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Objective:To explore the applicational value of identifying different types of echogenic foci and distinguishing the lesions between benign and malignant lesions in histopathology classification.Methods:The detailed clinical data of 223 patients (264 thyroid nodules) with echogenic foci in preoperative ultrasound from October 2018 to December 2019 in the Sir Run Run Shaw Hospital of Zhejiang University School of Medicine were retrospectively analyzed. The echogenic foci were categorized as big comet-tail artifact, small comet-tail artifact, microcalcification, coarse calcification, peripheral calcification and eggshell calcification. At the same time, other ultrasonographic features were included in order to comparatively analyze with postoperative pathological findings. Independent samples t test and univariate chi-square test were performed to obtain meaningful information of sex, age, body mass index (BMI), thyroid stimulating hormone (TSH), serum free triiodothyronine (FT 3), serum free thyroxine (FT 4), aspect ratio, composition, margin, echo type, echogenic foci; Logistic regression analysis was performed to screen out the independent influence factors in order to forecast malignant lesions. Spearman correlation analysis was performed to determine the ralationships between the clinical indicators and the pathologic results of thyroid lesions. Results:Among the 264 lesions, there were 219(83.0%) malignant nodules and 45(17.0%) benign nodules. For malignant lesions, except for big comet-tail artifact, other types of echogenic foci were all founded, including 152(69.4%) microcalcification, 41(18.7%) small comet-tail artifact, 17(7.8%) coarse calcification, 7(3.2%) peripheral calcification, 2(0.9%) eggshell calcification. While in benign lesions, there were 13(28.9%) microcalcification, 9(20.0%) coarse calcification, 8(17.8%) peripheral calcification, 6(13.3%) small comet-tail artifact, 6(13.3%) big comet-tail artifact, 3(6.7%) eggshell calcification with all echogenic foci types included. Univariate analysis showed that differences between benign and malignant lesions regarding age, serum FT 4, aspect ratio, composition, margin, echo type, echogenic foci were statistically significant (all P<0.05), Logistic regression analysis indicated that age, serum FT 4, hypoechoic, solid, small comet-tail artifact and microcalcification were independent influence factors for malignancy( OR=0.946, 0.026, 47.656, 9.032, 7.925, 12.767; all P<0.05), age and serum FT 4 were correlated with the pathologic results of thyroid lesions ( rs=-0.259, -0.156; all P<0.05). Conclusions:It is highly suggestive of malignancy when the thyroid lesions are solid, hypoechoic, and echogenic foci type is small comet-tail artifact or microcalcification.
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Objective:To investigate the application value of the ultrasonic elastic tissue dispersion quantitative analysis technique in differentiating thyroid nodules.Methods:A total of 164 nodules in 143 patients with thyroid nodules were examined by elastography ultrasound at Sir Run Run Shaw Hospital of Zhejiang University School of Medicine from January to November 2014. Eleven parameters were obtained by the tissue dispersion quantitative analysis software. These parameters were compared between benign and malignant groups by Mann-Whitney U test. The correlations between all the parameters and the pathologic results of thyroid nodules were analyzed by Spearman analysis. The receiver operating characteristic(ROC) curve of the parameter with the highest correlation coefficient was constructed. The cut-off value was calculated. Results:All parameters except correlation (CORR) had statistically significant differences between the groups of benign and malignant thyroid nodules(all P<0.01). Moreover, except CORR, the other parameters were correlated with the pathologic results of thyroid nodules(all P<0.05), with the highest coefficient in area ration of low-strain region (%AREA)( r s=0.818). ROC curves were constructed to estimate the clinic values of %AREA in diagnosis of thyroid cancer, the area under ROC curve was 0.991 for %AREA, the cut-off point was 74.83%, the sensitivity and specifity was 98.1% and 89.8%, respectively. Conclusions:The tissue dispersion quantitative analysis technique has high value in the differential diagnosis of benign and malignant thyroid nodules.
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Objective To evaluate the correlation between ultrasound features of papillary thyroid carcinoma(PTC)and lymph node metastasis by preoperative ultrasound elemental observation of thyroid nodules.Methods Three hundred and seventy-six patients who underwent primary thyroid surgery and confirmed by ultrasound and pathological data as single-focal PTC from Jannary to December 2017 in Sir Run Run Shaw Hospital of Zhejiang Univbersity College of Medicine were retrospectively analyzed. According to the presence or absence of lymph node metastasis,they were divided into central and lateral lymph node metastasis group and non-metastasis group.Independent risk factors for central lymph node metastasis (CLNM) and lateral lymph node metastasis (LLNM) were analyzed byχ2 test and multivariate Logistic regression.Results Multivariate analysis showed that the posterior margin of the cancer was <0.25 cm from the posterior wall of the thyroid gland as an independent risk factor for CLNM(P=0.025). Compared with the tumor volume ≤0.38 cm3 ,the cancer volume >0.38 cm3(P=0.000),was more prone to CLNM.And multivariate analysis showed that the anterior margin of the cancer was <0.17 cm(P =0.006)from the anterior thyroid capsule and the inner wall of the foci was <0.26 cm (P =0.014) as independent risk factors for LLNM.Compared with the maximum diameter of the tumor lesion ≤1 cm,the maximum diameter >2 cm (P =0.001) group was more prone to LLNM.Compared with the tumor volume ≤0.38 cm3 ,the tumor volume >0.38 cm3(P =0.000)was more prone to LLNM.ConclusionsThe larger volume of single focal PTC carcinoma and the closer to the posterior thyroid capsule are independent risk factors for CLNM.The larger volume and diameter of single focal PTC,and the closer to the anterior and medial wall capsule are independent risk factors for LLNM.
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Objective@#To evaluate the correlation between ultrasound features of papillary thyroid carcinoma (PTC) and lymph node metastasis by preoperative ultrasound elemental observation of thyroid nodules.@*Methods@#Three hundred and seventy-six patients who underwent primary thyroid surgery and confirmed by ultrasound and pathological data as single-focal PTC from Jannary to December 2017 in Sir Run Run Shaw Hospital of Zhejiang Univbersity College of Medicine were retrospectively analyzed. According to the presence or absence of lymph node metastasis, they were divided into central and lateral lymph node metastasis group and non-metastasis group. Independent risk factors for central lymph node metastasis (CLNM) and lateral lymph node metastasis (LLNM) were analyzed by χ2 test and multivariate Logistic regression.@*Results@#Multivariate analysis showed that the posterior margin of the cancer was <0.25 cm from the posterior wall of the thyroid gland as an independent risk factor for CLNM (P=0.025). Compared with the tumor volume ≤0.38 cm3, the cancer volume >0.38 cm3 (P=0.000), was more prone to CLNM. And multivariate analysis showed that the anterior margin of the cancer was <0.17 cm (P=0.006) from the anterior thyroid capsule and the inner wall of the foci was <0.26 cm (P=0.014) as independent risk factors for LLNM. Compared with the maximum diameter of the tumor lesion ≤1 cm, the maximum diameter >2 cm (P=0.001) group was more prone to LLNM. Compared with the tumor volume ≤0.38 cm3, the tumor volume >0.38 cm3 (P=0.000) was more prone to LLNM.@*Conclusions@#The larger volume of single focal PTC carcinoma and the closer to the posterior thyroid capsule are independent risk factors for CLNM. The larger volume and diameter of single focal PTC, and the closer to the anterior and medial wall capsule are independent risk factors for LLNM.
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Objective@#To evaluate the diagnostic efficacies of BRAFV600E testing and Bethesda system for reporting thyroid cytopathology (BSRTC) in thyroid nodules with thyroid imaging reporting and data system (TIRADS) category 4 and 5.@*Methods@#A total of 187 thyroid nodules in 187 patients underwent the examinations of ultrasound-guided fine needle aspiration cytology (FNAC) and BRAFV600E mutation were analyzed retrospectively. Receive operating characteristic (ROC) curve was used to investigate the diagnostic values of both methods and the clinical application of BRAFV600E combined with BSRTC was evaluated. SPSS17.0 software was used to analyze the data.@*Results@#Among 187 thyroid nodules, 123 were malignant nodules confirmed with histopathological examination and 64 benign nodules determined by FNAC, histopathological examination, or long-term follow-up. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of BRAFV600E test were better than those of BSRTC [69.1%, 98.4%, 98.8%, 62.4%(χ2=77.3, P=0.000) vs 62.6%, 93.8%, 95.1%, 56.6%(χ2=54.4, P=0.000)]. While the sensitivity, specificity, PPV and NPV of the combined test of BRAFV600E and BSRTC for diagnosis of malignant thyroid nodules were 87.8%, 92.2%, 95.6%, 79.7%(χ2=112.6, P=0.000), respectively. The area under the ROC curve for the combined test was higher than that for each of tests (0.900 vs 0.858 or 0.838).@*Conclusions@#The combined test of BRAFV600E mutation and BSRTC has a higher diagnostic efficacy for malignant thyroid nodules compared with BRAFV600E mutation or BSRTC alone.
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Objective To investigate the application value of the ultrasonic elastic tissue dispersion quantitative analysis technique in different stages of subacute thyroiditis (SAT).Methods One hundred and forty-four SAT lesions detected from 81 patients were enrolled in the patient group.They were further divided into three subgroups,including acute group (group Ⅰ),medium group (group Ⅱ) and recovery group (group Ⅲ).Another 59 healthy volunteers were collected as control group.All the participants accepted conventional ultrasound and elastographic examinations.Eleven parameters were obtained by the tissue dispersion quantitative analysis software.These parameters were compared between groups and among subgroups by ANOVA.The correlation between all the parameters and the course of SAT were analyzed by Spearman and Multiple linear regression methods.Results Between groups and among subgroups,the complexity (COMP) and correlation (CORR) were not statistically different(all P ＞0.05).Differences of kurtosis (KURT) and angular secon moment (ASM) among the three subgroups were not significant (all P ＞0.05).Differences between groups and among subgroups were significantly different among the value of all the other seven indexes (all P ＜0.01).Moreover,they were all correlated with the clinical staging,with the highest coefficient in area ration of low-strain region (％ AREA)(r =-0.881).Regression model was constructed and only ％ AREA was selected into the regression equation.ROC curves were constructed to estimate the clinic value of ％ AREA in staging patients of SAT,the areas under ROC curves were0.986(group Ⅰ vs group Ⅱ-Ⅲ) and 0.988 (group Ⅰ-Ⅱ vs group Ⅲ[) for ％AREA,respectively.Conclusions The tissue dispersion quantitative analysis technique is helpful in estimating the stiffness of thyroid in patients with SAT.
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<p><b>OBJECTIVE</b>To investigate the value of thyroglobulin measurement in ultrasound guided fine-needle aspiration(FNA-Tg)for detecting neck node metastasis in patients with papillary thyroid carcinoma(PTC)after thyroidectomy.</p><p><b>METHODS</b>A total of 128 suspicious metastatic lymph nodes in 112 patients were retrospectively analyzed. Postoperative pathologic results were taken as the gold standard. The values of FNA and FNA-Tg combined FNA in the diagnosis of metastatic lymph nodes were compared with different ultrasonic features.</p><p><b>RESULTS</b>The sensitivity, specificity and accuracy of single FNA for the diagnosis of neck node metastasis were 67.5%, 98.0% and 79.7% respectively, and those of FNA-Tg combined FNA were 87.0%, 100.0% and 92.2% respectively. Compared with single FNA, the sensitivity and accuracy of FNA-Tg combined FNA were increased significantly(χ(2)=8.319, P=0.004; χ(2)=8.275, P=0.004). When the ultrasonographic characteristics met any one of five indicators for neck node metastasis, the sensitivity, specificity and accuracy of single FNA for the diagnosis of neck node metastasis were 38.1%, 95.7% and 68.2% respectively, and those of FNA-Tg combined FNA were 71.0%, 100.0% and 86.4% respectively. Compared with single FNA, the sensitivity and accuracy of FNA-Tg combined FNA were increased significantly(χ(2)=4.709, P=0.030; χ(2)=4.141, P=0.042). When the ultrasonographic characteristics met any two of five indicators for neck node metastasis, the sensitivity, specificity and accuracy of single FNA for the diagnosis of neck node metastasis were 55.0%, 100.0% and 73.5% respectively, and those of FNA-Tg combined FNA were 90.0%, 100.0% and 94.1% respectively. Compared with single FNA, the sensitivity and accuracy of FNA-Tg combined FNA were increased significantly(χ(2)=6.140, P=0.013; χ(2)=5.314, P=0.021). The ultrasonographic characteristics met any three, four or five of five indicators or did not meet any of the indicators, there was no significant difference in the value of the diagnosis of metastatic lymph nodes between single FNA and FNA-Tg combined FNA(P>0.05).</p><p><b>CONCLUSIONS</b>The combination of FNA with FNA-Tg could be helpful in diagnosis of lymph node metastasis. When the suspicious lymph nodes had one or two ultrasound characteristics for neck node metastasis, FNA-Tg could raise the sensitivity and accuracy of FNA, and FNA-Tg could not significantly improve in the diagnosis of FNA when presenting with no or with more than 2 ultrasonographic features.</p>
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Humans , Biopsy, Fine-Needle , Carcinoma , Pathology , Carcinoma, Papillary , Lymph Nodes , Pathology , Lymphatic Metastasis , Diagnosis , Postoperative Period , Retrospective Studies , Sensitivity and Specificity , Thyroglobulin , Thyroid Neoplasms , Pathology , ThyroidectomyABSTRACT
<p><b>OBJECTIVE</b>To investigate the clinical value of contrast-enhanced ultrasonography (CEUS) in assessing the high-risk population of hepatic malignant tumor (HMT).</p><p><b>METHODS</b>Three hundred patients with high-risk of HMT were enrolled and examined by CEUS. The clinical data of these patients were collected. A comparative analysis was performed to assess the ability of CEUS for detecting and characterizing lesions in the liver. Kappa test was used for assessing the intra-and inter-observer reliability of CEUS.</p><p><b>RESULTS</b>In 87 enrolled patients with 119 malignant lesions detected by contrast-enhanced MRI, 112 lesions were detected by CEUS and 95 lesions were detected by unenhanced ultrasonography (US). The detection rate of CEUS for HMT was significant higher than that of US (94.1% vs. 79.8%; P < 0.01). More HMT lesions were detected by CEUS than by US in 17.2% patients. One hundred and seventy-seven patients with 215 lesions were confirmed by pathological diagnosis or long-time follow-up. There were 118 malignant and 97 benign lesions. The accuracy of CEUS for differential diagnosis of the liver lesions was 91.6% (197/215), significantly higher than that by US (59.1%, 127/215) (P < 0.01). CEUS improved the accuracy for 35.0% (62/177) patients. For 96 patients with 105 lesions detected for the first time, the agreement of diagnosis by CEUS was 92.4% (97/105). The reliability of CEUS was high (Kappainter = 0.866; Kappaintra = 0.934).</p><p><b>CONCLUSIONS</b>CEUS improves the detection rate and diagnostic accuracy rate of the HMT high-risk population, with a high agreement for diagnosing the new lesions. CEUS may be considered as a first-line method to assess the high-risk population of HMT conveniently, accurately and reliably.</p>
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Humans , Contrast Media , Diagnosis, Differential , Liver , Diagnostic Imaging , Liver Neoplasms , Diagnostic Imaging , Pathology , Magnetic Resonance Imaging , Reproducibility of Results , Sensitivity and Specificity , UltrasonographyABSTRACT
Objective To investigate the clinical value of double contrast-enhanced ultrasonography (DCUS) in diagnosing lymph nodes metastasis of gastric carcinoma.Methods One hundred and sixteen patients with gastric cancer diagnosed by gastroscope and confirmed by pathology after operation were examined by DCUS preoperatively.The enhanced characteristic of gastric carcinoma tissues was assessed by autotracking contrast quantification(ACQ) software.The baseline intensity(BI), peak intensity(PI), arrival time(AT) and time to peak(TTP) of gastric cancer was measured automatically,and the enhanced intensity (EI) and wash-in time(WIT) of gastric cancer was calculated manually (EI=PI-BI; WIT=TTP-AT).All of the subjects were divided into two groups according to their lymph nodes status postoperatively:group N1,sixty-nine patients with lymph nodes metastasis; and group N0, forty-seven patients without lymph nodes metastasis.The DCUS quantitative analysis and pathological results of these two groups were compared each other.The Kappa's test was used for inter-rater reliability.Results BI of group N1 in the gastric carcinoma tissues was lower than that of group N0 significantly [(1.41 ± 1.56)dB vs (3.92 ± 2.82)dB, t = - 4.81, P = 0.000].EI of group N1 in the gastric carcinoma tissues was higher than that of group N0 significantly [(20.67±3.71)dB vs (14.12±3.75)dB, t=7.31, P=0.000].Moreover, there was a significant difference of WIT in the gastric carcinoma tissues between these two groups[(9.12±2.99)s vs (10.88±3.05)s, t =-2.43, P=0.018].The WIT in patients with lymph nodes metastasis was shorter than that without it. A cut-off value ＞17.05 dB of EI in gastric cancer tissues for assessing the lymph nodes metastasis had a sensitivity of 80.50% and specificity of 76.70% respectively obtained by the area under the ROC curve. The Kappa value of this method was 0.88.Conclusions EI of gastric cancer tissues can be considered as a new potential index to evaluate the lymph nodes metastasis of gastric cancer.
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Objective To evaluate cardiac function in fetuses with intracardiac hyperechogenic focus (ICEF) by tissue Doppler imaging(TDI).Methods Fetal echocardiography was performed in 335 fetuses for evaluation of fetal cardiac function with ICEF by TDI,two-dimensional,M-mode and pulsed Doppler echocardiography.The ratio between early ventricular filling(E-wave)and active atrial filling(A-wave)peak velocities at the level of the atrioventricularvalves as an index of ventricular diastolic function.TDI mode was used to measure the mitral and tricuspid valve annulus including Em,Am and Sm.The characteristics of fetal echocardiography of 119 fetuses with ICEF were compared with 137 normal fetuses.Results E/A and Em/Am were significantly lower in fetuses with ICEF than in control fetuses.Positive correlation was found between the velocity of orifice and annulus in controls.No systematic differences were found in cardiac dimensions,ventricular shortening fraction,Doppler and TDI systolic indices between groups.Conclusions TDI is feasible and reproducible to evaluate fetal ventricular function,and it can avoid the influence of fetal heart rates and preloading.Fetuses with ICEF show lower Em/Am values in the second to third trimester echocardiography,it might indicate cardiac diastolic dysfunction.
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Objective To establish reference values of normal fetal heart conduction time intervals by tissue Doppler imaging(TDI)and pulsed Doppler(PD)echocardiography,and to assess their correlation with gestational-age and fetal heart rate.Methods One hundred and eighty-nine pregnant women underwent detailed echocardiographic examinations.Atrio-ventricular conduction time interval(AV)and the time interval from onset of ventricular contraction to the onset of atrial contraction of next cardiac cycle(VA)were measured by TDI and PD echocardiography.Results TDI-AV was(126.56±15.33)ms(95% CI 124.10～129.03 ms),TDI-VA was(285.22±24.53)ms(95% CI 281.27～289.16 ms),PD-AV was(127.42±12.88)ms(95% CI 125.35～129.49 ms),PD-VA was(287.42±25.19)ms(95% CI 283.37～291.47 ms).A paired t test revealed no systematic difference between the two approaches used to measure AV and VA.AV and VA were significantly positively correlated with gestational age,and significantly negatively correlated with fetal heart rate.Heart conduction time intervals were altered in fetus with paroxysmal arrhythmia.Conclusions This study established the normal values of fetal heart conduction time intervals.Prenatal determination of fetal heart conductional time intervals has important potential clinical utility in assessing fetal arrhythmia.