Feng-Hua Li

Microvascular Architecture of Breast Lesions Evaluation With Contrast-Enhanced Ultrasonographic Micro Flow Imaging

Objective. The purpose of this study was to evaluate the effectiveness of micro flow imaging (MFI) of the microvascular architecture with contrast‐enhanced ultrasonography for classification of breast lesions as benign or malignant and the microvascular architectural patterns. Methods. Contrast‐enhanced ultrasonography and MFI were performed in 61 women with breast lesions. The microvascular morphologic and distribution features of the breast tumors were evaluated with MFI. Receiver operating characteristic curve analysis was used to evaluate the diagnostic value of MFI, and the microvascular architectural patterns were analyzed. Results. Surgical pathologic analysis showed 29 benign and 32 malignant lesions. For MFI, the area under the receiver operating characteristic curve (Az) value for the overall features of the blood vessels for classification of breast lesions was 0.94. The accuracy, sensitivity, and specificity were 90.2% (55/61), 93.8% (30/32), and 86.2% (25/29), respectively. The Az value for the morphologic and distribution features of peripheral blood vessels was 0.91, which was significantly higher than the Az value for the morphologic and distribution features of interior vessels (P = .019). The microvascular architecture of the 61 lesions was categorized into 3 patterns: treelike, root hair–like, and crab claw–like. Benign lesions mainly displayed the treelike pattern (17 [58.6%]); malignant lesions tended to display the crab claw–like pattern (20 [62.5%]); and the root hair–like pattern was shown in both benign and malignant lesions (11 [37.9%] and 8 [25%], respectively). The microvascular architecture showed significant differences between benign and malignant lesions (P < .001). Conclusions. Micro flow imaging can clearly delineate the microvascular architecture of breast lesions and can aid in discrimination between benign and malignant breast lesions.

Correlation of real-time gray scale contrast-enhanced ultrasonography with microvessel density and vascular endothelial growth factor expression for assessment of angiogenesis in breast lesions.

Objective. The purpose of this study was to determine the correlation of real‐time gray scale contrast‐enhanced ultrasonographic (CEUS) patterns and parameters with microvessel density (MVD) and vascular endothelial growth factor (VEGF) expression for assessment of angiogenesis in breast lesions. Methods. Real‐time gray scale CEUS was performed in 53 women with breast lesions. Contrast‐enhanced ultrasonographic patterns and quantitative parameters were analyzed. Mean MVD and VEGF expression in breast lesions were measured by immunohistochemical analysis. Results. Surgical pathologic analysis showed 25 benign and 28 malignant lesions. Different CEUS patterns were observed in the high‐ and low‐MVD and ‐VEGF groups. Microvessel density and VEGF expression were significantly associated with heterogeneous enhancement with or without perfusion defects and radial or penetrating vessels surrounding the lesions (P <.05). The enhancement order and degree were significantly related to MVD (P <.01) but not correlated with VEGF expression (P > .05). Malignant and benign lesions did not differ significantly in time‐intensity parameters (P > .05). The peak intensity, rise in intensity, maximum rise slope of the curve, wash‐out slope of the curve, and area under the time‐intensity curve (area) were statistically correlated with MVD (P < .05). The highest correlation (r = 0.56; P < .001), however, was between the area and MVD. No significant association was found between any CEUS parameters and VEGF expression (P >.05). Conclusions. Contrast‐enhanced ultrasonographic patterns and parameters of breast lesions are more closely correlated with MVD than VEGF expression. Real‐time gray scale CEUS has a potential role in evaluating angiogenesis in breast lesions, but CEUS parameters are not correlated with the malignancy or benignity of breast tumors.

Evaluation of breast lesions by contrast enhanced ultrasound: Qualitative and quantitative analysis

OBJECTIVE To evaluate and compare the diagnostic performance of qualitative, quantitative and combined analysis for characterization of breast lesions in contrast enhanced ultrasound (CEUS), with histological results used as the reference standard. METHODS Ninety-one patients with 91 breast lesions BI-RADS 3-5 at US or mammography underwent CEUS. All lesions underwent qualitative and quantitative enhancement evaluation. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of different analytical method for discrimination between benign and malignant breast lesions. RESULTS Histopathologic analysis of the 91 lesions revealed 44 benign and 47 malignant. For qualitative analysis, benign and malignant lesions differ significantly in enhancement patterns (p<0.05). Malignant lesions more often showed heterogeneous and centripetal enhancement, whereas benign lesions mainly showed homogeneous and centrifugal enhancement. The detectable rate of peripheral radial or penetrating vessels was significantly higher in malignant lesions than in benign ones (p<0.001). For quantitative analysis, malignant lesions showed significantly higher (p=0.031) and faster enhancement (p=0.025) than benign ones, and its time to peak was significantly shorter (p=0.002). The areas under the ROC curve for qualitative, quantitative and combined analysis were 0.910 (A(z1)), 0.768 (A(z2)) and 0.926(A(z3)) respectively. The values of A(z1) and A(z3) were significantly higher than that for A(z2) (p=0.024 and p=0.008, respectively). But there was no significant difference between the values of A(z1) and A(z3) (p=0.625). CONCLUSIONS The diagnostic performance of qualitative and combined analysis was significantly higher than that for quantitative analysis. Although quantitative analysis has the potential to differentiate benign from malignant lesions, it has not yet improved the final diagnostic accuracy.

Differentiating benign from malignant solid breast lesions: Combined utility of conventional ultrasound and contrast-enhanced ultrasound in comparison with magnetic resonance imaging

OBJECTIVE To prospectively evaluate the diagnostic efficacy of conventional ultrasound (US), contrast-enhanced US (CEUS), the combined use of two modalities, and magnetic resonance imaging (MRI) in the differentiation of focal solid breast lesions. MATERIALS AND METHODS 61 patients with BI-RADS category 3-5 breast lesions detected at conventional US underwent CEUS and MRI. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of conventional US, CEUS, combination of two modalities and MRI for discrimination between benign and malignant breast lesions. RESULTS Tissue specimens of 61 breast lesions were obtained either from surgical resection (n=46) or from needle biopsy (n=15). Histopathologic diagnosis revealed 28 benign and 33 malignant lesions. The diagnostic performance of conventional US and CEUS in differentiating benign from malignant breast lesions showed no significant difference (P=0.741). The combination of two modalities significantly improved the diagnostic accuracy compared with either conventional US or CEUS alone (P=0.031 and P=0.012, respectively). The area under the ROC curve (A(z)) value for the combined use of two modalities for discrimination between benign and malignant breast lesions was 0.94, and that for MRI was 0.91, whereas no statistical difference was found between them (P=0.296). CONCLUSION The combined use of conventional US and CEUS has a better diagnostic performance than either method alone and displays good agreement with MRI in the differentiation capability for benign and malignant breast lesions.

Relationship between age and prostate size

In a community-based study, the relationship between age and human prostate size was investigated in a population of men between the ages of 40 and 70 years to determine the normal prostate increase curve equation. One thousand male volunteers were randomly recruited from the Shanghai community, and the length, width, height, volume of the transition zone (TZ) and the whole prostates were measured by transrectal ultrasound (TRUS). Each volunteer was evaluated by the International Prostate Symptom Score (IPSS). Among those who completed the examination, the mean prostate parameters were all positively associated with increased age. There were statistically significant differences between each age group (P<0.05). The mean transition zone volume (TZV) had a higher increase rate with age than the mean total prostate volume (TPV), indicating that the enlargement of the TZ contributed the most to the increase in TPV. While all prostate parameters were positively correlated with the IPSS, the strongest correlation was associated with the TZ length (TZL) and TZV. The growth curve equations for prostate width, height and length were also positively associated with increasing age.

Virtual touch tissue quantification (VTQ) in the diagnosis of thyroid nodules with coexistent chronic autoimmune Hashimoto's thyroiditis: A preliminary study

OBJECTIVES This study aimed at detecting whether Virtual Touch Tissue Quantification (VTQ) could be applied to differentiate between benign and malignant thyroid nodules with chronic autoimmune Hashimotos thyroiditis (HT). METHODS Convenient ultrasound and Virtual Touch Tissue Quantification were performed in 118 patients with 140 thyroid nodules with histology results. The HT group consisted of 46 patients with 58 nodules. The non-HT group consisted of 72 patients with 82 nodules. RESULTS The stiffness of extra-nodular thyroid tissue could be significantly affected by the severity of chronic autoimmune thyroiditis. The shear wave velocity of thyroid benign nodules and malignant nodules did not significantly differ in the HT group as compared with the non-HT group (benign nodules: 2.13±0.32m/s vs 1.98±0.48m/s, P=0.122; malignant nodules: 3.32±0.77m/s vs 3.30±0.74m/s, P=0.894). In two groups, the shear wave velocity of malignant nodules is significantly higher than that of benign nodules (HT group: 3.32±0.77m/s vs 2.13±0.32m/s; non-HT group: 3.30±0.74m/s vs 1.98±0.48m/s, P<0.001). The best cutoff point for shear wave velocity between malignant and benign thyroid nodules was 2.75m/s. CONCLUSIONS Virtual Touch Tissue Quantification technology could be performed in the differential diagnosis between malignant thyroid nodules and benign thyroid nodules independently from the coexistence of chronic autoimmune thyroiditis.

Differential Diagnosis of Polypoid Lesions of the Gallbladder Using Contrast-Enhanced Sonography

The purpose of this study was to evaluate the usefulness of real‐time contrast‐enhanced sonography and microvascular imaging for differential diagnosis of neoplastic and non‐neoplastic polypoid lesions of the gallbladder.

Diagnostic Efficacy of Contrast-Enhanced Sonography by Combined Qualitative and Quantitative Analysis in Breast Lesions A Comparative Study With Magnetic Resonance Imaging

The purpose of this study was to evaluate the diagnostic efficacy of contrast‐enhanced sonography for differentiation of breast lesions by combined qualitative and quantitative analyses in comparison to magnetic resonance imaging (MRI).

Value of contrast-enhanced sonographic micro flow imaging for prostate cancer detection with t-PSA level of 4-10 ng/mL.

OBJECTIVES To compare the efficiency of contrast-enhanced ultrasonographic micro flow imaging (MFI) with conventional transrectal ultrasound (TRUS) in detecting prostate cancer with serum total prostate-specific antigen (t-PSA) of 4.0-10.0 ng/mL. To evaluate the value of contrast-enhanced ultrasonographic MFI in detecting prostate cancer with t-PSA in diagnostic gray zone. METHODS 47 patients with t-PSA 4.0-10.0 ng/mL underwent gray scale, power Doppler TRUS and MFI examinations before ultrasound guided biopsies. Biopsies were performed at twelve sites in the base, the mid-gland and the apex of the prostate in each patient, when there was no abnormal ultrasound finding. When an abnormality was present at MFI, the biopsy specimen from the corresponding site was directed toward the abnormal finding. With histological results of prostate biopsy as reference standards, we assessed the cancer detection of these three methods. RESULTS 564 specimens were collected in this study, in which 101 were prostate cancer confirmed histologically. 152 of 564 specimens were demonstrated abnormal on MFI images, in which 71 were malignant and 81 were benign confirmed histologically. The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) for MFI in detecting prostate caner were 70.3%, 82.5%, 80.3%, 46.7% and 92.7%, respectively. The sensitivity and NPV for MFI were significantly better than gray scale (38.6%, 86.9%) and power Doppler (32.7%, 86.0%) (P<0.001) TRUS. CONCLUSIONS Contrast-enhanced ultrasonographic MFI could significantly improve the detection rate of prostate cancer with t-PSA in diagnostic gray zone (4-10 ng/mL) than conventional ultrasound.

Impact of hepatic arterial hemodynamics in predicting early hepatic arterial thrombosis in pediatric recipients younger than three yr after living donor liver transplantation.

We used Doppler US to evaluate the changes in hepatic arterial hemodynamics that occur following LDLT in pediatric recipients, with a view to assessing the utility of these parameters in predicting early HAT. A retrospective review of 144 pediatric recipients (73 males, 71 females) who underwent routine Doppler US in the first week after LDLT was undertaken, and changes in hepatic arterial hemodynamics were assessed. The HARI and HAPSV were compared in patients with early HAT (defined as occurring in the first postoperative week) and a control group, and the utility of these parameters in predicting early HAT after LDLT was determined. A total of 11 pediatric recipients experienced early HAT, being diagnosed on average four and a half days after LDLT. HARI and HAPSV values were significantly different between the early HAT group and controls. HARI values <0.6 on the day before the onset of early HAT were able to predict HAT development with a sensitivity of 81.8% and specificity of 95.2%. This provides evidence for routine Doppler US examination in these patients and supports consideration of more intensive anticoagulation in these high‐risk patients.