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Differentiation of prostate cancer from benign lesions using strain index of transrectal real-time tissue elastography.

OBJECTIVE This study was to assess the diagnostic value of strain index (SI) for transrectal real-time tissue elastography (TRTE) on differentiating malignant from benign lesions in the prostate peripheral zone. METHODS 83 patients suspected of having prostate cancer (PCa) underwent transrectal ultrasonography (TRUS) and TRTE examinations. The lesions in the prostate peripheral zone detected by TRTE were set as the regions of interest (ROI) for strain ratio (SR) measurement (SRA). The moderate texture tissues without lesion were set as the reference ROI for SR measurement (SRB). Then, SI (SRB/SRA) of total lesions (ASI) and local lesion (PSI) were calculated, and the diagnostic values of ASI and PSI on differentiating benign from malignant lesions were assessed respectively. RESULTS The range of PSI was 2.23-67.21 (29.97 ± 15.58) in malignant tumors and 0. 4-43.6 (7.79 ± 8.75) in benign lesions (AUC=0.90), while the range of ASI was 2.84-47.9 (8.38 ± 12.20) in malignant tumors and 0.4 -2.79 (5.85 ± 7.29) in benign lesions (AUC=0.62). There was significant difference of PSI values between the benign and malignant lesions (P<0.01). At the cutoff value of 17.44, PSI yielded the highest sensitivity (74.5%) and specificity (83.3%) for discriminating PCa from benign lesions. The capability of PSI in the diagnosis of PCa improved with the increase of Gleason scores. CONCLUSION PSI is one of the elasticity parameters obtained easily by TRTE, it can provide more information in the differentiation of prostate peripheral zone lesions.

Contrast-enhanced ultrasound imaging of active bleeding associated with hepatic and splenic trauma

PurposeThe aim of this study was to evaluate contrast-enhanced ultrasound (CEUS) imaging of active bleeding from hepatic and splenic trauma.Materials and methodsThree hundred and ninety-two patients with liver or/and spleen trauma (179 liver and 217 spleen injuries), who underwent CEUS examinations following contrast-enhanced computed tomography (CT), were enrolled in this retrospective study over a period of >4 years. CEUS detected contrast medium extravasation or pooling in 16% (63/396) of liver or spleen lesions in 61 patients, which was confirmed by contrast-enhanced CT. Special attention was paid to observing the presence, location, and characteristics of the extravasated or pooled contrast medium.ResultsThe CEUS detection rate for active bleeding was not different from that of contrast-enhanced CT (p=0.333). Information from surgery, minimally invasive treatment and conservative treatment was used as reference standard, and the sensitivities of the two techniques were not different (p=0.122). Of 63 lesions in 61 patients, CEUS showed that 74.6% (47/63) (21 liver lesions and 26 spleen lesions) presented contrast medium extravasation or pooling, both in the organ and out the capsule, in 14.3% (9/63) and only outside the capsule in 11.1% (7/63). CEUS imaging of active bleeding from hepatic and splenic trauma presented various characteristics, and the sizes and shapes of the active bleeding due to contrast medium extravasation or pooling were variable.ConclusionsCEUS can show the active bleeding associated with hepatic and splenic trauma with various imaging characteristics, thus making it possible to diagnose active bleeding using CEUS.RiassuntoObiettivoScopo di questo lavoro è stato valutare l’imaging con ecografia con mezzo di contrasto (CEUS) nel sanguinamento attivo nei traumi epatici e splenici.Materiali e metodiTrecentonovantadue pazienti con trauma epatico e/o splenico (179 traumi epatici e 217 splenici), sottoposti ad esame CEUS seguito da tomografia computerizzata (CT) con mezzo di contrasto, sono stati arruolati in questo studio retrospettivo per un periodo di più di 4 anni. La CEUS ha rilevato lo stravaso o l’accumulo di mdc nel 16% (63/396) delle lesioni epatiche o spleniche in 61 pazienti, confermato poi dalla TC con mezzo di contrasto. È stata prestata particolare attenzione nell’osservare la presenza, la localizzazione e il carattere dello stravaso o dell’accumulo del mezzo di contrasto.RisultatiLa capacità della CEUS di individuare un sanguinamento attivo non si è dimostrata differente da quella della TC con mezzo di contrasto (p=0.333). Le informazioni ottenute dalla chirurgia, sia dal trattamento minimamente invasivo sia da quello conservativo, presi come riferimento standard, e la sensibilità delle due tecniche non si sono dimostrate differenti (p=0.122). Nelle 63 lesioni in 61 pazienti, la CEUS ha mostrato che il 74,6% (47/63) delle lesioni (21 lesioni epatiche e 26 spleniche) ha presentato stravaso o accumulo di mdc, entrambi all’interno dell’organo o fuori dalla capsula nel 14,3% (9/63) e solo fuori dalla capsula nell’11,1% (7/63). L’imaging CEUS del sanguinamento attivo da traumi epatici e splenici presenta differenti caratteristiche, e le dimensioni e le forme del sanguinamento attivo dovuto allo stravaso o all’accumulo del mezzo di contrasto sono variabili.ConclusioniLa CEUS può mostrare il sanguinamento attivo associato a trauma epatico e splenico con diverse caratteristiche di imaging, rendendo quindi possibile diagnosticare il sanguinamento attivo.

MUSCLE CRUSH INJURY OF EXTREMITY: QUANTITATIVE ELASTOGRAPHY WITH SUPERSONIC SHEAR IMAGING

The aim of this study was to determine the characteristic of muscle crush injury at quantitative ultrasonographic elastography using supersonic shear imaging (SSI). Twenty-three New Zealand rabbits underwent crush injury to left hind leg caused by a special balloon cuff device. Conventional ultrasonography and SSI quantitative elastography were performed at both crushed and uncrushed regions of the left hind legs. Quantitative lesion elasticity was measured using the Youngs modulus (in kilopascals) at 0.5 h, 2 h, 6 h, 24 h and 72 h after the release of the crushing pressure. Compared with those from the uncrushed regions, both the maximum and mean elasticity values at these time points from the crushed regions were significantly higher (p < 0.001). A receiver operating characteristic (ROC) analysis was employed to assess diagnostic performance. ROC curves showed that extremity crush injury was diagnosed using elasticity value and the greater the elasticity value, the greater the diagnostic value. SSI provides quantitative elasticity measurements, thus, adding complementary information that potentially could help in crush injury characterization with conventional ultrasonography.

Comparison of Gray-Scale Contrast-Enhanced Ultrasonography with Contrast-Enhanced Computed Tomography in Different Grading of Blunt Hepatic and Splenic Trauma: An Animal Experiment

To compare the diagnostic value of contrast-enhanced ultrasonography (CEUS) with contrast-enhanced computed tomography (CECT) for the detection of different grading of solid organ injuries in blunt abdominal trauma in animals. A self-made miniature tools were used as models to simulate a blunt hepatic or splenic trauma in 16 and 14 anesthetized dogs, respectively. Baseline ultrasound, CEUS and CECT were used to detect traumatic injuries of livers and spleens. The degree of injuries was determined by CEUS according to the American Association for the Surgery of Trauma (AAST) scale and the results compared with injury scale based on CECT evaluation. CEUS showed 22 hepatic injury sites in 16 animals and 17 splenic injury sites in other 14 animals. According to AAST scale, 2 grade I, 4 grade II, 3 grade III, 5 grade IV and 2 grade V hepatic lesions were present in 16 animals; 2 grade I, 4 grade II, 6 grade III and 2 grade IV splenic lesions in 14 animals. On CECT scan, 21 hepatic and 17 splenic injuries were demonstrated. According to Becker CT scaling for hepatic injury, 1 grade I, 2 grade II, 4 grade III, 5 grade IV and 2 grade V hepatic injuries were present. On the basis of Buntain spleen scaling, 2 grade I, 5 grade II, 5 grade III, 2 grade IV splenic injuries were showed. After Spearman rank correlation analysis, the agreement of CEUS with CECT on the degree of hepatic and splenic injury is 93.3% and 92.9%, respectively. CT is currently considered as the reference method for grading blunt abdominal trauma, according to experiment results, CEUS grading showed high levels of concordance with CECT. CEUS can accurately determine the degree of injury and will play an important role in clinical application.

Percutaneous injection therapy for blunt splenic trauma guided by contrast-enhanced ultrasonography.

Objective. The purpose of this study was to investigate the application of contrast‐enhanced ultrasonography (CEUS) in managing blunt splenic trauma and the effectiveness of CEUS‐guided percutaneous injection therapy. Methods. Six patients with grade 3 or 4 splenic injuries as determined by CEUS and contrast‐enhanced computed tomography were given hemocoagulase atrox and absorbable cyanoacrylate percutaneously, which were injected into the injury region and active bleeding site, respectively, under CEUS guidance. Immediately after the procedure and 1 and 3 days, 1 and 2 weeks, and 1 and 6 months after the procedure, follow‐up CEUS up was performed in all patients. Results. Among the 6 patients, 4 cases of CEUS‐guided hemostatic injection were successful without complications. Rehemorrhage occurred in 1 patient, and a traumatic arteriovenous fistula occurred in another; repeated injection therapy in these 2 patients was effective. During the follow‐up, there were no complications, and spleen perfusion recovered gradually. Conclusions. Contrast‐enhanced ultrasonography can be used to guide percutaneous injection therapy and therefore achieve the goal of using interventional ultrasonography in managing splenic trauma.

Assessment of contrast-enhanced ultrasonography in diagnosis and preoperative localization of insulinoma.

OBJECTIVE This study was to evaluate the value of contrast-enhanced ultrasonography (CEUS) in the diagnosis and preoperative localization of insulinoma and explore the enhancement patterns of the tumors. METHODS Unenhanced and contrast-enhanced ultrasonographic examinations of 31 patients who underwent resection of insulinomas were retrospectively reviewed. The diagnosis sensitivity and localization specificity of CEUS for insulinomas were determined. Results of unenhanced ultrasonography and CEUS were compared by Chi-square test. RESULTS Unenhanced ultrasonography could display 9 of 37 (24.3%) surgically verified insulinomas in 31 patients, while the diagnosis sensitivity and localization specificity of preoperative CEUS was 33 (89.2%) and 32 (86.5%) of the 37 tumors, respectively. In contrast to the unenhanced ultrasonography, the improvement of CEUS in the diagnosis and preoperative localization of insulinomas was significant (p<0.0001). The enhancement pattern of insulinoma on CEUS was fast wash-in and slow wash-out. All the tumors were homogeneous hypervascularity in the earlier arterial phase, while the tumors still displayed hyperenhancing pattern in the late phase. CONCLUSION Our study demonstrates the great potential of CEUS in the diagnosis and preoperative localization of insulinomas. Since CEUS is a convenient, inexpensive, effective and non-invasive modality, the study supports the use of CEUS as a primary tool in the evaluation of patients with insulinomas.

Thyroid nodules with suspicious ultrasound findings: the role of ultrasound-guided core needle biopsy

The aim of this study was to evaluate the value of core needle biopsy (CNB) in the diagnosis of sonographically suspicious thyroid nodules. We retrospectively reviewed 997 patients with sonographically suspicious thyroid nodules who underwent CNB using pathological results as gold standard. In our result, the accuracy of CNB was 98.0%, and its area under the receiver operating characteristic curve was 0.981. The inconclusive result was in 22 (6.0%) of CNBs. Therefore, CNB demonstrates high rates of conclusive and accurate diagnosis in sonographically suspicious thyroid nodules, which may reduce repeat fine needle aspiration, diagnostic surgery, and unnecessary follow-up.

Laparoscopic Ultrasound Enhances Diagnosis and Localization of Insulinoma in Pancreatic Head and Neck for Laparoscopic Surgery With Satisfactory Postsurgical Outcomes

This study explored the value of laparoscopic ultrasonography (LUS) for tumor localization in laparoscopic pancreatic surgery of insulinomas, especially for tumors located at anatomically unfavorable positions. Twenty-eight patients with insulinomas were enrolled in this study between July 2007 and March 2009. Various image examinations were performed preoperatively. An iU22 ultrasound system equipped with a 5.0-9.0 MHz transducer was used for LUS. The tumor localization and postsurgical outcomes were evaluated. Intraoperative LUS precisely localized 33 insulinomas in 26 of 28 patients, whereas the preoperative imaging studies detected 27 of 33 (82%) tumors. No definite tumor in the pancreas and extra-pancreatic organs was identified in two patients by both preoperative and intraoperative imaging examinations. Of 33 tumors, 32 (97%) were localized in the pancreas (14 in the head and neck, 18 in the body and tail), whereas one (3%) was found in the duodenal ligament. Successful laparoscopic resection of insulinoma was performed in 21 of 26 patients, including resection of 11 tumors located in the head and neck of the pancreas. Five patients required conversion to open surgery. All insulinomas were benign with a mean size 13.8 mm. Four patients had pancreatic-related complications that spontaneously healed within 3 weeks after surgery. The median hospital stay was 8.5 days. Our study demonstrates that laparoscopic pancreatic resection under the guidance of advanced LUS is not only feasible and safe for tumors located at the body and tail but also for tumors located at the head and neck of the pancreas.

Contrast-Enhanced Sonographic Guidance for Local Injection of a Hemostatic Agent for Management of Blunt Hepatic Hemorrhage: A Canine Study

OBJECTIVE The purpose of this study was to determine whether injection of hemostatic agents directly into an injury site under the guidance of contrast-enhanced sonography can effectively control hemorrhage due to hepatic trauma. MATERIALS AND METHODS Fifteen mixed-breed dogs 2-3 years old and weighing 17-20 kg were anesthetized with intramuscular pentobarbital sodium (30 mg/kg). A special impacting device was used to induce hepatic trauma with a mean force of 5.3 +/- 0.3 kN. Twelve of the 15 dogs had hepatic injuries with a grade of 3-4 or 4. The 12 dogs were divided into treatment and control groups. In the treatment group, hemocoagulase atrox (1 Klobusitzky unit) and alpha-cyanoacrylate (1 mL) were administered by transcutaneous injection into the injury site and the bleeding site, respectively, under the guidance of contrast-enhanced sonography. The control group received injections of 0.9% normal saline solution. RESULTS After injection into the treatment group, no active bleeding was observed at the liver injury site. In the control group, evidence of active bleeding was present on contrast-enhanced sonograms. Laparotomy of the treatment group showed that hepatic injuries had been covered and adhered by clots and the glue membrane of the hemostatic agents and that free intraperitoneal blood volume was significantly less than in the control group (p < 0.001). Bleeding did not stop in the control group. CONCLUSION In dogs, transcutaneous local injection of hemostatic agents can effectively reduce blood loss due to severe liver trauma. Because it is simple, convenient, and effective, the technique may be an alternative for bedside and battlefield management of hepatic hemorrhage due to trauma.

Accuracy of 16/18G core needle biopsy for ultrasound-visible breast lesions

BackgroundTo assess the accuracy of ultrasound-guided 16G or 18G core needle biopsy (CNB) for ultrasound-visible breast lesions, and to analyze the effects of lesion features.MethodsBetween July 2005 and July 2012, 4,453 ultrasound-detected breast lesions underwent ultrasound-guided CNB and were retrospectively reviewed. Surgical excision was performed for 955 lesions (566 with 16G CNB and 389 with 18G CNB) which constitute the basis of the study. Histological findings were compared between the ultrasound-guided CNB and the surgical excision to determine sensitivity, false-negative rate, agreement rate, and underestimation rate, according to different lesion features.ResultsFinal pathological results were malignant in 84.1% (invasive carcinoma, ductal carcinoma in situ, lymphoma, and metastases), high-risk in 8.4% (atypical lesions, papillary lesions, and phyllodes tumors), and benign in 7.5%. False-negative rates were 1.4% for 16G and 18G CNB. Agreement rates between histological findings of CNB and surgery were 92.4% for 16G and 92.8% for 18G CNB. Overall underestimate rates (high-risk CNB becoming malignant on surgery and ductal carcinoma in situ becoming invasive carcinoma) were 47.4% for 16G and 48.9% for 18G CNB. Agreements were better for mass lesions (16G: 92.7%; 18G: 93.7%) than for non-mass lesions (16G, 85.7%; 18G, 78.3%) (P <0.01). For mass lesions with a diameter ≤10 mm, the agreement rates (16G, 83.3%; 18G, 86.7%) were lower (P <0.01).ConclusionsUltrasound-guided 16G and 18G CNB are accurate for evaluating ultrasound-visible breast mass lesions with a diameter >10 mm.