ABSTRACT
Objective:To evaluate the value of shear wave elastography (SWE) in skin assessment of Systemic sclerosis (SSc).Methods:A total of 58 SSc patients admitted to Peking University Third Hospital from May 2021 to October 2022 and 41 healthy volunteers were included in the study. Skin shear wave elastography (SWE) was performed at 17 sites defined in modified Rodnan skin score (mRSS) measurement, and shear wave velocity values were recorded to evaluate skin hardness. SPSS 22.0 software was used to analyze the skin hardness of SSc patients and healthy controls, and the correlation between skin hardness of SSc patients and clinical data was analyzed. A logistic regression model was constructed to evaluate the diagnostic efficacy of skin hardness at different sites of SSc patients, and to further select the most practical measurement site.Results:The SWE value of SSc patients was significantly higher than that of healthy control group ( P<0.05). There was a positive correlation between SWE and mRSS in the measurement of bilateral fingers, bilateral dorsal hands, bilateral forearms, fore-chest, abdomen, bilateral thighs, and bilateral dorsal feet. Skin stiffness measured by SWE was significantly correlated with SSc disease activity score (EScSG-DAI), ( r=0.71, P<0.001), disease injury score (SCTC-DI), (P=0.55, P=0.005) and functional score (HAQ-DI), ( r=0.46, P=0.003). Reducing the number of measurement sites to 12 (bilateral fingers, bilateral hands, bilateral forearms, bilateral upper arms, forehead, fore-chest, bilateral dorsum of feet) performs as well as all 17 measurement sites simultaneously in assessing disease activity. Conclusion:SWE is a good evaluation tool to reflect the skin lesions of SSc, which is of great value for the diagnosis and evaluation of the disease. We can further standardize the measurement sites and select the most appropriate evaluation strategy, so as to achieve better clinical application.
ABSTRACT
Ewing's sarcoma/primitive neuroectodermal tumor (EWS/PNET) in the kidney is a rare but high-grade malignant tumor that affects predominantly elder children and adolescents.Patients mostly present with nonspecific symptoms such as abdominal pain and gross hematuria.Since EWS/PNET has a rapid clinical progression with early metastasis and death,it is essential to make an accurate and early diagnosis.Once diagnosed,multimodality treatment,including radical surgery combined with adjuvant chemotherapy,and radiotherapy if necessary,is recommended.Unfortunately,there are no characteristic signsthat have been described in ultrasonography or any other imaging modalities so far.The diagnosis of EWS/PNET is now based on a classical histological and immunohistochemical investigation complemented by a demonstration of specific chromosomal changes.Strong immunoreactivity to CD99 is ubiquitous,and t(11;22) translocation is seen in approximately 90％ of EWS/PNET.Herein,we report a patient with such condition.The patient was a young woman,and she presented with sudden right flank pain clinically.Ultrasonography revealed a large heterogeneous mass in the lower pole of her right kidney.The tumor compressed the renal pelvis and led to upper pole caliectasis.Color Doppler demonstrated blood flow with a pulsatile arterialized waveform within the mass.The patient received radical nephrectomy with right renal vein and vena cava thrombectomy.A search for other sites of tumor involvement yielded negative results.And six cycles of chemotherapy were sequentially performed.The diagnosis of EWS/PNET was confirmed based on primitive small round cell histology and characteristic immunohistochemical results.She was still alive with no evidence of recurrence five years after initial diagnosis.We would like to point out that ultrasound is still a useful method for initial assessment,and ultrasound-guided fine needle aspiration may play an important role in determining preoperative diagnosis.
ABSTRACT
Objective:To explore the value of ultrasound in the diagnosis of anterosuperior acetabular labral tear.Methods:A total of 102 patients [(42 males and 60 females,age from 13 to 60 years,average age was (35.14 ± 9.16) years] with suspected anterosuperior acetabular labral tear were included in this study,including 44 left hip joints and 58 right hip joints.All the patients received hip joint ultrasound and magnetic resonance imaging (MRI) evaluation before arthroscopy surgery.Using arthroscopy as golden standard,the sensitivity,specificity,positive predictive value,negative predictive value and accuracy between ultrasound and MRI were calculated and compared.Results:There were 91 anterosuperior acetabular labral tears of 102 patients which were confirmed during arthroscopy surgery.Sixtynine patients were diagnosed correctly by ultrasound,including 60 anterosuperior acetabular labral tears and 9 with no acetabular labral tears,whereas 2 were false-positive and 31 were found to be false-negative.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy by ultrasound were respectively 65.93％,81.82％,96.77％,22.50％ and 67.65％.In contrast,seventy-seven patients were diagnosed correctly by MRI,including 70 anterosuperior acetabular labral tears and 7 with no acetabular labral tears,whereas 4 were false-positive and 21 were found to be false-negative.For MRI,the sensitivity,specificity,positive predictive value,negative predictive value and accuracy were respectively 76.92％,63.64％,94.59％,25.00％ and 75.49％.The results of ultrasound and MRI were in accordance in 68 of the 102 patients.There were 51 anterosuperior acetabular labral tears of the 68 patients who were diagnosed by both ultrasound and MRI,whereas there were 17 with no acetabular labral tears of the 68 patients who were diagnosed by both ultrasound and MRI.The results of ultrasound and MRI were inconsistent in 34 of the 102 patients.In 11 of the 34 patients,in which case ultrasound diagnosed anterosuperior acetabular labral tear,MRI found no acetabular labral tear.Whereas,in 23 of the 34 patients,in which case MRI diagnosed anterosuperior acetabular labral tear,ultrasound found no acetabular labral tear.As compared with MRI findings,ultrasound had a lower accuracy for anterosuperior acetabular labral tear than MRI,there was statistical difference on the accuracy for anterosuperior acetabular labral tear (P ＜ 0.01).Conclusion:Although ultrasound had a slightly lower sensitivity for anterosuperior acetabular labral tear,it had a higher specificity than MRI.Dynamic evaluation of anterosuperior acetabular labral tear is an advantage of ultrasound.Ultrasound could be used as a feasible method to evaluate anterosuperior acetabular labral tear.