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Objective To explore the factors what may influence the formation of tophi by high frequency ultrasound.Methods The gouty patients who were experiencing an acute attack and were clinically diagnosed with gouty arthritis were divided into two groups:the tophi group (44 cases) and the no tophi group (101 cases) group,clinical data and ultrasound features of joints were collected.The differences of ultrasound features and clinical characteristics between the two groups were analyzed.Results ① Ultrasound features showed that synovitis (x2=8.479,P=0.004) and effusion (x2=9.740,P=0.002) of the first metatarsophalangeal joint (MTP1) were most frequently observed in the no tophi group;bone erosion of MTP1 (x2=9.593,P=0.003),double contour (DC) sign (x2=14.069,P=0.000) and bone erosion (x2=5.870,P=0.020) of ankle joint,DC sign of knee joint (x2=8.224,P=0.006) were most frequently observed in the tophi group.Hyperechoic aggregates of MTP1 (x2=9.649,P=0.003) were most frequently observed in no tophi group.(②) Logistic regression analysis showed that MTP1 was the first attacked joint [OR=9.725,95％CI(2.765,34.209),P=0.000],the multiple joints involved [OR=1.908,95％CI (1.190,3.057),P=0.007] and bone erosion of MTP1 [OR=4.339,95％CI(1.300,14.490),P=0.017] were the main risks of the formation of tophi.Synovitis of MTP1 often presented in no tophi patients [OR=0.108,95％CI(0.026,0.441),P=0.002].Conclusion High frequency ultrasound combine with clinical data is of great value for evaluating the development and treatment of gout.
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Objective To evaluate the value of contrast-enhanced ultrasound (CEUS) in detection of synovial hyperplasia in wrist joint of patients with rheumatoid arthritis (RA) and to explore the correlation with disease activity . Methods Thirty-nine RA patients with their wrist involved were examined by CEUS . The imaging features of synovitis were observed and the analysis of time intensity curve ( TIC ) was performed by contrast dynamic software . Some quantitative parameters were obtained from these fitting curves including basic intensity ( a0 ) ,increased intensity ( a1 ) ,descending slope ( a2 ) ,ascending slope ( a3 ) , timetopeak(TTP),peakintensity(PI),actualpeakintensity(PI-a0),arrivaltime(AT),andareaunder the curve ( AUC) . And the correlation between these parameters with clinical activity index was analyzed . Results 35 .9％ (14/39) synovitis showed a centripetal enhancement pattern supplied by ring-like or arc-shaped arterials peripherally while 64 .1％ (25/39) showed diffusely entire enhancement . All the lesions were heterogeneous enhanced ,87 .2％ (34/39) of which exhibited hyperenhancement . The detection rate of perfusion defects was 41 .0％ (16/39) . The disease activity in the diffuse enhancement group was higher than that in the centripetal enhancement group ( 4 .64 ± 1 .09 vs 3 .69 ± 0 .67 , P = 0 .005 ) . CEUS quantitative parameters a3 and ( PI-a0 ) were positively correlated with erythrocyte sedimentation rate ( ESR) ( r =0 .465 , P =0 .006 ;r =0 .325 , P =0 .043) ,however TTP had a negative relationship ( r = -0 .352 , P =0 .041) . Conclusions Active synovitis usually represents as a diffuse enhancement pattern . A higher a3 and PI ,and a shorter TTP indicate a higher disease activity . CEUS plays a great role in monitoring RA disease activity both from qualitative and quantitative aspect .
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Objective To study the application of strain ratio in differentiation of benign and malignant thyroid nodules through analyzing the influencing factors of the elastic strain ratio (SR) of thyroid nodules.Methods There were 468 patients with 476 thyroid nodules in present study, who came from the Nanjing Drum Tower Hospital from January 2012 to February 2014. SR characteristics of thyroid nodules were retrospectively analyzed, and the critical values were found by receiver-operating characteristic (ROC) curve. Then the size, echo, calcification, blood flow and the correlation between SR and pathology were analyzed by Pearson bivariate correlation analysis.Results The ROC curve showed that SR=0.5 was the best threshold value of SR in differential diagnosis of benign and malignant thyroid nodules. The diagnostic sensitivity, specificity, and the area under the curve were 84.8％, 85.9％, and 0.894, respectively. SR was negatively correlated with echo and calcification, while positively correlated with nodule size and blood flow (r=0.158,P=0.001;r=-0.209,P=0.000;r=-0.218,P=0.000;r=0.189,P=0.000;r=-0.519,P=0.000). The pathology of thyroid nodules had no correlation with nodule size and blood flow (r=-0.025,P=0.582;r=-0.070,P=0.126). The pathology was positively correlated with echo and calcification, while negatively correlated with age (r=0.265,P=0.000;r=0.185,P=0.000;r=-0.207,P=0.000;r=-0.519,P=0.000). Conclusion To improve the accuracy of diagnosis, the differential diagnosis of benign and malignant thyroid nodules should be based on two-dimensional ultrasound combined with SR and fine needle aspiration.
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Objective To evaluate the value of elastic strain ratio (SR) in ultrasound guided fine needle aspiration (US-FNA) of thyroid nodule.Methods A total of 222 thyroid nodules from 216 patients were reviewed and analyzed by Logistic regression of clinical data,2D ultrasound,and SR.The odds ratios of variables in the equation were compared to assess various variables,especially of SR in the diagnosis.The sensitivity,specificity,and accuracy of the SR method,US-FNA method,and combined method were calculated.Results Three statistically significant features finally entered the Logistic regression model,followed by SR,echo,and age according to the odds ratio.The sensitivity,specificity,and accuracy of the SR method,US-FNA method and combined method were 85.4％,82.1％,83.3％ ; 91.5％,82.1％,85.6％ ; 97.6％,94.3％,95.5％ respectively.Conclusions SR＜0.5 is the most important risk factor in differential diagnosis of thyroid malignant nodules from benign nodules.SR raises the sensitivity,specificity,and accuracy of US-FNA method and plays an important role in diagnosing thyroid nodules via US-FNA.
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Objective To evaluate the value of 2D ultrasound and elastic strain ratio (SR) in diagnosis of thyroid nodule by fine needle aspiration (FNA).Methods 196 thyroid nodules were analyzed retrospectively with 2D ultrasound,elastography and FNA results,pathology results as the golden standard.A receiver operating characteristic (ROC) curve was used to identify the best cut-off point of SR.The Logistic regression analysis was used to evaluate the variables effectiveness on age,nodule echo,calcification and SR.Tried to discuss how to use SR before or after US-FNA in diagnosis of thyroid nodule.Results The SR of the malignant nodules group was significantly different from the benign nodules group,and the best cut-off point was 0.5 with sensitivity 91.7％,specificity 90.2 ％ and accuracy 90.8 ％.The Logistic analysis results were SR,age,echo,calcification according to the odds ratio.SR can screened nodules without puncture necessary before FNA,and increase the FNA sensitivity,specificity and accuracy after FNA.Conclusions SR has good application value in diagnosis thyroid malignant tumor.SR can reduce unnecessary FNA and make a supplementary diagnosis of FNA.