Underwent Ultrasound Research Articles

Hepatic steatosis among people living with HIV in Southern Brazil: prevalence and risk factors

Chronic liver disease is an important cause of morbidity and mortality among people living with human immunodeficiency virus (HIV) and is frequently related to non-alcoholic fatty liver disease (NAFLD). The objective is to estimate the prevalence and risk factors of hepatic steatosis among consecutive patients with stable HIV infection on antiretroviral therapy (ART). Also, the use of transient elastography (TE) as a mean to identify a subgroup at risk for non-alcoholic steatohepatitis (NASH) and/or liver fibrosis. HIV infected patients were enrolled between August2016 and February2017. Inclusion criteria: ≥18 years with undetectable HIV viral load. Exclusion criteria: pregnancy; alcohol intake ≥20 g/day and co-infection B or C viruses. Patients underwent ultrasound (US) to diagnose liver steatosis. Significant fibrosis (≥F2) was estimated if at least one of the following were present: APRI > 1.0, FIB4 > 3 and/or liver stiffness ≥7.1kPa. Subjects with TE ≥ 7.1kPa were proposed a liver biopsy and NAFLD Scoring System (NAS) ≥ 3 was considered as diagnosis of NASH. A total of 98 patients were included. Liver steatosis was diagnosed in 31 patients (31.6%) and was independently associated with male gender, BMI, ALT and total bilirubin levels. The prevalence of significant fibrosis assessed by TE, APRI and FIB4 was 26.9%, 6.4% and 3.2%, respectively. Seven patients had a TE result ≥7.1kPa. NASH was found in 5 (83.3%). Among HIV infected patients undergoing ART, almost one third have NAFLD. Neither TE, APRI or FIB4 were able to act as surrogates for significant liver fibrosis. Nevertheless, TE ≥ 7.1kPa was able to accurately select a subgroup of patients at risk for NASH.

Ultrasound and radiological features of abdominal unicentric castleman's disease: A case series study.

This study aimed to improve the diagnostic accuracy of abdominal unicentric Castleman's disease (UCD) by retrospectively summarizes the relatively specific imaging features of UCD.This study retrospectively collected fifteen patients with abdominal UCD confirmed by pathology. All patients were underwent ultrasound (US), computed tomography (CT), or magnetic resonance imaging (MRI) examination. The imaging findings of UCDs were analyzed by senior radiologists.Fifteen patients included 7 males and 8 females, aged 30 to 68 years old, with an average age of 51.73 ± 13.57. In the 15 cases, 7 were located around the mesentery, 4 were located in the retroperitoneal space, and 4 in the liver. Fifteen cases contained solid masses, of which 13 had clear margins and 2 had blurred margins. The size of the mass ranged from 1.5 to 14.2 cm, with an average of 6.49 ± 4.16 cm. US showed that 9 lesions were presented with hypo-echogenicity while 5 lesions presented with hyper-echogenicity spots. Unenhanced CT showed that the lesions were comprised of soft tissue while calcified lesions were found in 10 of the cases (66.67%, 10/15). T1-weighted imaging (T1WI) suggested the lesions as iso/hypo-signal, and mildly hyper-signal on T2-weighted imaging (T2WI). Diffusion-weighted imaging (DWI) showed different degrees of hyper-signal. Contrast-enhanced US and CT/MRI showed obvious enhancement at the arterial phase in 12 cases (85.71%, 12/14), most of which (50%, 7/14) showed continuous enhancement at the delayed phase. Feeding vessel could be seen within, or around the lesion in 5 cases (35.71%, 5/14).The study suggests that abdominal UCD commonly manifests as well-defined, homogeneous, solid, and hypervascular masses. Calcification and the presence of feeding vessel in the tumors are relatively specific features of abdominal UCD.

Impact of mandated prospectively reported apparent diffusion coefficient values on the rates of positivity for clinically significant prostate cancer by PI-RADS score.

Prior research has shown that retrospectively measured apparent diffusion coefficient (ADC) of prostate magnetic resonance imaging (MRI) lesions is associated with clinically significant prostate cancer (csPCa) on targeted biopsy suggesting that ADC should be measured and reported prospectively. To assess the impact of mandatory prospective measurement of ADC on the rates of positivity across PI-RADS scores for csPCa. Consecutive patients who underwent ultrasound (US)-MRI fusion prostate biopsy from August 2018 to July 2019 and who had prospectively reported ADC were compared to control patients who did not. Rates of positivity by PI-RADS category were computed and compared using Chi-square. Multivariable regression was performed. In total, 126 patients (median age 65 years) with 165 prostate lesions (19, 51, 70, and 25 PI-RADS 2, 3, 4, and 5, respectively) and prospectively reported ADC values were compared to 113 control patients (median age 66 years) with 157 prostate lesions (17, 42, 64, and 34 PI-RADS 2, 3, 4, and 5, respectively). Rates of positivity across PI-RADS scores were similar between the two cohorts; 11%, 25%, 55%, and 76% and 0%, 21%, 56%, and 62% for PI-RADS 2, 3, 4, and 5 in the test and control cohorts, respectively (Chi-square P = 0.78). Multivariate logistic regression showed no significant association between the presence of prospectively measured ADC and csPCa (odds ratio 1.1, 95% confidence interval 0.7-1.7, P = 0.82). Prospective ADC measurement may not impact PI-RADS category assignments or positivity rates for csPCa under current guidelines. Future versions of PI-RADS may need to incorporate ADC into scoring rules to realize their potential.

Percutaneous US-guided MWA of small liver HCC: predictors of outcome and risk factors for complications from a single center experience.

The aim of the present study was to identify predictors of outcome and complications in patients with small hepatocellular carcinoma (HCC) treated by percutaneous microwave ablation (MWA). Patients with non-previously treated small (≤ 3cm) HCCs who underwent ultrasound (US)-guided percutaneous MWA between July 2016 and January 2019 were included. For each patient, the following variables were registered: age, sex, albumin, platelet count, INR/PT, PTT ratio, total bilirubin, liver status, etiology of liver disease, Child-Pugh classification, tumor dimension, margin, and hepatic segment, tumor subcapsular, perihilar or perivascular location, HCC focality, ascites. During follow-up, complications and outcomes were registered. Variables were then analyzed in relation to both outcomes and complications. 74 patients were included. Mean CT follow-up was 6.2months (range 1-24months). At least one complication occurred in 48% of patients, the majority being asymptomatic imaging findings not requiring intervention. One major complication was registered (duodenal perforation: 1.3%). The occurrence of complications was associated with HCC multifocality and abnormal INR/PT, duodenal wall edema with tumor dimension, portal vein thrombosis with Child Pugh score, perihepatic free fluid with abnormal platelet count and comorbidities. Incomplete response rate at 1month was 18.9%. Local tumor progression and new HCC nodules rates were 13.5% and 27%, respectively. Incomplete response at 1month was associated with both alcoholic etiology of liver disease and II segment tumor location, new HCC nodules with PBC. Despite the small series analyzed, significant factors related with complications and outcomes may be kept in mind when planning the best treatment for each patient.

A Novel Sonographic Scoring Model in the Prediction of Major Salivary Gland Tumors.

To create a sonographic scoring model in the prediction of major salivary gland tumors and to assess the utility of this predictive model. Retrospective case series, academic tertiary referral center. Two hundred fifty-nine patients who underwent ultrasound (US), US-guided needle biopsies, and subsequent operations were enrolled. These data were used to build a predictive scoring model and the model was validated by 10-fold cross-validation. We constructed a sonographic scoring model by multivariate logistic regression analysis: 2.08 × (boundary) + 1.75 × (regional lymphadenopathy) + 1.18 × (shape) + 1.45 × (posterior acoustic enhancement) + 2.4 × (calcification). The optimal cutoff score was 3, corresponding to 70.2% sensitivity, 93.9% specificity, and 89.6% overall accuracy. The mean areas under the receiver operating characteristic curve (c-statistic) in 10-fold cross-validation was 0.90. The constructed predictive scoring model is beneficial for patient counseling under US exam and feasible to provide us the guidance on which kind of needle biopsy should be performed in major salivary gland tumors. 3b Laryngoscope, 131:E157-E162, 2021.

Contribution of Sonoelastography to Diagnosis in Distinguishing Benign and Malignant Breast Masses.

The purpose of this study was to investigate the contribution of strain index measurements and a 5-point scoring method to diagnostic accuracy in differential diagnosis of benign and malignant solid breast masses and to compare the diagnostic performances of both methods. Eighty female patients were included in this study. Before biopsy, all patients underwent ultrasound (US) and sonoelastographic examinations. The elastographic images of lesions were assessed according to the 5-point scoring method, and then elasticity scores were determined. Strain values of the masses and subcutaneous adipose tissue were measured. The diagnostic efficacies of B-mode US, sonoelastographic 5-point scoring, and strain index methods were compared with histopathologic findings. The mean age of the patients ± SD was 42 ± 13 years (range, 14-81 years). In histopathologic evaluations, 59 (74%) lesions were diagnosed as benign, and 21 (26%) were diagnosed as malignant. The mean strain index values were 10.45 ± 7.04 (range, 3.4-25.1) in malignant lesions and 2.88 ± 2.5 (range, 0.5-19.81) in benign lesions. The mean strain index for malignant lesions was significantly higher than that for benign lesions (P < .05). The highest sensitivity was found for B-mode US, and the highest specificity was found for the strain index. The diagnostic performance of the strain index was higher than that of the 5-point scoring method. The addition of a sonoelastographic examination to B-mode US prevents unnecessary biopsies. The strain index was found to be superior to the 5-point scoring method to a limited extent.

Hemostatic parameters in patients with spinal cord injury in subacute and chronic phase of the rehabilitation

Objective: The goal of this study was to measure hemostatic markers after SCI. Design: Assesing changes in coagulation and fibrynilitic system in SCI patients in different time post injury to Cross-sectional study. Setting: Rehabilitation Department of the Bydgoszcz University Hospital, Poland from 2011 to 2017. Participants: SCI patient during acute and chronic rehabilitation (N = 88). Outcome Measures: Assesing following parameters: platelet counts and levels of D-dimer, antithrombin III (ATIII), tissue factor (TF), tissue factor pathway inhibitor (TFPI) and the inflammatory marker, C-reactive protein (CRP). Interventions: Eighty-eight SCI patients were divided into three groups based on the time elapsed from injury: group I (three weeks to three months), group II (three to twelve months) and group III (more than twelve months). All patients underwent ultrasonography (US) to detect acute or chronic recanalized deep vein thrombosis (DVT). Platelet counts and levels of D-dimer, ATIII, TF, TFPI and CRP were assessed. TF and TFPI levels were measured in the control group of forty healthy individuals without SCI, the rest of the parameters were compared to laboratory norms. Results: D-dimer levels were significantly higher in group I compared to group II (P = .0002) and group III (P < .001). Group II had higher D-dimer levels than group III (P = .032). TFPI levels were higher in group II compared with group III (P = .0041) and control group (P = .000033). TF was significantly higher in all the SCI groups compared with the control group (P < .001). Conclusions: D-dimer and TF levels were still elevated twelve months after SCI. TF levels were also elevated over 12 months after inury. The results may indicate that sub-acute and even chronic SCI patients have disturbed coagulation and fibrynolitic system.

Evaluation of Modified STONE Score in Patients Presenting to the Emergency Department with Flank Pain

Purpose: Renal colic due to urinary system stone disease is one of the main complaints in emergency department (ED) admissions. The STONE score is the most used model. The “race” item in the nomogram is not useful for communities where the Black race is not dominant. Therefore, we aimed at investigating the diagnostic value of a new modified scoring system, in which we replaced the “race” item in the original nomogram by “obstruction = pelvicalyceal dilation.” Materials and Methods: The study included patients who were admitted to a tertiary university ED with flank pain and underwent ultrasonography (US) from June 2017 to November 2017. Patients' demographic data such as US findings and the STONE score parameters were recorded. “Obstruction (pelvicalyceal dilation)” replaced the “race” item of the original STONE score. The diagnostic value of the modified system was investigated by categorizing the scores as low risk (0–5 points), moderate risk (6–9 points), and high risk (10–13). Results: The study included 305 patients who met the inclusion criteria. The mean age was 39.45 ± 13.83 years, and 170 patients (55.7%) were male. Pelvicalyceal dilation was detected on US at a statistically significantly higher percentage in patients with stones compared to stone-free patients (P &lt; 0.001). The modified STONE score was statistically significantly higher in patients with stones compared to stone-free patients (P &lt; 0.001). Conclusion: We suggest that the replacement of the race parameter of the original STONE score by the US finding of pelvicalyceal dilation will enhance the diagnostic value of scoring in societies mostly comprising a non-Black population.

Biomethane production using ultrasound pre-treated maize stalks with subsequent microalgae cultivation

This study utilized a renewable energy source, agricultural waste, in anaerobic digestion (AD) at appropriate conditions to obtain biogas and biomethane as an energy carrier. Maize stalks underwent ultrasound (US) pre-treatment for better accessibility for microorganisms, as lignocelluloses have a stable structure, insoluble in water and resist both mechanical and enzymatic attack. The digestate after an anaerobic digestion process was used for cultivation of algae after adsorption with activated carbon for clarification. Photosynthetic microalgae have industrial and economic perspectives, so their low-cost cultivation has a great potential for many applications. The results showed the impact of US pre-treatment of maize stalks as a sole substrate and co-digested with algal biomass. The total yields were 1116 cm3/L, 1350.5 cm3/L and 1293.25 cm3/L for the untreated, ultrasonically pre-treated and microwaved maize stalks. The possibility of accumulating algal biomass using anaerobic digestate as a medium was demonstrated. US pre-treatment (400 W) showed high efficiency with respect to the extractives obtained per unit of energy input. Addition of 4 g/L of microalgal biomass as a co-substrate led to an increase in the biogas yield compared to native stalks. A small closed circle system, starting from anaerobic digestion of lignocellulosic substrates followed by microalgae cultivation in the digestate and subsequent return of microalgal biomass back in the bioreactor as a co-substrate was realized, encouraging circular economy. The suggested scheme is a simple and low-cost technology, as the substrate used is freely available and renewable, and algae proved to grow in a waste effluent as medium.

Puerperal mastitis in the past decade: results of a single institution analysis.

Although puerperal mastitis is a common disease, published data are poor. Increasing rates of community-acquired MRSA (CA-MRSA) cases are reported in the USA. However, information about common pathogens and CA-MRSA in Germany is still insufficient. The aim of this study was to investigate the most common pathogens of puerperal mastitis in the last decade, its therapy, resistance rate and the effectiveness of the current treatment strategies. The pathogens, the respective antibiograms and the treatment strategies of patients treated for puerperal mastits at the University Clinic Magdeburg (Germany) between 2006 and 2016 were retrospectively reviewed. Statistical analysis was performed using SPSS Version 21. In our series, 59 cases with puerperal mastitis were reviewed, 26 (44.1%) of these developed a breast abscess. In 37 of 59 (67.3%) cases the symptoms occurred in the first 8weeks postpartum. The most common pathogens were Staphylococcus aureus (64.9%) and Coagulase-negative Staphylococcus (13.5%). Methicillin-resistant Staphylococcus aureus (MRSA) was found in one case. Of the 19 cases with Staphylococcus aureus, 17 were resistant to Penicillin. Conservative management was mainly performed with Flucloxacillin (60%), which was successful in most cases. Sixteen of 26 (61.5%) women with abscesses underwent ultrasound (US)-guided needle aspiration. In this cohort, MRSA was not a main pathogen responsible for breast abscesses. Conservative treatment strategies remained constant during the observed period and Flucloxacillin was the most frequent antibiotic used. The analysis of the courses of diseases leads to the conclusion that surgical incision is progressively replaced by US-guided needle aspiration.

Incorporation of shear wave elastography into a prediction model in the assessment of cervical lymph nodes

Rationale and objectivesTo assess the performance of shear wave elastography (SWE) and an extended model in predicting malignant cervical lymph nodes (LNs).Materials and methods109 patients who underwent ultrasound (US) and SWE before needle biopsy were enrolled. The optimal cutoff value of elasticity indices (EIs) was determined by receiver operating characteristic (ROC) curves. The c-statistic, net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were used to compare extended model and traditional one.ResultsMalignant LNs had higher EIs than benign nodes (p < 0.001). The optimal cutoff point was 42 kilopascal, corresponding to 83.3% sensitivity, 64.7% specificity, and 68.8% overall accuracy. A multivariable logistic regression analysis confirmed that EI was an independent predictor for malignancy. The new extended prediction model had a positive NRI (0.96) and IDI (0.10) for predicting malignant neck LNs. Nevertheless, the c-statistic was not significantly different between the two models.ConclusionThe parameter of SWE theoretically improve the model performance. However, its real clinical impact is minor, as the parameters of US-based model is already very robust. SWE can be considered as an adjunctive quantitative tool beyond conventional US examination.

The Prenatal Diagnosis of Seven Fetuses with 7q11.23 Microdeletion or Microduplication

Objective: There is scant information available about fetuses with 7q11.23 copy number variants (CNVs) found during pregnancy. We studied the clinical significance of 7q11.23 CNVs in prenatal diagnosis. Materials and methods: The amniocentesis was performed on pregnant women who underwent ultrasound (US) of fetal abnormalities. After karyotype analysis, CNVs were detected using BACs-on-Beads (BoBs) technique and chromosome microarray analysis (CMA). Results: Of seven fetuses with CNV of 7q11.23, five had microdeletions and two had microduplications. Case 1 had a 7q11.23 microdeletion along with other CNVs. Case 7 was a newborn with a normal phenotype and 7q11.23 microduplication. Conclusion: The CNVs in 7q11.23 results in many clinical manifestations, but the specificity of clinical features is not high. This study demonstrated that BoBs combined with CMA allows prenatal diagnosis of CNVs involving 7q11.23, and provide a clinical basis for prenatal diagnosis and genetic counseling of such CNVs.

The value of clinical staging of thyroid cancer using ultrasonography and CT scan and its correlation with intraoperative and histopathological findings

Background: Thyroid cancer has incidence of 4 patients per 100,000 populations per year and majority are present between 25-65 years age. Over the years, various imaging have been utilised to detect thyroid cancer but its TNM-staging remains pathological only made on the resected specimen. The aims and objectives of the study was to differentiate thyroid cancer from others lesions, clinically stage them on ultrasonography and CT scan and correlate with histological findings.Methods: This prospective study was done from March 2012 to April 2015. A total of forty patients of FNAC proven or highly suspicious of thyroid cancer underwent ultrasonography (USG) and CT scan TNM staging before planned surgery. The histopathogical findings of resected specimen were correlated with clinical TNM staging of thyroid cancer. The significance of difference between USG and CT scan was calculated using Chi-square test. The difference in the sensitivity as well in specificity was statistically highly significant (p&lt;0.001) and significant (p&lt;0.005), respectively.Results: The largest number of thyroid cancer patient was between 31-40 years with male: female ratio of 1: 4 and 60% presented as asymptomatic lump in the neck. Out of two imaging, the CT scan had more sensitivity and specificity in thyroid cancer staging compared to ultrasonography which had 87.5% sensitivity and 95.8% specificity, respectively.Conclusions: Overall, the CT scan has more sensitivity and specificity in the assessment of thyroid lesions, thus it may be recommended as imaging method of choice in the clinical staging of thyroid cancer either alone in combination of ultrasonography.

Does establishing a preoperative nomogram including ultrasonographic findings help predict the likelihood of malignancy in patients with microcalcifications?

BackgroundMammography (MG) is highly sensitive for detecting microcalcifications, but has low specificity. This study investigates whether establishing a preoperative nomogram including ultrasonographic findings can help predict the likelihood of malignancy in patients with mammographic microcalcification.MethodsBetween May 2012 and January 2017, 475 patients with suspicious microcalcifications detected on MG underwent ultrasonography (US). The χ2 test was used to screen risk factors among the variables. Then, a multivariate logistic regression analysis was performed to identify independent predictors of malignant microcalcifications. A mammographic nomogram (M nomogram) and mammographic-ultrasonographic nomogram (M-U nomogram) were established based on multivariate logistic regression models. The discriminatory ability and clinical utility of both nomograms were compared by the receiver operating characteristics curve and decision curve analysis. The calibration ability was evaluated using a calibration curve.ResultsAmong the cases, 68.2% (324/475) were pathologically diagnosed as breast cancer and 31.8% (151/475) were benign lesions. Based on multivariate logistic regression analysis, age, clinical manifestation, morphology and distribution of microcalcifications on MG and lesions associated with microcalcifications on US were confirmed as independent predictors of malignant microcalcifications. In terms of discrimination ability, the C-index of the M-U nomogram was significantly higher than that of the M nomogram (0.917 vs 0.897, p = 0.006). The bias-corrected curve was close to the ideal line in the calibration curve. Decision curve analysis suggested that the M-U nomogram was superior to M nomogram.ConclusionsCombining mammographic parameters with ultrasonographic findings in a nomogram provided better performance than an M nomogram alone, especially for dense breasts, which suggests the value of ultrasonographic finding for individualized prediction of malignancy in patients with microcalcifications.

Minimally invasive treatment of pediatric head and neck dermoids: percutaneous drainage and radiofrequency coblation

BackgroundDermoids are common benign head and neck cysts in children containing a variety of different skin elements. Current standard treatment is surgical removal that sometimes requires extensive dissection to ensure complete resection and often leaves unwanted facial scarring. A minimally invasive treatment alternative should offer a similar rate of success with a decrease in operative complexity, recovery time and postoperative scarring.ObjectiveTo assess the outcomes of our minimally invasive percutaneous treatment of head and neck dermoids, we reviewed our 9-year interventional radiology (IR) department experience.Materials and methodsThe medical records, imaging and procedural details were reviewed from a cohort of pediatric patients with dermoids treated in our IR department from January 2009 through February 2018. Patients in the study underwent ultrasound (US)-guided cyst puncture, 3% Sotradecol (sodium tetradecyl sulfate [STS]) emulsification of the thick cyst contents allowing complete drainage, and radiofrequency coblation of the cyst wall.ResultsIn this retrospective study, we report on 22 dermoids in 21 patients. The average patient age was 3 years. Twenty-one of the 22 dermoids were successfully treated for an overall success rate of 95%. Four intraosseous dermoids were successfully treated using computed tomography (CT) guidance instead of, or in addition to, US. Average follow-up time was 22 months.ConclusionThe combination of percutaneous cyst drainage using STS as an emulsifying agent followed by radiofrequency coblation is a safe, effective, minimally invasive treatment for pediatric patients with head and neck dermoids.

The values of shear wave elastography in avoiding repeat fine-needle aspiration for thyroid nodules with nondiagnostic and undetermined cytology.

To evaluate the value of shear wave elastography (SWE) in avoiding repeat fine-needle aspiration of thyroid nodules with nondiagnostic and undetermined cytology. A total of 232 thyroid nodules with nondiagnostic (n=132) and undetermined (n=100) cytology underwent ultrasound (US) and SWE, followed by repeat ultrasound (US)-guided fine-needle aspiration cytology (FNAC). The final diagnosis was based on cytological or pathological findings. The US and SWE characteristics of benign and malignant nodules were compared using the χ2 -test. The receiver operating characteristic (ROC) curves of the thyroid imaging reporting and data system (TI-RADS) categories from the US and the EMean and ESD from the SWE were graphed, and the areas under the curves (AUCs) were compared using a Z test. There were significant differences between the benign and malignant nodules in terms of the echogenicity, shape, margin, calcification and TI-RADS categories (all P<0.05). The differences were significant between the malignant and benign nodules for EMean [(34.57±14.81)kPa vs. (19.18±7.09)kPa] and ESD [(13.68±13.01)kPa vs. (3.97±2.58)kPa] (both P<0.001). Though the difference in the AUCs of EMean (0.864) and ESD (0.876) was not significant (P=0.745), they both had higher diagnostic performances in comparison with TI-RADS categories (0.762) (all P<0.05). Moreover, ESD attained a sensitivity of 100% with a relatively higher specificity of 49.75% when its cut-off value was 3.3kPa. Shear wave elastography is a promising imaging method for reducing repeat FNAC for benign thyroid nodules with nondiagnostic and undetermined cytology when using ESD as an index.

Radioguided occult lesion localization in patients with recurrent thyroid cancer.

Well planned re-surgery is critical for recurrent/persistent thyroid cancer (TC). We aimed to investigate the clinical outcome of radioguided-occult lesion localization (ROLL) guided surgery in patients with recurrent/persistent TC. This study includes 29 patients [F/M: 22/7, median age 43 ± 12years (18-58)] with a diagnosis of TC (22 papillary, 2 follicular and 5 medullary). Before surgery, all patients underwent ultrasonography (USG) guided mapping and intra-lesional radioactivity injection. Surgery was performed based on the excision of radioactivity injected lesions by a gamma probe and non-injected tumor foci via USG-neck map. Researchers determined surgical success by post-operative tumor markers and neck-USG. Among 29 patients, 60 metastatic lesions were identified by USG [median size 10 ± 6.3mm (range 5-30)]. Neck-USG performed after surgery provided no evidence of disease (NED) in %97 (28/29) of TC patients. In the follow-up, stimulated thyroglobulin (Tg) levels were less than 1ng/ml in 79%(19/24) of DTC patients and suppressed Tg < 0.2ng/ml was noted in 92% (22/24).In patients with DTC with an incomplete structural response, we dramatically changed the American Thyroid Association (ATA) response category and achieved an excellent response in 92% (22/24) of patients. Among patients with MTC, 5/5 patients had normal USG and calcitonin levels were reduced by 60-80% in 4/5 and > 80% in1/5 patients. In this study we have shown that, ROLL-guided surgery yielded NED rate of %97 (28/29) and increased excellent response rates according to ATA guidelines. Further studies with larger patient groups and longer follow-up should be performed to confirm the efficacy of this surgery.

The contribution of contrast-enhanced spectral mammography in detecting breast carcinoma of dense breasts

Objective To assess the contribution of contrast-enhanced spectral mammography (CESM) in detecting breast carcinoma of dense breasts. Methods To retrospectively analyze the imaging and clinical data of 52 female patients with breast carcinoma which were confirmed by pathology in Tai′an Central Hospital of Shandong Province from April 2017 to April 2018.All cases classified as dense or uneven dense breasts by DM examination underwent Ultrasound (US), digital mammography (DM), CESM, dynamic contrast enhanced MRI (DCE-MRI).The breast imaging report and data system (BI-RADS) and breast density classification were both evaluated using the 5th edition of BI-RADS. The efficacy of US, DM, DM+CESM, DCE-MRI in detecting breast carcinoma (BI-RADS 5) was evaluated by χ2 test. Results Histopathology confirmed that 87 lesions were malignant and 35 lesions were benign. The sensitivity of US, DM, DM + CESM, DCE-MRI were 66.67%(58/87), 64.37%(56/87), 100.00%(87/87), 100.00%(87/87) and the specificity were 94.28%(33/35), 74.28%(26/35), 85.71%(30/35), 51.43%(18/35), respectively. There was statistically significant difference in specificity (χ2=9.545, P=0.002) and BI-RADS 5 category, detection 39.08%(34/87), 22.99%(20/87), respectively (χ2=5.263, P=0.022) between the DM + CESM group and DCE-MRI group. Conclusion In dense breasts, CESM has a high application value in breast carcinoma diagnosis. Key words: Breast neoplasms; Contrast enhanced spectral mammography; Dense breast; Dynamic contrast enhanced magnetic resonance imaging

Reliability of automated versus handheld breast ultrasound examinations of suspicious breast masses.

PurposeThe purpose of this study was to assess the reliability of automated breast ultrasound (ABUS) examinations of suspicious breast masses in comparison to handheld breast ultrasound (HHUS) with regard to Breast Imaging Reporting and Data System (BI-RADS) category assessment, and to investigate the factors affecting discrepancies in categorization.MethodsA total of 135 masses that were assessed as BI-RADS categories 4 and 5 on ABUS that underwent ultrasound (US)-guided core needle biopsy from May 2017 to December 2017 were included in this study. The BI-RADS categories were re-assessed using HHUS. Agreement of the BI-RADS categories was evaluated using kappa statistics, and the positive predictive value of each examination was calculated. Logistic regression analysis was performed to identify the mammography and US findings associated with discrepancies in the BI-RADS categorization.ResultsThe overall agreement between ABUS and HHUS in all cases was good (79.3%, kappa=0.61, P<0.001). Logistic regression analysis revealed that accompanying suspicious microcalcifications on mammography (odds ratio [OR], 4.63; 95% confidence interval [CI], 1.83 to 11.71; P=0.001) and an irregular shape on US (OR, 5.59; 95% CI, 1.43 to 21.83; P=0.013) were associated with discrepancies in the BI-RADS categorization.ConclusionThe agreement between ABUS and HHUS examinations in the BI-RADS categorization of suspicious breast masses was good. The presence of suspicious microcalcifications on mammography and an irregular shape on US were factors associated with ABUS yielding a lower level of suspicion than HHUS in terms of the BI-RADS category assessment.

Potential application of ultrasound-guided thermal ablation in rare liver tumors

BackgroundWith the advances of imaging techniques, the detection rate of rare liver tumor is increased. However, the therapeutic strategies of the rare liver tumors remain limited. MethodsWe analyzed twelve pathologically confirmed rare liver tumors in 8 patients. All of the patients underwent ultrasound (US) guided biopsy and subsequent thermal ablation. The tumors were ablated according to the preoperative plans and monitored by real-time US. CT/MRI fused with contrast enhanced US (CEUS) or three-dimensional (3D) US-CEUS images were used to guide and assess the ablation zone more accurately during thermal ablation. The rate of technical efficacy was assessed based on the contrast-enhance CT/MRI (CECT/MRI) results one month after ablation. Local tumor progression (LTP), recurrence and complications were followed up and recorded. ResultsAmong these twelve nodules, nine were subject to US-guided thermal ablation, whereas the other three inconspicuous nodules were subject to CEUS-guided thermal ablation. Intra-procedure CT/MRI-CEUS or 3D US-CEUS fusion imaging assessments demonstrated that the ablation zone sufficiently covered the original tumor, and no immediate supplementary ablation was required. Additionally, no major complications were observed during the follow-up period. The postoperative CECT/MRI confirmed that the technique success rate was 100%. Within the surveillance period of 13 months, no LTP or recurrence was noted. ConclusionsUS-guided thermal ablation was feasible and safe for rare liver tumors. The use of fusion imaging technique might make US-guided thermal ablation as effective as surgical resection, and this technique might serve as a potential therapeutic modality for rare liver tumors in the future.