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Objective:To investigate the value of Breast Ultrasound Report and Data System (BI-RADS) classification in diagnosis of special types of breast cancer.Methods:A total of 112 patients with special type of breast cancer (112 breast lesions) confirmed by pathology were analyzed by using BI-RADS ultrasound category in the Second Affiliated Hospital, Zhejiang University School of Medicine from August 2009 to August 2020. All patients underwent ultrasound before surgery. The breast lesions were evaluated by senior attending and junior resident according to BI-RADS ultrasound category respectively. Taking histopathological result as the gold standard, the sensitivity and accuracy of BI-RADS classification in the diagnosis of special types of breast cancer were calculated.The differences between different special types of breast cancer in terms of ultrasound characteristics and pathological features were analyzed. Kappa consistency test was used to evaluated the consistency of the results of two physicians.Results:In the 112 patients, pathological results showed that there were 20 cases of metaplastic carcinoma, 19 cases of invasive carcinoma with medullary features, 16 cases of differentiated carcinoma of apocrine gland, 12 cases of mucinous carcinoma, 12 cases of invasive micropapillary carcinoma, 10 cases of invasive papillary carcinoma, 6 cases of invasive lobular carcinoma and 17 cases of other special types of carcinoma. Among them, 4 cases (3.5%) were BI-RADS 3, 13 cases (11.6%) were BI-RADS 4a, 42 cases (37.5%) were BI-RADS 4b, 47 cases (42.0%) were BI-RADS 4c and 6 cases (5.4%) were BI-RADS 5. The accuracy and sensitivity of BI-RADS classification in diagnosis of special types of breast cancer was 96.43% and 96.43%, respectively. There was significant difference in BI-RADS grade among different special types of breast cancer ( P<0.05). Most lesions were characterized by hypoechoic with irregular shape and angular or microlobulated margin. The nodule size, boundary, echo and posterior echo in breast cancer with different special types showed significant differences (all P<0.05). There was a good consistency between the two physicians (Kappa=0.789). Conclusions:The ultrasonography features of different special types of breast cancer are different. BI-RADS classification has great value in diagnosis of special types of breast cancer.
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Objective:To evaluate the relationships among contrast-enhanced ultrasound (CEUS) features, molecular type, and biomarker expression of breast cancer.Methods:A retrospectively analysis of breast cancer patients confirmed by pathology were performed using Breast Imaging Report And Data System (BI-RADS) ultrasound category lesions in the Second Affiliated Hospital Zhejiang University School of Medicine from May 2020 to April 2021. All patients underwent conventional ultrasound and CEUS before biopsy and/or surgery. The relationships among BI-RADS category, quantitative and qualitative CEUS features and biomarker expression of breast cancer were evaluated.Results:All 149 patients with 149 breast lesions were included. The numbers of BI-RADS category 4A, 4B, 4C, and 5 were 8, 60, 49, and 32, respectively. Among them, the numbers of Luminal A like, Luminal B like (human epidermal growth factor receptor-2 (HER-2) positive), Luminal B like (HER-2 negative), HER-2 overexpression and triple negative type were 81, 29, 17, 15, and 7. No significant correlations were found among BI-RADS category, molecular types, and biomarker estrogen receptor (ER), progesterone receptor (PR), HER-2, and antigen Ki-67 (Ki-67) expression (all P>0.05). There were no correlations between quantitative or qualitative CEUS features and molecular types of breast cancer (all P>0.05). There were no correlations between qualitative CEUS variables and ER, PR, HER-2, and Ki-67 expression (all P>0.05). Ascending slope (AS) were negatively correlated with ER and PR expression( r=-0.40, P=0.01; r=-0.35, P=0.03). Descending slope (DS) were positively correlated with ER and PR expression( r=0.42, P=0.01; r=0.36, P=0.03). Arrive time (AT) were positively correlated with HER-2 expression( r=0.37, P=0.02). Conclusions:AS and DS are correlated with ER and PR expression.Arrive time (AT) is correlated with HER-2 expression. The quantitative variables of CEUS are helpful for evaluation of biomarker expression in breast cancer.
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Objective:To evaluate the value of ultrasound imaging in cervical lymphoma by constructing a prediction model of cervical lymphoma based on gray-scale ultrasonography radiomics.Methods:Retrospective analysis of ultrasonic sonographic data of 294 patients with cervical lymphadenopathy from June 2016 to June 2020 in the Affiliated Hangzhou Chest Hospital of Zhejiang University School of Medicine. The image features were extracted by imaging method, and the computer-generated random numbers were assigned to the training queue and the verification queue according to 7∶3 ratio. The minimum absolute contraction and selection algorithm (LASSO) were used to screen the optimal features, and support vector machine (SVM) was used to construct the imaging prediction model. The area under the ROC curve (AUC) was calculated to evaluate the performance of the prediction model.Results:Of the 294 cervical lymph nodes, 95 were lymphoma (32 Hodgkin′s lymphoma, 63 Non-Hodgkin′s lymphoma ), 199 cases were other lymph node diseases(34 metastatic lymph nodes, 67 lymph node tuberculosis, 98 reactive proliferative lymph nodes). A total of 107 features were extracted from gray scale ultrasound images, and after pretreatment and screening, 5 features were significantly associated with lymphoma. AUC, sensitivity, specificity and accuracy in the training and validation cohorts were 0.835, 85.1%, 85.7%, 85.5%, 0.793, 82.1%, 83.1%, 82.8%, respectively. The AUC, sensitivity, specificity and accuracy for a senior ultrasund doctor were 0.714, 65.3%, 79.9%, 75.2% in the idagnosis of cervical lymphoma.The diagnostic efficacy of the imaging prediction model was better than that of senior ultrasound doctor (AUC: 0.793 vs 0.714, Z=0.434), and the difference was statistically significant ( P<0.05). Conclusions:The imaging features based on gray scale ultrasound can provide more information on the diagnosis of lymphoma, and have good efficacy in the diagnosis of cervical lymphoma. Its diagnostic efficacy is better than that of the senior ultrasound attending physician.
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Objective:To assess the interobserver and inter-modalities agreement with two non-invasive diagnostic modalities of hepatocellular carcinoma in high-risk patients: contrast-enhanced ultrasound liver imaging reporting and data system (CEUS LI-RADS) and magnetic resonance imaging liver imaging reporting and data system (MRI LI-RADS).Methods:From August 2017 to August 2019, the CEUS and MRI data of patients at high risk for HCC from the Second Affiliated Hospital of Zhejiang University School of Medicine were analyzed retrospectively. A total of 217 lesions in 173 patients were classified according to CEUS LI-RADS v. 2017 or MRI LI-RADS v. 2018, by 4 blinded independent observers with more than 10 years of experience of CEUS or MRI. Interobserver and inter-modalities agreement was assessed with Cohen′s kappa.Results:The interobserver agreement was moderate and comparable for CEUS/MRI LI-RADS category (κ=0.606/0.603), the inter-modalities agreement was moderate for CEUS and MRI LI-RADS category (κ=0.564), LI-RADS 3, M, 4 and 5 by two imaging methods showed that the Kappa values were 0.739, 0.551, 0.734 and 0.592, respectively.Conclusions:The total inter-modalities agreement between CEUS and MRI LI-RADS categories is moderate, while the agreements of LI-RADS 3, 4 are strong, and LI-RADS M, 5 are moderate.
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Objective@#To explore the safety and clinical value of percutaneous ultrasound-guided core needle biopsy(PUS-CNB) and endoscopic ultrasound-guided fine needle aspiration(EUS-FNA) in pancreas mass.@*Methods@#Ultrasound-guided biopsy were performed in 109 cases who were difficult to diagnose to get specimens from the highly suspicious parts of the lesions by avoiding vessels. PUS-CNB were performed in 82 cases, EUS-FNA in 19 cases and both in 8 cases. The site and size of lesions were recorded preopeartion. Specimens with clear pathological diagnosis were considered as satisfactory materials. Specimens that were impossible to puncture due to the existence of high risk factors in the process of puncture were considered as unsuccessful biopsy. All patients were followed up after biopsy and complications were recorded.@*Results@#The satisfaction rate and success rate of PUS-CNB were 98.89% and 100%, the diagnostic accuracy and false negative rate were 97.78% and 2.22%. The satisfaction rate and success rate of EUS-FNA were 96.15% and 96.30%, the diagnostic accuracy and false negative rate were 80.77% and 23.81%. There were no serious complications such as pancreatic fistula, hemorrhage and needle transfer at the needle site after puncture.@*Conclusions@#Both PUS-CNB and EUS-FNA are safe and effective methods for the diagnosis of benign and malignant pancreatic lesions and have high clinical values. Reasonable selection of EUS-FNA and PUS-CNB can safely and reliably identify and diffentiate the benign and malignant pancreatic lesions.
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Objective To explore the safety and clinical value of percutaneous ultrasound‐guided core needle biopsy( PUS‐CNB) and endoscopic ultrasound‐guided fine needle aspiration( EUS‐FNA ) in pancreas mass . Methods Ultrasound‐guided biopsy were performed in 109 cases who were difficult to diagnose to get specimens from the highly suspicious parts of the lesions by avoiding vessels . PUS‐CNB were performed in 82 cases , EUS‐FNA in 19 cases and both in 8 cases . T he site and size of lesions were recorded preopeartion . Specimens with clear pathological diagnosis were considered as satisfactory materials . Specimens that were impossible to puncture due to the existence of high risk factors in the process of puncture were considered as unsuccessful biopsy . All patients were followed up after biopsy and complications were recorded . Results The satisfaction rate and success rate of PUS‐CNB were 98 .89% and 100% ,the diagnostic accuracy and false negative rate were 97 .78% and 2 .22% . T he satisfaction rate and success rate of EUS‐FNA were 96 .15% and 96 .30% ,the diagnostic accuracy and false negative rate were 80 .77% and 23 .81% . T here were no serious complications such as pancreatic fistula ,hemorrhage and needle transfer at the needle site after puncture . Conclusions Both PUS‐CNB and EUS‐FNA are safe and effective methods for the diagnosis of benign and malignant pancreatic lesions and have high clinical values . Reasonable selection of EUS‐FNA and PUS‐CNB can safely and reliably identify and diffentiate the benign and malignant pancreatic lesions .
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Objective To evaluate the diagnostic efficacies of contrast-enhanced ultrasound(CEUS) combined with BRAF V600E mutation detection in ultrasound-guided fine-needle aspiration cytology of thyroid nodules with atypia of undetermined significance . Methods A total of 129 thyroid nodules underwent the examinations of CEUS and BRAF V600E mutation were analyzed retrospectively . With surgical pathology as the gold standard ,ROC curve was used to investigate the diagnostic values of CEUS , BRAF V600E and the combination of the two methods . Results The sensitivity ,specificity and accuracy of CEUS and BRAF V600E gene detection for thyroid nodules with atypia of undetermined significance diagnosed by ultrasound-guided fine-needle aspiration biopsy were 86 .7％ ,83 .3％ ,85 .3％ and 72 .0％ , 100％ ,83 .7％ ,respectively . The sensitivity and accuracy of CEUS were higher than those of BRAF V 600E gene detection ( all P < 0 .001 ) ,however its specificity was lower than BRAF V 600E with statistically significance( P < 0 .001) ,those of the combined test of CEUS and BRAF V600E mutation analysis were 94 .7％ ,83 .3％ ,89 .9％ ,respectively . The combination of two methods had the highest diagnostic efficacy , with statistically difference ( P <0 .001) ,and the area under the ROC curve ( AUC) was higher than that for each test(0 .951 vs 0 .860 vs 0 .901) . Conclusions The combined test of CEUS and BRAF V600E mutation has a higher diagnostic efficacy for cytologically indeterminate thyroid nodules compared with CEUS or BRAF V600E mutation alone .
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Objective To assess the characterization and usefulness of contrast enhanced ultrasound (CEUS) to diagnose focal lesions of pancreas in comparison to contrast enhanced computed tomography (CECT).Methods 177 cases of focal solid lesions of the pancreas confirmed by pathology were collected.The enhanced patterns and diagnostic capability of CEUS were analyzed,and these results were compared with those of CECT.Results The diagnostic accuracies of ultrasound,CEUS and CECT were 61.6％ (109/177),89.3％ (158/177),and 92.1％ (163/177),respectively.There was no significant difference between the diagnostic accuracies of CEUS and CECT (P =0.071).The sensitivity,specificity,positive predictive value (PPV),negative predictive value (NPV),and accurate rate for CEUS were 90.9％,63.6％,73.8％,86.2％,82.5％ (the areas under the curve,AUC =0.820),and 89.8％,69.3％,76.7％,85.9％,84.7％ for CECT (AUC =0.847),respectively,when the hypo-enhanced was regarded as the cut value.No significant difference was found between these results from CEUS and CECT (P =0.071).Conclusions The diagnostic ability of CEUS in focal lesions of the pancreas is similar to that of CECT.
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Objective To compare the accuracy of double contrast-enhanced ultrasound (DCEUS) and multi-detector row CT (MDCT) in determining the gross classification in patients with gastric carcinoma (GC) preoperatively.Methods 239 patients with GC proved by endoscopic biopsy were included.DCEUS (intravenous microbubbles combined with oral contrast-enhanced ultrasound) and MDCT were performed preoperatively.The diagnostic accuracy of DCEUS and MDCT in determining gross classification was calculated and compared.Results The overall accuracy of DCEUS in determining the gross appearance of GC was higher than that of MDCT (85％ vs.80％,P ＜ 0.05);there was no significant difference in accuracy between DCEUS and MDCT for Borrmann Ⅰ and Ⅳ classification of AGC (x2 =1.175,P =0.323 for type Ⅰ;x2 =2.171,P =0.141 for type Ⅳ);the accuracy of DCEUS for EGC,Borrmann Ⅱ and Ⅲ classification of GC was higher than that of MDCT (x2 =16.307,P =0.000 for EGC;x2 =39.950,P =0.000 for type Ⅱ;x2 =35.770,P =0.000 for type Ⅲ).Conclusion DCEUS is valuable in determining gross typing of gastric adenocarcinoma preoperatively.
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Objective To compare the efficacy,safety and cost between ultrasound-guided percutaneous microwave ablation and surgical resection in patients with papillary thyroid microcarcinoma.Methods A total of 89 patients highly suspected papillary thyroid microcarcinoma by cervical ultrasonography were proved by ultrasound guided fine-needle aspiration biopsy in The Second Affiliated Hospital of Zhejiang University School of Medicine from January 2014 to February 2017.Totally 49 patients underwent microwave ablation(microwave group)while 40 patients underwent surgical resection(surgical group).T test was used to compare operation time,hospitalization expenses and the hospitalization time between the microwave group and the surgical group.Chi-squared test was applied to compare complications rate between the two groups.T test was used to compare the level of thyroid-related hormone before and after operation in the two groups.Results In the microwave group,the operation time,the hospitalization expenses and the hospitalization time were less [(55.85±5.05)min vs(25.73±9.46)min,(25435.91±5763.35)CNY vs(11307.48±3884.62)CNY and(6.78±3.03)d vs(2.92±0.78)d].These differences were statistically significant(t=-18.985,-13.084 and-7.747,P＜0.001).No severe complications occurred in the two groups.The difference of complications rate between the two groups was not statistically significant [6.1%(3/49)vs 10.0%(4/40),χ 2=-0.452,P=0.779].The level of 3'-triiodothyronine(FT3)and 4'-triiodothyronine(FT4)were higher after the operation in the microwave group,but these differences were not statistically significant.The level of FT3 and FT4 were lower [(4.5±0.50)pmol/L vs(3.90±0.72)pmol/L,(13.94±2.41)pmol/L vs(12.69±2.88)pmol/L],while the level of TSH was higher [(3.66±6.29)mIU/L vs(10.12±15.61)mIU/L] after operation in the surgical group.These differences were statistically significant(t=6.214,P＜0.001; t=2.808,P=0.008; t=-3.035,P=0.004).Conclusions Ultrasound-guided percutaneous microwave ablation is characterized by minimal invasion,good cosmetic effect,low cost and definite curative effect.It offered a new choice for the patients who refuse to undergo surgical resection.
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Objective@#To investigate the value of tumor perfusion parameter measured by using double contrast-enhanced ultrasound (DCEUS) QontraXt three-dimensional pseudocolor quantitative analysis to the therapeutic effect evaluation of preoperative neoadjuvant chemotherapy (NAC) in advanced gastric cancer (AGC) patients.@*Methods@#Eighty-nine AGC patients underwent 3 cycles of preoperative NAC (XELOX) followed by complete resection of lesion. The DCEUS QontraXt three-dimensional pseudocolor was performed one or two weeks before the NAC and operation were applied, respectively. The peak enhancement (PE), time to peak (TP), sharpness of the bolus (β) and area under the enhancement curve (AUC) of primary gastric tumor were measured by QontraXt three-dimensional pseudocolor quantitative analysis. These DCEUS parameters between respond and non-respond groups before and after NAC therapy were compared. The prediction accuracy of DCEUS to the therapeutic effect evaluation of preoperative NAC was determined by the receive operating characteristic (ROC) curves.@*Results@#Among 89 AGC patients, 52 patients responded to NAC therapy, while 37 patients resisted to NAC therapy. Twelve cases in respond group and 26 cases in non-respond group were mucinous carcinoma. Forty cases in respond group and 11 cases in non-respond group were non-mucinous carcinoma (P<0.05). In responder group, the PE and TP before NAC were (53.7±9.3)% and (14 521±2 667) ms, and (32.2±5.5)% and (17 235±1 898) ms after NAC. The ratio of changes of PE (ΔPE) and TP (ΔTP) were 0.43±0.17 and 0.36±0.14, respectively. In non-respond group, the PE and TP before NAC were (54.4±7.2)% and (13 869±3 247) ms, and (45.3±6.1)% and (15 127±1 423) ms after NAC therapy. The ratio of ΔPE and ΔTP were 0.24±0.20 and 0.22±0.12. The PE and TP after NAC, the ratio of ΔPE and ΔTP were significant different among these two groups (all of P<0.05). The ROC curves showed that the ratio of ΔPE in assessing the respond of gastric cancer patients to NAC was superior compared to other parameters (AUC=0.784, P=0.004). The optimal cut-off value of the ratio of ΔPE was 24% and its sensitivity and specificity to the therapeutic effect evaluation of NAC in gastric cancer were 82.7% and 64.9%.@*Conclusion@#DCEUS QontraXt three-dimensional pseudocolor quantitative analysis might be a novel, noninvasive and reliable method to evaluate the therapeutic effect of preoperative NAC in AGC patients.
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Objective@#To assess value of contrast enhanced ultrasound (CEUS) in TN staging of pancreatic cancer and compared with contrast enhanced computed tomography(CECT).@*Methods@#Seventy-eight cases with pancreatic cancer confirmed by pathology were enrolled in this study. All patients were examined using CEUS and CECT and staged according to the 8th guideline of pancreas tumors of AJCC. The diagnostic accuracies of CEUS in TN staging of pancreas tumors were compared with CECT.@*Results@#The diagnostic accuracies of CEUS in T staging and N staging of pancreatic cancer were 80.8%, and 78.2%, respectively. For CECT, the diagnostic accuracies in T staging and N staging were 88.5%, and 88.5%, respectively. There was no significant difference in the diagnostic accuracies between CEUS and CECT in T staging(χ2=1.56, P=0.21). The diagnostic accuracy of CEUS in N staging was significantly lower than that of CECT(χ2=3.86, P=0.04).@*Conclusions@#The diagnostic accuracy of CEUS in T staging of pancreatic cancer is similar to that of CECT, while in its N staging is lower than that of CECT.
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Objective@#To evaluate the diagnostic value of BRAF V600E mutation combined with shear wave elastography(SWE) for thyroid nodules of Bethesda Ⅲ diagnosed by fine-neddle aspiration(FNAC).@*Methods@#One hundred and seventeen thyroid nodules diagnosed as Bethesda Ⅲ in the department of ultrasound and confirmed by BRAF V600E gene detection, SWE examination and surgery were collected. BRAF V600E detection, SWE examination and both combined with pathological results were using to retrospective analysis.@*Results@#There were 75 benign nodules and 42 malignant nodules according to pathology. Sensitivity and negative predictive value of BRAF V600E combined with SWE were higher than single BRAF V600E mutation detection and SWE with statistically significant(P=0.01, 0.001; P=0.029, 0.01, respectively). There were no statistically differences between single BRAF V600E mutation detection and SWE for Bethesda Ⅲ nodules(P=0.483, 0.645).@*Conclusions@#BRAF V600E mutation detection combined with SWE can improve the sensitivity and negative predictive value in the diagnosis of Bethesda Ⅲ thyroid nodules.
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Objective To invesitigate the application of contrast enhanced ultrasound in differentiating focal organizing pneumonia( FOP) and primary lung cancer . Methods The imaging data of 23 cases with FOP ( FOP group) and 75 cases with primary lung cancer ( primary lung cancer group) on conventional ultrasound and contrast enhanced ultrasound were retrospectively analyzed . The size and arrival time( AT) of the contrast agent and the enhanced pattern of the two groups were compared . ROC curve was created to determine the most accurate AT for differential diagnosis . Results There was no significant difference in the gender and the size of nodule between the two groups ( P > 0 .05) . The age of FOP group was younger than that of primary lung cancer group ( P = 0 .013) . The AT of FOP group was much earlier than that of primary lung cancer group [ ( 6 .9 ± 2 .4) s vs ( 11 .4 ± 4 .3) s , P = 0 .000] . In FOP group ,20 patients ( 87 .0％ ) showed centrifugal enhancement , 2 patients ( 8 . 7％ ) showed centripetal enhancement and 1 patient ( 4 .3％ ) showed diffuse homogeneous enhancement ,respectively .In primary lung cancer group , 12 patients ( 16 .0％ ) showed centrifugal enhancement , 58 patients ( 77 .3％ ) showed centripetal enhancement ,2 patients ( 2 .7％ ) showed diffuse homogeneous enhancement and 3 patients ( 4 .0％ ) showed diffuse heterogeneous enhancement ,respectively . There was significant difference in the enhanced pattern between the two groups ( P = 0 .000) . Meanwhile ,8 patients in FOP group ( 34 .8％ ) and 31 patients in primary lung cancer group ( 41 .3％ ) had unenhanced region in the nodule ( P = 0 .574) . ROC analysis demonstrated that AT of 8 .5 s was the best cut-off value for the differential diagnosis . When AT earlier than 8 .5 was taken as diagnostic criterion for FOP ,the diagnositc sensitivity ,specificity were 74 .7％and 82 .6％ ,respectively . Conclusions Contrast-enhanced ultrasound can provide evidence in differentiating FOP from primary lung cancer .
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Objective To assess the therapeutic efficacy of subcutaneous transplantation pancreatic cancer in nude mice model with different size microbubbles. Methods Eighteen Balb/C nude mice with subcutaneous pancreatic carcinoma xenografts were divided into three groups:group A( 6 mice) did not received microbubbles and ultrasonic irradiation;group B(6 mice) received standard microbubbles and ultrasonic cavitation treatment;group C(6 mice) received up-sized microbubbles and ultrasonic cavitation treatment.Body weight and tumor size of nude mice were measured respectively at the time points of 0,7, 14,21 days after three times ultrasound radiation and before ultrasound treatment. Tumor volumes were calculated.Then the mice were sacrificed finally. Results There was no significant difference in tumor volumes among three groups before treatment( P > 0.05). Tumor volume continued to increase in all groups.Compared with group A,growth rate in group B and group C were lower,growth rate in group B was higher than that in group C,the difference was statistically significant( P < 0.05). There was no significant difference in the parameters of regional blood volume(RBV) and regional blood flow(RBF)among three groups before treatment( P > 0.05). RBV and RBF were decreased significantly after 3 days treatment in group B and group C( P <0.05),the RBV and RBF in group C were lower than those in group B,the differences were statistically significant( P <0.05).There was no significant difference in the body weight of nude mice before and after radiation among three groups during the follow-up period( P >0.05). Conclusions The cavitation effect of up-sized microbubbles is more efficient for mice subcutaneous pancreatic cancer xenograft tumor inhibition compared with standard microbubbles.
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Objective To evaluate the clinical value of contrast-enhanced ultrasound (CEUS) in predicting peripancreatic vascular invasion in pancreatic carcinoma through comparison with the findings on surgical exploration. Methods A total of 94 pancreatic cancer patients (confirmed by pathological examination) were included in this study. The CEUS data were analyzed retrospectively. The enhancement characteristics of lesions were documented. And the peripancreatic vascular invasion were analyzed. The main features of peripancreatic vascular invasion on CEUS were as followings: 1) peripancreatic arteries to be embedded, trapped in the tumor or surrounded by tumor, or to have intraluminal infiltration or luminal stenosis. 2)superior mesenteric vein, portal vein to be surrounded by tumor or to be narrow, distorted or occluded. The CEUS findings were compared with postoperative pathological results. Results 94 patients were diagnosed with pancreatic cancer by pathological examination, including 62 cases of pancreatic head carcinoma, 32 cases of pancreatic tail carcinoma. The imaging of contrast-enhanced ultrasound showed 6 cases (6.4%) of high uneven enhancement, 78 cases (83%) of low uneven enhancement, and 10 cases (10.6%) of heterogeneous enhancement in parenchyma phase, respectively. Twenty-five cases (26.6%) of CA invasion were detected by CEUS, while no invasion was observed in 69 cases (73.4%). Compared with pathological findings, the predictive sensitivity, accuracy, specificity, positive predictive value, negative predictive value of CEUS were 63.6%, 79.7%, 84.7%, 56.0%, 88.0%, respectively. Twenty-seven cases (28.7%) of SMA invasion were detected by CEUS, while no invasion were observed in 67 cases (71.3%). Compared with pathological findings, the predictive sensitivity, accuracy, specificity, positive predictive value, negative predictive value of CEUS were 66.6%, 77.6%, 80.2%, 44.0%, 91.0%, respectively. Besides, PV invasion features were found in 27 cases (28.7%), while 67(71.3%) cases were detected without invasion features. Compared with pathological findings, sensitivity, accuracy, specificity, positive predictive value, negative predictive value of CEUS in predicting PV invasion were 86.6%, 94.6%, 98.4%, 96.2%, 94.0%, respectively. Furthermore, CEUS detected SMV invasion in 26 cases (27.6%), while no invasion features in 68 (72.4%) cases. The sensitivity, accuracy, specificity, positive predictive value, negative predictive value for CEUS were 75.0%, 87.2%, 92.4%, 80.7%, 89.7%, respectively. Conclusion Due to its good diagnostic and predictive performance in detecting malignant pancreatic tumors and peripancreatic vascular invasion, CEUS could be served as an effective predictive modality in assessing the resectability of pancreatic carcinoma.
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<p><b>OBJECTIVE</b>To assess the value of ultrasonography in differential diagnosis of xanthogranulomatous cholecystitis (XGC) and wall-thickening type of gallbladder cancer (GBC).</p><p><b>METHODS</b>The clinical features and sonographic finding of 31 patients with XGC and 36 patients with wall-thickening type of GBC were retrospectively reviewed. The diagnosis of all cases was confirmed by pathological examination, and the ultrasonographic manifestations of the thickening of the gallbladder wall, intramural hypoechoic nodules, gallbladder mucosa line, gallbladder stones, biliary dilatation and gallbladder-liver boundary were compared between two groups.</p><p><b>RESULTS</b>There were significant differences in the intramural hypoechoic nodules, the continuous gallbladder wall mucosal line and dilatation of bile duct between XGC and GBC groups (all<0.05), while no statistically significant differences in the other sonographic features(all>0.05). In the six positive sonographic features of the XGC patients, the intramural hypoechoic nodules and the continuous mucosa line of the gallbladder wall had highest accuracy in the diagnosis of XGC(64.2% and 65.7%).</p><p><b>CONCLUSIONS</b>Intramural hypoechoic nodule and the continuous mucosal line are characteristic sonographic features of XGC, which can be used for the diagnosis of XGC.</p>
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Objective To evaluate the diagnostic performance of shear wave elastography ( SWE) with quantitative analysis and qualitative analysis of stiff rim sign between benign and malignant breast lesions . Methods Sixty-five female patients(65 lesions) underwent breast surgery or aspiration biopsy at the Second Affiliated Hospital of Zhejiang University were included . Elastic modulus of breast lesions and its rim in 1 mm ,2 mm ,3 mm were quantitive analyzed by SWE before surgery or aspiration biopsy ,Stiff rim sign was observed at the same time . Then ,the areas of receiver operating characteristic curves( AUC) of quantitative parameters of SWE and stiff rim sign were calculated to assess their clinical values in differentiating benign and malignant breast lesions ,and the correlation between them was evaluated . Afterwards , BI-RADS category was adjusted according to the optimal parameters combining the performance of SWE feature and conventional US features ,which could be used to evatulate the diagnostic effectiveness in differentiating benign and malignant breast lesions . Results The pathological results demonstrated 32 benign cases and 33 malignant cases in all patients .The maximum cut-off point of BI-RADS category was set between 4a and 4b .AUC value was 0 .935(0 .845-0 .981) ,while the sensitivity and specificity were 84 .8％ and 90 .6％ ,respectively .Maximum elasticity of 2 mm(E2Smax) area surrounding the malignant lesions were significantly higher than those in benign lesions ( P = 0 .001 ) . Among all quantitative SWE features ,E2Smax showed the highest AUC ( 0 .773) ,with sensitivity of 78 .8％ and specificity of 71 .9％ . In addition ,the stiff rim sign as qualitative parameter showed the highest AUC (0 .800) ,with sensitivity 81 .8％ and specificity 78 .1％ . The correlation coefficient between E2Smax and stiff rim sign was 0 .63 ,which was regarded as moderate correlation . the AUC of combination of stiff rim sign or E2Smax and conventional US features was 0 .937 and 0 .902 ,and the sensitivities were 81 .8％ , 93 .9％ ,the specificities were 90 .6％ and 75 .0％ . Conclusions SWE features ,especially E2Smax and hard rim sign are found moderate correlation ,and can improve a more accurate diagnosis in differentiating benign and malignant breast lesions combining with conventional US features .
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Objective To investigate the value of the automated breast volume scanning (ABVS) combined with virtual touch tissue imaging quantification (VTIQ) in the differential diagnosis of benign and malignant breast lesion.Methods Five hundred and seven patients with a total of 675 breast nodules were detected using ABVS and VTIQ technique.Of them,coronal plane imaging,SWVmax,SWVmin,and SWVmean (in m/s) for each nodule was acquired three days before operation or core needle biopsy.According to pathological results,the receiver operating characteristic (ROC) curve analysis was performed to evaluate the utility of the ABVS alone (retraction phenomenon on coronal plane),VTIQ alone and their combination in the diagnosis of breast lesions.Results Among all nodules,504 lesions were benign,and 171 were malignant.The rate of retraction phenomenon on coronal plane in malignant lesions was significantly higher than that in benign lesions (x2=279.89,P ＜ 0.001).The value of SWVmax,SWVmin,SWVmean (6.79± 1.71 m/s,5.03 ± 1.24 m/s,5.74± 1.36 m/s) in malignant nodules were higher than that of benign nodules [(3.41 ±1.51) m/s,(2.46± 0.87) m/s,(2.65 ± 1.23) m/s],the differences were statistically significant (t=32.43,33.85,26.77,all P ＜ 0.001).The AUC of malignant nodules for SWV (maximum,minimum,and average) were 0.922,0.934 and 0.937,respectively.With cut-off value of 4.045 m/s,SWVmean showed the best diagnostic performance.The sensitivity,specificity and accuracy of the retraction phenomenon on coronal plane,SWVmean and their combination in diagnosing malignant breast lesion were (39.65％,94.39％,95.78％),(97.50％,94.39％,95.53％) and (82.84％,93.51％,94.25％),respectively.And the SWVmean showed significant higher sensitivity than that of retraction phenomenon.The diagnostic capacity significantly improved when the two approaches were combined.Conclusion Both the retraction phenomenon on coronal plane and VTIQ had high diagnostic value,combining the two methods can improve the differential diagnosis ability for breast lesions.
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Objective To evaluate the diagnostic value of combined scoring of contrast enhanced ultrasound(CEUS) and ultrasonic elastography(UE) for thyroid imaging reporting and date system(TI RADS) 4 type nodules.Methods The CEUS and UE features of 520 TI RADS 4 type nodules were analyzed retrospectively.The scores of each nodule were evaluated and compared with pathological results and fine-needle aspiration cytology(FNAC).ROC curve was used to compare the diagnostic value of CEUS combined with UE or alone in the differential diagnosis of TI-RADS 4 nodules.Results The sensitivity,specificity,accuracy and area under the curve(AUC) of UE were 82.34％,82.25％,82.31％ and 0.841,respectively,when the cut off value of UE score was 4.The sensitivity,specificity,accuracy and AUC of CEUS were 78.63％,65.68％,74.42％ and 0.750,respectively,when the cut-off value of CEUS score was 4.The sensitivity,specificity,accuracy and AUC of CEUS combined with UE were 92.31 ％,75.74％,86.92％ and 0.885,respectively,when the cut-off value of combined score was 6.The sensitivity and accuracy of combined score were higher than those of two other methods,the difference was statistically significant (all P ＜ 0.05),the AUC of combined score was the biggest,it had the highest diagnostic efficacy.Conclusions Combined scoring of CEUS and UE can improve the accuracy in the differential diagnosis of TI-RADS 4 type nodules.
