Can transrectal ultrasonography distinguish anorectal malignant melanoma from low rectal adenocarcinoma? A retrospective paired study for ten years.

BACKGROUND: Anorectal malignant melanoma (ARMM) and low rectal adenocarcinoma (LRAC) have some similarities in clinical behaviors, histopathological characteristics and ultrasonographic findings, diagnostic errors are common. By comparing the transrectally ultrasonographic features between the two tumors, we propose to provide more possibilities in differentiating them. METHODS: The data of 9 ARMMs and 27 age- and gender-matched LRACs (the lower margin below the peritoneal reflection) in West China Hospital Sichuan University between April 2008 and July 2019 were retrospectively reviewed. The ultrasonic features between the two groups were compared. RESULTS: Transrectal ultrasonography (TRUS) showed that the length of ARMM was shorter than that of LRAC (28.22 ± 12.29 mm vs. 40.22 ± 15.16 mm), and ARMM had a lower position than that of LRAC (the distance to anal verge was 50.78 ± 11.70 vs. 63.81 ± 18.73 mm). Unlike LRAC, the majority of ARMM in our study was confined to the intestinal mucosa/submucosa (66.67/25.93%) (P < 0.05). CONCLUSIONS: Based on the data of our study, several ultrasonographic findings (length, invasion depth, and position) of ARMM were significantly different from LRAC. Accordingly, more attention should be paid to masses at anorectal junction with lower position, shorter length, and shallower infiltration depth. Instead of the most common tumor, LRAC, ARMM should be taken into account to avoid a misdiagnosis, which will result in a poorer prognosis.

[The Diagnostic Value of Double Contrast Enhanced Ultrasound in Colorectal Neoplasms].

OBJECTIVES: To determine the value of double contrast enhanced ultrasound (DCEUS) in detecting colorectal neoplasms. METHODS: The conventional abdominal ultrasound and DCEUS (hydrocolonal ultrasound+intravenous contrast-enhanced ultrasonography) were performed in 77 patients with 79 colorectal tumors. The clinical, ultrasonic and pathological data of the patients were reviewed. RESULTS: The conventional abdominal ultrasound detected 32 colorectal tumors (32/79, with a sensitivity of 40.1%), compared with 68 tumors found in DCEUS (68/79, with a sensitivity of 86.1%). The tumors were located accurately in 21.9%(7/32) and 88.2%(60/68) cases for the conventional abdominal ultrasound and DCEUS, respectively ( P<0.05). DCEUS accurately located 94.4%(51/54)cased with colon neoplasm. Two types of enhancing modes were found with colorectal neoplasm: entirely homogeneous enhancing and heterogeneous enhancing perpendicularly from the serosal part to the mucosal part. The enhancing modes were associated with the morphology of neoplasm. Thirty-nine segmented-thickened tumors were found with perpendicularly enhancing from the serosal surface to the mucosal surface, while 29 protruding tumors were found with enhancing from their pedicles or fund. CONCLUSIONS: DCEUS has higher detection sensitivity and location accuracy than conventional ultrasound.

Case report: An intrauterine device hugging the musculus rectus abdominis through the center of a cesarean scar.

A 34-year-old woman presented with an abscess of the abdominal wall, with a 10-day history of rupture and discharge. She had a history of cesarean section 17 years ago, intrauterine device (IUD) insertion 5 years ago, and intermittent lumbago and abdominal pain for the past 4 years. A V-shaped IUD was observed via ultrasound between the bladder and abdominal wall, clinging to the musculus rectus abdominis through the center of the cesarean scar. Pelvic computed tomography (CT) revealed a V-shaped metal density at the anterior upper edge of the bladder, one end of which seemed to penetrate the abdominal wall. IUD migration was confirmed by surgery 2 days later. The patient recovered after IUD removal. This case affirms that a migrated IUD can lead to serious complications, even if there are no obvious symptoms for many years. Apart from the fact that the IUD has fallen out of place, a migrated IUD should be removed promptly, regardless of obvious complications. Furthermore, regular ultrasound examination is important for early diagnosis of IUD displacement. Based on the relevant literature, we also hypothesize the possible mechanism of IUD migration between the anterior bladder wall and the abdominal wall. Core tip: Uterine perforation and IUD migration to the organs in the abdominopelvic cavity are serious complications of IUD insertion. We present a case of uterine perforation complicated by IUD migration with the application of intraoperative ultrasound localization. This case highlights that ultrasound, especially intraoperative ultrasound, can provide objective information for the diagnosis and localization of IUD migration, with the advantages of point of care, real-time imaging, convenience, low cost, and lack of radiation. Based on this case and on the relevant literature, we hypothesized the possible mechanism of IUD migration between the anterior bladder wall and the abdominal wall. To the best of our knowledge, no previous research has discussed the process of IUD migration beyond the anterior wall of the bladder.

The value of multi-modes of ultrasound in evaluating segmental mucosal healing in patients with Crohn's disease.

BACKGROUND: Mucosal healing, the result of endoscopic remission, is associated with prolonged clinical remission and delayed deterioration of Crohn's disease, which is significant and accompanied by reduced hospitalizations and surgeries. Currently, the relationship between ultrasonic parameters and mucosal healing remains controversial. To establish an ultrasonic regression model to evaluate mucosal healing, we conducted this preliminary study using multiple parameters from B-mode ultrasonography, colour Doppler flow imaging and shear wave elastography systematically. METHODS: This study consisted of two single-centre investigations based on development and validation populations who received endoscopies (as the gold standard) and ultrasound. The involved bowel segments were divided into mucosal healing (MH) and nonmucosal healing (NMH) groups according to endoscopic results. Eight ultrasonic parameters were observed, including bowel wall thickness (BWT), mesenteric fat thickness (MFT), median modulus of elasticity (Emean), average shear wave velocity (SWV), Limberg scoring (LG), bowel wall stratification (BWS), ascites (AS) and lymph node enlargement (LN). We developed an ultrasonic regression model in the development phase to evaluate segmental mucosal healing and undertook prospective validation of this model. RESULTS: A total of 124 patients with 380 involved bowel segments from the development and validation cohorts were evaluated. Eight ultrasonic parameters were significantly different between the two groups (P<0.05) in the development phase. Four significant parameters with better AUC performance were selected to establish an ultrasonic regression model to predict mucosal healing. The AUCs of this ultrasonic model were 0.975 and 0.942 in the development and validation cohorts, respectively. CONCLUSION: The multimodal ultrasonic model has the potential to evaluate segmental mucosal healing in Crohn's disease.

The establishment of a regression model from four modes of ultrasound to predict the activity of Crohn's disease.

To establish a multi-parametric regression model from four modes of ultrasound to predict the activity of Crohn's disease (CD) noninvasively. Score of 150 of the Crohn's Disease Activity Index (CDAI) was taken as the cut-off value to divide the involved bowel segments of 51 patients into the active and inactive group. Eleven parameters from four modes of ultrasound (B-mode ultrasonography, color Doppler flow imaging, contrast-enhanced ultrasonography and shear wave elastography) were compared between the two groups to investigate the relationship between multimodal ultrasonic features and CD activity. P < 0.05 was considered statistically significant. Parameters with AUC larger than 0.5 was selected to establish the prediction model of CDAI. Totally seven ultrasound parameters (bowel wall thickness, mesenteric fat thickness, peristalsis, texture of enhancement, Limberg grade, bowel wall perforation and bowel wall stratification) were significantly different between active and inactive group. A regression model was established based on the seven parameters as followed: CDAI = 211.325 + 3.186BWT - 53.003BWS + 6.280BWP + 0.392MFT + 22.239PS + 79.012LG + 72.793TE. (R2 = 0.72, P = 0.037). The multimodal ultrasound parametric regression model was designed to predict CDAI score invasively. The model has the potential to provide an alternative method for quantifying the CD activity.

Using shear wave elasticity in normal terminal ileum of a healthy southwest Chinese population: a pilot study of reference elasticity ranges.

BACKGROUND: Elastography has not been widely applied to the gastrointestinal tract. The bowel wall's normal elasticity values are still unknown and are necessary for studies of gastrointestinal diseases. This study explores the feasibility of using shear wave elastography (SWE) to measure the terminal ileum wall stiffness in healthy subjects and establish the corresponding normal ranges of elasticity values. METHODS: This observational study recruited 139 healthy adult volunteers from April to July 2020. All examinations were performed in the anterior terminal ileum wall. Shear wave velocity (SWV) and Young's modulus (E) values were measured in the midline on longitudinal sections and replicated different operators' obtained data. Also, bowel wall thickness (BWT) and depth were recorded. Subgroups were classified according to the volunteers' gender, age, body mass index (BMI), BWT, and depth. The intra-class correlation coefficient was calculated to analyze inter- and intra-operator consistency, and independent t-tests and one-way analysis of variance were used to explore the differences in variables. RESULTS: The inter- and intra-operator agreements were good to excellent by different operators and in the replicated measurements (intra-operator consistency: 0.963; inter-operator consistency: 0.842). In all volunteers, the mean SWV was 1.08±0.25 m/s, the mean E value was 3.84±1.84 kPa, and the median BWT was 2 mm. SWV and E did not show significant differences according to gender (P=0.589), age (P=0.738), BMI (P=0.678), depth (P=0.375), or BWT (P=0.410). BWT did not show significant differences according to age (P=0.142), BMI (P=0.863), or depth (P=0.368). CONCLUSIONS: SWE can be used in terminal ileum wall stiffness measurements with good reliability, and the SWE values do not appear to vary significantly according to different physiological factors. The corresponding elasticity ranges of the terminal ileum in normal adults were acquired.

[A preliminary study on data mining techniques for utilizing the breast ultrasound database].

Based on the breast ultrasound database of West China Hospital from January 1, 2002 to December 31, 2007, a study of data mining techniques for utilizing the diagnostic information of breast ultrasound and breast pathology was carried out. An innovative computerized retrieval system was invented. With the visual user interface of the system, the data of benignancy or malignancy diagnosed by ultrasound and pathologic examination, and the data on the diagnostic correlation of ultrasound and pathology were obtained, respectively. The qualities of data mining were 99. 98%-100%. By means of the retrieval system, the users can secure numerous data from the breast ultrasound database rapidly and accurately; so it contributes to the rational utilization of information from medical database for serving various medical studies. This method may also be helpful for doctors to utilize ultrasound database in other fields.

Vas deferens sonographic appearances of tuberculosis lesions of 19 cases of male genital systemic tuberculosis.

To investigate the sonographic findings of the vas deferens in male genital tuberculosis.The ultrasonographic findings of the vas deferens of 19 cases of genital tuberculosis were retrospectively analyzed.According to the pathological and ultrasound findings, the ultrasonographic appearances of the vas deferens tuberculosis could be divided into 4 groups, 1 of normal sonograms, 3 of abnormal sonograms. The abnormal ultrasonographic appearances of the vas deferens tuberculosis were considered 3 categories as follows: diffusely thickening of vas deferens, nodular thickening of vas deferens, and space-occupying lesions adjacent to the vas deferens.The ultrasound manifestations of vas deferens in tuberculosis of the male genital system have certain characteristics. Combination of clinical manifestations, history of tuberculosis, experimental antituberculosis treatment, and ultrasound examination of vas deferens can suggest tuberculosis of vas deferens. Furthermore, it can provide objective basis for the comprehensive and noninvasive evaluation of the impact of genital tuberculosis on the reproductive ability for further treatments.