Advanced Ultrasound in Diagnosis and Therapy

Vol. 4, No. 3 Published: 30 September 2020

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Cover, Foreword and Content

2020, 4 (3): 0-0.

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Review Article

Recent Advances in Microbubble-Augmented Cancer Therapy

Mohamed Tantawi, MD, Ji-Bin Liu, MD, John R Eisenbrey, PhD

2020, 4 (3): 155-168. DOI:10.37015/AUDT.2020.200055

Abstract ( 815 ) HTML ( 73 ) PDF ( 774KB ) ( 943 ) 　　

Contrast-enhanced ultrasound (CEUS) applications in cancer management have expanded over the past two decades. Through detection of vascularization and perfusion changes, CEUS provides a potentially reliable means of early prediction of response to different cancer therapies including systemic chemotherapy and locoregional therapies. Ultrasound-induced cavitation of contrast agents has a range of effects on the surrounding microenvironment. These effects can be manipulated to sensitize the tumors to radio- and chemotherapy, as well as achieve targeted delivery through drug-loaded contrast agents. Newer forms of drug carriers are being developed with improved drug-carrying capacity and tissue penetration. This review aims at providing a synopsis of the latest developments in CEUS’ use in oncologic therapy. While the majority of work described in this review is still in the pre-clinical phases, results have been encouraging and show potential translational benefit for cancer patients in the near future.

Research Advances in Ultrasound Imaging for Tumor in Situ

Ping Wang, MD, Lihong Sun, PhD, Suhui Sun, MD, Menghong Xu, MD, Lulu Zhang, MD, Jinxia Zhang, MD, Liquan Gao, PhD, Qingfeng Chen, PhD, Xiaolong Liang, PhD

2020, 4 (3): 169-175. DOI:10.37015/AUDT.2020.190040

Abstract ( 459 ) HTML ( 17 ) PDF ( 837KB ) ( 699 ) 　　

Known for being highly sensitive and noninvasive, ultrasound imaging using microbubble contrast agents is widely used in the clinic. To use ultrasound to image tissue beyond the vasculature, researchers have developed strategies that include nanobubbles, ultrasound contrast agents generated in situ, and gene expression of ultrasound contrast agents in situ. All of these strategies offer the capability of targeting tumor cells, intratumoral imaging tumor cells and require just a small incision or no incision. In this review, we will first describe the application of nanobubbles acting as ultrasound contrast agents. Then, we will briefly introduce the stimuli-responsive formulations to generate ultrasound contrast agents in situ. Finally, we will provide an overview of the use of state-of-the-art of gene expression of ultrasound contrast agents in situ to monitor cellular location and function inside living organisms.

Original Research

Automated Machine Learning in the Sonographic Diagnosis of Non-alcoholic Fatty Liver Disease

Sriharsha Gummadi, MD, Nirmal Patel, Haresh Naringrekar, MD, Laurence Needleman, MD, Andrej Lyshchik, MD PhD, Patrick O’Kane, MD, Jesse Civan, MD, John R Eisenbrey, PhD

2020, 4 (3): 176-182. DOI:10.37015/AUDT.2020.200008

Abstract ( 719 ) HTML ( 21 ) PDF ( 366KB ) ( 985 ) 　　

Objective: This study evaluated the performance of automated machine-learning to diagnose non-alcoholic fatty liver disease (NAFLD) by ultrasound and compared these findings to radiologist performance.
Methods: 96 patients with histologic (33) or proton density fat fraction MRI (63) diagnosis of NAFLD and 100 patients without evidence of NAFLD were retrospectively identified. The “Fatty Liver” label included 96 patients with 405 images and the “Not Fatty Liver” label included 100 patients with 500 images. These 905 images made up a “Comprehensive Image” group. A “Radiology Selected Image” group was then created by selecting only images considered diagnostic by a blinded radiologist, resulting in 649 images. Cloud AutoML Visionbeta (Google LLC, Mountain View, CA) was used for machine learning. The models were evaluated against three blinded radiologists.
Results: The “Comprehensive Image” group model demonstrated a sensitivity of 88.6% (73.3-96.8%) and a specificity of 95.3% (84.2-99.4%). Radiologist performance on this image group included a sensitivity of 81.0% (74.3-87.6%) and specificity of 86.0% (72.6-99.5%). The model’s overall accuracy was 92.3% (84.0-97.1%), compared with mean individual performance (83.8%, 78.4-89.1%). The “Radiology Selected Image” group model demonstrated a sensitivity of 88.6% (73.3 - 96.8%) and specificity of 87.9% (71.8-96.6%). Mean radiologist sensitivity was 92.4% (86.9-97.9%) and specificity was 91.9% (83.4-100%). The model’s overall accuracy was 88.2% (78.1-94.8%) which was comparable to the individual radiologist performance (92.2%, 90.1-94.2%) and consensus performance (95.6%, 87.6-99.1%).
Conclusions: An automated machine-learning algorithm may accurately detect NAFLD on ultrasound.

Quantitative Analysis of Textural Features Extracted from Sonograms of Biceps under Different Physiological States

Lanting Jia, MD, Jiaqi Zhao, MD, Qi Xu, PhD, Qian Pan, MD, Jianquan Zhang, MD

2020, 4 (3): 183-188. DOI:10.37015/AUDT.2020.190024

Abstract ( 338 ) HTML ( 3 ) PDF ( 366KB ) ( 616 ) 　　

Objective: To quantitatively analyze the difference of texture features of skeletal muscle in high-frequency ultrasound images under different physiological states using the multiscale decomposition method of ultrasound echo intensity interface reflections.
Methods: High frequency ultrasound images of the biceps brachii in different physiological states were collected from 20 healthy volunteers. In offline state, eight texture parameters including mean of texture gray scale (Mean), standard variance (SDev) of gray scale, number of blobs (NOB) of texture density, irregularity (IRGL) of texture primitive shape, mean size of blobs (SOB) of texture primitive, homogeneity of distribution (HOD) of texture uniformity, directionality of texture distribution (DOD), and periodicity of texture distribution (POD) were extracted by MATLAB software and compared and analyzed statistically.
Results: With the use of high frequency ultrasound, all healthy volunteers' biceps brachii showed isoechoic muscle bundles, organized arrangement of muscle fibers, and distinct and intact texture of structure. In different physiological states of biceps brachii of the same gender group, the NOB and the Mean showed statistically differences (P < 0.05). In the relaxation state of biceps brachii between different gender groups, the average SOB and the DOD showed statistically differences (P < 0.05). In the load state of biceps brachii between different genders, the NOB and the Mean showed statistically differences (P < 0.05).
Conclusions: The ultrasonic image changes of muscle fibers under different physiological states can be identified by quantitative texture characteristic parameters, providing more information for clinical computer-aided diagnosis of skeletal muscle injury.

Use of Contrast-Enhanced Ultrasound for Detecting the Disease Activity of the Carotid Artery in Takayasu Arteritis

Chaolun Li, MD, Lingying Ma, MD, Linjin Huang, MD, Hong Han, MD, Lingdi Jiang, MD, Wenping Wang, MD

2020, 4 (3): 189-194. DOI:10.37015/AUDT.2020.200010

Abstract ( 346 ) HTML ( 21 ) PDF ( 378KB ) ( 408 ) 　　

Objective: To investigate whether contrast-enhanced ultrasound (CEUS) is helpful for assessing the disease activity of Takayasu arteritis (TA).
Methods: Eighty-four patients with TA were examined with ultrasound (US) and CEUS. Intima-media thickness (IMT) of both sides of the common carotid artery was measured for each patient. Semiquantitative analyses of contrast enhancement within the arterial wall were performed with a visual interpretation scale. Disease activity was determined by one experienced physician based on Physician Global Assessment criteria.
Results: Carotid CEUS revealed that 6 arteries showed no enhancement (7.1%, 6/84) while 78 arteries showed homogeneous enhancement within the thickened wall (92.9%, 78/84). Grade 1 enhancement was noted in 40 patients, and grade 2 in 38 patients. IMT of the active group was significantly thicker than that of the inactive group (2.4 ± 0.9 mm vs. 1.8 ± 0.5 mm, P = 0.001) on B-mode US, and slightly correlated with ESR (r = 0.344, P < 0.05) and CRP (r = 0.261, P < 0.05). Grade 2 enhancement was observed more in the active patients (61.7% vs. 41.3%, P = 0.001) on CEUS.
Conclusions: CEUS is a convenient and non-invasive imaging modality that is useful for evaluating disease activity in TA patients by assessing the vascularization within the carotid wall.

A Novel Two-dimensional Quantitative Shear Wave Elastography Mode for Differential Diagnosis of Benign and Malignant Thyroid Nodules

Ying Zhang, MD, Yifeng Zhang, MD, Hanxiang Wang, MD, Anqi Zhu, MD, Hui Shi, MD

2020, 4 (3): 195-203. DOI:10.37015/AUDT.2020.190039

Abstract ( 363 ) HTML ( 3 ) PDF ( 432KB ) ( 406 ) 　　

Background: To evaluate the diagnostic performance of a novel two-dimensional quantitative shear wave elastography (SWE) of virtual touch tissue imaging quantification (VTIQ) in the differential diagnosis between benign and malignant thyroid nodules.
Methods: Two hundred and six solid thyroid nodules were included in this prospective study. Conventional ultrasound and VTIQ examinations were performed. The diagnostic performances of US, VTIQ, and the combination of the two methods were compared. The usefulness of VTIQ in different size of nodules was also assessed.
Results: There were 113 benign nodules and 93 malignant nodules on fine needle aspiration (FNA) or histology. The shear wave velocities (SWVs) in malignant nodules were all significantly higher than those in benign nodules (SWV max: 4.01 ± 1.72 m/s vs 3.25 ± 1.01 m/s, SWV min: 2.87 ± 0.69 m/s vs 2.46 ± 0.67 m/s, SWV mean: 3.33 ± 0.89 m/s vs 2.85 ± 0.81 m/s, SWV median: 3.31 ± 0.88 m/s vs 2.82 ± 0.77 m/s, all P value < 0.001). After combined VTIQ with ultrasound, the diagnostic performances improved compared with ultrasound alone or VTIQ alone. As for lesions of different sizes, areas under curve (AUC) for the largest diameter of nodules ≤ 1.0 cm was 0.711, which was lower than that for the largest diameter of the nodules > 1.0 cm (AUC was 0.862) (P < 0.05). Conventional ultrasound features such as halo sign and microcalcification were predictors for lymphatic metastasis in malignant thyroid nodules (P < 0.05).
Conclusions: VTIQ is a new method for measuring stiffness of thyroid lesions qualitatively. The diagnostic performance of combined using VTIQ and conventional ultrasound was better than that of using either alone. Malignant thyroid nodules with conventional ultrasound features such as halo sign and microcalcification were more likely to have lymphatic metastasis. The evaluation of small thyroid lesions remained a difficult problem.

Diagnostic Value of Ultrasound-Guided Water Enema for Secondary Intussusception in Children

Liezhen Hu, MD, Bei Xia, MD, Xiaopeng Ma, MD, Tingting Liu, MD, Tingting Ding, MD, Dong Xiao, MD, Bin Wang, MD, Wei Yu, MD, Zhou Lin, MD, Lei Liu, MD, Xia Feng, MD

2020, 4 (3): 204-210. DOI:10.37015/AUDT.2020.190029

Abstract ( 407 ) HTML ( 12 ) PDF ( 500KB ) ( 504 ) 　　

Objective: To investigate the diagnostic value of ultrasound-guided water enema for children with secondary intussusception.
Methods: We performed a retrospective analysis of the sonographic findings of 52 children with a confirmed diagnosis of SI through colonoscopy or surgical pathology between May 2016 and May 2019 in Shenzhen Children’s Hospital. The diagnostic value of ultrasound-guided water enema was evaluated.
Results: Of the 52 patients with SI (29 male, 23 female; average age, 50 months [range: 3 months to 12 years]), 16 had intestinal polyps, including 15 cases of juvenile polyps and 1 case of Peutz-Jeghers (P-J) polyps; 14 had Meckel's diverticulum; 11 had lymphoma; 10 had intestinal duplication; and 1 had jejunal schwannoma. All 52 patients were diagnosed with intussusception, of which 41 were confirmed with the presence of pathological lead points (PLPs) before water enema. After enema, PLP was demonstrated in 48 cases. All of the remaining 4 cases without a PLP diagnosis were found to be Meckel’s diverticulum. Ultrasonography revealed the specific features in each category. Patients with juvenile polyps showed hypoechoic masses in the intestinal lumen and some honeycomb-like anechoic masses while the single P-J polyp case showed hypoechoic masses with branching echoes in the intestinal lumen. Three of the Meckel’s diverticula cases showed irregular hyperechoic masses inside the intussusception, and 7 showed cystic masses inside the intussusception. All 11 lymphomas cases showed extremely hypoechoic masses. All 10 intestinal duplication cases showed cystic masses at the neck or inside the intussusception, with walls exhibiting intestinal wall-like structure. The case of jejunal schwannoma showed irregular hypoechoic masses at the neck of the intussusception. There were no major complications such as intestinal perforation occurred in all the children after the completion of water enema ultrasound examination.
Conclusion: Ultrasound-guided water enema helps identify PLPs and improves the diagnosis of primary diseases in children with SI.

Clinical Application of Ultrasound in the Diagnosis and Treatment of Reninoma

Qiuyang Li, MD, Ying Zhang, MD, Yong Song, MD, Aitao Guo, MD, Nan Li, BS, Yukun Luo, MD, Jie Tang, MD

2020, 4 (3): 211-216. DOI:10.37015/AUDT.2020.200013

Abstract ( 516 ) HTML ( 5 ) PDF ( 385KB ) ( 621 ) 　　

Objectives: To investigate the clinical value of ultrasound in the diagnosis and treatment of reninoma.
Methods: We retrospectively analyzed the ultrasound findings of 9 patients with reninoma confirmed by pathology after surgical resection in our hospital between September 2012 and August 2019. All patients underwent conventional preoperative ultrasonography. Three underwent contrast-enhanced ultrasound (CEUS) and 3 with complete endogenetic tumor underwent intraoperative ultrasonography.
Results: Of the 9 patients with conventional ultrasound, 7 had renal space-occupying lesions and 2 had missed diagnosis. A hypoechoic or hyperechoic solid mass with regular morphology, clear boundary, capsule, weak echo halo around the mass, incomplete thin strip color blood flow signal around the mass were shown in 7 cases. Color Doppler displayed color flow signal of the incomplete thin strip around the mass and arterial blood supply with an internal thin branch. In 3 patients (including 2 with missing diagnosis by conventional ultrasound) who underwent preoperative contrast-enhanced ultrasound, the reninoma manifested as low enhancement, and the perfusion pattern showed as slow wash-in and slow wash-out compared with normal renal cortex. In 3 patients (including 2 cases of missed diagnosis by conventional ultrasound) with completely endogenic reninoma, intraoperative ultrasound clearly showed the tumor characteristics, and all successfully underwent laparoscopic ultrasound-guided partial nephrectomy.
Conclusions: Preoperative conventional ultrasound combined with CEUS, and clinical features, are helpful for the qualitative diagnosis of reninoma. Laparoscopic partial resection is the first-choice treatment for reninoma. Intraoperative ultrasound can provide real-time imaging, accurately evaluate the tumor status, and provide important information for surgeons.

Time-intensity Curve Analysis of Hepatocellular Carcinoma using Two Contrast-enhanced Ultrasound Methods: Contrast Pulse Sequencing and Contrast Harmonic Imaging

Mengna He, MD, PhD, Lei Xu, MD, Tian’an Jiang, MD, PhD

2020, 4 (3): 217-222. DOI:10.37015/AUDT.2020.200007

Abstract ( 279 ) HTML ( 6 ) PDF ( 421KB ) ( 696 ) 　　

Objectives: To compare the features of the time-intensity curve (TIC) of hepatocellular carcinoma (HCC) by two different contrast-enhanced ultrasound (CEUS) methods: Contrast Pulse Sequencing (CPS) and Contrast Harmonic Imaging (CHI).
Methods: This prospective study included 22 HCC lesions. The CPS and CHI (Cadence? technique by Siemens) were performed in random order for each lesion, and the microbubbles were completely cleared between the two methods. The imaging by each method was recorded for 10 minutes. The CEUS video clips were analyzed off-line and the quantitative parameters of time intensity curve were obtained: the peak intensity (PI), time to peak (TTP), washout time (WT), relative value (RV) of intensity and AUC before WT and after WT, and the time of RV ≥15 dB lasted (RLT).
Results: Compared with CPS, CHI showed an earlier WT (64.0 ± 17.1 s vs 33.1 ± 7.0 s) of HCC lesions, a lower RV of intensity (36.8 ± 9.4 vs 10.3 ± 5.1) and AUC (1377.2 ± 205.7 vs 227.2 ± 56.7) before WT, but higher RV of intensity (17.8 ± 4.6 vs 32.2 ± 8.6) and AUC (1 124.1 ± 276.4 vs 2 664.1 ± 456.8) after WT, and longer RLT (121.4 ± 49.8 s vs > 150 s).
Conclusion: For long later phase observation after washout, CHI is better than CPS, but the observation of rapid perfusion before washout is not comparable to CPS. A combined use of these two methods is recommended based on our research.

Absent Blood Flow in the Testis on Color Doppler Ultrasound: The Causes, Differential Diagnosis and Clinical Value

Shun-Ping Chen, MD, Bin Chen, MD

2020, 4 (3): 223-229. DOI:10.37015/AUDT.2020.190035

Abstract ( 1061 ) HTML ( 30 ) PDF ( 2502KB ) ( 1618 ) 　　

Objectives: To investigate the causes, differential diagnosis, and clinical significance of absent blood flow (ABF) in the testis detected by color Doppler ultrasound (CDU) in acute scrotum.
Methods: A total of 263 patients with ABF in the testis detected by CDU in our hospital were reviewed retrospectively. However, only 111 patients who underwent surgery were included in this study. The ultrasonographic features of the testis and paratesticular tissue were analyzed. The surgical or surgical-pathologic results were taken as the reference standard to determine the causes of ABF in the testis.
Results: The causes of ABF in the testis were testicular torsion (n = 98, torsion group) and non-testicular torsion related diseases (n = 13, non-torsion group, including 8 testicular rupture, 3 epididymitis-orchitis combination with testicular necrosis, and 2 tumors). Tunica albuginea of the testis, diffuse enlarged epididymis, whirlpool sign, and internal echo of the testis were the better parameters for diagnosing the causes of ABF in the testis detected by CDU. And the accuracies of these approaches were 93.7%, 91%, 83.8%, and 81.1%, respectively. Whirlpool sign had a 100% positive predictive value (PPV), and disrupted tunica albuginea of the testis and diffuse enlarged epididymis each had 100% specificity for predicting testicular torsion. When the ultrasonographic findings were combined with these methods to determine the causes, the accuracy was 96.4% (107/111).
Conclusion: ABF in the testis detected by CDU is not always indicative of testicular torsion in acute scrotum; Analyzing ultrasound findings of the testis and paratesticular tissue can help with differential diagnosis of the causes of ABF in the testis and guide clinical decision-making.

Case Report

Bilateral Carotid Dissection Caused by a Dog Bite: Case Report and Review of the Literature

Limei Chen, MS, Ananta Adhikari, MS, Jianwen Guo, MD, Jingxin Zhong, MS, Guangjian Liu, MD, Feng Zhang, MS

2020, 4 (3): 230-233. DOI:10.37015/AUDT.2020.190042

Abstract ( 323 ) HTML ( 4 ) PDF ( 286KB ) ( 426 ) 　　

Arterial dissection is caused by intima damage and blood flow into the vascular wall, resulting in the separation of the intima and middle layer, intramural hematoma formation, and subsequently stenosis, occlusion, or aneurysm. A 68-year-old woman with bilateral common carotid artery dissection (CAD) caused by a dog bite two months prior was admitted to the hospital. Cerebral angiography, magnetic resonance angiography (MRA), and carotid color Doppler ultrasonography showed right CAD (aneurysm formation) with luminal stenosis (50%-69%), left common CAD (intramural hematoma formation). Bilateral common CAD caused by a dog bite is rare. The mechanism of CAD may be similar to iatrogenic dissection. After eliminating the contraindication of operation, right common carotid artery stenting was performed two months after conservative treatment.

Right Hepatic Lobe Agenesis Combined with Budd-Chiari Syndrome - A Case Report and Literature Review

Ruifang Xu, MD, Ji-Bin Liu, MD, Linxue Qian, MD, PhD

2020, 4 (3): 234-238. DOI:10.37015/AUDT.2020.200042

Abstract ( 292 ) HTML ( 9 ) PDF ( 347KB ) ( 489 ) 　　

Agenesis of the right lobe of the liver is an extremely rare congenital anomaly and usually detected by incidental cross-sectional imaging examination. Budd-Chiari syndrome is a rare cause of portal vein hypertension and hepatic failure, with the characteristic of the hepatic venous outflow tract obstruction. This article presented a clinical case of a 43 years old female diagnosed with agenesis of the right hepatic lobe combined with Budd-Chiari syndrome by ultrasonography (US) and computed tomography (CT) and conducted a literature review for imaging diagnosis of right hepatic lobe agenesis.

Sonographic Diagnosis of Extraperitoneal Round Ligament Leiomyoma in Inguinal Area

Ranran Zhao, MD, Zhihui Du, MD, Haoyu Xu, MD, Lei Liu, MD, Sujuan Sun, MD, Zhongbin An, MD, Huide Ma, MD, Duo Zhao, MD, Wei Zhao, MD, Shumin Wang, MD, PhD

2020, 4 (3): 239-242. DOI:10.37015/AUDT.2020.190037

Abstract ( 398 ) HTML ( 10 ) PDF ( 355KB ) ( 416 ) 　　

Leiomyoma, commonly known as fibroids, is a common female disease. Leiomyoma of the round ligament of the uterus is rare. Extraperitoneal leiomyoma of the round ligament can present as inguinal and vulvar mass mimicking an incarcerated hernia, lymph node, or lipomas. We are presenting a rare case of a 53-year-old female patient who was admitted to the hospital with a right inguinal mass. Our patient underwent surgery, and a leiomyoma of the round ligament was found. Before surgery, sonography and computed tomography (CT) will be helpful in the diagnosis of extraperitoneal leiomyoma of the round ligament.

Use of Ultrasound and Digital Subtraction Angiography for Arteriovenous Malformations in a Patient with Klippel-Trenaunay-Weber Syndrome

Zhimei Cheng, BS, Shuai Zhang, PhD, Ping Wang, BS, Hong Zhu, BS, Zhijing Wei, BS, Shi Zhou, BS

2020, 4 (3): 243-247. DOI:10.37015/AUDT.2020.200009

Abstract ( 292 ) HTML ( 7 ) PDF ( 362KB ) ( 557 ) 　　

We report a case of a 21-year-old woman with Klippel-Trenaunay-Weber syndrome (KTWS), a rare congenital syndrome involving capillary malformations, arteriovenous malformations, and soft tissue or bone hypertrophy. For this patient, ultrasound and digital subtraction angiography (DSA) were used to evaluate arteriovenous malformations. Arteriovenous shunts could be identified with both ultrasound and DSA. DSA was able to provide an overall view of the malformed blood vessels, whereas ultrasound was effective in showing the condition of the blood vessel walls and in assessing blood flow velocity. This case suggests that multiple imaging studies may be needed for the diagnosis and treatment of KTWS disease in these patients.

Cholesterol Granuloma of Omentum Comformed by Ultrasound-Guided Biopsy: A Case Report

Zhiguang Chen, MD, Xuemei Wang, MD, Liang Sang, MD

2020, 4 (3): 248-250. DOI:10.37015/AUDT.2020.190026

Abstract ( 299 ) HTML ( 2 ) PDF ( 368KB ) ( 378 ) 　　

Cholesterol granuloma (CG) is a histological lesion caused by an inflammatory reaction of the cholesterol crystal rather than an independent disease. We report the case of an 87-year-old woman who came to our hospital for slight abdominal pain lasting a week and who had a history of a pelvic mass found forty years ago. Ultrasound examination revealed abnormal omentum, which was suspected to be a source of metastasis from the pelvic mass. However, ultrasound-guided biopsy confirmed the abnormal omentum was CG. By describing this case, we aim to share the value of ultrasound-guided omentum biopsy in clinical diagnosis and treatment.

Liquid Isolation to Optimize Ultrasonic Display of Cervical Lymphatic Vessels

Jianquan Zhang, MD, Hongqiong Chen, MD, Lei Yan, MD, Jie Cheng, MD

2020, 4 (3): 251-254. DOI:10.37015/AUDT.2020.200044

Abstract ( 282 ) HTML ( 6 ) PDF ( 548KB ) ( 583 ) 　　

Lymphatic vessels are the only pathway for lymphatic fluid to flow into venous bloodstream, and they are also one of the main channels for migration and metastasis of malignant tumor cells. High-frequency ultrasound imaging has been used popularly as first choice for examination and preliminary assessment of cervical lymph nodes. However, its capacity of displaying lymphatic vessels is still insufficient up to date. Recently, liquid isolation has been increasingly used in ultrasound-guided thermal ablation treatment of thyroid nodules, parathyroid nodules, or cervical lymph nodes with malignant metastasis, playing a key role of protecting adjacent surrounding structures. In this paper, the role of liquid isolation in optimizing the ultrasonic display of cervical lymphatic vessels was presented and further likely novel technique based on this case was outlook as well.

Two- and Three-Dimensional Echocardiography for Primary Cardiac Lymphomas: A Case Report and Literature Review

Huan Cen, MS, Jinhua Li, MD, Bijing Li, MS, Pengtao Sun, MS

2020, 4 (3): 255-259. DOI:10.37015/AUDT.2020.190043

Abstract ( 330 ) HTML ( 7 ) PDF ( 356KB ) ( 685 ) 　　

Cardiac lymphomas have an extremely low incidence, with primary cardiac lymphomas accounting for only 0.5% of all extranodal lymphomas and 2% of primary cardiac tumors. Early diagnosis is critical for these tumors, which can proliferate rapidly. Here, we report a rare case of a 66-year-old man with primary cardiac lymphomas in the right atrium and right ventricle. This case establishes that two- and three-dimensional echocardiography is instructive in establishing the relationship of the mass and surrounding tissues and providing relevant hemodynamic information.

Educational Articles

Role of PCA in Offering Certifications and Other Related Services to POCUS Users Worldwide

Victor V Rao, MBBS, DMRD, RDMS, James A DellaValle, MD, MBA, Samantha Forcum, M.Ed, Jasmine Rockett, Hannah Mason, MA, PMP, Dale R. Cyr, MBA, CAE

2020, 4 (3): 260-263. DOI:10.37015/AUDT.2020.200058

Abstract ( 276 ) HTML ( 16 ) PDF ( 315KB ) ( 780 ) 　　

The POCUS Certification Academy, a subdivision of Inteleos, a non-profit certification organization, is striving to promote global standards and international certifications in the field of POCUS to enhance clinician proficiency and ensure patient safety. By offering relevant rigorous assessments, developing continuing education requirements, and promoting the use of point-of-care ultrasound worldwide, the POCUS Certification Academy is laying the foundation for the highest global standards in POCUS credentialing.