Ultrasonography In Differential Diagnosis Research Articles

Transcranial sonography in differential diagnosis of Parkinson disease and other movement disorders.

Background:Reports evaluating the efficacy of transcranial sonography (TCS) for the differential diagnosis of Parkinson disease (PD) and other movement disorders in China are scarce. Therefore, this study aimed to assess the application of TCS for the differential diagnosis of PD, multiple system atrophy (MSA), progressive supranuclear palsy (PSP), and essential tremor (ET) in Chinese individuals.Methods:From 2017 to 2019, 500 inpatients treated at the Department of Dyskinesia, Beijing Tiantan Hospital, Capital Medical University underwent routine transcranial ultrasound examination. The cross-sections at the midbrain and thalamus levels were scanned, and the incidence rates of substantia nigra (SN) positivity and the incidence rates of lenticular hyperechoic area were recorded. The echo of the SN was manually measured.Results:Of the 500 patients, 125 were excluded due to poor signal in temporal window sound transmission. Among the 375 individuals with good temporal window sound transmission, 200 were diagnosed with PD, 90 with ET, 50 with MSA, and 35 with PSP. The incidence rates of SN positivity differed significantly among the four patient groups (χ2 = 121.061, P < 0.001). Between-group comparisons were performed, and the PD group showed a higher SN positivity rate than the ET (χ2 = 94.898, P < 0.017), MSA (χ2 = 57.619, P < 0.017), and PSP (χ2 = 37.687, P < 0.017) groups. SN positivity showed a good diagnostic value for differentiating PD from the other three movement diseases, collectively or individually. The incidences of lenticular hyperechoic area significantly differed among the four patient groups (χ2 = 38.904, P < 0.001). Next, between-group comparisons were performed. The lenticular hyperechoic area was higher in the PD group than in the ET (χ2 = 6.714, P < 0.017) and MSA (χ2 = 18.680, P < 0.017) groups but lower than that in the PSP group (χ2 = 0.679, P > 0.017).Conclusion:SN positivity could effectively differentiate PD from ET, PSP, and MSA in a Chinese population.

Value of Contrast-Enhanced Ultrasound in Differential Diagnosis of Focal Liver Lesions

The article discusses the modern possibilities of identifying inflammatory bowel diseases using methods of radiation diagnosis. Methods of radiation diagnostics help determine the stages of inflammatory bowel diseases helping in timely diagnosis, prescription and timely correction of therapy. The use of an adequate amount of diagnostic measures allows early detection of complications requiring immediate surgical treatment, such as fibrostenotic lesions, fistulae, and abscesses.The sources of the review were publications included in peer-reviewed databases E-library, PubMed, GoogleScholar, conference materials and non-indexed publications, including web pages of conferences and repositories of scientific data from universities.

Ultrasound Differential Diagnosis and Prognosis of Right Main Bronchus Atresia in Fetus: Clinical Case

Background. Obstructive lesion of upper respiratory tract in fetus is extremely rare pathology with adverse perinatal outcomes.Clinical Case Description. Ultrasound examination of fetus (gestational age 21 weeks 6 days) has revealed one-sided isolated main bronchus atresia. Atresia was presented as enlargement of right lung due to mucus accumulation, its increased echogenicity, mediastinal displacement to the left and left lung size reduction. We performed differential diagnosis with cystic-adenomatous lung malformation type III, congenital lobar emphysema and pulmonary sequestration. These conditions are also characterized by lung echogenicity and volume increase but they are usually limited to one lung lobe or segment, and pulmonary sequestration has a systemic blood supply. The use of high-frequency transducers, lung vessels Doppler imaging and volume echography allow us to investigate in detail the lung structure of the fetus, correctly calculate the lungs volume and timely the main bronchus atresia at the second trimester of pregnancy.Conclusion. The ultrasound diagnosis of isolated main bronchus atresia is based on revealing of increased lung volume on ipsilateral side, its increased echogenicity, presence of hypoechogenic linear tubular structures (bronchocele), mediastinal displacement to the opposite side and extreme hypoplasia of the contralateral lung. Prognosis for the life is unfavorable.

Conventional Ultrasound Combined With Contrast-Enhanced Ultrasound in Differential Diagnosis of Gallbladder Cholesterol and Adenomatous Polyps (1-2 cm).

This study aimed to determine ultrasonic image characteristics that enable differentiation between cholesterol and adenomatous polyps and to assess the diagnostic efficacy of combining conventional ultrasound (CUS) with contrast-enhanced ultrasound (CEUS). Eighty-nine patients with gallbladder polyps of 1-2 cm in diameter were enrolled and examined by CUS and CEUS before cholecystectomy. The appearances on CUS and CEUS were recorded and analyzed. The receiver operating characteristic (ROC) curve was used to calculate the optimal size threshold for distinguishing cholesterol from adenomatous polyps. A logistic regression analysis was performed to identify diagnostic variables. ROC analysis was performed to evaluate the diagnostic efficacy of the size, the independent variables, and the combined factors. There were differences in size, number, vascularity on CUS and intralesional vascular shape, wash-out, and area under the curve on CEUS between the two groups (P< .05). ROC analysis indicated that a maximum diameter of 1.45 cm was the optimal threshold for the prediction of adenomatous polyps. The logistic regression analysis proved that the single polyp, presence of vascularity, and intralesional linear vessels were associated with adenomatous polyps (P< .05). ROC analysis showed that the area under the ROC curve, sensitivity, and specificity for the combination of the three independent variables were 0.858, 87.3%, and 67.6%. The number combined with intralesional vascular shape had the highest diagnostic sensitivity of 91.2%. The combination of CUS and CEUS demonstrated great significance in the differential diagnosis of cholesterol and adenomatous polyps.

超声检查鉴别诊断甲状腺结节良恶性的研究进展

超声检查鉴别诊断甲状腺结节良恶性的研究进展

Grayscale Color Mapping with the Mathematical Analysis of an Ultrasound Image in the Differential Diagnosis of Cystic and Solid Breast Masses

Objective. Atypical breast cysts are often quite a serious problem in noninvasive ultrasound differential diagnosis. To develop a system for automated analysis of grayscale ultrasound images, which on the principles of mathematical processing would make it possible to increase the specificity of diagnosis in this situation.Material and methods. The authors developed the CystChecker 1.0 software package. To test this system, they used a set of 217 ultrasound images: 107 cystic (including 53 atypical lesions that were hardly differentially diagnosed by standard methods) and 110 solid (both benign and malignant) breast masses. All the masses were verified by cytology and/or histology. Visual assessment was carried out analyzing grayscale ultrasound, color/power Doppler, and elastography images.Results. Using the system developed by the authors could correctly identify all (n = 107 (100%)) typical cysts, 107 (97.3%) of 110 solid masses, and 50 (94.3%) of 53 atypical cysts. On the contrary, the standard visual assessment provided a possibility of correctly identifying all (n = 107 (100%)) typical cysts, 96 (87.3%) of 110 solid masses, and 32 (60.4%) of 53 atypical cysts (p &lt; 0.05). The corresponding values of the overall specificity of automated and visual assessments were 98 and 87%, respectively.Conclusion. Using the system developed by the authors for automated analysis provides a higher specificity than the visual assessment of an ultrasound image, which is carried out by a qualified specialist.

Differential diagnosis of

To assess the combined diagnostic strategy of contrast-enhanced ultrasound (CEUS) and acoustic radiation force impulse (ARFI) in the precise differential diagnosis of clear cell renal cell carcinoma (CCRCC) and urothelium carcinoma of the renal pelvis (UCRP) with other small renal tumors (SRTs) ＜3 cm in size. The elastography self-corrected CEUS (ESC) mode was established to perform the quantitative differential diagnosis of SRTs (<3 cm). The kidney shear wave velocity (SWV) value recorded by ARFI showed substantial variability in patients with CCRCC (high elasticity value) and UCRP (low elasticity value) compared with other renal masses, thus providing critical self-correction information for the ultrasound differential diagnosis of SRTs. In this work, the ESC observations and the corresponding ESC criteria show a remarkable 94.6% accuracy in reference to the gold standards, thus allowing the quantitative, early triple distinction of CCRCC with UCRP and other SRTs in patients with suspicious SRTs. This ARFI self-corrected CEUS diagnostic strategy is far beyond a screening method and may have the potential to identify a window of therapeutic opportunity in which emerging therapies might be applied to patients with CCRCC and UCRP, reducing overtreatment and medical costs. In our study, a new rapid and non-invasive elastography self-corrected CEUS (ESC) ultrasound imaging mode was developed, which was useful in the triple distinction of CCRCC, UCRP, and other SRTs with 94.6% accuracy. ESC is a promising method in the differential diagnosis of SRTs with accuracy and practicability far beyond a single screening model.

Lung Ultrasound in Differential Diagnosis of Dyspnea

Lung Ultrasound in Differential Diagnosis of Dyspnea Abstract. Lung ultrasound offers an immediate diagnosis in accordance with the clinical examination in many causes of dyspnea: pleural effusion, pulmonary edema, pneumonia, pulmonary embolism and interstitial lung diseases. At first level exam, CXR, despite its intrinsic limitations and low accuracy, may still play a relevant role. CT scan remains the gold standard, but it requires patient transportation and use of radiation, which precludes an extensive use especially within the same patient. Lung ultrasound, after proper training of the physician, is able to provide greater accuracy than CXR and similar accuracy to the CT scan.

Acute scrotum in children and the role of Doppler sonography in differential diagnosis

Sixty-one patients aged from 2 months to 17 years who were hospitalized between 02.01.2017- 25.05.2019 in the Department of Pediatric Surgery for acute scrotum were investigated by Doppler sonography with S onoscape2 ultrasound equipped with a high-frequency 7-11 MHz linear transducer. Testicular appendage torsion was reported in 49 children, 6 patients were with testicular torsion and 4 were with orchiectomy. Five patients were diagnosed with orchiepididymitis and three patients were with acute scrotum because of different types of trauma. The present article describes the frequency of acute scrotum, its etiology and importance of Doppler investigation in the differential diagnosis of acute scrotum.

The role of ultrasonography in differential diagnosis of orbital lesions

The aim of this study is to assess the value of ultrasound in the differential diagnosis of orbital lesions. One hundred and thirty-eight patients with clinical features of an orbital mass were examined by orbital ultrasound prior to undergoing surgery, from January 2000 to January 2017. All patients underwent excisional or incisional orbital biopsy. The results of orbital ultrasonography were compared with the final histological diagnosis. Orbital lesions were localized by ultrasonography in 133/138 cases (96.4%); the false-negative rate of orbital echography was 3.6% (5/138). The nature of the orbital lesions was correctly determined by ultrasonography in 54.3% of the cases (75/138) preoperatively (true positives). In 58/138 (42%) patients, there was no correspondence between the ultrasound diagnosis and the histological diagnosis (false positives). The sensitivity of orbital ultrasonography for the detection of an orbital mass was 93.75% (CI 87.87-99.63%), while the specificity yielded no meaningful result (CI 0.00-60.24%). Moreover, the specificity of orbital ultrasonography to identify a malignant tumor falls within a CI of 0-62.72%. Orbital ultrasonography is a rapid and noninvasive test that is highly sensitive in displaying an orbital mass; however, the specificity in the differential diagnosis of orbital lesions is not meaningful, particularly if malignancy is suspected. The assessment of orbital diseases requires multiple diagnostic approaches to balance the strengths and weaknesses of each method.

Optical sonography in differential diagnosis of thyroid nodes

Objective To develop a non-invasive method for differential diagnosis of thyroid nodes. Material and methods Optical sonography was made in 623 patients with thyroid nodes including 374 women (60%) and 249 men (40%) aged 19-79 years (mean 64±15 years). All patients underwent ultrasound-assisted fine-needle aspiration biopsy. Cytological examination revealed cystic colloidal goiter (CCG) in 317 (51%) cases, follicular adenoma (FA) - in 197 (31.5%) cases, thyroid cancer - in 109 (17.5%) cases. All patients underwent surgery. Histological examination verified cystic colloidal goiter in 354 (56.8%) cases, follicular adenoma - 75 (12.0%) cases, thyroid cancer - 194 (31.2%) cases. Follicular cancer was diagnosed in 120 cases, papillary cancer - 70 cases, undifferentiated cancer - 4 cases. Results and conclusion Sensitivity, specificity and accuracy of optical ultrasonography in differential diagnosis of thyroid nodules were estimated. Sensitivity of ultrasonography in the diagnosis of thyroid malignancies was 0.75, specificity 0.62, accuracy 0.67. Sensitivity of ultrasonography in the diagnosis of thyroid adenoma was 0.85, specificity 0.62, accuracy 0.73. Sensitivity of optical sonography in the diagnosis of CCH was 0.62, specificity 0.61, accuracy 0.7. Optical sonography ensures differentiation of CCH and follicular adenoma, CCH and thyroid cancer, follicular adenoma and thyroid cancer. Sensitivity, specificity and accuracy of ultrasonography in differential diagnosis of FA and thyroid cancer are 0.85, 0.62, 0.73 and 0.8, 0.71, 0.7, respectively.

Suggested amendment of TI-RADS classification of thyroid nodules by shear wave elastography.

The application of the ultrasound elastography and Thyroid Imaging Reporting and Data System (TI-RADS) classification further expands the scope of ultrasound differential diagnosis between benign and malignant thyroid nodules. To investigate the value of the quantitative parameter of ultrasonic shear waves in optimizing the TI-RADS classification of thyroid nodules. A total of 168 thyroid nodules, initially classified using TI-RADS and scanned by shear wave elastography (SWE), were retrospectively analyzed. All cases were diagnosed by fine needle aspiration and histology following surgery. The benign rate of TI-RADS 3 nodules was 76.5%, while the benign rate of TI-RADS 4a nodules was 71.7%. Furthermore, the malignant rate of TI-RADS 4b nodules was 69.7%, while the malignant rate of TI-RADS 4c nodules was 85.7%. In differentiating benign from malignant nodules, the combination of TI-RADS classification and Emean had the largest area under the receiver operating characteristic curve (AUC). Using an Emean value of 42.25 kpa as the cut-off point, the malignant rate of TI-RADS 4a nodules decreased from 28.3% to 23.5%, while the malignant rate of TI-RADS 4b nodules increased from 69.7% to 79.4%. Compared to conventional ultrasound alone, the sensitivity, negative predictive value, and AUC of conventional ultrasound combined with SWE in the diagnosis of benign and malignant thyroid nodules significantly improved (P=0.012, 0.029, 0.001). The SWE technique can be used to further determine the benign and malignant nature of TI-RADS 4 lesions, providing further reference for the choice of clinical treatment. The TI-RADS classification system corrected by SWE is more significant in the diagnosis of benign and malignant thyroid nodules.

The role of transcranial Doppler ultrasonography in differential diagnosis of vertigo in the Emergency Department

Vertigo represents about 4% of access to the Emergency Department (ED). Several conditions, such as general medical illnesses, otovestibular diseases and neurological diseases (including posterior circulation stroke) cause acute vertigo. The incidence of cerebrovascular disease in patients with vertigo in ED varies from 3 to 5%. Although neurosonology studies on acute vestibular syndrome are scarce, the use of transcranial Doppler (TCD) and transcranial color Doppler (TCCD) in the management of vertigo patients has several advantages: it can be performed at the patient's bedside and repeated and, furthermore, its use is low-cost. In an acute stroke, with an experienced doctor, it can help distinguish an ischemic stroke from a hemorrhagic stroke. In acute central vertigo induced by posterior circulation stroke, the TCD or TCCD can be a screening test before angiographic neuroradiological studies for stenosis of vertebral or basal arteries. As a matter of fact, the clinical outcome, particularly in the posterior circulation stroke, is mainly related to a rapid diagnosis and subsequent treatment that will be able to quickly restore the blood flow. In conclusion, TCD and TCCD are useful in the differential diagnosis of vertigo in the ED, although we recognize the indisputable importance of clinical examination as a first step in vertigo management. In the evaluation of patients with acute central vertigo due to suspected posterior circulation stroke, the use of TCD or TCCD can rapidly reveal steno-occlusive disease of the posterior circulation, arterial dissections and give indirect signs of vertebra-basilar insufficiency.

P17.01: Ultrasound differential diagnosis of toraco‐abdominal fetal cystic masses

Establish the differential diagnosis of fetal toraco-abdominal cystic masses in ultrasound in our experience. Retrospective analysis of fetal toraco-abdominal hipoecogenic masses diagnosed in prenatal ultrasound imaging for the last three years (January 2016-December 2018) in a terciary centre. Ultrasound pathological images were stored and reviewed by two expert sonographers. Out of 5451 fetus analysed, there were 86 cases of fetal toraco-abdominal hipoecogenic toraco-abdominal masses at gestational ages ranging from 12-37 weeks of gestation. Differential diagnosis included 39 cases of kidney pathology, 7 cases of cysts of other abdominal locations (mesenteric, liver, ovarian, suprarrenal), 9 abdominal umbilical cord alterations, 6 intestinal obstructions, 8 disruptions of abdominal wall, 6 cases of ascitis, 10 thorax patology, 1 sacroccocigeal teratoma (table1). The most important ítems to differentiate a suspicious hipoecogenic mass are the localisation, its ultrasound characteristics, its relationship with other structures and to rule out different pathology. Special attention must be paid to renal disruptions. P17.01: Table 1. Differential diagnosis of toraco-abdominal fetal cystic masses Mesenteric cyst (N: 3) Liver cyst (N: 4) Ovarian cyst (N: 3) Suprarrenal cyst (N: 1) Aneurismatic dilation of UC (N: 4) Persistence of right umbilical vein (N: 5) Omphalocele (N: 4) Gastroschisis (N: 3) Umbilical hernia (N: 1) Ascitis with associated anomalies (N: 6) Sacroccocigeal teratoma (N: 1) Intestinal dilation (N: 5) Anular páncreas (N: 1) Renal dilation (N: 10) Pelvic kidney (N: 9) Polycystic kidney (N: 6) Megaurether (N: 6) Renal cyst (N: 4) Renal displasia (N: 3) Posterior urethral valves (N: 1) Congenital malformation of the pulmonary airway (N: 7) Broncogenic cyst (N: 1) Pleural effusion (N: 2) Supporting information can be found in the online version of this abstract Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

The value of contrast-enhanced ultrasonography in differential diagnosis of orbit tumors in extraconal compartment

Objective To provide a reference for differential diagnosis of orbit tumors in extraconal compartment by analyzing the parameters of contrast-enhanced ultrasonography (CEUS). Methods A total of 76 patients with orbit tumors in extraconal compartment who underwent CEUS examination were retrospectively analyzed. These patients were divided into two groups depending on histological diagnosis including 27 cases with malignant tumor and 49 cases with benign tumor. CEUS images were analyzed using Sonoliver software. The time-intensity curve (TIC) and dynamic vascular pattern curve (DVPC) were acquired and the characteristics of the arterial flow infusion of these were analyzed. The related parameters such as time of arrival time(AT), rise time (RT), time to peak(TTP), mean transit time(mTT), slope of rise(K1), the absolute value for slope of down (K2) were also obtained. The differences of DVPC, TIC and quantitative parameters between the two groups were compared. Receiver operating curve analysis was used to acquire the cut-off values of these parameters for differential diagnosis. Results ①TICs of the benign tumors were mainly fast rise and slow drop and DVPCs were mainly positive biphasic, while TICs of the malignant tumors were mainly fast rise and fast drop and DVPCs were mainly biphasic. ②The differences of quantitative parameters IMAX, K1, K2, mTT and RT of TICs were statistically significant between the two groups (P 0.05). ③IMAX=456.2%, K1=109.6, K2=35.2, RT=7.9 s, mTT=28.1 s were the best cut-off values for differential diagnosis. Among these parameters, mTT with 28.1 s had the highest diagnostic value(sensitivity: 81%, specificity: 77%). Conclusions The quantitative CEUS parameters can provide effective reference for differential diagnosis of orbit tumors in extraconal compartment. Key words: Contrast-enhanced ultrasonography; Orbit tumors in extraconal compartment; Time-intensity curve; Dynamic vascular pattern

Ultrasound differential diagnosis of hepatic hilar cystic lesions in neonates and infants

Objective To explore the value of ultrasound in differential diagnosis of hepatic hilar cyst in neonates and infants. Methods The ultrasonographic characteristics of 93 children with hilar cysts under 6 months of age admitted to the General Surgery Department of Beijing Children′s Hospital.Affiliated to Capital Medical University from January 2014 to December 2018 were retrospectively analyzed.According to the surgical results, they were divided into two groups: cystic biliary atresia (CBA) group and congenital choledochal cyst (CC) group, 21 cases in the CBA group and 72 cases in the CC group.The size of cyst in hepatic portal area, the shape of gallbladder in empty stomach, the expansion of intrahepatic and extrahepatic bile ducts, the deposition of biliary sludge and the communication between cyst and intrahepatic bile duct were observed by ultrasound. Results The cyst volume of CBA group was 0.4(0.1, 1.3)cm3, and that of CC group was 18.3(5.4, 50.3)cm3.The cyst volume of CBA group was significantly smaller than that of CC group (P<0.01); 19 cases had abnormal gallbladder morphology in CBA group and 4 cases in CC group (P<0.01); 1 case had biliary sludge in hilar cyst in CBA group and 51 cases had biliary sludge in cyst in CC group (P<0.01); no intrahepatic bile duct dilatation was observed in CBA group, and 54 cases had intrahepatic bile duct dilatation in CC group (P<0.01); no cyst communicated with intrahepatic bile duct in CBA group, and all cysts communicated with intrahepatic bile duct in CC group (P<0.01). Conclusion Gallbladder shape, cyst size, biliary sludge deposition, intrahepatic bile duct dilatation and the communication between cyst and intrahepatic bile duct can be used as sonographic features to differentiate CBA from CC. Key words: Ultrasound; Cystic biliary atresia; Choledochal cyst

Brightness Mode and Color Doppler Ultrasound in Differential Diagnosis of Breast Lesions in Saudi Females.

Objective:The aim of the study was to identify the pathological characteristics of benign and malignant breast lesions among Saudi females using brightness mode (B-mode) and color Doppler ultrasound (US).Materials and Methods:This study was retrospectively carried out in a single center in the Radiology and Medical Imaging Department, King Fahad Medical City, Riyadh, Saudi Arabia. A convenient method of sampling was used to include all patients referred for different diagnosis during the period of January 2016 and December 2018. A sample size of 100 cases was selected with 50% of the cases being benign breast lesions, while the rest were malignant. The data collection instruments comprised data collection sheets, while a Philips US system with a 9 MHz linear probe was used to give the differential results. The results were considered significant when P < 0.05. The statistical diagnostic test was used to detect sensitivity, specificity, and accuracy of US in the differential diagnosis of breast lesions in Saudi females.Results:B-mode and color Doppler US findings of breast mass measurements, shape, echotexture, and the presence and absence of vascularity present a sensitivity, specificity, and accuracy of 97.09%, 80.65%, and 93.28% in the diagnosis of benign and malignant breast masses.Conclusion:In Saudi females with dense breasts, the risk of breast cancer development is increased. Moreover, B-mode in combination with color Doppler US was highly determined the results of differential diagnosis for any breast lesions.

Application of automated breast volume scanner and mammography in differentiation of small breast lesions with BI-RADS-US 4

To evaluate the value of automatic breast volume scanner (ABVS) and mammography (MG) in differential diagnosis for small breast lesions with breast imaging reporting and data system ultrasound (BI-RADS-US) 4. Methods: ABVS and MG were performed for 103 patients with 109 breast lesions, which were classified as BI-RADS-US 4 by conventional ultrasound (US). Postoperative pathological diagnosis served as gold standard. The diagnostic efficacy for US, US combined with MG, US combined with ABVS and the combination of three methods were compared. Results: The sensitivity of US, US combined with MG, US combined with ABVS and the combination of three methods were 85.5%, 86.8%, 94.7% and 96.0%, respectively. The specificity for them were 66.7%, 69.7%, 81.8% and 84.9%, respectively. The accuracy for them were 79.8%, 81.6%, 90.8% and 92.7%, respectively. The area under the receiver operating characteristic (ROC) curve (AUC) for them were 0.76, 0.78, 0.88 and 0.90, respectively. The accuracy and AUC for US combined with ABVS in differential diagnosis of BI-RADS-US 4 small breast lesions were significantly higher than those of US and US combined with MG (P<0.05). There was no significant difference in sensitivity and specificity among these 3 groups (P>0.05). No significant difference was found in sensitivity, specificity, accuracy, and AUC between US combined with ABVS and the combination of three methods (P>0.05). Conclusion: Combination of US with ABVS can improve the diagnostic efficacy of conventional US in differential diagnosis for BI-RADS-US 4 small breast lesions, and it is superior to US combined with MG.

Contrast-enhanced ultrasonography in differential diagnosis of focal gallbladder adenomyomatosis and gallbladder cancer

Focal gallbladder adenomyomatosis (ADM) is a common disease that mimics gallbladder cancer (GBC) on ultrasonography. Here we aim to assess the value of contrast-enhanced ultrasound (CEUS) in differentiating ADM from GBC. Forty-one histopathologically proven focal ADMs and 34 GBCs (≤T2 stage) were enrolled in the study. Lesion location, blood flow signals, contrast pattern and appearance on contrast-enhanced ultrasound (CEUS) were compared respectively. Lesions were detected in fundus, body, neck at the rates of 61.0% (25/41), 26.8% (11/41) and 12.2% (5/41), respectively, in ADM patients, in comparison to 29.4% (10/34), 32.4% (11/34) and 38.2% (13/34), respectively, in GBC patients (p = 0.009). Blood flow signals were detected in 19.5% (8/41) of cases in ADMs, compared to 58.8% (20/34) in GBCs (p = 0.001). On CEUS, iso-enhancement, hypo-enhancement, intramural anechoic space and intactness of GB wall were detected in 41.5% (17/41), 39.0% (16/41), 56.1% (23/41) and 80.5% (33/41) cases of ADMs, in contrast to 17.6% (6/34), 20.6% (7/34), 20.6% (7/34) and 17.6% (6/34) of GBCs (p = 0.001, p = 0.001, p = 0.002, p < 0.001, respectively). The prior Youden's index were 0.81 based on intactness of GB wall on CEUS. Combined with CEUS helps improve the differential diagnosis accuracy of focal gallbladder ADMs.

Significance of contrast-enhanced ultrasonography in differential diagnosis of thyroid nodules.

The present study was aimed to compare the application values between 2-dimensional color Doppler ultrasonography (2DUS) and contrast-enhanced ultrasonography (CEUS) in the differential diagnosis of thyroid malignant nodules.A total of 124 patients suspectedly diagnosed with malignant thyroid nodules under conventional gray-scale ultrasonography were recruited in this study. All enrolled patients were examined by both 2DUS and CEUS.A total of 153 nodules (94.44%) and 45 cases (90.00%) with malignant nodules were detected by the CEUS. No significant differences were noted in nodule detection rates between 2DUS and CEUS (χ2 = 1.170, P = .279; χ2 = 0.796, P = .372). The aspect ratio, microcalcification, internal echo, borderline, Vmax, resistance index, and total scores of malignant nodules were higher than those of benign nodules (all P < .05) when diagnosed by 2DUS. The peripheral/internal enhancement time, peak intensity, local enhancement, ring enhancement, and total scores of malignant nodules were significantly higher compared with those of benign nodules (all P < .05) by CEUS. Total score of malignant nodules diagnosed by 2DUS was approximately 3.5 and 2.3 points for CEUS. The diagnostic accuracy of 2DUS as observed by area under the curve was 0.821 with the cut-off value of 3.9, the sensitivity was 82.5%, and the specificity was 85.6%. The diagnostic accuracy of CEUS was 0.862 with the cut-off value of 2.8, the sensitivity was 86.7%, and the specificity was 91.3%.Both 2DUS and CEUS are worthy of application values in the differential diagnosis from benign to malignant thyroid nodules.