Qing-Li Zhu

Real-time ultrasound elastography: its potential role in assessment of breast lesions.

We evaluated whether real-time ultrasound elastography (USE) performed in addition to conventional ultrasound (US) can improve the differentiation of benign from malignant breast lesions. Both conventional US and real-time USE were performed in 112 consecutive patients with 139 breast lesions using a Hitachi EUB-8500 US system. Each lesion was assigned an elasticity score according to the degree and distribution of strain induced manually by mild compression. The USE scores (1 to 5) were compared with the BI-RADS assessment categories (1 to 5) obtained with conventional US. Sensitivity, specificity and overall accuracy of each method were determined with surgical pathology as the gold standard. There were 70 benign and 69 malignant lesions. The mean elasticity score was significantly higher for malignant lesions than for benign lesions (4.33 +/- 0.11 vs. 2.10 +/- 0.13, p < 0.01). When a cutoff point of 4 was used, the sensitivity, specificity and accuracy were 85.5, 88.6 and 87% for USE and 94.2, 87.1 and 90.6% for conventional US, respectively. Of the 64 lesions assessed as BI-RADS 2 or 3(i.e., benign) based on conventional US, two were scored as 4 and 5 (i.e., malignant) using USE and were subsequently proven to be malignant. Of the 75 lesions with BI-RADS 4 or 5 category from conventional US, one was scored as a category 1 (benign) with USE and found to be benign by pathology. Our study results suggest that the addition of USE imaging to conventional US could be helpful in the detection and characterization of breast masses.

Utility of contrast-enhanced ultrasound for evaluation of thyroid nodules.

BACKGROUND No conventional imaging method reliably distinguishes between benign and malignant thyroid nodules. Our objectives were to characterize the enhancement patterns of thyroid nodules on gray-scale contrast-enhanced ultrasound (US) and to evaluate whether these patterns were useful in the differential diagnosis of thyroid nodules. METHODS Ninety-five patients, scheduled for surgery for thyroid nodules detected by gray-scale sonography, were enrolled in this prospective study. In all, there were 104 nodules (47 papillary carcinomas, 3 medullary carcinomas, 1 metastatic carcinoma, 44 hyperplasia nodule, 7 follicular adenomas, 1 suture granulomas, and 1 Hashimotos disease). After intraveneous (i.v.) injection of a 1.2 mL bolus of SonoVue, lesions were scanned with real-time gray-scale pulse inversion harmonic imaging US for at least 3 minutes at low mechanical index (MI) (0.05 to 0.08). The enhancement patterns were classified into one of four patterns by two experienced readers. RESULTS After administration of SonoVue, four enhancement patterns (homogeneous, heterogeneous, ring-enhancing, and no enhancement) were observed. Four benign and 3 malignant nodules had homogeneous enhancement pattern, 4 benign and 45 malignant nodules had heterogeneous enhancement, 44 benign and 3 malignant nodules had ring enhancement, and 1 benign nodule had no enhancement. There was a significant difference between benign and malignant nodules (p < 0.001). The benign thyroid nodules showed four enhancement patterns: ring enhancement 44/53 (83.0%), homogeneous enhancement 4/53 (7.5%), heterogeneous enhancement 4/53 (7.5%), and no enhancement 1/44 (1.9%). The malignant thyroid nodules showed three enhancement patterns: heterogeneous enhancement 45/51 (88.2%), ring enhancement 3/51 (5.9%), and homogeneous enhancement 3/51 (5.9%). Ring enhancement correlated highly with a benign diagnosis (sensitivity 83.0%, specificity 94.1%, positive predictive value 93.6%, negative predictive value 84.2%, and accuracy 88.5%). Heterogeneous enhancement correlated highly with a malignant diagnosis (sensitivity 88.2%, specificity, 92.5% positive predictive value 91.8%, negative predictive value 89.1%, and accuracy 90.4%). In both mixed and solid nodules, ring enhancement was highly predictive of a benign finding, whereas heterogeneous enhancement was highly predictive of a malignant finding. CONCLUSIONS Contrast-enhanced US enhancement patterns were different in benign and malignant lesions. Ring enhancement was predictive of benign lesions, whereas heterogeneous enhancement was helpful for detecting malignant lesions.

Evaluation of breast lesions with contrast-enhanced ultrasound using the microvascular imaging technique: Initial observations

The objective of this study was to evaluate the usefulness of contrast-enhanced ultrasound using the microvascular imaging technique in the diagnosis of breast lesions. In 104 patients with 104 breast lesions scheduled for surgery, conventional and contrast-enhanced ultrasound using the microvascular imaging technique were performed after administration of SonoVue. The enhancement patterns of breast lesions were classified as no enhancement, peripheral enhancement, homogeneous enhancement, regional enhancement, or heterogeneous enhancement based on the morphologic features of enhancement. The diagnostic value of contrast-enhanced ultrasound using the microvascular imaging technique was analyzed with the observers blinded to the clinical data and pathology (which served as the gold standard). None of the enhancement patterns was suggestive of benignity, with a sensitivity of 18.3%, specificity of 97.7%, positive predictive value (PPV) of 91.7%, negative predictive value (NPV) of 46.2%, and accuracy of 51.5%. The peripheral enhancement pattern was suggestive of malignancy, with a sensitivity of 39.5%, specificity of 98.3%, PPV of 94.4%, NPV of 69.4%, and accuracy of 73.8%. Homogeneous, regional, and heterogeneous enhancement patterns did not show meaningful diagnostic information. Contrast-enhanced ultrasound using the microvascular imaging technique provides diagnostic information on breast lesions.

Differentiation of benign and malignant breast lesions: a comparison between automatically generated breast volume scans and handheld ultrasound examinations.

OBJECTIVE To assess the diagnostic value of automated breast volume scanning (ABVS) or conventional handheld ultrasonography (HHUS) for the differentiation of benign and malignant breast lesions. MATERIALS AND METHODS The study prospectively evaluated 239 lesions in 213 women who were scheduled for open biopsy. The patients underwent ABVS and conventional HHUS. The sensitivity, specificity, accuracy, false positive rate, false negative rate, and positive and negative predictive values for HHUS and ABVS images were calculated using histopathological examination as the gold standard. Additionally, diagnostic accuracy was further evaluated according to the size of the masses. RESULTS Among the 239 breast lesions studied, pathology revealed 85 (35.6%) malignant lesions and 154 (64.4%) benign lesions. ABVS was similar to HHUS in terms of sensitivity (95.3% vs. 90.6%), specificity (80.5% vs. 82.5%), accuracy (85.8% vs. 85.3%), positive predictive value (73.0% vs. 74.0%), and negative predictive value (93.3% vs. 94.1%). The area under the receiver operating characteristic (ROC) curve, which is used to estimate the accuracy of the methods, demonstrated only minor differences between HHUS and ABVS (0.928 and 0.948, respectively). CONCLUSIONS The diagnostic accuracy of HHUS and ABVS in differentiating benign from malignant breast lesions is almost identical. However, ABVS can offer new diagnostic information. ABVS may help to distinguish between real lesions and inhomogeneous areas, find small lesions, and demonstrate the presence of intraductal lesions. This technique is feasible for clinical applications and is a promising new technique in breast imaging.

Interobserver agreement for sonograms of breast lesions obtained by an automated breast volume scanner

OBJECTIVE To evaluate the interobserver agreement of radiologists in the description and final assessment of breast sonograms obtained using an automated breast volume scanner (ABVS) using a unique descriptor of three-dimensional ultrasound (3D US) and the Breast Imaging Reporting and Data System (BI-RADS) US lexicon. METHODS From October to December 2010, 208 patients were subjected to an ABVS examination in the supine position, and data were automatically sent to the ABVS workstation. Two radiologists independently evaluated 234 breast masses (148 benign and 86 malignant masses) using a unique descriptor from the 3D US and the BI-RADS US lexicon. The reviewers were blinded to the patients mammographic images, medical history, and pathologic findings. The interobserver agreement was measured using kappa statistics. RESULTS Substantial agreement was obtained for lesion shape, orientation, margin, echo pattern, posterior acoustic features, calcification and final assessment (κ=0.79, 0.74, 0.76, 0.69, 0.68, 0.71 and 0.70, respectively). Fair agreement was obtained for retraction phenomenon and lesion boundary (κ=0.54 and 0.42, respectively). CONCLUSIONS The interobserver agreement for breast sonograms obtained by ABVS is good, especially for lesion shape and margin; however, the interobserver agreement for the retraction phenomenon, which is a unique descriptor of coronal-plane 3D US, needs to be improved.

Sonographic identification of complications of cosmetic augmentation with autologous fat obtained by liposuction.

To investigate sonographic features and evolution of breast fat nodules after cosmetic augmentation with autologous fat. Breast sonography was performed on 41 patients who underwent bilateral breast augmentation by autologous fat injection. Sonography was initiated 2 to 17 months after the operation. Follow-up sonography evaluated the size, positions, shape, echogenicity, margin features, calcifications, and evolutions of the suspicious nodules in the breasts. We visualized 118 nodules in 34 of the 41 patients after the fat graft. Echotextures in 118 nodules were cystic (73, 61.9%), complex (19, 16.1%), or solid (26, 22%). We observed that 86 of the 118 nodules (72.9%) had circumscribed margins, 94 nodules (79.7%) had regular shapes, 9 nodules (7.6%) had egg-like calcifications, and 106 nodules (98.3%) had no halo. All nodules lacked blood flow signal on color or spectral Doppler. Changes in nodule echotexture were observed during the follow-up. Four nodules changed from solid to complex, one nodule changed from solid to cystic, and one complex nodule exhibited an increased cystic component. The size of the nodules decreased in 13 cases and increased in 20 cases. There were 7 nodules with fat necrosis, which was removed surgically and confirmed by pathology. Breast ultrasound, an accurate and simple imaging technique, plays an important role in follow-up for temporal changes of fat nodules after autologous fat injection. Furthermore, breast ultrasound may avoid unnecessary biopsies.

Accuracy of an Automated Breast Volume Ultrasound System for Assessment of the Pre-operative Extent of Pure Ductal Carcinoma In Situ: Comparison with a Conventional Handheld Ultrasound Examination

The goal of the study described here was to compare the accuracy of an automated breast volume scanner (ABVS) with that of hand-held ultrasound (HHUS) in assessing the pre-operative extent of pure ductal carcinoma in situ (DCIS). This prospective study consisted of 33 patients with histopathologically proven pure DCIS who received conventional HHUS and ABVS examinations. The discrepancy and correlation coefficients were calculated to assess differences in sizes determined by imaging and histopathologic examination. Mean age was 51.8 y. Mean lesion size as assessed with the ABVS did not differ significantly from that determined by histopathology. Lesion size was adequately estimated, under-estimated or over-estimated with the ABVS in 64%, 15% and 21% of patients, and with HHUS in 42%, 15% and 42%, respectively (p < 0.05). The coefficient of correlation between histopathologic and ABVS measurements was higher than that between histopathologic and HHUS measurements. The ABVS appears to assess the extent of the lesion better than HHUS and can provide more accurate information pre-operatively.

A Preliminary Study of Acoustic Radiation Force Impulse Quantification for the Assessment of Skin in Diffuse Cutaneous Systemic Sclerosis

Objective. To investigate skin elasticity using acoustic radiation force impulse (ARFI) quantification in systemic sclerosis (SSc), and compare the modified Rodnan skin score (mRSS) with measured shear wave velocity (SWV) and thickness of the skin. Methods. Fifteen patients with diffuse cutaneous SSc (dcSSc) and 15 age-matched and sex-matched healthy controls were evaluated. The SWV and thickness of skin were measured at 17 sites corresponding to those assessed in the mRSS in each participant. The SWV measurements of skin were compared between patients with dcSSc and healthy controls. The correlations between the mRSS and the skin SWV and thickness were explored using Spearman’s correlation. Results. The SWV values were higher in patients with dcSSc compared with healthy controls at right hand dorsum, right forearm, left hand dorsum, left forearm, right foot dorsum, and left foot dorsum (p < 0.05). In patients with dcSSc, the SWV values of uninvolved skin were higher than those of controls (p < 0.001), and the SWV values increased with increasing skin scores except for skin score 3 (p < 0.05). The sum of the SWV values correlated with total clinical skin score (r = 0.841, p < 0.001), and the sum of the skin thickness correlated with total clinical skin score (r = 0.740, p = 0.002). Conclusion. ARFI quantification is feasible and reliable for assessing the skin involvement in dcSSc. ARFI quantification could identify early skin change that may precede palpable skin involvement, and may be a valuable adjunct to skin evaluation in patients with SSc.

Detecting Angiogenesis in Breast Tumors: Comparison of Color Doppler Flow Imaging With Ultrasound-Guided Diffuse Optical Tomography

We investigated the correlation between color Doppler flow imaging (CDFI) and ultrasound (US)-guided diffuse optical tomography (DOT) for detection of breast tumor angiogenesis. Both CDFI and DOT were performed in 214 breast lesions scheduled for biopsy. The lesions were classified as vascular or nonvascular on CDFI and total hemoglobin concentration (THC) was measured by DOT. Sonographic results were correlated with the THC measurements. Pathologic examination showed 118 breast cancers and 96 benign breast masses. When vascularization on CDFI as a sign of malignancy and a cutoff of 140 μmol/L was used, the sensitivity, specificity and accuracy were 83.9, 50.0 and 68.7% for CDFI and 83.9, 66.7 and 76.2% for DOT, respectively. Thirteen (11.0%) nonvascular breast cancers presented high THC levels. Twenty-five (52.1%) vascular benign tumors demonstrated low THC levels. Mean THC did not differ significantly in malignancies with vascular or without vascular (228.14 ± 85.37 μmol/L vs. 191.42 ± 92.59 μmol/L; p > 0.05). Likewise, for benign lesions, the difference between THC values in vascular lesions and nonvascular lesions was not statistically significant (140.86 ± 79.63 μmol/L vs. 110.13 ± 85.05 μmol/L; p > 0.05). Our results suggest that the addition of DOT to CDFI could be helpful for characterizing CDFI nonvascular lesions that are suspicious for malignancy or vascular lesions that are probably benign.

Diffuse Optical Tomography of Breast Carcinoma : Can Tumor Total Hemoglobin Concentration be Considered as a New Promising Prognostic Parameter of Breast Carcinoma?

RATIONALE AND OBJECTIVES Diffuse optical tomography (DOT) is an emerging functional modality, which can reflect tumor metabolic activity and angiogenesis. The purpose of this exploratory study was to correlate the total hemoglobin concentration (THC) measured by noninvasive DOT with prognostic factors in breast carcinomas. MATERIALS AND METHODS We prospectively imaged 251 breast carcinomas in 229 consecutive women (mean age, 51.18 ± 12.32 years) using DOT from 2007 to 2010. Tumor angiogenesis and metabolic activity were assessed based on quantitatively measured THC. The THC was correlated with prognostic factors, including tumor size, histopathologic classification, histologic grade, estrogen receptor (ER), progesterone receptor (PR), c-erbB-2, and p53. RESULTS In univariate analysis, THC was significantly correlated with the following prognostic factors: tumor size (P < .001), histologic grade (P < .001), ER (P < .05), PR (P < .001), and c-erbB-2 (P < .05). THC was not associated with histopathologic classification (P = .170) or p53 (P = .463). On the basis of a stepwise multiple regression analysis, THC of invasive ductal carcinoma was significantly correlated with tumor size (P < .001), histologic grade (P < .001), and PR (P < .05). CONCLUSIONS THC was associated with prognostic factors of breast carcinoma. THC may be considered as a new prognostic parameter of breast carcinoma and a prediction of tumor behavior and biological activity.