US Features Research Articles

Role of Doppler US and MRI in diagnosis of placenta accreta

The aim of this work is to evaluate the role of Doppler US and MRI in the diagnosis of placenta accreta. Patients and methodsDuring period between 2012 to 2013, 120 pregnant patients with previous cesarean section were investigated by ultrasound and Doppler and then in suspected cases MRI was obtained (10 cases). The Sonographic and MRI diagnoses were compared with the final pathologic or operative findings or with both. ResultsThe mean age of this study group was 29years ranging from 20 to 40. Among patients with confirmed placenta accreta, the mean age was 32.25 ranging from 25 to 40years. The mean parity of patients ranged from 1 to 6 with a mean of 1.6. Among patients with placenta accreta, the mean parity ranged from 2 to 6 with a mean of 3.75. The total number of cases with placenta accreta in this study was 4, all of which were previa. This was out of a total of 25 cases of placenta previa. Transabdominal US features were the presence of intraplacental lacunae (sonolucencies), loss of retroplacental clear zone and disruption of bladder–uterine serosa interface with smallest myometrial thickness <1mm over site of placental implantation by using color Doppler ultrasonography, the most prominent color Doppler feature in this study was the presence of intraplacental lacunar flow. Magnetic resonance imaging accurately predicted placenta accreta in 4 of 4 cases with placenta accreta and correctly ruled out placenta accreta in the rest six cases. ConclusionIn conclusion, data of the present study show that the use of transabdominal color Doppler ultrasonography complemented by MRI in suspected cases improves the diagnostic accuracy in prediction of placenta accreta in patients with previous cesarean delivery.

Triple-negative invasive breast cancer (TNBC): Mammographic, US, and MR imaging features according to androgen receptor (AR) expression.

159 Background: A subset of TNBC is characterized by an androgen gene signature and early clinical trials have demonstrated clinical benefit with the use of the AR antagonist, bicalutamide, for the treatment of patients with AR+, estrogen receptor/progesterone receptor- breast cancer. Methods: AR expression was assessed immunohistochemically in 125 patients (median age; 54 years, range; 26-82 years) with TNBC from a consecutive series of 1,086 operable invasive breast cancers. Two experienced breast imaging radiologists (6 and 24 years of experience, respectively) reviewed the mammograms, US, and MR images without knowledge of clinicopathologic findings. The imaging and pathologic features of 33 AR-positive TNBCs were compared with those of 92 AR-negative TNBCs by using the Fisher’s exact or chi-squared tests. Results: AR expression in TNBC is significantly associated with mammographic findings (P &lt; 0.001), lesion type at MR imaging (P &lt; 0.001), and mass shape or margin at ultrasound (P &lt; 0.001; P= 0.002). The highest PPVs for AR-positive cancer were non-mass enhancement on MR imaging (PPV, 1.00; 95% CI: 0.61, 1.00), calcifications only seen on mammography (PPV, 1.00; 95% CI: 0.37, 1.00), and spiculated masses on US (PPV, 1.00; 95% CI: 0.22, 1.00). Conclusions: AR-positive and AR-negative tumors have distinct imaging features in TNBC. The presence of calcifications or focal asymmetries at mammography, the presence of echogenic halo or non-complex hypoechoic masses at US, masses with irregular shape or indistinct margins at mammography and US, and masses with irregular shape or spiculated margins, or non-mass lesions at MR imaging were associated with AR expression in TNBC. These imaging features may be used to predict AR status, which could assist in treatment planning, prediction of response, and assessment of prognosis for patients with TNBC.

OP04.09: Ultrasound features of borderline ovarian tumors using the IOTA simple rules

The aim of this study was to evaluate the ultrasonographic features of BOT with the IOTA simple rules. We re-analyzed cross-sectional US images of BOT cases between 2012–2013 in Cipto Mangunkusumo Hospital, Jakarta. Ultrasound scans were performed using Accuvix V20 Prestige imaging system (Medison, South Korea). Features were re-classified using the IOTA simple rules. Malignant tumor was assigned if one of M criteria applied with no B criteria present, whereas benign tumor was assigned if one of B criteria applied without any of M criteria. Tumors cannot be classified if both M or B criteria applied or absent. Thirty-two cases of BOT were retrieved from medical record from 31 patients (one presented with bilateral BOT). Mean age was 42 years, ranging from 13 to 67 years old. Twenty-six (81.3%) tumors were classified as per magna cyst (more than 1500 mL). Using these simple rules, 8 (25%) were classified as benign, 13 (40.6%) malignant, and 11 (34.4%) unclassifiable. All tumors were confirmed post-surgically as BOT, consisting of 20 (62.5%) mucinous BOT, 9 (28.1%) serous BOT, 1 (3.1%) seromucinous BOT, and 2 (6.3%) as clear cell BOT. Borderline ovarian tumors remain difficult to be identified preoperatively. Using the IOTA simple rules, about 40% has malignant US features, while another 30% were unclassifiable.

MR imaging of myxofibrosarcoma and undifferentiated sarcoma with emphasis on tail sign; diagnostic and prognostic value.

To assess the prevalence of the tail sign in soft tissue sarcomas and determine whether the local recurrence rate differed based on the presence of the tail sign. In our retrospective study, myxofibrosarcoma (MFS, n = 25) and undifferentiated sarcoma (US, n = 38) comprised group 1, and the remaining tumours (n = 115) were assigned to group 2. Location, size, and imaging features of the tumours were assessed on MRI. The radiological-pathological correlation of the tail sign was analysed. The tail sign, thick fascial enhancement extending from the tumour margin, was more common and significantly thicker in group 1. In the subgroup analysis between MFS and US, there was no significant difference in the presence of a tail sign. Histological examination revealed extensive tumour cell infiltrations along the deep fascia from the main mass. Patients with a tail sign had a worse local recurrence-free survival than patients without it, not only in all tumours (p < 0.01), but also in group 1 (p = 0.019) CONCLUSIONS: The tail sign was a common MRI feature of both MFS and US, and was also associated with worse local recurrence-free survival. Radiologists should be aware of these MRI findings and inform the surgeon preoperatively in order to obtain a sufficient surgical margin to minimise the risk of local tumour recurrence. • The tail sign was a common MRI feature of myxofibrosarcoma and undifferentiated sarcoma. • The tail sign may be associated with worse local recurrence-free survival • Radiologists should be aware of this MRI finding and inform the surgeon.

FRI0554 Can Ultrasound BE Useful in Detection of Inactive Disease in Patients Affected by Jia? an Observational Case-Control Study of 128 Subjects

BackgroundMusculoskeletal Ultrasound (MSUS) is commonly used to detect synovial inflammation in adults affected by inflammatory rheumatisms. MSUS in children is nowadays still a challenge. For this reason MSUS in JIA...

OP0056 Can We Replace Temporal Artery Biopsy with Cranial Ultrasound for the Diagnosis of GIANT Cell Arteritis? A Retrospective Cohort Study of the Diagnostic Utility of Ultrasound in Routine Clinical Practice

BackgroundTemporal artery biopsy (TAB) has historically been considered the “gold standard” diagnostic test for Giant Cell Arteritis (GCA).ObjectivesThe aim of this study was to evaluate the diagnostic utility of cranial...

Ultrasonographic features in symptomatic osteoarthritis of the knee and relation with pain

Radiographic knee OA is moderately associated with pain. As OA is a disease of the entire joint, ultrasonography visualizing cartilage and soft tissue structures might provide more insight into the complex process of pain in knee OA. The objective of this study was to investigate the cross-sectional association between US findings and pain in knee OA. In this observational study, 180 patients fulfilling the ACR clinical criteria for knee OA underwent US examination of the most symptomatic knee. The US protocol comprised assessment of synovial hypertrophy, joint effusion, infrapatellar bursitis and Baker's cyst, medial meniscus protrusion and cartilage thickness. To evaluate the association between US features and pain (Numerated Rating Scale from 0 to 10 and the Knee Injury and Osteoarthritis Outcome Score pain subscale), regression analysis was performed. In regression analysis, no association between US or clinical or demographic features and the level of knee pain was found. In this cohort, no association between US features and the degree of knee pain was found. Despite the attractiveness of US (easy accessible, inexpensive and no radiation involvement) and the fact that previous research suggested otherwise, it remains uncertain which part of pain in knee OA is explained by pathology in soft tissue structures and whether US of the knee is the imaging tool of choice to visualize this pathology.

Thyroid fine-needle aspiration: the relevance of BRAF mutation testing

The manuscript ‘‘Additional BRAF mutation analysis may add additional diagnostic value in thyroid nodules with suspicion of malignant cytology alone even when the nodules do not show suspicious US features’’ [1] pointed out that some nodules, which were not considered suspicious on the ultrasound scan, can be potentially malignant. Moreover, the authors performed the V600E-BRAF test on the samples which were diagnosed in cytology as at variance with undetermined significance/follicular lesion (AUS/FLUS), to prove it. This study proves that nodules which are not suspicious on the ultrasound scan cannot reassure the clinician, altogether. Therefore, it is always necessary to check carefully all the thyroid nodules. The V600E-BRAF tests advantage is that it helps the cytopathologist to diagnose the papillary carcinoma and the follicular variant. The V600-Braf mutation is considered a specific marker of the thyroid papillary carcinoma. Concerning the role of mutation on the management of thyroid nodules, many studies have been published with no definitive conclusion. Therefore, it would be valuable to research this topic in more detail so as to clearly define the role of the V600 Braf test when performed on Fine-needle cytology. What is the role of V600E-BRAF mutation on Thyroid FNC?

A Risk-Adapted Approach Using US Features and FNA Results in the Management of Thyroid Incidentalomas Identified by 18F-FDG PET

To assess the risk of malignancy of thyroid incidentalomas found on 18F-FDG PET/CT by US features and cytologic results, and to evaluate the clinical usage of a combination of US features and cytology for post-FNA management of thyroid incidentalomas on 18F-FDG PET/CT. From September 2006 to December 2008, 132 patients with 134 thyroid incidentalomas detected on 18F-FDG PET/CT who had undergone US and US-FNA were included in this study. We evaluated the malignancy rate of thyroid incidentalomas in different subgroups subdivided by US features and US-FNA cytology results. Several variables were compared between the benign and malignant group. The risk of malignancy was 58.2 % (78/132) in thyroid incidentalomas on 18F-FDG PET/CT. Age, gender, and tumor size were not significantly different between the malignant and benign group. Malignancy rate of thyroid incidentalomas was significantly higher in the suspicious malignant (88.9 %) than in the probably benign group (11.3 %) on US (p < 0.001). Malignancy rates were high in thyroid nodules with "malignancy", "suspicious for malignancy", or "follicular neoplasm" on cytologic results, regardless of US features. However, malignancy rates of thyroid incidentalomas with "unsatisfactory" or "benign" results on cytology were higher in the suspicious malignant (75 %, 12.5 %, respectively) than in the probably benign (0 %) group on US. This study demonstrated that the risk of malignancy was high in thyroid incidentalomas on 18F-FDG PET/CT even without suspicious US features. However, there was no malignancy in nodules with no suspicious US features and benign cytology. Based on these results, we concluded that US may not replace FNA in the diagnosis of PET incidentalomas, and that a follow-up may be considered of thyroid incidentalomas with benign cytology and no suspicious US features.

Additional BRAF mutation analysis may have additional diagnostic value in thyroid nodules with “suspicious for malignant” cytology alone even when the nodules do not show suspicious US features

The BRAF(V600E) mutation test has been more effective in thyroid nodules with suspicious US features than ones without suspicious features. Therefore, we investigated the role of the BRAF(V600E) mutation as an additional study to cytology in diagnosing a thyroid nodule without suspicious US features. This study was performed at Severance hospital from December 2010 through February 2012. During this period, 2,650 patients with 2,918 nodules underwent FNA with an additional BRAF(V600E) mutation test. Among them, we excluded thyroid nodules with suspicious US features. Finally, 485 thyroid nodules in 466 patients (mean age 50.3 years; range 9-80 years) were included in this study. We compared the differences between patients with malignant and benign thyroid nodules. We evaluated the detection rates of the BRAF(V600E) mutation according to the Bethesda System for Reporting Thyroid Cytopathology (BSRTC). There were 60 (60/485, 12.4 %) malignant and 425 (425/485, 87.6 %) benign nodules. The detection rate of the BRAF(V600E) mutation in thyroid nodules without suspicious US features was only 6.6 % (32/485). Most had malignant cytology (62.5 %, 20/32). For nodules without malignant cytology, only 12 nodules (2.6 %, 12/462) had the BRAF mutation. Among the 12 nodules, nine nodules were suspicious for malignancy on cytology. Additional BRAF mutation analysis shows additional diagnostic value in thyroid nodules with "suspicious for malignant" cytology alone even when the nodules do not show suspicious US features. Therefore, the test should be selectively performed in thyroid nodules without suspicious US features, considering cost-effectiveness as well as diagnostic accuracy.

Ultrasonographic features of renal oncocytoma with histopathologic correlation

To analyze the sonographic (US) features of renal oncocytoma and correlate them with histopathologic findings. The medical records of 12 patients with a histologic diagnosis of renal oncocytomas were reviewed. The location, size, shape, margin, echogenicity, homogeneity, and blood flow distribution of the lesions were analyzed, and the US features were compared with histopathologic findings. Oncocytomas appeared as solid, solitary, well-marginated, unencapsulated, fairly homogeneous renal cortical masses (n = 10), with regular shape, relatively isoechoic (n = 5) or slightly hyperechoic (n = 7) to the adjacent renal parenchyma, and an exophytic growth pattern was exhibited in most cases (n = 9). Two larger masses (≥9 cm) demonstrated a central stellate scar and a characteristic of spoke-wheel vascular pattern. The tumors with a low percentage of stroma (<20%) were associated with an echotexture isoechoic to renal parenchyma, whereas oncocytomas with a higher percentage of stroma (>20%) were slightly hyperechoic. Although the US features are not pathognomonic, their presence should alert to the possible diagnosis of renal oncocytoma.

A nomogram for predicting malignancy in thyroid nodules diagnosed as atypia of undetermined significance/follicular lesions of undetermined significance on fine needle aspiration

We hypothesized that a nomogram constructed of clinical and imaging variables could be applied to predicting the risk of malignancy in thyroid nodules diagnosed as atypia of undetermined significance/follicular lesions of undetermined significance (AUS/FLUS) on ultrasonographic fine-needle aspiration (US-FNA). This retrospectively designed study included 393 thyroid nodules in 392 patients (mean age, 49 ± 12 years), which were diagnosed as AUS/FLUS with US-FNA during the study period. Medical records, US images, and cytopathology results were reviewed and analyzed. The 393 thyroid nodules were divided into training and validation sets. Logistic regression analysis was performed to predict the probability of malignancy, and nomograms were constructed using the training set and subsequently applied to the validation set. Three sets of nomograms were constructed separately using clinical factors and (1) individual US features; (2) final assessment of US; and (3) the number of suspicious US features. All 3 sets of nomograms built were proven accurate and discriminative, these nomograms had an area under the receiver operating characteristic curve (AUC) of 0.817 (95% confidence interval [CI], 0.757-0.877) when using clinical factors and individual US features, an AUC of 0.769 (95% CI, 0.705-0.833) wen using final assessment, and an AUC of 0.779 (95% CI, 0.718-0.840) when using the number of suspicious US features. The AUC of each validation set was 0.754 (95% CI, 0.659-0.850), 0.757 (95% CI, 0.661-0.853), and 0.721 (95% CI, 0.621-0.820), respectively. Nomograms constructed in our study using US can be utilized in predicting the probability of malignancy in thyroid nodules diagnosed as AUS/FLUS on US-FNA, and may help in selecting patients who are at high risk for malignancy.

Heterogeneous echogenicity of the underlying thyroid parenchyma: how does this affect the analysis of a thyroid nodule?

BackgroundHeterogeneous echogenicity of the thyroid gland has been associated with diffuse thyroid disease and benign and malignant nodules can coexist with diffuse thyroid disease. Underlying heterogeneous echogenicity might make it difficult to differentiate between benign and malignant nodules on US. Thus, the aim of this study was to evaluate the influence of underlying thyroid echogenicity on diagnosis of thyroid malignancies using US.MethodsA total of 1,373 patients who underwent US-guided fine needle aspiration of 1,449 thyroid nodules from June 2009 to August 2009 were included. The diagnostic performance of US assessment for thyroid nodules was calculated and compared according to underlying thyroid echogenicity. The diagnostic performance of US assessments in the diagnosis of thyroid malignancy according to the underlying parenchymal echogenicity was compared using a logistic regression with the GEE (generalized estimating equation) method. Each US feature of malignant and benign thyroid nodules was analyzed according to underlying echogenicity to evaluate which feature affected the final diagnosis.ResultsAmong the 1,449 nodules, 325 (22.4%) were malignant and 1,124 (77.6%) were benign. Thyroid glands with heterogeneous echogenicity showed significantly lower specificity, PPV, and accuracy compared to thyroid glands with homogeneous echogenicity, 76.3% to 83.7%, 48.7% to 60.9%, and 77.6% to 84.4%, respectively (P = 0.009, 0.02 and 0.005, respectively). In benign thyroid nodules, microlobulated or irregular margins were more frequently seen in thyroid glands with heterogeneous echogenicity than in those with homogenous echogenicity (P < 0.001).ConclusionHeterogeneous echogenicity of the thyroid gland significantly lowers the specificity, PPV, and accuracy of US in the differentiation of thyroid nodules. Therefore, caution is required during evaluation of thyroid nodules detected in thyroid parenchyma showing heterogeneous echogenicity.

Hand and Wrist Involvement in Systemic Sclerosis: US Features

Hand and Wrist Involvement in Systemic Sclerosis: US Features

How the preoperative ultrasound examination and BFI of the cervical lymph nodes modify the therapeutic treatment in patients with papillary thyroid cancer

BackgroundUltrasound is considered the best diagnostic method for the detection of metastatic cervical lymph nodes (LNs) in patients with papillary thyroid carcinoma (PTC). According to current guidelines, all patients undergoing thyroidectomy for malignancy should undergo preoperative neck ultrasound of the thyroid and central and lateral neck LNs, followed by fine needle aspiration of suspicious LNs. Cervical LN involvement determenes the extent of surgery. Complete surgical resection disease at the initial operation decreases likelihood of future surgery for recurrent disease and may impact survival. We use a new technique, B-flow imaging (BFI), recently used for evaluation of thyroid nodules, to estimate the presence of BFI twinkling signs (BFI-TS), within metastatic LNs in patients with PTC.MethodsBetween September 2006 and December 2012, 304 patients with known PTC were examined for preoperative sonographic evaluation with gray-scale US, color Doppler US and BFI. Only 157 with at least one metastatic LN were included in our study. All patients included underwent surgery, and the final diagnosis was based on the results of histologic examination of the resected specimens. The following LN characteristics were evaluated: LN shape, abnormal echogenicity, the absent of hilum, calcifications, cystic appearance, peripheral vascularization and the presence of BFI-TS.ResultsA total of 767 LNs were analyzed. 329 out of 767 were metastatic, according to the histopathologic findings. BFI-TS, showed 99.5% specificity and 81,5% sensitivity. We detected BFI-TS in 6 metastatic LNs that were negative to the other conventional US features.ConclusionsOur results indicate that the BFI-TS has a diagnostic accuracy higher than the other conventional sonographic signs. Our findings suggest that BFI can be helpful in the selection of suspicious neck LNs that should be examined at cytologic examination or open biopsy for accurate preoperative staging and individual therapy selection.

Three-dimensional cinema

Those observing the proliferation of three-dimensional (3D) films in US theaters wonder whether 3D will become ‘the new normal’ – the way that most films are produced and watched. Although skeptics abound, no one can answer this question with certainty now. But, if we consider this phrase from a different angle, it promises a more immediately revealing analysis of contemporary 3D cinema. Despite its appearance of born-again novelty, 3D has quickly established a highly codified stylistic repertoire. This repertoire is evidenced in the relationship that 3D US feature films have to classical Hollywood and contemporary film and image-making strategies. As it achieves its spatial effects, 3D obeys, wrestles with, and amplifies certain standard aspects of storytelling, visual style, and genre. Studying recent movies, including blockbusters, this article argues that 3D’s mixture of media heritages distills a highly conventionalized 3D aesthetic or a new stylistic normal.

AB0953 Is spinal osteophytosis associated with fatty liver?

BackgroundLypopolysaccharides (LPS)- induced cartilage damage is widely used as a model to investigate the effectiveness of cartilage protective agents in vitro. Overwhelming liver LPS of intestinal origin break impaired liver...

AB0923 Subclinical entheseal involvement in patients with psoriasis: A case-control ultrasound study

BackgroundUltrasonography (US) can demonstrate early abnormalities in entheses of asymptomatic patients. The existence of pre-clinical entheseal involvement in patients with psoriasis is debated.ObjectivesTo verify by US the presence of subclinical...

FRI0331 Comparison of clinical and ultrasonographic examination of 7200 joints in 100 JIA patients satisfying wallace criteria of inactive disease (ID), suggests to add ultrasonography as a new criteria of ID

Backgroundultrasonography (US) is useful to detect synovial inflammation in JIA but still seldom used by pediatric rheumatologists to confirm the clinical definition of inactive synovitisObjectivesUS and Power Doppler Signal (PDS)...

Overcoming the Illegitimacy Discount: Cultural Entrepreneurship in the US Feature Film Industry

How can organizations spanning institutionalized categories mitigate against the possibility of reduced attention by audiences? While there has been a good deal of research on the illegitimacy discount of category spanning, scant attention has been paid to how organizations might strategically address this potential problem. In this paper, we explore how the strategic naming of products might enhance audience attention despite the liabilities associated with category spanning. Drawing on a sample of films released in the United States market between 1982 and 2007, we analyze different naming strategies and show that names that simply signal familiarity are not potent enough to offset the illegitimacy discount, while names imbued with known reputations serve as a symbolic device that enhances audience attention to genre-spanning films.