[Application value of superb microvascular imaging for diagnosis of different size renal solid tumors].

Objective: To discuss the diagnostic value of superb microvacular imaging (SMI) in renal solid tumors of different sizes. Methods: A total of 142 patients with 146 renal tumors detected by ultrasound in Tianjin Medical University Cancer Institute and Hospital from September 2017 to March 2019 were retrospectively analyzed. The maximum diameter of lesions was 0.8-7.3 cm, and patients were divided into the maximum diameter ≤3.0 cm group (61 patients, 64 lesions) and the maximum diameter >3.0 cm group (61 patients, 82 lesions). All of the tumors were separately evaluated by SMI and color Doppler flow imaging (CDFI) with Adler grade, vascular morphology and peripheral blood flow. Results: In the group with maximum diameter ≤3.0 cm, 50 lesions were malignant and 14 were benign. In the group with maximum diameter >3.0 cm, 62 lesions were malignant and 20 were benign. In the group with maximum diameter ≤3.0 cm, there were no significant differences in location, boundary, echo, homogeneity and small cystic area between malignant tumors and benign tumors (P>0.05). In the group with maximum diameter >3.0 cm, there were significant differences in echo, homogeneity and small cystic area between malignant tumors and benign tumors (P<0.05). For all of the benign tumors, there were no significant difference between CDFI and SMI in evaluating Adler grade, vascular morphology and peripheral blood flow (P>0.05). For malignant tumors with maximum diameter ≤3.0 cm, 43 lesions with Adler grade 2-3 were detected by SMI, which was higher than CDFI (32, P<0.05). There were 38 lesions with dendritic and irregular vascular morphology detected by SMI, which was higher than CDFI (7, P<0.05). The detected rate of peripheral annular or semi-annular blood flow in lesions was 80.0% (40/50), higher than CDFI (18/50, P<0.05). While in malignant tumors with maximum diameter >3 cm, the lesion with peripheral annular or semi-annular blood flow detected by SMI was 38, higher than 22 of CDFI (P<0.05). The area under the receiver operating characteristic (ROC) curve for CDFI and SMI diagnosis of renal solid tumors with the maximum diameter ≤3.0 cm was 0.627 (sensitivity: 54.0%, specificity: 71.4%) and 0.791 (sensitivity: 94.0%, specificity: 64.3%), respectively, with statistically significant difference (P=0.039). The area under the ROC curve for CDFI and SMI diagnosis of renal solid tumors with the maximum diameter>3.0 cm was 0.852 (sensitivity: 85.5%, specificity: 85.0%) and 0.860 (sensitivity: 91.9%, specificity: 80.0%), respectively, without statistically significance (P=0.858). Conclusions: SMI is superior to CDFI in detecting low-velocity blood flow and microvessels in both malignant and benign renal tumors, and can effectively improve the display rate of peripheral blood flow in malignant tumors. Otherwise, SMI can provide better diagnostic efficiency for renal tumors with the maximum diameter ≤3.0 cm.

[Application of superb microvascular imaging in focal liver lesions].

Objective: To investigate the ability of superb-microvascular imaging (SMI) to detect microvascular characteristics of focal liver lesions (FLLs) and analyze the relationship between vascular index (VI) and microvascular density (MVD) and Ki-67 levels. Methods: The imaging data of patients diagnosed as FLLs at Tianjin Medical University Cancer Hospital in 2018 were collected. A total of 166 FLLs patients were divided into non-hepatocellular liver cancer (non-HCC group, 96) and HCC group (70), respectively. The whole group of patients were subjected to color Doppler blood flow imaging (CDFI) and SMI examination. The patient's Adler's semi-quantitative grading (0 to 3 levels) and vascular morphological characteristics (a-f type) were analyzed. The receiver operating characteristic (ROC) curve was used to evaluate the detection ability of HCC with SMI and CDFI blood flow characteristics, The Pearson correlation analysis was used to evaluate the correlation between HCC patients VI and MVD and the Spearman correlation analysis was used to evaluate the correlation between VI and Ki-67. Results: In HCC group, SMI detected 50 cases of high-level blood flow (Adler's semi-quantitative grade 2 to 3) patients, higher than 22 cases of CDFI (P=0.033). In HCC group, SMI detected 52 cases of blood-rich mode (e, f type), higher than 18 cases of CDFI (P<0.001). In non-HCC group, the difference of blood flow characteristics detection between CDFI and SMI was not statistically significant. In HCC group, SMI detected 52 cases of rich blood supply patterns, which was higher than 14 cases of non-HCC group (P<0.001). The area under the ROC curve of SMI was 0.760 (sensitivity was 74.3%, specificity was 85.4%), and the SMI rich blood supply mode had the best diagnostic effect on HCC based on the blood-rich mode as the HCC diagnostic standard. In HCC group, VI was positively correlated with MVD and Ki-67 (r=0.698 and r=0.669, respectively, P<0.05). Conclusions: SMI has better detection ability than CDFI for HCC microvascular characteristics, HCC has more blood-rich mode than non-HCC. In HCC, VI is positively correlated with MVD and Ki-67 expression levels.

[Comparative analysis of superb microvascular imaging and contrast-enhanced ultrasound in diagnosis of small renal masses].

Objective: To explore the value of superb microvascular imaging (SMI) and contrast- enhanced ultrasound (CEUS) in differential diagnosis of small renal masses. Methods: A total of 84 patients with 86 lesions of renal masses were collected from October 2016 to March 2018 in Tianjin Medical University Cancer Institute and Hospital. There were 56 males and 28 females,aged from 29 to 76 years old,with an average age of (54±10) years old. These tumors were all examined by using SMI and CEUS. And the imaging diagnostic results were compared based on the pathological results. Adler semi quantitative analysis of blood flow grading of the tumors were evaluated in SMI,and the evaluation standard was as follows:0-1 grade was benign, 2-3 grade was malignant. Besides,the patterns and enhancement of the small renal masses were observed in CEUS. The main diagnostic criteria of malignant tumors were "fast forward" , "rapid regression" and "high perfusion" . Some special types of renal cell carcinoma were diagnosed by "slow in" , "rapid regression" and "hypo-perfusion" . Benign tumors were diagnosed by "slow in" , "slow down" and "hypo-perfusion" . Results: Among 86 cases, 76 cases were confirmed as malignant masses and 10 cases were confirmed as benign masses by pathological diagnosis. By SMI, Adler grade of 89.5% (68/76) malignant tumors were 2-3, Adler grade of 6/10 benign tumors were 0-1. By CEUS, 77.6% (59/76) of malignant tumors were "fast forward" , 82.9% (63/76) were "rapid regression" , 76.3% (58/76) were "high perfusion" ; 7/10 of benign tumors were "slow in" , 5/10 were "slow down" and 6/10 were "low perfusion" . The accuracy, sensitivity, specificity, positive predictive value, negative predictive value and AUC of SMI were 86.0%,89.5%, 60.0%, 94.4%,42.9% and 0.747 respectively. The values for CEUS were 89.5%, 92.1%, 70.0%,95.9%, 53.8% and 0.811 respectively.There was no statistical difference in diagnostic efficacy between CEUS and SMI (P=0.288). Conclusions: Although there is no statistical significance between SMI and CEUS, the accuracy, sensitivity and positive predictive value of SMI in the diagnosis of small renal masses are higher,which can clearly show micro-vessels and exquisitely detect the low-velocity blood flow in small renal masses. In brief,SMI provides a new method in the differential diagnosis of small renal masses.

[Analysis of the relationship between ultrasonographic features and cervical lymph node skip metastasis of papillary thyroid micro-carcinoma].

Objective: To investigate the correlation between cervical lymph node skip metastasis with ultrasonographic characteristics of papillary thyroid micro- carcinoma (PTMC). Methods: We reviewed ultrasonographic features of 385 primary PTMC and cervical lymph node metastasis, confirmed by pathology in Tianjin Medical University Cancer Institute and Hospital, to evaluate the efficacy of ultrasonography in the diagnosis of cervical lymph node metastasis of PTMC patients. The relationship between ultrasonographic features of primary lesions and skip metastasis of cervical lymph nodes was analyzed by χ(2) test and multiple factor Cox regression. Results: Among the 385 cases of PTMC patients with cervical lymph node metastasis, 231 cases were central lymph node metastasis alone, 31 cases were lateral cervical lymph node metastasis alone, 123 cases were both central and lateral cervical lymph node metastasis. Among the 354 cases without skip metastasis of cervical lymph nodes, 48 cases were level Ⅱ, 92 cases were level Ⅲ, 83 cases were level Ⅳ, 9 cases were level Ⅴ, 354 cases were level Ⅵ. Among the 31 cases with skipping metastasis of cervical lymph nodes, 12 cases were level Ⅱ, 14 cases were level Ⅲ, 14 cases were level Ⅳ, 1 case was level Ⅴ. The sensitivity and specificity of preoperative ultrasonography in the diagnosis of central cervical lymph node metastasis were 46.3% and 66.7%, respectively, and those of lateral cervical lymph node were 91.0% and 87.8%, respectively. Univariate analysis showed that the abutment/perimeter, diameter and location of PTMC were significantly associated with skip metastasis (P<0.05), multivariate analysis showed that abutment/perimeter and location of PTMC were significantly associated with skip metastasis (P<0.05). Conclusions: The sensitivity and specificity of preoperative ultrasound diagnosis for lateral cervical lymph node metastasis of PTMC is higher than that of central metastasis. PTMC with abutment/perimeter ≥1/4 and upper portion location are prone to skip metastasis.

[Contrastive analysis of ultrasonographic features of synchronous and heterochronic liver metastasis in patients with stromal tumor].

Objective: To investigate the ultrasonographic features of synchronous and heterochronic liver metastasis in patients with stromal tumors, and to elucidate the value of ultrasonic examination in follow-up surgery. Methods: A total of 1 516 patients with pathologically confirmed gastrointestinal stromal tumors (GISTs) and extra-gastrointestinal stromal tumors (EGISTs) were enrolled. The ultrasonographic features of primary lesions and liver metastases in a total of 46 cases with 95 liver metastases were analyzed. Results: 24 out of 46 cases had primary lesion in the small intestine, 14 in the stomach, 4 in the abdominal cavity, 1 in the colon, 2 in the esophagus, and 1 in the mesentery. The expression of CD117, Dog-1 and CD34were detected by immunohistochemical staining. The positive rate of CD117 was 100%, the Dog-1 was 95.7% and the CD34 was 69.6%. There were statistically significant differences in the maximum diameter, boundary and blood flow of primary tumors in 28 patients with synchronous liver metastasis and 18 patients with heterochronic liver metastasis (P=0.001, 0.022 and 0.036, respectively). Of the 95 liver metastases, 86 (90.5%) were located in the right lobe of the liver, 79 (83.2%) had clear boundaries, 75 (78.9%) were hypoechoic or isoechoic, 55 (57.9%) showed colored patterns, and 68 (71.6%) had no halo.11 liver metastases were cystic masses, 59 were solid masses, and 25 were mixed masses. There was a statistically significant difference in blood flow between 65 synchronous hepatic metastases and 30 heterochronic liver metastases (P=0.017). Conclusions: There were differences of the primary tumor ultrasonographic features between the synchronous metastasis group and heterochronic metastasis group. The ultrasonographic features of primary tumors and liver metastases have important clinical significance for the diagnosis, follow-up and treatment of malignant mesenchymal tumors.

[Clinicopathological and ultrasound characteristics of extranodal extension in metastatic papillary thyroid carcinoma patients].

Objective: To explore clinicopathological and ultrasound characteristics of extranodal extension in metastatic papillary thyroid carcinoma patients. Methods: 176 patients with papillary thyroid carcinoma who were diagnosed in Tianjin Medical University Cancer Institute and Hospital between March 2011 and March 2016 were identified and recruited in the study. Among the 176 patients, 59 patients were diagnosed with regional lymph nodes metastasis accompanied with extranodal extension (extranodal extension positive group), 117 patients were regional lymph nodes metastasis without extranodal extension (extranodal extension negative group). The clinicopathological and ultrasound characteristics between extranodal extension positive group and extranodal extension negative group were also discussed in this article. Results: 59 patients were diagnosed with regional lymph nodes metastasis accompanied with extranodal extension (extranodal extension positive group). Single lymph node region of extranodal extension was identified in 40 patients, while 19 patients were confirmed with more than 2 regions of extranodal extension. The most frequent extranodal extension were detected in region Ⅵ lymph nodes(32 cases), following by Ⅲ(25 cases), Ⅳ(16 cases), Ⅱ(11 cases). In the aspect of ultrasound characteristics, metastatic papillary thyroid carcinoma with extranodal extension showed a higher incidence of node matting[13.6%(8/59) vs 3.4%(4/117), P=0.022], micro-calcification[66.1%(39/59) vs 46.2%(54/117), P=0.016], cystic[28.8%(17/59) vs 12.8%(15/117), P=0.013], aspect ratio(L/S)<2[88.1%(52/59) vs 75.2%(88/117), P=0.032] and larger diameter(1.95±1.01 cm vs 1.63±0.94 cm, P=0.028). Logistic multivariate analysis demonstrated that node matting (P=0.025) and cystic (P=0.026) were independent risk factors for extranodal extension. Conclusion: Node matting, micro-calcification, cystic, aspect(L/T)>2 and larger diameter were associated with extranodal extension in metastatic papillary thyroid carcinoma patients, especially node matting and cystic, which might help topre-operative ultrasound diagnosis of extranodal extension.

[Impact of age and gender on ultrasound imaging and TI-RADS stratification in patients with thyroid nodules].

OBJECTIVE: To explore the application value of Thyroid Imaging Reporting and Data System (TI-RADS) stratification in diagnosing thyroid nodules in respect of the effect of age and gender. METHODS: A total of 684 patients with thyroid nodules, including 118 males and 566 females, were stratified into subgroups according to their age and gender, and the results of TI-RADS evaluation were compared with their pathological diagnosis. RESULTS: The sensitivity, specificity, and AUC of TI-RADS grading for malignant thyroid nodules in the males was 84.7%, 66.7%, and 0.803 (95% CI 0.709-0.897), respectively. In the females, the sensitivity and specificity were 80.8% and 65.0%, respectively, with an AUC of 0.812 (95% CI 0.758-0.849). There was no statistically significant difference between genders when using TI-RADS to determine the nature of thyroid nodules (P>0.05). In the patients aged 26-35 years, the sensitivity, specificity and AUC of TI-RADS classification for malignant thyroid nodules were 85.4%, 90.0%, and 0.915 (95% CI 0.818-0.987), respectively. In the patients aged 36-45 years, the sensitivity and specificity of TI-RADS classification for malignant thyroid nodules were 84.4% and 78.1%, respectively, with an AUC of 0.898 (95% CI 0.842-0.953). In the patients aged 46-55 years, the corresponding parameters were 79.7%, 71.4% and AUC 0.822 (95% CI 0.789-0.925), respectivey, while in those aged 56-65 years, the corresponding data were 75.6%, 60.0%, and AUC 0.729 (95% CI 0.576-0.785), respectively. The ROC curve of patients aged 56-65 years was statistically significantly different from those of patients aged 26-35, 36-45 and 46-55 years (P<0.05 for all). CONCLUSIONS: Patient gender has no significant effect on the results of TI-RADS classification, but age of the patients does. The age factor should be considered during ultrasound diagnosis of thyroid nodules using TI-RADS classification.

[Application of three-dimensional ultrasonography to assess the abdominal lymph node metastasis of gastric carcinoma].

OBJECTIVE: To investigate the clinical value of three-dimensional ultrasonography (3D-US) in the diagnosis of abdominal lymph node metastasis of gastric carcinoma. METHODS: A total of 95 patients with gastric cancer diagnosed by gastroscopy and confirmed by pathology after operation were examined by 3D-US preoperatively.The characteristics of gastric carcinoma was assessed using QLAB software. The tumor volume, lesion diameter and invasion depth of gastric cancer were measured. RESULTS: All of the 95 subjects were divided into two groups according to their lymph nodes status postoperatively: group N+ , 71 patients with lymph node metastasis; and group N0, 24 patients without lymph node metastasis.The quantitative 3D-US analysis and pathological results of these two groups were compared with each other. The tumor volume of group N+ was significantly higher than that of the group N0 [(26.02±6.87)cm(3) vs. (13.11±2.79)cm(3), P<0.05], the invasion depth was significantly deeper in the group N+ than in the group N0 [(1.57±0.29)cm VS (1.10±0.29)cm, P<0.05]. However, there was no significant difference of the lesion diameters between these two groups. Multivariate analysis showed that tumor volume and depth of invasion are independently correlated with lymph node metastasis. A cut-off value=16.8 cm(3) of the tumor volume for assessing the lymph node metastasis had a sensitivity of 90.1% and specificity of 95.8%, respectively, obtained by the area under the ROC curve. CONCLUSION: The tumor volume of gastric cancer can be obtained by 3D-ultrasonography, and the tumor volume can be considered as a new potential index to evaluate the abdominal lymph node metastasis of gastric cancer before surgery.