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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 characterize the image morphology and time-intensity curve of renal cell cancer and angiomyolipoma on contrast-enhanced harmonic sonography. Methods A total of 57 patients with 58 renal masses were enrolled in this study prospectively. The renal masses included 47 renal cell carcinomas (RCC) and 11 angiomyolipomas (AML). All patients were evaluated by tradi-tional gray-scale sonography, color Doppler sonography and contrast-enhanced harmonic sonography. Imaging findings and time-intensity curves of all renal masses were analyzed. The contrast-enhance-ment features between RCC and AML were analyzed. Results 57.4% of RCCs were hyperechoic masses and peripheral surrounding vessels and / or penetrating vessels were noted in 83.0% of RCCs on color Doppler sonography. 54.5 % of AMLs were hyperechoic masses while peripheral surrounding vessels and / or penetrating vessels were only noted in 27.3% of AMLs on color Doppler sonography. On contrast-enhanced harmonic sonography, hyper- or iso-enhancement were noted in 83.0% of RCCs, while hypo-enhancement were noted in 81.8% of AMLs (P<0.01). Statistically significant differences were noted between RCC and AML in the values of peak time (P=0.03), wash time (p= 0.02), peak intensity-basic intensity (P=0. 01), AT/R (△A tumor/△A renal) (P=0.00), k (P= 0.02), and Aok (P=0.02). Conclusions Contrast-enhanced sonography is useful in the differentia-tion of renal masses. Most RCCs are hyper- or iso-enhanced while most AMLs are hypo-enhanced. Time-intensity curves are helpful in differentiating RCC and AML.
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Objective To evaluate the role of endorectal ultrasonography with coupling gel intrarectal filling in preoperative T stage of rectal cancer. Methods One hundred and fifteen patients with rectal cancer underwent endorectal ultrasonography with coupling gel intrarectal filling. The preoperative T stage according to ultrasonic manifestations was compared with histological findings. Results The total diagnostic accordance rate of preoperative T stage by endorectal ultrasonography with coupling gel intrarectal filling was 89.57%. The sensitivity of ultrasonography for T1, T2, T3 and T4 was 93.10%, 61.11%, 96.61%, 88.89%, while the specificity was 97.67%, 96.91%, 89.29%, 99.06%, respectively. The overstaging rate of ultrasonography was 6.96% (8/115), and the understaging rate was 3.48% (4/115). Conclusion Endorectal ultrasonography with coupling gel intrarectal filling is a valuable diagnostic method for T stage of rectal cancer.
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Objective To prospectively evaluate the value of US,MSCT,EUS and MRI in the quantitative evaluation of the extent of pancreaticobiliary duct obstruction in pancreatic cancer.Methods Consecutive 68 patients with pancreatic carcinoma underwent US,MSCT,EUS and MRI before surgery.The diameter of extrahepatic bile duct and pancreatic duet were measured,and correlation analysis was performed with surgical specimens.Results Diameters of extrahepatic bile duct scaled by US.MSCT,EUS and MRI were(16.60±6.33)mm,(18.90±6.74)mm,(18.80±5.88)nun and(17.26±4.83)mm,and diameter measured from surgical specimens was(18.39±6.05)mm;the correlation among the four imaging examinations and the surgical evaluation were r=0.3839,P=0.1055;r=0.7113,P=0.0011; r=0.3759,P=0.0465;r=0.3376,P=0.2872,respectively. Kappa Values were 0.6285,0.7115,0.6661 and 0.7490,respectively.The diameter of pancreatic duct was(15.90±3.41)mm,(6.83 4-3.70)mm,(6.77±3.22)mm and(5.58±2.65)mm,and diameter measured from surgical specimens was(5.97±2.60)mm,the correlation among the four imaging examinations and the surgical evaluation were r=0.3584,P=0.2895;r=0.6148,P＜0.0001; r=0.7373,P＜0.0001;r=1.0746,P＜0.0001.Kappa values were 4.159,9.094,9.001 and 4.050.All of these parameters were in coherence with surgical findings.Condusions US could be used as the initial method in the assessment of extrahepatic and pancreatic duct obstruction.MRI and MSCT,combined with EUS if necessary,could be used to quantitatively evaluate the extent of pancreaticobiliary obstruction.
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Objectiye To improve the diagnosis and treatment of chromophobe renal cell carcinoma(CRCC). Methods The clinical dota of 25 patients of CRCC were reviewed.Thirteen were xmales and 12 were females and thirteen on the left and twelve on the right.The mean age was 51 years.Sixteen(64%)patients were asymptomatic.Gross hematuria,low back pain and discomfort and fever occurred in the other 9 patients.Laboratory investigations showed 1 patient had raised alanine aminotransferase and 1 had high erythrocyte sedimentation rate. Results B-ultrasound was mainly characterized by low echo renal mass with intact capsule and low blood flow signals.CT and MR of CRCC were typically well circumscribed,homogeneous(unenhanced CT was 70%,MR was 73%)with no necrosis and hemorrhage,homogenous enhancement(CT was 65%,MR was 67%)and mild enhanced(CT was 65%,MR was 67 %)renal mass.Twenty-two patients with tumors＞4.0 cm had radical nephrectomy and three with tumors≤4.0 cm had partial nephrectomy.The average diameter of tumors was 7.6 cm.The cross-sections of the tumors were grossly homogeneous,pale or dark brown solid.Light microscopy showed that the tumors were composed of trabeculae or sheets with voluminous cells in pale or eosinophilic cytoplasm.Immunohistochemical assay was positive of CK8 and negative of Vimentin.The pathologic TNM stages were 8 with T1a,9 with T1b,6 with T2 and 2 with T3a.Twenty-three patients were followed up.After mean follow-up of 28 months,22 cases were tumor free.One patient had pulmonary metastasis 58 months after operation and had no reaction to interferon-α and chemotherapy and died. Conclusions The majority of CRCC patients are asymptomatic and usually with low-stages.There are some features in CT and MR appearance of CRCC such as well circumscribed and homogenous.Surgical treatment should follow the treatment principles of renal cell carcinoma and carries an excellent prognosis for most localized tumors but there has been no effective measures to treat metastasis disease.The interval between operation and metastasis is relatively long and the time of follow-up should be prolonged in CRCC.
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<p><b>OBJECTIVE</b>To assess the effect of ultrasonography and computerized tomography (CT) in the diagnosis of large upper abdominal mass.</p><p><b>METHODS</b>Data from 43 cases that were clinically and pathologically confirmed were retrospectively analyzed and the effect of their preoperative ultrasonography and CT was compared.</p><p><b>RESULTS</b>Four of 10 (40 percent) cases of liver mass were diagnosed correctly using ultrasonic device, nineteen of 25 (76 percent) cases of adrenal gland mass and 2 of 4 cases of kidney mass. Two of 10 (20 percent) cases of liver mass were correctly diagnosed by CT, and so were 6 of 22 (27.2 percent) cases of adrenal gland mass. In 4 patients with spleen mass, neither ultrasonography nor CT diagnosis was correct.</p><p><b>CONCLUSION</b>Because upper abdomen organs are closely connected with each other, correct imaging localization of a large mass in this region is not easy. In this study, we compared the accuracy of ultrasonography and CT in diagnosing large upper abdominal masses, and found that ultrasonography works better for adrenal rather than liver or kidney. Neither ultrasonography or CT could accurately diagnose a large mass in the spleen.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Abdominal Neoplasms , Diagnosis , Diagnostic Imaging , Pathology , Diagnostic Errors , Retrospective Studies , Tomography, X-Ray Computed , UltrasonographyABSTRACT
<p><b>OBJECTIVE</b>To analyse the features of gray scale and colour Doppler sonography for carotid body tumor, to improve the sonographic diagnostic accuracy.</p><p><b>METHODS</b>A retrospective review was performed of sonographic material of 18 carotid body tumors by gray scale sonography and 11 by colour Doppler sonography, with comparison with other diseases which are frequently misdiagnosed as carotid tumor.</p><p><b>RESULTS</b>Well-defined, even weakly hypoechoic masses were noted on gray scale ultrasonogram at the carotid bifurcation, commonly broadening the carotid bifurcation and often encasing the common, external and internal carotid arteries. Disorderly non-echoic channel- like structures in the tumor were sometimes observed. Colour Doppler sonography showed abundant flow in the tumor. The non-echoic channel- like structures were vascularities. Seventeen masses diagnosed by ultrasound were proved to be carotid body tumors. The other was confirmed as a neurogenic tumor, giving an accuracy rate of 94.4% for sonographic diagnosis.</p><p><b>CONCLUSION</b>Sonographic examination of the carotid body tumor is highly accurate. It is safe and reliable.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Carotid Body Tumor , Diagnostic Imaging , Diagnosis, Differential , Retrospective Studies , Sensitivity and Specificity , Ultrasonography, Doppler, ColorABSTRACT
Objective To improve the recognition of the imaging appearances of inflammatory pseudotumors of the spleen (IPS), 3 cases with IPS were reported. Methods The US (n=3), CT (n=3) and MRI (n=1) findings of IPS were reviewed and correlated with the pathologic findings. Results On US, a well-defined solitary mass with heterogeneous echo texture was found in all 3 cases. A hyperechoic rim with associated acoustic shadowing was shown in 1 case. In all of the 3 cases in nonenhanced CT scanning, a well-defined hypoattenuated mass was found. One had a calcified egg-shell-like rim; On the venous/delayed phase of enhanced CT after contrast administration in 2 cases, slight/marked enhancement was shown. On nonenhanced MRI in 1 case, the mass was shown as heterogeneous hypointensity on T1- and T2- weighted images. Conclusion IPS should be included in the differented diagnosis of solitary mass lesion of spleen. The imaging findings depend on the variable proportions of fibrous and granulomatous components within the lesion. IPS was characterized by well-defined solitary mass on sonogram, delayed enhancement on enhanced CT, and hypointensity on T2 weighted MR images.