Ultrasound Lesions Research Articles

Contributions of transfontanellar morphologic ultrasound to the evaluation of newborn brain injury in full-term neonates: A preliminary study

Background and objectives: Neonatal brain injury represents a serious problem since it is one of the most common causes of morbidity and mortality of newborns, and a common cause of life-long neurological disability. Transfontanellar ultrasound (TFUS) remains the method of choice to explore the newborn brain. This study aimed to clarify the diagnostic and prognostic value of TFUS in the management of brain injury in the full-term neonates. Materials and Methods: A total of 151 newborns with a mean age of 6.1 days were retrospectively analyzed. We compared the evolution of pregnancy and the clinical data of newborns after delivery with the results of the TFUS findings. Results: We found that the major risk factors for term newborn brain injury were dystocia (88.8%, PPV, 80.9%, Se, 39.7% reached 85% in cases of dystocia) and primiparity (p=0.01). The main features found in TFUS were cerebral ischemia (45%), ventricular dilatation (28.3%), and cerebral hemorrhage (25%). Conclusion: Our results show that the clinical condition was not correlated with ultrasound lesions. Dystocia should imperatively prompt to US evaluation of the newborn brain. Routinely performed in cases of suspected neonatal brain damage, the combination of dystocia and a normal TFUS result should lead to the discontinuation of imaging studies.

Dynamic contrast-enhanced breast magnetic resonance imaging findings that affect the magnetic resonance-directed ultrasound correlation of non-mass enhancement lesions: a single-center retrospective study.

Our single-center retrospective study aimed to evaluate the relationship between magnetic resonance (MR)-directed ultrasound (MDUS) detectability and MRI findings of non-mass enhancement (NME) lesions, regarding the morphologic and enhancement features, the distance from the skin and nipple, and the presence of concomitant landmarks. A total of 350 MRI-detected NME lesions that were determined between January 2015 and May 2019 and subsequently underwent MDUS were analyzed. The MRI findings, biopsy results, and follow-up outcomes of lesions were recorded. The correlation between the MRI findings of the lesions and MDUS detectability was analyzed. 114 (32.6%) of the 350 lesions had a counterpart in the MDUS. Respectively, 66 (37.9%), 38 (43.2%) and 59 (38.3%) of the lesions detected in MDUS were larger than 20 mm in size, with a distance of less than 20 mm to the nipple and 15 mm to the skin. The lesion size and lesion distance to the nipple and skin were significantly associated with a ultrasound correlate (p < 0.05). The MDUS detection rate was significantly higher in NME lesions with MR findings including diffuse distribution (p < 0.001), clustered-ring enhancement pattern (p < 0.001), washout kinetic curve (p = 0.006), and MR-BIRADS category 5 (p < 0.001). Multivariate logistic regression showed that only the clustered-ring enhancement pattern was significantly associated with an MDUS correlation (p < 0.001). Statistically significant correlations were found between the size, distance to the nipple and skin, distribution pattern, enhancement pattern and kinetic curve of the NME lesions on MRI and ultrasound detectability. We found that clustered-ring enhancement patterns were significantly more frequent in MR-directed ultrasound detectable lesions.

Efficacy of Serial Ultrasonographic Examinations in Predicting Return to Play in Agility Dogs with Shoulder Lameness.

Simple SummaryAgility dog is one of the most popular canine sports among pet owners, and agility-related soft tissue injuries are becoming frequent in dogs. The need to check the progression of shoulder tendon healing in order to permit a safe return to sport is now urgent. The aim of the present study was to help veterinary sports medicine professionals check the progression of shoulder tendon healing in lesions that have been treated with a standardised physiotherapeutic program. The results showed that ultrasonographic examination could be considered a reliable method of following the progression of healing of shoulder tendon lesions when carried out every two months within the six months after injury, together with the administration of a standardised physiotherapeutic program. The ultrasonographic protocol should be associated with a clinical evaluation in order to give the correct return to play time to the owners.The aim of this study is to investigate the use of shoulder ultrasound as a method of predicting the likelihood of returning to competition in agility dogs with shoulder teno-muscular injuries after a standardised rehabilitation protocol. Thirty-two agility dogs with a clinical and ultrasonographic diagnosis of shoulder teno-muscular injury were included in a prospective study with physical and ultrasound examinations at the time of diagnosis (T0) and at two (T2), four (T4) and six (T6) months; during this period, the dogs received rehabilitation treatments. The endpoint of the study was to obtain information regarding participation in agility competitions 12 months after diagnosis, based on telephone interviews with the owners. The clinical lameness score (CLS) and the ultrasound lesion score (ULS) were used as outcome measurements. The CLS indicated partial recovery from a shoulder injury at T2 (78%), while the ULS indicated no satisfactory recovery at T2 in any patient. At 4 months, the CLS alone was not a valuable predictor of full recovery from a shoulder injury in agility dogs. Relative Risk indicated that, at T2, ultrasound was 23.8 times more valuable in identifying a shoulder lesion as compared to clinical lameness score (CLS), and it was 2.53 times more valuable at T4.

Case Report on Gastric Carcinoma

Introduction: Gastric cancer or stomach cancer is an any malignant tumor arising from the region extending between the gastroesophageal (GE) junction and the pylorus. The incidence and mortality of gastric cancer have been declining in most developed countries. The age-adjusted risk fell 5% from 1985-1990.Clinical.&#x0D; Findings: Abdominal pain in an region, weakness and loss of appetite from 50 days, pain in lower limb from one month, nausea and vomiting, history of passage of black color stool (for two days, 50 days back), loss of weight five kg in last one month.&#x0D; Diagnostic Evaluation: Hb - 11.2 gm/dl Decreased , RBC 4.17cumm,CBC MCH- 22.6 Pico gm (decrease), Platelet -1.2 lakhs / cumm (decrease), Eosinophil- 9 % (increase )Monocytes-2% (decrease), KFT- sodium – 132 meq/L (decrease) LFT -bilirubin (conjugated) – 0.30 gm %(decrease)Bilirubin (unconjugated ) 0.33 gm %{ decrease}, CT scan, MRI, Upper GI endoscopy - showed abnormal mass ,Endoscopic ultrasound lesion as small as 2-3 mm in diameter, USG CECT Abdomen Report- showed enhancing wall thickening Involving body of gastric without obvious perigastric extension Or significant, consistent with gastric carcinoma. Histopathology report of gastrectomy specimen showed poorly Differentiated adenocarcinoma gastric­ mixed type – pT4a N1 M0.&#x0D; Therapeutic Interventions: Inf. Metrogyl 500 mg TDS, Inj. Amikacin 500 mg OD, Inj. Pantop 40 mg BD , Inj. Piptaz in 100ml NS 4.5 mg TDS, Inj. Levofloxacin 500 mg OD, Tab. Telma 40 mg OD, Inj. PCM in 100ml NS 500 mg TDS, Chemotherapy and Radiation therapy was also Done.&#x0D; Outcome: After treatment, the patient show improvement. His abdominal pain , nausea and vomiting , pain in lower limb were relieved and After all pharmacological, surgical and medical intervention , patient is now in stables condition his mental and it physical condition is improving and laboratory value are in normal range, and he is able to do his daily activities.&#x0D; Conclusion: My patient was admit in surgery Ward No- 28 , AVBRH with a known case of Gastric carcinoma and he had complaint of abdominal pain, nausea and vomiting ,pain in lower limb , weakness, black color stool and loss of appetite. After getting appropriate treatment his condition was improve.

A pre-operative prognostic model predicting all cause and cause specific mortality for women presenting with invasive breast cancer

PurposeThe aim of this study is to develop a pre-operative prognostic model based on known pre-operative factors. MethodsA database of ultrasound (US) lesions undergoing biopsy documented US lesion size, stiffness, and patient source prospectively. Women with invasive cancer presenting between 2010 and 2015 were the study group. Breast and axillary core results and ER, PR and HER receptor status were collected prospectively. Assessment of US skin thickening, US distal enhancement and presence of chronic kidney disease (CKD) was performed retrospectively. Patient survival and cause of death were ascertained from computer records. Predictive models for (i) all-cause mortality (ACM) and (ii) breast cancer death (BCD) were built and then validated using bootstrap k-fold cross-validation. A comparison of predictive performance was made between a full cause-specific Cox model, a sub cause-specific Cox model, and a full Fine-Gray sub-distribution hazard model. Results1136 patients were included in the study. The median follow-up time was 6.2 years. 125 (11%) women died from breast cancer and 155 (14%) died from other causes. For the prediction of BCD, the cause-specific Cox sub-model performed the best. The time dependent AUC begins above 0.91 in year one to 3 reducing to 0.83 in year 6. The factors included in the Cox sub model were tumour size, skin thickening, source of detection, tumour grade, ER status, pre-operative nodal metastasis and CKD. ConclusionWe have shown that a model based on preoperative factors can predict BCD. Such prediction if externally validated and incorporating treatment data could be useful for treatment planning and patient counselling.

The clinical correlation of findings obtained by fine needle fenestration biopsy of the canine spleen with visible ultrasound changes

The medical records databases (March 2016 to March 2021) of the Faculty of Veterinary Medicine, University of Zagreb, were examined to determine the frequency and clinical relevance of cytological diagnoses from fine-needle fenestration biopsy (FNFB) of the spleen in dogs with visible ultrasound changes. Seventy-five dogs were divided into clinically relevant and irrelevant groups, according to the clinical relevance of the diagnosis. The incidence of clinically relevant diagnoses was 28/75 (37.3%). Malignant diagnoses were over-represented (23/28; 82.1%), followed by hemorrhages/hematomas (3/28; 10.7%) and suppurative inflammation (2/28; 7.1%). The most common malignancy was lymphoma (12/28; 42.9%). There was no correlation between the ultrasound lesions examined and the relevant cytological diagnoses, except in cases of patchy echo texture (P = 0.010). Lesion size greater than 1.74 cm had the highest sensitivity/specificity values (91.3%; 42.1%) with a significant area under the curve (AUC) of 0.68 (P = 0.029) for predicting clinically relevant findings. The complication rate due to bleeding was 2/130 (1.5%). In conclusion, splenic FNFB can be safely performed in dogs as it carries a low risk of development of complications. Specific ultrasonographic findings, such as patchy echo texture pattern, may increase the suspicion of the presence of neoplastic disease in the form of lymphoma. According to ROC analysis, lesion size greater than 1.74 increases the possibility of predicting clinically relevant findings.

Accurate segmentation of breast tumors using AE U-net with HDC model in ultrasound images

Breast cancer poses a great threat on women health due to its high malignant rate. In China, ultrasound screening is the commonly-used method for breast cancer diagnosis, and the localization and segmentation of the lesions in ultrasound images are helpful for breast cancer detection. In this paper, an Attention Enhanced U-net with hybrid dilated convolution (AE U-net with HDC) model was proposed and employed to segment the breast tumors in ultrasound images. First, based on Attention U-net, we added a new loss function to update the weight matrix in the AGs module, in order to enhance the weight of the lesion area. Combined with fine-tuning training method, the precision of breast ultrasound image lesion region segmentation was improved from 82.38% to 86.28% and the M-IOU was improved from 76.27% to 81.81%. Second, three groups of HDC with expansion rates of [1,2,5] were integrated into AE U-net to replace the four convolution operations. HDC module brought larger receptive field and reduced the loss of spatial information. The experimental results proved that HDC module was helpful to improve the Acc of image segmentation results from 94.18% to 95.81% and the Recall from 78.69% to 80.48%. Combined with U-net, the F1 score, AUC, Acc and M-IOU of the network proposed in this paper had significantly improved. It proved that AE U-net with HDC model would have very important research value and application prospect for modern medicine.

Evaluating the Hyperechoic lesions of breast by ultrasonography: A clinical and radiologic study

Background: Benign lesions in the past were thought to be hyperechogenic lesions on ultrasonography. Recently, this conception has been changed where various malignant breast lesions were hyperechogenic on ultrasound and hyperechogenic lesions turned out to be malignant on histopathologic examination.Aim: The present retrospective clinical study was conducted to assess the clinical presentation, frequency, and related imaging finding of hyperechoic malignant breast lesions in cases with core needle biopsies guided ultrasonographically, and also, to assess ultrasonographic features that help in the prediction of the hyperechoic lesion to be malignant.Methods: In a total of 2255 subjects, an ultrasonographically guided core needle biopsy was done for 2168 subjects. The hyperechoic carcinomas were identified among all the assessed cases diagnosed by ultrasonography-guided core needle biopsy was calculated. For malignant lesions, imaging malignancy predictors were identified using 6 ultrasonography images comparison in malignant and high-risk cases. The sonographic findings assessed were orientation, vascularity, shape, posterior acoustic features, margins, and echogenicity. The results were formulated after the statistical evaluation.Results: A total of 2255 ultrasonographically guided core needle biopsy was done for 2168 subjects where 52.01% (n=1173) lesions were benign, 40.97% (n=924) were malignant, and 7% (n=158) were high risk. The study results have shown that in total 2255 lesions assessed, 0.57% (n=13) lesions were hyperechoic in 13 females after analyzing the image. In 924 malignant lesions 0.97% (n=9) lesions were hyperechoic. Circumscribed margins were seen in 62.5% (n=5) and non-circumscribed by 37,5% (n=3) study subjects with benign lesions, and by 100% (n=5) subjects with malignant lesions (p=0.007). For the shape of the lesions, more malignant lesions had irregular and lobular margins 100 (n=5) lesions, whereas, in benign lesions, 87.5 (n=7) had irregular/lobular margins (p=0.002). Conclusion: The present study concludes that hyperechoic breast lesions on ultrasonography have less prevalence of 0.57% (n=13) lesions in the present study. Hence, hyperechoic breast lesions are less encountered on sonography. However, whenever these hyperechoic lesions are seen, the probability of malignancy should not be excluded.

Automatic detection of ultrasound breast lesions: a novel saliency detection model based on multiple priors

Automatic detection of ultrasound breast lesions: a novel saliency detection model based on multiple priors

Does the presence of an ultrasound dot-like lesion of the rotator cuff affect outcomes after humeral intramedullary anterograde nailing?

article: Does the presence of an ultrasound dot-like lesion of the rotator cuff affect outcomes after humeral intramedullary anterograde nailing? - Minerva Orthopedics 2021 August;72(4):418-24 - Minerva Medica - Journals

Discriminative deep learning based benignity/malignancy diagnosis of dermatologic ultrasound skin lesions with pretrained artificial intelligence architecture.

Deep-learning algorithms (DLAs) have been used in artificial intelligence aided ultrasonography diagnosis of thyroid and breast lesions. However, its use has not been described in the case of dermatologic ultrasound lesions. Our purpose was to train a DLA to discriminate benign form malignant lesions in dermatologic ultrasound images. We trained a prebuilt neural network architecture (EfficientNet B4) in a commercial artificial intelligence platform (Peltarion, Stockholm, Sweden) with 235 color Doppler images of both benign and malignant ultrasound images of 235 excised and histologically confirmed skin lesions (84.3% training, 15.7% validation). An additional 35 test images were used for testing the algorithm discrimination for correct benign/malignant diagnosis. One dermatologist with more than 5 years of experience in dermatologic ultrasound blindly evaluated the same 35 test images for malignancy or benignity. EfficientNet B4 trained dermatologic ultrasound algorithm sensitivity; specificity; predictive positive values, and predicted negative values for validation algorithm were 0.8, 0.86, 0.86, and 0.8, respectively for malignancy diagnosis. When tested with 35 previously unevaluated images sets, the algorithm´s accuracy for correct benign/malignant diagnosis was 77.1%, not statistically significantly different from the dermatologist's evaluation (74.1%). An adequately trained algorithm, even with a limited number of images, is at least as accurate as a dermatologic-ultrasound experienced dermatologist in the evaluation of benignity/malignancy of ultrasound skin tumor images devoid of clinical data.

Peripheral Nerve Focused Ultrasound Lesioning-Visualization and Assessment Using Diffusion Weighted Imaging.

Objectives: Magnetic resonance-guided focused ultrasound (MRgFUS) is a non-invasive targeted tissue ablation technique that can be applied to the nervous system. Diffusion weighted imaging (DWI) can visualize and evaluate nervous system microstructure. Tractography algorithms can reconstruct fiber bundles which can be used for treatment navigation and diffusion tensor imaging (DTI) metrics permit the quantitative assessment of nerve microstructure in vivo. There is a need for imaging tools to aid in the visualization and quantitative assessment of treatment-related nerve changes in MRgFUS. We present a method of peripheral nerve tract reconstruction and use DTI metrics to evaluate the MRgFUS treatment effect.Materials and Methods: MRgFUS was applied bilaterally to the sciatic nerves in 6 piglets (12 nerves total). T1-weighted and diffusion images were acquired before and after treatment. Tensor-based and constrained spherical deconvolution (CSD) tractography algorithms were used to reconstruct the nerves. DTI metrics of fractional anisotropy (FA), and mean (MD), axial (AD), and radial diffusivities (RD) were measured to assess acute (<1–2 h) treatment effects. Temperature was measured in vivo via MR thermometry. Histological data was collected for lesion assessment.Results: The sciatic nerves were successfully reconstructed in all subjects. Tract disruption was observed after treatment using both CSD and tensor models. DTI metrics in the targeted nerve segments showed significantly decreased FA and increased MD, AD, and RD. Transducer output power was positively correlated with lesion volume and temperature and negatively correlated with MD, AD, and RD. No correlations were observed between FA and other measured parameters.Conclusions: DWI and tractography are effective tools for visualizing peripheral nerve segments for targeting in non-invasive surgical methods and for assessing the microstructural changes that occur following MRgFUS treatment.

Peripheral Arterial Disease of the Lower Limbs: Epidemiological and Ultrasound Profile of Patients with Stenosis at the Conakry University Hospital

Introduction: Peripheral arterial disease of the lower limbs (PAD) is a partial or total obliteration of one or more arteries intended for the lower limbs by atheroma. Its prevalence increases with age, but also with other major cardiovascular risk factors such as diabetes, smoking, high blood pressure and dyslipidemia. Its diagnosis is essentially based on arterial Doppler ultrasound, which studies the topography and extension of the lesions, thus constituting the essential tool for therapeutic decision-making. The objective was to describe the epidemiological and ultrasound profile of patients with atheromatous arterial stenosis of the lower limbs. Methodology: This was a cross-sectional descriptive study running from 1 January 2019 to 31 March 2020, we took a duration of 15 months. This study was carried out at the Conakry University Hospital (Donka and Ignace Deen Hospitals). Results: In our series, the average age was 64.7 ± 13 years, with a sex ratio of 1.04. The average age was 64.7 ± 13 years, with a sex ratio of 1.04. The average age of the women in our series was 64.7 ± 13 years. Risk factors were dominated by advanced age (78.67%), diabetes (58%), hypertension (57%) and physical inactivity (47.66%). Among the 300 patients, 145 were carriers of atheromatous arterial stenosis, or a frequency of 48.33%. The leg arteries were the most affected, followed by the common femoral arteries. Concerning the degree of stenosis, patients with stenosis greater than 70% were the most represented. Conclusion: Peripheral arterial disease of the lower limbs (AOMI) is a pathology not to be neglected in Guinea. Patients have several risk factors : stenosis is an important part of the ultrasound lesions of this disease.

Accuracy of an urine-based liquid biopsy genetic test in detecting renal pelvic cancer.

e16500 Background: Renal pelvis cancer is accounting for about two-thirds of upper tract urinary carcinoma. Lesions in renal pelvis often lead to a differential diagnosis that requires ureteroscopic biopsy. Besides causing discomfort and pain, ureteroscopy prior to surgery increases risk of tumor implantation and recurrence. Although urine cytology and FISH were applied, more effective non-invasive diagnostic method is imperative for diagnosis of renal pelvic cancer. Methods: A total of 141 patients with one or more lesions in renal pelvis detected by ultrasound were enrolled. 50-ml first-void urine sample was collection before ureteroscopic biopsy and was analysis by Genetron uro-18 genes panel, by which mutations in 17 genes and methylation status of ONECUT2 were analysis using high-throughput sequencing. If mutations and/or ONECUT2 methylation were detected in urine sediment DNA, the patients were considered as high risk of renal pelvis cancer. The results of the urine-based liquid biopsy genetic test were compared with pathology report and urine FISH results of urinary cells. Results: According to pathological analysis with ureteroscopic biopsy, 42 out of 141 patients (29.7%) were diagnosis with renal pelvic cancer: 13 low-grade, 24 high-grade, 5 equivocal. For 33 renal pelvic cancer patients with FISH testing result of urinary cells, only 54.5% (18/33) samples were positive. By Genetron uro-18 genes test, 95 patients (67.4%) were classified as high risk and 46 (32.6%) patients were low risk. The overall specificity was 88.0% (88/95) and overall sensitivity was 92.9% (39/42), which is significant higher than FISH test of urinary cells. Conclusions: With high specificity and sensitivity, Genetron uro-18 genes test could be incorporated in renal pelvic cancer diagnosis, especially for patients with a ultrasound detectable lesions. Ureteroscopy prior to surgery could be reduced, which may lead to decrease risk of tumor implantation and recurrence.

OP0223 DEVELOPMENT AND PRELIMINARY VALIDATION OF ULTRASONOGRAPHIC DISEASE ACTIVITY AND DAMAGE SCORES IN PSORIATIC ARTHRITIS PATIENTS: RESULTS FROM THE UPSTREAM (ULTRASOUND IN PSORIATIC ARTHRITIS TREATMENT) STUDY

Background:The UPSTREAM (NCT03330769) is a 24-month multi-center prospective cohort study that primarily aims to evaluate the additional value of musculoskeletal ultrasound (msk-US) over clinical examination in predicting 6-month minimal disease activity in Psoriatic Arthritis (PsA). (1)Objectives:To develop and preliminarily validate an activity msk-US score and a damage msk-US score for PsA using the UPSTREAM database.Methods:Patients classified with PsA according to CASPAR criteria and starting a new course of therapy for clinically active peripheral joint disease were eligible. The information regarding objectives, study design, clinical and US assessment has already been published (1). The msk-US examination was performed in 42 joints, 36 tendons, 12 entheses and 2 bursae defined through a web-based exercise (2). The sonographic elementary lesions were allocated to disease activity [i.e. synovitis (sy), tenosynovitis (ts), peritendinitis (pt), bursitis (bs) all evaluated both in Grey Scale (GS) and Power Doppler (PD) and active enthesitis (en)] and to damage (i.e. joint erosion, bone proliferation, tendon tear, enthesophyte, calcification and irregular enthesis bone profile). Hands and feet X-ray were assessed using the modified Sharp-Van der Heijde (mSVH) score. A principal component (PC) analysis (PCA) was performed for each score and the number of PCs was defined by means of parallel analysis using baseline data. Each PC was normalized (n) taking into account the proportion between the observed value (e.g. sy-GS count) and the maximum expected value (e.g. 42 for sy-GS). Spearman’ correlation was used to investigate the construct and discrimination validity of the new scores.Results:Between February 2017 and May 2020, 312 PsA patients (155 men), with a mean (SD) age of 52.8 13.4, were enrolled from 19 centers; 22 expert sonographers were involved with substantial agreement for US lesions evaluated (k ≥0.7). The median [IQR] disease duration was 1.3 [0.1-6.1] years and the median [IQR] tender joint and swollen joint counts were 6 [3-13] and 2 [1-5], respectively. The weight derived from PCA for each sonographic lesions and the final equation for calculating the scores are reported in Figure 1 (1A activity and 1B damage). The final msk-US activity score [n(ts-GS + ts-PD)*2.87] + [n(bs-GS + bs-PD)*1.76] + [n(pt-GS + pt-PD)*1.43] + [n(active en)*1.00] + [n(sy-GS)*0.83] + [n(sy-PD)*0.45] has the best construct and discrimination validities according to a significant correlation with all clinical variables usually related to clinical activity (Table 1). The msk-US damage score correlated with mSVH score, HAQ and other clinical variables (Table 1).Table 1.VariablesMsk-US activity scoreMsk-US damage scoreSpearman correlationP-valueSpearman correlationP-valueESR0.1960.0020.0750.235CRP0.209&lt;0.0010.0680.254TJC0.338&lt;0.0010.286&lt;0.001SJC0.338&lt;0.0010.0720.221Dactylitis count0.284&lt;0.001-0.0610.306LEI0.1940.0010.214&lt;0.001Physician GA0.150.0120.0160.793Patient GA activity0.1380.018-0.0730.221Patient GA pain0.1990.001-0.0270.648HAQ0.238&lt;0.0010.1460.014BASDAI0.237&lt;0.0010.1750.003PSAID-90.70.0040.1480.013DAPSA0.392&lt;0.0010.228&lt;0.001Sharp van Der Heijde score0.1150.20.2660.003Figure 1.Conclusion:These newly developed and preliminary validated msk-US activity and damage scores could be used in patients with PsA in the context of observational and controlled trials.

OMERACT definition and reliability assessment of chronic ultrasound lesions of the axillary artery in giant cell arteritis

ObjectivesTo define chronic ultrasound lesions of the axillary artery (AA) in long-standing giant cell arteritis (GCA) and to evaluate the reliability of the new ultrasound definition in a web-based exercise. MethodsA structured Delphi, involving an expert panel of the Large Vessel Vasculitis subgroup of the Outcome Measures in Rheumatology (OMERACT) Ultrasound Working Group was carried out. The reliability of the new definition was tested in a 2-round web-based exercise involving 23 experts and using 50 still images each from AA of long-standing and acute GCA patients, as well as 50 images from healthy individuals. ResultsThe final OMERACT ultrasound definition of chronic changes was based on measurement and appearance of the intima-media complex. The overall reliability of the new definition for chronic ultrasound changes in longstanding GCA of the AA was good to excellent with Light's kappa values of 0.79-0.80 for inter-reader reliability and mean Light's-kappa of 0.88 for intra-reader reliability. The mean inter-rater and intra-rater agreements were 86-87% and 92%, respectively. Good reliabilities were observed comparing the vessels with longstanding versus acute GCA with a mean agreement and kappa values of 81% and 0.63, respectively. ConclusionThe new OMERACT ultrasound definition for chronic vasculitis of the AA in GCA revealed a good to excellent inter- and intra-reader reliability in a web-based exercise of experts.

Enthesis lesions are associated with X-ray progression in psoriatic arthritis.

To analyze the relationship among enthesis ultrasound (US) lesions and radiological structural damage in psoriatic arthritis (PsA) patients. Consecutive PsA patients with swelling of at least 1 of the 2nd to 5th metacarpophalangeal joints were included. Clinical and demographic data were collected. The Madrid Sonographic Enthesitis Index (MASEI) was selected to evaluate the enthesis, with its total score and MASEI-activity and MASEI-structural damage subscores. The modified Sharp van der Heijde method for PsA and the New York criteria for sacroiliitis were selected to evaluate cumulative bone damage on X-rays. Twenty-seven patients were included. Male gender, older age, longer PsA duration and acute reactant factors were associated with greater bone cumulative damage. Enthesis tendon thickening, enthesophytes, total MASEI and the MASEI-structural damage subscore showed significant correlations with radiographic peripheral and sacroiliac damage scores. Tendon thickening and enthesophytes were the enthesis lesions more frequently associated with radiographic damage in PsA. The enthesis MASEI score was associated with axial and articular radiographic structural damage in PsA patients. The MASEI-structural damage subscore correlated better with cumulative bone damage in PsA than the MASEI-activity subscore.

Evaluation of the performance of traditional machine learning algorithms, convolutional neural network and AutoML Vision in ultrasound breast lesions classification: a comparative study.

In recent years, there was an increasing popularity in applying artificial intelligence in the medical field from computer-aided diagnosis (CAD) to patient prognosis prediction. Given the fact that not all healthcare professionals have the required expertise to develop a CAD system, the aim of this study was to investigate the feasibility of using AutoML Vision, a highly automatic machine learning model, for future clinical applications by comparing AutoML Vision with some commonly used CAD algorithms in the differentiation of benign and malignant breast lesions on ultrasound. A total of 895 breast ultrasound images were obtained from the two online open-access ultrasound breast images datasets. Traditional machine learning models (comprising of seven commonly used CAD algorithms) with three content-based radiomic features (Hu Moments, Color Histogram, Haralick Texture) extracted, and a convolutional neural network (CNN) model were built using python language. AutoML Vision was trained in Google Cloud Platform. Sensitivity, specificity, F1 score and average precision (AUCPR) were used to evaluate the diagnostic performance of the models. Cochran's Q test was used to evaluate the statistical significance between all studied models and McNemar test was used as the post-hoc test to perform pairwise comparisons. The proposed AutoML model was also compared with the current related studies that involve similar medical imaging modalities in characterizing benign or malignant breast lesions. There was significant difference in the diagnostic performance among all studied traditional machine learning classifiers (P<0.05). Random Forest achieved the best performance in the differentiation of benign and malignant breast lesions (accuracy: 90%; sensitivity: 71%; specificity: 100%; F1 score: 0.83; AUCPR: 0.90) which was statistically comparable to the performance of CNN (accuracy: 91%; sensitivity: 82%; specificity: 96%; F1 score: 0.87; AUCPR: 0.88) and AutoML Vision (accuracy: 86%; sensitivity: 84%; specificity: 88%; F1 score: 0.83; AUCPR: 0.95) based on Cochran's Q test (P>0.05). In this study, the performance of AutoML Vision was not significantly different from that of Random Forest (the best classifier among traditional machine learning models) and CNN. AutoML Vision showed relatively high accuracy and comparable to current commonly used classifiers which may prompt for future application in clinical practice.

Sonographic Evaluation of Hidradenitis Suppurativa with Smartphone-Linked Portable Ultrasound

Background: Clinical staging systems for hidradenitis suppurativa (HS) have poor interrater reliability and may underestimate disease activity. Sonographic staging systems may overcome these challenges, but conventional ultrasound (US) machines are expensive and bulky. Portable (p)US may facilitate the integration of sonography into routine practice. Objectives: To assess the ability of a novel smartphone-linked pUS device to identify key sonographic lesions of HS. Methods: The charts of 16 patients with HS who were assessed with pUS at the outpatient Dermatology and Wound Care Clinics of a university hospital center were retrospectively reviewed. Clinical and sonographic images of the affected areas were examined. The main outcome measures were the number of patients with identifiable sonographic lesions and the number of patients with subclinical lesions detected by pUS. Results: All 3 key sonographic lesions of HS were identifiable with pUS. Sonographic lesions were identified in 10 patients (62.5%). Subclinical lesions were identified in 2 patients (12.5%); in both cases, this affected management decisions. Conclusions: We demonstrate the ability of pUS to identify the key sonographic lesions of HS. pUS is a simple and affordable way to integrate HSUS into clinical and research settings, with clear potential benefits to patients.

Ultrasound arterial anomalies in patients exposed to nilotinib therapy for chronic myeloid leukemia.

Patients exposed to nilotinib for chronic myeloid leukemia (CML) appear to be at risk of arterial complication. The prevalence and aspect of ultrasound asymptomatic arterial lesions are unknown. To describe prevalence and characteristics of ultrasound arterial anomalies in patients treated with nilotinib for CML. Patients treated with nilotinib from 2006 to 2015 in the department of the Paoli-Calmettes Institute, Marseille, were included retrospectively. A vascular ultrasound screening was carried out from 2010. The arterial lesions at the first examination were described: plaque and its echogenicity, stenosis or occlusion. A vascular arterial anomaly (VAA) was defined by the presence of a clinical and/or ultrasound anomaly. Patients with or without VAA at initial vascular examination were compared using bivariate and multivariate analysis. 74 patients were included (51.4% men, mean age 54.5 years); 25 patients had ultrasound arterial anomalies (33.8%). Carotid bulb was the most involved territory (44%). Arterial anomalies were: 88% plaques, 44%>50% stenosis and 12% occlusion. 72.7% plaques were echolucent or hypoechogenic. A VAA was present in 25 patients with initial vascular evaluation (33.8%). Patients with VAA at baseline were significantly older (64.9 vs 49.3, P<0.001), older at nilotinib initiation (60.8 vs 46.5, P<0.001), with more arterial hypertension (40% vs 12.2%, P=0.01), with more cardiovascular risk factors (P=0.03). In patient with no cardiovascular risk factor 12.5% had VAA (n=24). Nilotinib seems to be associated to arterial lesions of unstable lipid-like appearance. The most involved arterial territory was the carotid bulb and the most common lesion was echolucent or hypoechogenic plaque. VAA can occur in patients without cardiovascular risk factors. This result encourages us to systematically screen and follow all patients exposed to nilotinib even those without cardiovascular risk factors.