Associations of plaque morphology and location with Intraplaque neovascularization in the carotid artery by contrast-enhanced ultrasound imaging.

Objective: Intraplaque neovascularization (IPN) is a known indicator of plaque vulnerability, and is thus considered a predictor of stroke. The morphology and location of the carotid plaque may be correlated with plaque vulnerability. Therefore, our study aimed to examine the associations of carotid plaque morphology and location with IPN. Methods: A total of 141 patients with carotid atherosclerosis (mean age, 64.99 ± 10.96 years) who underwent carotid contrast-enhanced ultrasound (CEUS) between November 2021 and March 2022 were retrospectively analyzed. IPN was graded according to the presence and location of microbubbles within the plaque. The association of IPN grade with carotid plaque morphology and location was evaluated using ordered logistic regression. Results: Of the 171 plaques, 89 (52%) were IPN Grade 0, 21 (12.2%) were Grade 1, and 61 (35.6%) were Grade 2. IPN grade significantly associated with both plaque morphology and location, with higher grades observed among Type III morphology and common carotid artery plaques. Significant negative association was further shown between IPN grade and serum high-density lipoprotein cholesterol (HDL-C) level. Plaque morphology and location, and HDL-C remained significantly associated with IPN grade after adjusting for confounding factors. Conclusion: The location and morphology of carotid plaques were significantly associated with the IPN grade on CEUS, and therefore show potential as biomarkers for plaque vulnerability. Serum HDL-C was also identified as a protective factor against IPN, and may play a role in the management of carotid atherosclerosis. Our study provided a potential strategy for identification of vulnerable carotid plaques and elucidated the important imaging predictors of stroke.

Ultrasonographic evaluation of the rete testis thickness: a promising approach to differentiate obstructive from nonobstructive azoospermia.

This study aimed to evaluate the ability of rete testis thickness (RTT) and testicular shear wave elastography (SWE) to differentiate obstructive azoospermia (OA) from nonobstructive azoospermia (NOA). We assessed 290 testes of 145 infertile males with azoospermia and 94 testes of 47 healthy volunteers at Shanghai General Hospital (Shanghai, China) between August 2019 and October 2021. The testicular volume (TV), SWE, and RTT were compared among patients with OA and NOA and healthy controls. The diagnostic performances of the three variables were evaluated using the receiver operating characteristic curve. The TV, SWE, and RTT in OA differed significantly from those in NOA (all P ≤ 0.001) but were similar to those in healthy controls. Males with OA and NOA were similar at TVs of 9-11 cm 3 ( P = 0.838), with sensitivity, specificity, Youden index, and area under the curve of 50.0%, 84.2%, 0.34, and 0.662 (95% confidence interval [CI]: 0.502-0.799), respectively, for SWE cut-off of 3.1 kPa; and 94.1%, 79.2%, 0.74, and 0.904 (95% CI: 0.811-0.996), respectively, for RTT cut-off of 1.6 mm. The results showed that RTT performed significantly better than SWE in differentiating OA from NOA in the TV overlap range. In conclusion, ultrasonographic RTT evaluation proved a promising diagnostic approach to differentiate OA from NOA, particularly in the TV overlap range.

Carotid plaque score and ischemic stroke risk stratification through a combination of B-mode and contrast-enhanced ultrasound in patients with low and intermediate carotid stenosis.

Objective: The occurrence of ischemic stroke (IS) is closely related to the characteristics of carotid plaque (CP). Due to the effect of stroke risk stratification based on B-mode ultrasound (US) and contrast-enhanced ultrasound (CEUS) that has not been studied in patients with low and intermediate carotid stenosis, we construct and validate a CP score and ischemic stroke risk stratification (ISRS) using a combination of B-mode and CEUS, in order to provide new convenient strategies to stratify these patients to prevent stroke. Materials and methods: This retrospective study evaluated 705 patients with low and intermediate carotid stenosis who underwent B-mode and CEUS from November 2021 to April 2023. Qualitative B-mode and CEUS features of carotid plaques were analyzed using a univariable and multivariable logistic regression to construct the CP score. Then, we combined the CP score with Essen stroke risk score (ESRS) to develop ISRS. Results: This study included a total of 705 patients with low and intermediate carotid stenosis, of which 394 were symptomatic patients (with a mean age of 71.03 ± 10.48 years) and 311 were asymptomatic patients (with a mean age of 65.13 ± 10.31 years). Plaque echogenicity, plaque morphology, carotid intima-media thickness in B-mode US and intraplaque neovascularization grading and perfusion pattern in CEUS were significantly associated with IS. The ISRS incorporating these five predictors and ESRS showed good discrimination and calibration in both primary cohort [area under the curve (AUC), 0.91; Hosmer-Lemeshow test, p = 0.903] and validation cohort (AUC, 0.84; Hosmer-Lemeshow test, p = 0.886). Conclusion: We developed an effective and practical tool to identify and stratify patients with low and intermediate carotid stenosis, based on the CP score and ISRS estimation. Our study may provide new insights into managing patients with no indication of surgery.

The association between conventional ultrasound and contrast-enhanced ultrasound appearances and pathological features in small breast cancer.

OBJECTIVE: To investigate the association between ultrasound appearances and pathological features in small breast cancer. MATERIALS AND METHODS: A total of 186 small breast cancers in 186 patients were analyzed in this retrospective study from January 2015 to December 2019 according to pathological results. Forty-seven cases of axillary lymph node metastasis were found. All patients underwent radical axillary surgery following conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS) examinations. The association between ultrasound appearances and pathological features was analyzed using univariate distributions and multivariate analysis. Then, a logistic regression model was established using the pathological diagnosis of lymph node metastasis and biochemical indicators as the dependent variable and the ultrasound appearances as independent variables. RESULTS: In small breast cancer, risk factors of axillary lymph node metastasis were crab claw-like enhancement on CEUS and abnormal axillary lymph nodes on US. The logistic regression model was established as follows: (axillary lymph node metastasis) = 1.100×(crab claw-like enhancement of CEUS) + 2.749×(abnormal axillary lymph nodes of US) -5.790. In addition, irregular shape on CEUS and posterior echo attenuation on US were risk factors for both positive estrogen receptor and progesterone receptor expression, whereas calcification on US was a risk factor for positive Her-2 expression. A specific relationship could be found using the following logistic models: (positive ER expression) = 1.367×(irregular shape of CEUS) + 1.441×(posterior echo attenuation of US) -5.668; (positive PR expression) = 1.265×(irregular shape of CEUS) + 1.136×(posterior echo attenuation of US) -4.320; (positive Her-2 expression) = 1.658×(calcification of US) -0.896. CONCLUSION: Logistic models were established to provide significant value for the prediction of pre-operative lymph node metastasis and positive biochemical indicators, which may guide clinical treatment.

Qualitative analysis of contrast-enhanced ultrasound in the diagnosis of small, TR3-5 benign and malignant thyroid nodules measuring ≤1 cm.

OBJECTIVE: To evaluate the performance of contrast-enhanced ultrasound in the diagnosis of small, solid, TR3-5 benign and malignant thyroid nodules (≤1 cm). METHODS: From January 2016 to March 2018, 185 thyroid nodules from 154 patients who underwent contrast enhanced ultrasound (CEUS) and fine-needle aspiration or thyroidectomy in Shanghai General Hospital were included. The χ2 test was used to compare the CEUS characteristics of benign and malignant thyroid nodules, and the CEUS features of malignant nodules assigned scores. The total score of the CEUS features and the scores of the above nodules were evaluated according to the latest 2017 version of the Thyroid Imaging Reporting and Data System (TI-RADS). The diagnostic performance of the two were compared based on the receiver operating characteristic curves generated for benign and malignant thyroid nodules. RESULTS: The degree, enhancement patterns, boundary, shape, and homogeneity of enhancement in thyroid small solid nodules were significantly different (p＜0.05). No significant differences were seen between benign and malignant thyroid nodules regarding completeness of enhancement and size of enhanced lesions (p＞0.05). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the TI-RADS classification TR5 in diagnosis of malignant nodules were 90.10%, 55.95%, 74.59%, 72.22%, and 82.46%, respectively (area under the curve [AUC]=0.738; 95% confidence interval[CI], 0.663-0.813). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the total score of CEUS qualitative analysis indicators were 86.13%, 89.29%, 87.57%, 90.63%, and 84.27% respectively (AUC = 0.916; 95% CI, 0.871-0.961). CONCLUSION: CEUS qualitative analysis is superior to TI-RADS in evaluating the diagnostic performance of small, solid thyroid nodules. Qualitative analysis of CEUS has a significantly higher specificity for diagnosis of malignant thyroid nodules than TI-RADS. ADVANCES IN KNOWLEDGE: The 2017 version of TI-RADS has recently suggested the malignant stratification of thyroid nodules by ultrasound. In this paper we applied this system and CEUS to evaluate 185 nodules and compare the results with pathological findings to access the diagnostic performance.

Incorporation of contrast-enhanced ultrasound in the differential diagnosis for breast lesions with inconsistent results on mammography and conventional ultrasound.

OBJECTIVE: To identify the efficacy of contrast-enhanced ultrasound (CEUS) in re-evaluating masses with inconsistent Breast Imaging Reporting and Data System (BI-RADS) on mammography (MG) and conventional ultrasound (US). MATERIALS AND METHODS: A total of 637 breast lesions were evaluated with MG, US, and CEUS within 6 months and assessed as BI-RADS MG and US. CEUS was used as an additional screening to rerate BI-RADS US according to a five-point system. Lesions were divided into consistent or inconsistent group on the basis of BI-RADS MG and US assessment. The performance of MG, US, and CEUS in the overall and inconsistent group as well as the clinicopathological differences between consistent and inconsistent group were compared using Z test, Mann-Whitney U test, and t-test. RESULTS: The respective AUCs of MG and US were 0.742, 0.843 for overall group and 0.412, 0.789 for inconsistent group. The corresponding values of rerated CEUS BI-RADS were 0.958 and 0.950, which were significantly prior to those of MG and US (p < 0.001). Younger age, negative lymph node status, and dense breast were significantly associated with inconsistent group. CONCLUSION: Incorporation of CEUS to re-evaluate lesions can improve the diagnostic efficacy comparing to MG or US alone especially when disagreement occurred.

Shear-wave elastography: role in clinically significant prostate cancer with false-negative magnetic resonance imaging.

OBJECTIVES: To analyze the diagnostic value of adding SWE to MRI for the diagnosis of clinically significant prostate cancer with false-negative MRI results. METHODS: This was a retrospective study of 367 patients who underwent MRI, SWE, and prostate biopsy between March 2016 and November 2018 at the Shanghai Tenth People's Hospital. Serum prostate-specific antigen (PSA) and free PSA (fPSA) were measured preoperatively. Diagnostic value and accuracy was determined for MRI alone and MRI + SWE using the receiver operator characteristic curve (ROC) analysis. RESULTS: MRI misdiagnosed 17.9% (21/117) clinically significant prostate cancers, including 15 lesions in the peripheral zone and 6 in the central zone. Both qualitative and quantitative SWE could help detect 66.7% (10/15) significant prostate cancers with false-negative MRI, but there was no association with the Gleason score (p > 0.05). When considering the sextant of the peripheral zone, a significant association was not seen with histopathology in qualitative SWE (p = 0.071) and quantitative SWE (p = 0.598). Among age, PSA, fPSA, volume of the prostate gland, fPSA/PSA, and PSAD, only PSAD (p = 0.019) was associated with SWE results in patients with negative MRI. CONCLUSIONS: Adding SWE to MRI in patients with negative MRI for prostate examination could allow the correct diagnosis of additional patients and reduce the false-negative rate. KEY POINTS: • MRI plays an important role in clinically significant prostate cancers diagnosis. • SWE plays an important role in clinically significant prostate cancers with negative MRI. • Adding SWE to MRI in patients with negative MRI for prostate examination could allow the correct diagnosis of additional patients and reduce the false-negative rate.

Diagnostic value of acoustic radiation force impulse for BI-RADS category 4 breast lesions of different sizes.

OBJECTIVE: To determine the diagnostic value of combined conventional ultrasound (US) and acoustic radiation force impulse (ARFI) imaging for the differential diagnosis of BI-RADS category 4 breast lesions of different sizes. MATERIALS AND METHODS: From April 2013 to January 2015, 283 patients (with a total of 292 breast lesions) who underwent US and ARFI examination were included in this retrospective study. The SWV for the lesion and adjacent normal breast tissue were measured and the SWV ratio was calculated. VTI grade was also assessed. The lesions were separated into three groups on the basis of size, and two combinations of ARFI parameters (SWV + VTI and SWV ratio + VTI) were applied to reassess the BI-RADS categories. Diagnoses were confirmed by pathological examination after biopsy or surgery. ROC analysis was performed to assess the diagnostic efficiency of each method. The Z test was used to compare the difference between AUC of the two methods. RESULTS: Significant improvement was seen in the diagnostic performance of US with the use of the ARFI parameters SWV + VTI (77/179 [43.0%] of BI-RADS category 4A breast lesions were downgraded) and SWV ratio + VTI (64/179 [35.8%] of BI-RADS category 4A breast lesions were downgraded, including two malignant cases that were misdiagnosed as benign) (P < 0.01). The difference between the performances of the two combinations-SWV + VTI and SWV ratio + VTI-was significant only in breast lesions <10 mm in size, where the AUC of SWV ratio + VTI was significantly greater than the AUC of SWV + VTI (0.929 vs. 0.874; P < 0.01). CONCLUSION: Combination of US with ARFI can improve diagnostic performance and help avoid unnecessary biopsy in BI-RADS category 4 breast lesions. The combination of SWV ratio + VTI can improve BI-RADS classification of small lesions (<10 mm size).

Association of conventional ultrasound, elastography and clinicopathological factors with axillary lymph node status in invasive ductal breast carcinoma with sizes > 10 mm.

BACKGROUND: To evaluate whether conventional ultrasound, elastography [conventional strain elastography of elasticity imaging, acoustic radiation force impulse induced strain elastography of virtual touch tissue imaging, and a novel two-dimensional shear wave elastography of virtual touch tissue imaging quantification] and clinicopathological factors are associated with axillary lymph node metastasis in invasive ductal breast carcinoma with sizes > 10 mm. MATERIALS AND METHODS: We evaluated 150 breast lesions from 148 patients using the above methods and the clinicopathological factors. Univariate and multivariate logistic regression analysis were performed to determine the axillary lymph node metastasis risk factors. Diagnostic performance was evaluated using receiver operating characteristic curve analysis. RESULTS: Sixty-three tumors (42%) were node-positive, 87 (58%) were node-negative. Aspect ratio, virtual touch tissue imaging grade, shear wave velocity, pathological invasive tumor size, and histological grade maintained independent significance in predicting nodal involvement. The mean tumor shear wave velocitys (4.60, 6.49, 7.16) increased in proportion to metastatic node number (0, 1-3, ≥ 4, respectively; P < 0.001). For all tumors in this study, the cut-off shear wave velocity was 6.16 m/s and was associated with 64.1% sensitivity, 78.0% specificity and an area under the ROC curve of 0.799 (95% confidence interval, 0.731-0.868). CONCLUSIONS: Aspect ratio, virtual touch tissue imaging grade, shear wave velocity, pathological invasive tumor size and histological grade are independently associated with axillary lymph node metastasis in invasive ductal breast carcinoma with sizes > 10 mm.

Combination of conventional ultrasonography and virtual touch tissue imaging quantification for differential diagnosis of breast lesions smaller than 10 mm.

OBJECTIVE: To determine the value of combining conventional ultrasonography with virtual touch tissue imaging quantification (VTIQ) for differential diagnosis of breast lesions smaller than 10 mm. METHODS: A total of 98 breast lesions smaller than 10 mm were examined by conventional ultrasound and VTIQ using a Siemens ACUSON S3000 ultrasound machine. Pathologic diagnosis was established after surgery or fine needle biopsy. RESULTS: Malignant lesions were characterized by taller-than-wide shape, poorly circumscribed margin, and marked hypoechogenicity. The mean VTIQ shear wave velocity (SWV) value of malignant lesions was 4.88±1.87 m/s (range, 1.75-9.34 m/s), significantly higher than that of benign lesions (2.68±1.02 m/s; range, 1.18-4.67 m/s). The optimal cutoff SWV value was 3.27 m/s, with sensitivity, specificity, diagnostic accuracy, positive predictive value (PPV), and negative predictive value (NPV) of 86.20%, 95.65%, 92.86%, 89.29%, and 94.29%, respectively. The combination of SWV >3.27 m/s plus the US feature of poorly circumscribed margin had the highest sensitivity (93.33%) and specificity (100%) for diagnosis of malignant breast lesions. CONCLUSION: Features such as taller-than-wide shape, poorly circumscribed margin, and marked hypoechogenicity on conventional US, and SWV >3.27 m/s on VTIQ, are indicators of malignancy in breast lesions with diameter <10 mm. The combination of poorly circumscribed margin and SWV >3.27 m/s provides the highest specificity and diagnostic accuracy.

Diagnostic value of contrast-enhanced ultrasound and shear-wave elastography for breast lesions of sub-centimeter.

BACKGROUND: Contrast-enhanced ultrasound (CEUS) and shear-wave elastography (SWE) are used for diagnostic purposes. OBJECTIVE: Investigate the diagnostic value of CEUS and SWE for breast lesions of sub-centimeter diameter. METHODS: Sixty-two patients (mean age: 49.3±12.1 years) with 66 lesions (mean diameter, 8.1±1.5 mm) were analyzed. Conventional ultrasound (US), CEUS and SWE were undertaken. Pathologic specimens were obtained through biopsy or surgery. Lesions were measured in kilopascals. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were analyzed. RESULTS: For conventional US, the sensitivity was 92.31%, specificity 28.30%, PPV 24.00%, NPV 93.75%, and accuracy 40.90%, whereas those for SWE were 61.54%, 98.11%, 88.89%, 91.23%, and 90.91% (p = 0.000) and CEUS were 92.31%, 60.38%, 36.37%, 96.97%, and 66.67% (p = 0.001), respectively. For SWE + CEUS, the sensitivity was 61.54%, specificity 100.00%, PPV 100.00%, NPV 91.38%, and accuracy 92.42% (p = 0.000). There was a significant difference between US and CEUS (p = 0.004), but not for SWE or SWE + CEUS (p = 0.568; p = 0.205). For SWE + CEUS, there was a significant difference with SWE alone and CEUS alone (p = 0.000; p = 0.008). Between SWE and CEUS, the difference was significant (p = 0.031). CONCLUSIONS: SWE and CEUS could help to differentiate between malignant and benign breast lesions <1 cm in diameter.

Conventional US combined with acoustic radiation force impulse (ARFI) elastography for prediction of triple-negative breast cancer and the risk of lymphatic metastasis.

PURPOSE: To evaluate the combination of conventional ultrasound (US) and acoustic radiation force impulse (ARFI) elastography in predicting triple-negative breast cancer and the likelihood of lymphatic metastasis. MATERIALS AND METHODS: A total of 178 women presenting from May 2013 to September 2015 with pathologically proven triple-negative (n = 60) or hormone receptor (HR)-positive/human epidermal growth factor receptor 2 (HER2)-negative breast cancer (n = 118) were reviewed. Conventional US and ARFI imaging including Virtual touch tissue image (VTI) and Virtual Touch tissue Quantification (VTQ), were performed for each breast nodule. Parameters collected included patient age, lymph node involvement, histological grade, tumor subtype, appearance on conventional US, shear wave velocity (SWV) value, VTI score and the boundary on VTI. The ARFI findings were compared with the pathological findings. RESULTS: Younger age (P < 0.001), higher histological grade (P < 0.001), lymphatic metastasis (P < 0.001), more nodes involved (P = 0.001), larger tumor size (P = 0.008), regular shape (P = 0.032), high VTI score (P = 0.006), unclear VTI boundary (P = 0.033), SWV ≥3.51 m/s (P = 0.015) were significantly associated with triple-negative breast cancer. High VTI score (P = 0.004) and a high SWV ≥4.15 m/s (P = 0.002) were significantly associated with lymphatic metastasis. CONCLUSION: Conventional US combined with ARFI may be used to predict triple-negative breast cancer. Those cancers with higher SWV and the high VTI score have a higher likelihood of lymphatic metastasis.

A novel two-dimensional quantitative shear wave elastography to make differential diagnosis of breast lesions: Comprehensive evaluation and influencing factors.

BACKGROUND: Virtual touch imaging quantification (VTIQ), a form of shear wave elastography, may help in the diagnosis of breast lesions. OBJECTIVE: We aimed to evaluate the diagnostic performance of combined VTIQ and conventional ultrasound (US), and assess the factors influencing VTIQ measurement. METHODS: From September 2014 to December 2014, 162 patients with breast lesions were examined by US and VTIQ to assess shear wave speed (SWS) and morphological characteristics (lesion shape, orientation, margin and echo pattern). The sensitivity, specificity and accuracy of VTIQ, US and VTIQ+US for the diagnosis of breast lesions was evaluated in comparison to pathological results. Factors influencing deviations in SWS measurements were assessed by logistic regression. RESULTS: The SWS cut-off between malignant and benign lesions was 3.73 m/s. The sensitivity, specificity and accuracy were: 98.07%, 55.96%, and 69.57% for US; 76.92%, 78.89% and 78.26% for VTIQ; and 98.07%, 84.40% and 88.82% for US+VTIQ. The two factors that influenced the SWS results were the lesion margin (odds ratio [OR], 16.363; 95% confidence interval [CI], 3.220-29.020) and vascularity (OR, 6.712; 95% CI, 1.358-9.072). CONCLUSIONS: The lesion margin and vascularity could affect the measurement of SWS as well as the experience of examiner. However, VTIQ is still a reliable method that provides valuable information in the differential diagnosis of breast lesions, and may reduce unnecessary biopsies.

Comparison of Virtual Touch Tissue Quantification and Virtual Touch Tissue Imaging Quantification for diagnosis of solid breast tumors of different sizes.

BACKGROUND: Acoustic radiation force impulse imaging (ARFI) with Virtual Touch Tissue Quantification (VTQ) or Virtual Touch Tissue Imaging Quantification (VTIQ) measures shear wave velocity (SWV), which is proportional to tissue stiffness, a diagnostic parameter for malignancy. OBJECTIVE: To compare the performance of VTQ and VTIQ in diagnosing solid breast tumors. METHODS: Conventional ultrasound, VTQ and VTIQ were used to examine 246 solid breast tumors from 230 patients. Tumors were grouped according to size: <10 mm, 10-20 mm, >20 mm. Pathological diagnoses were via histological examination of biopsies. ROC curves were used to assess diagnostic performance and optimal cut-off points for VTQ and VTIQ. RESULTS: For all sizes, SWVVTQ and SWVVTIQ were higher for malignant versus benign tumors (P < 0.05). SWVVTQ and SWVVTIQ were both higher for tumors≥10 mm (P < 0.05). Areas under the ROC curves (diagnostic performance index; 0.860-0.952) did not differ significantly between VTQ and VTIQ. Optimal cut-off values for SWVVTQ and SWVVTIQ were higher for tumors≥10 mm. CONCLUSION: The diagnostic performance of VTQ and VTIQ was moderate to good for solid breast tumors. Although both methods have higher sensitivities in tumors≥10 mm, their overall diagnostic performance was similar for all sizes.

Diagnostic value of virtual touch tissue imaging quantification for benign and malignant breast lesions with different sizes.

The study was to explore diagnostic value of the virtual touch tissue imaging quantification (VTIQ) in distinguishing benign and malignant breast lesions of variable sizes. We performed conventional ultrasound and VTIQ in 139 breast lesions. The lesions were categorized into three groups according to size (group 1, ≤ 10 mm; group 2, 10-20 mm; and group 3, > 20 mm), and their mean, min, and max shear wave velocities (SWVs) were measured. Diagnoses were confirmed by pathological examination after surgery or needle biopsy. Receiver-operating characteristic curves (ROC) were constructed to determine the optimum cut-off values, calculate the area under curve (AUC), the sensitivity, specificity and accuracy for each velocity. For all groups, the mean, min, and max SWVs of malignant lesions were significantly higher than those of benign lesions (P < 0.05). The cut-off values of mean, min, and max SWVs were not significantly different among the three groups. In addition, the diagnostic performance of mean, min, and max SWV values is analogous, regardless of lesion size. In conclusion, VTIQ is a strong complement to conventional ultrasound, which is a promising method in the differential diagnosis of the breast lesions with different sizes. Further studies validate our results as well as reduce the number of unnecessary biopsies, regardless of size is warranted.

Parameters of prostate cancer at contrast-enhanced ultrasound: correlation with prostate cancer risk.

OBJECTIVE: to investigate the correlation between the parameters of prostate cancer (PCa) at contrast-enhanced ultrasound (CEUS) with PCa risk. METHODS: 84 patients (68 ± 8 years; range, 33-79 years) who had undergone CEUS were included. All the images were offline analyzed. Parameters (maximum intensity (IMAX), rise time (RT), time to peak (TTP) and mean transit time (mTT)) were recorded and compared with PSA level, Gleason score, clinical stages and PCa risk. RESULTS: Age was correlated significantly with PCa risk. RT and mTT of outer gland were associated with PCa risk. No significant correlation was found between PSA and CEUS enhancement parameters. Furthermore, with the exception of IMAX of inner gland and IMAX of outer gland, there were no significant differences of enhancement parameters in Gleason score groups and clinical stages groups. CONCLUSION: The enhancement parameters of PCa at CEUS may be used to predict PCa risk. And it is helpful for the choice of therapeutic options.

Relationship between parameters from virtual touch tissue quantification (VTQ) imaging with clinicopathologic prognostic factors in women with invasive ductal breast cancer.

OBJECTIVES: To investigate the association of shear wave velocity (SWV) and its ratio (SWV ratio) using virtual touch tissue quantification (VTQ) imaging with clinicopathologic prognostic factors in women with invasive ductal breast cancer. METHODS: 138 consecutive women with invasive ductal breast cancer, who were diagnosed by pathological examination, were recruited between September 2011 and October 2013. Clinicopathologic findings were investigated in each participant, including age, invasive size, lymph node status, histological grade, estrogen receptor (ER) expression, progesterone receptor (PR) expression and human epidermal growth factor receptor 2 (C-erbB-2) expression. SWV and its ratio (breast mass/adjacent breast tissue) were measured by the VTQ imaging, and univariate analysis and multivariate regression analyses were applied to investigate their relationship with all clinicopathologic abnormalities. RESULTS: In univariate analyses, large mass size (P < 0.001), lymph node involvement (P < 0.001), High histological grade (P = 0.001) and C-erbB-2 expression (P = 0.029) were significantly associated with SWV, whereas large invasive size (P < 0.001), lymph node involvement (P = 0.001) and high histological grade (P = 0.007) were significantly related to SWV ratio. Multiple linear regression indicated that invasive size was the strongest pathologic determinant of SWV and its ratio (P < 0001). CONCLUSION: SWV and its ratio by the VTQ imagining were significantly associated with clinicopathologic abnormalities, and may therefore provide prognostic information in patients with invasive ductal breast cancer.

Three-dimensional ultrasonography for the prediction of breast cancer prognosis.

PURPOSE: To determine the value of three-dimensional (3D) ultrasonography findings in the prediction of breast cancer prognosis. METHODS: The findings of 3D ultrasonography of 221 breast tumors were compared with pathologic prognostic factors, including tumor diameter, axillary lymph node status, histologic grade, estrogen receptor (ER) and progesterone receptor (PR) status, human epidermal growth factor receptor 2 (C-erb-B2), Ki-67 (cell proliferation marker) and p53 expression. RESULTS: The convergence sign was correlated to the tumor diameter, axillary lymph node status, histologic grade, ER and PR status. The convergence sign was found significantly more frequently in the small tumor group (diameter ≤ 2 cm; p=0.001), in breast tumors associated with axillary lymph node metastases (p=0.034), in lower histologic grade (grade I and II) (p=0.011) and in positive ER and PR expression group (p=0.049; p=0.023, respectively). The appearance of tumor margins was correlated to axillary lymph node status and C-erb-B2 expression, with most breast tumors associated with axillary lymph node metastases and negative C-erb-B2 expression exhibiting irregular margins on 3D ultrasonography (p=0.000; p=0.039). The homogeneity of the tumor boundary was detected significantly more frequently in breast tumors without axillary lymph node metastases (p=0.037). CONCLUSION: The 3D ultrasonographic characteristics of breast tumors, especially the convergence sign, may be used to predict breast cancer prognosis and provide a basis for making more accurate therapeutic decisions.

Multifunctional Bi2S3/PLGA nanocapsule for combined HIFU/radiation therapy.

A multifunctional organic-inorganic hybrid nanocapsule based on Bi2S3-embedded poly (lactic-co-glycolic acid) (PLGA) nanocapsule has been elaborately designed to combine the merits of both polymeric shell structure and Bi2S3 nanoparticles. Hydrophobic Bi2S3 nanoparticles were successfully introduced into the PLGA nanocapsules via a facile and efficient water/oil/water (W/O/W) emulsion strategy. The elastic polymeric PLGA shell provides the excellent capability of ultrasound contrast imaging to the Bi2S3/PLGA. Meanwhile, the potential of these microcapsules to enhance the high intensity focused ultrasound (HIFU) therapy was demonstrated. Importantly, this research provided the first example of both in vitro and in vivo to demonstrate the radiosensitization effect of Bi2S3-embedded PLGA hybrid nanocapsules against prostate cancer under external X-ray irradiation. Thus, the successful integration of the Bi2S3 and PLGA nanocapsules provided an alternative strategy for the highly efficient ultrasound guided HIFU/RT synergistic therapy.

Transperineal ultrasound-guided 12-core prostate biopsy: an extended approach to diagnose transition zone prostate tumors.

OBJECTIVE: Transperineal ultrasound-guided (TPUS) 12-core prostate biopsy was evaluated as an initial strategy for the diagnosis of prostate cancer, The distribution of prostate cancer lesions was assessed with zone-specific biopsy. METHODS: From January 2010 to December 2012, 287 patients underwent TPUS-guided 12-core prostate biopsy. Multiple cores were obtained from both the peripheral zone (PZ) and the transition zone (TZ) of the prostate. Participants' clinical data and the diagnostic yield of the cores were recorded and prospectively analyzed as a cross-sectional study. RESULTS: The diagnostic yield of the 12-core prostate biopsy was significantly higher compared to the 6-core scheme (42.16 vs. 21.6%). The diagnostic yield of the 10-core prostate biopsy was significantly higher compared to the 6-core scheme (37.6 vs. 21.6%). The 12-core scheme improved the diagnostic yield in prostates >50 ml (12-core scheme: 28.1% vs. 10-core scheme: 20.4%; p = 0.034). CONCLUSIONS: The 12-core biopsy scheme is a safe and effective approach for the diagnosis of prostate cancer. TZ biopsies in patients with larger prostates should be included in the initial biopsy strategy.