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Prenatal Ultrasound Diagnosis of Klippel-trenaunay Syndrome Associated with the Thickened Thigh and Dilated Inferior Vena Cava: A Case Report and Literature Review
Shiyun Peng, MM, Pan Yang, MM, Jinzhou Wan, MM, Siyu Yue, MB, Ling Wang, MB, Xiyue Zhang, MB, Fan Yang, MD
Advanced Ultrasound in Diagnosis and Therapy    2021, 5 (4): 313-316.   DOI: 10.37015/AUDT.2021.210012
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Klippel-Trenaunay syndrome (KTS) is a rare congenital disorder. In this case study, we reported prenatal ultrasound study on a 33-year-old pregnant woman at the gestation of 26 weeks and 3 days, whose fetus was suspected of KTS associated with enlarged right thigh and dilated inferior vena cava. Additionally, we comprehensively reviewed literatures of prenatal KTS published on Medline to further understanding of the prenatal ultrasonographic manifestations of KTS.

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Renal Contrast-enhanced Ultrasound: Clinical Applications and Emerging Researc
Felipe Velasquez-Botero, MD, Ananya Balasubramanya, Ying Tang, MD, Qiang Lu, MD, Ji-Bin Liu, MD, John R. Eisenbrey, PhD
ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY    2022, 6 (4): 129-146.   DOI: 10.37015/AUDT.2022.220036
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Contrast-enhanced ultrasound (CEUS) is an imaging modality that has achieved considerable relevance in various clinical settings including the assessment of renal disease. CEUS is performed by injecting microbubble-based ultrasound contrast agents (UCAs) that create signals to display the microvasculature, allowing quantitative and qualitative assessment of parenchymal perfusion and real-time visualization of the renal anatomy. In recent years, CEUS has been widely accepted and applied for the assessment of kidney perfusion and the characterization of indeterminate renal masses, primarily due to its diagnostic efficacy, availability, low cost, reproducibility, and absence of nephrotoxicity. CEUS provides a higher spatial and temporal resolution than other cross-sectional imaging, resulting in high sensitivity and specificity for its applications in a variety of renal conditions including cancer monitoring following ablation, detection of transplant complications, hypoperfusion, acute traumatic injury, renal artery stenosis, parenchymal infection, and kidney intervention guidance. Additionally, the continuous investigation and development of new technologies surrounding this imaging technique have shown encouraging preliminary results for the use of CEUS in the evaluation of molecular expression in several disease processes, the dynamic analysis of blood flow kinetics, and the implementation of super-resolution imaging systems. The purpose of this article is to provide an overview of the current and potential clinical applications of renal CEUS.

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Comparison of Diagnostic Efficacy of US, CT, and MRI for Pancreatic Intraductal Papillary Mucinous Neoplasms
Yue Yu, MM, Ling Zhang, MM, Bangwei Zeng, MM, Zhikui Chen, PhD
Advanced Ultrasound in Diagnosis and Therapy    2021, 5 (4): 291-297.   DOI: 10.37015/AUDT.2021.210008
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Objective: Imaging modalities for pancreatic intraductal papillary mucinous neoplasm (IPMN) often provide a large amount of information, and an adequate comparison of their diagnostic efficacies cannot be made by simply referring to the diagnostic accuracy rates. The aim of the study was to apply a novel scoring system to evaluate the pancreatic IPMN diagnostic efficacy of transabdominal ultrasound (TAUS), computed tomography (CT), and magnetic resonance imaging (MRI).

Methods: The clinical and diagnostic imaging data of 42 patients with pancreatic IPMN diagnosed at Fujian Medical University Union Hospital between January 2014 and November 2020 were retrospectively analyzed. We applied our scoring system for the quantitative, location, and qualitative diagnosis of each imaging modality, and the diagnostic efficacy was determined.

Results: The mean rank scores of quantitative diagnosis for MRI, CT, and TAUS were 53, 48.96, and 48.54, respectively (P = 0.267). The mean rank scores of location diagnosis for these three methods were 51.72, 49.58, and 48.97, respectively (P = 0.752). The mean rank scores of qualitative diagnosis for MRI, CT, and TAUS were 59.69, 41.08, and 51.18, respectively; the difference was statistically significant (P = 0.015).

Conclusions: The novel scoring system could comprehensively and accurately evaluate the diagnostic efficacy of TAUS, CT, and MRI for pancreatic IPMN. MRI had the highest quantitative, localization, qualitative, and comprehensive diagnostic efficacy.

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Diagnostic Performance of Superb Microvascular Imaging for Breast Masses: A Systematic Review and Meta-analysis
Zehui Fu, MD, Siqi Wang, MD, Jian Zhang, MD, Yejun Lu, MD, Xiaomin Mo, MD, Ye He, MD, Chong Wang, MD, Hui Chen, MD
ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY    2022, 6 (3): 95-103.   DOI: 10.37015/AUDT.2022.210028
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Objective: In the present study, we aimed to evaluate the diagnostic performance of superb microvascular imaging (SMI) for breast masses through a meta-analysis.

Methods: PubMed, EMBASE, Cochrane Library, and Web of Science Core Collection databases, as well as the most comprehensive Chinese academic databases in medicine, such as China Biology Medicine Disc, China National Knowledge Infrastructure, and Wanfang Database, were systematically searched. All included studies used histopathological results as the reference standard. To assess the diagnostic performance, we calculated the pooled sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR-), diagnostic odds ratio (DOR), and the area under the curve (AUC). In addition, a subgroup meta-regression analysis was performed to investigate the heterogeneity.

Results: Fourteen of 1,075 identified articles were included in the current review. The pooled sensitivity, specificity, LR+, LR-, and DOR for SMI were 0.85 (95% CI: 0.79-0.89), 0.80 (95% CI: 0.71-0.87), 4.3 (95% CI: 2.9-6.2), 0.19 (95% CI 0.14-0.26), and 22 (95% CI: 14-36), respectively. The AUC was 0.90 (0.87 - 0.92). Meta-regression showed that there were heterogeneities for sensitivity, but not for specificity.

Conclusions: SMI had good sensitivity, specificity, and excellent diagnostic value in distinguishing benign breast masses from malignant masses and could potentially help select suspicious breast masses for surgery.

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Clinical Applications of Crystal Vue Technology: A Review
Shijing Song, MD, Qingqing Wu, MD, Jingjing Wang, MD, Jinghua Li, MD, Dan Yan, MD
Advanced Ultrasound in Diagnosis and Therapy    2022, 6 (1): 1-6.   DOI: 10.37015/AUDT.2021.200067
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Three-dimensional (3D) imaging plays an important role in the construction of normal anatomy and abnormal structures. The 3D images can be obtained through computed tomography, magnetic resonance, ultrasonography (US) and other technologies with different values and prospects. 3D-US imaging has unique advantages such as being radiation-free, time-saving and cost-effective. The Crystal Vue is a novel 3D-US rending technology that provides valuable information in several obstetrical and gynaecological studies. This review focuses on the application of Crystal Vue technology in the evaluation of foetal skeleton, maxillofacial region, central nervous system, digestive tract and abnormally invasive placenta, cervical pessary, and ureteral stones.

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Contrast-enhanced Ultrasound for Evaluation of Active Needle Tract Bleeding during Thermal Ablation of Liver Cancer
Huolin Ye, MD, Qiannan Huang, MD, Qingjing Zeng, MD, Xuqi He, MD, Erjiao Xu, MD, Yinglin Long, MD, Kai Li, MD, Rongqin Zheng, MD
ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY    2022, 6 (3): 104-111.   DOI: 10.37015/AUDT.2021.210019
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Objective: To investigate the accuracy of contrast-enhanced ultrasound (CEUS) in the diagnosis and localization of active needle-tract bleeding (ANTB) during thermal ablation for liver cancer.

Methods: Between June 2013 and December 2018, liver cancer patients with poor coagulation function or suspected needle-tract bleeding during ablation were enrolled in the study. Conventional US and CEUS were applied to detect ANTB and the bleeding sites, and sequentially abdominal paracentesis drainage (APD) was used as the gold standard for the diagnosis of ANTB. Thermal ablation guided by conventional US or CEUS was used to stop the bleeding.

Results: Among the 77 enrolled patients, 21 patients (27.3%, 21/77) had ANTB. In total, four (19.0%) and 21 (100%) cases of ANTB were diagnosed by colour Doppler US and CEUS, respectively. The sensitivity, specificity and accuracy of colour Doppler US for diagnosing ANTB were 19.0%, 100% and 77.6%, respectively. The sensitivity, specificity, and accuracy of CEUS for diagnosing ANTB were 100%, 100% and 100%, respectively. The sensitivity of CEUS to diagnose ANTB was significantly higher than that of colour Doppler US (P < 0.001). All cases of ANTB were arterial bleeding and were stopped by thermal ablation under the guidance of colour Doppler US or CEUS.

Conclusion: Compared to colour Doppler US, CEUS could detect ANTB with significantly higher sensitivity and accurately guide needle-tract ablation during thermal ablation of liver cancer.

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Ectopic Pregnancy Implanted in the Diaphragm: A Case Report and Literature Review
Jing Ma, MD, Yuchen Wang, MD, Xiaohui Sun, MD, Aiqing Zhang, MD, Bo Zhao
Advanced Ultrasound in Diagnosis and Therapy    2022, 6 (1): 26-28.   DOI: 10.37015/AUDT.2021.200065
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Abdominal pregnancy is a rare occurrence and the location is hardly seen in the upper abdomen. We described a case of a 34-year-old female presenting with upper abdominal pain and reflex sensitivity in the right shoulder. Ultrasound examination revealed a mass under the diaphragm which was suspected to be a liver abscess. The result of an enhanced CT scan was suggestive of an ectopic pregnancy between the diaphragm and right liver lobe. However, Laparoscopic surgery was performed and the histopathological examination confirmed the diagnosis of diaphragmatic pregnancy. By describing this case, we aim to share the value of patients with consistent upper abdominal pain and elevated serum hCG level, a thorough examination of the upper abdomen and pelvic with US as well as CT or MRI is crucial for timely diagnosis.

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Research Progress in Ultrasonic Regulation of Cholinergic Anti-inflammatory Pathwa
Wuqi Zhou, MD, Yishu Song, MD, Rui Wang, MD, Qiaofeng Jin, MD, Mingxing Xie, PhD, Li Zhang, PhD
ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY    2022, 6 (4): 147-152.   DOI: 10.37015/AUDT.2022.200034
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The cholinergic anti-inflammatory pathway is a neuro-immune regulatory pathway that mediates anti-inflammatory effects based on the vagus nerve, acetylcholine and α7 nicotinic acetylcholine receptors. In recent years, the effect of nerve stimulation by ultrasound has attracted much attention and has been widely studied. Ultrasound can stimulate the vagus nerve or spleen nerve and activate the cholinergic anti-inflammatory pathway, exerting anti-inflammatory and organ protection effects, which is expected to provide a new treatment for many inflammatory diseases. The purpose of this review is to introduce the composition, mechanisms and regulation methods of cholinergic anti-inflammatory pathway, and discuss its therapeutic implications.

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Contrast-enhanced Ultrasound Features of Lymphoepithelioma-Like Cholangiocarcinoma with Multiple Metastases: A Case Report
Guiwu Chen, MS, Wenqin Liu, MS, Zhizhong He, PhD, Xiaomin Liao, MS, Yuhuan Xie, PhD
ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY    2022, 6 (3): 122-124.   DOI: 10.37015/AUDT.2021.210027
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Lymphoepithelioma-like cholangiocarcinoma (LEL-CC) is an intrahepatic cholangiocarcinoma with a prominent lymphoid infiltrate. According to previous reports, most LEL-CCs are a single lesion with a notably better prognosis compared to typical liver cancers. However, most literature reported pathological features and lacked imaging features, especially that of ultrasound. We report on a 74-year-old female with LEL-CC presented with headache and malaise for six months. We performed superficial ultrasonography, abdominal ultrasonography, hepatic contrast-enhanced ultrasound, positron emission tomography-computed tomography, and ultrasound-guided biopsy. We definitively diagnosed LEL-CC with multiple metastases in the liver, skeleton, and lymph nodes.

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Distributed Cloud-based Ultrasound Platform: Innovative Pathway to Develop Ultrasound Imaging System
Jianqiao Zhou, MD
Advanced Ultrasound in Diagnosis and Therapy    2022, 6 (1): 33-37.   DOI: 10.37015/AUDT.2022.220002
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The current medical ultrasound imaging device is mainly divided into console ultrasound device and portable ultrasound device. In this article, a new concept along with an innovative pathway to develop ultrasound imaging devices, namely distributed cloud-based ultrasound system (DCUS), was proposed. In DCUS, the ultrasound probes from multiple terminals are used to complete the transmission and reception as well as analog-to-digital conversion of ultrasonic signals, and upload the original radio frequency (RF) signals or in-phase and quadrature (IQ) signals to the cloud server through ultra-bandwidth high-speed communication technology, while the centralized cloud server platform finishes processing of ultrasonic signals and transmits and distributes ultrasound imaging to each related terminal in real time. Various artificial intelligence (AI) algorithms can also be deployed on the cloud-based platform to achieve AI-powered imaging optimization, protocol standardization, and assisted diagnosis. Thus, by utilizing new cloud-based platform and super-high transmission technology and combining the advantages of console ultrasound and portable ultrasound systems with flexibility, high imaging quality and intelligent features, DCUS could become whole new ultrasound system for medical imaging applications in foreseeable future.

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Etiologies and Adverse Outcomes of Fetuses with Short Femur Length Based on Proportion and Percentile Categorization
Jianan Li, BS, Hong Xu, MD, Mei Shen, BS, Shiyu Li, BS, Longxia Wang, MD, Yanping Lu, MD, Qiuyang Li, MD
Advanced Ultrasound in Diagnosis and Therapy    2022, 6 (1): 7-13.   DOI: 10.37015/AUDT.2021.210015
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Objective: To compare the etiologies and adverse outcomes of pregnancies with short fetal femur length (FL) categorized based on relative proportion and percentile placement.
Methods: Fetuses (n = 254) with short FL measured by ultrasound were classified into four groups: severe and disproportionate short FL (group A); severe and proportionate short FL (group B); mild and disproportionate short FL (group C); mild and proportionate short FL (group D). Etiologies and outcomes of pregnancies were compared between groups.
Results: A larger percentage of skeletal dysplasia occurred in group A (28.57%) than in the other three groups (group B: 1.85%; group C: 4.08%; group D: 0). Groups A and B also had higher rates (group A: 40.82%, group B:33.33%) of fetal growth restriction (FGR) than groups C and D (group C: 4.08%; group D:3.92%). No difference in chromosomal and genetic anomalies was detected among groups (P = 0.307); however, the rate of chromosomal and genetic testing in group A was higher than in group D (P = 0.001). Group A (57.14%) had a significantly lower rate of live birth than the other three groups, and group D (98.04%) had a higher live birth rate than groups B (87.04%) and C (83.67%). Considering only living fetuses, higher rates of preterm birth (P < 0.001), low birth weight (LBW) (P < 0.001), neonatal intensive care unit (NICU) admission or pediatric hospital referral (P = 0.004), Apgar score (1 min/5 min) ≤7 (P < 0.001) and fetal distress or neonatal asphyxia (P = 0.004) were found in group A compared to group D.
Conclusion: Fetuses with severe and disproportionate short FL should be flagged for possible skeletal dysplasia. Fetuses with severe short FL should be watched for FGR prenatally. Invasive prenatal tests are recommended for fetuses with severe and disproportionate FL but not recommended for those with mild and proportionate short FL. Outcomes of fetuses with severe and disproportionate short FL were worse than that of fetuses with mild and proportionate short FL.

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Ultrasound and Color Doppler Flow Imaging of Paratesticular Leiomyoma
Nianyu Xue, MM, Yaya Chen, MD, Guoyao Wang, BS, Shengmin Zhang, BS
ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY    2022, 6 (3): 119-121.   DOI: 10.37015/AUDT.2021.210022
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Objective: In this paper, we retrospectively analyzed the ultrasonographic features of paratesticular leiomyoma to help doctors correctly diagnose the disease before operation and guide surgical treatment.

Methods: From 2013 to 2020, 16 cases of paratesticular leiomyomas confirmed by pathology in our hospital were retrospectively analyzed. The retrospective analysis included the ultrasound and color Doppler flow imaging (CDFI) of paratesticular leiomyoma which were evaluated by two experienced radiologists based on the features of ultrasound images of lesions.

Results: All the 16 paratesticular leiomyoma presented as hypoechoic masses with a clear boundary and round shape. The echotexture of 6 large leiomyomas showed a typical vortex appearance. In the remaining 10 small leiomyomas, thin cord-like hyper-echogenic appearance was found. Color Doppler flow imaging showed that the blood flow signal within a large leiomyoma mass (n = 1) was significantly higher than that of surrounding testis while the blood flow signals of the smaller leiomyomas (n = 5) had significantly less flow signals compared with the testis. The remaining leiomyoma masses (n = 10) had similar flow signals to the testicular blood flow.

Conclusion: Sonography can be used to detect testicular tumors and to differentiate extratesticular from intratesticular masses. The ultrasound features of paratesticular leiomyoma included hypo- and hyperechoic mass, a round or typical vortex shape as well as various vascularity based on the size of the tumors.

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Functional Brain Imaging Based on the Neurovascular Unit for Evaluating Neural Networks after Strok
Yongyue Zhang, MM, Yang Sun, MM, Li Zhang, MM, Rongjin Zhang, MM, Shumin Wang, PhD
ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY    2022, 6 (4): 153-164.   DOI: 10.37015/AUDT.2022.210033
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The exploration of human brain function has always been a research hotspot in the field of neuroscience. The concept of a neurovascular unit suggests that cerebral microcirculation can be used as a reliable signal to reflect neural function. Accordingly, functional imaging techniques based on the neurovascular unit are very promising because of their ability to reveal neurovascular coupling and evaluate the functional rehabilitation of cerebrovascular diseases represented by stroke. In the present review, we first describe the role of the neurovascular unit in the injury and repair processes after stroke. We then briefly introduce the relative characteristics and advantages of representative neurovascular unit-based functional imaging. Finally, we summarized the value of these techniques in the evaluation of neural networks after stroke.

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Ultrasound of Pancreaticoduodenal Pseudoaneurysm without Obvious Cause, A Case Report
Zi’ang Yang, BS, Xia Xu, BS
ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY    2022, 6 (3): 125-127.   DOI: 10.37015/AUDT.2022.210029
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Pancreaticoduodenal pseudoaneurysm, accounting for only 2% of visceral aneurysms, is a rare but fatal clinical entity. It is a common complication associated with chronic pancreatitis. We here present a case of a 63-year-old Chinese man, who was diagnosed with pancreaticoduodenal pseudoaneurysm by ultrasound and CT. His past medical history was unremarkable, and no obvious cause of the disease could be found. The patient was treated successfully with endovascular embolization using microcoils with no clinical complications.

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Using S-Detect to Improve Breast Ultrasound: The Different Combined Strategies Based on Radiologist Experienc
Ying Zhu, MD, Xiaohong Jia, MD, Yijie Dong, MD, Juan Liu, MD, Yilai Chen, MD, Congcong Yuan, MD, Weiwei Zhan, MD, Jianqiao Zhou, MD
ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY    2022, 6 (4): 180-187.   DOI: 10.37015/AUDT.2022.220007
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Objective: To investigate the best combined method of S-Detect, a computer-aided diagnosis (CAD) system, with breast ultrasound (US) according to radiologists’ experience.

Methods: From March 2019 to June 2019, 259 breast masses in 255 women were included in this study. Ultrasonographic images of the target masses were prospectively analyzed by radiologists and CAD. Three combined methods, including method 1 [selective downgrading combination for Breast Imaging Reporting and Data System (BI-RADS) 4a lesions], method 2 (selective upgrading combination for BI-RADS 3 lesions) and method 3 (selective upgrading or downgrading combination for BI-RADS 3 or 4a lesions), were applied to interpret the CAD results. The sensitivity, specificity, the area under the receiver operating characteristic curve (AUC) of experienced or inexperienced radiologists before and after adding CAD results were compared using the histopathological results as a reference standard.

Results: In identifying breast malignancy, the AUC for CAD was similar to that of experienced radiologists (P= 0.410), but higher than that of inexperienced radiologists (P= 0.003). When combining CAD with experienced radiologists based on method 1 and combining CAD results with inexperienced radiologists based on method 3, the AUCs were significantly improved (P= 0.024 and 0.003, respectively) compared to US alone, with significantly increased specificity (P< 0.001 for both) and no significantly decreased sensitivity (P> 0.05 for both).

Conclusion: The combination of CAD system and conventional ultrasound can improve ultrasound diagnostic performance in determining breast malignancy. The method 1 and method 3 combinations are respectively recommended for experienced and inexperienced radiologists when CAD is combined with conventional breast ultrasound.

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Uterine Artery Pseudoaneurysm after Cesarean Section Treated with Superselective Embolization: A Case Repor
Jullie Anne Chiste, Larissa Cavalli de Oliveira, Liziane Lorusso, Anna Luisa Aranha Nunes, João Vitor Bacarin
ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY    2022, 6 (4): 210-213.   DOI: 10.37015/AUDT.2022.210031
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Uterine artery pseudoaneurysm is a rare complication associated with obstetric or gynecological procedures. We described a case report of a primigravid, underwent cesarean section who evolved with massive, intermittent vaginal bleeding requiring multiple blood transfusions. The diagnosis of uterine artery pseudoaneurysm was suspected on transvaginal Doppler ultrasound and confirmed on computed tomography angiography. Due to the patient's stability, age and undefined offspring, superselective uterine artery embolization was chosen for treatment and the procedure successfully performed.

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Diagnostic Values of CEUS, CECT and CEMRI for Renal Cystic Lesions on the Current Bosniak Criterion-A Meta-analysi
Xiaojuan Yang, MD, Huihui Yang, MD, Yu He, MD, PhD
ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY    2022, 6 (4): 165-173.   DOI: 10.37015/AUDT.2022.210037
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Objective: CT-based Bosniak classification system has been routinely used to assess complex renal cystic lesions and also been applied to contrast-enhanced magnetic resonance imaging (CEMRI) and contrast-enhanced ultrasound (CEUS). Besides, the 2019 new version incorporated MRI into the Bosniak system. However, the role of US in the Bosniak system has not been clearly established. The aim of this study was to compare the diagnostic ability of CEUS, CECT and CEMRI for renal cystic lesions based on the current Bosniak classification.

Methods: Related studies were searched in PubMed, EMBASE, and the Cochrane Library databases from January 1, 2010 to December 14, 2020. QUADAS-2 was used to assess the study quality. Meta-analysis was performed by “midas modules” of Stata SE 15.0 software. The bivariate mixed-effect model was used. The pooled sensitivity and specificity of these three modalities were calculated and compared. Meta-regression and subgroup analyses were conducted to reveal the source of heterogeneity.

Results: CEUS showed highest pooled sensitivity and specificity, which were 98% (95% CI: 91%, 100%) and 80% (95% CI: 64%, 90%) respectively. Pooled estimates of CEMRI were slightly lower than those of CECT with the sensitivity 85% (95% CI: 77%, 91%) versus 88% (95% CI: 77%, 94%) and specificity 71% (95% CI: 52%, 85%) versus 79% (95% CI: 70%, 86%), respectively.

Conclusions: Based on the current Bosniak classification, CEUS seemed superior to CECT and CEMRI for the diagnosis of complex renal cystic masses, and could serve as a valuable alternative for CECT and CEMRI.

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Ultrasound Features of Thyroid Metastatic Tumors from the Digestive System: A Report of 2 Case
Chao Zhang, BS, Yingying Li, MD, Mingbo Zhang, MD
ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY    2022, 6 (4): 217-222.   DOI: 10.37015/AUDT.2022.220021
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Thyroid metastatic tumors are a series of rare clinical disease with an incidence of approximately 1.4-3%, of which metastatic tumor from the digestive system is even rarer. Thyroid metastatic tumor from the digestive system is characterized by a rapid growth tumor with high invasiveness and poor prognosis. Ultrasound (US) and contrast-enhanced ultrasound (CEUS) could provide more information for making diagnosis, determining lesion range, and offering biopsy guidance. Ultrasound-guided core needle biopsy (CNB) should be used instead of fine needle aspiration (FNA) to confirm the pathological diagnosis. Here, we report two cases of thyroid metastatic tumor from the digestive system. By describing these cases, we aimed to assess the clinical value of conventional US and CEUS in the diagnosis and treatment of these tumors.

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Emerging Applications of Contrast-enhanced Ultrasound in Trauma
Brenda E. Tester, BS, MS, Ji-Bin Liu, MD, John R. Eisenbrey, PhD, George Koenig, MD
Advanced Ultrasound in Diagnosis and Therapy    2022, 6 (2): 39-47.   DOI: 10.37015/AUDT.2022.220017
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The use of contrast-enhanced ultrasound (CEUS) has expanded over the past decade to include a variety of diagnostic and therapeutic applications. These include urgent clinical situations that require timely diagnosis and subsequent treatment. With the introduction of microbubble ultrasound contrast agents (UCAs), CEUS provides increased sensitivity and specificity over conventional ultrasound. Within the trauma setting, CEUS benefits include point of care imaging and an ability to monitor perfusion in real-time. Additionally, UCAs are non-nephrotoxic, and can be used when contrast enhanced CT is contraindicated. In this review, we discuss recent advancements of CEUS within trauma settings.

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Peripheral Nerve Lipomatosis: Pathology, Clinical Features, Imaging Diagnosis and Treatmen
Ping Xu, MM, Heping Deng, MD, Bo Lu, MD, Yaru Mi, MM
ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY    2022, 6 (4): 174-179.   DOI: 10.37015/AUDT.2022.210039
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This article provides a review of pathology, clinical features, imaging diagnosis and treatment of lipomatosis of nerve (LN), aiming to improve the comprehensive understanding of the disease and achieve early diagnosis and treatment. By searching for the relevant literature, we systematically summarized the pathology, clinical features, imaging diagnosis and treatment of LN in peripheral nerve. Lipomatosis of nerve is a rare benign tumor-like lesion in the peripheral nerve. LN can present primarily as painless neoplasm, macrodactyly, or neurological dysfunction. Magnetic resonance imaging and ultrasonography are commonly used imaging methods before operation, which can characterize and locate the scope of the disease. There are few ultrasonographic studies on LN of peripheral nerve, mostly in the form of case report or small sample analysis. Treatment of lipomatosis of nerve varies with clinical symptoms and lacks consensus. Although LN is benign lesion, it can be invasive, progressive, and recurrent. It is very important to understand the problems of neurological dysfunction caused by LN. More studies are needed to provide more detailed imaging information for clinicians and to achieve the effective treatment.

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Role of Lung Ultrasound in Diagnosing and Differentiating Transient Tachypnea of Newborn and Respiratory Distress Syndrome in Preterm Neonates
Srinivasan S, MD, Neeti Aggarwal, MD, Sushma Makhaik, MD, Anupam Jhobta, MD
ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY    2022, 6 (3): 112-118.   DOI: 10.37015/AUDT.2022.210034
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Objective: Transient tachypnea of newborn (TTN) and respiratory distress syndrome (RDS) are the most common causes of respiratory distress among preterm neonates. The aim of this study was to evaluate the accuracy of lung ultrasonography (LUS) for diagnosing and differentiating TTN and RDS in preterm neonates.

Methods: This was a prospective single center study. From January 2020 to June 2021 a total of 114 preterm neonates who were admitted to neonatal intensive care unit (NICU) with symptoms of respiratory distress within 6 hours of birth were subjected to clinical examination, laboratory testing, chest x-ray (AP and lateral view’s) and LUS. Their clinical course was closely monitored. On the basis of final diagnosis made on day three of admission they were divided into two groups, 37 diagnosed with TTN and 61 with RDS. Patients diagnosed with other conditions including neonatal pneumonia, meconium aspiration syndrome etc. were excluded from analysis. LUS findings in RDS and TTN were analyzed and compared to each other.

Results: Pulmonary edema manifesting as alveolo-interstitial syndrome, double lung point and less commonly as white out lungs in absence of consolidation had a 100% sensitivity and specificity in diagnosing TTN. A combination of three signs of consolidation with air or fluid bronchograms, white out lungs and absent spared areas has a 100% sensitivity and specificity for diagnosing RDS. Double lung point was seen only in infants suffering from TTN while consolidation with air or fluid bronchograms was only seen in cases of RDS.

Conclusion: Lung ultrasound can accurately diagnose and reliably differentiate TTN and RDS in preterm neonates. Hence LUS can become an initial screening tool in NICU.

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Ultrasound-guided Microwave Ablation of Adenolymphoma of Parotid Gland: A Case Report
Xiaohui Ji, MD, Juanjuan Li, MD, Dongxia Gao, MD
Advanced Ultrasound in Diagnosis and Therapy    2022, 6 (1): 22-25.   DOI: 10.37015/AUDT.2021.200046
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Adenolymphoma is the second most common benign parotid tumor after pleomorphic adenoma. Although microwave ablation (MWA) has been proved to be effective for benign breast and thyroid nodules, there are few studies on ablation of adenolymphoma of parotid gland. An 82-year-old male with adenolymphoma of bilateral parotid gland treated with ultrasound-guided MWA. After 12 months of follow-up, the volume of bilateral parotid nodules was significantly reduced without recurrence and obvious complications. In conclusion, ultrasound-guided MWA is a safe and effective method for patients with parotid adenolymphoma who cannot tolerate surgery.

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Performance of Elastography, Color Doppler and B Mode Ultrasound to Differentiate Fibroadenomas from Phyllodes Tumor
Lynda Aoudia, Amal Kouchkar, Salah Eddine Bendib
ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY    2022, 6 (4): 195-203.   DOI: 10.37015/AUDT.2022.220003
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Objective: To evaluate and compare the diagnostic performance of B-mode ultrasound (B-mode US), strain elastography (SE), color Doppler ultrasound (color Doppler US) and the combination of these modalities in differentiation between fibroadenomas and phyllodes tumors.

Methods: This retrospective study included 220 breast lesions, between January 2016 and January 2018. B-mode US, strain elastography, and color Doppler US were realized to evaluate each lesion. The results of three modalities were compared between the B-mode US and the combination of B-mode US, elastography, and color Doppler US: sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating characteristic curve (AUC). The pathological findings were used as the reference standard.

Results: Among 220 breast masses, 189 of the lesions were fibroadenomas, 31 were phyllodes tumors. Addition of strain elastography and color Doppler US to B-mode US increased the specificity from 27.5% (95% confidence interval [CI]: 21.15%, 33.88%) to 95.24% (95% CI: 92.20%, 98.27%; P < 0.001); PPV from 16.46% (95% CI: 10.79%,22.14%) to 60.87% (95% CI: 40.92%, 80.82%; P < 0.001) and AUC from 0.584 (95% CI: 0.481, 0.687) to 0.886 (95% CI: 0.824, 0.948; P < 0.001).

Conclusion: The combination B-mode US, strain elastography and color Doppler US increase the diagnostic performance in distinguishing fibroadenomas from phyllodes tumors.

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Contrast-enhanced Ultrasound of Undifferentiated Embryonal Sarcoma of the Liver in Adult: Two Cases Report and Literature Revie
Yanling Chen, MM, Hantao Wang, MM, Hong Han, PhD, Yi Dong, PhD, Wen-ping Wang, MD
ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY    2022, 6 (4): 204-209.   DOI: 10.37015/AUDT.2022.220014
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Undifferentiated embryonal sarcoma of the liver (UESL) is an aggressive mesenchymal tumor, which presents a low incidence in adults. The low morbidity and atypical clinical manifestations conduce to difficulty in preoperative diagnosis. Imaging manifestations of this tumor is important for its identification. Contrast-enhanced ultrasound (CEUS) was a promising tool to characterize hepatic lesions and proved to have high diagnostic accuracy. The present study reported the CEUS characteristics of UESL in two adult patients, which exhibited peripheral rim hyper-enhancement along with progressively centripetal enhancement and large areas of perfusion defection. Sonographers should be fully aware of this rare disease for better differential diagnosis.

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Graphene Oxide/Polylactic Acid Microbubbles for Efficient Removal of Lead Ions from Aqueous Solutio
Meng Han, MD, Ruirui Kang, MD, Juanjuan Chen, MD
ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY    2022, 6 (4): 188-194.   DOI: 10.37015/AUDT.2022.210030
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Objective: Heavy metal pollution has become one of the environmental contamination problems in today's world. Adsorption materials can effectively remove heavy metal ions from the water. There are some shortcomings for traditional adsorbents, such as difficult separation after adsorption, long separation time, and may cause secondary pollution in the environment without recycling. The aim of this study was to seek new materials with effective ways to absorb heavy metal ions in the water.

Methods: A new kind of adsorption material consisted of polylactic acid (PLA) microbubble and graphene oxide (GO) (i.e., PLA@GO microbubbles) was fabricated which can combine by electrostatic adsorption with the assistance of PAH. The influence of the initial concentration of heavy metal of lead ion, pH value, and absorption time on the adsorption effect of PLA@GO microbubbles was tested in this study.

Results: Graphene oxide modified on PLA microbubble has huge specific surface area and various functional groups, which can adsorb heavy metal ions in water. The resulting PLA@GO microbubble showed a homogeneous spherical structure with a size of 500-1.5 μm, which was suitable for its effective separation from water. The optimal dosage of PLA@GO microbubbles was 10 mg, the pH value of the solution was 5.0, and the adsorption time was 20 minutes which correlates to 75 mg/L of leadions.

Conclusion: The characteristics of the PLA@GO microbubbles showed a strong adsorption capacity, high adsorption efficiency, and a shorter balance time which provided an environment-friendly new material to remove heavy metal ions from water.

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Shear Wave Dispersion Imaging for Measuring Carotid Elasticity and Viscosity
Zhaojun Li, MD, PhD, Cuiqin Shen, MS, Qingqing Chen, MB, Lei Sha, MB, Xianghong Luo, MD, PhD, Lianfang Du, MD, PhD
Advanced Ultrasound in Diagnosis and Therapy    2022, 6 (1): 14-21.   DOI: 10.37015/AUDT.2021.200071
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Objective: To assess the viscoelasticity of the carotid artery using shear wave dispersion Imaging and to determine the relevant factors.
Methods: Ninety volunteers were recruited and divided into elder group and young group. Shear wave dispersion (SWD) imaging was applied to measure carotid viscoelasticity. The other arterial parameters, including arterial pulse wave velocity (PWV), inner diameter (CD), intima-medium thickness (CIMT), peak systolic velocity (PSV), mean flow velocity (MFV), and velocity time integral (VTI) of the common carotid artery (CCA) were also recorded by using ultrasound measurement.
Results: Measurements showed the SWD were lower, while CD, CIMT and PWV were higher in the elder group than those of young group. However, SWD was negatively correlated with VTI, and PSV respectively (r = -0.492 and -0.533, all P < 0.05). SWD was also positively correlated with MFV (r = 0.354, P < 0.05). In elder group, SWD was negatively correlated with PSV and PWV, respectively (r = -0.372 and -0.422, all P < 0.05) while in young group, SWD positively correlated with CD, CIMT and MFV (r = 0.531, 0.462 and 0.479 respectively, and all P < 0.05).
Conclusion: SWD imaging shown relationship with ultrasound parameters of carotid artery and has a potential for assessment of arterial viscoelasticity.

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Appendicular Mucocele: A Rare Diagnosis Made by Use of Ultrasound and Its Histopathological Correlatio
Sachin Khanduri, Surbhi , Ashkrit Gupta, Harleen Chawla, Asif Khan, Vaibhav Pathak, Saim Ali Siddiqui, Shahnawaz , Shreya Chitravanshi, Rohit
ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY    2022, 6 (4): 214-216.   DOI: 10.37015/AUDT.2022.220019
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Appendiceal mucocele is a rare disease. Sometimes it is discovered accidentally and sometimes it resembles acute appendicitis. The incidence is 0.2% to 0.7% of all appendectomies specimens. A case report of A 35-year female presented to the emergency room with a history of progressively increasing abdominal pain on and off for 3 months. Tenderness in the right lower quadrant of the abdomen was noted with a palpable mass in the right iliac fossa. An abdominal ultrasound examination was performed, and the patient was found to have an Appendicular mucocele-onion peel sign (sonographic layering within a cystic mass). The patient underwent surgery, and the diagnosis was confirmed by the histopathological report. If mucocele is treated incorrectly, pseudomyxoma peritonei which is characterized by a malignant process may develop. The term mucocele is widely used in diagnosing both benign and malignant lesions.

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The Annual National Congress of the Chinese Society of Ultrasound in Medicine (CSUM) is one of the most prestigious and influential academic conferences in China, with the largest number of participants. The 22th Annual Meeting of Chinese Society of Ultrasound in Medicine (CSUM 2022) will be held from November 3 to November 6 in Chengdu, Sichuan, China. The scientific program of the meeting received 4,625 proceeding papers which covers the latest developments and trends in basic and clinical ultrasound research, continuing education and promotion of ultrasound-related guidelines and consensus, clinical application of new technologies such as interventional ultrasound, elastography, real-time three-dimensional ultrasound, and contrast-enhanced ultrasound.

The conference will hold a Young English-Presentation Forum to provide a stage for early career doctors to display academic achievement and cultivate the international vision of young physicians. A total of 271 papers were submitted for this forum, including 20 on Ob/Gyn ultrasound, 75 on abdominal ultrasound, 55 on interventional ultrasound, 45 on superficial organs and vascular ultrasound, and 76 on echocardiography. Under the recommendation of the Academic Committee of the General Assembly, the journal of AUDT selected 25 abstracts from the oral presentation group to be published online and in print. Following publication in AUDT, these abstracts can be cited as scientific publications and shared with the international community.

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Automated Cardiac Measurement
Isabella Braun, Matthias Friedrichs, Sean Lucas, Hendrik Wiebel
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Evaluation of Features of Adrenal Adenomas and Nonadenomas Using Dynamic Contrast-Enhanced CT Biomarkers
Xifu Wang, MD, Xizhong Dong, BS, Tingting Huang, MS, Jie Meng, BS, Yuanxun Kuang, MS, Jiwen Kang, BS, Renju Bai, MD, Zhaojun Li, MD
Advanced Ultrasound in Diagnosis and Therapy    2021, 5 (4): 304-312.   DOI: 10.37015/AUDT.2021.210020
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Objective: To investigate the correlation between the DCE-CT imaging biomarkers and histological biomarkers of tumor angiogenesis in adrenal adenomas and non-adenomas for the enhancement mechanism of DCE-CT.

Methods: Forty-two patients with 45 adrenal masses including 27 adenomas and 18 non-adenomas diagnosed pathologically were enrolled in this study. The features of DCE-CT (imaging biomarkers) and tumor angiogenesis (histological biomarkers) in adrenal masses were evaluated, and their correlations were explored.

Results: The enhanced features of DCE-CT in adrenal masses were classified: rapid washout group and slow washout group. Type A and C of time density (TD) curves, relative washout rate (Washr) ≥34%, and absolute washout rate (Washa) ≥43% belonged to the rapid group. In contrast, type B, D and E, Washr <34%, and Washa <43% belonged to the slow group. There was significant difference between the biomarkers of DCE-CT in adrenal masses. The rapid group was mainly found in adenomas, whereas the slow was mainly present in nonadenomas. The tumor angiogenesis, histological biomarkers, including microvessel density (MVD), vascular endothelial growth factor (VEGF), and microvascular ultrastructures demonstrated significant difference between the rapid and the slow washout group revealed by DCE-CT. The MVD and VEGF expression in rapid group were remarkably higher than those in slow group. Meanwhile, the tumor angiogenesis was also significantly different between adenomas and nonadenomas. The MVD and VEGF expression were also significantly higher in adenomas than those in nonadenomas. Furthermore, different microvascular ultrastructures were identified between adenomas and nonadenomas, which were in accordance with those between the rapid and the slow group. Microvascular ultrastructures in adrenal adenomas and/or the rapid group showed regular lumens and nonstenosis; more pinocytotic vesicles and fenestrations of endothelium; widening of the intercellular space; uniform thinning and better integrity of basal membrane; regular and uniform thinning, along with less stroma of extra vessel space. In comparison, opposite microvascular ultrastructures, in adrenal nonadenomas and/or the slow group.

Conclusion: The close correlation of DCE-CT imaging biomarkers and histological biomarkers of tumor angiogenesis was found between adrenal adenomas and nonadenomas. Tumor angiogenesis in adrenal adenomas and nonadenomas were shown the different enhancement characteristics at DCE-CT.

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Diagnosis And Management of Carotid Atherosclerosis with 3D Duplex Ultrasonograph
Muhammad Hasan, MBBCh , RPVI , RVT , RDCS , RDMS
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Intel® oneAPI Base Toolkit Helps SonoScape Optimize the Performance of Its S-Fetus 4.0 Obstetric Screening Assistan
Intel; Naizhang Feng, Guoyi Zhou
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Application Value of Two-Dimensional Ultrasound Combined with Contrast-Enhanced Ultrasound for the Diagnosis of Multiple Bile Duct Hamartomas: A Case Report
Tong Zhang, MD, Xiaolin Yin, Shuang Zheng, MD, Mingwei Sui, MD, Dezhi Zhang, MD
Advanced Ultrasound in Diagnosis and Therapy    2021, 5 (4): 317-320.   DOI: 10.37015/AUDT.2021.200064
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Bile duct hamartomas (BDHs), also known as von Meyenburg complexes, are small neoplasms of the liver, of which the pathology is a benign bile duct malformation. We report a case of multiple BDHs of a 55-year-old male diagnosed using two-dimensional (2-D) ultrasound combined with contrast-enhanced ultrasound (CEUS) and further clinically diagnosed using magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography (MRCP). The 2-D ultrasound showed diffusely distributed hyperechoic nodules and cystic masses in the liver, accompanied by small strong echoes with a comet tail sign. The CEUS showed that the hyperechoic nodules observed no abnormal enhancement in the arterial phase and equal enhancement with the surrounding liver tissue in the portal vein and delayed phase. We conclude that the appearance of BDHs on ultrasound has distinct characteristics and can be used as the preferred method for diagnosis. The CEUS can differentially diagnose the disease and improve diagnostic accuracy. Therefore, 2-D ultrasound, combined with CEUS, is a helpful method for diagnosing BDHs.

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Absence of the Horizontal Portion of the Left Portal Vein Diagnosed by Ultrasound and Computed Tomography
Yanling Cheng, MM, Xi Liu, MD, PhD, Wenxiao Zhu, BM, Chuang Gao, BM, Hao Sun, BM, Hongtao Li, BM
Advanced Ultrasound in Diagnosis and Therapy    2021, 5 (4): 321-324.   DOI: 10.37015/AUDT.2021.210002
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The absence of the horizontal portion of the left portal vein is rare, and it is often not diagnosed by ultrasound. This article reports a case where ultrasound identified a structural anomaly between the gallbladder and the round ligament of the liver, and then computed tomography confirmed the absence of the horizontal portion of the left portal vein. We proposed the possible etiologies from an embryonic development perspective, and described the questions to be further investigated after a literature review.

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Follicular Thyroid Neoplasmon Conventional and Contrast-enhanced Ultrasound
Xuehong Diao, MD, Lin Chen, MD, Bo Yu, MS, Jiamei Jin, MS, Jia Zhan, MD, Yue Chen, BS
Advanced Ultrasound in Diagnosis and Therapy    2022, 6 (2): 48-57.   DOI: 10.37015/AUDT.2022.210026
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Objective: The aim of this study was to identify features of follicular thyroid neoplasm by conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS) based on morphological and pathological correlations and make diagnostic strategy for predicting malignancy.

Methods: Conventional US and CEUS were performed in 21 follicular thyroid cancers (FTCs) and 35 follicular adenomas (FAs) that were pathologically approved. Sonographic features were retrospectively reviewed, and diagnostic performance were analyzed using pathology as reference standard.

Results: The most useful character in diagnosis of FTC by conventional US was round shape (OR=6.6), followed by absent of halo sign (Odds ratio, OR = 4.79) and calcification (OR = 3.875). Among all CEUS morphological and blow flow findings, incomplete rim enhancement pattern (OR = 19.2) and the presence of perfusion defects (OR = 5.454) were the most effective features to discriminate between FTC and FA. Based on the five discriminatory parameters, a diagnostic criterion was established to assess the risk of FTC. The sensitivity, specificity, positive predictive values (PPV), negative predictive values (NPV) and accuracy for predicting malignancy were 81.0 %, 80 %, 70.8 %, 87.5 % and 80.4%, respectively.

Conclusions: CEUS provided additional sonographic features which is helpful for predicting potentially malignancy of follicular thyroid neoplasm.

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Quantitative Evaluation of Cirrhosis by Geometrical Characteristics of Hepatic Capsule Based on High-frequency Ultrasound Imaging: an Experimental Study
Jialin Song, MS, Xiang Liu, MD, Jianquan Zhang, MD, Jiaqi Zhao, MD, Lulu Zhao, MS
Advanced Ultrasound in Diagnosis and Therapy    2021, 5 (4): 298-303.   DOI: 10.37015/AUDT.2021.200073
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Objective: To explore the feasibility of quantitative evaluation of cirrhosis by geometrical characteristics of hepatic capsule based on high-frequency ultrasound imaging.

Methods: Rabbits with models of cirrhosis were established and then were divided into four groups: control, 6-week, 12-week and 18-week groups. Two-dimensional high-frequency ultrasound images of hepatic capsule of all rabbits were collected to obtain hepatic capsual contours and key points refltected shapes of these contours (shape control points) which were approximated by the principle of vertical gradient maximization under the manual supervision. Subsequently, the number of continuous segments of the contour line, the mean value and variance of angles between adjacent seed points were extracted to evaluate the continuity and smoothness of the contour line of the hepatic capsule.

Results: With aggravating cirrhosis, the number of segments required to make the sum of lengths of continuous segments reach up to 80% of the total width of the imaging section was gradually increased. The differences between the control group and 18-week group (P = 0.025) as well as between 6-week group and 18-week group (P = 0.004) were statistically significant. Similarly, the mean value and variance of the angles were also gradually increased, and the differences between the control group and the 6-week (P = 0.015, P = 0.036), 12-week (P < 0.001, P = 0.002) and 18-week groups (P = 0.023, P < 0.001) were statistically significant. In addition, the difference in variance of angles between the 6-week group and 18-week group (P = 0.030) was statistically significant.

Conclusion: Sonographic analysis of geometrical characteristics of the hepatic capsule could be used to partially indicate the presence of early-stage cirrhosis, which could provide a quantitative method for non-invasive assessment of cirrhosis.

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Advanced Ultrasound in Diagnosis and Therapy    2022, 6 (3): 0-0.  
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Cloud-based Ultrasound System: Feasibility and Potential
Ji-Bin Liu, MD, FAIUM, Editor-in-Chief, AUDT
Advanced Ultrasound in Diagnosis and Therapy    2022, 6 (1): 38-38.   DOI: 10.37015/AUDT.2022.220004
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Neurofibromatosis with Intrahepatic, Retroperitoneal and Pelvic Involvement: A Case Report and Literature Review
Danqing Huang, MS, Min Tang, MS, Aimei Li, MD, Decai Yu, MD, Jun Chen, MD, Min Wu, MS, Wenping Wang, MD, Wentao Kong, MD
Advanced Ultrasound in Diagnosis and Therapy    2022, 6 (1): 29-32.   DOI: 10.37015/AUDT.2021.200066
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Neurofibromatosis type 1 (NF1) is a benign peripheral nerve sheath tumor, which can primarily cause neurocutaneous manifestations. We herein present a rare case of periportal neurofibromatosis with intrahepatic, retroperitoneal and pelvic involvement. The patient underwent abdominal ultrasound (US), magnetic resonance imaging, and a positron emission tomography-computed tomography. Despite these various imaging features, a diagnosis of lymphomas could not be entirely excluded. The patient therefore underwent US-guided biopsy, and a diagnosis of intrahepatic neurofibromatosis was made. Through retrospective analysis of this case along with literature review, we concluded that distributing along the Glisson’s sheath may be a characteristic in the diagnosis of NF that involves liver.

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