Breast Tumor Classification using Short-ResNet with Pixel-based Tumor Probability Map in Ultrasound Images.

Breast cancer is the most common form of cancer and is still the second leading cause of death for women in the world. Early detection and treatment of breast cancer can reduce mortality rates. Breast ultrasound is always used to detect and diagnose breast cancer. The accurate breast segmentation and diagnosis as benign or malignant is still a challenging task in the ultrasound image. In this paper, we proposed a classification model as short-ResNet with DC-UNet to solve the segmentation and diagnosis challenge to find the tumor and classify benign or malignant with breast ultrasonic images. The proposed model has a dice coefficient of 83% for segmentation and achieves an accuracy of 90% for classification with breast tumors. In the experiment, we have compared with segmentation task and classification result in different datasets to prove that the proposed model is more general and demonstrates better results. The deep learning model using short-ResNet to classify tumor whether benign or malignant, that combine DC-UNet of segmentation task to assist in improving the classification results.

Application of Point-of-care Cardiac Ultrasonography in COVID-19 Infection: Lessons Learned from the Early Experience.

The outbreak of the SARS-CoV-2 infection, also known as coronavirus disease 2019 (COVID-19), was formally defined a pandemic by the World Health Organization (WHO) in March 2020, and is still a global health issue. Since there is a high prevalence of acute cardiac injury in patients with COVID-19 infection, point-of-care cardiac ultrasound (PoCCUS) may be used for longitudinal monitoring of patients infected with COVID-19. However, there is still limited experience on the application of PoCCUS in the COVID-19 pandemic. Within the point of care setting in our system, focused cardiac US exams were performed with specific imaging protocols on the basis of suspicion of a specific disease, such as ruling out tamponade or thrombotic complications. Our preliminary experience shows that PoCCUS helps distinguish the causes of dyspnea in febrile patients. The COVID-19 infection may play a role in unmasking or exacerbating underlying chronic cardiovascular conditions, especially in patients with inadequate past history. In hospitalized patients with COVID-19, CURB-65 score for pneumonia severity and raised D-dimer were significantly associated with deep vein thrombosis (DVT). COVID-19 patients with DVT had worse prognosis, and patients with lower leg edema deserve further evaluation by using point-of-care ultrasound for the lower legs and heart. In COVID-19 patients with arrhythmia, PoCCUS used by experienced hands may reveal abnormal right ventricle (RV) functional parameters and lead to a more comprehensive cardiac US study. When there is suspicion of cardiac disease, PoCCUS can be done first, and if information is inadequate, limited transthoracic echocardiography (TTE), and critical care echocardiography (CCE) can be followed. Ultrasound practitioners should follow the standard precautions for COVID-19 as outlined by the Centers for Disease Control and Prevention to prevent transmission of infection, regardless of suspected or confirmed COVID-19.

Radiofrequency Ablation of Benign Thyroid Nodules: Recommendations from the Asian Conference on Tumor Ablation Task Force - Secondary Publication.

Radiofrequency ablation (RFA) is a thermal ablation technique widely used for the management of benign thyroid nodules. To date, five academic societies in various countries have reported clinical practice guidelines, opinion statements, or recommendations regarding the use of thyroid RFA. However, despite some similarities, there are also differences among the guidelines, and a consensus is required regarding safe and effective treatment in Asian countries. Therefore, a task force was organized by the guideline committee of the Asian Conference on Tumor Ablation with the goal of devising recommendations for the clinical use of thyroid RFA. The recommendations in this article are based on a comprehensive analysis of the current literature and the consensus opinion of the task force members.

The AFSUMB Consensus Statements and Recommendations for the Clinical Practice of Contrast-Enhanced Ultrasound using Sonazoid.

The first edition of the guidelines for the use of ultrasound contrast agents was published in 2004, dealing with liver applications. The second edition of the guidelines in 2008 reflected changes in the available contrast agents and updated the guidelines for the liver, as well as implementing some nonliver applications. The third edition of the contrast-enhanced ultrasound (CEUS) guidelines was the joint World Federation for Ultrasound in Medicine and Biology-European Federation of Societies for Ultrasound in Medicine and Biology (WFUMB-EFSUMB) venture in conjunction with other regional US societies such as Asian Federation of Societies for Ultrasound in Medicine and Biology, resulting in a simultaneous duplicate on liver CEUS in the official journals of both WFUMB and EFSUMB in 2013. However, no guidelines were described mainly for Sonazoid due to limited clinical experience only in Japan and Korea. The new proposed consensus statements and recommendations provide general advice on the use of Sonazoid and are intended to create standard protocols for the use and administration of Sonazoid in hepatic and pancreatobiliary applications in Asian patients and to improve patient management.

Percutaneous ethanol ablation of intrahepatic arterial pseudoaneurysm: A case report.

Hepatic arterial pseudoaneurysm is a rare but potentially fatal condition that requires prompt management. We report a case of hepatic arterial pseudoaneurysm developed after radiofrequency ablation of a hepatocellular carcinoma. The patient was successfully treated with percutaneous absolute ethanol injection under ultrasound guidance. Follow-up studies with ultrasound and computed tomography for 2 years after treatment revealed no evidence of local recurrence of hepatocellular carcinoma and of the pseudoaneurysm.

Safety of Perfluorobutane (Sonazoid) in Characterizing Focal Liver Lesions.

BACKGROUND: The purpose of this study was to report the safety of perfluorobutane (Sonazoid) as a vascular-phase imaging agent in characterizing focal liver lesions (FLLs). MATERIALS AND METHODS: From May 2014 to April 2015, a total of 54 individuals who received Sonazoid contrast-enhanced ultrasound (CEUS) were enrolled at 5 hospitals of 4 medical centers. All individuals were included in safety evaluation. A prospective study to evaluate the adverse effect (AE) incidences after intravenous administration of Sonazoid. RESULTS: Sonazoid was well tolerated. Treatment-emergent adverse events (TEAEs) representing AE were recorded for 13 (24.1%) patients. The most common AE was abdominal pain (9.3%), followed by heart rate irregularity (5.6%). The majority of these patients (69.2%) experienced TEAEs that were mild in intensity. Sonazoid causes no significant AEs after intravenous injection. The only noteworthy AEs are related to tolerable myalgia (3.7%), abdominal pain (1.9%), and headache (1.9%). None of the 54 patients showed serious adverse effects. CONCLUSION: Sonazoid shows good safety and tolerance of intravenous use during CEUS of the liver for evaluation of FLLs.

Shoulder joint synovial chondromatosis presenting as multiple axillary masses: A case report.

Synovial chondromatosis is a rare, benign, proliferative cartilaginous lesion arising from the synovial tissue, tenosynovium, or bursal lining. We describe the case of a patient who initially presented with multiple axillary masses. Breast ultrasound (US) was requested due to the concern of a breast tumor with axillary lymph node metastases. US study was helpful and provided adequate information to suggest the diagnosis.

A Case of Tubular Adenoma of Gallbladder Diagnosed Using Contrast-Enhanced Ultrasonography.

Contrast-enhanced ultrasound (CEUS) has been used to diagnose gallbladder (GB) diseases for recent years because it is sensitive to visualize vascularity. Herein, we report a case who had a 1.7 cm × 1.2 cm polypoid lesion located in the gallbladder fundus with a feeding artery located in the stalk. On CEUS, the lesion showed early arterial phase enhancement (time to peak enhancement 18 s), persisting throughout the venous and delay phases. This enhancing pattern suggested that the lesion was a GB adenoma rather than a GB carcinoma. Cholecystectomy was performed, and pathology of the tissue revealed tubular adenoma of the GB.

Solitary fibrous tumor of the breast: A case report and review of the literature.

Solitary fibrous tumor (SFT) is an uncommon neoplasm of mesenchymal origin, which can be benign or malignant. Most SFTs develop from the pleura, but they can also be found in other sites. There are only few reports of SFT occurring in the breast. We herein report such a rare case. Sonography demonstrated an ovoid lesion mimicking a fibroadenoma, whereas color Doppler imaging showed marked internal vascularity. A brief literature review on imaging features of SFTs is added. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:350-354, 2017.

Left Ulnar Artery Pseudoaneurysm and Left Hand Swelling Simulated by Elephantiasis in a Patient with Neurofibromatosis Type 1.

Elephantiasis is a condition featured by gross enlargement of body parts to massive proportions. Neurofibromatosis type 1 (NF1) is a multisystem genetic disorder. Vascular anomaly is one among the complications of NF1. We report a case of NF1 who had a left hand vascular pseudoaneurysm with left hand swelling mimicking elephantiasis. The characteristics of sonography make it an excellent imaging modality to investigate this sort of superficial vascular lesion.

Right-Sided Colonic Diverticulitis: Clinical Features, Sonographic Appearances, and Management.

PURPOSE: This study aims to evaluate patients with right-sided colonic diverticulitis detected at ultrasonography (US). METHODS: We retrospectively analyzed 14 patients. Demographic data, clinical features, and US images were documented. RESULTS: In the 14 patients, clinical manifestations included right lower abdominal tenderness (93%), leukocytosis (57.1%), and fever (28.6%). Diverticulitis occurred in cecum and ascending colon with a similar frequency (35.7%). US features included diverticular wall thickening (50%), surrounding echogenic fat (50%), intradiverticular echogenic material (50%), adjacent lymph node enlargement (21.4%), intradiverticularor peridiverticular fluid collection (28.6%), and color flow signals on or surrounding the diverticula (14.3%). Two (14.2%) patients suffered from recurrence. Two (14.3%) patients had abscess formation, and one (7.1%) patient had diverticulum perforation. Most (85.7%) patients received conservative treatment only. One (7.1%) patient received computed tomography-guided drainage due to diverticulum perforation and pocket of abscess formation. One patient underwent surgery due to recurrent diverticulitis-related fistula. CONCLUSION: Common US features of diverticulitis include diverticular wall thickening, surrounding echogenic fat, and intradiverticular echogenic material. Proper recognizing of these features helps in differentiating diverticulitis from appendicitis and may obviate an unnecessary emergent surgery.

Type I Choledochal Cyst Complicated With Acute Hemorrhagic Pancreatitis: A Case Report.

Choledochal cysts rarely present with acute pancreatitis. We report a patient with type I choledochal cyst(s) who had concomitant acute frank hemorrhagic pancreatitis. A 14-year-old male noted with a history of recurrent abdominal pain, fever and jaundice. Ultrasonography (US) of abdomen at the Emergency Department depicted distended gall bladder with wall thickening. Apparently dilated intrahepatic ducts (IHDs) and fusiform dilatation of the common bile duct (CBD), and mild dilatation of the pancreatic duct were also noted, suggesting a type I choledochal cyst( ). Computed tomography (CT) demonstrated calcifications in the uncinate process of the pancreas in addition to the similar findings on US. He subsequently underwent choledochal cyst excision with a Roux-en-Y hepaticojejunostomy. After surgical treatment, he has been doing well for 3 years.

Epidermoid cyst of the testis: An atypical sonographic appearance.

Epidermoid cysts are rare. They represent the most common benign tumor of the testis. The sonographic appearances of testicular epidermoid cysts usually include avascular, mostly lamellated, heterogeneous internal echotexture, with hypoechoic and hyperechoic concentric rings, accounting for the typical onion-ring appearance. On MRI, epidermoid cysts show a low-signal-intensity center, with internal concentric rings of alternating high- and low-signal intensity on T2-weighted images, which correlates with the onion-ring appearance. We report a patient with testicular epidermoid cyst with atypical ultrasound and MRI appearances that led to the erroneous initial diagnosis of "burned-out" tumor. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:448-451, 2016.

Using Free Navigation Reference Points and Prefabricated Bone Plates for Zygoma Fracture Model Surgeries.

Surgical navigation systems have been an important tool in maxillofacial surgery, helping surgeons create a presurgical plan, locate lesions, and provide guidance. For secondary facial bone reductions, a good presurgical plan and proper execution are the key to success. Previous studies used predetermined markers and screw holes as navigation references; however, unexpected situations may occur, making the predetermined surgical plan unreliable. Instead of determining positions preoperatively, this study proposes a method that surgeons can use intraoperatively to choose surface markers in a more flexible manner. Eight zygomatic fractures were created in four skull models, and preoperative computed tomography (CT) image data were imported into a self-developed navigation program for presurgical planning. This program also calculates the ideal positions of navigation references points for screw holes. During reduction surgery, markers on fractured bone are selected, registered, and calculated as free navigation reference points (FNRPs). The surface markers and FNRPs are used to monitor the position of the dislocated bone. Titanium bone plates were prefabricated on stereolithography models for osteosynthesis. Two reductions with only FNRPs, as well as six reductions with FNRPs and prefabricated bone plates, were successfully performed. Postoperative CT data were obtained, and surgical errors in the six-reduction group were evaluated. The average deviation from the screw hole drilling positions was 0.92 ± 0.38 mm. The average deviation included displacement and rotation of the zygomas. The mean displacement was 0.83 ± 0.38 mm, and the average rotations around the x, y, and z axes were 0.66 ± 0.59°, 0.77 ± 0.54°, and 0.79 ± 0.42°, respectively. The results show that combining presurgical planning and the developed navigation program to generate FNRPs for assisting in secondary zygoma reduction is an accurate and practical method. Further study is necessary to prove its clinical value.

Thyroid metastasis from breast cancer presenting with diffuse microcalcifications on sonography: a case report.

Microcalcifications are frequently associated with papillary thyroid cancers. Metastatic nodules from extrathyroid malignancies may mimic primary thyroid neoplasm on sonography, but do not present with microcalcifications. We report the case of a 45-year-old woman with a history of invasive ductal carcinomas of bilateral breasts, status post surgery and neoadjuvant chemotherapy. Four years after surgery, thyroid sonography revealed diffuse microcalcifications without nodular component. Core needle biopsy confirmed thyroid metastasis from primary breast cancer.

Comparison of prognosis by viral etiology in patients with hepatocellular carcinoma after radiofrequency ablation.

UNLABELLED: BACKGROUND; Radiofrequency ablation (RFA) has been performed as a first line curative treatment modality for patients with hepatocellular carcinoma (HCC) within the Milan criteria currently. However, prognosis of hepatitis B- and hepatitis C-related HCC after RFA remains debatable. This study aimed to assess the impact of viral etiology on the prognosis of HCC patients undergoing RFA. MATERIAL AND METHODS: One hundred and ninety-two patients with positive serum HBV surface antigen (HBsAg) and negative serum antibody against HCV (anti-HCV) were enrolled as the B-HCC group and 165 patients with negative serum HBsAg and positive anti-HCV as the C-HCC group. Post-RFA prognoses were compared between the two groups using multivariate and propensity score matching analyses. RESULTS: The B-HCC group had higher male-to-female ratio and better liver functional reserve than the C-HCC group. After a median follow-up of 23.0 ± 22.7 months, 55 patients died and 189 patients had tumor recurrence after RFA. The cumulative five-year survival rate was 75.9% and 69.5% in the B-HCC and C-HCC groups, respectively (p = 0.312), while the five-year recurrence-free survival rate was 19.0% and 26.6%, respectively (p = 0.490). After propensity-score matching, the B-HCC group still had comparable overall survival rate (p = 0.679) and recurrence-free survival rate (p = 0.689) to the C-HCC group. For 132 patients with Barcelona-Clinic Liver Cancer stage 0, the five-year overall survival and recurrence-free survival rates were also comparable between the two groups (p = 0.559 and p = 0.872, respectively). CONCLUSION: Viral etiology is not essential for determining outcome in HCC patients undergoing RFA.

Stochastic region competition algorithm for Doppler sonography segmentation.

PURPOSE: A probabilistic image segmentation algorithm called stochastic region competition is proposed for performing Doppler sonography segmentation. METHODS: The image segmentation is conducted by maximizing a posteriori that models histogram likelihood, gradient likelihood, and a spatial prior. The optimization is done by a modified expectation and maximization (EM) method that aims to improve computation efficiency and avoid local optima. RESULTS: The algorithm was tested on 155 color Doppler sonograms and compared with manual delineations. The qualitative assessment shows that our algorithm is able to segment mass lesions under the condition of low image quality and the interference of the color-encoded Doppler information. The quantitative assessment analysis shows that the average distance between the algorithm-generated boundaries and manual delineations is statistically comparable to the variability of manual delineations. The ratio of the overlapping area between the algorithm-generated boundaries and manual delineations is also comparable to that between different sets of manual delineations. A reproductivity test was conducted to confirm that the result is statistically reproducible. CONCLUSIONS: The algorithm can be used to perform Doppler sonography segmentation and to replace the tedious manual delineation task in clinical application.

Younger hepatocellular carcinoma patients have better prognosis after percutaneous radiofrequency ablation therapy.

GOALS: To evaluate the impact of age on the prognosis of patients with hepatocellular carcinoma (HCC) undergoing percutaneous radiofrequency ablation (RFA). BACKGROUND: Whether age plays an important role in the outcomes of HCC after RFA remains controversial. STUDY: Two hundred fifty-eight consecutive treatment naive HCC patients who underwent RFA were enrolled. Patients aged ≤ 65 years (n = 100) were defined as the younger group and those aged > 65 years (n = 158) were the elderly group. Their clinicopathologic features and prognosis were compared. RESULTS: Younger patients had a higher male-to-female ratio, higher prevalence of hepatitis B virus, and smaller tumor size than elder patients. After median follow-up of 28.5 ± 18.7 months, 45 patients died. The cumulative 5-year survival rates were 81.3% and 65.4% in younger and elder HCC patients, respectively (P = 0.008). Multivariate analysis disclosed that age > 65 years, serum albumin level ≤ 3.7 g/dL, prothrombin time international normalized ratio > 1.1, α-fetoprotein (AFP) > 20 ng/mL, and no antiviral therapy after RFA were independent risk factors associated with poor overall survival. Besides, there were 163 patients with tumor recurrence after RFA. Multivariate analysis showed that age > 65 years, platelet count ≤ 10/mm, AFP > 20 ng/mL, multinodularity, and tumor size > 2 cm were the independent risk factors predicting recurrence. CONCLUSIONS: Both liver functional reserve (serum albumin level, prothrombin time international normalized ratio, platelet count, and antiviral therapy) and tumor factors (tumor size, number, and AFP level) were crucial in determining post-RFA prognosis in HCC patients. Moreover, younger HCC patients have better overall survival and lower recurrence rate after RFA compared with elder patients.

Prognostic significance of computed tomography scan-derived splenic volume in hepatocellular carcinoma treated with radiofrequency ablation.

GOALS: To evaluate the clinical implication of splenic volume measured by computed tomography (CT) scan in hepatocellular carcinoma (HCC) patients undergoing percutaneous radiofrequency ablation (RFA). BACKGROUND: Splenomegaly is an important sign of portal hypertension and poor liver function in patients with advanced liver disease. But whether it could predict the prognosis of patients with HCC is still obscure. STUDY: We enrolled 161 treatment-naive HCC patients. Splenomegaly was defined as splenic volume >300 mL by CT scan and its impact on prognosis was analyzed. Moreover, noninvasive serum markers were validated to predict splenomegaly. RESULTS: A total of 78 patients were with splenomegaly, while the remaining 83 patients had normal splenic volume at the time of receiving RFA. After a median follow-up of 38.1±20.8 months, 41 patients died. The cumulative 5-year survival rates were 54.8% and 77.8% in patients with splenomegaly and in those with normal splenic volume, respectively (P=0.003). By multivariate analysis, age 65 years and older, serum albumin levels ≤3.5 g/dL, and splenic volume >300 mL were independent risk factors associated with poor overall survival after RFA. For predicting splenomegaly by noninvasive serum markers, platelet count yielded the highest area under the curve from corresponding receiver operating curves with a level of 0.868 at a cut-off value of 11,7000/mm(3). CONCLUSIONS: HCC patients with splenomegaly measured by CT scan have relatively poorer liver functional reserve than those with normal splenic volume. Splenomegaly is an independent risk factor predicting overall survival for patients with small HCC undergoing RFA.

Differences in sonographic features of ruptured and unruptured epidermal cysts.

OBJECTIVES: This study aimed to report the differences in sonographic features of ruptured and unruptured epidermal cysts. METHODS: We reviewed and analyzed the sonographic features of superficial epidermal cysts of in 2 subgroups of 46 patients: 20 with ruptured cysts and 26 with unruptured cysts. All lesions were diagnosed either by excisional biopsy or by debridement biopsy. Sonographic features used in the analysis included tumor size, location, echo texture, pericystic changes, boundary, and shape on gray scale sonography and lesion vascularity on color Doppler sonography. Pathologic examinations were reviewed with emphasis on differences between ruptured and unruptured epidermal cysts. RESULTS: Unruptured epidermal cysts showed significantly higher frequencies of an oval shape, presence of a halo, well-circumscribed boundaries, and lack of blood flow signals (P < .05). In contrast, ruptured cysts usually had a lobulated shape, a slightly poorly defined or poorly defined boundary, the absence of a halo, and intermediate grades of lesion vascularity. The lesion sizes and sonographic features, including dermal attachment, a hypoechoic echo texture, posterior acoustic enhancement, and the presence of intralesional hyperechoic strips and hypoechoic debris, showed no significant differences between the groups (P > .05). In pathologic studies, acute and chronic inflammatory reactions, more prominent microvessels, and abscess formation in the adjacent stromal tissue, the lesions, or both could be detected in the 20 ruptured epidermal cysts but not in the unruptured cysts. CONCLUSIONS: This research shows that recognition of different sonographic features is helpful for differentiating ruptured and unruptured epidermal cysts.