Xuehong Diao

Comparative Study of Automated Breast 3-D Ultrasound and Handheld B-Mode Ultrasound for Differentiation of Benign and Malignant Breast Masses

The automated breast volume scanner (ABVS) represents a new technology for diagnosing breast masses. In this study, a total of 219 breast masses in 175 patients underwent both conventional handheld B-mode ultrasound (HHUS) and ABVS examinations, and the differences in the diagnostic values of the two modalities for benign and malignant breast masses were compared with the final pathologic findings. In addition, the diagnostic accuracy for breast masses with features including retraction phenomenon and hyperechoic rim in the coronal plane of the ABVS was evaluated. There were no differences between the ABVS and HHUS in terms of sensitivity (92.5% vs. 88.0%), specificity (86.2% vs. 87.5%), accuracy (88.1% vs. 87.2%), false-positive rate (13.8% vs. 12.5%), false-negative rate (11.8% vs. 7.5%), positive predictive value (74.7% vs. 75.6%) and negative predictive value (96.3% vs. 94.3%) (p > 0.05 for all). However, there were significant differences between the malignant and benign masses with respect to retraction phenomenon and hyperechoic rim in the coronal plane of the ABVS. For retraction phenomenon, both the specificity and positive predictive value of a malignant diagnosis reached 100%, and the accuracy and false-positive rate were 96.8% and 0, respectively; for the hyperechoic rim, the specificity, negative predictive value and accuracy of a benign diagnosis were 92.8%, 95.3% and 95.9%, respectively. Overall, ABVS is a promising modality for the clinical diagnosis of breast masses with retraction phenomenon and hyperechoic rim in the coronal plane, although the ABVS and HHUS do not differ in diagnostic accuracy for the differentiation of malignant or benign breast masses.

Superb Microvascular Imaging—A new vascular detecting ultrasonographic technique for avascular breast masses: A preliminary study

OBJECTIVES Superb Microvascular Imaging (SMI) is a new vascular imaging technique detecting a slower velocity that color Doppler flow image (CDFI) cannot. The aim of this study is to evaluate the clinical value of SMI for detecting penetrating vessels (PVs) in avascular breast lesions. METHODS Seventy-nine patients with 82 breast lesions were examined by conventional ultrasound and diagnosed as Breast Imaging Reporting and Data System (BI-RADS) level 3 or 4. CDFI detected no PVs; subsequently, Power Doppler (PD), Advanced Dynamic Flow (ADF), and SMI were performed to detect any PVs in the breast lesions. RESULTS Compared with PD or ADF, SMI revealed significantly (P<0.01) higher median numbers of PVs in breast lesions. The area under the receiver operating characteristic curve was 0.914 before the corrected classification versus 0.947 after the corrected classification (P<0.05). CONCLUSIONS SMI was helpful in the differential diagnosis of benign versus malignant in avascular breast lesions, especially those in BI-RADS category 4.

Acoustic radiation force impulse imaging (ARFI) for differentiation of benign and malignant thyroid nodules—A meta-analysis

OBJECTIVES Work-up of thyroid nodules remains challenging. Acoustic radiation force impulse imaging (ARFI)-generated shear wave elastography, which can measure quantitatively tissue stiffness (virtual touch tissue quantification) is used as a complement to conventional sonography for improving the diagnosis of thyroid nodules. This meta-analysis was performed to expand on a previous meta-analysis to assess the diagnostic power of ARFI in differentiating benign and malignant thyroid nodules. METHODS The MEDLINE, PubMed, SpringerLink databases up to December 31, 2014, were searched. The pooled sensitivity, specificity, and summary receiver operating characteristic curve were obtained from individual studies with a random effects model. RESULTS Sixteen studies that included a total of 2436 nodules in 2147 patients for ARFI studies were analyzed. The overall mean sensitivity and specificity of ARFI for differentiation of thyroid nodules were 0.80 (95% confidence interval [CI], 0.73-0.87) and 0.85 (95% CI, 0.80-0.90), respectively. A significant heterogeneity was found for both sensitivity and specificity of the different studies (P<0.001). The area under the curve for the ARFI was 0.91. CONCLUSIONS ARFI has high sensitivity and specificity for identification of thyroid. This technique might be useful to select patients with thyroid nodules for surgery.

Comparative Study of Acoustic Radiation Force Impulse Imaging With Real-Time Elastography in Differential Diagnosis of Thyroid Nodules

The aims of this study were to evaluate whether acoustic radiation force impulse (ARFI) imaging of the thyroid gland and thyroid nodules yields reliable results and to compare the values of ARFI imaging with those of real-time elastography (RTE) in the differential diagnosis of thyroid nodules. RTE and ARFI were performed in 30 patients with 58 thyroid nodules. The results were compared with pathologic findings. Receiver operating characteristic curves were drawn to evaluate the diagnostic results. The area under the curve for RTE (0.78) was smaller than that for ARFI (0.94) (p < 0.01). ARFI imaging of thyroid tissue yields more reliable results than RTE.

The diagnostic value of contrast-enhanced ultrasound in differentiating small renal carcinoma and angiomyolipoma

The aim of this study was to explore the value of contrast-enhanced ultrasound (CEUS) in differentiating small renal masses. A total of 102 small renal masses (≤ 3 cm) in 99 patients were examined using conventional ultrasound (CUS) and CEUS, and the findings were reviewed and evaluated in comparison to pathology. Significant differences between renal cell carcinomas (RCCs) and angiomyolipomas (AMLs) were noted in terms of the orientation and echogenicity on CUS (p < 0.05 for both), but the location, shape, margins, homogeneity, and blood flow signals of RCCs on color Doppler flow imaging (CDFI) were similar to those of AMLs (p > 0.05 for all). On CEUS, however, the enhancement intensity, washout in the late phase, and perilesional rim-like enhancement differed significantly for RCCs and AMLs (p = 0.000 for all). Significant differences between CEUS and CUS in terms of sensitivity (88.9% vs. 55.6%), the negative predictive value (68.0% vs. 29.5%), the false negative rate (9.9% vs. 44.5%), and accuracy (88.3% vs. 58.9%) were noted (p < 0.05 for all). CEUS, with its unique features, has value in diagnosing small RCCs and AMLs and outperforms CUS in differentiation of small RCCs and AMLs.

Diagnostic Value of an Automated Breast Volume Scanner for Abdominal Hernias

This study explored the diagnostic values of an automated breast volume scanner (ABVS) for abdominal external hernias.

Automated Volume Scanner System Ultrasonography for Evaluation of Varicose Veins of the Lower Extremities

Objective: To assess the utility of automated volume scanner system (AVSS) ultrasonography in the clinical evaluation of varicose veins of the leg. Methods: Varicose veins of the leg were evaluated using both handheld ultrasonography and AVSS. Morphological features (tortuosity, focal ectasia, thrombosis) and saphenous vein diameter were observed. Results: A total of 69 legs (43 patients) were examined. The overall quality of AVSS images was excellent in all cases. AVSS allowed visualization of the entire length of the great and small saphenous veins. Significantly more cases of tortuosity, focal ectasia and thrombosis were detected using AVSS than handheld ultra -sonography. The size and mean diameter of veins were consistent between the two methodologies. Conclusions: Coronal plane AVSS ultrasonography images were useful for the detection of tortuosity, focal ectasia and thrombosis. AVSS and handheld ultrasonography can be combined to provide both anatomical and functional information, facilitating the planning of surgical treatment of varicose veins.

Is there an extraclinical value of automated breast volume scanner compared with hand-held ultrasound?: A pilot study

Abstract The aim of this study was to investigate the extraclinical value of automated breast volume scanning (ABVS) in the diagnosis of breast tumor compare to hand-handle ultrasound (HHUS). One hundred twenty-four patients with breast tumor were performed HHUS and ABVS before operation. The research focused on whether there were newly found tumors or new findings on the coronal planes by using ABVS compared with HHUS. Then, the classification adjustments of breast imaging reporting and data system (BI-RADS) were made according to new findings on the coronal planes by using ABVS. There are totally 166 breast tumors found in 124 patients by HHUS, while 8 more were observed by ABVS, 4 of which were malignant and the rest were benign. The sensitivity and specificity of ABVS coronal plane findings were 37.0% and 92.5%, respectively. The area under receiver operating characteristic curve was 0.89 before the corrected classification versus 0.93 after the corrected classification, there were no significant differences (P > .05). There was no significant extraclinical value in differentiating diagnosis of malignant tumors and benign breast tumors by ABVS comparing to HHUS. However, those minimal lesions missed diagnosis could be found by ABVS with continuously automatic scanning.

Quantification of solid hypo-echoic thyroid nodule enhancement with contrast-enhanced ultrasound

Background: The purpose of this study was to investigate the value of the quantitative assessment of enhancement on contrast-enhanced ultrasound (CEUS) for diagnosing solid hypo-echoic thyroid nodules (SHTNs). Methods: A total of 87 SHTNs were imaged by both conventional ultrasound (CUS) and CEUS. The sonographic features, enhancement pattern, and dynamic perfusion changes of the thyroid lesion were evaluated and compared. The final diagnosis was based on histological findings. Results: Of all nodes, 32 were benign, and 55 were malignant. The benign thyroid nodules mainly exhibited diffuse enhancement. The 55 malignant nodules mainly exhibited absent or faint dotted enhancement patterns. Quantitative analysis of CEUS revealed that the Peak enhancement and area under the curve (AUC) of malignant nodules were markedly reduced compared to those of benign nodules. Significant differences between CEUS and CUS were noted with respect to the sensitivity, negative predictive value, false negative rate and accuracy. Conclusions: CEUS is a promising imaging-based approach that can assist in the differential diagnosis of solid hypo-echoic thyroid nodules.

Ultrasonographic United Stiffness Score System: Resolving the Discrepancy between Acoustic Radiation Force Impulse and Real-time Elastography in Evaluating the Thyroid Nodules Stiffness

Objective: The aim of this study was to assess the ultrasonographic united stiffness score system (UUSSS) in diagnosing thyroid nodules, and retrospectively analyze the discrepancy between acoustic radiation force impulse (ARFI) and real-time elastography (RTE). Methods: 170 conventional ultrasound (US) proven thyroid nodules in 70 patients were included and all were examined by RTE and ARFI. RTE and ARFI were first analyzed respectively, comparing with pathological findings. Then nodules have discrepancy between ARFI and RTE were retrospectively analyzed by UUSSS. Results: The AUC (area under curve) of ARFI combined RTE in 170 nodules was 0.87 (sensitivity=79.4% (54/68), specificity=84.3% (86/102), PPV=77.1% (54/70), NPV=86.0% (86/100), accuracy for ARFI were 82.4% (140/170), relatively to RTE was 0.83, 80.9%, 65.7%, 61.1%, 83.8%, 71.8%.The AUC of UUSSS was 0.876 (sensitivity=83.8% (57/68), specificity=87.3% (89/102), PPV=81.4% (57/70), NPV=89.0% (89/100), accuracy for UUSSS was 85.9% (146/170). The difference between area under UUSSS and RTE ROC curves was statistically significant (p<0.05), but was insignificant between UUSSS and ARFI (p=0.2245). There were 47 thyroid nodules had discrepancy in assessing the stiffness between ARFI and RTE. In these nodules, the accuracy of UUSSS was 83.0% (39/47), there were significant difference compare to RTE (20/47) (p=0.000), and ARFI (27/47) (p=0.012). Conclusions: UUSSS is useful to increase the diagnostic accuracy compare to independent RTE and ARFI, especially for those had discrepancy between ARFI and RTE. UUSSS is easy and convenient to re-evaluate stiffness on RTE and ARFI basis, and it place no additional cost burden.