Ultrasound-Base Radiomics for Discerning Lymph Node Metastasis in Thyroid Cancer: A Systematic Review and Meta-analysis.

PURPOSE: Ultrasound is the imaging modality of choice for preoperative diagnosis of lymph node metastasis (LNM) in thyroid cancer (TC), yet its efficacy remains suboptimal. As radiomics gains traction in tumor diagnosis, its integration with ultrasound for LNM differentiation in TC has emerged, but its diagnostic merit is debated. This study assesses the accuracy of ultrasound-integrated radiomics in preoperatively diagnosing LNM in TC. METHODS: Literatures were searched in PubMed, Embase, Cochrane, and Web of Science until July 11, 2023. Quality of the studies was assessed by the radiomics quality score (RQS). A meta-analysis was executed using a bivariate mixed effects model, with a subgroup analysis based on modeling variables (clinical features, radiomics features, or their combination). RESULTS: Among 27 articles (16,410 TC patients, 6356 with LNM), the average RQS was 16.5 (SD:5.47). Sensitivity of the models based on clinical features, radiomics features, and radiomics features plus clinical features were 0.64, 0.76 and 0.69. Specificities were 0.77, 0.78 and 0.82. SROC values were 0.76, 0.84 and 0.81. CONCLUSION: Ultrasound-based radiomics effectively evaluates LNM in TC preoperatively. Adding clinical features does not notably enhance the model's performance. Some radiomics studies showed high bias, possibly due to the absence of standard application guidelines.

Application of simple ultrasound Doppler hemodynamic parameters in the diagnosis of severe renal artery stenosis in routine clinical practice.

Background: Doppler ultrasound (DUS) is recommended in first-line imaging for the diagnosis of renal artery stenosis (RAS). However, the correct selection of Doppler direct or indirect parameters and their optimal thresholds remain controversial. This study explored simple ultrasound Doppler parameters to diagnose severe RAS (RAS ≥70%) in routine clinical practice. Methods: In this retrospective study, patients with clinically suspected renovascular hypertension who first underwent renal artery DUS and contrast-enhanced ultrasound (CEUS) and subsequent digital subtraction angiography (DSA) or computed tomography angiography (CTA) were consecutively included. Clinical characteristics and ultrasound Doppler hemodynamic parameters were collected, including peak systolic velocity (PSV), the ratio of the peak velocities in the renal artery and the aorta (RAR), the ratio of the peak velocities in the renal artery and the segmental artery (RSR), and the ratio of the peak velocities in the renal artery and the interlobar artery (RIR). All enrolled patients were divided into two groups based on the degree of diameter reduction: a severe stenosis group (diameter reduction ≥70%) and a non-severe stenosis group (diameter reduction <70%). Logistic regression analysis was performed to determine the independent predictors for severe stenosis. Receiver operating characteristic curves and areas under the curve were used to evaluate the diagnostic performance of the ultrasound Doppler parameters. Results: A total of 85 patients (106 renal arteries) with RAS were included in this study. The optimal thresholds of PSV in the main renal artery and the PSV ratios for diagnosing severe RAS obtained via receiver operating characteristic curves were 249.5 cm/s for PSV, 2.94 for RAR, 5.1 for RSR, and 7.5 for RIR. The areas under the curve of PSV and the ratios all exhibited good diagnostic efficiency (all >0.8). The combination of these four Doppler variables demonstrated a significant benefit to the overall diagnostic value compared with any factor alone [area under the curve (AUC) =0.962; 95% confidence interval (CI): 0.906-0.989; P<0.05]. The combination of PSV and RSR (AUC =0.925; 95% CI: 0.858-0.967) exhibited comparable diagnostic efficiency to the combination of four ultrasonographic variables (z statistic =1.882; P=0.06). Conclusions: This simple and accurate method to evaluate severe RAS based on the velocity obtained via basic DUS may facilitate the detection of severe RAS in the majority of medical institutions and provide a reliable basis for the selection of proper candidates for further angiography or revascularization.

Renal elasticity and perfusion changes on ultrasonography in an early-stage diabetic rat model.

Background: Renal hemodynamic changes in early diabetes occur before the onset of significant structural abnormalities or clinical manifestations, and timely detection of these changes has clinical significance. This study aimed to evaluate renal elasticity and perfusion changes in an early-stage diabetic rat model by shear wave elastography (SWE) and contrast-enhanced ultrasound (CEUS), and to explore the potential correlations between renal elasticity and perfusion parameters. Methods: A total of 18 male Sprague-Dawley rats were randomly divided into three groups: a control group (group 1, n=6), a diabetic group (group 2, n=6), and a diabetic group receiving drug therapy (group 3, n=6). An intraperitoneal injection of streptozotocin (STZ) for 2 days combined with a high-fat diet (HFD) was used as the early-stage diabetic rat model. The diabetic rats in group 3 were treated with canagliflozin and losartan for 6 weeks, whereas the rats in groups 1 and 2 were given equal amounts of purified water. Renal stiffness on SWE and perfusion parameters on CEUS were measured and compared among the three groups, then the rats were sacrificed, and serum, urine, and renal histopathology were evaluated to confirm the development of early diabetes. Results: The early-stage diabetic rats without significant pathological changes exhibited bigger kidneys and higher blood glucose (all P<0.05). Among the CEUS parameters, peak enhancement (PE), wash-in area under the curve (WiAUC), wash-in perfusion index (WiPI), wash-out AUC (WoAUC), wash-in and wash-out AUC (WiWoAUC), rise time (RT), and time to peak (TTP) of diabetic rats in group 2 were significantly increased (all P<0.05), and the hyperperfusion ameliorated significantly after drug treatment. The renal elasticity measured by SWE varied in accordance with certain perfusion parameters, and was strongly positively correlated with WiAUC (r=0.701, P<0.001), WoAUC (r=0.647, P<0.001), and WiWoAUC (r=0.655, P<0.001), and moderately positively correlated with PE (r=0.539, P=0.001), WiPI (r=0.555, P<0.001), RT (r=0.425, P=0.010), and TTP (r=0.439, P=0.007). Conclusions: Renal elasticity and perfusion changes in the early stage of diabetes, and renal elasticity was positively associated with delayed and increased perfusion.

Correlation of renal cortical blood perfusion and BP response after renal artery stenting.

Background: This study aimed to observe the correlation between renal cortical blood perfusion (CBP) parameters and BP response in patients with severe renal artery stenosis (RAS) who underwent stenting. Methods: This was a single-center retrospective cohort study. A total of 164 patients with unilateral severe RAS after successful percutaneous transluminal renal artery stenting in Beijing Hospital from October 2017 to December 2020 were included. According to the results of BP evaluated at 12 months, all patients were divided into the BP response group (n = 98) and BP nonresponse group (n = 66). The baseline clinical and imaging characteristics and follow-up data about 24 h ABPM and CBP were recorded and analyzed. Pearson correlation analysis was used to evaluate the relationship between CBP parameters and 24 h average SBP. Univariate and multivariate logistic regression analysis was used to evaluate the risk factors for BP response. Results: Among 164 patients with severe RAS, there were 100 males (61.0%), aged 37-75 years, with an average of 56.8 ± 18.4 years, and average artery stenosis of 84.0 ± 12.5%. The BP nonresponse patients had a longer duration of hypertension, more current smoking subjects and diabetic patients, lower eGFR, increased number of hypertensive agents, and rate of insulin compared with the BP response group (P < 0.05). After PTRAS, patients in the BP response group were associated with significantly lower BP and improved CPB, characterized by increased levels of maximum intensity (IMAX), area under ascending curve (AUC1), area under the descending curve (AUC2), shortened rising time (RT), mean transit time (mTT), and prolonged time to peak intensity (TTP; P < 0.05). However, the BP nonresponse group was only associated with significantly reduced RT (P < 0.05) compared with baseline data. During an average follow-up of 11.5 ± 1.7 months, the BP response group was associated with significantly lower levels of SBP, DBP, 24 h average SBP, and 24 h average DBP compared with the nonresponse group (P < 0.05). Pearson correlation analysis showed that the the pre-operative CBP parameters, including IMAX (r = 0.317), RT (r = 0.249), AUC1 (r = 0.614), AUC2 (r = 0.558), and postoperative CBP parameters, including RT (r = 0.283), AUC1 (r = 0.659), and AUC2 (r = 0.674) were significantly positively correlated with the 24 h average SBP, while the postoperative TTP (r = -0.413) and mTT (r = -0.472) were negatively correlated with 24 h average SBP (P < 0.05). Multivariate Logistic regression analysis found that diabetes (OR = 1.294), NT-proBNP (OR = 1.395), number of antihypertensive agents (OR = 2.135), pre-operation IMAX (OR = 1.534), post-operation AUC2 (OR = 2.417), and baseline dDBP (OR = 2.038) were related factors for BP response (all P < 0.05). Conclusion: Patients in the BP nonresponse group often have diabetes, a longer duration of hypertension, significantly reduced glomerular filtration rate, and heavier renal artery stenosis. CBP parameters are closely related to 24 h average SBP, and pre-operation IMAX and post-operation AUC2 are markers for a positive BP response.

Value of contrast-enhanced ultrasound for diagnosis and follow-up of renal artery stenosis in patients with chronic kidney disease.

OBJECTIVE: To evaluate whether contrast-enhanced ultrasound (CEUS) is an accurate, non-nephrotoxic diagnostic method and follow-up tool for use in patients with chronic kidney disease (CKD) and renal artery stenosis (RAS). METHODS: In this prospective and monocentric study, we compared the sensitivity and specificity of CEUS for the diagnosis of RAS in CKD patients, using digital subtraction angiography (DSA) or computed tomographic angiography (CTA) as the gold standard methods. Further, the value of CEUS for distinguishing restenosis from other diseases was assessed. The ultrasound physicians conducted the examinations and served as the CEUS report readers who were blinded to the DSA or CTA results. RESULTS: Patients with RAS (n = 60) were enrolled. Average patient age was 64.4 ± 18.0 years and median estimated glomerular filtration rate was 66.1 mL/min/1.73 m2. CEUS was used to image 94 stenotic renal arteries and DSA- or CTA-verified stenosis was present in 96 renal arteries. The kappa value for CEUS was 0.776 (P < 0.001), with an accuracy of 92.5%, a sensitivity of 94.7%, and a specificity of 84.0%. The accuracy of CEUS was the same for the diagnosis of the CKD3b-5 group as for the CKD1-3a group (100% vs. 87.5%, P = 0.148). There was no difference in CEUS accuracy for the diagnosis of Takayasu RAS compared with atherosclerotic RAS (95.8% vs. 91.7%, P = 0.795). Twenty-nine CEUS examinations were performed to follow in-stent restenosis or progression of RAS, with a median follow-up time of 5.0 months (range 1.0-20.0). Two cases of in-stent restenosis in patients suffering from deteriorating kidney function and recurrent hypertension were examined by CEUS. CONCLUSION: CEUS examination is a credible alternative for diagnosing moderate and severe RAS in patients with CKD, and is a reliable tool for follow-up surveillance after renal artery revascularization treatment. It shouldn't be thought as a color-coded duplex ultrasonography rescue in these patients.

[Comparative study of endorectal ultrasonography and magnetic resonance imaging in preoperative staging of rectal cancer].

OBJECTIVE: To evaluate the diagnostic value of endorectal ultrasonography (ERUS) and magnetic resonance imaging (MRI) in preoperative staging of rectal carcinoma. METHODS: A total of 44 patients with biopsy proven rectal tumor underwent preoperative ERUS and MRI examinations. All patients were evaluated to determine the diagnostic accuracy of depth of transmural tumor invasion and lymph node metastases.Imaging results were compared with histopathological findings. RESULTS: The accuracy of T staging (uT1, uT2, uT3, uT4) for ERUS was 95.5%, 90.9%, 93.2% and 97.7% and the overall accuracy 88.6% (39/44) . The sensitivity was 83.3%, 72.7%, 72.2%, 77.8% and the specificity 97.3%, 92.9%, 96.2% and 97.6%. The accuracy of T staging (T1, T2, T3, T4) for MRI was 93.2%, 90.9%, 93.2%, 100.0% and the overall accuracy 86.4% (38/44) . The sensitivity was 71.4%, 93.8%, 94.4% and 100.0% and the specificity 97.3%, 89.3%, 92.3% and 100.0%. Detection of lymph node metastases:the accuracy of ERUS was 75.0% (33/44), MRI 93.2% (41/44). The sensitivity and specificity was found to be 68.4% (13/19) and 80.0% (20/25) on ERUS, 94.7% (18/19) and 92.0% (23/25) on MRI respectively. CONCLUSION: ERUS and MRI may be used for accurate preoperative staging of rectal cancer.ERUS has higher accuracy and sensitivity for T1 stage while MRI is preferred for lymph node metastasis.

[The study in detection of microcalcification in early breast cancer by ultrasound and its correlation with pathohistology].

OBJECTIVE: To discuss the role of ultrasound in examining microcalcification of early breast cancer and its correlation with pathohistological type and grade. METHODS: 178 lesions in 165 cases of early breast cancer confirmed by pathology after surgical resection were examine by high frequency ultrasound, meanwhile microcalcification were detected and reported. 39 lesions in 32 cases are carcinoma in situ and microinvasive carcinoma of breast. 139 lesions in 133 cases are early invasive breast carcinoma that is below 2 cm in diameter and doesn't invasive the lymph node and other parts of the body. To analyse the sensitivity of detection micro-calcification of early breast cancer by ultrasound and its correlation with pathohistological type and grade. RESULTS: The sensitivity is 81.6% in detecting microcalcification of early breast cancer by ultrasound. There is no significant statistical difference in detecting microcalcification between the two group (P = 0.217). There is no significant statistical difference in detecting microcalcification of early invasive breast cancer between the different pathologic types (P > 0.05), and there are no significant differences in detecting microcalcification of early breast cancer between the different pathologic grades (group I: P = 0.202, group II: P = 0.415). There is significant difference in detecting microcalcification of solid tumor by ultrasonic examination in group I between the different pathologic grades (P = 0.029). CONCLUSION: There is higher sensitivity in detecting microcalcification of early breast cancer by ultrasonography. Microcalcification of early breast cancer may be no closely related to pathologic grades. US has a certain value to clinic in detecting microcalcification of early breast cancer.

Study of endorectal ultrasonography in the staging of rectal cancer.

BACKGROUND: There is no consensus regarding the performance for endorectal ultrasonography (ERUS) at every stage of rectal cancer. Thus, the purpose of our study was to further assess the value of ERUS in the preoperative staging of rectal cancer. METHODS: A retrospective study was performed with 44 consecutive patients (mean age: (63.3 ± 10.2) years) who underwent surgical treatment for endorectal carcinoma and were preoperatively evaluated using Biplane ERUS between September 2008 and December 2010. We compared the ERUS staging with the pathological findings based on surgical specimens. RESULTS: ERUS staging agreed with the histologic staging in 39 of the 44 (88.6%) patients: the agreement on the depth of transmural invasion was good (κ = 0.73; 95%CI: 0.60 - 0.86, P = 0.000). The detection sensitivities of rectal cancer with ERUS were as follows: T1 85.7%, T2 87.5%, T3 88.9%, and T4 100.0% with specificity values of T1 97.3%, T2 92.9%, T3 96.2%, and T4 97.6%. ERUS correctly staged patients with T1 95.5%, T2 90.9%, T3 70.5%, and T4 97.7%. The positive predictive value of ERUS was lowest for T4 (75%), but highest for T3 (94.1%) followed by T2 (87.5%) and T1 (85.7%); the negative predictive values of ERUS from high to low were ordered as T4 (100%), T1 (97.3%), T2 (92.9%), and T3 (92.6%). The percentage of total over-staged cases was 4.5% and the under-staged cases was 6.8%. The extent of perirectal lymph node metastases was determined with a sensitivity of 68.4% (13/19), specificity of 80.0% (20/25), and diagnostic accuracy of 75.0% (33/44). CONCLUSION: Biplane ERUS has a high diagnostic accuracy for tumoral invasion of the rectal wall at every T stage, but relatively low diagnostic accuracy for lymph node metastases.

[Monitoring of ultrasonography in artificial vascular graft for arteriovenous fistula].

OBJECTIVE: To evaluate the monitoring of ultrasonography in artificial vascular graft for arteriovenous fistula and its complications in patients with chronic renal failure. METHODS: Eighteen cases of artificial vascular graft arteriovenous fistula after four to six weeks were enrolled. The diameter, the peak velocity and blood flow were examined in arterial fistula. And the artificial vascular diameter, the peak velocity and blood flow of artificial vessels next to artery were all examined and analyzed. And the patients with symptoms in the upper extremity were tested by ultrasound. RESULTS: Intravascular blood showed good filling in fistula and artificial blood vessels in four to six weeks after artificial vascular graft for arteriovenous fistula by color doppler ultrasonography. The arterial fistula diameter, the peak velocity and blood flow were (3.61 +/- 0.68) mm and (298.56 +/- 93.42) cm/s and (583.62 +/- 216.77) ml/min. Artificial vascular diameter in (4.47 +/- 0.61) mm, the peak velocity and blood flow were (219.37 +/- 68.42) cm/s and (325.23 +/- 117.12) ml/min in the artificial blood vessels next to artery. Seven patients with upper extremity discomfort were examined by ultrasonography. One case was serum swollen. Three cases were thrombosis in artificial vessels. One case was pseudoaneurysm. Two cases were edema. CONCLUSIONS: Ultrasonography plays a significant clinic role in testing artificial vascular graft for arteriovenous fistula and its complications.