Comparative evaluation of shear wave elastography elasticity values in thyroid nodules with cytology results and TI-RADS scoring in differentiation of benign-malignant nodules.

PURPOSE: The aim of this prospective study was to investigate the diagnostic performance of shear wave elastography (SWE) in differentiating benign and malignant thyroid nodules and their correlation with the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS). METHODS: This prospective study included 370 thyroid nodules in 308 patients aged 18-70 years. All the patients underwent B-mode ultrasound (US), Doppler examination, and SWE and were given an ACR TI-RADS risk score before fine needle aspiration biopsy (FNAB) and/or surgery. The correlation between SWE parameters and ACR TI-RADS categories was investigated statistically and compared with histopathologic results. Additionally, the diagnostic performance of SWE was evaluated to distinguish malignant and benign thyroid nodules. RESULTS: One hundred and thirty-five of the 370 thyroid nodules were malignant, and 235 nodules were benign. The mean shear wave velocity (SWV) value of the malignant nodules (3.70 ± 0.98 m/s) was statistically higher than that of the benign nodules (2.70 ± 0.37 m/s). The best cutoff value of the mean SWV for differentiating benign and malignant nodules was found to be 2.94 m/s (sensitivity 90.4%, specificity 89.9%, positive predictive value 81.3%, negative predictive value 94.1%, p < 0.001). The average score of the nodules according to the ACR TI-RADS was 3.57 ± 1.83 in benign nodules and 7.38 ± 2.69 in malignant nodules (p ≤ 0.001). CONCLUSION: This study showed that combining SWE and TI-RADS improves the specificity of TI-RADS alone in differentiating benign and malignant nodules.

Does ARFI elastography complement B-mode ultrasonography in the radiological diagnosis of idiopathic granulomatous mastitis and invasive ductal carcinoma?

BACKGROUND: Idiopathic granulomatous mastitis (IGM) is a chronic, unpleasant autoimmune inflammatory condition and is clinically and radiologically often confused with breast malignancy. PURPOSE: To investigate the contributions of qualitative and quantitative aspects of acoustic radiation force impulse (ARFI) elastography to the differential diagnosis between IGM and invasive ductal carcinoma (IDC) in the breast. MATERIAL AND METHODS: Ninety-four women with IDC and 39 with IGM were included in the study. Shear wave velocity (SWV) was calculated for all lesions using quantitative elastography. Next, each lesion's correspondence on qualitative elastographic images to those on the B-mode images was evaluated: pattern 1, no findings on elastography images; pattern 2, lesions that were bright inside; pattern 3, lesions that contained both bright and dark areas; and pattern 4, lesions that were dark inside. Pattern 4 was subdivided into 4a (dark area same size as lesion) and 4b (dark area larger than lesion size). Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were calculated. RESULTS: The mean SWV based on ARFI elastography was 3.78 ± 1.26 m/s for IGM and 5.34 ± 1.43 m/s for IDC lesions (P < 0.05). Based on qualitative ARFI elastography, IDC lesions were mostly classified as pattern 4b, while IGM lesions were mostly classified as pattern 1 or 2 (P = 0.01). Evaluation of both the qualitative and quantitative aspects of ARFI elastography yielded a sensitivity of 89% and specificity of 84%. CONCLUSION: ARFI elastography may facilitate the differential diagnosis between IGM and IDC.

Prediction of pancreatic fistula after pancreatectomy by virtual touch tissue imaging and quantification (VTIQ) technology.

OBJECTIVES: The aim of this study was to quantitatively evaluate the stiffness of pancreatic parenchyma and solid focal pancreatic lesions (FPLs) by virtual touch tissue imaging and quantification (VTIQ) technique and to investigate the potential usefulness of VTIQ method in the prediction of post-operative pancreatic fistula (POPF) after pancreatectomy. METHODS: In this prospective study, patients who scheduled to undergo pancreatectomy were initially enrolled and received VTIQ assessment within one week before surgery. VTIQ elastography (Siemens ACUSON Sequoia, 5C-1 transducer) was used to measure the shear wave velocity (SWV) value of FPLs and the body part pancreatic parenchyma. The palpation stiffness of pancreas was qualitatively evaluated during operation by surgeons. POPF was finally diagnosed and graded through a three-weeks post-operative follow-up according to international study group of pancreatic fistula (ISGPF). SWV values were compared between POPF positive and negative group. Receiver operating characteristic (ROC) analysis was used to evaluate the diagnostic efficacy of SWV value in predicting POPF. RESULTS: From December 2020 to June 2021, 44 patients were finally enrolled in this study, among which, 26 patients were identified to develop POPF after pancreatectomy. The SWV value of pancreatic parenchyma in POPF positive group was significantly lower than that in POPF negative group (P = 0.001). However, there was no significant difference in palpation stiffness between the two groups (P = 0.124). Besides, neither the SWV value of FPL nor the SWV ratio between FPL to surrounding pancreatic parenchyma differ significantly between POPF positive and negative group (P > 0.05). Taking SWV value of pancreatic parenchyma >1.10 m/s as a cut-off value for predicting POPF, area under the receiver operating characteristic curve (AUROC) was 0.864 with 72.2% sensitivity, 92.3% specificity, 86.7% positive predictive value (PPV) and 82.8% negative predictive value (NPV), respectively. CONCLUSIONS: VTIQ technique might be a potential non-invasive imaging method to predict POPF before pancreatectomy in future clinical practice.

Reducing Unnecessary Biopsy of American College of Radiology Thyroid Imaging Reporting and Data System Category 4 Nodules.

OBJECTIVES: To assess the effectiveness of strain elastography (SE), Virtual Touch tissue imaging and quantification (VTIQ; Siemens Medical Solutions, Mountain View, CA) and their combination (SE + VTIQ) in distinguishing benign from malignant American College of Radiology Thyroid Imaging Reporting and Data System category 4 nodules (TR4) to reduce unnecessary biopsy. METHODS: In this retrospective study, 985 thyroid nodules from 920 patients were initially enrolled and examined with conventional ultrasound, SE, and VTIQ. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of SE, VTIQ, and SE + VTIQ were calculated respectively. An area under the receiver operating characteristic curve analysis was applied to evaluate the diagnostic efficiency of SE, VTIQ, and SE + VTIQ in the differentiation of benign and malignant TR4 nodules. RESULTS: A total of 864 patients with 922 TR4 nodules were enrolled ultimately, as 63 thyroid nodules from 56 patients were excluded because they did not meet the inclusion criteria of this study. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of SE, VTIQ, and SE + VTIQ were 72.4% versus 86.3% versus 82.1%, 77.7% versus 80.5% versus 83.5%, 70.6% versus 76.1% versus 80.2%, 73.4% versus 76.3% versus 83.5%, and 75.5% versus 79.7% versus 82.8%, respectively. The areas under the receiver operating characteristic curve for the diagnosis of TR4 nodules by SE, VTIQ, and SE + VTIQ were 0.751, 0.817, and 0.844. CONCLUSIONS: In spite of a slight decrease in the sensitivity, the application of combining SE and VTIQ techniques can improve the specificity and accuracy of TR4 nodule diagnosis, which can help reduce unnecessary biopsies of TR4 nodules.

Combination of high-frequency ultrasound and virtual touch tissue imaging and quantification improve the diagnostic efficiency for mild carpal tunnel syndrome.

BACKGROUND: Carpal tunnel syndrome (CTS) is the most common entrapment symptom in the peripheral nerves. High-frequency ultrasound (HFUS) is widely used in the diagnosis of CTS. Virtual Touch Tissue Imaging and Quantification (VTIQ), which provides more information about the hardness of organization, is used to diagnose CTS. However, the data of diagnostic value of them in various degrees of CTS are limited. Whether the combination of HFUS and VTIQ can improve the diagnostic efficiency also remains unknown. The study aimed to explore the diagnostic value of HFUS and VTIQ in various degrees of CTS and whether combination of HFUS and VTIQ could improve the diagnostic efficiency of CTS. METHODS: A collection and analysis of 133 CTS patients and 35 volunteers from January 2016 to January 2019 were performed. We compared the clinical characteristics, cross-sectional area (CSA) value and shear wave velocity SWVmean value of CTS group with volunteer group. RESULTS: The CSA value and SWVmean value of CTS cohort were significantly higher than volunteer group (10.79 ± 2.88 vs. 8.06 ± 1.39, p < 0.001, 4.36 ± 0.95 vs. 3.38 ± 1.09, p < 0.001, respectively). The area under the curve (AUC) of receiver operating characteristic (ROC) curve of CSA value and SWVmean value were 0.794 and 0.757, respectively. Hierarchical analysis of CSA value and SWVmean value showed that the AUC in the moderate and severe CTS group were higher than in mild CTS group. Furthermore, the CSA value combined with SWVmean value used to diagnose mild CTS was 0.758, which was higher than that of single CSA value or single SWVmean value. CONCLUSIONS: Both HFUS and VTIQ technology were feasible to evaluate CTS. HFUS was suitable for use in diagnosis of moderate and severe CTS. For mild CTS, combination of HFUS and VTIQ was relevant to improve the diagnostic efficiency of CTS.

Diagnostic Performance of Acoustic Radiation Force Impulse Elastography for the Differentiation of Benign and Malignant Superficial Lymph Nodes: A Meta-analysis.

To estimate the diagnostic performance of acoustic radiation force impulse elastography in distinguishing between benign and malignant superficial lymph nodes, relevant articles published before October 31, 2018, in China and other countries were used. Conclusively, a total of 18 articles were analyzed. Sixteen studies used Virtual Touch tissue quantification (Siemens Healthineers, Erlangen, Germany), and 4 studies used Virtual Touch tissue imaging (Siemens Healthineers). After a meta-analysis, it was found that acoustic radiation force impulse elastography is an efficient method for detecting superficial lymph nodes. In addition, if the cutoff value for the shear wave velocity were less than 2.85 m/s, the summary sensitivity would increase, and the heterogeneity would be reduced.

Assessment of Virtual Touch Tissue Imaging Quantification and the Ultrasound Thyroid Imaging Reporting and Data System in Patients With Thyroid Nodules Referred for Biopsy.

OBJECTIVES: To evaluate the diagnostic performance of Virtual Touch tissue imaging quantification (VTIQ; Siemens Medical Solutions, Mountain View, CA) in combination with the Thyroid Imaging Reporting and Data System (TI-RADS) for assessing thyroid nodules referred for biopsy. METHODS: A total of 197 surgically or cytologically proven thyroid nodules in 187 patients were included. Nodules evaluated by conventional ultrasound (US) and VTIQ examinations were classified into US TI-RADS categories. The shear wave velocity (SWV) on VTIQ was assessed, and the cutoff value was obtained from a receiver operating characteristic curve analysis. Diagnostic performances of conventional US, VTIQ, and their combination were compared. RESULTS: There were 134 benign and 63 malignant nodules. The sensitivity and specificity for the US TI-RADS were 98.4% and 20.1%, respectively. The areas under the receiver operating characteristic curves for the mean, maximum, minimum, and ratio of the SWV were 0.818, 0.805, 0.799, and 0.728. With a cutoff value of 2.90 m/s, the sensitivity and specificity of the mean SWV were 71.4% and 82.8%. By applying this value or less as a standard for downgrading TI-RADS category 4a to category 3 lesions, the specificity significantly rose from 20.1% to 47.0% (P < .001) without a loss of sensitivity. CONCLUSIONS: The additional application of VTIQ can improve the specificity of the TI-RADS for evaluating thyroid nodules without a loss of sensitivity.

Value of shear wave elastography by virtual touch tissue imaging quantification in patients with diffuse thyroid gland pathology

Background/aim: This study was performed to assess the diagnostic accuracy of shear wave elastography by virtual touch tissue imaging quantification in patients with diffuse thyroid gland pathology and to differentiate Graves' disease from Hashimoto's thyroiditis. Materials and methods: Thirty patients with Hashimoto's thyroiditis and 22 patients with Graves' disease were evaluated with conventional ultrasonography and shear wave elastography by virtual touch tissue imaging quantification. Thirty healthy participants formed the control group. Ten elastographic measurements of each thyroid lobe were performed in all three study groups. The mean shear wave velocity was calculated and compared between the patients and controls. Results: The mean shear wave velocity of the controls (1.92 ± 0.14 m/s) was significantly lower than that of the patients with Graves' disease (2.71 ± 0.22 m/s) and Hashimoto's thyroiditis (2.50 ± 0.20 m/s). Patients with Graves' disease had significantly higher shear wave velocities than those with Hashimoto's thyroiditis (P < 0.001). Conclusion: Shear wave elastography by virtual touch tissue imaging quantification can be used to discriminate a normal thyroid gland from diffuse thyroid gland pathology after conventional sonography and may assist in the diagnosis of Graves' disease and Hashimoto's thyroiditis.

Comparison of Acoustic Radiation Force Impulse Imaging and Strain Elastography in Differentiating Malignant From Benign Thyroid Nodules.

OBJECTIVES: This study aimed to evaluate the diagnostic value of acoustic radiation force impulse (ARFI) imaging and strain elastography in differentiating malignant from benign thyroid nodules. METHODS: This study included 128 patients (104 female and 24 male; mean age ± standard deviation, 48 ± 11 years; range, 23-76 years) with 152 pathologically proven thyroid nodules. Conventional sonography, strain ratio (SR) of strain elastography, virtual touch tissue imaging (VTI) grade, and virtual touch tissue quantification (shear wave velocity [SWV]) from ARFI imaging data were generated for each nodule. The diagnostic performance of the three elastography analysis methods was analyzed and compared by multiple receiver operating characteristic curve analysis. The interobserver agreement for VTI grade was also assessed. RESULTS: The best cutoff values for VTI grade, mean SWV, and mean SR for predicting malignant thyroid nodules were greater than or equal to grade χ, 2.87 m/s and 2.37, respectively. The area under the receiver operating characteristic curve for VTI grade, mean SWV, and mean SR was 0.854, 0.869 and 0.849, respectively (P > .05), and the accuracy was 83.55, 81.58 and 80.26%, respectively (P > .05). The accuracy of the combined use of conventional sonography and ARFI imaging for VTI grade, mean SWV, and mean SR was 98.03, 95.39 and 96.71%, respectively, which was slightly higher than that of conventional sonography (P > .05). The interobserver agreement produced a κ-value of 0.98 (95% confidence interval, 0.959-1.000). CONCLUSIONS: Both strain elastography and ARFI imaging have high sensitivity and specificity for differentiating malignant from benign thyroid nodules. Combined with sonography, these techniques can improve the accuracy of thyroid nodule diagnosis.

Preliminary Evaluation of Virtual Touch Tissue Imaging Quantification for Differential Diagnosis of Metastatic and Nonmetastatic Cervical Lymph Nodes.

OBJECTIVES: Virtual Touch tissue imaging quantification (VTIQ; Siemens Medical Solutions, Mountain View, CA) is useful for assessing tissue hardness. This study aimed to investigate the value of VTIQ in differential diagnosis of cervical lymph nodes. METHODS: We retrospectively analyzed conventional sonograms and VTIQ images of 85 pathologically confirmed patients with superficial lymph node lesions. Conventional sonography was first performed, with 2-dimensional images described. Then VTIQ shear wave velocity (SWV) values of superficial lymph nodes were measured. With pathologic diagnosis as the reference standard, a receiver operating characteristic curve was generated to evaluate VTIQ efficacy in differential diagnosis of metastatic and nonmetastatic cervical lymph nodes. RESULTS: Of the 85 nodes, 44 and 41 were metastatic and nonmetastatic, respectively. The latter group included 24 and 17 hematologic/lymphatic system disease and reactive hyperplastic nodes, respectively. Shear wave velocity values of metastatic nodes were significantly higher than those of their nonmetastatic counterparts (P < .001). With an area under the curve (AUC) of 0.953 and SWV cutoff of 3.27 m/s, accuracy, sensitivity, and specificity were 89.4%, 88.6%, and 90.2%, respectively, for distinguishing metastatic and nonmetastatic nodes. An AUC of 0.943 and SWV cutoff of 3.23 m/s yielded accuracy, sensitivity, and specificity of 88.2%, 88.6%, and 87.5% for differentiating metastatic from hematologic/lymphatic system disease nodes. Finally, an AUC of 0.968 and SWV cutoff of 3.27 m/s yielded accuracy, sensitivity, and specificity of 90.2%, 88.6%, and 94.1% for differentiating metastatic from reactive hyperplastic nodes. CONCLUSIONS: Virtual Touch tissue imaging quantification is efficient in differential diagnosis of metastatic and nonmetastatic cervical lymph nodes.

Diagnostic Value of Virtual Touch Tissue Imaging Quantification for Evaluating Median Nerve Stiffness in Carpal Tunnel Syndrome.

OBJECTIVES: To measure the shear wave velocity (SWV) of the median nerve by Virtual Touch tissue imaging quantification (VTIQ; Siemens AG, Erlangen, Germany) through the beginning of the carpal tunnel and to determine whether VTIQ could be used to diagnose carpal tunnel syndrome. METHODS: This study recruited 49 consecutive patients (72 wrists) with a definitive diagnosis of carpal tunnel syndrome and 23 healthy volunteers (46 wrists). We measured the median nerve diameter and cross-sectional area by 2-dimensional sonography and the SWV by VTIQ. The interobserver variability was analyzed, and diagnostic values were evaluated by drawing a receiver operating characteristic curve. RESULTS: The median nerve SWV was significantly higher in the carpal tunnel syndrome group (3.857 m/s) than the control group (2.542 m/s; P < .05). A 3.0-m/s SWV cutoff value revealed sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 83.3%, 91.3%, 93.8%, 77.8%, and 86.4%, respectively. The interobserver agreement was excellent for the SWV measurements. CONCLUSIONS: The median nerve SWV at the carpal tunnel inlet is significantly higher in patients with carpal tunnel syndrome, for whom VTIQ appears to be a highly reproducible diagnostic technique.

Prediction of cervical lymph node metastasis in patients with papillary thyroid cancer using combined conventional ultrasound, strain elastography, and acoustic radiation force impulse (ARFI) elastography.

OBJECTIVES: To investigate the value of combined conventional ultrasound (US), strain elastography (SE) and acoustic radiation force impulse (ARFI) elastography for prediction of cervical lymph node metastasis (CLNM) in papillary thyroid cancer (PTC). METHODS: A consecutive series of 203 patients with 222 PTCs were preoperatively evaluated by US, SE, and ARFI including virtual touch tissue imaging (VTI) and virtual touch tissue quantification (VTQ). A multivariate analysis was performed to predict CLNM by 22 independent variables. Receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic performance. RESULTS: Multivariate analysis demonstrated that VTI area ratio (VAR) > 1 was the best predictor for CLNM, followed by abnormal cervical lymph node (ACLN), capsule contact, microcalcification, capsule involvement, and multiple nodules (all P < 0.05). ROC analyses of these characteristics showed the areas under the curve (Az), sensitivity, and specificity were 0.600-0.630, 47.7 %-93.2 %, and 26.9 %-78.4 % for US, respectively; and they were 0.784, 83.0 %, and 73.9 %, respectively, for VAR > 1. As combination of US characteristics with and without VAR, the Az, sensitivity, and specificity were 0.803 and 0.556, 83.0 % and 100.0 %, and 77.6 % and 11.2 %, respectively (P < 0.001). CONCLUSIONS: ARFI elastography shows superior performance over conventional US, particularly when combined with US, in predicting CLNM in PTC patients. KEY POINTS: • Conventional ultrasound is useful in predicting cervical lymph node metastasis preoperatively. • Virtual touch tissue imaging area ratio is the strongest predicting factor. • Predictive performance is markedly improved by combining ultrasound characteristics with VAR. • Acoustic radiation force impulse elastography may be a promising complementary tool.

Virtual Touch Tissue Imaging for Differential Diagnosis of Thyroid Nodules: Additional Value of the Area Ratio.

OBJECTIVES: To evaluate the additional value of the area ratio on Virtual Touch tissue imaging (VTI; Siemens Medical Solutions, Mountain View, CA) for diagnosis of thyroid nodules referred to surgery. METHODS: From April 2013 to February 2014, 205 consecutive patients with 225 histologically proven thyroid nodules were enrolled in this retrospective study. Virtual Touch tissue imaging and area ratio measurements were performed for each nodule. The area ratio was defined as the area of the nodule on VTI divided by the area on B-mode sonography. Nodule stiffness on VTI was graded from I (soft) to VI (hard). Receiver operating characteristic curve analyses of VTI, area ratio, and the combination of VTI and area ratio were performed. The sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), and Youden index were also evaluated. RESULTS: By receiver operating characteristic curve analyses, the cutoff values were VTI grade IV and area ratio of 1.09, respectively. Nodules with VTI grade IV or higher or area ratio of 1.09 or higher were more likely to be malignant. The sensitivity, specificity, accuracy, PPV, NPV, and Youden index were 78.6%, 92.3%, 88.0%, 82.1%, 90.5%, and 0.709 for VTI and 81.4%, 87.1%, 85.3%, 74.0%, 91.2%, and 0.685 for area ratio (all P > .05). However, when using the criterion of VTI grade IV or higher and area ratio of 1.09 or higher as a combination, the sensitivity, specificity, accuracy, PPV, NPV, and Youden index increased to 94.3%, 97.4%, 96.4%, 94.3%, 97.4%, and 0.917 (all P< .05 compared to VTI or area ratio alone, except for specificity between VTI and the combination). CONCLUSIONS: The diagnostic performance of VTI grading and the area ratio for differentiation between benign and malignant thyroid nodules is equivalent. The performance is further improved with a combination of VTI grading and area ratio analysis.

Combination of Virtual Touch Tissue Imaging and Virtual Touch Tissue Quantification for Differential Diagnosis of Breast Lesions.

OBJECTIVES: Breast cancer is the second leading cause of death from cancer in women, and early detection is the key to successful treatment. Unfortunately, even with technological advances, the specificity of imaging modalities is still low. Therefore, we evaluated the value of a newly developed noninvasive technique, acoustic radiation force impulse imaging, for differentiating benign versus malignant breast lesions. METHODS: We prospectively examined 141 breast lesions in 122 patients. All lesions were classified according to the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) for mammography, BI-RADS for sonography, and Virtual Touch tissue imaging (VTI; Siemens Medical Solutions, Mountain View, CA) pattern. Internal and marginal shear wave velocity (SWV) values for the lesions were noted. The sensitivity, specificity, accuracy, and positive and negative predictive values for VTI and Virtual Touch tissue quantification (VTQ; Siemens Medical Solutions) were calculated. RESULTS: The marginal SWV values were statistically higher in malignant lesions (mean ± SD, 5.41 ± 1.37 m/s) than benign lesions (2.91 ± 0.88 m/s; P < .001). When the SWV cutoff level was set at 4.07 m/s, and the higher of the internal and marginal values was adopted, the combination of VTI and VTQ showed 95.1% sensitivity, 99.0% specificity, and 97.8% accuracy. CONCLUSIONS: Breast Imaging Reporting and Data System category 4 lesions are the main focus of research for early detection of breast cancer. Unfortunately, BI-RADS category 4 assessment covers a wide range of likelihood of malignancy (2%-95%). This wide range reflects the necessity for a more specific imaging modality. The combination of VTI and VTQ could increase the diagnostic performance of conventional sonography.

Virtual touch tissue imaging on acoustic radiation force impulse elastography: a new technique for differential diagnosis between benign and malignant thyroid nodules.

Objectives- Acoustic radiation force impulse elastography is a newly developed ultrasound elasticity imaging technique that included both Virtual Touch tissue quantification and Virtual Touch tissue imaging (VTI; Siemens Medical Solutions, Mountain View, CA). This study aimed to evaluate the usefulness of VTI in differentiating malignant from benign thyroid nodules. Methods- This study included 192 consecutive patients with thyroid nodules (n = 219) who underwent surgery for compressive symptoms or suspicion of malignancy. Tissue stiffness on VTI elastography was scored from 1 (soft) to 6 (hard). The VTI scores between malignant and benign thyroid nodules were compared. The intraobserver and interobserver agreement for VTI elastography was also assessed. Results- On VTI elastography: score 1 was found in 84 nodules (all benign); score 2 in 37 nodules (3 papillary carcinomas and 34 benign nodules); score 3 in 25 nodules (1 medullary carcinoma, 6 papillary carcinomas, and 18 benign nodules); score 4 in 53 nodules (50 papillary carcinomas and 3 benign nodules); score 5 in 17 nodules (14 papillary carcinomas and 3 benign nodules); and score 6 in 3 nodules (all papillary carcinomas). A VTI elasticity score of 4 or greater was highly predictive of malignancy (P< .01), and the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 87.0% (67 of 77), 95.8% (136 of 142), 91.8% (67 of 73), 93.1% (136 of 146), and 92.7% (203 of 219), respectively. The κ values were 0.69 for intraobserver agreement and 0.85 for interobserver agreement. Conclusions- Virtual Touch tissue elasticity imaging has great potential as an adjunctive tool combined with conventional sonography for differential diagnosis between benign and malignant thyroid nodules.

Evaluating Skin Involvement in Systemic Sclerosis Using High-Frequency Ultrasound and Virtual Touch Tissue Imaging.

OBJECTIVE: This study aimed to explore the diagnostic significance of high-frequency ultrasound combined with visual touch tissue imaging quantification (VTIQ) in the diagnosis and management of systemic sclerosis (SSc). METHODS: Patients diagnosed with SSc and normal volunteers were recruited and divided into an experimental group and a control group, with 30 cases in each group, respectively. The skin thickness at six sites was assessed using high-frequency ultrasound, and the shear wave velocity (SWV) was determined using the VTIQ method. The differences in skin thickness and SWV between the experimental group and the control group were compared and a receiver operating characteristic (ROC) curve was plotted. The value of high-frequency ultrasound, VTIQ, and high-frequency ultrasound combined with VTIQ for evaluating skin involvement in SSc was determined. RESULTS: The difference in SWV sum at six sites and the thickness sum was statistically significant (all p = 0.000 < 0.05) from that of the control group, and there was a strong association between the SWV sum, thickness sum, and Rodnan skin score at the six sites in the experimental group (p = 0.000, r = 0.726; p = 0.000, r = 0.679). Based on the ROC curve, the area under the curve (AUC) for high-frequency ultrasound examination was 0.789. The AUC for VTIQ examination was 0.893, while the AUC for high-frequency ultrasound combined with VTIQ examination was 0.923. The combined examination method showed the highest AUC, indicating the best diagnostic performance. CONCLUSION: The integration of high-frequency ultrasound and VTIQ provides a quantitative approach for assessing the extent of skin involvement in SSc patients, offering valuable insights for clinical diagnosis and treatment purposes.

Breast Imaging Reporting and Data System evaluation of breast lesions improved with virtual touch tissue imaging average grayscale values.

BACKGROUND: Early breast cancer diagnosis is of great clinical importance for selecting treatment options, improving prognosis, and enhancing the quality of patients' survival. OBJECTIVE: We investigated the value of virtual touch tissue imaging average grayscale values (VAGV) helper Breast Imaging Reporting and Data System (BI-RADS) in diagnosing breast malignancy. METHODS: We retrospectively analyzed 141 breast tumors in 134 patients. All breast lesions were diagnosed pathologically by biopsy or surgical excision. All patients first underwent conventional ultrasound (US) followed by virtual touch tissue imaging (VTI). The measurement of the VAGV of the lesion was performed by Image J software. BI-RADS classification was performed for each lesion according to the US. We performed a two-by-two comparison of the diagnostic values of VAGV, BI-RADS, and BI-RADS+VAGV. RESULTS: VAGV was lower in malignant tumors than in benign ones (35.82 ± 13.39 versus 73.58 ± 42.69, P< 0.001). The area under the receiver operating characteristic curve (AUC) value, sensitivity, and specificity of VAGV was 0.834, 84.09%, and 69.07%, respectively. Among BI-RADS, VAGV, and BI-RADS+VAGV, BI-RADS+VAGV had the highest AUC (0.926 versus 0.882, P= 0.0066; 0.926 versus 0.834, P= 0.0012). There was perfect agreement between the two radiologists using VAGV (ICC= 0.9796) and substantial agreement using BI-RADS (Kappa= 0.725). CONCLUSION: Our study shows that VAGV can accurately diagnose breast cancer. VAGV effectively improves the diagnostic performance of BI-RADS.

Contrast-enhanced ultrasound (CEUS) and shear wave elastography (SWE) features for characterizing serous microcystic adenomas (SMAs): In comparison to pancreatic neuroendocrine tumors (pNETs).

Objectives: Serous microcystic adenoma (SMA), a primary benign pancreatic tumor which can be clinically followed-up instead of undergoing surgery, are sometimes mis-distinguished as pancreatic neuroendocrine tumor (pNET) in regular preoperative imaging examinations. This study aimed to analyze preoperative contrast-enhanced ultrasound (CEUS) and shear wave elastography (SWE) features of SMAs in comparison to pNETs. Material and methods: In this retrospective study, patients with imaging-diagnosed pancreatic lesions were screened between October 2020 to October 2022 (ethical approval No. B2020-309R). Performing by a Siemens Sequoia (Siemens Medical Solutions, Mountain View, CA, USA) equipped with a 5C-1 curved array transducer (3.0-4.5 MHz), CEUS examination was conducted to observe the microvascular perfusion patterns of pancreatic lesions in arterial phase, venous/late phases (VLP) using SonoVue® (Bracco Imaging Spa, Milan, Italy) as the contrast agent. Virtual touch tissue imaging and quantification (VTIQ) - SWE was used to measure the shear wave velocity (SWV, m/s) value to represent the quantitative stiffness of pancreatic lesions. Multivariate logistic regression was performed to analyze potential ultrasound and clinical features in discriminating SMAs and pNETs. Results: Finally, 30 SMA and 40 pNET patients were included. All pancreatic lesions were pathologically proven via biopsy or surgery. During the arterial phase of CEUS, most SMAs and pNETs showed iso- or hyperenhancement (29/30, 97 % and 31/40, 78 %), with a specific early honeycomb enhancement pattern appeared in 14/30 (47 %) SMA lesions. During the VLP, while most of the SMA lesions remained iso- or hyperenhancement (25/30, 83 %), nearly half of the pNET lesions revealed an attenuated hypoenhancement (17/40, 43 %). The proportion of hypoenhancement pattern during the VLP of CEUS differed significantly between SMAs and pNETs (P = 0.021). The measured SWV value of SMAs was significantly higher than pNETs (2.04 ± 0.70 m/s versus 1.42 ± 0.44 m/s, P = 0.002). Taking a SWV value > 1.83 m/s as a cutoff in differentiating SMAs and pNETs, the area under the receiver operating characteristic curve (AUROC) was 0.825, with sensitivity, specificity and likelihood ratio (+) of 85.71 %, 72.73 % and 3.143, respectively. Multivariate logistic regression revealed that SWV value (m/s) of the pancreatic lesion was an independent variable in discriminating SMA and pNET. Conclusion: By comprehensively evaluating CEUS patterns and SWE features, SMA and pNET may be well differentiated before the operation. While SMA typically presents as harder lesion in VTIQ-SWE, exhibiting a specific honeycomb hyperenhancement pattern during the arterial phase of CEUS, pNET is characterized by relative softness, occasionally displaying a wash-out pattern during the VLP of CEUS.

Virtual touch tissue imaging for differential diagnosis in ACR TI-RADS category 3-4 thyroid nodules: Conservative and aggressive methods.

PURPOSE: Many Thyroid Imaging Reporting and Data System (TI-RADS) category 3-4 nodules are benign. Our study aimed to add virtual touch tissue imaging (VTI) to TI-RADS using two methods, namely conservative and aggressive, and to explore which method had better diagnostic performance and which method avoided more unnecessary biopsies. METHODS: From January 2016 to December 2021, we included 121 thyroid nodules classified as TI-RADS category 3-4 in 115 consecutive patients in this retrospective study. This study used the reference standard for pathological diagnosis by surgical resection or biopsy. The diagnostic performance of the different methods was evaluated and compared by receiver operating characteristic (ROC) and area under the ROC curve (AUC). RESULTS: In this study, the aggressive approach had the best diagnostic performance among TI-RADS alone, the conservative approach, and the aggressive approach (AUC: 0.863 versus 0.598, P = 0.0007; 0.863 versus 0.755, P = 0.0067). When we used an aggressive approach, 75.44% (43/57) of the 57 false-positive nodes diagnosed by TI-RADS were appropriately downgraded from TI-RADS category 4 to category 3, avoiding unnecessary biopsies. CONCLUSION: VTI improves the diagnostic performance of TI-RADS. The aggressive approach of combining the TI-RADS with VTI would help reduce unnecessary biopsies.

Diagnostic Value of Ultrasound Elastography in the Differentiation of Breast Invasive Ductal Carcinoma and Ductal Carcinoma In situ.

BACKGROUND: Ultrasound elastography (US-E) has been shown superior to the conventional US in diagnosing benign and malignant breast lesions. In contrast, the role of US-E in the differentiation of breast invasive ductal carcinoma (IDC) and ductal carcinoma in situ (DCIS) has been poorly described. OBJECTIVE: This study was designed to examine the diagnostic value of US-E in the differentiation of IDC and DCIS. METHODS: Medical records of all patients who underwent preoperative US-E evaluation and were diagnosed with IDC or DCIS at our hospital from April-December 2019 were retrieved and analyzed. Those who had prior surgical treatment, chemotherapy or radiotherapy were excluded. RESULTS: Twenty women with DCIS and 111 women with IDC were included in this study. There were no significant differences in age, maximum lesion diameter and tumor volume between the two groups. While shear wave velocity (SWV) inside the lesion and in the surrounding tissue, strain ratio and tumor area ratio were not substantially different between the two groups, SWV at the edge of the lesion was significantly higher in IDC cases, which had an AUC value of 0.66 with a sensitivity of 65.8% and a specificity of 60.0% for the differential diagnosis of IDC and DCIS. CONCLUSION: Edge SWV is significantly higher in IDC than that in DCIS, which had a moderate diagnostic value for the differentiation of IDC and DCIS, similar to the performance of diffusion-weighted magnetic resonance imaging as reported in the literature. In terms of cost-effectiveness, US-E could be very useful while waiting for further evaluations to determine whether US-E combined with other diagnostic modalities improves the diagnostic performance.