%) and accuracy(80.36%) were lower than those of coronary angiography(100.00%, 98.21%, 100.00%), there were statistically significant differences (χ2=4.173, P=0.034; χ2=5.154, P=0.024; χ2=4.173, P=0.034). Conclusion Cardiac echocardiography has a high diagnostic value in differential diagnosis of segmental wall motion abnormalities in CHD.It can guide the clinical treatment of these patients to formulate a reasonable treatment plan.Moreover, it is easy to operate, with low cost and more acceptable to patients. Key words: Coronary artery disease; Segmental wall motion abnormality; Ultrasonography, doppler, color; Coronary angiography; Differential diagnosis; Confirmation; Specificity; Sensitivity

Understanding the effect of methane gas sensitivity using ultrasonic sensors and multi-matching layers inside a natural gas vehicle tank

This research paper is the experimental study to investigate the effect of ultrasound sensitivity in the pure methane gas space as the pressure and sensor distance increases. We offer the solution to overcome the low sensitivity characteristics of ultrasonic sensors in the methane gas space. This proposal shows the physical characteristics analyzed with self-induced vibration, beam pattern, amplitude, attenuation, and Gaussian distribution validation in CH4 gas space. An ultrasonic sensor is designed with PbTio3 material of an MS-50 PTZ. The signal processing analysis system (APAS) is composed of the mechanical and controlling sections including three mass flow controllers, an air cylinder, safety valves, three pressure regulators, a CVC, ultrasound sensors, and two gas tanks (air and CH4). The experiment is performed in a wide range of the initial conditions, i.e., supplying voltage of 25 V, current of 0.2 A, pulse rate of 7 Hz, measuring distance of 0.32 to 1.02 m, resonance frequency of 57.3 Hz, ambient temperature of 296 K, and pressure increases of 1, 2, 3 and 4 bar. The ultrasonic sensitivity of a sensor (T: EVA and R: EVA) significantly enhanced the acoustic impedance in a methane gas space as pressure increases. It is verified that the sensitivity effect of an ultrasonic sensor used with ethylene vinyl acetate (EVA) matching layer is higher in the methane gas space than a chemical wood (CW) matching layer. Consequently, the effect of gas sensitivity computed by a GDA including the width (W), area (A), and height (H) is enhanced by an EVA sensor in comparison to other Models.

Diagnostic efficiency of renal ultrasound after the first urine infection in infants

Several authors question the performance of systematic renal ultrasound after first urinary tract infection (UTI) in young children, given the high sensitivity of prenatal ultrasounds to detect major malformations and the low prevalence of clinical relevant findings. The aims of this study are to evaluate the yield of renal ultrasound performed after the first UTI in patients aged less than 2 years and to analyse potential risk factors (RF) of altered renal ultrasound. Retrospective study, including patients aged less than 2 years diagnosed with UTI in the Emergency Department between July 2013 and December 2014. Patients with an underlying nephro-urological pathology, previous UTIs and those without prenatal or post-infection renal ultrasound were excluded. Altered renal ultrasound was defined as the presence of dilated urinary tract or structural abnormalities. Potential RF analysed were: male, age less than 3 months, presence of fever and microorganism other than Escherichia coli. Univariate and multivariate logistic regression were performed. A total of 306 patients were included. Altered renal ultrasound was found in 35 cases (11.4%; 95% CI 8.3-15.5): 24 (68.6%) urinary tract dilation, and 11 (31%) structural abnormalities. Among the cases with altered ultrasound, 68.6% were male, 51.4% were younger than 3 months, 74.3% were febrile, and 31.4% were caused by microorganisms other than E. coli, compared to 45% (P=.009), 31.7% (P=.021), 78.2% (P=.597) and 10% (P=.001) of cases with normal ultrasound. In the multivariate analysis, age less than 3 months (OR 2.1; 95% CI 1.0-4.3, P=.05) and microorganism other than E. coli (OR 3.8; 95% CI 1.7-8.7, P=.002) remained as RF. The yield of renal ultrasound after the first UTI is low. Its indication should be individualised according to the presence of RF: age less than 3 months and microorganism other than E. coli.

Diagnostic efficiency of renal ultrasound after the first urine infection in infants

IntroductionSeveral authors question the performance of systematic renal ultrasound after first urinary tract infection (UTI) in young children, given the high sensitivity of prenatal ultrasounds to detect major malformations and the low prevalence of clinical relevant findings. The aims of this study are to evaluate the yield of renal ultrasound performed after the first UTI in patients aged less than 2 years and to analyse potential risk factors (RF) of altered renal ultrasound. Patients and methodsRetrospective study, including patients aged less than 2 years diagnosed with UTI in the Emergency Department between July 2013 and December 2014. Patients with an underlying nephro-urological pathology, previous UTIs and those without prenatal or post-infection renal ultrasound were excluded. Altered renal ultrasound was defined as the presence of dilated urinary tract or structural abnormalities. Potential RF analysed were: male, age less than 3 months, presence of fever and microorganism other than Escherichia coli. Univariate and multivariate logistic regression were performed. ResultsA total of 306 patients were included. Altered renal ultrasound was found in 35 cases (11.4%; 95% CI 8.3–15.5): 24 (68.6%) urinary tract dilation, and 11 (31%) structural abnormalities. Among the cases with altered ultrasound, 68.6% were male, 51.4% were younger than 3 months, 74.3% were febrile, and 31.4% were caused by microorganisms other than E. coli, compared to 45% (P=.009), 31.7% (P=.021), 78.2% (P=.597) and 10% (P=.001) of cases with normal ultrasound. In the multivariate analysis, age less than 3 months (OR 2.1; 95% CI 1.0–4.3, P=.05) and microorganism other than E. coli (OR 3.8; 95% CI 1.7–8.7, P=.002) remained as RF. ConclusionsThe yield of renal ultrasound after the first UTI is low. Its indication should be individualised according to the presence of RF: age less than 3 months and microorganism other than E. coli.

Hepatocellular carcinoma surveillance in the 21st century: Saving lives or causing harm?

Hepatocellular carcinoma (HCC) is the third most common cause of cancer related death worldwide. Prognosis and treatment options largely depend on tumor stage at diagnosis, with curative treatments only available if detected at an early stage. However, two thirds of patients with HCC are diagnosed at a late stage and not eligible for cure. Therefore several liver professional societies recommend HCC surveillance using abdominal ultrasound with or without alpha fetoprotein in at-risk populations, including patients with cirrhosis and subsets of those with chronic hepatitis B. Available data suggest HCC surveillance can significantly improve early tumor detection, curative treatment eligibility, and overall survival. However, the potential benefits of HCC surveillance must be considered in light a shifting HCC demographic from a viral-mediated cancer to an increasing proportion of patients having non-alcoholic steatohepatitis, which has been shown to limit ultrasound sensitivity and may mitigate observed benefits. Further, benefits of HCC surveillance must be weighed against potential physical, financial and psychological harms. Continued data for both benefits and harms of HCC surveillance in contemporary populations are necessary. In the interim, providers should continue to strive for high quality HCC surveillance in at-risk patients.

Sonography of Palpable Breast Lumps in a Tertiary Health Care Centre in Nepal

With a palpable lesion in the breast, the goal is to diagnose malignancy at the earliest. Ultrasonography is used for evaluating symptomatic patients especially those with dense breasts where mammography gives limited information. The objective of this study was to evaluate the sonographic pattern of the palpable breast lumps and correlate with the final pathological diagnosis. This was a retrospective study done at our tertiary health care center, from July 2016 to March 2017, including 121 patients presenting to the ultrasound department with complaint of palpable breast lump and whose pathological reports could be followed up. Various sonographic features were studied, sonography and final diagnosis compared. On sonography, about 46% of the cases were benign, 35 % malignant and 18 % indeterminate while tissue diagnosis revealed 63% to be benign, 34% malignant. The most common lesions in each group and sonographic characteristics were evaluated. Of the benign lesions, fibroadenoma was the most common. Most of the indeterminate lesions on sonography were histologically mastitis. We found nearly 58% of the malignant lesions had microlobulated margins. The sensitivity of sonography was 92.9% and specificity 97.5% with diagnostic accuracy 94.8%. Most of the palpable lumps were benign in our study, most common being fibroadenoma. We had a relatively higher percentage of malignancy which may be due to patients with obviously benign lesions not undergoing tissue diagnosis in our setting. The sonographic features and diagnosis correlated well with the histological diagnosis.

Evaluation of chitosan impregnated with silver nanoparticles in the treatment of chronic venous leg ulcer: An open-label controlled study

Background: The treatment of chronic venous leg ulcer (CVLU) is a major challenge. Much scientific advancement was made. Chitosan, derived from N-deacetylation of chitin, has been successfully used to promote wound healing. Silver nanoparticles (AgNPs) are used as bactericides. The aim of this work is to evaluate the efficacy and safety of chitosan alone or that impregnated with AgNPs compared to traditional compression bandage dressing in the treatment of CVLU. Materials and Methods: Thirty-eight CVLU patients completed the treatment for 3 months. They were treated with compression bandage and categorized into three groups: Group A included 12 patients used chitosan impregnated with the AgNPs, Group B included 11 patients used chitosan alone, and Group C included 15 patients used compression bandage alone. For all patients, routine investigations, lower limbs Duplex ultrasound and bacterial culture and sensitivity from the ulcers before and after treatment were done. Results: The healing of ulcers in the treated groups was mostly apparent in Groups A and C. Conclusions: Chitosan impregnated with AgNPs can be a hopeful treatment for CVLU. However, compression bandage alone is also effective for the treatment of CVLU.

A Comparative Study between Bedside Chest Ultrasound and Traditional Chest Radiography in Critically Ill Patients

Background: Bedside chest ultrasound emerge a sensitive tool with much higher sensitivity than plain chest x-ray. It avoids the cost, risk of transportation to perform the CT chest and that of radiation exposure. Aim of the Study: was to evaluate the sensitivity and the specificity of bedside ultrasound in the detection and the evaluation of chest conditions of critically ill patients in comparison of CT chest as the gold standard tool. Patients and Methods: This prospective study was conducted on a registry of 80 patients with different chest pathology admitted to the Medical-Surgical Intensive Care Unit of Bab Al Shaeria Hospital between March and November 2018. Results: bedside chest ultrasound sensitivity in detection and evaluation of pneumothorax, pleural effusion, and consolidation and Interstitial lung disease in comparison to CT chest showed sensitivity around 93 % with little cost, without risk of radiation exposure and transportation of critically ill patients. Conclusion: Bedside chest ultrasound is a highly sensitive and specific tool in the detection and evaluation of many chest conditions that eliminates the risk of transportation of unstable patients and that of radiation exposure and is easily accessible in resource limited areas.

A Comparative Study between Bedside Chest Ultrasound and Traditional Chest Radiography in Critically Ill Patients

Background: Bedside chest ultrasound emerge a sensitive tool with much higher sensitivity than plain chest x-ray. It avoids the cost, risk of transportation to perform the CT chest and that of radiation exposure. Aim of the Study: was to evaluate the sensitivity and the specificity of bedside ultrasound in the detection and the evaluation of chest conditions of critically ill patients in comparison of CT chest as the gold standard tool. Patients and Methods: This prospective study was conducted on a registry of 80 patients with different chest pathology admitted to the Medical-Surgical Intensive Care Unit of Bab Al Shaeria Hospital between March and November 2018. Results: bedside chest ultrasound sensitivity in detection and evaluation of pneumothorax, pleural effusion, and consolidation and Interstitial lung disease in comparison to CT chest showed sensitivity around 93 % with little cost, without risk of radiation exposure and transportation of critically ill patients. Conclusion: Bedside chest ultrasound is a highly sensitive and specific tool in the detection and evaluation of many chest conditions that eliminates the risk of transportation of unstable patients and that of radiation exposure and is easily accessible in resource limited areas.

Verifying the Placement of Nasogastric Tubes at an Emergency Center: Comparison of Ultrasound with Chest Radiograph

The objective of this study was to verify the nasogastric tube position with neck ultrasound and subxiphoid ultrasound, by giving air-water mixture and auscultation and to compare the effectiveness of these methods with chest radiography. This is a single-center, prospective, single-blind study. Patients who were admitted to our emergency department and had an indication of nasogastric tube placement were included. Nasogastric tube localization was verified with neck ultrasound and subxiphoid ultrasound, by giving air-water mixture, auscultation, and direct radiography that was accepted as the ‘gold standard technique'. A total of 49 patients (27 Male, 22 Female) with a mean age of 58.3±22.7 years were included. Sensitivity of neck ultrasound was 91.5%, and positive predictive value was 100%. As for the subxiphoid ultrasound sensitivity was 78.72%. When neck ultrasound + subxiphoid ultrasound and giving water-air mixture were combined sensitivity reached 95.74%. Sensitivity of neck ultrasound + subxiphoid ultrasound + air-water mixture + auscultation was 97.87% and positive predictive value was 100%. In the light of our results, neck and subxiphoid ultrasound seem to be an alternative method for verifying nasogastric tube localization. Combination of the air-water mixture and auscultation with ultrasound improves the sensitivity.

Recurrent laryngeal nerve injury assessment by intraoperative laryngeal ultrasonography: a prospective diagnostic test accuracy study.

IntroductionRecurrent laryngeal nerve injury is one of the major complications related to thyroid surgery. Intraoperative recurrent laryngeal nerve functional status monitoring is becoming a standard part of thyroid surgery. However, the current methods for intraoperative nerve functional status assessment are associated with a demand for specialized devices and increased costs.AimTo assess the validity of a new method – intraoperative laryngeal ultrasonography – for prediction of recurrent laryngeal nerve injury.Material and methodsThis prospective diagnostic test accuracy study included 112 patients undergoing thyroid surgery in Vilnius University Hospital Santaros Clinics. Neurostimulation combined with laryngeal ultrasonography and laryngeal palpation was performed intraoperatively to evaluate recurrent laryngeal nerve functional status. Recurrent laryngeal nerve injury was confirmed by laryngoscopy, which was performed on the first postoperative day and considered to be the gold standard method.ResultsData on 112 consecutive patients and 200 nerves at risk were collected. The temporary vocal cord palsy rate was 5.4% per patient and 3% per nerve at risk. No permanent palsy or bilateral injury cases were registered in the study cohort. Laryngeal ultrasound sensitivity counted per nerve at risk was 83.3%, specificity 97.2%, accuracy 96.4%, positive predictive value 62.5% and negative predictive value 99%.ConclusionsLaryngeal ultrasonography is a feasible new technique for accurate intraoperative recurrent laryngeal nerve injury evaluation.

Development of Ultrasound-Triggered and Magnetic-Targeted Nanobubble System for Dual-Drug Delivery

Non–small cell lung cancer (NSCLC) constitutes more than 85% of lung cancer case. Pemetrexed is used to treat types of NSCLC, and pazopanib is used for some types of soft tissue sarcoma. The aim of the study was development of pemetrexed and pazopanib carrying nanobubble system with magnetic responsiveness and ultrasound sensitivity properties for targeted NSCLC therapy. Drugs were linked to newly designed peptide, and peptide drug conjugates were attached to amine-modified magnetite. Resulting nanoparticles were encapsulated into liposomes, and liposomes were extruded, then nanobubble system was prepared. Moreover, nanobubble biodistribution was monitored by in vivo imaging system. As a result, based on high-performance liquid chromatography data, magnetite and peptide-pemetrexed were conjugated with 54.02% yield, and magnetite and peptide-pazopanib were bound with 63.53% yield. Hydrodynamic size of nanobubbles, prepared from liposomes filtered through 800 nm and 400 nm, was determined as 491.1 ± 130.2 and 275.8 ± 117.8 nm, respectively. Carrier system was accumulated into tumor area with 80.22% yield of the injected carrier system. It was found that nanobubbles were magnetic responsive for accumulation via magnetic field and could be disrupted by ultrasound via focused acoustic pressure, which lead to targeted drug delivery. These nanobubble systems could be investigated for intravenous and inhaler administration in further studies.

Ultrafast Doppler for Neonatal Brain Imaging

The emergence of functional neuroimaging has dramatically accelerated our understanding of the human mind. The advent of functional Magnetic Resonance Imaging paved the way for the next decades’ major discoveries in neuroscience and today remains the “gold standard” for deep brain imaging. Recent improvements in imaging technology have been somewhat limited to incremental innovations of mature techniques instead of breakthroughs. Recently, the use of ultrasonic plane waves transmitted at ultrafast frame rates was shown to highly increase Doppler ultrasound sensitivity to blood flows in small vessels in rodents. By identifying regions of brain activation through neurovascular coupling, Ultrafast Doppler was entering into the world of preclinical neuroimaging. The combination of many advantages, including high spatio-temporal resolution, deep penetration, high sensitivity and portability provided unique information about brain function. Ultrafast Recently, Ultrafast Doppler imaging was found able to non-invasively image the spatial and temporal dynamics of microvascular changes during seizures and interictal periods with an unprecedented resolution at bedside. This talk will be based on the technical basis, the added value and the clinical perspectives provided by this new brain imaging modality that could create a breakthrough in the knowledge of brain hemodynamics, brain insult, and neuroprotection [1] , [2] , [3] .

PRospective Imaging of CErvical cancer and neoadjuvant treatment (PRICE) study: role of ultrasound to assess residual tumor in locally advanced cervical cancer patients undergoing chemoradiation and radical surgery

To determine the diagnostic performance of two-dimensional (2D) ultrasound parameters, three-dimensional (3D) power Doppler and contrast-enhanced indices in detecting residual disease in locally advanced cervical cancer patients triaged to neoadjuvant treatment followed by radical surgery. Between October 2010 and June 2014, we screened 108 women with histologically documented locally advanced cervical cancer Stage IB2-IVA, of whom 88 were included in the final analysis. 2D ultrasound parameters, 3D power Doppler and contrast-ultrasound parameters were assessed 5 weeks after the end of neoadjuvant chemoradiation therapy. The pathological response was defined as complete (absence of any residual tumor after treatment) or partial (including microscopic and/or macroscopic residual tumor at pathology examination). The two response groups were compared and receiver-operating characteristics (ROC) curves generated to determine the best cut-off value of sonographic tumor diameter to predict residual disease. Histology was considered as reference. Complete pathological response to chemoradiation was observed in 40 (45.5%) patients and partial response in 48 (54.5%). The presence of residual disease, as confirmed at pathology examination, was detected by 2D grayscale ultrasound with a sensitivity of 64.6% and specificity of 65%. Color Doppler examination in the cases with lesions visualized on grayscale imaging detected the presence of residual disease, confirmed at pathology, with a sensitivity of 87.1% and specificity of 21.4%. The best area under the ROC curve (0.817) was for the detection of pathological residual disease of at least 6 mm in diameter, using a cut-off value of 12 mm for the largest tumor diameter assessed using 2D grayscale ultrasound (sensitivity, 95%; specificity, 70.6%). Neither 3D vascular indices nor contrast-ultrasound parameters obtained for lesions suspected at ultrasound following chemoradiation differed significantly between patients with histological complete and those with partial response. Our results show that grayscale and color Doppler ultrasound have a low level of diagnostic performance in detecting residual disease after neoadjuvant chemoradiation in patients with locally advanced cervical cancer. The best performance was achieved in detection of macroscopic (≥ 6 mm) residual disease. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Prospective observational study of point-of-care ultrasound for diagnosing pneumonia

ObjectivesThe clinical diagnosis of pneumonia lacks specificity and may lead to antibiotic overuse, whereas radiological diagnoses can lack sensitivity. Point-of-care lung ultrasound is an emerging diagnostic tool. There are limited...