Ultrasonic Diagnosis Research Articles

Value of three-vessel and trachea view plus aortic arch coronal section in ultrasonic diagnosis and classification of fetal right aortic arch

Objective To explore the value of three-vessel and trachea(3VT) view plus aortic arch coronal section in ultrasonic diagnosis and classification of fetal right aortic arch(RAA). Methods Echocardiography data and follow-up results of 44 fetuses with RAA were retrospectively analyzed. Sonographic features on 3VT view and aortic arch coronal section were summarized. Results Among 44 fetuses with RAA, 27 cases(61.36%) were RAA with aberrant left subclavian artery(ALSA) and the left ductus arteriosus(LDA) connecting the ALSA and U-shaped vascular ring was formed; 17 cases(38.64%) were mirror right aortic arch(MRAA). Among 17 cases with MRAA, 3 cases were with LDA connecting the descending aorta(DAO) and U-shaped vascular ring was formed; 1 case was with LDA connecting the left innominate artery(LINA), 8 cases were with absent ductus arteriosus(ADA), 5 case were with right ductus arteriosus(RDA), no vascular ring was formed. Parts of MRAA were combined with other complex intracardiac abnormalities. RAA-ALSA-LDA were rarely combined with intracardiac abnormalities. Conclusions 3VT view is simple and intuitive for diagnosing RAA. Aortic arch coronal section has great clinical value in determining the concrete type of RAA. Key words: Echocardiography; Fetus; Aortic disease; Three-vessel and trachea view; Aortic arch coronal section

Spectrums and Outcomes of Adnexal Torsion at Different Ages.

To investigate the role of ultrasound in the preoperative diagnosis of adnexal torsion and describe its histological spectrum and outcomes at different ages. This study comprised a retrospective investigation of a data set that included 195 female patients with clinically suspected adnexal torsion between January 2010 and July 2015. Each patient received a detailed pelvic ultrasound examination by an experienced ultrasound examiner, and a definitive diagnosis was achieved via surgery. The accuracy of an ultrasonic diagnosis of adnexal torsion was assessed. The patients were divided into three groups: female children and adolescents, fertile women, and postmenopausal women. The size, type, histological spectrum, and outcome of adnexal torsion in the different groups were also described. The sensitivity, specificity, and accuracy of ultrasound were 0.84, 0.77, and 0.81, respectively. There were significant differences in the presence of ultrasonic hallmarks among the true positive, false positive, and false negative cases of adnexal torsion. Ovarian torsion was identified in 94 cases, and isolated tubal torsion was identified in 15 cases. The most common histologic diagnoses of the pediatric group and the other two groups were a normal ovary and teratoma, respectively. The most common histologic diagnoses in the cases of isolated tubal torsion were mesosalpinx cyst and oviduct inflammation. Ultrasonography plays an important role in the preoperative diagnosis of adnexal torsion. Despite ovarian involvement in most of the cases, isolated oviduct torsion was not uncommon. The spectrum of histological diagnoses varied among the age groups.

Prenatal ultrasonic diagnosis and differential diagnosis of isolated right aortic arch with mirror-image branching.

This study sought to evaluate the fetal echocardiography features of isolated right aortic arch (RAA) with mirror-image branching and to improve the rate and accuracy of prenatal diagnosis of this condition. We reviewed fetal echocardiograms from all cases of isolated RAA with mirror-image branching diagnosed at our institution between August 2012 and December 2015 and classified these cases into normal and abnormal types of ductus arteriosus based on the course of the arterial duct arch. We confirmed the diagnoses by postnatal echocardiography. A total of 11 cases of isolated RAA with mirror-image branching, with the left ductus and the descending aorta located on the left side of the spine, were diagnosed using fetal echocardiography. Ten cases involved normal ductus arteriosus, with the left ductus connecting the left pulmonary artery to the descending aorta, five of which were referred to our institution for suspicions of double aortic aorta. 1 case involved abnormal ductus arteriosus, with the left ductus connecting the left pulmonary artery to the left innominate artery. RAA with mirror-image branching can be detected via fetal echocardiography, which can reveal the relationship between of the aortic arch and the trachea and can enable the identification of the course of brachiocephalic branching. The identification of isolated RAA with mirror-image branching is crucial for distinguishing this condition from other types of aortic arch anomalies, particularly double aortic aorta, which can have a rather different prognosis.

Comparison between ultrasonography and magnetic resonance imaging in diagnosis of breast tumor

Objective To compared the clinical diagnostic value of ultrasound and magnetic resonance imaging(MRI)in breast tumor. Methods A total of 30 patients with breast disease who were admitted from January 2015 to January 2016.All patients were performed ultrasound and MRI.The postoperative pathological examination results were taken as the diagnostic criteria, the accuracy of ultrasound and MRI were compared. Results The accuracy of MRI diagnosis in breast tumor(86.9%)was significantly higher than the accuracy of ultrasonic diagnosis(39.3%). The sensitivity and specificity of MRI was significantly higher than those in ultrasonic diagnosis, the rate of missed diagnosis and misdiagnosis was significantly lower than that of ultrasonic, the differences were all statistically significant(P<0.05). Conclusion The accuracy of MRI in diagnosing breast tumors is higher than that of ultrasonography, although the price is more expensive, which can be used as a useful supplement to other inspection methods. Key words: Ultrasonography; Magnetic resonance imaging; Breast tumor

Design and evaluation of medical ultrasonic adaptive beamforming algorithm implementation on heterogeneous embedded computing platform

Medical ultrasonic imaging has been utilized in a variety of clinical diagnoses for many years. Recently, because of the needs of portable and mobile medical ultrasonic diagnoses, the development of real-time medical ultrasonic imaging algorithms on embedded computing platforms is a rising research direction. Typically, delay-and-sum beamforming algorithm is implemented on embedded medical ultrasonic scanners. Such algorithm is the easiest to implement at real-time frame rate, but the image quality of this algorithm is not high enough for complicated diagnostic cases. As a result, minimum-variance adaptive beamforming algorithm for medical ultrasonic imaging is considered in this paper, which shows much higher image quality than that of delay-and-sum beamforming algorithm. However, minimum-variance adaptive beamforming algorithm is a complicated algorithm with O(n3) computational complexity. Consequently, it is not easy to implement such algorithm on embedded computing platform at real-time frame rate. On the other hand, GPU is a well-known parallel computing platform for image processing. Therefore, embedded GPU computing platform is considered as a potential real-time implementation platform of minimum-variance beamforming algorithm in this paper. By applying the described effective implementation strategies, the GPU implementation of minimum-variance beamforming algorithm performed more than 100 times faster than the ARM implementation on the same heterogeneous embedded platform. Furthermore, platform power consumptions, computation energy efficiency, and platform cost efficiency of the experimental heterogeneous embedded platforms were also evaluated, which demonstrated that the investigated heterogeneous embedded computing platforms were suitable for real-time portable or mobile high-quality medical ultrasonic imaging device constructions.

Factors controlling fetal echocardiography determine the diagnostic accuracy of isolated ventricular septal defect.

Fetal echocardiography (FECG) is a key screening tool for prenatal cardiac abnormalities. Herein, we examined the ultrasonic factors determining prenatal ultrasonic diagnosis of isolated ventricular septal defect (IVSD). The diagnostic role of ultrasonic factors was investigated in patients in middle or late pregnancy, diagnosed with IVSD by FECG and confirmed using postnatal echocardiography. One hundred and six patients with IVSD were enrolled; the majority had perimembranous VSD. The combined imaging mode of 2 dimentional-echocardiography (2DE) and color doppler flow imaging (CDFI) showed the highest rate (56.6%) of IVSD detection, while CDFIwas more efficient than 2DE (32.1% vs. 11.3%). The single-view mode was more efficient than multiple-view mode (75.5% vs. 24.5%). The highest efficient mode to detect IVSD was achieved using combined imaging mode on the single view of the left ventricular outflow tract view (LVOTV) (28.3%). FECG correctly classified 71.7% of fetal IVSD. There was a significant difference of accuracy rate in classifying IVSD among the three different imaging modes (χ 2=7.141, P<0.05). The single imaging mode of CDFIand the mode of CDFIcombined with 2DE correctly classified 75.9% and 75.0% of fetal IVSD, respectively. LVOTV was the most accurate view of fetal IVSD classification (85.2%; χ 2=15.782, P<0.05). There was no difference in accuracies of IVSD classification among multiple-view modes (χ 2=2.343, P>0.05) or between single-view mode and multiple-view mode (χ 2=0.32, P>0.05). Single LVOTV in CDFIor CDFIcombined with 2DE of FECG were the most effective diagnostic modes for fetal IVSD diagnosis.

A New Diagnosis Standard for Enterovesical Fistula in Crohn's Disease by Intracavitary Contrast-Enhanced Ultrasound

Enterovesical fistula is a relatively rare condition complicating Crohn's disease (CD), often requiring surgical treatment [1]. Ascertaining the presence of fistula and visualization of its anatomy are important for undertaking a decision for surgery and may impact the operative strategy. However, conventional x-ray studies often fail to demonstrate the fistula tract. Ultrasonography (US), computed tomography (CT) and magnetic resonance (MR) imaging have a high sensitivity and specificity for the diagnosis of intra-abdominal fistulas, with similar diagnostic accuracies [2]. However, these methods may still fall short of detection of occult and complex fistulas and/or delineating their tracts. Intra-cavitary contrast-enhanced ultrasound (IC-CEUS) was recently proved useful for detecting biliary tract and perianal fistula by locally-injected contrast agent [3-4]. Compared with CT and MR, IC-CEUS has the advantages of non-ionizing radiation and cost-efficacy. We describe the feasibility of IC-CEUS for detection of entero-vesical fistula in a patient with CD using surgery as reference standard. Our center is one of the starting area of the first domestic CD bowel ultrasound unit, has accumulated more than 600 cases, this paper reviews the literature at home and abroad, and combined with the ultrasonic diagnosis and the experience with abdominal abscess on CD interventional therapy – catheter drainage in 30 cases is discussed.

超音波診断用CMUTの積層薄膜構造の検討

This research reports thin films composition of vibrating film on capacitive micromachined ultrasonic transducers (CMUT) for ultrasonic diagnoses. The CMUT constitutes an electrostatically vibrating film, which is fabricated by deposition processes of SiO2 and SiN films as insulator and TiN and Al films as top electrode on an Si substrate. The ultrasonic waves are transmitted by addition of AC voltage between the top electrode of vibrating film and the Si substrate, whereas the reflective ultrasonic wave are received with the vibrating film and converted to the electrical signals for ultrasonic diagnostic images. When the vibrating film is initially deformed by an internal stress of the stacked thin films, the transmitting strength of ultrasonic waves and the capacitance change by receiving reflective ultrasonic waves are not enough to achieve a high sensitivity. Thus, the thickness of SiO2 and SiN films was analytically and experimentally determined to achieve the flat vibrating film. Accordingly, a 300-nm-thick SiO2 film with a compressive stress of 150 MPa and a 1700-nm-thick SiN film with a tensile stress of 100 MPa were decided as one proper films composition. Also, the prototype CMUT can acquire an image of sponge simulated a test body.

妊婦超音波検査支援ロボットの開発

We have been developing a prenatal care robot for supporting an ultrasonic diagnosis. In this paper, we intend to develop a core function for both obtaining clear images without lacks and ensuring a safety of pregnant women. In order to minimize the lack, the ultrasonic probe is operated for maintaining it perpendicular to the body surface. For safety, the number of actuators achieving those motions is minimized and most joints are moved passively. From results, it was confirmed that the ultrasonic probe follows the body surface smoothly and touches approximately vertically. We show the possibility of the proposed function for obtaining images with little lacks.

Evaluation of the Usefulness of Quantitative Shear Wave Elastography for Differentiating Benign and Malignant Salivary Gland Tumors

Elastography is a technique for assessing hardness and includes both qualitative and quantitative approaches. The utility of quantitative shear wave elastography (SWE) for the differential diagnosis of salivary gland tumors is unclear. Hence, we investigated this by comparing the results of Virtual Touch Quantification (VTQ), a form of quantitative SWE, of different salivary gland tumors. Patients with salivary gland tumors who underwent ultrasonography in our department between July 2014 and April 2017 and had a cytological or histological diagnosis were included. The ultrasonic diagnosis device used was the ACUSON S2000 (Siemens Medical Solutions USA, Inc. Malvern, PA, USA). A solid part of the tumor was selected for measurement with VTQ. For VTQ, the shear wave speed was calculated within a 5-mm square ROI; instances where calculation was impossible are indicated with x.xx. Thus, the feasibility of VTQ measurement and the measured value (m/s) of each tumor were compared. Seventy-one cases were benign tumors (45 Warthin's tumors and 26 pleomorphic adenomas) and 15 cases were malignant tumors. The VTQ measurability ratio and measured value medians were 70.4% and 2.44, respectively, for the benign tumors (82.2% and 2.35 for Warthin's tumor, 50% and 2.76 for pleomorphic adenoma) and 13.3% and 1.58, respectively, for the malignant tumors. VTQ successfully measured most cases of Warthin's tumors, but failed to measure malignant tumors and pleomorphic adenomas. Because of this low rate, the utility of the measured values could not be determined. However, when a measurement was possible, this had the potential to aid in the prediction of benign tumors, especially Warthin's tumor, which can be followed-up with observation.

Partial discharge diagnosis of ceramic pin insulators considering cost-worth analysis: Case study in a medium voltage feeder

Power distribution networks have extensive and long length medium voltage (MV) feeders due to direct contact with the customer. Network extension will be followed by an increase in the number of installed insulators. Pin ceramic insulators cause various problems for the operation of the distribution network because they are made of two-piece (TP). The expansion and contraction of cementitious material between two pieces of insulators create some defects for poor quality of production and critical conditions of insulation problem for these insulators. In this paper, the ultrasonic diagnosis method based on monitoring of partial discharge (PD) signals of TP pin ceramic insulators have been studied and the leakage losses of these insulators in network conditions for a MV feeder of North Khorasan Electrical Distribution Company (NKEDC), called Khanloq feeder, were calculated. Finally, the economic consideration of a sample project of insulator replacement and estimating the project investment return for Khanloq feeder by using PD signals analysis have been discussed.

Acoustic Impedance Analysis with High-Frequency Ultrasound for Identification of Fatty Acid Species in the Liver

Acoustic properties of free fatty acids present in the liver were studied as a possible basis for non-invasive ultrasonic diagnosis of non-alcoholic steatohepatitis. Acoustic impedance was measured for the following types of tissue samples: Four pathologic types of mouse liver, five kinds of FFAs in solvent and five kinds of FFAs in cultured Huh-7 cells. A transducer with an 80-MHz center frequency was incorporated into a scanning acoustic microscopy system. Acoustic impedance was calculated from the amplitude of the signal reflected from the specimen surface. The Kruskal–Wallis test revealed statistically significant differences (p < 0.01) in acoustic impedance not only among pathologic types, but also among the FFAs in solvent and in cultured Huh-7 cells. These results suggest that each of the FFAs, especially palmitate, oleate and palmitoleate acid, can be distinguished from each other, regardless of whether they were in solution or absorbed by cells.

The ultrasonic diagnosis of piriform sinus fistula and the thyroid abscess caused by it

The ultrasonic diagnosis of piriform sinus fistula and the thyroid abscess caused by it

Value of ultrasonography in differential diagnosis of granulomatous lobular mastitis and breast cancer

Objective To investigate the value of color Doppler ultrasonography in differential diagnosis of granulomatous lobular mastitis (GLM) and breast cancer. Methods Preoperative sonograms of 45 GLM, 115 invasive ductal carcinoma (IDC) and 90 ductal carcinoma in situ (DCIS) patients were retrospectively analyzed and further confirmed by histopathology. Results The average age of patients in GLM group was obviously younger than those in IDC and DCIS groups(P<0.001). The size of mass lesion in GLM group was significantly larger than those in IDC and DCIS groups(P<0.001). Compared to IDC group, GLM group showed higher detection rate of liquidity area and mammary ductal ectasia (P<0.01), while less lesions with irregular shape, large A/T ratios (≥0.7), calcification, spiculate margin, peripheral hyperechoic zone or posterior echo attenuation (P<0.05). There were more lesions with spiculate margin, liquidity area or axillary lymph node enlargement found in GLM group than in DCIS group (P<0.01), but less calcification (P<0.001). The accordance rate of ultrasonic diagnosis and postoperative histopathology results in 45 GLM patients was 33.3%(15/45). Conclusions GLM shows the characteristic sonographic findings. In addition, there are some differences between GLM and both IDC & DCIS, such as spiculate margin, peripheral hyperechoic zone, blood flow richness and axillary lymph node enlargement. Combined with the clinical data, understanding the sonographic features of GLM is beneficial to its differential diagnosis with breast cancer. Key words: Ultrasonography; Granulomatous mastitis; Diagnosis, differential

Diagnosis and treatment of breast cancer during pregnancy: a review of twelve cases

Objective To investigate the principles of diagnosis and treatment of breast cancer during pregnancy. Methods Clinical data of twelve patients with breast cancer during pregnancy admitted to Peking Union Medical College Hospital between January 1995 and October 2015 were analyzed retrospectively. Follow-up studies on the prognosis of the mothers and infants and the long-term survival were carried out, and data were analyzed with descriptive statistical analysis. Results Of these twelve patients, eleven were diagnosed with breast cancer preliminarily by ultrasound. In the remaining one who presented with paraneoplastic neurological syndrome, breast tumor was discovered by the whole-body positron emission tomography/computed tomography (PET-CT) examination after emergent cesarean section. The mean gestational age at ultrasonic diagnosis in the eleven patients was (26.3±3.0) weeks, and all of them received surgical treatment during pregnancy. The mean gestational age at surgery was (28.2±4.4) weeks. Ten patients with epithelial tumor underwent modified radical mastectomy. One patient with breast malignant phyllodes tumor received local extended lumpectomy. Postoperative pathological staging revealed one patient with stage Ⅰa, two with stage Ⅱa, one with stage Ⅱb, six with stage Ⅲa, and one with stage Ⅲb. The patient with paraneoplastic neurological syndrome was diagnosed as having stage Ⅳ breast cancer, and received chemotherapy, radiotherapy and endocrinotherapy. One patient received chemotherapy during pregnancy. None of the patients received radiotherapy during pregnancy. All twelve patients, except one with breast malignant phyllodes tumor, received postpartum adjuvant therapy. All patients were followed up regularly. Five patients were followed up for more than five years, the progression-free survival rate was 4/5 and the overall survival was 5/5. The other seven patients were followed up for less than five years, the progression-free survival rate was 6/7 and the overall survival was 7/7. Eleven of the twelve patients had live birth. Eleven cases received cesarean section at (36.5±2.8) gestational weeks, and the other one had mid-trimester induction of labor at 27 gestational weeks. Of four premature infants, three were sent to neonatal intensive care unit because of neonatal respiratory distress syndrome, and one died of intracranial hemorrhage. The prognosis of the ten survived infants was good. Conclusions Breast cancer is one of the most common malignant tumors during pregnancy, and it often presents in more advanced stages compared with that in non-pregnant women. Multidisciplinary cooperation and detailed assessment of maternal-fetal risks and benefits are necessary. Key words: Pregnancy complications, neoplastic; Breast neoplasms; Pregnancy outcome

Value of ultrasound in obstetrics and gynecology emergency in diagnosis and differential diagnosis

Objective To explore the value of ultrasonography in the diagnosis and identification of Obstetrics and Gynecology in accident and emergency. Methods A retrospective method was taken to 80 cases of obstetrics and gynecology emergency patients with ultrasound diagnosis data analysis in the hospital from June 2014 to June 2015, and compared to surgical and pathological diagnosis, to observe the ultrasonic diagnosis value. Results The correct rate of the ultrasound diagnosis of ectopic pregnancy, ovarian cyst torsion, inevitable abortion, threatened abortion, corpus luteum rupture, trophoblastic disease, and acute pelvic inflammatory disease was 90.9%, 94.1%, 100.0%, 100.0%, 85.7% , 75.0%, and 100.0%, and the overall diagnostic accuracy was 93.8%. Conclusions The Emergency Department of obstetrics and gynecology patients used ultrasound has a better diagnosis effect, and high diagnostic accuracy. At the same time, the ultrasound examination is gynecology and obstetrics emergency check the preferred way, strong repeatability, and better observed lesions, high application value. Key words: Ultrasonography; Emergencies; Genital diseases, female/US; Pregnancy complications/US; Diagnosis, differential

Tissue characterization of skin ulcer for bacterial infection by multiple statistical analysis of echo amplitude envelope

To characterize skin ulcers for bacterial infection, quantitative ultrasound (QUS) parameters were estimated by the multiple statistical analysis of the echo amplitude envelope based on both Weibull and generalized gamma distributions and the ratio of mean to standard deviation of the echo amplitude envelope. Measurement objects were three rat models (noninfection, critical colonization, and infection models). Ultrasound data were acquired using a modified ultrasonic diagnosis system with a center frequency of 11 MHz. In parallel, histopathological images and two-dimensional map of speed of sound (SoS) were observed. It was possible to detect typical tissue characteristics such as infection by focusing on the relationship of QUS parameters and to indicate the characteristic differences that were consistent with the scatterer structure. Additionally, the histopathological characteristics and SoS of noninfected and infected tissues were matched to the characteristics of QUS parameters in each rat model.

Ultrasonic diagnosis of patients with clonorchiasis and preliminary study of pathogenic mechanism.

To discuss the liver function damage mechanism of patients with clonorchiasis by analyzing the ultrasound characteristics, liver function, change of the serum inflammatory factors and cell apoptosis factors. Color Doppler ultrasound technique was adopted to detect the portal vein and blood flow change of patients with clonorchiasis; ELISA was used to determine the level of different serum inflammatory factors. The levels of serum total bilirubin, serum albumin and glutamic-pyruvic transaminase were detected by automatic biochemical analyzer. Western blot was used to determine the expression of proteins relevant to apoptosis. Compared with the health control group, the trunk diameter of portal vein and the thickness of spleen, as well as the hepatic artery pulsation index of clonorchiasis patients increased obviously, the mean blood flow velocity of portal vein (P<0.05 or P<0.01) decreased. The content of total bilirubin and transaminase in plasma increased significantly, but albumin decreased (P<0.05). Levels of TNF-α, IL-6 and IFN-γ increased remarkably, and the level of every factor was significantly different among patients with Child-Pugh , Child-Pugh II and Child-Pugh III classification of liver function (P<0.05 or P<0.01). With the exacerbation of liver dysfunction, levels of TNF-α, IL-6 and IFN-γ gradually increased (P<0.05). Compared with the healthy control group, the expression quantity of apoptosis protein Fas, FasL, Bax and Caspase-3 increased significantly (P<0.05 or P<0.01), but Bcl-2 decreased (P<0.05). Changes of ultrasonic characteristics and liver dysfunction, caused by liver fluke infection, may be related to that both inflammatory response and apoptosis response have participated in the pathogenic process and liver damage course of clonorchiasis.

Analysis of only 0-1 min clip or 1-4 min Clip for focal liver lesions during contrast-enhanced ultrasonography

Purpose: To evaluate the reliability of analysis of only 0-1min clips and 1-4min clips versus the entire clips in performing contrast-enhanced ultrasonography (CEUS) of focal liver lesions (FLLs).Methods: Contrast-enhanced ultrasonography (CEUS) examinations of 43 single FLLs were performed. All clips were analyzed in three ways, the entire clips, 0-1 min clips and 1-4 min clips, benign or malignant diagnosis and pathological diagnosis of each FLL were concluded by the three ways subsequently.Results: The results of correct diagnosis were assessed using Chi-square test. There was no difference with regard to benign or malignant diagnosis, between 0-1min clips and the entire clips, or between 1-4 min clips and the entire clips (p = 0.243 and p = 0.747, respectively). Moreover, no significant differences in pathological diagnosis existed between 0-1min clips and the entire clips, and 1- 4min clips versus entire clips (p=0.808 and p = 0.808, respectively). No significant differences existed among CEUS entire clip, 0-1min clip and 1-4min clip in identifying FLLs, and based on which the diagnosis of two different FLLs during CEUS with only one injection of contrast agent can be available.Conclusion: Only 0-1min clips or 1-4 min clips can be used to instead of the entre clip in performing CEUS of FLLs.Keywords: Focal liver lesions, Contrast-enhanced ultrasonography, Ultrasonic diagnosis, Clips

Clinical analysis of lymphocytic thyroiditis coexistent with papillary thyroid carcinoma

To analyse the clinical features and treatment strategies of papillary thyroid carcinoma(PTC) coexistent with lymphocytic thyroiditis (LT). A total of 292 patients including 25 males and 267 females with LT and thyroid nodules treated in the department of head and neck surgery between Sep 2011 and Sep 2014 was analysed retrospectively and divided into two groups according to pathological results, of them 262 patients, with a median age of 47 years old, were LT with PTC and 30 patients, with a median age of 54 years old, were LT with benign nodules. Among 262 patients having LT with PTC, 259 were diagnosed as having malignant or suspicious malignant nodules and 3 having benign nodules with ultrasound before surgery, 98 cases were considered multifocal malignant nodules by preoperative ultrasound, and 112 cases were positive in cervical lymph nodes, including bilateral positive in 37 cases. Of 30 patients having LT with benign nodules, 14 were diagnosed malignant or suspicious malignant nodules and 16 benign nodules. The mean age in 262 patients with PTC was less significantly than that in 30 patients with benign nodules (P<0.05). Ultrasound showed a high proportion of calcification and microcalcification in patients with PTC (34%) compared to patients with benign nodules(13%)(P<0.05). There were not significant differences in the mean levels of serum thyroid stimulating hormone(TSH) (2.80 vs 2.99 mU/L, P=0.233), thyroglobulin(TG) (27.14 vs 18.60 μg/L, P=0.747), and anti-thyroglobulin antibodies(ATG)(417.3 vs 378.7 U/ml, P=0.834) between patients with PTC and those with benign nodules. In patients with PTC, multifocal tumor accounted for 42%. The central and lateral lymph node metastasis rates were respectively 50% and 24%, and the occult metastasis rate of lateral neck lymph node was 16%. Univariate analysis showed that age less than 45 years old, multifocal tumor, tumor diameter more than or equal to 2cm and extrathyroidal extension were associated with central lymph node metastasis (P<0.05), but not with lateral neck metastasis. Multivariate analysis showed a closed correlation only between the lymph node metastases in central and lateral neck levels (P<0.05). Calcification and microcalcification have the same importance in the ultrasonic diagnosis for PTC in patients with LT. Total thyroidectomy and prophylactic central lymph node should be a choice for LT with PTC. Lymph node metastasis in level Ⅵ indicates the possibility of lateral cervical lymph node metastasis in the patients having LT with PTC.