Strain Elastography: A Valuable Additional Method to BI-RADS?

BACKGROUND: Breast lesions classified as BI-RADS-US 3 are probably benign and observation was recommended, while a considerable number of BI-RADS-US 4 lesions were benign, resulting in excessive biopsies. We focus exclusively on BI-RADS-US 3 and 4 lesions and hypothesize that improved diagnostic performance can be achieved by integrating real-time elastography (strain ratio) into the BI-RADS-US classification system. METHOD: From April 2010 to September 2015, 1071 lesions were included in the final analysis. After the conventional ultrasound examination, the BI-RADS-US (2013) classification was used to evaluate the lesions. Then the strain ratios were calculated, and the final diagnosis was made on the basis of histological results. The sensitivity, specificity, accuracy, PPV and NPV were calculated and the AUCs were compared. Additionally, an analysis of the diagnostic performance expressed by the pretest and posttest probability of disease (POD) was performed in BI-RADS-US 3 and 4A lesions. RESULTS: With the cutoff point of 2.98, the sensitivity, specificity and accuracy of the strain ratio method were 86.9 %, 86.6 % and 82.6 %, respectively. In BI-RADS-US 3 lesions, a suspicious strain ratio significantly modified the POD from 1.3 % to a posttest POD of 29.8 %. In BI-RADS-US 4A lesions, a suspicious strain ratio significantly modified the POD from 8.5 % to a posttest POD of 48.7 %. CONCLUSION: Ultrasonographic elastography (strain ratio) yields additional diagnostic information in the evaluation of BI-RADS-US 3 and 4 breast lesions. The strain ratios should be integrated into the BI-RADS-US classification system and into daily practice.

ACR TI-RADS classification combined with number of nodules, halo features optimizes diagnosis and prediction of follicular thyroid cancer.

OBJECTIVES: To investigate the application value of The American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) category combined with other ultrasound features of nodules in distinguishing follicular thyroid carcinoma (FTC) from thyroid follicular adenoma (FTA). METHODS: We collected and retrospectively analyzed clinical and ultrasound data for 118 and 459 patients with FTCs and FTAs, respectively, at our hospital. Next, we used ACR TI-RADS classification combined with other ultrasound features of nodules to distinguish FTC from FTA. Multivariate Logistic regression was used to screen independent risk factors for FTC, which were subsequently used to construct a nomogram for predicting FTC. RESULTS: ACR TI-RADS categories 4 and 5, unilateral multiple nodules, and halo thickness≥2 mm were independent risk factors for FTC. ACR TI-RADS category combined with number of nodules, halo features of the nodule was a significantly better prediction model for FTC diagnosis (AUC = 0.869) than that of ACR TI-RADS classification alone (AUC = 0.756). CONCLUTIONS: Clinicians need to pay attention to the halo of nodules when distinguishing FTA from FTC. Notably, ACR TI-RADS combined with other nodule ultrasound features has superior predictive performance in diagnosis of FTC compared to ACR TI-RADS classification alone, thus can provide an important reference value for preoperative diagnosis of FTC.

Ultrasonography predicts the results of labial salivary gland biopsy in patients with suspected Sjögren's syndrome: a matrix risk model.

OBJECTIVE: Although a positive result of labial salivary gland biopsy (LSGB) is critical for the diagnosis of Sjögren's syndrome, rheumatologists prefer assessing the non-invasive objective items and hope to learn the predicted probability of positive LSGB before referring patients with suspected Sjögren's syndrome to receive biopsy. This study aimed to explore the predictive value of combined B-mode ultrasonography (US) and shear-wave elastography (SWE) examination on LSGB results. METHODS: A derivation cohort and later a validation cohort of patients with suspected Sjögren's syndrome were recruited. All participants received clinical assessments, B-mode US and SWE examination on bilateral parotid and submandibular glands before LSGB. Positive LSGB was defined by a focus score ⩾1 per 4 mm2 of glandular tissue. RESULTS: In the derivation cohort of 91 participants, either the total US scores or the total SWE values of four glands significantly distinguished patients with positive LSGB from those with negative results (area under the curve (AUC) = 0.956, 0.825, both p < 0.001). The positive predictive value (PPV) was 100% in patients with total US scores ⩾9 or with total SWE values ⩾33 kPa. The negative predictive value (NPV) was 100% in patients with total US scores <5, but 68% in patients with total SWE values <27 kPa. A matrix risk model was derived based on the combination of total US scores and total SWE values. Patients can be stratified into high, moderate, and low risk of positive LSGB. In the validation cohort of 52 participants, the PPV was 94% in the high-risk subpopulation and the NPV was 93% in the low-risk subpopulation. CONCLUSION: A novel matrix risk model based on the combined B-mode US and SWE examination can help rheumatologists to make a shared decision with suspected Sjögren's syndrome patients on whether the invasive procedure of LSGB should be performed.

Structures, luminescence and photocatalytic properties of two nanostructured cadmium(II) coordination polymers synthesized by sonochemical process.

By varying the dicarboxylate coligands, two nano-sized cadmium(II) coordination polymers (CPs), [Cd(bix)(DCTP)]n (1) and [Cd(bix)2(BPDC)]n (2) (bix=1,4-bis(imidazol-1-ylmethyl)benzene, H2DCTP=2,5-dichloroterephthalic acid, H2BPDC=biphenyl-4,4'-dicarboxylic acid) were synthesized hydrothermally and sonochemical irradiation. CPs 1-2 and their nanostructures have been characterized by elemental analysis, single-crystal X-ray diffraction, and scanning electron microscopy (SEM). CP 1 features a uninodal 4-connected 2D sql network consisting of two different helical arrays. Whilst, CP 2 displays 2D layer which constructed by the linear chains and M2L2 type discrete loops. The effect of ultrasonic power and temperature on the morphology and size of CPs 1-2 are investigated in detail. Nano-sized 1-2 show the relatively high photocatalytic performance for degradation of Methylene Blue (MB) under UV irradiation.

A new three-dimensional bis(benzimidazole)-based cadmium(II) coordination polymer.

A new coordination polymer (CP), formulated as [Cd(L)(DCTP)]n (1) (L=1,1'-(1,4-butanediyl)bis(2-methylbenzimidazole), H2DCTP=2,5-dichloroterephthalic acid), was synthesized under hydrothermal conditions and the performance as luminescent probe was also investigated. Single-crystal X-ray diffraction reveals CP 1 is a 3D 3-fold interpenetrated dia network with large well-defined pores. It is found that CP 1 revealed highly sensitive luminescence sensing for Fe3+ ions in acetonitrile solution with a high quenching efficiency of KSV=2541.238L·mol-1 and a low detection limit of 3.2µM (S/N=3). Moreover, the photocatalytic efficiency of 1 for degradation of methylene blue could reach 82.8% after 135min. Therefore, this coordination polymer could be viewed as multifunctional material for selectively sensing Fe3+ ions and effectively degrading dyes.

Ultrasonic synthesis of two nanostructured cadmium(II) coordination supramolecular polymers: Solvent influence, luminescence and photocatalytic properties.

Two nanoparticles of cadmium(II) coordination polymers (CPs) formulated as [Cd(L)(DCTP)]n (1) and [Cd(L)2(DCTP)·2H2O]n (2) (L=1,2-bis(2-methylbenzimidazol-1-ylmethyl)benzene, H2DCTP=2,5-dichloroterephthalic acid) were prepared by the sonochemical approach in different solvents and characterized by elemental analysis, IR spectra, scanning electron microscopy (SEM), and powder X-ray diffraction. Structural determination reveals that CP 1 displays a 2D four-connected sql net layer, Whilst CP 2 exhibits a 1D "V"-like chain structure. Luminescence properties, thermal behavior, and photocatalytic activities of the nanoparticles of CPs 1 and 2 on the degradation of methylene blue were investigated. The photocatalytic mechanism is carried out by introducing t-butyl alcohol (TBA) as a widely used OH scavenger. Furthermore, the influence of solvents, reaction time, and ultrasound irradiation temperature on the morphology and size of the nanostructure CPs 1 and 2 were investigated. The results indicated that an increase of time and ultrasound irradiation temperature decreased the nanostructured size.

Sonochemical synthesis of two nanostructured silver(I) coordination polymers based on semi-rigid bis(benzimidazole) ligands.

Nanoparticles of two silver(I) coordination polymers (CPs), [Ag2(L1)2(DCTP)]n (1) and [Ag2(L2)(DCTP)]n (2) (L1=1,3-bis(5,6-dimethylbenzimidazol-1-ylmethyl)benzene, L2=1,4-bis(benzimidazol-1-yl)-2-butene, H2DCTP=2,5-dichloroterephthalic acid), were synthesized by the sonochemical approach and hydrothermal method. Both CPs were characterized by elemental analysis, IR spectra, single-crystal X-ray diffraction, scanning electron microscopy (SEM), and thermogravimetric analyses (TGA). CP 1 exhibits a 2D 4-connected sql net with the point symbol {44.62}. While CP 2 displays a 2D 3,4-connected 3,4L13 net with the point symbol {4.62}2{42.62.82}. The structural diversity indicates that semi-rigid bis(benzimidazole) co-ligands play important roles in tuning the structures of the mixed Ag(I) CPs. The ultrasound irradiation time, temperature, and power showed significant effects on the morphology and growth process of the nanoparticles of two silver(I) CPs. The luminescence and photocatalytic properties of the nanoparticles of CPs 1-2 on the degradation of methyl blue (MB) were also investigated in detail.

Construction of noninterpenetrating and interpenetrating Co(ii) networks with halogenated carboxylate modulated by auxiliary N-donor co-ligands: structural diversity, electrochemical and photocatalytic properties.

Six Co(ii)-based coordination polymers (CPs) with characteristic frameworks and topologies-namely, [Co(L1)(DCTP)]n (1), [Co(L2)(DCTP)]n (2), [Co(L3)(DCTP)]n (3), {[Co3(L4)3(DCTP)3·H2O]·H2O}n (4), [Co(L5)1.5(DCTP)]n (5) and [Co(L6)(DCTP)]n (6)-were successfully hydrothermally synthesized by employing the halogenated linear ligand 2,5-dichloroterephthalic acid (H2DCTP). The interpenetrated structures could be rationally modulated by auxiliary N-donor co-ligands containing 1,1'-(1,4-butanediyl)bis-1H-benzimidazole (L1), 1,4-bis(5,6-dimethylbenzimidazol-1-yl)-2-butylene (L2), 1,2-bis(2-methylbenzimidazol-1-ylmethyl)benzene (L3), 1,4-bis(2-methylbenzimidazol-1-ylmethyl)benzene (L4), 1,2-bis(5,6-dimethylbenzimidazol-1-ylmethyl)benzene (L5) and 1,4-bis(5,6-dimethylbenzimidazol-1-ylmethyl)benzene (L6). These diaphanous crystals were clearly characterized by elemental analysis, infrared (IR) spectra and X-ray powder diffraction (XRPD) as well as single-crystal X-ray diffraction analysis. With the aid of the flexible N-donor co-ligands, CP 1 occupies a non-interpenetrated 2D sheet with the point symbol {44·62} sql net topology, CP 2 possesses a 3D hexagon-shaped network with the point symbol {66} three-fold interpenetrated sqc6 topology, CP 3 exhibits a 2D layer with the point symbol {44·62} sql net topology, CP 4 reveals an unusual 3D framework with the point symbol {42·63·8} three-fold interpenetrated sra topology, CP 5 has a 3D hexagon-shaped network with the point symbol {66} two-fold interpenetrated sqc6 topology, while CP 6 displays a 3D hexagon-shaped network with the point symbol {66} three-fold interpenetrated sqc6 topology. The diverse structures of CPs 1-6 illustrate that the substitute group and position of the methyl group of the bis(benzimidazole) derivatives play a significant role in the assembly of such interpenetrated frameworks. Moreover, luminescence properties and thermal behavior, as well as the electrochemical and photocatalytic properties of CPs 1-6 on the degradation of methylene blue, are also presented.

What Help Could Ultrasound Elastography Give to the Diagnosis of Breast Papillary Lesions?

On the basis of results of our previous studies and the findings of other scholars, the most common histologic type of false-positive diagnosis with strain elastography (SE) was papilloma. The objectives of our study were to evaluate whether SE could contribute to conventional ultrasound differentiation between benign and malignant papillary lesions and between papillary lesions and other common benign breast lesions. Data on 89 papillary lesions at our hospital, including 74 benign and 15 malignant papillary lesions, were included in our study. In addition, 198 non-papillary benign tumors were selected as the control group, including 126 fibroadenomas and 72 cases of fibrocystic mastopathy. All patients gave written informed consent. All patients with breast lesions underwent conventional ultrasound and SE examination. Breast Imaging Recording and Data System (BI-RADS) category and SE score were compared with respect to sensitivity, specificity and accuracy in differentiating between benign and malignant papillary lesions. We then explored the possibility of using BI-RADS combined with SE to differentiate papillary lesions from non-papillary benign tumors. For differentiating between benign and malignant papillary lesions, the area under the receiver operating characteristic curve (AUC) of BI-RADS was 0.568, whereas the AUC values of SE score, strain ratio and BI-RADS combined with SE were 0.517, 0.584 and 0.509, respectively (p > 0.05). For differentiating between papillary lesions and non-papillary benign lesions, the AUC of BI-RADS combined with SE was 0.835, which was higher than the values for BI-RADS (0.775) and SE (SE score: 0.648, strain ratio: 0.661) (p < 0.001). The specificity and accuracy of BI-RADS combined with SE were significantly higher than those for BI-RADS alone without a decrease in sensitivity (p < 0.05). SE could not improve the diagnostic efficiency of BI-RADS in differentiating between benign and malignant papillary lesions. However, BI-RADS combined with SE could improve the specificity of BI-RADS without decrease in sensitivity for differentiating breast papillary lesions from non-papillary benign lesions.

Ultrasound Elastography Combined With BI-RADS-US Classification System: Is It Helpful for the Diagnostic Performance of Conventional Ultrasonography?

PURPOSE: To evaluate the additive diagnostic performance of ultrasound elastography (UE) to ultrasound (US) with the 2003 or 2013 Breast Imaging Reporting and Data System (BI-RADS)-US classification systems for the differentiation of benign and malignant breast lesions. METHODS: From June 2010 to December 2012, 738 women with 770 breast lesions were recruited into this retrospective study. Breast lesions were evaluated separately by US, UE, and both. US assessment was based on the 2003 or 2013 BI-RADS-US, and UE assessment was based on a previously reported 5-point scale. Diagnostic performance of US, UE, and both was compared. RESULTS: Before category 4 lesions were subdivided, the area under the receiver operating characteristic curve (AUC) for US, UE, and both were, respectively, 0.735, 0.877, 0.878 (P < .01). When subcategories of 4 lesions were considered, the AUC for US, UE, and both were, respectively, 0.865, 0.877, and 0.883 (P > .05). Adding UE to analysis of 4A lesions can decrease the percentages of malignancy to 2.56%. CONCLUSION: When the 2003 BI-RADS was considered, UE could give US some help in differentiating breast lesions. However, when the 2013 BI-RADS was considered, UE gave little help to US, although it reduced unnecessary biopsies of benign category 4A lesions.

Could ultrasonic elastography help the diagnosis of breast cancer with the usage of sonographic BI-RADS classification?

OBJECTIVES: The purpose was to evaluate whether BI-RADS (the Breast Imaging Recording and Data System) combined with UE (ultrasound elastography) could improve the differentiation and characterization of benign and malignant breast lesions by comparing with BI-RADS. METHODS: A total of 1080 patients with 1194 breast lesions were studied retrospectively at 8 different institutions from 3 geographic areas across China (North, South, and West) from June 2010 to March 2012. Each institutional ethic review board approved the study and all patients gave written informed consent. All the cases were examined by conventional US (ultrasonography) and UE prior to ultrasound-guided core biopsy. Performance of BI-RADS and BI-RADS combined with UE were compared in different size groups, age groups and area groups. RESULTS: BI-RADS combined with UE cloud improve the accuracy by 13.2% compared to BI-RADS alone for all lesions, 23.2% for <10 mm lesions, 13.3% for ≥10-20 mm lesions, 6.3% for ≥20 mm lesions, 18.4% for <50 years group, 1.7% for ≥50 years group, 13.7% for northern area group, 17.7% for southern area group and 4.4% for western area group. CONCLUSIONS: The help which UE contributed to BI-RADS was greater for breast lesions <10mm and <50 years group.

Inhibition of matrix metalloproteinase 9 expression in rat dermal fibroblasts using small interfering RNA.

BACKGROUND: Matrix metalloproteinases (MMPs) degrade extracellular matrix components. Increased MMP-9 content in diabetic skin contributes to skin vulnerability and refractory foot ulcers. To identify ways to decrease MMP-9 levels in skin, inhibition of MMP-9 expression in dermal fibroblasts using small interfering RNA was investigated in vitro. METHODS: A full-thickness wound was created on the midback of streptozotocin-induced diabetic rats; skin biopsies were performed 3 days later. Skin MMP-9 expression was observed by immunohistochemical analysis. Dermal fibroblasts from 1-day-old normal Sprague Dawley rats cultured with high glucose and homocysteine concentrations were transfected with small interfering RNA complexes. Cells were collected 30, 48, and 72 hours after transfection, and reverse transcription-polymerase chain reaction, Western blot analysis, and gelatin zymography for MMP-9 were performed. RESULTS: Expression of MMP-9 was increased in diabetic rat skin, especially around wounds. After 30-, 48-, and 72-hour transfection with each MMP-9-specific small interfering RNA, reverse transcription-polymerase chain reaction showed markedly decreased MMP-9 messenger RNA expression, protein abundance, and activity. Of four MMP-9 small interfering RNAs, one sequence had a stable high inhibition rate (>70% at 30 and 48 hours after transfection). CONCLUSIONS: Expression of MMP-9 was increased in diabetic rat skin, especially around wounds, and was markedly inhibited after MMP-9 small interfering RNA transfection in vitro (P < .05). These findings may provide new treatments for diabetic skin wounds.

Activation of skin renin-angiotensin system in diabetic rats.

The renin-angiotensin system (RAS) is reportedly involved in chronic diabetic complications such as diabetic nephropathy, but changes of the RAS in diabetic skin remain unknown. The aim of this study was to investigate the expression of angiotensin (Ang) II and its type 1 (AT1) and type 2 (AT2) receptors in diabetic skin tissues, and explore the relationship between the local RAS and pathological changes of diabetic skin. Our results showed that thinning of epidermis, degeneration of collagen, fracture of dermal layer, and atrophy/disappearance of subcutaneous fat were observed in diabetic skin. The expression level of AngII was increased in diabetic skin tissues compared to that in controls. mRNA and protein expression of AT1 receptor were also increased while the level of AT2 receptor decreased; the relative expression of AT1 to AT2 receptors was approximately threefold higher in diabetes than in controls. Furthermore, in the culture medium of primary cultured fibroblasts from diabetic skin, the concentration of AngII was significantly higher than that of normal control. The mRNA and protein expression of AT1 receptor was also increased in fibroblasts of diabetic skin compared to controls, while the protein expression of AT2 receptor was decreased. Taken together, our results suggest that the local RAS system is activated in diabetic skin and AngII receptor is likely to mediate the pathological changes of diabetic skin.