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Drakonaki EE, Adriaensen M, Simoni P, Aparisi Gomez MP. The beauty of pediatric musculoskeletal ultrasound. ROFO-FORTSCHR RONTG 2024. [PMID: 38740063 DOI: 10.1055/a-2300-2821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Ultrasound is a powerful technique in pediatric imaging and musculoskeletal (MSK) imaging in many specific clinical scenarios. This article will feature some common and less common spot diagnoses in pediatric musculoskeletal ultrasound.Cases were collected by members of the Educational Committee of the ESSR (European Society of musculoSkeletal Radiology) and the Pediatric Subcommittee of the ESSR with expertise in musculoskeletal ultrasound.Fifteen clinical entities are discussed based on the features that allow diagnosis by ultrasound.Clinical history, location, and ultrasound appearance are the keys to spot diagnoses when performing pediatric musculoskeletal ultrasound. · Ultrasound in pediatric musculoskeletal imaging can achieve a diagnosis in specific clinical settings.. · Clinical history, location, and ultrasound appearance are keys to spot diagnoses.. · Knowledge of spot diagnoses in pediatric musculoskeletal ultrasound facilitates daily clinical practice..
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Affiliation(s)
- Elena E Drakonaki
- Department of Anatomy, University of Crete School of Medicine, Heraklion, Greece
- Department of MSK imaging, Diagnostic and Interventional Ultrasound Practice, Heraklion, Greece
| | - Miraude Adriaensen
- Department of Medical Imaging, Zuyderland Medical Centre, Heerlen, Netherlands
| | - Paolo Simoni
- Department of Rheumatology, Centre hospitalier universitaire de Liege, Liege, Belgium
| | - Maria Pilar Aparisi Gomez
- Radiology, Auckland City Hospital, Auckland, New Zealand
- Radiology, Instituto Musculoesquelético Europeo (IMSKE), Valencia, Spain
- Department of Anatomy and Medical Imaging, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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2
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Long B, Zhang H, Zhang H, Chen W, Sun Y, Tang R, Lin Y, Fu Q, Yang X, Cui L, Wang K. Deep learning models of ultrasonography significantly improved the differential diagnosis performance for superficial soft-tissue masses: a retrospective multicenter study. BMC Med 2023; 21:405. [PMID: 37880716 PMCID: PMC10601110 DOI: 10.1186/s12916-023-03099-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 09/29/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Most of superficial soft-tissue masses are benign tumors, and very few are malignant tumors. However, persistent growth, of both benign and malignant tumors, can be painful and even life-threatening. It is necessary to improve the differential diagnosis performance for superficial soft-tissue masses by using deep learning models. This study aimed to propose a new ultrasonic deep learning model (DLM) system for the differential diagnosis of superficial soft-tissue masses. METHODS Between January 2015 and December 2022, data for 1615 patients with superficial soft-tissue masses were retrospectively collected. Two experienced radiologists (radiologists 1 and 2 with 8 and 30 years' experience, respectively) analyzed the ultrasound images of each superficial soft-tissue mass and made a diagnosis of malignant mass or one of the five most common benign masses. After referring to the DLM results, they re-evaluated the diagnoses. The diagnostic performance and concerns of the radiologists were analyzed before and after referring to the results of the DLM results. RESULTS In the validation cohort, DLM-1 was trained to distinguish between benign and malignant masses, with an AUC of 0.992 (95% CI: 0.980, 1.0) and an ACC of 0.987 (95% CI: 0.968, 1.0). DLM-2 was trained to classify the five most common benign masses (lipomyoma, hemangioma, neurinoma, epidermal cyst, and calcifying epithelioma) with AUCs of 0.986, 0.993, 0.944, 0.973, and 0.903, respectively. In addition, under the condition of the DLM-assisted diagnosis, the radiologists greatly improved their accuracy of differential diagnosis between benign and malignant tumors. CONCLUSIONS The proposed DLM system has high clinical application value in the differential diagnosis of superficial soft-tissue masses.
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Affiliation(s)
- Bin Long
- Institute of Medical Technology, Peking University Health Science Center, Beijing, 100191, China
- Department of Diagnostic Ultrasound, Peking University Third Hospital, Beijing, China
| | - Haoyan Zhang
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China
- School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China
| | - Han Zhang
- Department of Ultrasound, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wen Chen
- Department of Diagnostic Ultrasound, Peking University Third Hospital, Beijing, China
| | - Yang Sun
- Department of Diagnostic Ultrasound, Peking University Third Hospital, Beijing, China
| | - Rui Tang
- Institute of Medical Technology, Peking University Health Science Center, Beijing, 100191, China
- Department of Diagnostic Ultrasound, Peking University Third Hospital, Beijing, China
| | - Yuxuan Lin
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Qiang Fu
- Department of Ultrasound, Beijing Civil Aviation General Hospital, Beijing, China
| | - Xin Yang
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China
- School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China
| | - Ligang Cui
- Institute of Medical Technology, Peking University Health Science Center, Beijing, 100191, China.
- Department of Diagnostic Ultrasound, Peking University Third Hospital, Beijing, China.
| | - Kun Wang
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China.
- School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China.
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3
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Garner HW, Wessell DE, Lenchik L, Ahlawat S, Baker JC, Banks J, Demertzis JL, Moon BS, Pierce JL, Scott JA, Sharda NK, Surasi DS, Temporal M, Chang EY. ACR Appropriateness Criteria® Soft Tissue Masses: 2022 Update. J Am Coll Radiol 2023; 20:S234-S245. [PMID: 37236746 DOI: 10.1016/j.jacr.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 05/28/2023]
Abstract
Imaging should be performed in patients with a suspected soft tissue mass that cannot be clinically confirmed as benign. Imaging provides essential information necessary for diagnosis, local staging, and biopsy planning. Although the modalities available for imaging of musculoskeletal masses have undergone progressive technological advancements in recent years, their overall purpose in the setting of a soft tissue mass remains unchanged. This document identifies the most common clinical scenarios related to soft tissue masses and the most appropriate imaging for their assessment on the basis of the current literature. It also provides general guidance for those scenarios that are not specifically addressed. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | | | - Leon Lenchik
- Panel Vice-Chair, Wake Forest University School of Medicine, Winston Salem, North Carolina
| | - Shivani Ahlawat
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jonathan C Baker
- Mallinckrodt Institute of Radiology Washington University School of Medicine, Saint Louis, Missouri
| | - James Banks
- Nova Southeastern University, Fort Lauderdale, Florida
| | | | - Bryan S Moon
- The University of Texas MD Anderson Cancer Center, Houston, Texas; American Academy of Orthopaedic Surgeons
| | | | - Jinel A Scott
- SUNY Downstate Health Sciences University, Brooklyn, New York
| | - Neema K Sharda
- Duke University School of Medicine, Durham, North Carolina; American Geriatrics Society
| | - Devaki Shilpa Surasi
- The University of Texas MD Anderson Cancer Center, Houston, Texas; Commission on Nuclear Medicine and Molecular Imaging
| | - Michael Temporal
- Billings Clinic, Billings, Montana; American Academy of Family Physicians
| | - Eric Y Chang
- Specialty Chair, VA San Diego Healthcare System, San Diego, California
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Bazzocchi A, Guglielmi G, Aparisi Gómez MP. Sarcoma Imaging Surveillance. Magn Reson Imaging Clin N Am 2023; 31:193-214. [PMID: 37019546 DOI: 10.1016/j.mric.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Soft tissue sarcomas (STS) are a heterogeneous group of solid tumors. There are many histologic subtypes. The prognosis after treatment may be estimated by the analysis of the type of tumor, grade, depth, size at diagnosis, and age of the patient. These type of sarcomas most commonly metastasize to the lungs and may have a relatively high rate of local recurrence, depending on the histologic type and surgical margins. Patients with recurrence have a poorer prognosis. The surveillance of patients with STS is therefore extremely important. This review analyzes the role of MR imaging and US in detecting local recurrence.
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Affiliation(s)
- Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna 40136, Italy.
| | - Giuseppe Guglielmi
- Department of Radiology, Hospital San Giovanni Rotondo, Italy; Department of Radiology, University of Foggia, Viale Luigi Pinto 1, Foggia 71100, Italy
| | - Maria Pilar Aparisi Gómez
- Department of Radiology, Auckland City Hospital, 2 Park Road, Grafton, Auckland 1023, New Zealand; Department of Radiology, IMSKE, Calle Suiza, 11, Valencia 46024, Spain
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Safai Zadeh E, Görg C, Prosch H, Horn R, Jenssen C, Dietrich CF. The Role of Thoracic Ultrasound for Diagnosis of Diseases of the Chest Wall, the Mediastinum, and the Diaphragm-Narrative Review and Pictorial Essay. Diagnostics (Basel) 2023; 13:767. [PMID: 36832255 PMCID: PMC9956010 DOI: 10.3390/diagnostics13040767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/29/2023] [Accepted: 02/08/2023] [Indexed: 02/22/2023] Open
Abstract
The diagnostic capabilities of ultrasound extend far beyond the evaluation of the pleural space and lungs. Sonographic evaluation of the chest wall is a classic extension of the clinical examination of visible, palpable, or dolent findings. Unclear mass lesions of the chest wall can be differentiated accurately and with low risk by additional techniques such as color Doppler imaging, contrast-enhanced ultrasound, and, in particular, ultrasound-guided biopsy. For imaging of mediastinal pathologies, ultrasound has only a complementary function but is valuable for guidance of percutaneous biopsies of malignant masses. In emergency medicine, ultrasound can verify and support correct positioning of endotracheal tubes. Diaphragmatic ultrasound benefits from the real-time nature of sonographic imaging and is becoming increasingly important for the assessment of diaphragmatic function in long-term ventilated patients. The clinical role of thoracic ultrasound is reviewed in a combination of narrative review and pictorial essay.
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Affiliation(s)
- Ehsan Safai Zadeh
- Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstraße, 35033 Marburg, Germany
| | - Christian Görg
- Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstraße, 35033 Marburg, Germany
| | - Helmut Prosch
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna General Hospital, 1090 Vienna, Austria
| | - Rudolf Horn
- Center da Sandà Val Müstair, 7536 Sta. Maria, Switzerland
| | - Christian Jenssen
- Medical Department, Krankenhaus Maerkisch-Oderland, 15344 Strausberg, Germany
- Brandenburg Institute of Clinical Ultrasound, Medical University Brandenburg, 16816 Neuruppin, Germany
| | - Christoph Frank Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Bern, Beau Site, Salem und Permanence, 3018 Bern, Switzerland
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Bignotti B, Rossi F, Signori A, Solari N, Spina B, Martinoli C, Tagliafico AS. Magnetic Resonance Imaging or Ultrasound in Localized Intermediate- or High-Risk Soft Tissue Tumors of the Extremities (MUSTT): Final Results of a Prospective Comparative Trial. Diagnostics (Basel) 2022; 12:diagnostics12020411. [PMID: 35204502 PMCID: PMC8871362 DOI: 10.3390/diagnostics12020411] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 01/27/2023] Open
Abstract
Objectives: To report final results of the MUSTT trial, which has been designed to independently compare magnetic resonance imaging (MRI) and ultrasound (US) for local recurrences of non-metastatic patients operated for malignant soft tissue tumors (STT). Methods: Magnetic resonance imaging or ultrasound in soft tissue tumors (MUSTT) is a prospective monocentric study recruiting asymptomatic, non-metastatic patients operated on for localized soft tissue sarcomas between 2015 and April. Eligible patients had MRI and physician-performed ultrasound (US) with an independent interpretation of imaging. Outcome measures were compared using ROC analysis and the X2 test. An analysis of all patients was performed on a per-follow-up event basis. Results: A total of n = 51 patients who met the inclusion criteria agreed to participate. Among them, n = 8 were lost to follow-up, n = 6 had US and MRI acquired after a time frame > 7 days and were therefore excluded. Complete data available for 37 patients with 232 MRI and 232 US scan were finally considered (men/women: 18/20; age range, 18–84 years). Recurrences within 5 years occurred in 10/37 patients (27%). ROC analysis comparing US and MRI showed an AUC with 95% confidence intervals of 0.909 (0.832 to 0.981) for US and 0.966 (0.939 to 0.989) for MRI with Prob > X2 = 0. Conclusions: Each of these tests detected local recurrences with suitable accuracy. MRI did not result clearly superior to US in terms of diagnostic accuracy, but US showed some false positive or negative results.
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Affiliation(s)
- Bianca Bignotti
- Ospedale Policlinico San Martino, 16132 Genoa, Italy; (B.B.); (N.S.); (B.S.)
- Department of Experimental Medicine (DIMES), University of Genoa, 16132 Genoa, Italy;
| | - Federica Rossi
- Department of Experimental Medicine (DIMES), University of Genoa, 16132 Genoa, Italy;
- Ospedale Santa Corona, Pietra Ligure, 17027 Genoa, Italy
| | - Alessio Signori
- Department of Health Sciences (DISSAL), University of Genoa, 16132 Genoa, Italy;
| | - Nicola Solari
- Ospedale Policlinico San Martino, 16132 Genoa, Italy; (B.B.); (N.S.); (B.S.)
| | - Bruno Spina
- Ospedale Policlinico San Martino, 16132 Genoa, Italy; (B.B.); (N.S.); (B.S.)
| | - Carlo Martinoli
- Ospedale Policlinico San Martino, 16132 Genoa, Italy; (B.B.); (N.S.); (B.S.)
- Department of Health Sciences (DISSAL), University of Genoa, 16132 Genoa, Italy;
- Correspondence: (C.M.); or (A.S.T.)
| | - Alberto Stefano Tagliafico
- Ospedale Policlinico San Martino, 16132 Genoa, Italy; (B.B.); (N.S.); (B.S.)
- Department of Health Sciences (DISSAL), University of Genoa, 16132 Genoa, Italy;
- Correspondence: (C.M.); or (A.S.T.)
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Whittle C, Fajre X, Silva C, Castro A. Herniated superficial lipomas in gluteal and thigh support areas: a special clinical ultrasound presentation. Acta Radiol 2022; 64:244-249. [PMID: 35102754 DOI: 10.1177/02841851221076328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Lipomas are the most frequent benign tumor. They have been described as soft, well-defined, slow-growing palpable masses, and classified as deep or superficial. PURPOSE To present the clinical and ultrasound findings of herniated superficial subcutaneous lipoma (HSL), located in pressure/support areas, not previously described. MATERIAL AND METHODS A seven-year retrospective review was performed. Patients with a preoperative high-resolution ultrasound (HRUS) diagnosis of HSL archived in the computational system and histological study information were selected. RESULTS A total of 37 patients (mean age = 46 years) were recruited. The clinical diagnoses were "lipoma" or "suspected lipoma" in just 46% of the cases. This was three times more frequent in women. Tumors were located mainly in the gluteal (38%) and proximal thigh areas (35%). Clinically, all patients showed small, soft, rounded skin nodules. On HRUS, they appear as lipomatous tumors that protruded, compressed, and thinned the covering dermal layer. The subcutaneous portion was bigger than the herniated part, with an iceberg image. CONCLUSION HSL in support areas have a special clinical ultrasound presentation, not previously described. It is important to recognize them for a proper diagnosis and treatment, especially because they clinically may present as small superficial lesions; however, they are associated with a larger subcutaneous portion (iceberg image). It is probable that an estrogen influence on the adipose tissue can be suspected because of the female predominance.
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Affiliation(s)
- Carolina Whittle
- Department of Radiology, Facultad de Medicina, Clinica Alemana – Universidad del Desarrollo, Santiago, Chile
| | - Ximena Fajre
- Department of Dermatology, Facultad de Medicina, Clínica Alemana – Universidad del Desarrollo, Santiago, Chile
| | - Catalina Silva
- Department of Dermatology, Facultad de Medicina, Clínica Alemana – Universidad del Desarrollo, Santiago, Chile
| | - Alex Castro
- Department of Pathology, Clínica Alemana, Facultad de Medicina, Universidad del Desarrollo, Santiago, Chile
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Sambri A, Fiore M, Giannini C, Pipola V, Zucchini R, Aparisi Gomez MP, Musa Aguiar P, Gasbarrini A, De Paolis M. Primary Tumors of the Sacrum: Imaging Findings. Curr Med Imaging 2021; 18:170-186. [PMID: 33982654 DOI: 10.2174/1573405617666210512011923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/25/2021] [Accepted: 01/28/2021] [Indexed: 11/22/2022]
Abstract
The diagnosis of sacral neoplasms is often delayed because they tend to remain clinically silent for a long time. Imaging is useful at all stages of managing sacral bone tumors: from the detection of the neoplasm to the long-term follow-up. Radiographs are recommended as the modality of choice to begin the imaging workup of a patient with known or suspected sacral pathology. More sensitive examinations such as computerized tomography (CT), magnetic resonance (MRI), or scintigraphy are often necessary. The morphological features of the lesions on CT and MRI help to orientate the diagnosis. Although some imaging characteristics are helpful to limit the differential diagnosis, an imaging-guided biopsy is often ultimately required to establish a specific diagnosis. Imaging is of paramount importance even in the long-term follow-up in order to assess any residual tumor when surgical resection is incomplete, to assess the efficacy of adjuvant chemotherapy and radiotherapy, and to detect recurrence.
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Affiliation(s)
- Andrea Sambri
- University of Bologna, Bologna, Italy.,IRCCS Azienda Ospedaliero Universitaria Policlinico di Sant’Orsola, Bologna, Italy
| | | | | | | | | | - Maria Pilar Aparisi Gomez
- Department of Radiology, Auckland City Hospital; 2 Park Road, Grafton, 1023 Auckland, New Zealand.,Department of Radiology, Hospital Vithas Nueve de Octubre; Calle Valle de la Ballestera, 59, 46015 Valencia, Spain
| | - Paula Musa Aguiar
- Serdil, Clinica de Radiologia e Diagnóstico por Imagem; R. São Luís, 96 - Santana, Porto Alegre - RS, 90620-170. Brazil
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