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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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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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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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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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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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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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Contrast-enhanced Ultrasound of Undifferentiated Embryonal Sarcoma of the Liver in Adult: Two Cases Report and Literature Review
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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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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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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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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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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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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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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Contrast-enhanced Ultrasound Improves Technical Sufficiency of Fine-needle Aspiration in Suspicious Thyroid Nodules
Ying Fu, MD, Shi Tan, MD, LiGang Cui, MD, Fang Mei, MD
Advanced Ultrasound in Diagnosis and Therapy    2021, 5 (3): 219-225.   DOI: 10.37015/AUDT.2021.200063
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Objectives: To evaluate contrast-enhanced ultrasound (CEUS) for guiding fine-needle aspiration (FNA) of suspicious thyroid nodules to obtain sufficient biopsy specimens.
Methods: A total of 236 uncertain thyroid nodules detected in 228 patients from October 2016 to March 2017 were retrospectively reviewed and analyzed in this study. Overall, 117 patients underwent CEUS-guided FNA, and 111 patients underwent ultrasound (US)-guided FNA. The target for aspiration was only at the enhanced area in the CEUS group. In the US-guided group, aspiration was conducted within the nodule at various angles and areas. The final cytopathologic findings were reported using the Bethesda criteria. The inadequacy, indeterminacy, malignancy, and benignity rates of FNA specimens were compared between two groups.
Results: There were no significant differences in age, sex, or nodule size between the two groups. The inadequacy rate in the CEUS group was significantly lower than that in the US group (P = 0.008). Twenty-two benign nodules were diagnosed using CEUS-guided FNA, whereas seven were diagnosed using US-guided FNA (P = 0.006). The indeterminacy and malignancy rates were similar for both groups.
Conclusions: CEUS-guided FNA improves the diagnostic success rate and reduces uncertainty by facilitating accurate biopsy of suspected thyroid nodules with microcirculation perfusion imaging.

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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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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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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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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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State-of-the-Art and Development Trend of Interventional Ultrasound in China
Yang Qi, MD, Dengsheng Sun, MD, Linyao Wang, MD, Jie Yu, MD, Ping Liang, MD
Advanced Ultrasound in Diagnosis and Therapy    2023, 7 (4): 313-320.   DOI: 10.37015/AUDT.2023.230049
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Interventional ultrasound (IUS) is an important branch of modern minimally invasive medicine that has been widely applied in clinical practice due to its unique techniques and advantages. As a relatively emerging field, IUS has progressed towards standardization, precision, intelligence, and cutting-edge directions alone with more than 40 years of development, which is becoming increasingly important techniques in clinical medicine. This article will briefly review the development and advancement of IUS for diagnosis and treatment in China in the era of precision medicine from the aspects of artificial intelligence, virtual navigation, molecular imaging, and nanotechnology.

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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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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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Diagnosis of Anomalous Origin of Left Main Coronary Artery from Right Sinus of the Valsalva Based on the “Seagull Sign” in Echocardiography: A Case Study
Yun Zheng, MM, Shiwen Fu, MM, Wei Miao, MM, Shanshan Qu, MM, Junhua Wang, MM, Liping Guo, MM, Xihe Sun, MM
Advanced Ultrasound in Diagnosis and Therapy    2022, 6 (2): 68-71.   DOI: 10.37015/AUDT.2022.210032
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The anomalous origin of the left main coronary artery from the right sinus of the Valsalva (ALCA) is rare, and varies significantly in congenital heart disease. Patients are usually asymptomatic, and in most cases, coronary abnormalities are discovered by chance at autopsy after coronary angiography or sudden cardiac death. As a routine physical examination procedure, echocardiography is particularly important for the rapid and sensitive diagnosis of ALCA. We report a case of ALCA using echocardiography. “Seagull sign” is a direct ALCA sign manifesting on the short axis section of the artery with two vessels coming from the right coronary sinus. Based on this case, we propose this specific ultrasound sign as a way to improve the diagnostic rate.

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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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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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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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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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Intel® oneAPI Base Toolkit Helps SonoScape Optimize the Performance of Its S-Fetus 4.0 Obstetric Screening Assistant
Intel; Naizhang Feng, Guoyi Zhou
Advanced Ultrasound in Diagnosis and Therapy    2022, 6 (4): 238-244.  
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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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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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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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Graphene Oxide/Polylactic Acid Microbubbles for Efficient Removal of Lead Ions from Aqueous Solution
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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Appendicular Mucocele: A Rare Diagnosis Made by Use of Ultrasound and Its Histopathological Correlation
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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Application and Progress of Ultrasound Technology in Atherosclerosis
Qiaoer Gong, BS, Nianyu Xue, MS
Advanced Ultrasound in Diagnosis and Therapy    2023, 7 (1): 8-15.   DOI: 10.37015/AUDT.2023.220030
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Atherosclerosis (AS) is the main pathophysiological process behind CVD. Cardiovascular diseases caused by AS (such as stroke, coronary heart disease, etc.) are characterized by a high prevalence, high disability rate and high mortality, which greatly increase the burden on families and society. Thus, it is important to find AS as early as possible. When atherosclerosis occurs, the earliest sign of its structural and functional changes is arterial stiffness, and endothelial dysfunction is the key link. Arteriosclerosis is caused by the imbalance between collagen and elastin in the arteries. Elastin fibers gradually decrease, and stiffer collagen fibers increase, making the vessels less elastic. Endothelial dysfunction also affects the regulatory function of arterial vascular tension, and accelerates the remodeling of the vascular wall, to make blood vessels more rigid. Quantitative measurement of arterial stiffness and carotid intima-media thickness (CIMT) is an important tool for early detection of vascular lesions. At present, ultrasound technology including echo tracking (ET), wave intensity (WI), real-time shear wave elastography (SWE), ultrafast pulse wave velocity (ufPWV), shear wave dispersion (SWD), cardio-ankle vascular index (CAVI), arterial velocity pulse index and arterial pressure volume index (AVI and API) has the advantages of being noninvasive, real-time, economical and reproducible in the assessment of atherosclerosis, and is widely used in the early diagnosis of AS. Most importantly, the change in arterial hardness detected by traditional ultrasound technology precedes the change in intima-media thickness, suggesting that ultrasonic elasticity monitoring may be a more sensitive method of predicting AS and can find and prevent cardiovascular diseases earlier.

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Diagnosis And Management of Carotid Atherosclerosis with 3D Duplex Ultrasonography
Muhammad Hasan, MBBCh , RPVI , RVT , RDCS , RDMS
Advanced Ultrasound in Diagnosis and Therapy    2022, 6 (4): 245-246.  
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The Effects of Liver Function Damage after Thermal Ablation on the Prognosis of HCC Patients and Its Prediction
Yan Zhou, Jianmin Ding, Fengmei Wang, Zhengyi Qin, Yandong Wang, Hongyu Zhou, Xiang Jing
Advanced Ultrasound in Diagnosis and Therapy    2021, 5 (2): 80-86.   DOI: 10.37015/AUDT.2021.210017
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Objective: To investigate the influence of liver function damage in patients with hepatocellular carcinoma (HCC) after microwave ablation (MWA) on the prognosis and to establish an algorithm to predict liver function damage.
Methods: This is a retrospective study. A total of 745 patients were enrolled and classified into the modeling group and the validation group. The risk factors of liver function damage were analyzed by using logistic regression model. The β coefficients derived from a logistic analysis were used to calculate the risk score. Diagnostic accuracy based on risk score was assessed by the area under the curve (AUC).
Results: 69 patients in the modeling group suffered from liver function damage. The 1-,3-,5- and 7-year progression free survival were 69.4%, 37.2%, 22.6% and 12.4% for patients without liver function damage and 69.5%, 33.0%, 14.4% and 0% for patients with liver function damage, respectively (P = 0.537). The 1-, 3-, 5- and 7-year overall survival were 94.3%, 75.9%, 61.5% and 54.5% for patients without liver function damage and 81.3%, 57.1%, 42.7% and 42.7% for those with liver function damage (P = 0.004), respectively. The AUC of the risk score for predicting liver function damage was 0.798 for the modeling group and 0.832 for the validation group. The sensitivity and specificity of the risk score to identify liver function damage was 65.2%, 84.4% in the modeling group and 60.6%, 88.3% in the validation group, respectively.
Conclusion: Liver function damage after MWA is unfavorable the long-term prognosis. The prediction algorithm based on five risk factors is robust and can be used to predict possible liver function damage.

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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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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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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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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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