Ultrasound Viscosity Imaging in Breast Lesions: A Multicenter Prospective Study.

RATIONALE AND OBJECTIVES: To explore and validate the clinical value of ultrasound (US) viscosity imaging in differentiating breast lesions by combining with BI-RADS, and then comparing the diagnostic performances with BI-RADS alone. MATERIALS AND METHODS: This multicenter, prospective study enrolled participants with breast lesions from June 2021 to November 2022. A development cohort (DC) and validation cohort (VC) were established. Using histological results as reference standard, the viscosity-related parameter with the highest area under the receiver operating curve (AUC) was selected as the optimal one. Then the original BI-RADS would upgrade or not based on the value of this parameter. Finally, the results were validated in the VC and total cohorts. In the DC, VC and total cohorts, all breast lesions were divided into the large lesion, small lesion and overall groups respectively. RESULTS: A total of 639 participants (mean age, 46 years ± 14) with 639 breast lesions (372 benign and 267 malignant lesions) were finally enrolled in this study including 392 participants in the DC and 247 in the VC. In the DC, the optimal viscosity-related parameter in differentiating breast lesions was calculated to be A'-S2-Vmax, with the AUC of 0.88 (95% CI: 0.84, 0.91). Using > 9.97 Pa.s as the cutoff value, the BI-RADS was then modified. The AUC of modified BI-RADS significantly increased from 0.85 (95% CI: 0.81, 0.88) to 0.91 (95% CI: 0.87, 0.93), 0.85 (95% CI: 0.80, 0.89) to 0.90 (95% CI: 0.85, 0.93) and 0.85 (95% CI: 0.82, 0.87) to 0.90 (95% CI: 0.88, 0.92) in the DC, VC and total cohorts respectively (P < .05 for all). CONCLUSION: The quantitative viscous parameters evaluated by US viscosity imaging contribute to breast cancer diagnosis when combined with BI-RADS.

Ecoendoscopia en la estadificación del cáncer de esófago y de estómago / Endoscopic ultrasound for staging of esophageal and gastric cancers

RESUMEN Antecedentes: tanto el adenocarcinoma gástrico (ACG) como el esofágico (ACE) son una de las princi pales causas de muerte por cáncer digestivo en el mundo, si bien la ecoendoscopia (EUS) ha demos trado ser una herramienta valiosa en la estadificación preoperatoria del ACG y ACE en casos seleccio nados. Objetivo: evaluar la utilidad de la EUS en la estadificación de ACG y ACE para seleccionar los pacientes candidatos a neoadyuvancia, comparándola con la etapa previa a la implementación de la EUS en un centro quirúrgico de la Argentina. Material y métodos: se incluyó una serie consecutiva de pacientes con ACE y ACG durante el período 2013- 2019. Se excluyeron pacientes con criterios de irresecabilidad y operados de urgencia. Se dividió la muestra en cuatro grupos: G1 y G2 ACE con y sin EUS, G3 y G4 ACG con y sin EUS, respectivamente. Se evaluaron variables clínicas, anatomopatológicas y de supervivencia en todos los grupos. Resultados: se incluyó un total de 89 pacientes, de los cuales 40 fueron por ACE, 30 pacientes perte necieron a G1 vs. 10 a G2. Se analizaron 49 pacientes con ACG, 20 pertenecieron a G3, mientras que 29 a G4. En los pacientes estadificados con EUS, en G1, 23 pacientes realizaron neoadyuvancia (76 %) versus 2 pacientes en G2 (20 %) p: ≤ 0,005. En G3 realizaron quimioterapia perioperatoria 8 pacientes (40 %), mientras que en G4, solo dos pacientes (7 %) p: ≤ 0,005. En cuanto al análisis de metástasis ganglionares (G+) en la anatomía patológica, tuvimos un aumento esperable en los pacientes no esta dificados con EUS en cáncer esofágico donde, en G1, el 30% tuvieron G+ versus 60% en G2 p: ≤ 0,005. En G3 y G4 se observó un 45 % de G+. Con un tiempo promedio de seguimiento de 36 meses (6-72), si bien no observamos una diferencia significativa en cuanto a supervivencia global ni recurrencia, observamos una tendencia a favor de los pacientes estadificados con EUS. Conclusión: la utilización de la EUS en la estadificación preoperatoria de ACG y ACE es importante. Aunque su uso puede ser un desafío en muchos centros de la Argentina, futuros esfuerzos son necesa rios para incluir) este estudio en casos seleccionados en la estadificación de tales pacientes.

ABSTRACT Background: Gastric adenocarcinoma (GAC) and esophageal adenocarcinoma (EAC) are one of the leading causes of mortality from gastrointestinal cancer worldwide. Endoscopic ultrasound (EUS) has proved to be a valuable tool for preoperative staging of GAC and EAC in selected cases. Objective: The aim of this study was to evaluate the usefulness of EUS for staging of EAC and GAC and selecting patients who are candidates for neoadjuvant therapy, as compared with the previous stage before the implementation of EUS, in a surgical center in Argentina. Material and methods: Consecutive patients with EAC and GAC between 2013-2019 were included. Patients with criteria of unresectable cancer or who underwent emergency surgery were excluded. The sample was divided into four groups G1 and G2 (EAC with and without EUS, respectively) and G3 and G4 (GAC with and without EUS, respectively). The clinical and anatomopathological variables and survival were evaluated in all the groups. Results: A total of 89 patients were included, 40 with EAC (30 in G1 and 10 in G2, and 49 with GAC, 20 in G3 and 29 in G4. Of the patients undergoing EUS staging in G1, 23 (75%) received neoadjuvant therapy vs. 2 patients in G2 (20%) (P ≤ 0.005). Eight patients (40%) in G3 and 2 (7%) in G4 received perioperative chemotherapy (P ≤ 0.005). Lymph node metastases were observed in 9 (30%) of surgical specimens of EAC in G1 and in 60% in G2 (P ≤ 0.005), and in 45% in G3 and G4. After a mean follow-up of 36 months (6-72), we observed a non-significant trend toward higher overall survival and disease-free survival in patients undergoing EUS staging. Conclusion: EUS for preoperative staging pf EAC and GAC is a useful tool. Although the use of EUS use may be a challenging task in many centers in Argentina, future efforts are needed to include this test in selected cases for staging patients with these types of cancers.

The accuracy of sonoelastography in fatty degeneration of the supraspinatus: a comparison of magnetic resonance imaging and conventional ultrasonography.

OBJECTIVE: Sonolastography (SE) technique is one of the new functional ultrasonic imaging techniques, which was developed in the past few years and can obtain the distributions of elasticity in tissues. Using magnetic resonance imaging (MRI) as the standard of reference, the purpose of this study was to evaluate the ability of SE to assess the fatty degeneration of suprasupinatus (SSP) and to compare it to the MRI and the conventional ultrasonography (US) findings. MATERIALS AND METHODS: The institutional review board approved the study, and a retrospective analysis between January 2013 and September 2013 was performed on 101 shoulders of 98 consecutive patients using MRI, US, and SE for the evaluation of shoulder lesion. Oblique sagittal images of SSP were obtained using SE. The SE images were evaluated by reviewers using an experimentally proven color grading system. RESULTS: When comparing SE to standard MRI findings, the mean sensitivity of SE was 95.6 %, the specificity 87.5 %, and the accuracy 91.1 %. The interobserver reliability of the SE findings was "almost perfect agreement" with a weighted kappa coefficient of 0.81. On comparing MRI with the SE findings, the grades of MRI and SE have a positive correlation (r = 0.855, P = <0.001). Furthermore, the grades of US and SE also have a positive correlation (r = 0.793, P = <0.001). CONCLUSION: SE is valuable in the quantitative assessment of the severity of the fatty atrophy of the supraspinatus and has an excellent accuracy, an excellent correlation with MRI and the conventional US, and an excellent interobserver reliability.

Correlation between radius and respiration variation of inferior vena cava and hemodynamicmonitoring values of pulse-indicated continuous cardiac output(PiCCO)in septic shock pigs / 中华急诊医学杂志

Objective To explore the correlation between radius and respiratory variation of inferior vena cava(IVC)and hemodynamic monitoring values of pulse-indicated continuous cardiac output(PiCCO)in septic shock pigs.Methods A total of 8 pigs were used to establish animal model of septic shock by intravenous infusing LPS(100 μg/kg),and fluid resuscitation was followed with normal saline.Ultrasound was used to measure the maximum radius(IVCmax)and minimum radius(IVCmin)of IVC,and respiration variation index(RVI)was calculated at basic status,septic shock,1 hour and 6 hours after fluid resuscitation,respectively.Respiratory variation index of IVC were calculated as:RVI =(IVCmax-IVCmin)/ IVCmax × 100％.Hemodynamic monitoring values,including ITBV,GEDV,SVV and CI of PiCCO,were recorded at the same time.Radius and RVI of IVC and PiCCO values between before and after fluid resuscitation were compared by LSD-t test.Correlation between radius and RVI of IVC andhemodynamic monitoring values were calculated by Pearson correlation coefficient.Results Compared with the moment of septic shock,IVC IVCmin,GEDV,ITBV and CI at 1 after hour fluid resuscitation were larger(P ＜ 0.01)and SVV and IVCrvi were smaller(P ＜ 0.01).Compared with the moment of septic shock and 1 after hour fluid resuscitation,IVC[VCmin,GEDV,[TBV and CI at 6 hours after fluid resuscitation were larger(P ＜ 0.01)and SVV and IVCrvi were smaller(P ＜ 0.01).IVCmax correlated with SVV(P=0.024)and it failed to correlate with GEDV,ITBV and CI.IVCmin correlated with GEDV(P=0.003),ITBV(P =0.001),SVV(P =0.009)and CI(P =0.015),respectively.RVI was correlated withGEDV(P＜0.01),ITBV(P＜0.01),SVV(P=0.007)and CI(P＜0.001),respectively.Conclusions Radius and RVI of IVC was correlated with hemodynamic monitoring values of PiCCO.It can serve as a parameter to rapidly estimate the blood volume.

Ultrasonographic diagnosis and clinical prognosis of fetal congenital cystic adenomatoid malformation of the lung / 中国医学影像技术

Objective To explore the diagnostic value of ultrasonography of fetal congenital cystic adenomatoid malformation of the lung (CCAM), and to predict the prognosis according to ultrasonographic findings. Methods The chest of 19 fetus with CCAM was multi-sectionally scanned with two-dimensional ultrasonography. The position, appearance and size of mass were observed, and complications were continuously followed. Results CCAM was pathologically confirmed in 13 fetus after induced abortion. One neonatal died, while CCAM in other 5 fetus disappeared before 36 weeks. The mass of typeⅠCCAM became smaller and smaller, and eventually disappeared. The echo-free spaces in typeⅡbecame smaller and fewer, and the strong echo weakened to the same level as normal lung. For type Ⅲ, the echo of solid mass weakened to the same level as normal lung, or transformed to typeⅡ gradually, and finally recovered to normal echo of lung as the gestational age increased. During follow up, there were 10 fetus (10/19, 52.63%) that lung adenoma cyst increased with the gestational age increased, and the heart, mediastinal shifted, pleural effusion, and (or) fetal edema were observed. Conclusion Ultrasound examination is a reliable method for the diagnosis of CCAM, and enable to predict the prognosis of the affected fetuses. If heart and mediustinum displacement, pleural effusion, hydrops fetal or other abnormalities exist, it's necessary to terminate the pregnancy.

Diagnostic yield of tissue sampling using a bite-on-bite technique for incidental subepithelial lesions.

BACKGROUND/AIMS: Techniques for endoscopic evaluation of gastrointestinal subepithelial lesions include conventional endoscopy, jumbo biopsy, endoscopic ultrasonogrphy (EUS), EUS-guided fine needle aspiration, and endoscopic submucosal resection. However, these procedures have many limitations, such as low diagnostic yields and high complication rates. We therefore evaluated the diagnostic yield for tissue sampling of incidental subepithelial lesions using the bite-on-bite technique. METHODS: One hundred and forty subepithelial lesions were found in 129 patients during conventional diagnostic esophagogastroduodenoscopy by one examiner from October 2003 to November 2004. Bite-on-bite biopsies with conventional-sized forceps were taken from 36 patients having 37 lesions that did not appear to be hypervascular or to have a thick overlying epithelium. Two to eight bites were performed to obtain submucosal tissue for one lesion. RESULTS: The bite-on-bite technique was diagnostic in 14 of the 37 lesions (38%). Blood oozing for more than 30 seconds occurred in five cases, but was easily controlled by epinephrine injection (2 cases) or hemoclip (3 cases). The diagnostic yield tended to be higher in the esophagus than in the stomach and duodenum (54% vs. 28%, p=0.109). CONCLUSIONS: The bite-on-bite technique for subepithelial lesions is an effective and safe method in selected cases. This technique may be useful for incidental subepithelial lesions, especially those of the esophagus, except for ones with a high risk of bleeding or thick overlying epithelium.

"Clinical observation of the dangerous acupuncturation of ""Jing Bi"" guided with color Doppler ultrasonography" / 中国医学影像技术

Objective To assess the local anatomy of the Jing Bi with high-frequency ultrasound, and to evaluate the clinical significance of high-frequency ultrasound in acupuncture. Methods A total of 206 healthy subjects were observed with the high-frequency ultrasound. Two common location points of Jing Bi were selected and acupunctured under guidance of high-frequency ultrasound. The sensation of subjects was observed. Brachial plexus diameter, distance between skin and membrana pleuralis, as well as the brachial plexus and the pleura were measured. Results The filiform needle tip to lung, lung tissue and the brachial plexus were all showed, and the brachial plexus diameter, distance between skin and membrana pleuralis, the distance between the brachial plexus and the pleura were obtained. The patients felt when the needle reached the membrane of brachial plexus. All subjects got feeling within 10 seconds after acupuncture, and no pneumothorax occurred. Conclusion The local anatomy of dangerous acupoints can be accurately observed with high-frequency ultrasound. High-frequency ultrasound has important value and significance for acupuncturing the dangerous acupoints.

Diagnostic Yield of Tissue Sampling Using a Bite-On-Bite Technique for Incidental Subepithelial Lesions

BACKGROUND/AIMS: Techniques for endoscopic evaluation of gastrointestinal subepithelial lesions include conventional endoscopy, jumbo biopsy, endoscopic ultrasonogrphy (EUS), EUS-guided fine needle aspiration, and endoscopic submucosal resection. However, these procedures have many limitations, such as low diagnostic yields and high complication rates. We therefore evaluated the diagnostic yield for tissue sampling of incidental subepithelial lesions using the bite-on-bite technique. METHODS: One hundred and forty subepithelial lesions were found in 129 patients during conventional diagnostic esophagogastroduodenoscopy by one examiner from October 2003 to November 2004. Bite-on-bite biopsies with conventional-sized forceps were taken from 36 patients having 37 lesions that did not appear to be hypervascular or to have a thick overlying epithelium. Two to eight bites were performed to obtain submucosal tissue for one lesion. RESULTS: The bite-on-bite technique was diagnostic in 14 of the 37 lesions (38%). Blood oozing for more than 30 seconds occurred in five cases, but was easily controlled by epinephrine injection (2 cases) or hemoclip (3 cases). The diagnostic yield tended to be higher in the esophagus than in the stomach and duodenum (54% vs. 28%, p=0.109). CONCLUSIONS: The bite-on-bite technique for subepithelial lesions is an effective and safe method in selected cases. This technique may be useful for incidental subepithelial lesions, especially those of the esophagus, except for ones with a high risk of bleeding or thick overlying epithelium.

Progress of ultrasonography in diagnosis of breast tumors / 肿瘤研究与临床

The incidence of breast tumors has increasing trend year by year recently.Ultrasound has become a main means of screening and diagnosis in breast tumors for its lack of radiation,harmlessness to op- erator and patient,convenience and repeatrbility.Grey-scale uhrasonography,color doppler flow imaging,col- or doppler energy contrast enhanced ultrasonogrphy,3-D ultrasonography,elastomography,ultrasound-guided biopsy are main methods for both detection and differentiation in breast tumors.The purpose of this paper is to review the applications of these techniques in breast tumors diagnosis.

Two Cases of Fetus in Fetu Diagnosed with Prenatal Ultrasonography

Fetus in fetu is a poorly understood and rare congenital malfomation. This is a rare form of monozygotic twin that asymmetric twin becomes internalized in the other twin thus acting endoparasitically. Fetus in fetu can be distinguised from teratoma, because of vertebral column, skeletal axis, and well-differentiated internal organs. We present the findings in the two cases of fetus in fetu that were diagnosed with prenatal ultrasonography. After birth, we removed fetus-like structures and confirmed by pathologic examination. Fetus-like structures were consisted of vertebral column, extremities, and other well-developed internal organs.

Selective Distal Splenocaval Shunt for the Treatment of Portal Hypertension / 第三军医大学学报

Ten cases of portal hypertension were treated with selective distal spleno-caval shunt in the period from January 1984 to October 1985. The liver function was grade Ⅰ in 6 cases, grade Ⅱ in 2, and grade Ⅲ in the other 2. The operative procedure consisted of a direct end to side anastomosis between the distal part of the splenic vein and the inferior vena cava. There was no operative mortality. An average reduction of 4.4 cm of water of the portal pressure was obtained after the completion of the anastomosis. All the patients have been followed up for 3-24 months, and they are all doing very well and have resumed their original job fully or partially. Neither rebleeding nor hepatic encephalopathy occurred. The patency of the anastomosis was demonstrated by ultrasonography and angiography. The spleen was markedly shrinked in size and became softened.Ours is a new type of selective shunt. No report of such a kind of shunt has ever been published in the literature. It is recommended that this operation be used in the treatment of portal hyperension since it is effective.