The added value of ultrasound imaging biomarkers to clinicopathological factors for the prediction of high-risk Oncotype DX recurrence scores in patients with breast cancer

Background

The Oncotype DX (ODX) recurrence score (RS), a 21-gene assay, has been proven to recognize patients at high risk of recurrence (RS ≥26) who would benefit from chemotherapy. However, it has limited availability and high costs. Our study thus aimed to identify ultrasound (US) imaging biomarkers and develop a prediction model for identifying patients with a high ODX RS.

Methods

In this retrospective study, consecutive patients with T1-3N0-1M0 breast cancer who were hormone receptor positive and human epidermal growth factor receptor 2 (HER2) negative who had an available ODX RS were reviewed. Patients treated from May 2012 and December 2015 were placed into a training cohort, and those treated from January 2016 to January 2017 were placed in a validation cohort. Clinicopathologic data were collected, and preoperative US scans were analyzed. Univariable and multivariable regression analyses were performed to evaluate the independent predictors for a high-risk of breast cancer in the training cohort, and a nomogram was developed and evaluated with the area under the receiver operating characteristic curve (AUC), calibration curve, and decision curve analysis (DCA).

Results

A total of 363 patients were in the training cohort and 160 in the validation cohort, with the proportion with a high RS (RS 26-100) being 14% and 13.1%, respectively. Echogenic halo, enhanced posterior echo, low level of progesterone receptor (PR), and high Ki-67 index were identified as independent risk factors for high RS (all P values <0.05). The nomogram was constructed based on the combined model, which showed a better discrimination ability than did the clinicopathological model [combined model: AUC =0.95, 95% confidence interval (CI): 0.93-0.97; clinicopathological model: AUC =0.89, 95% CI: 0.86-0.92; P=0.001] and greater clinical benefit according to DCA. Furthermore, the nomogram was found to be effective in the validation cohort (AUC =0.90, 95% CI: 0.84-0.94), especially in patients with stage T1N0M0 disease (AUC =0.91, 95% CI: 0.84-0.95).

Conclusions

US features may serve as valuable imaging biomarkers for the prediction of high recurrence risk in patients with T1-3N0-1M0 breast cancer and hormone receptor (HR)-positive and HER2-negative status. A nomogram incorporating PR status, Ki-67 index, and US imaging biomarkers showed a good discrimination ability in the early selection of patients at high risk of recurrence, especially in those with stage T1N0M0 disease.

Comparison of ultrasound risk stratification systems for pediatric thyroid nodules

Background

There is currently insufficient data to validate adult-based US risk stratification systems (RSSs) for the identification of malignant thyroid nodules in a pediatric population.

Methods

From October 2016 and May 2023, 173 thyroid nodules of pediatric patients (age ≤ 18 years) with definitive pathology results and ultrasound (US) examination within 1 month before surgery or fine-needle aspiration (FNA) biopsy in our institution were enrolled in this study. The clinical and US characteristics of these nodules were retrospectively reviewed and categorized according to the ACR-TIRADS, C-TIRADS, and ATA guidelines. The diagnostic performance of US-based FNA criteria (original and simulating) of the three guidelines in thyroid cancer detection was estimated.

Results

The three RSSs had similar AUC according to the categories(0.849-0.852, all P > 0.05). When combined with the original FNA criteria of the three RSSs to manage the nodules, the FNA rate of ACR-TIRADS and C-TIRADS were significantly less than ATA guidelines (53.18% vs. 64.63%, P < 0.05, and 52.60% vs. 64.63%, P < 0.05). The missed malignancy rate (MMR) and unnecessary FNA rate (UFR) of ATA guidelines (50.00%, 35.85%) was highest among the three RSSs, followed by the C-TIRADS (37.80%, 19.57%) and the ACR-TIRADS (37.04%, 19.57%). When nodules < 1 cm with the highest category in each RSS biopsied, that is when using the simulating FNA thresholds, the MMR was reduced overall (all P < 0.001), without a change in the UFR (all P > 0.05). All the three RSSs showed a substantial improvement in accuracy and malignant detection rate (all P < 0.05).

Conclusion

The ACR-TIRADS, C-TIRADS, and ATA guidelines showed high missed malignancy rates when using their original recommended FNA criteria. When nodules < 1 cm with the highest category in each RSS biopsied, the missed malignancy rate of each RSS was decreased. Decreasing the FNA thresholds for highly suspicious malignant nodules may therefore be an effective means of managing malignant thyroid nodules in pediatric patients.

Ultrasound Image Analysis with Vision Transformers-Review

Ultrasound (US) has become a widely used imaging modality in clinical practice, characterized by its rapidly evolving technology, advantages, and unique challenges, such as a low imaging quality and high variability. There is a need to develop advanced automatic US image analysis methods to enhance its diagnostic accuracy and objectivity. Vision transformers, a recent innovation in machine learning, have demonstrated significant potential in various research fields, including general image analysis and computer vision, due to their capacity to process large datasets and learn complex patterns. Their suitability for automatic US image analysis tasks, such as classification, detection, and segmentation, has been recognized. This review provides an introduction to vision transformers and discusses their applications in specific US image analysis tasks, while also addressing the open challenges and potential future trends in their application in medical US image analysis. Vision transformers have shown promise in enhancing the accuracy and efficiency of ultrasound image analysis and are expected to play an increasingly important role in the diagnosis and treatment of medical conditions using ultrasound imaging as technology progresses.

Motion correction of 3D dynamic contrast-enhanced ultrasound imaging without anatomical B-Mode images: Pilot evaluation in eight patients

BACKGROUND

Dynamic contrast-enhanced ultrasound (DCE-US) is highly susceptible to motion artifacts arising from patient movement, respiration, and operator handling and experience. Motion artifacts can be especially problematic in the context of perfusion quantification. In conventional 2D DCE-US, motion correction (MC) algorithms take advantage of accompanying side-by-side anatomical B-Mode images that contain time-stable features. However, current commercial models of 3D DCE-US do not provide side-by-side B-Mode images, which makes MC challenging.

PURPOSE

This work introduces a novel MC algorithm for 3D DCE-US and assesses its efficacy when handling clinical data sets.

METHODS

In brief, the algorithm uses a pyramidal approach whereby short temporal windows consisting of three consecutive frames are created to perform local registrations, which are then registered to a master reference derived from a weighted average of all frames. We applied the algorithm to imaging studies from eight patients with metastatic lesions in the liver and assessed improvements in original versus motion corrected 3D DCE-US cine using: (i) frame-to-frame volumetric overlap of segmented lesions, (ii) normalized correlation coefficient (NCC) between frames (similarity analysis), and (iii) sum of squared errors (SSE), root-mean-squared error (RMSE), and r-squared (R2 ) quality-of-fit from fitted time-intensity curves (TIC) extracted from a segmented lesion.

RESULTS

We noted improvements in frame-to-frame lesion overlap across all patients, from 68% ± 13% without correction to 83% ± 3% with MC (p = 0.023). Frame-to-frame similarity as assessed by NCC also improved on two different sets of time points from 0.694 ± 0.057 (original cine) to 0.862 ± 0.049 (corresponding MC cine) and 0.723 ± 0.066 to 0.886 ± 0.036 (p ≤ 0.001 for both). TIC analysis displayed a significant decrease in RMSE (p = 0.018) and a significant increase in R2 goodness-of-fit (p = 0.029) for the patient cohort.

CONCLUSIONS

Overall, results suggest decreases in 3D DCE-US motion after applying the proposed algorithm.

Potential added value of computed tomography radiomics to multimodal prediction models for benign and malignant breast tumors

Background

Early diagnosis is crucial to the treatment of breast cancer, but conventional imaging detection is challenging. Radiomics has the potential to improve early diagnostic efficacy in a noninvasive manner. This study examined whether integrating computed tomography (CT) radiomics information based on ultrasound (US) models can improve the efficacy of breast cancer prediction.

Methods

We retrospectively analyzed 420 patients with pathologically confirmed benign or malignant breast tumors. Clinical data and examination images were collected, and the population was divided into training (n=294) and validation (n=126) groups at a ratio of 7:3. The region of interest (ROI) was manually segmented along the tumor boundary using MaZda software, and the features of each ROI was extracted. After dimension reduction and screening, the best features were retained. Subsequently, random forest (RF), support vector machines, and K-nearest neighbor classifiers were used to establish prediction models in an US and combined-methods group.

Results

Finally, 8 of the 379 features were retained in the US group. Random forest was found to be the best model, and the area under the curve (AUC) of the training and validation groups was 0.90 [95% confidence interval (CI): 0.852-0.942] and 0.85 (95% CI: 0.775-0.930), respectively. Meanwhile, 12 of the 750 features were retained in the combined group. In this regard, random forest proved to be the best model, and the AUC of the training and validation group was 0.95 (95% CI: 0.918-0.981) and 0.92 (95% CI: 0.866-0.969), respectively. The calibration curve showed a good fit of the model. The decision curve showed that the clinical net benefit of the combined group was far greater than that of any single examination, and the prediction model of the combined group exhibited a degree of practical clinical value.

Conclusions

The combined model based on US and CT images has potential application value in the prognostic prediction of benign and malignant breast diseases.

Detection of microvascular damage of membranous nephropathy by MicroFlow imaging: a novel ultrasound technique

Background

MicroFlow imaging (MFI) is a novel noninvasive ultrasound (US) technique that depicts microcirculatory blood vessels in the kidney while filtering out tissue motion and enhancing blood flow signals. We aimed to investigate the value of MFI for the detection of renal microvascular perfusion in chronic kidney disease caused by stage I-II membranous nephropathy (MN).

Methods

Seventy-six participants including biopsy-proven MN (n=38) and healthy volunteers (n=38) were prospectively examined using MFI from March 2020 to December 2020. In addition, patients with MN were subdivided into a mild group, a moderate group, and a severe group based on the results of vascular pathology evaluation. All MFI images were analyzed by Image Pro Plus to obtain a cortical vascular index (VI). Basic patient information, relative US parameters and laboratory results were then acquired for each participant. Finally, after the univariate analysis among multiple groups, binary logistic regression (forward LR) and ordered logistic regression were used for multivariate analysis. Significance was set at P<0.05.

Results

VI was significantly lower in MN patients compared with that of healthy controls (0.65±0.09 vs. 0.35±0.18, P<0.001). After multivariate analysis, we found that the exploratory diagnostic performance of VI [area under the curve (AUC): 0.94; 95% confidence interval (CI): 0.89-0.99] outperformed that of serum creatinine (Scr) (AUC: 0.87; 95% CI: 0.79-0.95) in identifying MN. We also observed considerable differences among MN groups in parameters including VI (P=0.006), estimated glomerular filtration rate (eGFR) (P=0.037), shape (P=0.013), and impression (P=0.007). In addition, in the group with mild vascular damage, the exploratory diagnostic performance of VI (AUC: 0.79; 95% CI: 0.64-0.94) was better than other parameters, such as eGFR (AUC: 0.63; 95% CI: 0.43-0.84).

Conclusions

MFI detected abnormal renal microvascular perfusion in patients with MN (particularly in those with early vascular damage or preserved renal function) without the use of a contrast agent. Combining MFI with B-mode US can improve the predictive performance of traditional kidney US.

Prediction of central lymph node metastasis in patients with papillary thyroid microcarcinoma by gradient-boosting decision tree model based on ultrasound radiomics and clinical features

Background

In recent years, the study of radiomics in thyroid diseases has developed rapidly. This study aimed to establish a preoperative radiomics prediction model for central compartment lymph node metastases (CLNMs) in papillary thyroid microcarcinoma (PTMC) patients using gradient-boosting decision tree (GBDT) model and evaluate the performance of the model.

Methods

A total of 274 patients with PTMC admitted for thyroid surgery at China-Japan Union Hospital of Jilin University from January 2020 to July 2022 were retrospectively analyzed. Patients were randomized into training and validation cohorts according to a ratio of 8:2. Radiomics features were extracted from the ultrasound (US) images of PTMC lesions. The open-source software Pyradiomics was used to extract radiomics features, and WEKA software was used to select CLNM-related radiomics features. Clinical risk factors for CLNM were screened by statistical methods. The GBDT model was constructed by combining radiomics features and clinical risk factors, and compared with the diagnostic efficacy of US-reported cervical lymph node status. Shapley Additive exPlanations (SHAP) was applied to visualize and analyze the GBDT model globally and locally.

Results

A total of seven radiomics features were significantly correlated with central lymph node status in the training and validation cohorts. The predictors in the GBDT model included the radiomics features, sex, age, and body mass index (BMI). The area under the curve (AUC) values of the GBDT model in the training and validation cohorts were 0.946 [95% confidence interval (CI): 0.920-0.972] and 0.845 (95% CI: 0.714-0.976), respectively, compared with 0.583 (95% CI: 0.508-0.659) and 0.582 (95% CI: 0.430-0.736) for US-reported lymph node status alone. The Delong test showed a significant difference between AUS in the training and validation cohorts (P<0.001, respectively). SHAP visual analysis showed the effect of each parameter on the GBDT model globally and locally. Decision curve analysis demonstrated the clinical utility of the GBDT model.

Conclusions

The prediction of CLNM by the GBDT model, based on US radiomics features and clinical factors, can be better than that by using US alone in patients with PTMC. Furthermore, the GBDT model may serve a guidance of clinical decision for patient's treatment strategy.

Diagnostic performance of contrast-enhanced ultrasound in breast lesions: what diagnostic models could be used for lesions of different sizes?

Background

Previous studies show the size of lesions could affect the diagnostic accuracy of contrast-enhanced ultrasound (CEUS). It is unclear whether CEUS has good diagnostic performance for lesions ≤2.0 and ≤1.0 cm. It is beneficial for the early diagnosis to explore the application of CEUS in breast lesions of different sizes. This study aims to analyze the diagnostic performance of CEUS and explore diagnostic models better suited to breast lesions of different sizes.

Methods

A total of 1,059 lesions (656 benign and 403 malignant) examined by ultrasound and CEUS with definite pathological results were included in this retrospective study and divided into training (n=847) and validation (n=212) sets. All lesions were divided into three groups according to size. Diagnostic models (M0: all lesions; M1: ≤1.0 cm, M2: >1.0-2.0 cm, and M3: >2.0 cm) were developed through logistic regression analyses of CEUS features from the training set. Diagnostic performance was evaluated using the area under the receiver operating characteristic curve (AUC) and validated in the validation set.

Results

The median age of patients was 45±11 years (range, 18-80 years). The AUC values of M0 combined with the Breast Imaging Reporting and Data System (BI-RADS) in the training and validation sets were 0.921 and 0.922, respectively (P=0.893). The AUC values of M0 combined with BI-RADS in the three groups were 0.844, 0.936 and 0.928 respectively. M0 was less effective in diagnosing lesions ≤1.0 cm (0.844 vs. 0.921, P=0.029). The AUC of M1 combined with BI-RADS for lesions ≤1.0 cm was higher than that of M0 (0.893 vs. 0.844, P=0.047), and M2 and M3 had no statistical difference in diagnostic performance when compared with M0 (P=0.243; P=0.246).

Conclusions

The diagnostic performance of CEUS was closely related to lesion size. Establishing a new diagnostic model for lesions ≤1.0 cm can improve the CEUS diagnostic performance for breast lesions ≤1.0 cm.

Multiparametric Ultrasound for Diagnosing Testicular Lesions: Everything You Need to Know in Daily Clinical Practice

BACKGROUND

Ultrasonography (US) represents the gold standard imaging method for the assessment of testicular lesions (TL). The gray-scale (GSUS) and color-Doppler (CDUS) ultrasound examination allow sonographers to investigate the size, margins, echotexture, and vascular features of TLs with the aim to differentiate benign from malignant lesions. Recently, the use of contrast-enhanced US (CEUS) and sonoelastography (SE) has led to further improvements in the differential diagnosis of TL. Although GSUS and CDUS are often sufficient to suggest the benign or malignant nature of the TL, CEUS can be decisive in the differential diagnosis of unclear findings, while SE can help to strengthen the diagnosis. The contemporary combination of GSUS, CDUS, CEUS, and SE has led to a new diagnostic paradigm named multiparametric US (mp-US), which is able to provide a more detailed characterization of TLs than single techniques alone. This narrative and pictorial review aimed to describe the mp-US appearance of several TLs.

METHODS

An extensive Medline search was performed to identify studies in the English language focusing on the mp-US evaluation of TLs.

RESULTS

A practical mp-US "identity card" and iconographic characterization of several benign and malignant TLs is provided herein.

CONCLUSIONS

The mp-US characterization of TL reported herein can be useful in daily clinical practice.

Application of ultrasound-based radiomics models of breast masses to predict invasive components of encapsulated papillary carcinoma

Background

Axillary lymph node (ALN) metastasis is seen in encapsulated papillary carcinoma (EPC), mostly with an invasive component (INV). Radiomics can offer more information beyond subjective grayscale and color Doppler ultrasound (US) image interpretation. This study aimed to develop radiomics models for predicting an INV of EPC in the breast based on US images.

Methods

This study retrospectively enrolled 105 patients (107 masses) with a pathological diagnosis of EPC from January 2016 to April 2021, and all masses had preoperative US images. Of the 107 masses, 64 were randomized to a training set and 43 to a test set. US and clinical features were analyzed to identify features associated with INVs. Then, based on the manually segmented US images to obtain radiomics features, the models to predict INVs were built with 5 ensemble machine learning classifiers. We estimated the performance of the predictive models using accuracy, the area under the receiver operating characteristic (ROC) curve (AUC), sensitivity, and specificity.

Results

The mean age was 63.71 years (range, 31 to 85 years); the mean size of tumors was 23.40 mm (range, 9 to 120 mm). Among all clinical and US features, only shape was statistically different between EPC with INVs and those without (P<0.05). In this study, the models based on Random Under Sampling (RUS) Boost, Random Forest, XGBoost, AdaBoost, and Easy Ensemble methods had good performance, among which RUS Boost had the best performance with an AUC of 0.875 [95% confidence interval (CI): 0.750-0.974] in the test set.

Conclusions

Radiomics prediction models were effective in predicting the INV of EPC, whereas clinical and US features demonstrated relatively decreased predictive utility.

Incidental Focal Spleen Lesions: Integrated Imaging and Pattern Recognition Approach to the Differential Diagnosis

Spleen lesions and pseudolesions, detected incidentally in imaging, are not uncommon and may require further work-up. The imaging appearance of focal splenic lesions (FSLs) may not be pathognomonic, because of considerably overlapping features. Consequently, all imaging techniques lack specificity to fully characterize FSLs. Clinical correlation is mandatory, so as, first of all, to categorize the patient as having or not having a history of solid or hematologic malignancy. Nowadays, many patients have old imaging studies available for comparison and, consequently, it is important to understand if the lesion was previously present or not, and if the size is the same or has changed. In the absence of comparison studies, and with a lack of imaging features of benignity, further investigation may be necessary, using PET, biopsy, or short-term follow-up. Some algorithms have been proposed to manage incidental FSLs; however, none of these strategies has been validated by prospective studies to date. In this review we illustrate the topic of incidental FSLs and we analyze a number of published algorithms.

Factors associated with prolonged duration of ultrasound-guided brachial plexus block for the upper limb fracture surgery: a cross-sectional study

Background

Previous studies of factors associated with prolonged duration of ultrasound-guided brachial plexus block have included multiple surgical procedures or multiple anesthetic approaches, all of which are important confounders, and there is no study based on a single method of anesthesia exploring the factors affecting the resolution of brachial plexus block during upper limb surgery, especially in Asians. This study aimed to identify the risk factors affecting the prolonged duration of US-guided brachial plexus block in American Society of Anesthesiologists (ASA) I-II grade patients to improve postoperative analgesia.

Methods

This study enrolled patients scheduled to undergo surgery for upper limb fracture in Anting Hospital, Shanghai from May 2021 to September 2021. Inclusion criteria: (I) patients aged 18 years and above; (II) ASA I-II grade patients; (III) success of US-guided brachial plexus block. Based on the median duration of brachial plexus block, patients were divided into a <5-hour group and a ≥5-hour group. The factors were selected base on previous studies conclution and clinical demographic characteristics of patients. Multivariable logistic regression was used to estimate relevant influencing factors.

Results

A total of 129 patients (51.2% males; 51.01±16.54 years old) were analyzed. The duration of brachial plexus block was 2-12 hours, with a median duration of 5.09 hours. Multivariable analysis suggested that age 40-49 years [odds ratio (OR): 4.841; 95% confidence interval (CI): 1.033 to 22.695; P=0.045], 50-59 years (OR: 4.730, 95% CI: 1.149 to 19.474; P=0.031), 60 years (OR: 8.540; 95% CI: 1.605 to 45.449; P=0.012), gender (OR: 3.314; 95% CI: 1.330 to 8.257; P=0.010), alanine aminotransferase (ALT; OR: 5.817, 95% CI: 1.509 to 22.472; P=0.011), and glomerular filtration rate (GFR) <60 (OR: 22.700; 95% CI: 1.994 to 198.386; P=0.012) were the risk factors for the duration of brachial plexus block.

Conclusions

It is advisable to use the lowest effective dose for the shortest possible time when using ropivacaine in upper limb fracture surgery patients with elevated ALT (≥40 U/L) and lower GFR (<60 mL/min) in male patients aged ≥60 years.

Developmental retardation of femoral head size and femoral head ossification in mild and severe developmental dysplasia of the hip in infants: a preliminary cross-sectional study based on ultrasound images

Background

For infants up to 6 months, ultrasound (US) screening of developmental dysplasia of the hip (DDH) is recommended. This cross-sectional study investigated the developmental data of femoral head size and femoral head ossification in mature infant hips and the impact of mild and severe DDH on femoral head development based on US images.

Methods

We reviewed all hip US studies performed from January 2018 to December 2019 to evaluate DDH in infants younger than 6 months at West China Hospital, Sichuan University. The femoral head diameter (FHD) and femoral head ossification center type of each hip were recorded. A total of 1,037 normal participants with 2,074 mature hips and 367 DDH participants with 456 dysplastic hips were included in this study.

Results

For normal mature hips (Graf I), the FHD of mature male hips was significantly larger than that of female hips from the age of 2 months to 6 months (all P values <0.01), and the femoral head ossification center of males occurred significantly later than that of females at the same age from 3 months to 6 months (all P values <0.05). Compared with the matched mature hips, the FHDs of Graf IIa (-), IIb, IIc, and D, III or IV hips were significantly smaller (1.64 vs. 1.72 cm, 1.75 vs. 1.79 cm, 1.65 vs. 1.73 cm, 1.51 vs. 1.71 cm, respectively; all P values <0.05), and the occurrence of the femoral head ossification center was delayed in Graf IIa (-) and D, III or IV hips (both P values <0.05). However, no significant developmental retardation of the femoral head was observed in Graf IIa (+) hips.

Conclusions

We identified a relatively normal range for the development of infants' hips from 1 month old to 6 months old and found significant developmental retardation of the femoral head in Graf IIa (-), IIb, IIc, and D, III or IV hips. This is a preliminary study of the developmental impact of DDH on the femoral head, and we will continue the follow-up study after treatment.

A novel prediction tool based on shear wave elastography, gallbladder ultrasound, and serum biomarkers for the early diagnosis of biliary atresia in infants younger than 60 days old

Background

Early Kasai surgery before 60 days of life results in better clinical outcomes in patients with biliary atresia (BA). We aimed to develop and validate a prediction tool for the early diagnosis of BA in infants younger than 60 days old.

Methods

This prospective study recruited consecutive infants younger than 60 days old with conjugated hyperbilirubinemia who were evaluated with an ultrasound (US) scan, including B-mode US with color Doppler flow imaging (CDFI) features and liver two-dimensional shear wave elastography (2D SWE), from March 2017 to July 2021. The reference standard for diagnosis was intraoperative cholangiography, liver biopsy, or the resolution of jaundice. Area under the receiver operating characteristic curve (AUC) analysis, logistic regression analysis, and establishment of a nomogram were performed.

Results

A total of 174 patients (mean age, 46 days), including 87 infants with BA and 87 non-BA cholestatic infants, were included in the study. The established nomogram based on gallbladder (GB) abnormality, liver 2D SWE, and serum γ-glutamyl transferase (GGT) and alanine aminotransferase (ALT) had an AUC of 0.99 [95% confidence interval (CI): 0.94-1.00], a sensitivity of 92%, and a specificity of 100%. The nomogram in the validation cohort also had good diagnostic performance in the diagnosis of BA, with an AUC of 0.98 (95% CI: 0.95-1.00).

Conclusions

The new prediction tool had a good diagnostic performance in the early prediction of BA in infants younger than 60 days old and will facilitate timely Kasai surgery.

Development and internal validation of a conventional ultrasound-based nomogram for predicting malignant nonmasslike breast lesions

BACKGROUND

The aim of this study was to develop a conventional ultrasound (US) features-based nomogram for the prediction of malignant nonmasslike (NML) breast lesions.

METHODS

Consecutive cases of adult females diagnosed with NML breast lesions via US screening in our center from June 1st, 2017, to April 17th, 2020, were retrospectively enrolled. Candidate variables included age, clinical symptoms, and the image features obtained from the conventional US. Nomograms were developed based on the results of the multiple logistic regression analysis via R language. One thousand bootstraps were used for internal validation. The area under the curve (AUC) and the bias-corrected concordance index (C-index) were calculated. Decision curve analysis (DCA) was also performed for further comparison between the nomogram and the Breast Imaging Reporting and Data System (BI-RADS). The study has not yet been registered.

RESULTS

A total of 229 patients were included in the study after exclusion and follow-up. The overall malignant rate of NML breast lesions was 31.0%. Age, clinical symptoms, echo pattern, calcification, orientation, and Adler's classification were selected to generate the nomogram according to the results of the multivariable logistic regression analysis. The bias-corrected C-index and the AUC of our nomogram were 0.790 and 0.828, respectively. The DCA showed that our model had larger net benefits in a range from 0.2 to 0.7 when compared with the BI-RADS.

CONCLUSIONS

We developed a prediction model using a combination of age, clinical symptoms, echo pattern, calcification, orientation, and Adler's classification for malignant NML breast lesion prediction that yielded adequate discrimination and calibration.

Multi-Sensing Techniques with Ultrasound for Musculoskeletal Assessment: A Review

The study of muscle contractions generated by the muscle-tendon unit (MTU) plays a critical role in medical diagnoses, monitoring, rehabilitation, and functional assessments, including the potential for movement prediction modeling used for prosthetic control. Over the last decade, the use of combined traditional techniques to quantify information about the muscle condition that is correlated to neuromuscular electrical activation and the generation of muscle force and vibration has grown. The purpose of this review is to guide the reader to relevant works in different applications of ultrasound imaging in combination with other techniques for the characterization of biological signals. Several research groups have been using multi-sensing systems to carry out specific studies in the health area. We can divide these studies into two categories: human-machine interface (HMI), in which sensors are used to capture critical information to control computerized prostheses and/or robotic actuators, and physiological study, where sensors are used to investigate a hypothesis and/or a clinical diagnosis. In addition, the relevance, challenges, and expectations for future work are discussed.

Ultrasound-guided 3-in-1 trigger point injection for treating myofascial pain syndrome in muscles of the lateral scapular area: a case report

BACKGROUND

Myofascial pain syndrome (MPS) is a common cause of musculoskeletal pain. MPS in the muscles of the lateral scapula frequently develops due to poor sitting posture (rounded shoulders and cervical kyphosis) in the office as well as long working hours. Herein, we introduce the use of the trigger point injection (TPI) technique in three muscles (i.e., the deltoid, infraspinatus, and teres major muscles) with the same sonographic view for the purpose of treating MPS in the lateral scapular area.

CASE DESCRIPTION

A 48-year-old woman presented to our hospital complaining of dull pain in the right lateral scapular area that had persisted for 4 months. The numeric rating scale (NRS) pain score was 5. After confirming taut bands and tenderness in the muscles of the right lateral scapular area, we diagnosed the patient with MPS within the deltoid, infraspinatus, and teres major muscles. Under ultrasound (US) guidance, a mixed solution of 1 mL of 2% lidocaine and 2 mL of normal saline was injected layer by layer into the three muscles within the same sonographic view. At the 1-month follow-up (F/U) visit, the patient reported only slight initial pain (NRS score, 1).

CONCLUSIONS

Thus, we recommend our US-guided 3-in-1 technique for performing TPI to treat MPS in the muscles of the lateral scapular area.

Seronegative rheumatic arthritis has milder inflammation and bone erosion in an ultrasound study of disease-modifying anti-rheumatic drugs (DMARDs)-naïve Chinese cohort

Background

Compared with the seropositive rheumatic arthritis (sp-RA), seronegative rheumatic arthritis (sn-RA) lacks ultrasound (US) research. It is unknown whether sn-RA patients had more severe synovitis than sp-RA ones at the same level of swollen joint counts (SJCs). We designed the US study to find out the answers.

Methods

All cases satisfied the 2010 classification criteria, first diagnosed and disease-modifying anti-rheumatic drugs (DMARDs) naïve with the characteristics of abnormal swelling or pain in the wrist, proximal interphalangeal (PIPs), and metacarpophalangeal (MCPs) joints. Demographic data was collected. US examinations, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), visual analogue scale scores (VASs), patient global assessment (PGA), physician’s global assessment (PhGA), disease activity score of 28 joints (DAS28), and van der Heijde-modified Sharp score (vdHSS) were used to evaluate the disease activity among these groups. Anticitrullinated peptide antibody (ACPA), rheumatoid factor (RF) and SJCs were used to divide the patients into 3 groups, which were defined as follows: Group A, sp-RA (positive RF and/or ACPA) with SJC >10; Group B, sp-RA with SJC ≤10; and Group C, sn-RA (all negative RF and ACPA with SJC >10 due to the criteria).

Results

A total of 139 cases were recruited. Fifty-six were Group A, 54 were Group B, and 29 were Group C. All indexes above and the total US scores were significantly lower in Group C than Group A (both groups with SJC >10) (ESR, CRP, VASs, PGA, PhGA, DAS28, vdHSS, US total score respectively: 58.8 vs. 37.5, P=0.009; 37.5 vs. 17.8, P=0.008; 61.7 vs. 52.8, P=0.032; 62.2 vs. 53.9, P=0.031; 59.8 vs. 48.3, P=0.029; 6.92 vs. 5.56, P=0.000; 61.7 vs. 44.5, P=0.023; 31.4 vs. 20.9, P=0.000). The difference of the total US scores above was mostly contributed by the symptoms of synovitis. The total US scores were prominently lower in Group C with the duration over 2 years (2–5 years, >5 years, respectively compared to <2 years: 16.3 vs. 27.4, P=0.044; 16.5 vs. 27.4, P=0.048), and vdHSS were remarkably higher in almost all groups with a duration of over 5 years. For the patients with a duration over 2 years, bone erosions occurred earlier in sp-RA than in sn-RA patients.

Conclusions

Sn-RA patients had milder synovitis than sp-RA ones at the same extent of disease activity. In addition, sn-RA had delayed progress of bone erosion than the sp-RA group.

Difference and ratio of the cross-sectional area of median nerve at the carpal tunnel and the pronator quadratus muscle in diagnosing carpal tunnel syndrome: a cross-sectional study

Background

At present, the most commonly used diagnostic method of carpal tunnel syndrome (CTS) is based on clinical manifestations and electrophysiology, but the electrophysiology is not cheap, invasive, and lacks the presentation of peripheral nerve conditions, which is exactly the advantage of ultrasound (US). The purpose of this study was to evaluate the accuracy and effectiveness of US in the diagnosis of CTS by calculating the cross-sectional area (CSA) at the carpal tunnel and proximally at the level of the pronator quadratus muscle., and to find an appropriate index that can be used to achieve the diagnosis in a more cost-effective manner.

Methods

Forty-three wrists from 35 symptomatic CTS patients and 23 wrists from 18 asymptomatic volunteers were evaluated. Diagnosis in the CTS group was based on the American Academy of Neurology clinical diagnostic criteria. The ultrasonic probe was placed at the carpal tunnel and the distal 1/3 of the pronator muscle respectively, and the carpal tunnel cross-sectional area (CSAC) and the proximal cross-sectional area (CSAP) was calculated, with a further calculation of their difference (ΔCSA) and ratio (R-CSA).

Results

There was a significant difference between the 2 groups regarding mean ± standard deviation (SD) of CSAC, CSAP, ΔCSA, and R-CSA (P<0.01). The cutoff value of 12.14 mm² for CSAC had a sensitivity and specificity of 90.7% and 100%, respectively; the cutoff value of 1.235 mm² for R-CSA had a sensitivity and specificity of 97.67% and 95.65%, respectively; and the cutoff value of 2.035 mm² for ΔCSA had a sensitivity and specificity of 100% and 100%, respectively. Therefore, US was found to be an effective method for the diagnosis of CTS. Receiver operating characteristic curve (ROC) analysis of all patients showed area under the curve (AUC) was 0.9778 for CSAC, 0.9949 for R-CSA and 1.000 for ΔCSA.

Conclusions

US can provide reference values for the diagnosis of CTS. CSAC, ΔCSA, and R-CSA can be used for CTS diagnosis and evaluation. The ROC curve analysis showed that among the 3 values, ΔCSA was the most useful in the diagnosis of patients with CTS. ΔCSA is considered a valid diagnostic value for CTS, as its threshold of 2.04 mm² showed the highest sensitivity and specificity.

Nomogram based on radiomics analysis of ultrasound images can improve preoperative BRAF mutation diagnosis for papillary thyroid microcarcinoma

BACKGROUND

The preoperative identification of BRAF mutation could assist to make appropriate treatment strategies for patients with papillary thyroid microcarcinoma (PTMC). This study aimed to establish an ultrasound (US) radiomics nomogram for the assessment of BRAF status.

METHODS

A total of 328 PTMC patients at the China-Japan Friendship Hospital between February 2019 and November 2021 were enrolled in this study. They were randomly divided into training (n = 232) and validation (n = 96) cohorts. Radiomics features were extracted from the US images. The least absolute shrinkage and selection operator (LASSO) regression was applied to select the BRAF status-related features and calculate the radiomics score (Rad-score). Univariate and multivariate logistic regression analyses were subsequently performed to identify the independent factors among Rad-score and conventional US features. The US radiomics nomogram was established and its predictive performance was evaluated via discrimination, calibration, and clinical usefulness in the training and validation sets.

RESULTS

Multivariate analysis indicated that the Rad-score, composition, and aspect ratio were independent predictive factors of BRAF status. The US radiomics nomogram which incorporated the three variables showed good calibration. The discrimination of the US radiomics nomogram showed better discriminative ability than the conventional US model both in the training set (AUC 0.685 vs. 0.592) and validation set (AUC 0.651 vs. 0.622). Decision curve analysis indicated the superior clinical applicability of the nomogram compared to the conventional US model.

CONCLUSIONS

The US radiomics nomogram displayed better performance than the conventional US model in predicting BRAF mutation in patients with PTMC.

Microbubble-mediated sonothrombolysis with BR38 of a venous full blood thrombus in a rat embolic stroke model

Background

Early recanalization of an occluded vessel is associated with a better clinical outcome in acute ischemic stroke. Intravenous thrombolysis using recombinant tissue plasminogen activator (rt-PA) is only available in a minority of patients and often fails to reopen the occluded vessel. Mechanical recanalization is more effective in this matter but only available for selected patients when a thrombectomy centre can be reached. Therefore, sonothrombolysis might represent an alternative or complementary approach. Here, we tested microbubble-mediated sonothrombolysis (mmSTL) in a thromboembolic stroke model for middle cerebral artery occlusion (MCAO) in rats.

Methods

Sixty-seven male Wistar rats underwent MCAO using an autologous full blood thrombus and were randomly assigned to four groups receiving rt-PA, mmSTL, a combination of both, or a placebo. Diagnostic workup included neurological examination, assessment of infarct size, and presence of intracerebral haemorrhage by magnetic resonance imaging (MRI) and presence of microbleedings in histological staining.

Results

Neurological examination revealed no differences between the treatment groups. In all treatment groups, there was a reduction in infarct size 24 hours after MCAO as compared to the placebo (P≤0.05), but there were no differences between the active treatment groups (P>0.05) (placebo 0.75±0.10 cm³; mmSTL 0.43±0.07 cm³; rt-PA 0.4±0.07 cm³; mmSTL + rt-PA 0.27±0.08 cm³). Histological staining displayed intracerebral microbleedings in all animals. The frequency of gross bleeding detected by MRI did not differ between the groups (placebo 3; mmSTL 4; rt-PA 2; mmSTL + rt-PA 2; P>0.05) and was not associated with worse performance in clinical testing (P>0.05). There were no statistical differences in the mortality between the groups (P>0.05).

Conclusions

Our study showed the efficacy and safety of mmSTL with or without rt-PA in an embolic rat stroke model using a continuous full blood thrombus. Sonothrombolysis might be useful for patients who need to be transported to a thrombectomy centre or for those with distal vessel occlusion.

Collaterals in portal hypertension: anatomy and clinical relevance

Portal hypertension is a key pathophysiology of chronic liver diseases typified with cirrhosis or noncirrhotic portal hypertension. The development of collateral vessels is a characteristic feature of impaired portal hemodynamics. The paraumbilical vein (PUV), left gastric vein (LGV), posterior gastric vein (PGV), short gastric vein (SGV), splenorenal shunt (SRS), and inferior mesenteric vein (IMV) are major collaterals, and there are some rare collaterals. The degree and hemodynamics of collateral may affect the portal venous circulation and may compensate for the balance between inflow and outflow volume of the liver. Additionally, the development of collateral shows a relation with the liver function reserve and clinical manifestations such as esophageal varices (EV), gastric varices, rectal varices and the other ectopic varices, hepatic encephalopathy, and prognosis. Furthermore, there may be an interrelationship in the development between different collaterals, showing additional influences on the clinical presentations. Thus, the assessment of collaterals may enhance the understanding of the underlying pathophysiology of the condition of patients with portal hypertension. This review article concluded that each collateral has a specific function depending on the anatomy and hemodynamics and is linked with the relative clinical presentation in patients with portal hypertension. Imaging modalities may be essential for the detection, grading and evaluation of the role of collaterals and may help to understand the pathophysiology of the patient condition. Further investigation in a large-scale study would elucidate the basic and clinical significance of collaterals in patients with portal hypertension and may provide information on how to manage them to improve the prognosis as well as quality of life.

In Vivo Imaging of Biodegradable Implants and Related Tissue Biomarkers

Non-invasive longitudinal imaging of osseointegration of bone implants is essential to ensure a comprehensive, physical and biochemical understanding of the processes related to a successful implant integration and its long-term clinical outcome. This study critically reviews the present imaging techniques that may play a role to assess the initial stability, bone quality and quantity, associated tissue remodelling dependent on implanted material, implantation site (surrounding tissues and placement depth), and biomarkers that may be targeted. An updated list of biodegradable implant materials that have been reported in the literature, from metal, polymer and ceramic categories, is provided with reference to the use of specific imaging modalities (computed tomography, positron emission tomography, ultrasound, photoacoustic and magnetic resonance imaging) suitable for longitudinal and non-invasive imaging in humans. The advantages and disadvantages of the single imaging modality are discussed with a special focus on preclinical imaging for biodegradable implant research. Indeed, the investigation of a new implant commonly requires histological examination, which is invasive and does not allow longitudinal studies, thus requiring a large number of animals for preclinical testing. For this reason, an update of the multimodal and multi-parametric imaging capabilities will be here presented with a specific focus on modern biomaterial research.

Imaging of Joint and Soft Tissue Involvement in Systemic Lupus Erythematosus

PURPOSE OF REVIEW

To highlight the potential uses and applications of imaging in the assessment of the most common and relevant musculoskeletal (MSK) manifestations in systemic lupus erythematosus (SLE).

RECENT FINDINGS

Ultrasound (US) and magnetic resonance imaging (MRI) are accurate and sensitive in the assessment of inflammation and structural damage at the joint and soft tissue structures in patients with SLE. The US is particularly helpful for the detection of joint and/or tendon inflammation in patients with arthralgia but without clinical synovitis, and for the early identification of bone erosions. MRI plays a key role in the early diagnosis of osteonecrosis and in the assessment of muscle involvement (i.e., myositis and myopathy). Conventional radiography (CR) remains the traditional gold standard for the evaluation of structural damage in patients with joint involvement, and for the study of bone pathology. The diagnostic value of CR is affected by the poor sensitivity in demonstrating early structural changes at joint and soft tissue level. Computed tomography allows a detailed evaluation of bone damage. However, the inability to distinguish different soft tissues and the need for ionizing radiation limit its use to selected clinical circumstances. Nuclear imaging techniques are valuable resources in patients with suspected bone infection (i.e., osteomyelitis), especially when MRI is contraindicated. Finally, dual energy X-ray absorptiometry represents the imaging mainstay for the assessment and monitoring of bone status in patients with or at-risk of osteoporosis. Imaging provides relevant and valuable information in the assessment of MSK involvement in SLE.

Multimodality carotid plaque tissue characterization and classification in the artificial intelligence paradigm: a narrative review for stroke application

Cardiovascular disease (CVD) is one of the leading causes of morbidity and mortality in the United States of America and globally. Carotid arterial plaque, a cause and also a marker of such CVD, can be detected by various non-invasive imaging modalities such as magnetic resonance imaging (MRI), computer tomography (CT), and ultrasound (US). Characterization and classification of carotid plaque-type in these imaging modalities, especially into symptomatic and asymptomatic plaque, helps in the planning of carotid endarterectomy or stenting. It can be challenging to characterize plaque components due to (I) partial volume effect in magnetic resonance imaging (MRI) or (II) varying Hausdorff values in plaque regions in CT, and (III) attenuation of echoes reflected by the plaque during US causing acoustic shadowing. Artificial intelligence (AI) methods have become an indispensable part of healthcare and their applications to the non-invasive imaging technologies such as MRI, CT, and the US. In this narrative review, three main types of AI models (machine learning, deep learning, and transfer learning) are analyzed when applied to MRI, CT, and the US. A link between carotid plaque characteristics and the risk of coronary artery disease is presented. With regard to characterization, we review tools and techniques that use AI models to distinguish carotid plaque types based on signal processing and feature strengths. We conclude that AI-based solutions offer an accurate and robust path for tissue characterization and classification for carotid artery plaque imaging in all three imaging modalities. Due to cost, user-friendliness, and clinical effectiveness, AI in the US has dominated the most.

In Vivo Assessment of Hypoxia Levels in Pancreatic Tumors Using a Dual-Modality Ultrasound/Photoacoustic Imaging System

Noninvasive anatomical and functional imaging has become an essential tool to evaluate tissue oxygen saturation dynamics in preclinical or clinical studies of hypoxia. Our dual-wavelength technique for photoacoustic (PA) imaging based on the differential absorbance spectrum of oxyhemoglobin (oxy-Hb) and deoxyhemoglobin (deoxy-Hb) can quantify tissue oxygen saturation using the intrinsic contrast property. PA imaging of tissue oxygen saturation can be used to monitor tumor-related hypoxia, which is a particularly relevant functional parameter of the tumor microenvironment that has a strong influence on tumor aggressiveness. The simultaneous acquisition of anatomical and functional information using dual-modality ultrasound (US) and PA imaging technology enhances the preclinical applicability of the method. Here, the developed dual-modality US/PA system was used to measure relative tissue oxygenation using the dual-wavelength technique. Tissue oxygen saturation was quantified in a pancreatic tumor mouse model. The differences in tissue oxygenation were detected by comparing pancreatic samples from normal and tumor-bearing mice at various time points after implantation. The use of an in vivo pancreatic tumor model revealed changes in hypoxia at various stages of tumor growth. The US/PA imaging data positively correlated with the results of immunohistochemical staining for hypoxia. Thus, our dual-modality US/PA imaging system can be used to reliably assess and monitor hypoxia in pancreatic tumor mouse models. These findings enable the use of a combination of US and PA imaging to acquire anatomical and functional information on tumor growth and to evaluate treatment responses in longitudinal preclinical studies.

Mammography breast density: an effective supplemental modality for the precise grading of ultrasound BI-RADS 4 categories

Background

High breast density is significantly associated with an increased risk of breast diseases. Presently, suspected breast masses assessed as Breast Imaging-Reporting and Data System (BI-RADS) grade 4 provide a wide range of positive predictive values. Moreover, subcategories (4a, 4b, and 4c) are still under consideration as the diagnostic criteria are neither comprehensive nor objective. However, whether mammography breast density (MBD) has any impact on the accurate grading of BI-RADS 4 assessed by ultrasound (US) remains unknown.

Methods

A total of 1,086 women with 1,293 breast masses were included and assessed as BI-RADS 3-5 by US. The subcategories of MBD (from the ACR-a to the ACR-d group) were assessed by mammography according to the criteria of the American College of Radiology (ACR). The clinicopathological characteristics of these patients were reviewed retrospectively. The malignancy rates of breast masses among different subgroups assessed by BI-RADS were re-estimated with MBD.

Results

Almost all BI-RADS 3 masses were classified as benign and nearly all BI-RADS 5 masses were identified as malignant. Significant inverse associations between MBD and malignancy rates were detected between the BI-RADS 4a and BI-RADS 4b groups. Moreover, malignancy rates decreased significantly from ACR-a to ACR-d for BI-RADS 4a and 4b breast lesions (P<0.001). However, this trend was not observed in BI-RADS 4c breast lesions.

Conclusions

MBD could serve as a crucial factor for the accurate grading of BI-RADS 4 lesions assessed by US. We strongly recommend the adoption of the MBD as a possible supplemental screening modality for US. Furthermore, it is equally beneficial for accurate risk assessment and screening recommendations based on MBD.

The role of ultrasound in determining the amount of pleural effusion

Background

There is no standardized system to evaluate pleural effusion size on ultrasound (US). We aimed to explore the role of US in determining the amount of pleural effusion, with an attempt to provide evidence for clinical efficacy evaluation and treatment program selection.

Methods

A total of 98 patients undergoing thoracoscopy at our center were enrolled in this study. The patients take a sitting position, then the maximum depths of the pleural effusion by US at the subscapular line, posterior axillary line, midaxillary line, anterior axillary line, and midclavicular line, as well as the maximum thickness of the pleural effusion at the subscapular line, were measured before pleural effusion drainage. Then, the corresponding values in the lateral position were also measured. The relationships between the actual pleural effusion amounts and the measurements at these lines were analyzed using the multivariate linear regression model (MLRM).

Results

The regression equation of the group with a pleural effusion amount of 500–1,000 mL in the sitting position showed statistical significance (P=0.001). The P values of the maximum depths at the subscapular line (X₁) and midclavicular line (X₅) and the maximum thickness at the subscapular line (X₆) were below 0.05. Thus, a final model was established using X₁, X₅, and X₆ as the independent variables.

Conclusions

The combination of US examination and MLRM enables the quantitative determination of pleural effusion.

Application of ultrasound and contrast-enhanced ultrasound to distinguish salivary focal inflammatory masses from malignant masses: A retrospective observational study

BACKGROUND

The aim was to retrospectively analyze the ultrasonographic and clinical characteristics of focal inflammatory masses and malignant masses of salivary gland by using B-mode ultrasound (US) and contrast-enhanced ultrasound (CEUS) for differential analysis.

METHODS

The features of US and CEUS were retrospectively analyzed for 19 cases of focal salivary inflammatory masses and 45 cases of malignant salivary masses. All cases were confirmed by pathohistological examination.

RESULTS

On B-mode US, the incidence of expansive growth patterns of malignant salivary masses (44.4%, 20/45) was significantly higher than that of focal salivary inflammatory masses (15.8%, 3/19) (p = 0.029). The rate of lymphadenopathy surrounding salivary glands of malignant salivary masses (42.2%, 19/45) was significantly higher than that of focal salivary inflammatory masses (15.8%, 3/19) (p = 0.042). On CEUS, clear enhancement margins were more common in malignant salivary masses (44.4%, 20/45) compared to focal salivary inflammatory masses (15.8%, 3/19) (p = 0.029); Rapid washout was more common in malignant salivary masses (82.2%, 37/45) than focal salivary inflammatory masses (31.6%, 6/19) (p <  0.001). Rapid washout on CEUS and craniocaudal diameter were independent predictive factors in differentiating salivary inflammatory masses and malignant masses according to binary logistic regression analysis. US and CEUS achieved a sensitivity of 80.0%, a specificity of 78.9%and an accuracy of 80.0%for discrimination between salivary inflammatory masses and malignant masses.

CONCLUSION

Therefore, a multimodal ultrasonographic pathway combining clinical manifestations, B-mode US and CEUS was needed to differentiate between salivary focal inflammatory masses and malignancies to avoid unnecessary biopsies.

Specimen number based diagnostic yields of suspicious axillary lymph nodes in core biopsy in breast cancer: clinical implications from a prospective exploratory study

Background

Ultrasound (US)-guided core needle biopsy (CNB) is widely applied in the pathological diagnosis of suspicious axillary lymph nodes (ALNs) in breast cancer. However, the number of specimens removed during biopsy is currently based on the preference of the individual radiologist. This study aims to analyze the specimen number based diagnostic yields of US guided CNB of suspicious ALNs in breast cancer.

Methods

Core biopsy specimens of suspicious lymph nodes were prospectively obtained from breast cancer patients treated at our hospital between November, 2018, and July, 2019. Four specimens were obtained from each patient and labeled 1-4 in the order they were removed. Each specimen underwent pathological evaluation to determine whether metastasis had occurred. The diagnostic yields of the specimens were calculated and differences in diagnostic accuracy according to the number of specimens were evaluated by McNemar's test.

Results

A total of 167 patients were enrolled, and 139 (83.2%) cases were identified as metastasis by CNB. The diagnostic yields were: 74.2% (specimen 1), 87.8% (specimens 1-2), 91.2% (specimens 1-3), and 94.6% (specimens 1-4). The increases in diagnostic yield from specimen 1 to 1-2 and from specimens 1-2 to 1-4 were significant; however, no significant differences were detected between specimens 1-3 and the first two, or between specimens 1-4 and the first three in this sample size. The lower diagnostic abilities for the first two specimens were associated with shorter long- and short-axis lengths of lymph nodes on US.

Conclusions

Although the second specimen contributed significant diagnostic yield of suspicious axillary lymph nodes in core biopsy in breast cancer, a minimum number cannot be determined by this study. Additional specimens may improve diagnostic yield particularly in patients with small nodes.

How Can We Manage Gallbladder Lesions by Transabdominal Ultrasound?

The most important role of ultrasound (US) in the management of gallbladder (GB) lesions is to detect lesions earlier and differentiate them from GB carcinoma (GBC). To avoid overlooking lesions, postural changes and high-frequency transducers with magnified images should be employed. GB lesions are divided into polypoid lesions (GPLs) and wall thickening (GWT). For GPLs, classification into pedunculated and sessile types should be done first. This classification is useful not only for the differential diagnosis but also for the depth diagnosis, as pedunculated carcinomas are confined to the mucosa. Both rapid GB wall blood flow (GWBF) and the irregularity of color signal patterns on Doppler imaging, and heterogeneous enhancement in the venous phase on contrast-enhanced ultrasound (CEUS) suggest GBC. Since GWT occurs in various conditions, subdividing into diffuse and focal forms is important. Unlike diffuse GWT, focal GWT is specific for GB and has a higher incidence of GBC. The discontinuity and irregularity of the innermost hyperechoic layer and irregular or disrupted GB wall layer structure suggest GBC. Rapid GWBF is also useful for the diagnosis of wall-thickened type GBC and pancreaticobiliary maljunction. Detailed B-mode evaluation using high-frequency transducers, combined with Doppler imaging and CEUS, enables a more accurate diagnosis.

Advances in translational imaging of the microcirculation

The past few decades have seen an explosion in the development and use of methods for imaging the human microcirculation during health and disease. The confluence of innovative imaging technologies, affordable computing power, and economies of scale have ushered in a new era of "translational" imaging that permit us to peer into blood vessels of various organs in the human body. These imaging techniques include near-infrared spectroscopy (NIRS), positron emission tomography (PET), and magnetic resonance imaging (MRI) that are sensitive to microvascular-derived signals, as well as computed tomography (CT), optical imaging, and ultrasound (US) imaging that are capable of directly acquiring images at, or close to microvascular spatial resolution. Collectively, these imaging modalities enable us to characterize the morphological and functional changes in a tissue's microcirculation that are known to accompany the initiation and progression of numerous pathologies. Although there have been significant advances for imaging the microcirculation in preclinical models, this review focuses on developments in the assessment of the microcirculation in patients with optical imaging, NIRS, PET, US, MRI, and CT, to name a few. The goal of this review is to serve as a springboard for exploring the burgeoning role of translational imaging technologies for interrogating the structural and functional status of the microcirculation in humans, and highlight the breadth of current clinical applications. Making the human microcirculation "visible" in vivo to clinicians and researchers alike will facilitate bench-to-bedside discoveries and enhance the diagnosis and management of disease.

Validity and reliability of high-resolution ultrasound imaging for the assessment of regional body composition in stage 5 chronic kidney disease patients undergoing continuous ambulatory peritoneal dialysis

BACKGROUND

Accurate measurement of muscle mass is an important research and clinical tool. High-resolution ultrasound (US) has shown potential as a method to assess muscle and fat mass at specific anatomical sites. However, there is limited evidence for the reliability of US to measure muscle size in patients receiving continuous ambulatory peritoneal dialysis (CAPD). Therefore, we examined the validity and reliability of an US method compared to a gold standard comparison for the assessment of a quadriceps muscle in this clinical population.

METHODS

Twenty people receiving CAPD (mean age = 56.5 ± 16.7 years) at a single dialysis unit were assessed on two occasions, 7 days apart. Measures of the mid-thigh, such as vastus lateralis (VL) anatomical cross-sectional area (ACSA), VL muscle thickness and subcutaneous fat thickness were compared for US reliability and validity compared to magnetic resonance imaging (MRI) measures.

RESULTS

US had high validity against gold standard MRI measures, with intraclass correlation coefficients (ICC) equating to VL ACSA of 0.95, VL thickness of 0.99 and fat thickness of 0.98. The US measurements also exhibited high intra-rater reliability (ICCs: VL thickness = 0.98, total muscle thickness = 0.97 and fat thickness = 0.99) in measuring body composition at the mid-VL site in the study population.

CONCLUSIONS

Valid assessment of regional body composition can be achieved via high-resolution US in patients receiving CAPD. The validity and reliability of the US in repeated measures (in comparison to the gold standard MRI) warrant further investigation in the wider chronic kidney disease population.

Automatic Fetal Middle Sagittal Plane Detection in Ultrasound Using Generative Adversarial Network

Background and Objective: In the first trimester of pregnancy, fetal growth, and abnormalities can be assessed using the exact middle sagittal plane (MSP) of the fetus. However, the ultrasound (US) image quality and operator experience affect the accuracy. We present an automatic system that enables precise fetal MSP detection from three-dimensional (3D) US and provides an evaluation of its performance using a generative adversarial network (GAN) framework. Method: The neural network is designed as a filter and generates masks to obtain the MSP, learning the features and MSP location in 3D space. Using the proposed image analysis system, a seed point was obtained from 218 first-trimester fetal 3D US volumes using deep learning and the MSP was automatically extracted. Results: The experimental results reveal the feasibility and excellent performance of the proposed approach between the automatically and manually detected MSPs. There was no significant difference between the semi-automatic and automatic systems. Further, the inference time in the automatic system was up to two times faster than the semi-automatic approach. Conclusion: The proposed system offers precise fetal MSP measurements. Therefore, this automatic fetal MSP detection and measurement approach is anticipated to be useful clinically. The proposed system can also be applied to other relevant clinical fields in the future.

Abdominal ultrasonographic manifestations in pediatric patients with tuberous sclerosis complex

BACKGROUND

Tuberous sclerosis complex (TSC) is a rare genetic disease which leads to formation of benign tumors in the brain and other organs of the body. Ultrasound (US) can detect the location, quantity, size and internal echo of TSC-associated renal diseases, liver angiomyolipoma (AML), and co-existing lesions, providing important diagnostic basis for clinical diagnosis. The aim of the present study was to investigate the abdominal ultrasonographic features of pediatric TSC and explore the advantages of abdominal ultrasonography in clinical practice.

METHODS

Data of children with TSC, who presented to the Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, between January 2016 and November 2018, were analyzed by a retrospective chart review. The cases were identified from electronic medical records (EMR) system and underwent ultrasonography, we yielded a total of 12 patients.

RESULTS

The 12 pediatric patients, including 5 boys and 7 girls, ranged in age from 9 months to 13 years old. And they all had a history of epilepsy. All the patients underwent brain magnetic resonance imaging (MRI) or computed tomography (CT) examination, which revealed a scattered distribution of multiple hyperintense nodules. Of the 12 patients, 10 had TSC-associated bilateral renal AMLs, 5 had hepatic AML, and 4 had renal cysts.

CONCLUSIONS

US is a useful and non-invasive tool for the detection of TSC-associated renal and liver lesions and for clinical follow-up among pediatric patients.

Imaging of body composition in children

Overweight and obesity in children and adolescents have become a worldwide public health concern with an ever-increasing prevalence. An excessive accumulation of intraabdominal fat tissue increases the risk of developing insulin resistance, diabetes, and cardiovascular diseases in adulthood. Body composition has a role in metabolism regulation in children and adolescents with differences between genders and age groups. Until recently, Air Displacement Plethysmography and Dual-energy X-ray Absorptiometry (DXA) have been the most common techniques used to assess body composition in children. Ultrasound (US) is an accurate, readily available, and radiation-free technique to quantify intra-abdominal fat in adults, but its use in children has not yet been validated. Computed tomography (CT) is a reliable tool to assess body composition, but its use in children should be avoided due to the significant radiation burden. Quantitative Magnetic Resonance Imaging (qMRI) provides an accurate measurement of body composition, through the quantification of the visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and brown adipose tissue (BAT), as well as lean mass. Furthermore, qMRI provides other significant estimates such as the Proton Density Fat-Fraction of the fat tissue. This review article aims to briefly describe the state of art of the advanced imaging techniques to provide a quantitative assessment of body composition in children and adolescents.

Acute epiploic appendagitis: ultrasound and computed tomography findings of a rare case of acute abdominal pain and the role of other imaging techniques

Purpose

Acute epiploic appendagitis (EA) is a relatively rare, benign and local inflammatory disease involving the epiploic appendices. Unlike its mimics, EA is generally a self-limiting inflammatory disease and can be treated conservatively.

Case presentation

A 33-year-old Caucasian man presented to our emergency department with a sever and sharp left iliac fossa pain. He underwent abdominal X-ray, ultrasound (US) and computed tomography (CT) evaluations.

Conclusion

We illustrate US and CT findings to increase the radiologists’ awareness of this condition and to avoid diagnostic delay and unnecessary use of antibiotics, hospitalization and surgery.

COVID-19 pneumonia manifestations at the admission on chest ultrasound, radiographs, and CT: single-center study and comprehensive radiologic literature review

PURPOSE

To investigate the imaging features of emerging COVID-19 pneumonia on chest ultrasound (US), radiographs (CXR) and computed tomography (CT) examinations performed at admission and to provide a comprehensive radiological literature review on ongoing radiological data from recent publications.

MATERIALS AND METHODS

In this retrospective single-center study, we enrolled consecutive patients from February 15, 2020, to March 15, 2020, with laboratory-confirmed SARS-CoV-2 hospitalized in Valduce Hospital (Como, Italy). Multi-modality imaging findings were evaluated and compared. Literature research was conducted through a methodical search on Pubmed and Embase databases.

RESULTS

Fifty-eight patients (36 men, 22 women; age range, 18-98 years) were included in the study. Among these, chest US, CXR, and CT were performed respectively in twenty-two, thirty-two and forty-two patients. Lung US findings were consistent with diffuse B lines (100%) and subpleural consolidations (27.3%). CXR showed prevalent manifestations of consolidations (46.9%) and hazy increased opacities (37.5%). Typical CT features included bilateral and multilobar ground-glass opacities (GGO) with (59.5%) and without (35.7%) consolidations having a predominantly peripheral distribution (64.3%). Other imaging features included crazy paving pattern (57.1%), fibrous stripes (50%), subpleural lines (35.7%), architectural distortion (28.6%), air bronchogram sign (26.2%), vascular thickening (23.8%) and nodules (2.4%). Also, enlarged lymph nodes (14.3 %) and pleural effusion (7.1%) were observed. The literature review identified twenty-six original studies supporting our imaging chest findings.

CONCLUSION

The spectrum of chest imaging manifestations of COVID-19 pneumonia upon admission includes B-lines and consolidations on US, consolidations and hazy increased opacities on CXR, and multifocal GGO with consolidations on CT.

Application of non-thermal pretreatment techniques on agricultural products prior to drying: a review

BACKGROUND

Most agricultural crops contain high moisture content (80-95% wet basis (wb)) which makes them very susceptible to microbial damage leading to shorter shelf-life and high postharvest losses. The high perishability of these agricultural products requires preservation techniques to prolong their shelf-lives. Drying remains an important component of processing in this regard. Therefore, any pretreatment methods for drying agricultural product that decreases the moisture content and minimizes drying time by conserving the quality of the crop product is of prime significance. This article is a comprehensive review of recent developments of non-thermal pretreatment (NTP) methods. A summary of their significance, emerging and innovative methods of this technology together with its applications and limitations are discussed. This article further examines the environmental impact of NTP techniques.

RESULTS

NTP techniques, such as high pressure, ultrasound, pulsed electric field and osmotic dehydration methods are essential operations for pre-dehydration of agricultural products prior to drying. These techniques can avoid the deleterious effects of heat on nutritive value, colour and flavour of agricultural products compared to thermal pretreatments. They also enhance the inactivation of the enzymes, improve energy efficiency and mass transfer, reduce processing time, preserve bioactive compounds, improve drying kinetics and drying rate, minimize enzymatic browning, and enhance product quality.

CONCLUSION

These findings will provide a better understanding of different NTP methods and also make available more information for selecting pretreatment techniques for drying of agricultural products. © 2020 Society of Chemical Industry.

Ultrasound elastography as a potential method to evaluate entrapment neuropathies in elite athletes: a mini-review

Entrapment neuropathies constitute a significant albeit still neglected problem in athletes. Currently available diagnostic options in patients with suspected neuropathies, nerve conduction studies, and magnetic resonance imaging have some drawbacks, mostly related to their invasive character, high cost, and limited availability. This paper reviews published articles documenting the use of ultrasound elastography, a novel technique to determine tissue strain, in the evaluation of nerve stiffness in entrapment neuropathy, and it discusses potential pros and cons of this method in the examination of elite athletes. Based on the review of literature, ultrasound elastography - especially shear wave elastography - seems suitable for the evaluation of entrapment neuropathies in elite athletes. Published evidence from the general population suggests that most common entrapment neuropathies (carpal tunnel syndrome, ulnar neuropathy of the elbow, ulnar tunnel syndrome) are associated with a significant increase in the stiffness of affected nerves, which can be accurately detected with ultrasound elastography. Before adding ultrasound elastography to the armamentarium of diagnostic tests used routinely in athletes, its accuracy in the detection of entrapment neuropathies needs to be verified in this specific group, and the reference values for peripheral nerve strain in sportspersons need to be determined.

A new application of ultrasound-magnetic resonance multimodal fusion virtual navigation in glioma surgery

Background

Long-term survival and high-quality life of patients with gliomas depends on the extent of resection (EOR) and the protection of functional white matter fibers. The navigation system provides precise positioning for surgery based on preoperative magnetic resonance imaging (MRI) but the precision decreases when intraoperative brain drift occurs. Ultrasound (US) can support real-time imaging and correct brain shift. The real-time US-MRI multimodal fusion virtual navigation system (UMNS) is a new technique for glioma surgery. In order to obtain a maximum EOR and functional protection, this study aimed to explore the feasibility, efficiency, and safety of real-time UMNS for glioma surgery, and to evaluate the benefit of the new application by UMNS presetting markers between the tumor and functional white matter fiber surgery.

Methods

A retrospective analysis included 45 patients who underwent glioma surgery, 19 patients with only intraoperative US, and 26 patients with UMNS. A preoperative plan was made by 3D-slicer software based on preoperative MRI. This was combined with a reconstruction of diffusion tensor imaging (DTI) that designed the important locations as "warning points" between functional white matter fibers and tumor. Following patient registration, markers were injected into preset "warning points" under image-guided UMNS in order to give us a warning during surgery in case of postoperative function deficits. The operating time, volumetric assessment in glioma resection, and postoperative complications were evaluated and used to compared those surgeries using intraoperative US (iUS) with those surgeries using intraoperate MRI (iMRI) navigation.

Results

A total of 45 patients underwent glioma surgery. Gross total removal (GTR) of iUS alone was achieved in 6 of 19 cases, while this was achieved in 22 of 26 cases with UMNS alone, demonstrating an improvement in rate of GTR from 31.58% to 84.62%, respectively. This may be attributable to the superior US image quality provided by UMNS. In 13 of 26 cases, there was improved image quality (from poor/moderate to moderate/good) with the aid of UMNS. In addition, the consistency of EOR of postoperative MRI evaluated by UMNS (92.31%) was higher than when using iUS alone (42.11%). The whole process of intraoperative scanning time and marker injection did not lead to a significant delay of the operating time compared to using iUS alone, and has been reported to be shorter than with iMRI as well. Furthermore, the percentage of postoperative morbidity in the UMNS group was lower than that in the iUS group (motor deficit: 11.54% vs. 42.11%; aphasia: P =3.85% vs. 31.58%, respectively).

Conclusions

Real-time UMNS is an effective, timesaving technology that offers high quality intraoperative imaging. Injection markers between functional white matter fibers and tumor by UMNS can help to obtain a maximum EOR of glioma and functional protection postoperatively. The integration of iUS into the neuronavigation system offered quick and helpful intra-operative images.

Clinical value of contrast-enhanced ultrasound in transthoracic biopsy of malignant anterior mediastinal masses

Background

Given low incidence and high heterogeneity, the treatment strategies of anterior mediastinal masses (AMMs) are diverse based on pathology. The purpose of the study is to evaluate the usefulness of contrast-enhanced ultrasound (CEUS) in transthoracic biopsy of malignant AMMs when compared with that of ultrasound (US) alone and to screen lesions that are more suitable for CEUS evaluation and guidance.

Methods

We reviewed all the US- and CEUS-guided transthoracic core needle biopsy (CNB) of AMMs performed in National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College between July 2013 and April 2019. A total of 68 patients (mean age 36 years; male-female ration 1.6:1) who were suspected with malignant AMMs were enrolled in the study. Among them, 20 patients received pre-biopsy CEUS examination (CEUS group); 48 patients underwent conventional US examination and guidance (US group). Demographic, radiologic, pathologic, medical records, and biopsy procedure details were retrospectively reviewed and compared between the two groups.

Results

The display of internal necrosis areas was significantly improved when compared with that of the conventional US (70%, 30%; P=0.008). Specifically, CEUS improved the diagnostic accuracy of US-guided transthoracic biopsy (95.0%, 79.2%; P=0.210) and especially for AMMs exceeding 10 cm (100%, 68.2%; P=0.040) and carcinoma (100%, 0%; P=0.048). The number of punctures in US group and CEUS group was 2.6 and 4.4 times, respectively (P<0.001). In case of similar number of punctures (1 to 3 times), CEUS improved diagnostic accuracy when compared to that of the conventional US (100%, 75%; P=0.486). The technical success rate was 100% (68/68). In both groups, patients did not exhibit symptomatic complications such as bleeding, pneumothorax, or hemoptysis after the biopsy.

Conclusions

The application of CEUS in transthoracic biopsy of malignant AMMs improved diagnostic accuracy when compared with conventional US and especially played more important role in lesions exceeding 10 cm and presumptive clinical carcinoma.

An investigation of the classification accuracy of a deep learning framework-based computer-aided diagnosis system in different pathological types of breast lesions

Background

Deep learning-based computer-aided diagnosis (CAD) is an important method in aiding diagnosis for radiologists. We investigated the accuracy of a deep learning-based CAD in classifying breast lesions with different histological types.

Methods

A total of 448 breast lesions were detected on ultrasound (US) and classified by an experienced radiologist, a resident and deep learning-based CAD respectively. The pathological results of the lesions were chosen as the golden standard. The diagnostic performances of the three raters in different pathological types were analyzed.

Results

For the overall diagnostic performance, deep learning-based CAD presented a significantly higher specificity (76.96%) compared with the two radiologists. The area under ROC of CAD was almost equal with the experienced radiologist (0.81 vs. 0.81), while significantly higher than the resident (0.81 vs. 0.70, P<0.0001). In the benign lesions, deep learning-based CAD had a higher accuracy than both the two radiologists, which correctly classified as benign lesions in 119/135 of fibroadenomas (88.1%), 25/35 of adenosis (71.4%), 14/27 of intraductal papillary tumors (51.9%), 5/10 of inflammation (50%), and 4/8 of sclerosing adenosis (50%). But only the differences between CAD and the two radiologists in fibroadenomas had statistical significance (P=0.0011 and P=0.0313), and the differences between CAD and the resident in adenosis had statistical significance (P=0.012). In the malignant lesions, 151/168 of invasive ductal carcinomas (89.9%), 21/29 of ductal carcinoma in situ (DCIS) (72.4%) and 6/7 of invasive lobular carcinomas (85.7%) were diagnosed as malignancies by deep learning-based CAD, with no significant differences between CAD and the two radiologists.

Conclusions

In the diagnosis of these common types of breast lesions, deep learning-based CAD had a satisfying performance. Deep learning-based CAD had a better performance in the breast benign lesions, especially in fibroadenomas and adenosis. Therefore, deep learning-based CAD is a promising supplemental tool to US to increase the specificity and avoid unnecessary benign biopsies.

Characterization of a Fiber Bundle-Based Real-Time Ultrasound/Photoacoustic Imaging System and Its In Vivo Functional Imaging Applications

Photoacoustic (PA) imaging is an attractive technology for imaging biological tissues because it can capture both functional and structural information with satisfactory spatial resolution. Current commercially available PA imaging systems are limited by their bulky size or inflexible user interface. We present a new handheld real-time ultrasound/photoacoustic imaging system (HARP) consisting of a detachable, high-numerical-aperture (NA) fiber bundle-based illumination system integrated with an array-based ultrasound (US) transducer and a data acquisition platform. In this system, different PA probes can be used for different imaging applications by switching the transducers and the corresponding jackets to combine the fiber pads and transducer into a single probe. The intuitive user interface is a completely programmable MATLAB-based platform. In vitro phantom experiments were conducted to test the imaging performance of the developed PA system. Furthermore, we demonstrated (1) in vivo brain vasculature imaging, (2) in vivo imaging of real-time stimulus-evoked cortical hemodynamic changes during forepaw electrical stimulation, and (3) in vivo imaging of real-time cerebral pharmacokinetics in rats using the developed PA system. The overall purpose of this design concept for a customizable US/PA imaging system is to help overcome the diverse challenges faced by medical researchers performing both preclinical and clinical PA studies.

Ultrasound-Enhanced Catalytic Ozonation Oxidation of Ammonia in Aqueous Solution

Excessive ammonia is a common pollutant in the wastewater, which can cause eutrophication, poison aquatic life, reduce water quality and even threaten human health. Ammonia in aqueous solution was converted using various systems, i.e., ozonation (O₃), ultrasound (US), catalyst (SrO-Al₂O₃), ultrasonic ozonation (US/O₃), ultrasound-enhanced SrO-Al₂O₃ (SrO-Al₂O₃/US), SrO-Al₂O₃ ozonation (SrO-Al₂O₃/O₃) and ultrasound-enhanced SrO-Al₂O₃ ozonation (SrO-Al₂O₃/US/O₃) under the same experimental conditions. The results indicated that the combined SrO-Al₂O₃/US/O₃ process achieved the highest NH₄⁺ conversion rate due to the synergistic effect between US, SrO-Al₂O₃ and O₃. Additionally, the effect of different operational parameters on ammonia oxidation in SrO-Al₂O₃/O₃ and SrO-Al₂O₃/US/O₃ systems was evaluated. It was found that the ammonia conversion increased with the increase of pH value in both systems. The NH₃(aq) is oxidized by both O₃ and ·OH at high pH, whereas the NH₄⁺ oxidation is only carried out through ·OH at low pH. Compared with the SrO-Al₂O₃/O₃ system, the ammonia conversion was significantly increased, the reaction time was shortened, and the consumption of catalyst dosage and ozone were reduced in the SrO-Al₂O₃/US/O₃ system. Moreover, reasonable control of ultrasonic power and duty cycle can further improve the ammonia conversion rate. Under the optimal conditions, the ammonia conversion and gaseous nitrogen yield reached 83.2% and 51.8%, respectively. The presence of tert-butanol, CO₃²⁻, HCO₃⁻, and SO₄²⁻ inhibited the ammonia oxidation in the SrO-Al₂O₃/US/O₃ system. During ammonia conversion, SrO-Al₂O₃ catalyst not only has a certain adsorption effect on NH₄⁺ but accelerates the O₃ decomposition to ·OH.

Sonication of Yeast Biomasses to Improve the Ageing on Lees Technique in Red Wines

Ageing on Lees (AOL) is a technique to improve the aromatic and gustatory complexity of wine, mainly by improving its body and reducing its astringency. However, the autolytic process is slow, resulting in high production costs. This work evaluated the effect of adding sonicated lees and combining it with oak chips, as a new technique to accelerate the AOL process and improve the aromatic quality of aged red wine. Cell disruption due to sonication was verified by optical microscopy. Volatile acidity, total polyphenol index, color intensity, tonality, dissolved oxygen, anthocyanins, and fermentative volatiles were monitored throughout the ageing of the wines. Sensory analysis was performed at the end of the ageing process. Polysaccharides released from the cell walls and the oxygen consumption, was quantified using a hydroalcoholic solution. The results indicated a 20% increase of the polysaccharide content and suggested an increase in the antioxidant capacity of the lees. No significant changes were observed in the fermentative volatile compounds and the total polyphenol index (TPI), except for those wines in contact with wood. The sonication of lees had some protective effect on the total anthocyanins content, however, color intensity was significantly lower in the sonicated treatments. The sonication of the lees did not cause any defect at the sensory level. Therefore, sonication could allow a reduction in the SO₂ addition to wine, as well as a shortening of the ageing times.

Diagnostic value of three-dimensional saline infusion sonohysterography in the evaluation of the uterus and uterine cavity lesions

Purpose

The purpose of this review is to illustrate and discuss the seldom used technique of three-dimensional (3D) saline infusion sonohysterography (SIS) based on instillation of sterile saline through a catheter into the uterus under real-time vaginal transducer observation for assessment of the endometrial cavity.

Material and methods

The cases for this pictorial review were selected from the imaging material collected at the Ultrasound Unit, Clinical Imaging Department, Women’s Hospital of Hamad Medical Corporation during a seven-year period from 2011 to 2017. This was a retrospective collection of 216 consecutive cases that underwent two-dimensional (2D) and 3D SIS for evaluation of the uterine cavity, followed by verification of results with histopathology. An open-sided speculum is inserted into the vagina. An intrauterine catheter is then threaded into the endometrial cavity. After that, the speculum is removed carefully, and a vaginal transducer is inserted. Using a 60-ml syringe attached to the catheter, saline solution is instilled under direct real-time observation (2D SIS). Subsequently, reconstruction of the three-dimensional anatomy of the intrauterine cavity is performed.

Pictorial review

The review presents the most common indication for SIS, like abnormal bleeding in pre- and postmenopausal patients. SIS allows us to distinguish between focal lesions and global endometrial thickening. SIS should be supported as a second-line diagnostic procedure for abnormal uterine bleeding, when findings from transvaginal ultrasound are inconclusive.

Conclusions

The addition of 3D techniques to SIS procedure helps in the distinction between endometrial and myometrial lesions, also it facilitates delineation of uterine anatomy, resulting in more precise and accurate diagnosis.

Imaging findings of congenital anomalies of seminal vesicles

The seminal vesicles are paired organs of the male reproductive tract, which produce and secrete seminal fluid. Although congenital anomalies of seminal vesicles are usually asymptomatic, they may lead to various urogenital symptoms, including infertility. Due to their embryologic relationship with other urogenital organs, congenital anomalies of seminal vesicles may accompany other urinary or genital anomalies. Congenital anomalies of seminal vesicles include agenesis, hypoplasia, duplication, fusion, and cyst. These anomalies can be diagnosed with various imaging techniques. The main purpose of this article is to summarise imaging findings and clinical importance of congenital anomalies of seminal vesicles with images of some rare and previously unreported anomalies.

Management protocol for primary hyperparathyroidism in a single institution: utility of surgeon performed ultrasound

Background

We aimed to: (I) discover preoperative diagnostic studies, intraoperative techniques, and patient factors most predictive of cure within a single hospital system; (II) establish practice guidelines for surgical treatment of primary hyperparathyroidism to maximize outcomes based on this hospital system's performance.

Methods

A retrospective chart review was undertaken of all parathyroid-related procedures from 01/01/02 to 7/31/15 at the Veteran's Administration Hospital.

Results

Seventy-one patients were eligible and charts available for analysis. Preoperative studies most predictive of cure were a combination of sestamibi parathyroid scan and surgeon performed ultrasound (S-US). When studies did not agree, S-US was most often correct. Intraoperative parathyroid hormone (PTH) rapid assay was helpful in predicting cure, but added an average of 33 minutes to operating room time. Patients who had two corroborating preoperative localizing studies, one of which was S-US, that agreed with intraoperative findings, and who did not undergo intraoperative PTH confirmation enjoyed equal cure rates and shorter operating room times. Successful achievement of normal calcium was high at 95.8%. Vitamin D deficiency was prevalent in this patient population, prompting more aggressive preoperative investigation and replacement.

Conclusions

A management protocol was developed based on the findings of this study: (I) obtain two preoperative localization studies, one of which is surgeon-performed ultrasound; (II) obtain preoperative vitamin D levels and supplement as indicated; and (III) in select patients who have two strongly corroborating preoperative localization studies, one of which is surgeon performed ultrasound, and intraoperative findings are consistent with the localizing studies, intraoperative PTH (IOPTH) may not be necessary.