Rui-Na Zhao

Contrast-enhanced Ultrasound in Detecting Endoleaks with Failed Computed Tomography Angiography Diagnosis after Endovascular Abdominal Aortic Aneurysm Repair.

Background: Endovascular aneurysm repair (EVAR) is one of the first-line therapies of abdominal aortic aneurysms. Postoperative endoleak is the most common complication of EVAR. Computed tomography angiography (CTA), which is routine for follow-up, has side effects (e.g., radiation) and also has a certain percentage of missed diagnosis. Preliminary studies on contrast-enhanced ultrasound (CEUS) have shown that the sensitivity of CEUS for detecting endoleak is no lower than that of CTA. To investigate the advantages of CEUS, we conducted CEUS examinations of post-EVAR cases in which CTA failed to detect endoleak or could not verify the type of endoleak. Methods: Post-EVAR patients, who were clinically considered to have endoleak and met the inclusion criteria were enrolled between March 2013 and November 2014. All of the patients underwent color Doppler flow imaging (CDFI) and a CEUS examination. Size, location, microbubble dispersion, and hemodynamic characteristics of leaks were recorded. Comparison between the diagnosis of CEUS and CDFI was conducted using Fishers exact test and clinical outcomes of all patients were followed up. Results: Sixteen patients were enrolled, and 12 (75%) had endoleaks with verified types by CEUS. Among 12 cases of endoleaks were positive by CEUS, 10 were CDFI-positive, and the four CEUS-negative cases were all negative by CDFI. The diagnostic values of CEUS and CDFI were statistically different (P = 0.008). Six patients with high-pressure endoleaks received endovascular re-intervention guided by CEUS results. One patient with type III endoleak had open surgery when endovascular repair failed. Conclusions: CEUS is a new, safe, and effective means for detection of endoleaks post-EVAR. This technique can be used as a supplement for routine CTA follow-up to provide more detailed information on endoleak and its category.

Logistic Regression Analysis of Contrast-Enhanced Ultrasound and Conventional Ultrasound Characteristics of Sub-centimeter Thyroid Nodules.

The purpose of the study described here was to determine specific characteristics of thyroid microcarcinoma (TMC) and explore the value of contrast-enhanced ultrasound (CEUS) combined with conventional ultrasound (US) in the diagnosis of TMC. Characteristics of 63 patients with TMC and 39 with benign sub-centimeter thyroid nodules were retrospectively analyzed. Multivariate logistic regression analysis was performed to determine independent risk factors. Four variables were included in the logistic regression models: age, shape, blood flow distribution and enhancement pattern. The area under the receiver operating characteristic curve was 0.919. With 0.113 selected as the cutoff value, sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 90.5%, 82.1%, 89.1%, 84.2% and 87.3%, respectively. Independent risk factors for TMC determined with the combination of CEUS and conventional US were age, shape, blood flow distribution and enhancement pattern. Age was negatively correlated with malignancy, whereas shape, blood flow distribution and enhancement pattern were positively correlated. The logistic regression model involving CEUS and conventional US was found to be effective in the diagnosis of sub-centimeter thyroid nodules.

Ultrasound is helpful to differentiate Bethesda class III thyroid nodules: A PRISMA-compliant systematic review and meta-analysis

Background: Fine-needle aspiration (FNA) is the most dependable tool to triage thyroid nodules for medical or surgical management. However, Bethesda class III cytology, namely “follicular lesion of undetermined significance” (FLUS) or “atypia of undetermined significance” (AUS), is a major limitation of the US-FNA in assessing thyroid nodules. As the most important imaging method, ultrasound (US) has a high efficacy in diagnosing thyroid nodules. This meta-analysis aimed to assess the role of US in evaluating Bethesda class III thyroid nodules. Methods: With keywords “Undetermined Significance,” “Bethesda Category III,” “Bethesda system,” “Cytological Subcategory,” “AUS/FLUS,” “Atypia of Undetermined Significance,” and “Ultrasound/US,” papers in PubMed, Cochrane Library, Medline, Web of Science, Embase, and Google Scholar from inception to December 2016 were searched. A meta-analysis of these trials was then performed for evaluating the diagnostic value of thyroid ultrasound in Bethesda Category III thyroid nodules. Results: Fourteen studies including 2405 nodules were analyzed. According to the criteria for US diagnosis of thyroid nodules in each article, with any one of suspicious features as indictors of malignancy, US had a pooled sensitivity of 0.75 (95% CI 0.72–0.78) and a pooled specificity of 0.48 (95% CI 0.45–0.50) in evaluating Bethesda Class III Nodules. The pooled diagnostic odds ratio was 10.92 (95% CI 6.04–19.74). The overall area under the curve was 0.84 and the Q* index was 0.77. With any 2 or 3 of US suspicious features as indictors of malignancy, the sensitivity and specificity were 0.77 (95% CI 0.71–0.83) and 0.54 (95% CI 0.51–0.58), 0.66 (95% CI 0.59–0.73) and 0.71 (95% CI 0.68–0.74), respectively. Conclusions: US was helpful for differentiating benign and malignant Bethesda class III thyroid nodules, with the more suspicious features, the more likely to be malignant.

Sonographic and Clinical Features of Papillary Thyroid Microcarcinoma Less than or Equal to Five Millimeters: A Retrospective Study.

Objective To retrospectively compare the sonographic and clinical features of papillary thyroid microcarcinoma (PTMC) ≤5 mm and PTMC >5 mm to improve the diagnostic value of ultrasonography. Methods A total of 367 cases of PTMC between January 2013 and December 2014 was included in this study. The patients were classified into group A (≤5 mm, n = 181) or group B (>5 mm, n = 186), and the sonographic and clinical features were reviewed and compared between the two groups. Results There was no significant difference in the shape, ratio of length/width, boundary, peripheral halo ring, echogenicity, cystic change and accompanying Hashimotos thyroiditis between these two groups. However, the calcification (61.3% vs. 72.6%) and hypervascularity (13.8% vs. 24.7%) were more frequent in group B (p = 0.026 and 0.008, respectively). The patients were younger, and more patients were aged less than 45 years (41.4% vs. 57.0%) in group B. Capsular invasion (7.2% vs. 34.4%), multifocality (21.5% vs. 48.9%), bilaterality (17.1% vs. 39.8%), central lymph node metastasis (13.8% vs. 38.2%) and lateral lymph node metastasis (1.1% vs. 5.4%) were more frequent in group B. No clinical or sonographic feature was related to cervical lymph node metastasis in group A, while less than 45 years in age (p = 0.010), male gender (p = 0.040), capsular invasion (p<0.001), multifocality (p = 0.016) and calcification (p = 0.042) were related to cervical lymph node metastasis in group B. Conclusions The sonographic features of PTMC ≤5 mm were similar to those of PTMC >5 mm, including an irregular shape, a length/width ratio of ≥1, an unclear boundary, no peripheral halo ring, hypoechogenicity, no cystic change, calcification, no hypervascularity and no accompanying Hashimotos thyroiditis. The clinical features of PTMC ≤5 mm were less aggressive than those of PTMC >5 mm.

Comparison of Clinical and Ultrasonographic Features of Poorly Differentiated Thyroid Carcinoma and Papillary Thyroid Carcinoma

Background:The clinical behavior and management of poorly differentiated thyroid carcinoma (PDTC) are very different from papillary thyroid carcinoma (PTC). By comparing the clinical and ultrasonographic features between the two tumors, we proposed to provide more possibilities for recognizing PDTC before treatment. Methods:The data of 13 PDTCs and 39 age- and gender-matched PTCs in Peking Union Medical College Hospital between December 2003 and September 2013 were retrospectively reviewed. The clinical and ultrasonic features between the two groups were compared. Results:The frequencies of family history of carcinoma, complication with other thyroid lesions, lymph node metastases, recurrent laryngeal nerve injuries, and distant metastases were higher in PDTCs (30.8%, 61.6%, 69.2%, 23.1%, and 46.2%, respectively) than those in PTCs (2.6%, 23.1%, 25.6%, 2.6%, and 2.6%, respectively) (P < 0.05). The mortality rate of PDTCs was greatly higher than PTCs (P < 0.01). Conventional ultrasound showed that the size of PDTCs was larger than that of PTCs (3.1 ± 1.9 cm vs. 1.7 ± 1.0 cm). Clear margins and rich and/or irregular blood flow were found in 92.3% of PDTCs, which differed substantially from PTCs (51.7% and 53.8%, respectively) (P < 0.05). Conclusions:PDTC is more aggressive and its mortality rate is higher than PTCs. Accordingly, more attention should be given to suspicious thyroid cancer nodules that show large size, regular shape, and rich blood flow signals on ultrasound to exclude the possibility of PDTCs.

Comparison of ultrasonic features between anaplastic thyroid carcinoma and papillary thyroid carcinoma.

OBJECTIVE To explore the difference of the ultrasonic features between anaplastic thyroid carcinoma and papillary thyroid carcinoma. METHODS The ultrasound data of 7 patients with histopathologically confirmed anaplastic thyroid carcinomas who were treated in PUMC Hospital from April 2001 to June 2014 were retrospectively studied. In addition, 21 sex-and age-matched patients with histopathologically confirmed papillary thyroid carcinomas during the same period were enrolled as the control group. The pathologic results were regarded as the gold standard. The ultrasonic features of anaplastic thyroid carcinoma and papillary thyroid carcinoma were analyzed and compared. RESULTS Patients with anaplastic thyroid carcinoma were predominantly females (5/7,71.4%), with an average age of (64.9 ± 11.3) years. Large mass [(5.17 ± 1.26) cm vs. (1.85 ± 1.89)cm, P<0.001], anteroposterior-to-transverse diameter ratio less than 1(100.0% vs. 47.6%, P ＝ 0.03), and punctuate calcification (100.0% vs. 52.4%, P ＝ 0.03) were more frequently associated with anaplastic thyroid carcinoma than with papillary thyroid carcinoma. No significant difference was observed between the two groups in the shape, margin, cystic change, echogenicity, echotexture,vascularity,and envelope (all P>0.05). CONCLUSION In elderly women with common malignant features on ultrasound, the thyroid nodules with a maximum diameter greater than 5 cm,anteroposterior-to-transverse diameter ratio less than 1,and microcalcifications are highly likely to be anaplastic thyroid carcinoma.

Diagnostic value of contrast-enhanced ultrasound of thyroid nodules coexisting with Hashimoto's thyroiditis.

OBJECTIVE To evaluate the value of contrast-enhanced ultrasound (CEUS) in diagnosing thyroid nodules coexisting with Hashimotos thyroiditis (HT). METHODS Totally 62 thyroid nodules in 48 HT patients were retrospectively analyzed. The CEUS characteristics were reviewed, and diagnostic value of enhancement pattern and peak intensity were calculated. RESULTS Peak intensity (P=0.002) and enhancement pattern (P<0.001) differed significantly between malignant and benign thyroid nodules. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of heterogeneous enhancement were 97.6%, 85.7%, 93.0%, 94.7%, and 93.5%, respectively. Sensitivity, specificity, PPV, NPV and accuracy of low intensity at peak time were 85.4%, 52.4%, 77.8%, 64.7%, and 74.2%, respectively. CONCLUSIONS Heterogeneous enhancement is effective in the diagnosis of malignant thyroid nodules coexisting with HT. CEUS can improve the diagnostic accuracy in distinguishing thyroid nodules with unknown malignancy under the conventional ultrasound.

Usefulness of ultrasonography in the differential diagnosis of thyroidal follicular tumor

OBJECTIVE To evaluate the usefulness of ultrasonography in distinguishing follicular carcinoma from adenoma. METHODS The ultrasound data of 37 patients with histopathologically confirmed follicular carcinomas who were treated in PUMC Hospital from January 2000 to November 2012 were retrospectively studied. In addition, 74 sex-and age-matched patients with histopathologically confirmed adenomas during the same period were enrolled as the control group. The pathologic results were regarded as the gold standard. RESULTS Irregular shape (32.4% of follicular carcinoma vs 5.4% of adenoma), absence of thin halo (67.6% vs 36.5%), indistinct margin (21.6% vs 1.4%), hypoechoic appearance (64.9% vs 39.2%), punctuate calcification(40.5% vs 13.5%), absence of cystic change (78.4% vs 54.1%), and being complicated with other thyroid disease (56.8% vs 28.4%) were more frequently associated with follicular carcinoma than with benign adenoma (P<0.05). No significant difference in the echotexture and internal flow was observed between the two groups (P>0.05). CONCLUSION Although follicular carcinoma and adenoma share many sonographic features, irregular shape, absence of thin halo, indistinct margin, hypoechoic appearance, punctuate calcification, absence of cystic change, and being complicated with other thyroid disease favor a follicular carcinoma diagnosis.

Sonographic Evaluation of Metastatic Cervical Lymph Nodes

Cervical nodal metastases are common in patients with head and neck cancers. Early assessment is important for treatment planning and prognosis. Ultrasound has been widely used in the evaluation of neck lymph nodes, with common parameters including location, size, shape, boundary, hilus, echogenicity, vascular pattern, and resistance index. The diagnostic accuracy has been dramatically improved along with the introduction of new techniques including contrast-enhanced ultrasound, elastography, and ultrasound-guided fine needle aspiration biopsy. Neck ultrasound has became an important tool in preoperative assessment and postoperative follow-up for patients with head and neck cancers.

Pathology Verified Concomitant Papillary Thyroid Carcinoma in the Sonographically Suspected Thyroid Lymphoma： A Case Report

PAPILLARY thyroid carcinoma(PTC)is the most common thyroid cancer and consists of nearly80%of all cases of thyroid cancer.~1 It is associated with the lowest level of malignancy and an excellent prognosis.Primary thyroid lymphoma(PTL)is a lymphomatous process which develops in the thyroid