Superb microvascular imaging is as sensitive as contrast-enhanced ultrasound for detecting synovial vascularity in rheumatoid arthritis.

Background: Detection of synovitis is essential for assessing rheumatoid arthritis (RA) activity and predicting prognosis. This study aimed to compare the diagnostic performance of superb microvascular imaging (SMI) with that of contrast-enhanced ultrasound (CEUS) in patients with RA in clinical remission. Methods: SMI and CEUS were applied to 63 patients with active RA and 48 patients with RA in clinical remission. Differences in positive synovial vascularity (SV) and its semi-quantitative scale were observed, and the correlations of SMI and CEUS results with C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and rheumatoid factor (RF) were analyzed. Results: For the 63 joints with active RA, the detection rates of SV as determined by SMI and CEUS were 90.5% (95% CI: 83.0-97.9%) and 93.7% (95% CI: 87.5-99.8%), respectively, with no significant difference observed between the two modalities (t=-1.137; P=0.260). There was good agreement between the two modalities in detecting positive blood flow (Kappa =0.784) and blood flow signal score (Kappa =0.792). For the 48 joints with clinical remission, the detection rates of SV determined by SMI and CEUS were 79.2% (95% CI: 67.2-91.1%) and 83.3% (95% CI: 72.4-94.3%), respectively, with no significant difference found between the two modalities (t=1.000; P=0.322). There was high consistency between the two modalities in detecting positive blood flow (Kappa =0.727) and blood flow signal score (Kappa =0.661). The vascularity scores of SMI and CEUS were positively correlated with CRP, ESR, and RF in the joints with active RA, but not in those with clinical remission. Conclusions: SMI is as sensitive as CEUS for detecting vessels in the synovium and displaying local SV in patients with RA who achieve clinical remission.

Differences among the Thyroid Imaging Reporting and Data System proposed by Korean, the American College of Radiology and the European Thyroid Association in the diagnostic performance of thyroid nodules.

The aim of this study was to evaluate the diagnostic performance of the Thyroid Imaging Reporting and Data System (TIRADS) in the forms proposed by Kwak (K-TIRADS), the American College of Radiology (ACR-TIRADS) and the European Thyroid Association (EU-TIRADS). A total of 846 thyroid nodules were evaluated by K-TIRADS, ACR-TIRADS and EU-TIRADS. All the ultrasound data were analyzed and classified according to the criteria of the three systems. In addition, we calculated the risk of malignancy and plotted receiver operating characteristic (ROC) curves. Moreover, the diagnostic efficacy for malignancy were compared. Of the 846 thyroid nodules, 316 were malignant nodules and 530 were benign nodules. The areas under the ROC curves of K-TIRADS (0.827) and ACR-TIRADS (0.817) were not significantly different (P=0.2425); however, they were greater than that of EU-TIRADS (0.758) (P=0.000). The sensitivity of K-TIRADS (94.94%) was higher than that of ACR-TIRADS (61.08%) or EU-TIRADS (58.86%) (P=0.000), while ACR-TIRADS (89.62%) and EU-TIRADS (83.21%) had higher specificity than K-TIRADS (50.75%) (P=0.000). Although all the K-TIRADS, ACR-TIRADS and EU-TIRADS have values in risk stratification for thyroid nodules, they cannot simultaneously achieve high sensitivity and high specificity. Further research should be performed to develop a TIRADS which is more suitable for the population of China.

Homogeneity Parameter in Contrast-Enhanced Ultrasound Imaging Improves the Classification of Abnormal Cervical Lymph Node after Thyroidectomy in Patients with Papillary Thyroid Carcinoma.

OBJECTIVE: To explore the conventional and contrast-enhanced ultrasound (CEUS) features of cervical lymph node metastasis (CLNM) in papillary thyroid carcinoma (PTC) patients postoperatively and analyze its pathological basis. MATERIALS AND METHODS: Conventional and CEUS were performed in 86 abnormal cervical lymph nodes (ACLNs) from 56 PTC patients who had received thyroidectomy. Then, fine-needle aspiration (FNA) was taken to confirm pathological results, a multivariate analysis was performed to correlate the sonographic features of the CLNM, and then an equation for CLNM was established. RESULTS: Fifty-four lymph nodes were confirmed to be metastasis of PTC by FNA. Intensity at peak time, homogeneity, and color flow patterns, cystic change, or microcalcification and echogenicity were significantly associated with CLNM. Multivariate analysis showed three strongest features (homogeneity, intensity of peak, and cystic change or calcification) to be significantly associated with the evidence of CLNM. Then, the equation was established with the following significant predictive factors: P = 1/1 + exp∑[-3.213 + 2.77 ∗ cystic or calcification + 0.13 ∗ CDFI patterns + 3.65 ∗ homogeneity + 2.43 ∗ intensity at peak time]. CONCLUSION: Depiction of a heterogeneous hyperenhancement of cervical lymph nodes within CEUS studies and cystic change or microcalcification in conventional ultrasound were identified as predictive for metastatic lymph node invasion, and the equation was more accurate for predicting CLNM compared to single B-mode ultrasound and CEUS feature.

Renal Masses: Evaluation with Contrast-Enhanced Ultrasound, with a Special Focus on the Pseudocapsule Sign.

The aim of this study was to analyze the diagnostic performance of contrast-enhanced ultrasound (CEUS) in differentiating between benign and malignant renal masses, with a special emphasis on the value of the pseudocapsule sign. A total of 163 consecutive patients with 163 renal masses were involved. The conventional ultrasonography and CEUS features were assessed. Sensitivity, specificity and the area under the receiver operating characteristic curve (Az) were calculated for qualitative CEUS, and a multivariate analysis was performed to analyze the correlation between the sonographic features and malignancy. Time to peak (TTP) and peak intensity (PI) were compared between benign and malignant renal masses for quantitative CEUS analysis in 72 of 163 patients. Intraclass correlations were calculated for variability in intensity and time parameters between qualitative and quantitative evaluation. Among all qualitative CEUS features, the pseudocapsule sign showed the highest Az (0.777; 95% confidence interval: 0.701-0.853) and yielded the highest sensitivity (67.4%) and specificity (88.0%); multivariate logistic regression analysis showed that the pseudocapsule sign and color Doppler flow imaging patterns were the two strongest independent predictors for malignancy. For quantitative CEUS analysis, higher PI and shorter TTP were found in malignant renal masses than those in benign ones. The Intraclass correlation coefficient values among qualitative and the quantitative assessments were 0.00 for time and 0.03 for intensity. The pseudocapsule sign offered the most efficient performance among all the qualitative and quantitative CEUS features.

Additional Value of Superb Microvascular Imaging for Thyroid Nodule Classification with the Thyroid Imaging Reporting and Data System.

Superb microvascular imaging (SMI) is an innovative vascular imaging technique for ultrasound (US). Compared with conventional color Doppler imaging (CDI) and power Doppler imaging (PDI), SMI can detect more blood flow in thyroid nodules. In this study, a total of 203 thyroid nodules (160 benign nodules, 43 malignant nodules) in 195 patients were assessed with the Thyroid Imaging Reporting and Data System (TI-RADS) published by the American College of Radiology in 2017) and SMI. With TI-RADS alone, 24 (15.0%), 76 (47.5%), 65 (40.6%) and 39 (24.4%) thyroid nodules were classified as TR2, TR3, TR4 and TR5, respectively. However, with the combination of TI-RADS and SMI, 31 (19.4%), 79 (49.4%), 44 (27.5%) and 49 (30.6%) thyroid nodules were classified as TR2, TR3, TR4 and TR5, respectively. The area under the receiver operating characteristic curves for the combination (0.952) was larger than that for TI-RADS alone (0.883) (Z = 3.478, p = 0.001). The efficiency of TI-RADS alone and the TI-RADS + SMI combination in diagnosing thyroid nodules was determined for all except TR2 nodules. Although no significant differences between the methods were observed for TR3 and TR5 thyroid nodules (p > 0.05), the diagnostic efficiency of TI-RADS + SMI for TR4 thyroid nodules was higher than that of TI-RADS alone for TR4 nodules (p < 0.05). This study indicated that the vascularity of thyroid nodules can be well characterized using SMI, and the combined use of gray-scale US and SMI can improve the diagnostic performance of TI-RADS for TR4 thyroid nodules.

The values of shear wave elastography in avoiding repeat fine-needle aspiration for thyroid nodules with nondiagnostic and undetermined cytology.

OBJECTIVE: To evaluate the value of shear wave elastography (SWE) in avoiding repeat fine-needle aspiration of thyroid nodules with nondiagnostic and undetermined cytology. METHODS: A total of 232 thyroid nodules with nondiagnostic (n = 132) and undetermined (n = 100) cytology underwent ultrasound (US) and SWE, followed by repeat ultrasound (US)-guided fine-needle aspiration cytology (FNAC). The final diagnosis was based on cytological or pathological findings. The US and SWE characteristics of benign and malignant nodules were compared using the χ2 -test. The receiver operating characteristic (ROC) curves of the thyroid imaging reporting and data system (TI-RADS) categories from the US and the EMean and ESD from the SWE were graphed, and the areas under the curves (AUCs) were compared using a Z test. RESULTS: There were significant differences between the benign and malignant nodules in terms of the echogenicity, shape, margin, calcification and TI-RADS categories (all P < 0.05). The differences were significant between the malignant and benign nodules for EMean [(34.57 ± 14.81) kPa vs. (19.18 ± 7.09) kPa] and ESD [(13.68 ± 13.01) kPa vs. (3.97 ± 2.58) kPa] (both P < 0.001). Though the difference in the AUCs of EMean (0.864) and ESD (0.876) was not significant (P = 0.745), they both had higher diagnostic performances in comparison with TI-RADS categories (0.762) (all P < 0.05). Moreover, ESD attained a sensitivity of 100% with a relatively higher specificity of 49.75% when its cut-off value was 3.3 kPa. CONCLUSIONS: Shear wave elastography is a promising imaging method for reducing repeat FNAC for benign thyroid nodules with nondiagnostic and undetermined cytology when using ESD as an index.

Is there an extraclinical value of automated breast volume scanner compared with hand-held ultrasound?: A pilot study.

The aim of this study was to investigate the extraclinical value of automated breast volume scanning (ABVS) in the diagnosis of breast tumor compare to hand-handle ultrasound (HHUS).One hundred twenty-four patients with breast tumor were performed HHUS and ABVS before operation. The research focused on whether there were newly found tumors or new findings on the coronal planes by using ABVS compared with HHUS. Then, the classification adjustments of breast imaging reporting and data system (BI-RADS) were made according to new findings on the coronal planes by using ABVS.There are totally 166 breast tumors found in 124 patients by HHUS, while 8 more were observed by ABVS, 4 of which were malignant and the rest were benign. The sensitivity and specificity of ABVS coronal plane findings were 37.0% and 92.5%, respectively. The area under receiver operating characteristic curve was 0.89 before the corrected classification versus 0.93 after the corrected classification, there were no significant differences (P > .05).There was no significant extraclinical value in differentiating diagnosis of malignant tumors and benign breast tumors by ABVS comparing to HHUS. However, those minimal lesions missed diagnosis could be found by ABVS with continuously automatic scanning.

Role of Contrast-Enhanced Ultrasound in Diagnosis of Thyroid Nodules in Acoustic Radiation Force Impulse "Gray Zone".

The aim of this study was to evaluate the clinical value of contrast-enhanced ultrasound (CEUS) in the diagnosis of thyroid nodules in the acoustic radiation force impulse (ARFI) "gray zone" (the shear wave velocity is in the range 2.5-3 m/s). ARFI was performed before thyroidectomy in 70 patients with 200 thyroid nodules, and then CEUS was performed in 40 thyroid nodules in the "gray zone." The accuracy of ARFI for the 200 thyroid nodules was 82% (164/200). The accuracy of ARFI for the 40 "gray zone" thyroid nodules was 70% (28/40), whereas the accuracy of CEUS for the "gray zone" thyroid nodules was 90% (36/40). There was a significant difference in accuracy (p < 0.05). CEUS has better accuracy for thyroid nodules in the ARFI "gray zone." CEUS supplemented ARFI in differential diagnosis of benign and malignant thyroid nodules.

Superb Microvascular Imaging-A new vascular detecting ultrasonographic technique for avascular breast masses: A preliminary study.

OBJECTIVES: Superb Microvascular Imaging (SMI) is a new vascular imaging technique detecting a slower velocity that color Doppler flow image (CDFI) cannot. The aim of this study is to evaluate the clinical value of SMI for detecting penetrating vessels (PVs) in avascular breast lesions. METHODS: Seventy-nine patients with 82 breast lesions were examined by conventional ultrasound and diagnosed as Breast Imaging Reporting and Data System (BI-RADS) level 3 or 4. CDFI detected no PVs; subsequently, Power Doppler (PD), Advanced Dynamic Flow (ADF), and SMI were performed to detect any PVs in the breast lesions. RESULTS: Compared with PD or ADF, SMI revealed significantly (P<0.01) higher median numbers of PVs in breast lesions. The area under the receiver operating characteristic curve was 0.914 before the corrected classification versus 0.947 after the corrected classification (P<0.05). CONCLUSIONS: SMI was helpful in the differential diagnosis of benign versus malignant in avascular breast lesions, especially those in BI-RADS category 4.

Acoustic radiation force impulse imaging (ARFI) for differentiation of benign and malignant thyroid nodules--A meta-analysis.

OBJECTIVES: Work-up of thyroid nodules remains challenging. Acoustic radiation force impulse imaging (ARFI)-generated shear wave elastography, which can measure quantitatively tissue stiffness (virtual touch tissue quantification) is used as a complement to conventional sonography for improving the diagnosis of thyroid nodules. This meta-analysis was performed to expand on a previous meta-analysis to assess the diagnostic power of ARFI in differentiating benign and malignant thyroid nodules. METHODS: The MEDLINE, PubMed, SpringerLink databases up to December 31, 2014, were searched. The pooled sensitivity, specificity, and summary receiver operating characteristic curve were obtained from individual studies with a random effects model. RESULTS: Sixteen studies that included a total of 2436 nodules in 2147 patients for ARFI studies were analyzed. The overall mean sensitivity and specificity of ARFI for differentiation of thyroid nodules were 0.80 (95% confidence interval [CI], 0.73-0.87) and 0.85 (95% CI, 0.80-0.90), respectively. A significant heterogeneity was found for both sensitivity and specificity of the different studies (P<0.001). The area under the curve for the ARFI was 0.91. CONCLUSIONS: ARFI has high sensitivity and specificity for identification of thyroid. This technique might be useful to select patients with thyroid nodules for surgery.

Inhibitory effects of subcutaneous tumors in nude mice mediated by low-frequency ultrasound and microbubbles.

The aim of the present study was to investigate the sonication effects of 21-kHz ultrasound (US) with microbubbles (MBs) on the subcutaneous prostate tumors of nude mice. In total, 15 tumor-bearing nude mice were divided into three groups: The control group, the low-frequency US group and the US+MB group. The MBs used were from US contrast agent SonoVue. The parameters of the US were as follows: 21 kHz, 26 mW/cm2 and a 40% duty cycle (2 sec on, 3 sec off) for 3 min, once every other day for 2 weeks. Color Doppler flow imaging, hematoxylin and eosin (HE) staining, immunoblotting and transmission electron microscopy (TEM) were used to evaluate the results. Following 2 weeks of treatment, the blood flow signal disappeared in the US+MB group only, and the tumor size was smaller when compared with the control and US groups. For the immunoblotting, the intensity of cyclooxygenase-2 and vascular endothelial growth factor in the US+MB group was lower compared with the other two groups. Tumor necrosis was present and the nucleus disappeared upon HE staining in the US+MB group. Upon TEM analysis, increased cytoplasmic vacuolation and dilatation of the perinuclear cisternae of the tumor cells were found in the US+MB group. In the control and US groups, the tumors had intact vascular endothelia and vessel lumens. However, lumen occlusion of the vessels was observed in the US+MB group. In conclusion, 21-kHz low-intensity US with MBs may result in vessel occlusion and growth inhibitory effects in the subcutaneous tumors of nude mice.

Comparative study of acoustic radiation force impulse imaging with real-time elastography in differential diagnosis of thyroid nodules.

The aims of this study were to evaluate whether acoustic radiation force impulse (ARFI) imaging of the thyroid gland and thyroid nodules yields reliable results and to compare the values of ARFI imaging with those of real-time elastography (RTE) in the differential diagnosis of thyroid nodules. RTE and ARFI were performed in 30 patients with 58 thyroid nodules. The results were compared with pathologic findings. Receiver operating characteristic curves were drawn to evaluate the diagnostic results. The area under the curve for RTE (0.78) was smaller than that for ARFI (0.94) (p < 0.01). ARFI imaging of thyroid tissue yields more reliable results than RTE.

Comparative study of automated breast 3-D ultrasound and handheld B-mode ultrasound for differentiation of benign and malignant breast masses.

The automated breast volume scanner (ABVS) represents a new technology for diagnosing breast masses. In this study, a total of 219 breast masses in 175 patients underwent both conventional handheld B-mode ultrasound (HHUS) and ABVS examinations, and the differences in the diagnostic values of the two modalities for benign and malignant breast masses were compared with the final pathologic findings. In addition, the diagnostic accuracy for breast masses with features including retraction phenomenon and hyperechoic rim in the coronal plane of the ABVS was evaluated. There were no differences between the ABVS and HHUS in terms of sensitivity (92.5% vs. 88.0%), specificity (86.2% vs. 87.5%), accuracy (88.1% vs. 87.2%), false-positive rate (13.8% vs. 12.5%), false-negative rate (11.8% vs. 7.5%), positive predictive value (74.7% vs. 75.6%) and negative predictive value (96.3% vs. 94.3%) (p > 0.05 for all). However, there were significant differences between the malignant and benign masses with respect to retraction phenomenon and hyperechoic rim in the coronal plane of the ABVS. For retraction phenomenon, both the specificity and positive predictive value of a malignant diagnosis reached 100%, and the accuracy and false-positive rate were 96.8% and 0, respectively; for the hyperechoic rim, the specificity, negative predictive value and accuracy of a benign diagnosis were 92.8%, 95.3% and 95.9%, respectively. Overall, ABVS is a promising modality for the clinical diagnosis of breast masses with retraction phenomenon and hyperechoic rim in the coronal plane, although the ABVS and HHUS do not differ in diagnostic accuracy for the differentiation of malignant or benign breast masses.