US Features Research Articles

Role of Sonographic Characteristics of Thyroid Bed Lesions Identified Following Thyroidectomy in the Diagnosis or Exclusion of Recurrent Cancer.

Background US of the thyroid bed in patients with thyroid cancer often depicts small lesions, but it is unclear whether US characteristics of lesions can help predict cancer recurrence. Purpose To determine whether size or US features of lesions in the thyroid bed after thyroidectomy in conjunction with clinical features can help predict thyroid cancer recurrence. Materials and Methods With use of a US reporting database, all patients imaged between July 2006 and June 2016 with an indication of post-thyroidectomy follow-up were retrospectively identified. Recorded data included patient demographic characteristics; date of thyroidectomy; thyroid cancer type; presence, size, and US characteristics of thyroid bed lesions; and results of fine-needle aspiration (FNA). Images were reviewed for lesions that underwent FNA. The Fisher exact test was used for analysis. Results A total of 1885 patients (mean age ± standard deviation, 48 years ± 15; 1493 female patients) underwent 5732 US examinations. Most patients (1541 of 1885 [82%]) had papillary cancer. Overall, 3163 thyroid bed lesions were reported in 5732 US examinations (40.4%). More than half of these lesions (1860 of 3163 [58.8%]) had a maximum measurement of 6 mm or greater. FNA was performed in 144 of the 3163 lesions (4.6%), of which 61 (42.4%) were malignant, 33 (22.9%) were benign, and 50 (34.7%) were nondiagnostic. Five nondiagnostic lesions eventually proved malignant. Only the presence of punctate echogenicities in the lesion (28 of 61 malignant lesions [45.9%]; three of 33 benign lesions [9%]; 12 of 50 nondiagnostic lesions [24%]; P < .001) or the history of positive lymph nodes at thyroidectomy (44 of 61 malignant lesions [72.1%]; 10 of 33 benign lesions [30%]; 19 of 50 nondiagnostic lesions [38%]; P < .001) were associated with malignancy. Of 3019 thyroid bed lesions that did not undergo FNA, three were malignant and 2248 showed no growth at follow-up US ranging from 6 months to 10 years and are presumed benign. Of the 1303 lesions smaller than 6 mm, only two (0.2%) were malignant. Conclusion Small lesions are commonly found in the thyroid bed after thyroidectomy, and most are likely to be benign. Lesions smaller than 6 mm with no punctate echogenicities had a minimal risk for malignancy. © RSNA, 2021 See also the editorial by Grant and Malhi in this issue.

Ultra-microangiography in evaluating the disease activity of rheumatoid arthritis and enhancing the efficacy of ultrasonography: A preliminary study

ObjectiveUltra-microangiography (UMA) is a novel Doppler technique that has high sensitivity for low-velocity blood flows. In this study, a distinctive imaging feature, penetrating blood vessels on the surface of eroded bones within the inflamed joints, was observed on UMA. We aimed to investigate the feasibility of UMA in assessing disease activity and identify the clinical value of the UMA feature for evaluating rheumatoid arthritis (RA). Methods and materialsPower-Doppler ultrasound (PDUS) and UMA were performed on small joints of RA patients. The semiquantitative scores of PDUS and UMA of the joints were assessed and compared. The UMA imaging feature of penetrating vessels on the surface of eroded bones was evaluated, and the patients were divided into three groups based on imaging features. (Group 1: no inflammatory signs; Group 2: inflammatory US features but no UMA features; and Group 3: detected UMA features). The correlations between the groups and clinical parameters were assessed. ResultsA total of 52 patients with RA were recruited, with 364 joints (MCP, PIP, MTP and wrist) scanned. Synovial blood vessel signals were detected for 68 by PDUS and for 93 by UMA (display rate of blood vessel signals: 18.68 % VS 25.55 %). UMA presented better display capability of blood vessels within the inflamed regions than that of PDUS in overall. Significant differences were detected in clinical scores (P < 0.0001 for DAS28 [ESR], DAS28 [CRP], SDAI, CDAI, CRP P = 0.0303, SJC P = 0.0059, and TJC P = 0.0423) between Group 2 and 3. Significant correlations between the groups and clinical parameters were also observed (DAS28 [ESR] ρ=0.750; DAS28 [CRP] ρ=0.762; SDAI ρ=0.778; CDAI ρ=0.773; CRP ρ= 0.524; SJC ρ=0.742; TJC ρ=0.693, P < 0.0001), indicating that the UMA feature was related to high disease activity. ConclusionsUMA can help enhance the detection rate of micro-vascularization. The UMA feature of the penetrating vessels on the surface of eroded bones is likely to be associated with severe disease activity.

Makrokalsifiye Tiroid Nodüllerinde İnce İğne Aspirasyon Biyopsisi (İİAB) Sonuçlarının Değerlendirilmesi

Objective: Thyroid nodule is the most common disease of the thyroid gland and is closely associated with thyroid cancer. The gold standard method in diagnosis is Fine Needle Aspiration Biopsy (FNAB). Although the relationship between nodules containing microcalcification and malignancy is well known, there is no consensus on the relation of nodules with macrocalcification to malignancy and the adequacy of FNAB. In this study, it was aimed to compare the results of FNAB of nodules with and without macrocalcification in US examination. Methods: In this retrospective study, 466 nodules undergoing FNAB of 450 patients who applied for biopsy were included in the study. The demographic characteristics of the patients, US features of the nodules and cytopathology results of FNAB in the Bethesda classification were recorded. Nodules were divided into two main groups as calcified and non-calcified. US features and cytopathology results of the groups were compared. Results: Transverse sizes of calcified nodules were found to be larger than non-calcified ones (p = 0.003). In addition, solid composition, hypoechoic and prominent hypoechoic echogenicity, and irregular border feature were found with a higher rate in the calcified group (p &lt;0.001). No significant difference was found between insufficient sample/non-diagnostic cytology (Bethesda-1) ratios in both groups (19.2% and 14.7%). Cytopathologically, number of malignant and suspected malignant nodules (Bethesda 5 and 6) were found to be higher in the calcified group (p=0.05). Conclusion: According to the results of this study, detection of macrocalcification in thyroid nodules in US examination does not cause a significant increase in insufficient FNAB results. However, the presence of macrocalcification increases the risk of malignancy of the thyroid nodule.

Ultrasonographic Findings in Symptomatic Knee Osteoarthritis in Relation to Pain

Background: Osteoarthritis (OA) is the most common form of arthritis and one of the leading causes of disability. OA affects around 250 million people worldwide. Musculoskeletal ultrasound (MSUS) has become important and primary diagnostic tool in visualization of inflammatory and degenerative conditions of joints, ligaments, cartilage and muscles. Aims: To study the cross-sectional association between ultrasonographic findings and pain in knee osteoarthritis. Patients and methods: Fifty patients fulfilling the clinical criteria for knee OA had undergone US examination of the most symptomatic knee and pain assessment; studies were performed at Benha teaching hospital.Statistical analysis:The statistical analysis and presentation of data was conducted using the mean, slandered deviation, t-test and Pearson’s correlation by SPSS version 20.Results:After data acquisition and statistical analysis no association between US findings and the level of knee pain was found.Conclusion: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), 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. Key message:No association between US features and the degree of knee pain, was found.

Impact of BMI on Preoperative Axillary Ultrasound Assessment in Patients With Early Breast Cancer.

The accuracy of axillary ultrasound (AUS) with fine-needle aspiration with varying patient body mass index (BMI) is still unclear. The aim of our study was to evaluate whether the US features of axillary lymph nodes changes with BMI of patients. A retrospective review was performed involving 144 out of 270 patients with early breast cancer who underwent breast surgery with sentinel lymph node biopsy. Diagnostic efficacy of AUS in preoperative axillary nodal staging was assessed in relation to BMI. Negative predictive values of AUS for the overweight and obese groups were statistically significantly lower compared to the normal/underweight group (p=0.02 and p=0.003, respectively). Additionally, Spearman's correlation coefficient R between BMI and positive sentinel lymph node biopsy was 0.257, suggesting a significantly positive linear relationship between the two variables in the cohort overall. Our results demonstrate how in our cohort the negative predictive value of AUS was significantly influenced by adipose tissue and that the selection of the most suitable instrumental diagnostic technique might contribute to improving heterogeneous results.

Correlation between Primary Myelofibrosis and the Association of Portal Thrombosis with Portal-Biliary Cavernoma: US, MDCT, and MRI Features

Abstract Objective Myelofibrosis is a rare chronic myelolymphoproliferative disease and is associated with increased risk of venous thromboembolism. The objective of this study is to retrospectively evaluate patients with primary myelofibrosis who underwent abdominal US, MDCT and MRI, in order to identify the development of portal thrombosis and its correlation with portal-biliary cavernoma. Methods We evaluated 125 patients with initial diagnosis of primary myelofibrosis and nonspecific abdominal pain who had undergone US with color Doppler. In 13 patients (8 men, 5 females; age: 45–85), US detected portal thrombosis with associated portal-biliary cavernoma. All patients subsequently underwent contrast-enhanced MDCT and MRI and 4 patients MR-cholangiography. The correlation between primary myelofibrosis and portal thrombosis and cavernoma respectively was calculated using χ2 test. Results About 10% of patients with primary myelofibrosis preliminary evaluated with US had partial (8 pts) or complete (5 pts) portal thrombosis associated with portal-biliary cavernoma with a χ2 = 0. In all patients, US detected a concentric thickening of main bile duct (MBD) wall (mean value: 7 mm); color Doppler always showed dilated venous vessels within the thickened wall of the biliary tract. Contrast-enhanced CT and MRI confirmed thickening of MBD walls with their progressive enhancement and allowed better assessment of the extent of the portal system thrombosis. MR-cholangiography showed a thin appearance of the MBD lumen with evidence of ab extrinsic compression. Conclusions The evidence of portal thrombosis and portal-biliary cavernoma in 10% of the patients with primary myelofibrosis indicates a close correlation between the two diseases. In the detection of portal thrombosis and portal-biliary cavernoma, US with color Doppler is the most reliable and economical diagnostic technique while contrast-enhanced MDCT and MRI allow better assessment of the extent of the portal vein thrombosis and of the complications of myelofibrosis.

Non-mass lesions detected by breast US: stratification of cancer risk for clinical management.

To develop a classification system using imaging features to interpret breast non-mass lesions (NMLs) detected on US and to stratify their cancer risk. This retrospective study included 715 patients with 715 breast NMLs detected on breast US from 2012 to 2016. Each patient underwent mammography at the time of diagnosis. Radiologists assessed US and mammographic features and final BI-RADS categories. Multivariable logistic regression was used to find imaging features associated with malignancy in a development dataset (n = 460). A system to classify BI-RADS categories (3 to 5) was developed based on the odds ratios (ORs) of imaging features significantly associated with malignancy and validated in a distinct validation dataset (n = 255). Among 715 NMLs, 385 (53.8%) were benign and 330 (46.2%) were malignant. In the development dataset, the following B-mode US features were associated with malignancy (all p < 0.001): segmental distribution (OR = 3.03; 95% confidence interval [CI], 1.50-6.15), associated calcifications (OR = 4.26; 95% CI, 1.62-11.18), abnormal ductal change (OR = 4.91; 95% CI, 2.07-11.68), and posterior shadowing (OR = 20.20; 95% CI, 6.46-63.23). The following mammographic features were also associated with malignancy (all p < 0.001): calcifications (OR = 7.98; 95% CI, 3.06-20.81) and focal asymmetry (OR = 4.75; 95% CI, 1.90-11.88). In the validation dataset, our classification system using US and mammography showed a higher area under the curve (0.951-0.956) compared to when it was not applied (0.908-0911) to predict malignancy with BI-RADS categories (p < 0.05). Our classification system which incorporates US and mammographic features of breast NMLs can help interpret and manage all NMLs detected on breast US by stratifying cancer risk according to BI-RADS categories. • When diagnosing breast NMLs detected on US, suspicious US features are segmental distribution, associated abnormal ductal change, calcifications, and posterior shadowing within or around the NML on B-mode US, while a probably benign US feature is the presence of multiple small cysts. • Corresponding suspicious mammographic features of breast NMLs detected on US are associated calcifications and focal asymmetry. • Our classification system which incorporates US features with and without mammography can potentially be used to interpret and manage any NMLs detected on breast US in clinical practice.

ESTRADIOL IS ASSOCIATED WITH DECREASED CARDIOVASCULAR RISK COMPARED TO ETHINYLESTRADIOL WHEN CONTAINED IN COMBINED HORMONAL PREPARATIONS: IMPLICATIONS FOR THE DEVELOPMENT OF NEW ENDOMETRIOSIS THERAPIES

Combined estrogen-progestin preparations have a long history in women’s health and are currently used for multiple indications, including the treatment of endometriosis-related symptoms. Empirically, estradiol (E2) and its ester, estradiol valerate (E2Val) carry a reduced cardiovascular risk due to their reduced impact on the hepatic system compared to the most-widely used estrogen ethinylestradiol (EE). However, robust comparative studies in pre-menopausal women are limited. A new hormonal product containing E2 in combination with the progestin norethindrone acetate (NETA) and the gonadotropin-releasing hormone receptor antagonist, relugolix, has been developed for the treatment of uterine fibroids and endometriosis. This analysis tries to quantify the cardiovascular risk of E2/E2Val-NETA in pre-menopausal women. A pooled analysis of four large cohort studies assessing the risk of cardiovascular events in users of combined oral contraceptives (COCs). Data regarding users of COCs containing either E2/E2Val or EE≤30μg were retrieved from four large prospective, controlled, observational, cohort studies in 14 European countries, US and Canada. Baseline characteristics, including reproductive, contraceptive and medical history, were summarized using descriptive statistics. Propensity score sub-classification was applied to balance baseline parameters between cohorts and time-to-event analysis of venous and arterial thromboembolic events was carried out based on the extended Cox model to calculate crude and adjusted hazard ratios (HR) including 95%-confidence intervals (CI). The analysis was based on 210,000 women, who contributed 470,000 women years of exposure. The observed prevalence of prognostic factors at baseline showed typical features of US and European COC users. However, the mean age in the E2/E2Val cohort was higher compared to the EE≤30μg cohort (31.7 years ±9.76 and 26.1 years ±7.89, respectively). A time-to-event analysis of the VTE data was carried out based on the extended Cox model. Validity of the model was demonstrated by the standardized differences summarized over strata as weighted average yielded upon PS sub-classification, which were consistently <0.25 and mostly <0.1. A comparison between cohorts showed a decreased risk of venous thromboembolism in users of COCs containing E2/E2Val vs users of COCs containing EE≤30μg; adjusted hazard ratio: 0.49 (95% CI, 0.28-0.84). A risk reduction in the E2/E2Val cohort was also observed with regards to arterial thromboembolic events; adjusted hazard ratio: 0.26 (95% CI, 0.08-0.83). Data presents a solid safety assessment of combined hormonal preparations in over 200,000 pre-menopausal women and shows a decreased cardiovascular risk of E2/E2Val when compared to low-dose EE. This provides reassurance for current users of E2/E2Val-containing COCs and opens new perspectives for the development of safe and effective endometriosis treatments, such as the recently developed product containing E2/NETA, in combination with relugolix.

Nomogram based on radiomics analysis of primary breast cancer ultrasound images: prediction of axillary lymph node tumor burden in patients.

To establish a prediction model for evaluating the axillary lymph node (ALN) status of patients with T1/T2 invasive breast cancer based on radiomics analysis of US images of primary breast lesions. Between August 2016 and November 2018, a total of 343 patients with histologically proven malignant breast tumors were included in this study and randomly assigned to the training and validation groups at a ratio of 7:3. ALN tumor burden was defined as low (< 3 metastatic ALNs) or high (≥ 3 metastatic ALNs). Radiomics features were obtained using the PyRadiomics package, and the radiomics score was established by least absolute shrinkage and selection operator regression. A nomogram combining the breast cancer US radiomics score with patient age and lesion size was generated based on the multivariate logistic regression results. In the training and validation cohorts, 29.1% (69/237) and 32.08% (34/106) of patients were pathologically diagnosed with more than 2 metastatic ALNs, respectively. The radiomics score consisted of 16 US features, and patient age and lesion diameter identified by US were included to construct the model. The AUC of the model was 0.846 (95% CI, 0.790-0.902) for the training cohort and 0.733 (95% CI, 0.613-0.852) for the validation cohort. The calibration curves showed good agreement between the predictions and observations. Our novel nomogram demonstrates high accuracy in predicting ALN tumor burden in breast cancer patients. We also suggest further development of PyRadiomics to improve US radiomics. • A nomogram based on US was developed to predict ALN tumor burden (low, < 3 metastatic ALNs; high, ≥ 3 metastatic ALNs). • The nomogram could assist clinicians in evaluating treatment strategies for T1/T2 invasive breast cancer.

Developing a tool that could reliably refute total thyroidectomy for solitary Bethesda IV thyroid nodules.

To assess the reliability of a simple, accessible, cost-effective rule-out tool, for use in triaging patients with Bethesda IV nodules to appropriate surgery. The diagnostic tool was assembled by combining the negativity for suspicious ultrasound features (irregular margins, microcalcification, and a taller-than-wide orientation), and mutational marker negativity (BRAF and NRAS). The tool, (US-/mutation-), was tested on 167 patients with solitary Bethesda IV nodules. The primary outcome was its negative predictive value (NPV) for lesions requiring total thyroidectomy (TT). The impact of mutational marker negativity, as part of the tool, was evaluated by comparing the NPV of (US-/mutation-) to that of (US-/mutation+). 10 out of 167 lesions were positive for a mutational marker. These underwent TT, and only 2/10 (20%) were benign, on final histology. In 6/8 malignant lesions, TT was concordant with current clinical guidelines. 157 patients comprised the negative study cohort, for both mutational markers and suspicious US features. These underwent thyroid lobectomy, and 17 cases resulted in malignancy, only 8 of which required completion thyroidectomy. Accordingly, the NPV of (US-/mutation-) for malignancy was 89% (140/157), and 95% (149/157) for malignancy requiring TT. However, the NPV of (US-/mutation+) was 20% for malignancy, and 40% for malignancy requiring TT. These differences were statistically significant (89% vs. 20%; p < 0.0001, and 95% vs. 40%; p < 0.0001). US-/mutation- is a reliable rule-out tool, with sufficient diagnostic accuracy to spare patients, with Bethesda IV nodules, an overly radical TT.

Comparing the Cardiovascular Risk of Norethindrone Acetate &amp; Levonorgestrel Pills: Is There a Difference? [10I

INTRODUCTION: Combined oral contraceptives containing norethindrone acetate (NETA) are widely used in the US and globally, but how they compare to levonorgestrel-containing pills is unknown. This pooled analysis compares the safety of NETA and levonorgestrel (LNG) in pills with ethinyl estradiol (EE) ≤30 mcg. METHODS: We pooled cohorts of NETA (EE ≤30 mcg) and LNG (EE ≤30 mcg) users from four large prospective, controlled, non-interventional, cohort studies in 14 European countries, US and Canada. Baseline characteristics, including reproductive, contraceptive and medical history, were summarized using descriptive statistics. Propensity score sub-classification was applied to balance baseline characteristics between cohorts. Time-to-event analysis of venous and arterial thromboembolic events was carried out based on the extended Cox model to calculate crude and adjusted hazard ratios with 95% confidence intervals. RESULTS: Approximately 80,000 women contributed 145,000 women years of exposure. The prevalence of prognostic factors at baseline showed typical features of US and European oral contraceptive users. A comparison between NETA vs LNG showed no significant difference in the risk of venous thromboembolism: adjusted hazard ratio 0.73 (95% CI 0.48-1.11). A similar result was observed considering the risk of arterial thromboembolism (adjusted hazard ratio 0.89 [95% CI 0.42-1.89]). CONCLUSION: Low-dose oral contraceptives containing NETA and LNG are associated with similar low risks of venous and arterial disease. This analysis provides reassurance for both women and clinicians regarding the safety of contemporary oral contraceptives.

Ultrasound Elastography and TI- Rads (Thyroid Imaging Reporting and Data System) in the Diagnostic Evaluation of Thyroid Nodules

Abstract Background Thyroid nodules refers to an abnormal growth of thyroid cells that forms a lump within the thyroid gland. Although the vast majority of thyroid nodules are benign , a small percent is presenting as a thyroid cancer. Objective To quantify the sensitivity &amp; the specifity of ultrasound elastography and TI-RAADS in evaluation of thyroid nodules among study population in Ain Shams university hospitals. Patients and Methods Type of study: cross sectional study. Study setting: it was conducted at Ain Shams University hospitals. Study period: March2018 to September 2018. Sample size: 41 patients were included in this study. Results There is a significant increase in the hyperechoic and isoechoic echogenicity in benign groups while no significant difference in hypoechogenicity and a significant difference in very hypoechogenicity in malignant group P- value=0.002. Conclusion Finally both the use of TI- RADS and elastography are methods to evaluate thyroids nodules according to US features and scoring systems that they are easy to perform, not invasive, informative, not costy and can be combined together to increase the accuracy of evaluation.

Use of CEUS LI-RADS for the Accurate Diagnosis of Nodules in Patients at Risk for Hepatocellular Carcinoma: A Validation Study.

To validate the contrast agent-enhanced US Liver Imaging Reporting and Data System (CEUS LI-RADS) algorithm for accurate diagnosis of hepatocellular carcinoma (HCC) and categorization of all nodules encountered in patients at risk for HCC. A single-center retrospective review of 196 nodules in 184 patients at risk for HCC (consisting of 139 HCCs, 18 non-HCC malignancies, and 39 benign nodules) was performed in a three-reader blinded read format, with the use of the CEUS LI-RADS algorithm. Pathologic confirmation was available for 143 nodules (122 HCCs, 18 non-HCC malignancies, and three benign nodules). Nodule sizes ranged between 1.0 and 16.2 cm. Nodules assessed with contrast-enhanced US were assigned various CEUS LI-RADS categories by three blinded readers. CEUS LI-RADS categorization was then compared against histopathologic findings, concurrent CT, and/or MR images or follow-up imaging to assess diagnostic accuracy of CEUS LI-RADS. In addition, the proportion of HCC in all LI-RADS (LR) categories, univariable and multivariable feature analysis, and interrater agreement using Light κ were determined. The LR-5 category, determined through radiologist categorization of nodules using the CEUS LI-RADS criteria, showed sensitivity, specificity, positive predictive value, and negative predictive value of 86% (119 of 139), 96% (55 of 57), 98% (119 of 121), and 73% (55 of 75), respectively, for the diagnosis of HCC. Two false-positive cases of LR-5 included a cholangiocarcinoma and a combined hepatocellular and cholangiocarcinoma. The remainder of the cholangiocarcinomas in the sample (n = 8) were appropriately categorized as LR-M. Multivariable logistic regression analysis showed that washout of greater than 60 seconds was the contrast-enhanced US feature most predictive of HCC diagnosis, whereas washout of less than 60 seconds was the feature most predictive of nonhepatocellular malignancy. The proportion of HCC nodules categorized in the LR-M and LR-4 categories was 35% and 20%, respectively. Light κ agreement between readers for LI-RADS categorization was 90%. This study showed excellent specificity for the CEUS LI-RADS LR-5 category, allowing for confident imaging diagnosis of HCC, without necessity for pathologic confirmation. In addition, there was accurate differentiation of HCC from non-HCC malignancies and benign nodules. Only a single cholangiocarcinoma was misdiagnosed as category LR-5, with the remainder of the cholangiocarcinomas in the sample appropriately characterized as category LR-M.Keywords: Abdomen/GI, Evidence Based Medicine, Liver, Neoplasms-Primary, Ultrasound-Contrast© RSNA, 2020.

Association Between Preoperative US, Elastography Features and Prognostic Factors of Papillary Thyroid Cancer With BRAFV600E Mutation.

Purpose: To investigate the value of US and elastography for predicting prognostic factors of papillary thyroid cancer (PTC) in the positive BRAFV600E Mutation group.Materials and Methods: A total of 116 BRAFV600E Mutation patients with PTCs were enrolled in this prospective study, who were preoperatively evaluated by US, US elasticity imaging (EI), and Virtual Touch tissue imaging (VTI) and Virtual Touch tissue quantification (VTQ) of acoustic radiation force impulse (ARFI) imaging. Multivariate logistic regression analysis was performed to assess 23 independent variables for predicting prognostic factors. Diagnostic performance was evaluated with receiver operating characteristic (ROC) curve analysis.Results: Forty-two (36.2%) of 116 PTC patients with BRAFV600E Mutation had central lymph node metastasis (LNM). Nine (7.8%) and fifty-six (48.3%) had lateral LNM and extra-thyroidal extension (ETE), respectively. In multivariate logistic regression analyses, rich internal flow [odds ratio [OR]: 6.66] was the best predictor for central LNM, followed by male sex (OR: 4.22), halo sign absence (OR: 2.78) (all P < 0.05). VTQ ratio (OR: 1.57) was the only predictor for lateral LNM (P = 0.02). Rich internal flow (OR: 6.33) was the strongest predictor for ETE, followed by male sex (OR: 3.29), halo sign absence (OR: 2.90), and VTQ ratio (OR: 1.63) (all P < 0.05).Conclusion: VTQ ratio on ARFI imaging, rich internal flow and halo sign absence on US are the predicting prognostic factors in PTC patients with BRAFV600E Mutation. The specificities were significantly increased by combining ARFI imaging and US features, which has a potential to avoid unnecessary therapeutic neck dissection in the high-risk PTC patients.

P643 Development of quantitative ultrasonographic activity score in ileal Crohn’s disease

Abstract Background Intestinal ultrasound (IUS) is as an accurate bedside tool for monitoring Crohn’s disease (CD). However, there is no validated quantitative ultrasonographic score for evaluation of the activity of intestinal inflammation in CD. Such a score may facilitate the use of IUS-based monitoring in clinical practice and in clinical trials in CD. For magnetic resonance enterography (MRE), the magnetic resonance index of activity (MaRIA) is most commonly used. Thus, the aim of our study was to correlate IUS data for the terminal ileum with segmental MARIA score for the terminal ileum in order to devise a quantitative inflammatory index for IUS. Methods In this retrospective cohort study, the data of CD patients who were followed in the Gastroenterology Department at Sheba medical centre between January 2016 and December 2018 were extracted. Inclusion criteria were age &amp;gt;18 and an interval&amp;lt;3 months between MRE and IUS. MaRIA score for the terminal ileum was compared with ultrasonographic features of inflammation that included: bowel wall thickness (continuous variable), echogenicity of the bowel wall, pseudostratification of the bowel wall layers, inflammatory mesenteric fat and lymph nodes, hyperemia present on colour Doppler flow and complications (nominal variable). A linear regression model that included the significantly correlated variables was constructed. Results Forty-two patients with established Crohn’s disease were included. A stepwise multiple regression model was constructed to predict MaRIA score using US features. Two variables were found to be independently significant in the explanatory model, terminal ileum thickness (r = 0.68, p = 0.001) and US fat proliferation (r = 0.45, p = 0.019). A model was constructed as follows: MaRIA = 7 + 2.5 * TI US thickness (mm) + 7 * US fat proliferation (0 = no, 1 = yes). This model has an R2 of 0.51 for explaining the variability in the results. Conclusion Quantitative IUS measurements are significantly correlated with segmental MaRIA score in the terminal ileum; a simple computational model for prediction can be constructed; however,, the accuracy of such model to predict segmental MaRIA was moderate. Additional work to develop quantitative IUS parameters in CD is merited.

Sonographic features of follicular variant of papillary thyroid carcinoma (FV-PTC) and diagnostic performance of the 2017 ACR TI-RADS in FV-PTC.

To find the sonographic features of follicular variant of papillary thyroid carcinoma (FV-PTC) and evaluate the diagnostic performance of 2017 ACR TI-RADS in FV-PTC. From June 2017 to June 2019, 104 FV-PTC patients (106 nodules) and 337 classic papillary thyroid carcinoma (C-PTC) patients (343 nodules) with both sonograms and pathologic results were included. Sonographic features of FV-PTC and C-PTC were evaluated and compared, and 2017 ACR TI-RADS scores and levels were calculated. Pathologically, the incidence of Hashimoto's thyroiditis and extrathyroidal extension was higher in the FV-PTC group. Most of both the FV-PTC and C-PTC groups were diagnosed as PTC or suspicious PTC by fine-needle aspiration biopsy (FNAB). FV-PTC tended to be isoechoic, while most nodules of C-PTC were hypoechoic or very hypoechoic. Compared with C-PTC, FV-PTC had lower percentages of a taller-than-wide shape (11.3% vs. 46.6%) and lobulated or irregular margin (33.0% vs. 61.8%), and a higher percentage of extrathyroidal extension (20.8% vs. 8.2%). FV-PTC featured macrocalcifications, whereas punctate echogenic foci were more frequently seen in the C-PTC group. Other characteristic US appearances of FV-PTC included uneven hypoechoic halo and peripheral vascularity. The mean TI-RADS score of FV-PTC cases was lower in the FV-PTC group, 11.3%, 44.3%, and 42.5% of which were categorized as TI-RADS 3, 4, and 5, respectively. FV-PTC features isoechoic appearance, macrocalcifications, uneven hypoechoic halo, and peripheral vascularity on US, with lower incidences of microcalcifications and taller-than-wide shape, and tends to have lower TI-RADS scores and levels. For the nodules categorized as TI-RADS 3 or 4, the FNAB criteria should be broaden when these nodules have FV-PTC US features.

Influence of non-steroidal anti-inflammatory drugs on the inflammatory sonographic features in erosive hand osteoarthritis: an intervention study.

ObjectiveThe aim was to examine whether inflammatory US features in erosive hand OA patients change when discontinuing intake of NSAIDs before US examination in a non-randomized study.MethodsPatients (n = 99) were allocated to the NSAIDs or control group according to their intake at baseline. US was performed at baseline (T0) and 2 weeks after discontinuation of NSAIDs (T1). Inflammatory features (i.e. synovial proliferation, effusion and power Doppler signal) were scored using a semi-quantitative scale (from zero to three). Pain levels were scored on a numerical rating scale. Binomial mixed models were fitted for US features, and odds ratios of having a US score of at least two vs at most one for synovial proliferation and effusion, and zero vs at least one for power Doppler were calculated.ResultsAt baseline, both groups [NSAIDs group (n = 47) vs control group (n = 52)] were comparable for numerical rating scale pain, disease duration, number of radiographically affected joints, BMI and US baseline data, but not for age (P = 0.005). At T1, more synovial proliferation and power Doppler signal was seen compared with T0 in the NSAIDs group (P = 0.018 and 0.031, respectively). However, the interaction term time*NSAIDs was not found to be significant for any variable. The numerical rating scale pain at T1 was higher compared with baseline, although statistically non-significant.ConclusionNo significant changes in inflammatory US features were seen in patients with erosive hand OA after withdrawal of NSAIDs for 2 weeks. This study suggests that an NSAID-free period is not necessary before assessing inflammatory disease activity in erosive hand OA.

Advanced diagnostic imaging and intervention in tendon diseases.

Degenerative tendon pathology represents one of the most frequent and disabling musculoskeletal disorders. Diagnostic radiology plays a fundamental role in the clinical evaluation of tendon pathologies. Moreover, several minimally invasive treatments can be performed under imaging guidance to treat tendon disorders, maximizing the efficacy and reducing procedural complications. In this review article we describe the most relevant diagnostic features of conventional and advanced US and MRI imaging in tendon disorders, along with the main options for image-guided intervention. (www.actabiomedica.it)

Contrast-enhanced ultrasound findings of adult renal cell carcinoma associated with Xp11.2 translocation/TFE3 gene fusion: comparison with clear cell renal cell carcinoma and papillary renal cell carcinoma

BackgroundTo investigate the contrast-enhanced ultrasound (CEUS) findings of renal cell carcinoma (RCC) associated with Xp11.2 translocation/TFE3 gene fusion (Xp11.2/TFE3) in adult patients by comparison with those of clear cell RCC (ccRCC) and papillary RCC (pRCC).MethodsIn total, 110 patients (110 renal masses) who underwent CEUS examinations were enrolled in this study. The cases included 18 Xp11.2/TFE3 RCCs, 60 ccRCCs and 32 pRCCs. All masses were confirmed by operative pathology. The CEUS imaging data of these patients were retrospectively analysed by two readers. The conventional US and CEUS features of Xp11.2/TFE3 RCC were compared with those of ccRCC and pRCC.ResultsThe age of the patients with Xp11.2/TFE3 RCC ranged from 20 to 68 years, with a mean age of 38.3 ± 16.3 years and a slight female predominance. The weighted kappa value that interprets the concordance between the interobserver agreement of the US and CEUS features ranged from 0.61 to 0.89. On conventional US and CEUS imaging of Xp11.2/TFE3 RCCs, the tumours were hypoechoic (6/18, 33.3%), isoechoic (8/18, 44.4%), and hyperechoic (4/18, 22.2%). The cystic component was present in 5 cases (27.8%), calcification was present in 9 cases (50.0%), and colour flow signal was present in 7 cases (38.9%). Most cases showed simultaneous wash-in (11/18, 61.1%); the peak enhancement showed hypoenhancement (6/18, 33.3%), isoenhancement (10/18, 55.6%), and hyperenhancement (2/18, 11.1%); most cases exhibited heterogeneous enhancement (12/18, 66.7%) and fast- or simultaneous-out (16/18, 88.9%); and a pseudocapsule was present in 6 cases (33.3%). In the multivariate logistic regression analysis, calcification and lower peak enhancement were more likely to be present in Xp11.2/TFE3 RCC than in ccRCC (P < 0.05), and younger age and relatively high peak enhancement were more likely to be present in Xp11.2/TFE3 RCC than in pRCC (P < 0.05). The calcification combined peak enhancement model differentiated Xp11.2/TFE3 RCC from ccRCC, and the age combined peak enhancement model differentiated Xp11.2/TFE3 RCC from pRCC with an AUC, a sensitivity and a specificity of 0.896, 94.4% and 73.3% and 0.786, 50.0% and 100.0%, respectively.ConclusionsThe specific CEUS features combined with demographic information and clinical symptoms may be helpful for differentiating Xp11.2/TFE3 RCC from ccRCC and pRCC.

Comparison of Ultrasound-Guided Fine Needle Aspiration Cytology and Ultrasound-Guided Core Biopsy in Preoperative Axillary Staging for Early Breast Cancer

Current national guidance supports the use of either ultrasound-guided core biopsy (USCB) or ultrasound-guided fine needle aspiration cytology (USFNAC) to detect preoperatively axillary lymph node involvement in early breast cancer but does not support one over the other. To compare the accuracy of USFNAC to USCB in diagnosing axillary lymph node metastasis in early-stage breast cancer in our symptomatic breast care unit. Historical case series data for patients from November 2007 to May 2012 was analysed. Our study included newly diagnosed, symptomatic, clinically node-negative breast cancers. Women with screen-detected breast cancer, those who had breast staging by magnetic resonance imaging, those unfit for surgery and those with locally advanced cancers were excluded. GE Logic E9 and Philips ultrasound machines were used for the study. A total of 1213 axillary ultrasound scans were performed during the period of the study. Four hundred eighty-eight women were eligible for the study with a mean age of 57.8 years. Eighty-three (17%) had USFNAC, 116 (23.7%) had USCB and 289 (59.2%) had normal/benign US features. The sensitivity and specificity of USFNAC were 58% and 100%, respectively. For USCB, sensitivity and specificity were 82% and 100%, respectively, and for US alone, sensitivity and specificity were 50% and 77%, respectively. We support the routine use of USCB over USFNAC for women who have breast cancer with indeterminate or suspicious axillary involvement on ultrasound, due to its greater accuracy.