CONTENTS

Cover, Foreword and Content
2023, 7 (3): 0-0.
Abstract ( 104 ) PDF ( 11363KB ) ( 165 ) 　　

Review Articles

Artificial Intelligence-assisted Medical Imaging in Interventional Management of Valvular Heart Disease

Wenwen Chen, BS, Yuji Xie, MD, Zisang Zhang, MD, Ye Zhu, MS, Yiwei Zhang, MD, Shuangshuang Zhu, MD, PhD, Chun Wu, MD, PhD, Ziming Zhang, MD, Xin Yang, PhD, Man wei Liu, MD, PhD, Mingxing Xie, MD, PhD, Li Zhang, MD, PhD

2023, 7 (3): 217-227. DOI:10.37015/AUDT.2023.230030

Abstract ( 153 ) HTML ( 12 ) PDF ( 11902KB ) ( 152 ) 　　

The integration of medical imaging and artificial intelligence (AI) has revolutionized interventional therapy of valvular heart diseases (VHD), owing to rapid development in multimodality imaging and healthcare big data. Medical imaging techniques, such as echocardiography, cardiovascular magnetic resonance (CMR) and computed tomography (CT), play an irreplaceable role in the whole process of pre-, intra- and post-procedural intervention of VHD. Different imaging techniques have unique advantages in different stages of interventional therapy. Therefore, single imaging technique can’t fully meet the requirements of complicated clinical scenarios. More importantly, a single intraoperative image provides only limited vision of the surgical field, which could be a potential source for unsatisfactory prognosis. Besides, the non-negligible inter- and intra-observer variability limits the precise quantification of heart valve structure and function in daily clinical practice. With the help of analysis clustered and regressed by big data and exponential growth in computing power, AI broken grounds in the interventional therapy of VHD, including preoperative planning, intraoperative navigation, and postoperative follow-up. This article reviews the state-of-the-art progress and directions in the application of AI for medical imaging in the interventional therapy of VHD.

Clinical Application of Robot-assisted Teleultrasound

Keyan Li, MD, Faqin Lv, MD, Junlai Li, MD

2023, 7 (3): 228-234. DOI:10.37015/AUDT.2023.230031

Abstract ( 109 ) HTML ( 5 ) PDF ( 12689KB ) ( 109 ) 　　

With the development of network technology and intelligent robot technology, Robot-assisted teleultrasound has played an important role in clinical fields. The application of real-time remote ultrasound technology has made the ultrasonic diagnosis break through the limitation of time and space distance, and solved the problem of shortage of medical resources to a certain extent. This article introduces the development and application basis of robot-assisted teleultrasound, summarizes the clinical application status, and discusses the advantages and limitations of its current application. In addition, we discuss the value in application scenario, interventional therapy and intracavitary ultrasound in the future.

Advances and Applications of Transperineal Ultrasound Imaging in Female Pelvic Floor Dysfunction

Shuangyu Wu, MM , Xinling Zhang, MD

2023, 7 (3): 235-247. DOI:10.37015/AUDT.2023.220044

Abstract ( 151 ) HTML ( 9 ) PDF ( 14562KB ) ( 83 ) 　　

Pelvic floor dysfunction (PFD) is a series of diseases with anatomical and/or functional abnormalities of the pelvic organs, which is common in women and can considerably interfere with their quality of life. Imaging is increasingly being used and can contribute towards better understanding, management, and prediction of long-term outcomes in women who suffer from PFD. Of the available techniques such as X-ray, computed tomography, magnetic resonance imaging, and ultrasound, the latter is generally superior for female pelvic floor imaging, especially in the form of transperineal imaging. This technique is safe, cost-effective, simple, widely available, and can provide an overview of the female pelvic floor. This review will outline the basic methodology, introduce recent researches in the field, and provide an overview of likely future utility of this technique in the evaluation of PFD.

Decreased Cerebral Flow Velocities from General Anesthesia are Not Associated with Cerebral Hyperperfusion Syndrome

Yumei Liu, MD, PhD, Yang Hua, MD, Yabing Wang, MD, PhD, Nan Zhang, MS, Ting Ma, MD, PhD, Yue Zhao, MS, Na Li, MS, Na Lei, MS, Ran Liu, MS

2023, 7 (3): 248-253. DOI:10.37015/AUDT.2023.220032

Abstract ( 106 ) HTML ( 3 ) PDF ( 12767KB ) ( 81 ) 　　

Objective: General anesthesia (GA) can decrease cerebral flow velocities and predispose patients to cerebral hyperperfusion syndrome (CHS) and other perioperative adverse events after carotid endarterectomy (CEA). The aim of this study was to investigate whether decreased pre-operative flow velocity is associated with an increased risk of CHS and perioperative cerebral infarct, and to further identify risk factors if there is any.
Methods: We retrospectively evaluated 920 consecutive patients who received CEA from 2010 to 2020 at a major academic hospital in China. Middle cerebral artery (MCA) blood flow velocities were measured before and after induction of the GA by transcranial Doppler (TCD). Patients were classified into two groups: the NORMAL group if flow velocity decreased<30% and the LOW group if flow velocity decreased ≥30%. The ultrasonographic diagnostic criterion of CHS was defined as the 100% increase in flow velocity by TCD from the baseline to post-CEA. The occurrence of CHS, perioperative cerebral infarction was compared between the two groups.
Results: 399 (43.4%) were classified as LOW measurement, and 521 (56.6%) patients were classified as NORMAL measurement. In the LOW group, there were more patients with diabetes, fewer patients with ipsilateral ICA severe stenosis and the opening of anterior/posterior communicating artery. Although the occurrence of CHS per ultrasonography criteria was higher in the LOW group (21.3% vs 15.7%, P = 0.03), the occurrence of CHS per clinical criteria (3.2%, vs 2.1%, P = 0.28) or the perioperative cerebral infarct between the two groups (5.8% vs 5.0%, P = 0.60) is equivalent.
Conclusion: Patients with decreased flow velocities post-GA were more likely to meet the ultrasonography criteria for CHS, but they are not at risk of developing clinical CHS or perioperative cerebral infarct.

Systematic Approaches and Designs for the Optimal Diagnosis and Treatment of Thyroid Nodules via Fine Needle Aspiration

Jian-Quan Zhang, PhD, Lei Yan, MD

2023, 7 (3): 254-259. DOI:10.37015/AUDT.2023.230033

Abstract ( 114 ) HTML ( 2 ) PDF ( 11727KB ) ( 71 ) 　　

With the increasing utilization of semi-thyroidectomy and rapid advancements in ultrasound-guided thermal ablation therapy for the management of papillary thyroid carcinoma (PTC) and PTC cervical lymph node metastasis, ultrasound-guided fine-needle aspiration biopsy (FNAB) has emerged as the predominant approach for the pre-treatment cytopathologic diagnosis of PTC. Numerous expert consensuses and practice guidelines have delineated the acquisition of sufficient, high-quality cellular specimens for cytological examination. However, new challenges keep emerging in the real-world practice of thyroid FNAB, primarily stemming from the perceptions and expertise of physicians or technicians who perform FNAB. The aim of this study was to delineate the key deficiencies in specimen collection during FNAB, elucidate principles of systematic thinking, and propose preventive measures for these issues, along with a range of innovative concepts and technical approaches. Effectively addressing these concerns will enhance FNAB implementation and facilitate advancements in novel therapeutic modalities, such as thermal ablation, to ameliorate prognosis.

Original Research

Ultrasound-Guided Attenuation Parameter May Replace B-mode Ultrasound in Diagnosing Nonalcoholic Fatty Liver Disease

Bo Jiang, MD, Yiman Du, MD, Xiang Fei, MD, Jianing Zhu, MD, Lianhua Zhu, MD, Qiuyang Li, MD, Yukun Luo, MD, PhD

2023, 7 (3): 260-266. DOI:10.37015/AUDT.2023.220037

Abstract ( 131 ) HTML ( 12 ) PDF ( 11847KB ) ( 75 ) 　　

Objective: To compare the diagnostic sensitivity and consistency of ultrasound-guided attenuation parameter (UGAP) with B-mode ultrasound in nonalcoholic fatty liver disease (NAFLD) patients, and explored their correlation with clinical indicators.
Methods: Patients suspected of NAFLD from July to November 2021 were enrolled in this prospective study. After performing the B-mode ultrasound and UGAP examination, all patients were divided into four groups according to the grade of NAFLD obtained by two modalities, respectively. The diagnostic agreement of the two modalities were evaluated, and the diagnostic sensitivity was compared by the McNemar test. The correlation between clinical indicators and the attenuation coefficient (AC) of UGAP was analyzed by linear regression.
Results: The intraclass correlation coefficient of UGAP was 0.958 (95%CI: 0.943,0.970), while the kappa value of B-mode ultrasound grading was 0.799 (95%CI: 0.686, 0.912). The diagnostic sensitivity of UGAP was higher than that of B-mode ultrasound (99.0% vs. 32%, P < 0.001). BMI and TG can be distinguished in different grades of NAFLD diagnosed by B-mode ultrasound, while BMI, ALT, HDL, and Apo A can be distinguished in different grades of NAFLD diagnosed by UGAP. BMI (r = 0.502, P < 0.001), ALT (r = 0. 396, P < 0.001), TG (r = 0.418, P < 0.001), HDL (r = -0. 359, P < 0.001) and Apo A (r = -0.228, P = 0.020) were linearly correlated with the AC value of UGAP.
Conclusions: Compared with the B-mode ultrasound, UGAP had a higher sensitivity and consistency in diagnosing NAFLD, and correlated well with some laboratory indicators, which may be more valuable in screening and diagnosis of NAFLD.

Localization of Nonpalpable Breast Lumps by Ultrasound Local Coordinates and Skin Inking: A Randomized Controlled Trial

Leila Bayani, MD, Donya Goodarzi, BS, Reza Mardani, MD, Bita Eslami, PhD, Sadaf Alipour, MD

2023, 7 (3): 267-271. DOI:10.37015/AUDT.2023.220033

Abstract ( 124 ) HTML ( 6 ) PDF ( 11705KB ) ( 76 ) 　　

Background and Purpose: Surgery of ultrasound-detected non-palpable breast lesions should be guided by ultrasound. Commonly radiologists localize the lesion under ultrasound preoperatively, which necessitates the availability of a localization device and may involve a substantial cost. We performed a study to prospectively assess the feasibility of ultrasound-guided localization without any special device.
Methods: Women with non-palpable benign breast masses were assigned to the “guide wire insertion” (GWI) or the “local coordinates and skin inking” (LOCSI) groups. In both groups, the tumor was marked as a shadow on the skin by the radiologist under ultrasound. In the GWI group, a guidewire was inserted, and in the LOCSI group, the local coordinates of the lesion relative to the skin and the nipple as well as its clockwise placement were reported.
Results: Overall, 29 cases were included in the study, 11 in the GWI and 18 in the LOCSI groups. In all cases, the specimen was correctly excised. The weights of the resected specimens were significantly higher with GWI; LOCSI prevented excessive tissue extraction. Clinicians reported LOCSI as “very easy” more frequently, and surgery took less time.
Conclusions: Overall, our study showed that LOCSI was feasible and can be a suitable method in areas with limited resources. We propose similar studies with a larger sample size, inclusion of malignant cases for margin assessment, and estimation of the cost-effectiveness of the technique.

Lung Nodule Classification in CT Images Using Improved DenseNet

Xiuping Men, PhD, Vladimir Y. Mariano, PhD, Aihua Duan, PhD, Xiaoyan Shi, PhD

2023, 7 (3): 272-278. DOI:10.37015/AUDT.2022.220018

Abstract ( 145 ) HTML ( 3 ) PDF ( 831KB ) ( 119 ) 　　

Objective: Computed tomography (CT) imaging of the chest is an effective diagnostic tool assisting physicians in making a diagnosis. This study aimed to propose a new convolutional neural network for classifying the lung nodules of the patient through chest CT scan data to determine whether the patient has related disease genes.
Methods: We proposed a DenseNet-based neural network structure that uses multi-scale convolutional kernels to obtain features of different receptive fields, which are fed into a DenseNet containing four improved DenseBlocks, followed by a classification module to obtain the model output, i.e., whether a lung nodule contains a cancer gene. We conducted classification experiments on a CT scan dataset containing 465 training samples and 117 test samples.
Results: The results showed that DenseNet was better than ResNet in terms of classification, whereas ResNet was better than VGG, which was consistent with the findings of previous studies. However, because these models were more complex, they suffered from overfitting problems. Among all of the models used in this paper, our proposed network achieved the best results in terms of accuracy, F1 score, and sensitivity without an over fitting. The accuracy was 72.0%, sensitivity was 78%, and F1 score was 68%.
Conclusion: The proposed DenseNet neural network can improve and assist medical imaging diagnostic physicians in the initial diagnosis of lung nodules.

Comparison of Sonographic Quantitative Assessment of Splenomegaly in Thalassemia Patients Receiving Whole Blood and Packed Red Cell Transfusions

Muhammad Arif Afridi, MS , Raham Bacha, PhD , Nadeem Ullah, BS , Syed Muhammad Yousaf Farooq, PhD , Malik Mairaj Khalid, BS , Imran Khan, BS , Ashfaq Ahmad, Mujahid Sher, PhD

2023, 7 (3): 279-284. DOI:10.37015/AUDT.2023.220039

Abstract ( 132 ) HTML ( 4 ) PDF ( 11762KB ) ( 38 ) 　　

Objective: An observational cross-sectional study to assess sonographic splenomegaly quantitatively in thalassemia patients grouped with respect to transfusion given whole blood vs packed red cells.
Methods: A study was conducted among 330 patients equally divided into two groups, undergoing an abdominal ultrasound examination with a transducer frequency ranging from 3-5 MHz during the period December 2021 to August 2022. An independent t-test was applied to compare the splenic volume in thalassemia patients given whole blood transfusions versus packed red cells transfusions, and Cohen's d was used to indicate the standardized difference between two ultrasound splenic volume means.
Results: The mean splenic volume of the patients who received whole blood cells was 320.62 ± 219.05 cm³, which is greater than the patients who received packed red cells, whose mean was 60.72 ± 58.72 cm³, The splenomegaly was quantitatively assessed in six age groups ranging from 1 to 3 years, 4 to 6 years, 7 to 9 years, 10 to 12 years, 13 to 15 years, and 16-18 years and mean splenic volume in each age group was compared to those receiving whole blood or packed red cells transfusion. there is a statistically significant difference between both transfusion receiving groups, having a larger Cohen’s d size effect of 1.62.
Conclusion: Ultrasound is a reliable imaging modality for assessing splenic volume and linear parameters of the spleen with greater splenomegaly in thalassemia patients with whole blood transfusions than those with packed red cells when quantitatively assessed according to relevant age groups. Thalassemia patients should be transfused packed red cells to delay splenomegaly, that should be assessed sonographically.

Case Reports

Contrast-Enhanced Ultrasound in the Detection and Evaluation of Maxillofacial Arteriovenous Malformation: A Case Report

Chang Liu, MD, Weiwei Shen, MD, Peng Fu, MD, Youchen Xia, MD, Jianxun Ma, MD, Ligang Cui, MD, Shi Tan, MD

2023, 7 (3): 288-292. DOI:10.37015/AUDT.2023.220024

Abstract ( 83 ) HTML ( 4 ) PDF ( 13039KB ) ( 49 ) 　　

Arteriovenous malformation (AVM) is a kind of congenital endothelial malformation that results from errors in vascular morphogenesis. Here we present a case of maxillofacial AVM in a 19-year-old male for its imaging characteristics on contrast-enhanced ultrasound (CEUS). On conventional ultrasound, the lesion was a large subcutaneous mass with abnormal vasculature. On CEUS, it manifested as a “quick wash-in and slow wash-out” enhancement. Moreover, CEUS showed a much larger range of the lesion than gray-scale imaging, with left ophthalmic artery involved. CEUS enabled real-time observation of the microcirculatory perfusion of the lesion and played a very important role in the detection and evaluation of maxillofacial AVM.

Schistosoma Japonicum Infection of the Ureter and Bladder: A Case Report and Literature Review

Rongchen Wang, MM, Li Qiu, MD

2023, 7 (3): 293-295. DOI:10.37015/AUDT.2023.230005

Abstract ( 66 ) HTML ( 8 ) PDF ( 12322KB ) ( 41 ) 　　

Schistosoma japonicum causes intestinal schistosomiasis, which affects mainly the rectum and sigmoid colon but rarely the urinary tract. Here we report a rare case of S. japonicum infection of the bladder and ureter, and describe its clinical features and imaging findings. We also put this case in perspective with the literature on S. japonicum infections in humans.

Spontaneous Remission of Pediatric Undescended Testis Torsion during Color Doppler Ultrasound Examination

Huiyong Hu, MS, Hairong Wang, MS, Yunfeng Xu, MS

2023, 7 (3): 296-298. DOI:10.37015/AUDT.2023.220029

Abstract ( 72 ) HTML ( 4 ) PDF ( 12333KB ) ( 27 ) 　　

Undescended testis or cryptorchidism is the most common reproductive system disease in children. About 3% of full-term and 30% of premature male infants are born with one or both testicles undescended. Most cryptorchidism is asymptomatic and is occasionally found due to inguinal pain caused by testicular torsion. Herein, we presented a case of pediatric patient with abdominal pain as initial symptom who was found the left inguinal cryptorchidism complicated by testicular torsion, and then spontaneous remission during the color Doppler ultrasonography examination.

Solitary Metastatic Carcinoma of Colon from Renal Cell Carcinoma Misdiagnosed as Primary Colon Carcinoma

Yemei He, MM, Danni He, MM, Xuankun Liang, MM, Zuofeng Xu, MD, PhD

2023, 7 (3): 299-301. DOI:10.37015/AUDT.2023.220045

Abstract ( 69 ) HTML ( 3 ) PDF ( 12923KB ) ( 22 ) 　　

The gastrointestinal tract, particularly the colon, represents a rare site of metastatic carcinoma. It is difficult to diagnose because of its nonspecific clinical and imaging features. Herein, we reported the case of a 64-year-old Asian male who presented with a solitary mass on his right colon. We successively performed contrast-enhanced ultrasonography, computed tomography (CT) and colonoscopy. Colonoscopy-guided biopsy revealed inflammatory granulomatous and necrotic tissue. The mass was resected and identified as a metastatic carcinoma of renal cell carcinoma (RCC). The details of the case and review of related articles are presented.

Imaging Features and Misdiagnosis Analysis of Hyaline Vascular Castleman Disease in the Parotid Region: A Case Report

Pengyan Zhang, MS, Ling Ren, MD, Yuguang You, BS, Wenjun Xiao, MS

2023, 7 (3): 302-304. DOI:10.37015/AUDT.2023.220048

Abstract ( 87 ) HTML ( 7 ) PDF ( 12497KB ) ( 53 ) 　　

Castleman disease (CD), first described in 1954, is a rare lymphoproliferative disorder. A 20-year-old female patient was treated for a "painless mass below the right ear for 1 year". The imagological examination of the patient showed a soft tissue mass about 2.8 cm in diameter in the right parotid gland. Moreover, the patient underwent a right superficial parotidectomy and facial nerve dissection. The mass in the parotid gland was removed, and CD was confirmed by further pathological examination. Imagological examination contributes to the diagnosis and preoperative evaluation of CD.