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Objective@#To analyze the feature of breast complex cystic masses and to classify it at ultrasonography (US), which applied to the Breast Imaging Reporting and Data System (BI-RADS) categories 4a to 4c with pathological results as the golden standards.@*Methods@#The ultrasonographic data and clinical features of 78 patients with complex cystic masses confirmed by pathology in Cancer Hospital from July 2014 to June 2017 were retrospectively reviewed. The complex cystic breast masses were divided into four classes on the basis of their US features: type 1 [thick wall and (or) thick septa (> 0.5 mm)], type 2 (one or more intra-cystic masses), type 3 (mixed cystic and solid components with cystic components more than 50%) and type 4 (mixed cystic and solid components with solid components more than 50%). Positive values (PPVs) were calculated for each type. Multiple linear regression analysis was used to analyze the ultrasonographic features of the masses (lesion size, margins, blood flow resistance index, calcification, and axillary lymph nodes, etc.) with malignant correlation.@*Results@#There were 81 lesions in 78 patients. Among the 81 masses based on US appearance, 14 (17.3%) were classified as type Ⅰ, 18 (22.2%) as type Ⅱ, 18 (22.2%) as type Ⅲ, and 31 (38.3%) as type Ⅳ. The positive predictive values of the malignant lesions of type Ⅰ, type Ⅱ, Ⅲ and Ⅳ were 7.1%, 16.7%, 61.1% and 48.3%, respectively (P=0.040). In all the 81 masses, 14 were BI-RADS categories 4a, 18 were BI-RADS categories 4b and 49 were BI-RADS categories 4c. Masses with maximum diameter equal to or larger than 2.0 cm, unclear margins, RI≥0.7 and presence of abnormal axillary nodes assessment had a high probability of malignancy (P=0.030, 0.038, <0.001 and 0.025, respectively).@*Conclusion@#Ultrasound typing is helpful for differentiating benign and malignant breast complex cysts and classifying BI-AIDS 4a to 4c, thus providing clearer treatment for clinical practice.
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Objective To evaluate the performance of ultrasonography (US) for the preoperative staging of papillary thyroid carcinoma (PTC). Methods One hundred and twenty-one patients with cytologically proven PTC were prospectively collected. Patients were recruited at the Chinese Academy of Medical Sciences Cancer Hospital from January 2014 to November 2014. Preoperative US was performed for the evaluation of primary tumor size, extrathyroidal extension and neck lymph node metastasis according to the 6th UICC TNM staging system. Results The sensitivity, specificity, positive predictive value (PPV) and negative predicative value (NPV) of US in predicting extrathyroidal extension were 89.6%(60/67), 72.2%(39/54), 80.0%(60/75), 84.8%(39/46), respectively. The accuracies of preoperative US for T1, T2, T3, T4 stage were 75.0%(36/48), 100%(1/1), 81.9%(59/72), 0, respectively. The sensitivity, specificity, PPV, and NPV of US in predicting neck lymph node metastasis were 47.5%(29/61), 90.0%(54/60), 82.9%(29/35), 62.8%(54/86), respectively. Conclusion Ultrasonography is a feasible tool for preoperative staging of PTC and is helpful for accurate prediction of extrathyroidal tumor extension and lateral neck lymph node metastasis.
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Objective To analyze the sonographic ifndings of large adrenal cortical adenoma. Methods The sonographic characteristics of thirteen cases of large adrenal cortical adenoma (diameter≥4.0 cm) which were diagnosed by surgery from January 2006 to August 2012 were retrospectively reviewed. Results In all cases, the adenomas had distinct margins. The mean size of lesions was (5.5±1.6) cm, ranging from 4.0 cm to 8.8 cm. On echotexture, three lesions were homogeneous and the remaining ten lesions were heterogeneous. In addition, seven contained hypoechoic nodules and hyperechoic septum, three had anechoic area, three had extremely hyperechoic area with acoustic shadow, and two had patchy hyperechoic area. On Doppler, most lesions had no lfow signal. Conclusions Large adrenal adenomas have complete capsule and heterogeneous internal echoes with septum, calciifcation, necrosis and hemorrhages. These characteristics are less frequently seen incommon adrenal adenoma, therefore may be helpful in recognition of large adrenal adenoma in clinical practice.
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Objective To describe the clinical and imaging manifestations of patients with synovitis acne pustulosis hyperostosis osteomyelitis (SAPHO) syndrome,and to analyze the diagnostic importance of different clinical and imaging manifestations for SAPHO syndrome. Methods Seventeen patients (7 males and 10 females) with SAPHO syndrome were recruited in this study.Age ranged from 36 to 67 years with a mean age of (48 ± 8) years. All patients fulfilled the diagnostic criteria of Benhamou. Serum HLA B27 antigen records were reviewed for all patients. Imaging data of the abnormal bone sites were collected by conventional radiograph in all patients,CT in 13 patients as well as MR in 3 patients.Average time to take for a definite diagnosis of the syndrome was 3.7 years (ranged from O.5 to 13 years).Results Serum HLA B27 antigen was positive in all patients. Both skin and bone abnornalities were found in all patients.Ten patients had skin palmoplantar pustulosis and two patients had acne. Involving sites of bone and joints include sacroiliac joints,anterior chest and limbs.Sacroiliac joints were asymmetrically involved with imaging features in all patients.Eight patients exhibited anterior chest wall involvement. Five patients had osteomyelitis at limbs. For all images of 17 patients,CT was superior to conventional radiography in detecting abnormal changes of bone erosion and soft tissue swelling.MR imaging was able to depict edema changes that was not detectable by CT and radiography.Conclusion SAPHO syndrome is a rare disease,but for patients with skin and bone-joint abnormalities,especially with skin palmoplantar pustulosis,acne as well as with imaging features at the sacroiliac joint and anterior chest wall,SAPHO syndrome should be taken into a diagnostic consideration.
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Objective To analyze the cause of missing diagnosis for vertebral fracture on lateral chest radiography. Methods Lateral chest radiographies of 1638 hospitalized patients (871 males and 767 females) were retrospectively reviewed for identifying vertebral fractures. Their ages ranged from 50 to 91 years with the mean of 63.5 years. Complains and application for chest radiography in all patients were not related to osteoporosis and vertebral fracture. Vertebral fracture and fracture severity were evaluated using Genant's semiquantitative visual method, taking approximately a 20%-25% vertebral height reduction as mild grade,26%-40% as moderate grade and 41% or greater as severe grade. Evaluation results of the vertebral fracture, original X-ray reports, as well as medical records were compared for further analysis. Results Eighty-four in 1638 patients showed vertebral fractures on the lateral chest radiographies. Of them,vertebral fractures were reported in 30 cases and 54 patients were not reported on their original X-ray reports. There were 63 vertebral fractures in 54 un-reported patients, most of which were single fracture (75% or 47/63). Grade Ⅰ fracture accounted for 54% (34/63), Grade Ⅱ fracture 33% (21/63), while 13% presented grade Ⅲ fracture (8/63). In all 84 patients with vertebral fractures, only 5 cases (6%)underwent dual energy X-ray absorptiometry (DXA) measurement, 5 cases ( 6% ) were recorded to have vertebral fractures on the medical papers, as well as 15 cases ( 18% ) were prescribed drugs related to the osteoporosis when discharged from hospital All drugs prescribed for the 15 patients were limited only to calcium. Conclusions More attention should be paid to osteoporosis by doctors including radiologists.Vertebral fracture on lateral chest radiography should be completely diagnosed, which is helpful for both prevention and treatment.