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Point-of-Care Ultrasound: New Concepts and Future Trends
Yaoting Wang, MD, Huihui Chai, MD, Ruizhong Ye, MD, Jingzhi Li, MD, PhD, Ji-Bin Liu, MD, Chen Lin, Chengzhong Peng, MD
Advanced Ultrasound in Diagnosis and Therapy    2021, 5 (3): 268-276.   DOI: 10.37015/AUDT.2021.210023
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Ultrasound (US) technology, with major advances and new developments, has become an essential and first-line imaging modality for clinical diagnosis and interventional treatment. US imaging has evolved from one-dimensional, two-dimensional to three-dimensional display, and from static to real-time imaging, as well as from structural to functional imaging. Based on its portability and advanced digital imaging technique, US was first adopted by emergency medicine in the 1980s and gradually gained popularity among other specialists for clinical diagnosis and interventional treatment. Point-of-Care Ultrasound (POCUS) was then proposed as a new concept and developed for new uses, which greatly extended clinical US applications. Nowadays, artificial intelligence (AI), cloud computing, 5G network, robotics, and remote technologies are starting to be integrated into US equipment. US systems have gradually evolved to an intelligent terminal platform with powerful imaging and communication tools. In addition, specialized US machines tend to be more suitable and important to meet increasing demands and requirements by various clinical specialties and departments. In this article, we review current US technology and POCUS as new concepts and its future trends, as well as related technological developments and clinical applications.

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Micro/Nanobubbles Driven Multimodal Imaging and Theragnostics of Cancer
Xiaoting Zhang, BS, Zhifei Dai, PhD
Advanced Ultrasound in Diagnosis and Therapy    2021, 5 (3): 163-172.   DOI: 10.37015/AUDT.2021.200053
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Ultrasound imaging has attracted great interest of researchers due to their application in cancer diagnosis and treatment. Ultrasound contrast agents, microbubbles and nanobubbles are widely explored as a multifunctional platform, not only carrying other contrast agents for multimodal imaging to complement the disadvantages of each imaging modality, but also carrying drug/gene for cancer theragnostic. In this article, the characteristics and differences of microbubbles and nanobubbles are briefly introduced and reviewed. Besides, the microbubbles and nanobubbles driven multimodal imaging and theragnostic of cancer are summarized.

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Renal Contrast-enhanced Ultrasound: Clinical Applications and Emerging Research
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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Thyroglossal Duct Cyst Papillary Carcinoma: A Case Report and Review of the Literature
Rong Hu, MM, Hui Liang, MD, Bei Wang, MD
Advanced Ultrasound in Diagnosis and Therapy    2021, 5 (2): 102-105.   DOI: 10.37015/AUDT.2021.200050
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Thyroglossal duct cyst is the most common congenital cyst, locating in the midline neck below the hyoid bone. Carcinoma occurring in a thyroglossal duct cyst is rare. Diagnosis generally depends on postoperative pathological diagnosis, because preoperative diagnosis is difficult, but imaging and fine-needle aspiration biopsy (FNAB) can help with the diagnosis. In addition, there is no consensus on the optimal management of thyroglossal duct cyst carcinoma. This paper describes a case of carcinoma in the thyroglossal duct cyst in a 60-year-old man and contains a review of the literature about the presentation, imaging manifestations and treatment.

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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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Sonographic Features of Borderline Phyllodes Tumor of the Breast: A Case Report
Yaqin Sun, MD, Shumin Wang, MD, PhD, Zhanfei Zhe, MD, Xin Qi, MD, Li Li, MD, Qin Liu, MD
Advanced Ultrasound in Diagnosis and Therapy    2021, 5 (3): 262-264.   DOI: 10.37015/AUDT.2021.210006
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Phyllodes tumors of the breast are rare fibroepithelial neoplasm which are generally divided into benign, borderline, or malignant. In this case study, we reported a 40-year-old female presented with an asymptomatic right breast mass underwent sonographic evaluation. The surgical histopathology was diagnosed as borderline phyllodes tumor. Sonographic features of the tumor are described in detail, and the relevant literatures are reviewed and discussed.

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Value of Ultrasound Images and Reports Scoring System in Quality Control
Li Qiu, MD, Yulan Peng, MD, Qiang Lu, MD, Yan Luo, MD
Advanced Ultrasound in Diagnosis and Therapy    2021, 5 (3): 245-248.   DOI: 10.37015/AUDT.2021.210003
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Objective: To assess the value of ultrasound images and reports scoring system for quality control in clinical ultrasound practice.
Methods: Ultrasound images and reports scoring system was established and implemented in the Department of Medical Ultrasound at West China Hospital of Sichuan University in 2014. The scoring system along with formulated corresponding management measures was used for quality control of ultrasound examination and clinical practice assessment. The quantitative scoring results were summarized and analyzed.
Results: Through the quantitative assessment of the quality of the images and reports of ultrasound examinations, the total report score in our department had risen from 4.93 in 2014 to 4.98 in 2018. “Inconsistency between description and conclusion” accounted for 46.47% of all report errors, which was the most common report error. The total image score also increased slightly to ≥ 4.98 during the past three years. The most common image error was “not saving color Doppler images”, which accounted for 84.48% of all image errors. The total score of images was higher than that of text reports.
Conclusion: It is important to establish the ultrasound images and reports scoring system for quality control of ultrasound practice. Using quantitative scores for ultrasound images and reports can improve the quality control of ultrasound examination and strengthen the management of clinical operation.

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Targeted Delivery of Therapeutic Gas by Microbubbles
Lingling Xu, MM, Yihan Chen, MM, Qiaofeng Jin, PhD, Li Zhang, MD, Wenpei Fu, BS, Shan Lin, MM, Ling Lin, BS, Rui Wang, BS, Dandan Chen, MM, Zhengyang Han, MM, Mingxing Xie, MD, Yali Yang, MD
Advanced Ultrasound in Diagnosis and Therapy    2021, 5 (3): 173-182.   DOI: 10.37015/AUDT.2021.200059
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Gas therapy is a new therapeutic method that has been developed in recent years and shows great clinical prospects for the treatment of tumours and cardiovascular, nerve, and immune system diseases. Therapeutic gases, including oxygen, hydrogen, nitric oxide, hydrogen sulfide, xenon, and other bioactive gases are involved in modulating cell signaling pathways and have important physiological functions with substantial therapeutic potential. However, their precise delivery remains a major challenge. Recently, researchers began to use ultrasound to trigger microbubbles that have encapsulated these gases for intravenous administration. This not only enhances the contrast of ultrasound imaging, but also precisely releases gases in the targeted area using ultrasound-targeted microbubble destruction. This article reviews the latest advances in the use of microbubbles to load therapeutic gases for the treatment of diseases.

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Doppler-based Renal Resistive Index for Prediction of Acute Kidney Injury in Critically Ill Patients: A Systematic Review and Meta-analysis
Jianing Zhu, MD, Ying Zhang, MD, Xiaoming Li, MD, Qiuyang Li, MD, PHD, Yukun Luo, MD, PHD
Advanced Ultrasound in Diagnosis and Therapy    2021, 5 (3): 183-196.   DOI: 10.37015/AUDT.2021.210013
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Objectives: To determine the efficacy of Doppler-based renal resistive index (RRI) in the prediction of acute kidney injury (AKI) in critically ill patients.
Methods: A systematic review and meta-analysis of cohort studies was conducted. Relevant studies were identified in PubMed, Embase and Cochrane Library from inception to November 1, 2020, and reference lists of identified primary studies. Prospective studies that examined the diagnostic accuracy of RRI in AKI were included.
Results: Among the 126 articles identified, 18 were included, with a total of 1656 patients. Bivariate analysis yielded pooled sensitivity and specificity of 0.81 (95% CI 0.74-0.86) and 0.75 (95% CI 0.65-0.83), respectively. The summary positive likelihood ratio was 3.2 (95% CI 2.2-4.6), and negative likelihood ratio was 0.26 (95% CI 0.19-0.36).
Conclusion: Elevated RRI may be an early predictor of AKI in critically ill patients. Further large-scale prospective studies are needed to confirm the predictive efficacy and determine the performance and optimal cutoff value of RRI among the included studies.

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Ultrasound Elastography in Liver Tissue: Current Status
Mingzhu Zhang, MD, Zhaoyan Ding, MD, Xiaoyan Niu, MD, Yuxiu Gao, MD, Cheng Zhao, MD
Advanced Ultrasound in Diagnosis and Therapy    2021, 5 (3): 197-203.   DOI: 10.37015/AUDT.2021.210014
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Chronic liver disease is common in China and worldwide, with liver fibrosis as the primary pathological finding. Any chronic liver disease can lead to hepatic fibrosis and gradually develop into cirrhosis. Complications, such as portal hypertension, gastrointestinal bleeding, and liver failure can occur. Some patients even develop hepatocellular carcinoma. Thus, timely diagnosis of hepatic fibrosis is vital for the assessment of etiology, treatment, and prognosis. Conventional ultrasound imaging shows low sensitivity with its subjectivity for preliminary diagnosis of liver fibrosis, creating limitations in qualitative and quantitative evaluation. Ultrasound elastography is a recently developed technique that can help overcome these limitations. The elastic imaging method combines conventional ultrasound to assess liver stiffness along with routine examination. This "one-stop" check for liver disease opens new prospects for clinical and scientific research and improves the accuracy of disease diagnosis for broad clinical application. This article will review the current status of ultrasound elastography for its applications in chronic liver diseases.

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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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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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Characterization of Breast Lesions: Comparison between Three-dimensional Ultrasound and Automated Volume Breast Ultrasound
Wanru Jia, MD, Jingwen, Zhang, MD, Yijie Dong, MD, Ying Zhu, MD, Xiaohong Jia, MD, Weiwei Zhan, MD, Jianqiao Zhou, MD
Advanced Ultrasound in Diagnosis and Therapy    2021, 5 (3): 204-211.   DOI: 10.37015/AUDT.2021.210007
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Objective: This study aimed to compare the diagnostic performance of three-dimensional ultrasound (3D-US) and automated breast volume scanner (ABVS) for the characterization of benign and malignant breast lesions.
Methods: Ninety patients who underwent surgery and preoperative conventional ultrasound (US), 3D-US, and ABVS examinations were enrolled in this study. The image quality and adjacent structures of the lesions in the coronal plane were compared. The combination of US, 3D-US, and ABVS for retraction phenomenon of the lesion was compared and the diagnostic performance of each combination was analyzed.
Results: ABVS displayed better image quality and adjacent structures than 3D-US (P < 0.001). The area under the curve (AUC) was 0.913, 0.842, and 0.871 for US, 3D-US, and ABVS, respectively. The AUC of the retraction phenomenon of the lesion was 0.732 and 0.810 for 3D-US and ABVS, respectively. When they were combined, US+ABVS showed the highest AUC of 0.924. No significant difference of diagnostic performances was found among conventional US, US+3D-US, and US+ABVS(P > 0.05).
Conclusions: Compared with 3D-US, ABVS seems to be superior in showing the retraction phenomenon of breast lesions and in the characterization of breast lesions alone or in combination with conventional US. Although no significant difference was observed between them, both ABVS and 3D-US provided valuable information in the coronal plane and improved our confidence level in breast lesion characterization, especially when combined with the conventional US.

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Expert Consensus on Standardized Practice of Oral Contrast Agent-Enhanced Gastric Ultrasonography (Shanghai, 2020 edition)
Gastrointestinal Ultrasound Task Force, Ultrasound Research and Education Institute, Clinical Research Center of Interventional Medicine, School of Medicine, Tongji University , Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment , National Clinical Research Center of Interventional Medicine , Abdominal Group, Ultrasound Branch, Shanghai Medical Association , Abdominal and Vascular Ultrasound Sub-Committee, Society of Ultrasound Medicine, Shanghai Association of Social Medical Institutions
Advanced Ultrasound in Diagnosis and Therapy    2021, 5 (2): 115-133.   DOI: 10.37015/AUDT.2021.210009
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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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Research Progress in Ultrasonic Regulation of Cholinergic Anti-inflammatory Pathway
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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Hepatic Reactive Lymphoid Hyperplasia and Primary Hepatic Lymphoma: Ultrasound Features and Differentiation Diagnosis
Xiaohui Qiao, MD, Kun Chen, MD, Gang Chen, MD, PhD, Liyun Xue, MD, Guangwen Cheng, MD, Hong Ding, MD, PhD
Advanced Ultrasound in Diagnosis and Therapy    2021, 5 (2): 63-72.   DOI: 10.37015/AUDT.2021.200069
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Objective: To investigate the ultrasound features of hepatic reactive lymphoid hyperplasia (HRLH) and primary hepatic lymphoma (PHL), and determine the value of ultrasound on the diagnosis and differentiation of them.
Methods: The ultrasound findings of 11 HRLH lesions and 14 PHL lesions from April 2011 to September 2020 were retrospectively analyzed. The conventional ultrasound and contrast-enhanced ultrasound (CEUS) manifestations of them were compared.
Results: HRLH showed significant female preference than PHL (100% and 64.3%) (P = 0.046). There were no significant differences of other demographics between HRLH and PHL patients. On conventional ultrasound, the diameter of HRLH (16.5 ± 3.8 mm) was significantly smaller than that of PHL (48.3 ± 36.2 mm) (P = 0.008), and a regular shape was seen more frequently in HRLH (90.9%) than that in PHL (50%) (P = 0.038). There were no significant differences of other indexes between HRLH and PHL. On CEUS, both HRLH and PHL presented arterial enhancement and washout in early portal phase. But rim enhancement at the beginning of washout was seen more frequently in HRLH (90.0%) than that in PHL (33.3%) (P = 0.036), and HRLH usually displayed hyperenhancement (100%) in arterial phase while PHL could be hypoenhancement (16.7%), isoenhancement (33.3%) and hyperenhancement (50%) (P = 0.036).
Conclusion: Ultrasound can supply valuable imaging evidences for the diagnosis of HRLH and PHL. The ultrasound features including size, shape, degree of arterial phase enhancement and rim enhancement at the beginning of washout can be used for the differentiation of HRLH and PHL.

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Functional Brain Imaging Based on the Neurovascular Unit for Evaluating Neural Networks after Stroke
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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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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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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Automated Measurements of Left Ventricular Ejection Fraction and Volumes Using the EchoPAC System
Xiaoxue Chen, MD, Shaoling Yang, PhD, Qianqian He, MD, Yin Wang, PhD, Linyan Fan, MD, Fengling Wang, MD, Kun Zhao, MD, Jing Hu, MD
Advanced Ultrasound in Diagnosis and Therapy    2021, 5 (3): 226-235.   DOI: 10.37015/AUDT.2021.200072
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Objective: To evaluate the clinical value of automated measurements by AutoEF (GE EchoPAC system, version 113) in left ventricular (LV) volumes and ejection fraction (EF) estimation based on the biplane Simpson’s method (manual method) in different clinical subsets.
Methods: A total of 322 subjects participated in this study (the common group). In the common group, 112 patients with coronary heart disease (CHD) were divided into the CHD group, and 34 CHD patients with LV wall motion abnormalities (WMA) comprising the CHD group, renamed the WMA group. LV volumes and EF were assessed using both manual tracing and automated estimation. Time spent on each method was documented. The agreements in echocardiographic measurements by different methods were assessed by intraclass correlation coefficients (ICC) and Bland-Altman analysis.
Results: The average analysis time of the automated method was 12 ± 1 s/patient with excellent repeatability. ICC revealed good consistency between manual and automated EF in all groups, especially in the CHD and WMA groups, although Bland-Altman analysis showed non-negligible bias in EF estimation between the two methods. ICC analysis showed a good correlation between automated and manual EF in all the good and poor image quality subgroups.
Conclusion: Automated method by AutoEF was a time-saving, excellent reproducible, and resistant to image interference approach, with a strong potential in left ventricular function measurements, especially for patients with CHD and/or WMA.

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Contrast-enhanced Ultrasound Assessment of Treatment Response in a Patient with Multifocal Hepatocellular Carcinoma Treated with Transarterial Chemo and Radioembolization
Esika Savsani, Mohamed Tantawi, MD, Corinne E. Wessner, MBA, RDMS, RVT, Philip Lee, MD, Andrej Lyshchik, MD, PhD, Kevin Anton, MD, PhD, Colette M. Shaw, MD, Ji-Bin Liu, MD, John R. Eisenbrey, PhD
Advanced Ultrasound in Diagnosis and Therapy    2021, 5 (3): 254-257.   DOI: 10.37015/AUDT.2021.210018
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Minimally invasive locoregional therapies have become important treatment options for patients with intermediate or late-stage hepatocellular carcinoma (HCC) who are ineligible for surgical resection or liver transplantation. Imaging modalities are essential for procedural guidance and for assessing treatment response thereafter. We report a unique finding of a patient with multifocal HCC treated with transarterial radioembolization (TARE) with yttrium-90 (Y90) and transarterial chemoembolization (TACE). We compared contrast-enhanced ultrasound (CEUS) with contrast-enhanced magnetic resonance imaging (CE-MRI) in the evaluation of treatment response to demonstrate advantages of CEUS imaging technique and its early detection of viable tumor.

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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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Guidelines for Echocardiographic Diagnosis of Cardiomyopathy: Recommendations from Echocardiography Group of Ultrasound Medicine Branch in Chinese Medical Association, Echocardiography Committee of Cardiovascular Branch in Chinese Medical Association
Echocardiography Group of Ultrasound Medicine Branch in Chinese Medical Association, Echocardiography Committee of Cardiovascular Branch in Chinese Medical Association
Advanced Ultrasound in Diagnosis and Therapy    2022, 6 (2): 72-94.   DOI: 10.37015/AUDT.2022.210021
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Diagnostic Values of CEUS, CECT and CEMRI for Renal Cystic Lesions on the Current Bosniak Criterion-A Meta-analysis
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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The Morphology and Hemodynamic Characteristics of Patients with Internal Jugular Vein Stenosis
Lingyun Jia, MD, Yang Hua, MD, Xunming Ji, MD, Kaiyuan Zhang, MD, Shengnan Li, MD, Yu Tang, MD, Yingqi Xing, MD
Advanced Ultrasound in Diagnosis and Therapy    2021, 5 (2): 73-79.   DOI: 10.37015/AUDT.2021.210001
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Objective: This study was to investigate the characteristic morphology and hemodynamics in patients with internal jugular vein (IJV) stenosis by color duplex ultrasonography (CDU).
Methods: From 2017 October to 2019 October, 111 patients with unilateral IJV regional stenosis at the J3 segment (IJV out of the jugular foramen to the anatomic level of the carotid artery bifurcation) and 126 healthy individuals (control group) were enrolled. Using CDU, the diameter, maximum velocity (Vmax), maximum pressure gradient (PGmax), and mean flow volume (FVm) of bilateral IJVs were measured. With MR venous angiography (MRV) and/or CT venous angiography (CTV) as reference, the optimal cut-off values of Vmax and PGmax were determined by ROC analysis.
Results: Among the 111 patients, 39 (35.1%) were associated with intracranial hypertension (ICH). The diameter at the IJV stenosis was significantly smaller than that of the segment distal to the stenosis (2.04 ± 0.36mm vs. 4.49 ± 0.68mm, t = 19.367, P < 0.001). The Vmax and PGmax at the IJV stenosis segment were obviously higher than those at the segment distal to the stenosis (Vmax: 106.8 ± 29.0 cm/s vs. 32.4 ± 13.1 cm/s, t = 29.259; PGmax: 5.10 ± 2.69 mmHg vs. 0.50 ± 0.53 mmHg, all P < 0.001). With MRV/CTV as reference, the ROC curves of Vmax and PGmax at the stenosis site showed high diagnostic efficacy. The optimal cut-off value of Vmax was 75cm/s, with a sensitivity of 87.4% and a specificity of 95.2%. The optimal cut-off value of PGmax was 2.2 mmHg, with a sensitivity of 92.8% and a specificity of 96.0%.
Conclusion: CDU may be a useful method to evaluate IJV regional stenosis.

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Performance of Elastography, Color Doppler and B Mode Ultrasound to Differentiate Fibroadenomas from Phyllodes Tumors
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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Using S-Detect to Improve Breast Ultrasound: The Different Combined Strategies Based on Radiologist Experience
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 Report
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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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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Peripheral Nerve Lipomatosis: Pathology, Clinical Features, Imaging Diagnosis and Treatment
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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Contrast-enhanced Ultrasound for Diagnosing Pancreatic Solitary Fibrous Tumor: A Case Report
Lei Chen, MM, Cong Chen, MM, Qingfu Qian, MM, Zhikui Chen, PhD
Advanced Ultrasound in Diagnosis and Therapy    2021, 5 (3): 265-267.   DOI: 10.37015/AUDT.2021.210004
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Solitary fibrous tumors (SFTs) are rare, especially in the pancreas. Here, we present a case of pancreatic SFT in a 45-year-old woman for its imaging characteristics on contrast-enhanced ultrasound (CEUS). On gray-scale imaging, the lesion was a regular, well-defined, and extremely hypoechoic mass in the body of the pancreas. On CEUS, it manifested as a slightly “slow wash-in and quick wash-out” heterogeneous enhancement. The patient underwent laparoscopic partial pancreatectomy, and the pathological findings confirmed the diagnosis of SFT with malignant potential. CEUS enabled real-time observation of the microcirculatory perfusion of the lesion, which is very useful when a differential diagnosis of pancreatic SFT is suspected.

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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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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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Sonographic Features of Urothelial Carcinoma: A Case Study
Chelsea Robb. BS, RDMS, RVT, Traci Fox, EdD, RT(R), RDMS, RVT
Advanced Ultrasound in Diagnosis and Therapy    2021, 5 (2): 95-97.   DOI: 10.37015/AUDT.2021.200038
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The most common type of bladder cancer is urothelial carcinoma which arises from the inside lining (e.g., urothelium) of the bladder. As the disease progresses, the tumor may invade into the deep layer of the bladder wall, spread to adjacent areas of the bladder, or to other organs of the body. Common clinical symptoms of bladder cancer may present as painless hematuria. High-resolution ultrasound imaging has been used for diagnosis and differential diagnosis of bladder abnormalities. We report a case study using gray-scale and Doppler imaging to evaluate urothelial carcinoma of urinary bladder.

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Feasibility and Efficacy of the Segmental Localization of Lumbar Vertebrae by Ultrasound vs X-ray Examination: A Prospective Comparative Study
Bo Yu, MD, Peng Huang, MD, Yukun Luo, MD, Mingbo Zhang, MD
Advanced Ultrasound in Diagnosis and Therapy    2021, 5 (3): 212-218.   DOI: 10.37015/AUDT.2021.200062
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Objectives: To explore the feasibility and efficacy of the segmental localization of lumbar vertebrae by ultrasound (US) compared with X-ray.
Methods: From February 2019 to May 2019, 43 patients (24 males and 19 females), with an average age of 46±15 years, were prospectively enrolled in this study. Longitudinal paramedian sagittal and transverse process sections were used to determine the lumbar segments by US scan. X-ray examination was used to verify the segmentation. The time for segmentation was recorded, and the learning curve of the average localization time was analyzed.
Results: Of all the enrolled patients, 5 had lumbar segmental and alignment abnormalities, and 38 had normal lumbar vertebrae. US accurately located vertebrae in 38 normal cases and 5 abnormal cases, with a 100% accuracy rate, as verified by X-ray examination. The localization time was significantly less for US than for X-ray examination, both in normal cases and in cases with segmental or alignment abnormalities (all P < 0.001). The learning curve of US-guided segmental localization continuously decreased with an increasing number of operations and entered the plateau stage after the third operation day.
Conclusions: The US-guided segmental localization of lumbar vertebrae is an accurate new method that is efficient and easy to learn and does not require radiation.

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Improving Diagnostic Coincidence Rate of Graves’ Disease by Ultrasound Examination with Clinical Symptoms
Bingyan Liu, MD, Jie Hu, MD, Wei Liao, MD, Donglin Wang, MD, Xiangxiang Jing, MD
Advanced Ultrasound in Diagnosis and Therapy    2021, 5 (2): 87-94.   DOI: 10.37015/AUDT.2021.190014
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Objective: Combining ultrasound parameters with patient’s clinical symptoms to explore the feasibility of improving the diagnostic coincidence rate of hyperthyroidism.
Methods: A total of 179 untreated patients with diffuse echogenic changes of the thyroid on ultrasound and abnormal laboratory examinations were enrolled this study. There were 119 cases of hyperthyroidism, 29 cases of subclinical hyperthyroidism, 26 cases of subclinical hypothyroidism, and 5 cases of Hashimoto’s thyroiditis with clinically confirmed diagnosis. The thyroid volume, blood supply grade, peak velocity of the superior thyroid artery (STA) by ultrasound, heart rate (HR), and clinical symptoms was used to determine the optimal indicators for the diagnosis of hyperthyroidism, and to compare these indicators (study group) with the previous ultrasound criteria reported in the literature (control group).
Results: According to logistic regression analysis, from all the factors studied, hyperthyroidism symptoms had the most significant correlation with the diagnosis of hyperthyroidism (P = 0.001), followed by STA peak velocity (P = 0.005), HR (P = 0.009), echogenicity(P = 0.015)and blood flow Grade III (P = 0.041) in order of importance, the other factors include thyroid volume, blood flow Grade I and II were not correlated with the diagnosis of hyperthyroidism (P > 0.05). The diagnostic coincidence rate of hyperthyroidism by increased STA peak velocity was 85.7% (102/119), while the hyperthyroidism symptoms significantly increased the diagnostic coincidence rate to 95.8% (114/119). Comparing the study group to the control group, the area under the receiver operating curve (ROC) was 0.993 vs 0.899 (Z = 3.868, P = 0.001). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 89.92% vs. 68.91%, 96.67% vs. 96.67%, 92.18% vs. 78.21%, 98.17% vs. 97.62%, and 82.80% vs. 61.05%, respectively.
Conclusions: The optimal indicators for the diagnosis of hyperthyroidism is the presence of hyperthyroidism symptoms in untreated patients with diffuse echogenic changes of the thyroid, followed by increased STA peak velocity. This suggests that ultrasound doctors should carefully considerate clinical information and instead of just limited to ultrasound itself. By combining ultrasound parameters with the clinical manifestations of patients, the diagnostic coincidence rate can be truly improved.

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Incomplete Shone’s Complex with BAV and VSD in Adult Diagnosed by Echocardiography
Yichen Qu, MD, Ya Yang, MD, Jinjie Xie, MD, Rongjuan Li, MD, Han Zhang, MD, Li Song, MD, Yueli Wang, MD, Jing Li, MD
Advanced Ultrasound in Diagnosis and Therapy    2021, 5 (2): 106-108.   DOI: 10.37015/AUDT.2021.200017
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Abstract: The Shone’s complex, defined as a constellation of parachute mitral valve (PMV), supravalvular ring of the left atrium, subaortic stenosis, and aorta coarctation, is a rare entity, which more commonly occurs in its incomplete form. We report the case of a 28-year-old female patient who presented for chest congestion and palpitation with history of congenital mitral valve malformation. Echocardiography revealed the coexistence of PMV, aortic coarctation with bicuspid aortic valve (BAV), and ventricular septum defect (VSD). The patient then received surgical intervention. The diagnosis of Shone’s complex with BAV and VSD made by echocardiography were confirmed later at surgery.

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Ultrasound Features of Thyroid Metastatic Tumors from the Digestive System: A Report of 2 Cases
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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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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