Value of the strain ratio in the differential diagnosis of intraocular tumors by elastosonography: A retrospective case-control study

Purpose: To examine the role of the strain ratio in elastosonography for the differential diagnosis of common intraocular tumors such as choroidal melanoma, choroidal hemangioma, choroidal metastatic carcinoma, and retinoblastoma. Methods: This study included patients suffering from intraocular space?occupying lesions and who visited Beijing Tongren Eye Center of Beijing Tongren Hospital affiliated to Capital Medical University from June 2016 to March 2020. All patients underwent a physical examination, fundus examination with mydriasis, color Doppler ultrasonography, elastosonography, magnetic resonance imaging (MRI), and fundus angiography within 1 week. All patients were grouped as choroidal melanoma, choroidal metastatic carcinoma, retinoblastoma, choroidal hemangioma, and optic disk melanocytoma. A receiver operating characteristic (ROC) curve analysis was performed to assess the strain ratio for diagnosing malignant intraocular tumors. Results: A total of 155 patients (161 eyes) were recruited. The strain ratios measured were 39.59 ± 15.92 for choroidal melanoma, 36.85 ± 13.64 for choroidal metastatic carcinoma, 38.93 ± 17.27 for retinoblastoma, 13.42 ± 10.93 for choroidal hemangioma, and 3.84 ± 1.32 for optic disk melanocytoma. The strain ratios of the three malignant lesions were significantly higher than those of the two benign lesions (all P < 0.001). The area under the ROC curve was 0.95 ± 0.028. The optimal cutoff point was 22.67, with 85.7% sensitivity and 96.4% specificity. Conclusion: There were significant differences in elasticity between the malignant and benign intraocular tumors. The strain ratio using elastosonography could serve as an important auxiliary examination to distinguish between benign and malignant intraocular tumors

Can the unnecessary operations for suspected thyroid nodules be avoided by the combined use of the strain ratio and elastography score? / As cirurgias desnecessárias para nódulos tireoidianos suspeitos podem ser evitadas pelo uso combinado da razão de compressão e do escore da elastografia?

Abstract Introduction Only 5%-15% of thyroid surgical specimens are reported as malignant. Most of the operations are performed due to suspicion of malignancy as a result of fine needle aspiration biopsy but invasiveness, non-diagnostic results and potential repeat biopsies are disadvantages of fine needle aspiration biopsy. Objective The aim of this study was to investigate the effectiveness of simultaneously using both the strain ratio and elasticity score in the differential diagnosis of thyroid nodules, as well as to assess the compatibility of these two methods. Methods A total of 144 nodules were included in the study. The final histopathologic diagnosis was used as the reference standard. The area under the curve sensitivity, specificity, and cut-off values of the strain ratio and elasticity score were determined using receiver operating characteristic curve analysis. The compatibility and comparison of strain ratio and elasticity score were also performed. Results Twenty eight nodules (19.4%) were malignant. The strain ratio and elasticity score results were found to be significantly successful in predicting thyroid malignancy (p < 0.001 for both). Moreover, the area under the curve for the strain ratio and elasticity score were found to be 0.944 and 0.960, respectively. The diagnostic accuracy of the elasticity score was found to be superior to that of the strain ratio, but this difference was not statistically significant (p = 0.456). When the compatibility of the strain ratio and elasticity score was examined, the two evaluations were revealed to be statistically consistent with each other (Kappa = 0.767; p < 0.001). When the strain ratio and the elasticity score were used together, the specificity of capturing the correct diagnosis increased from 84.5% to 93.1%. Conclusion When the strain ratio an elasticity score were used together for the differential diagnosis of thyroid nodules, more accurate results were obtained. Thus, combining both methods may be a promising alternative to fine needle aspiration biopsy in order to prevent unnecessary surgical interventions for suspected thyroid nodules.

Resumo Introdução Apenas 5% a 15% das amostras cirúrgicas de tireoide são relatadas como malignas. A maioria das cirurgias é feita devido à suspeita de lesão maligna como resultado da biópsia por punção aspirativa com agulha fina. Entretanto, invasividade, resultados não diagnósticos e biópsias repetidas são desvantagens desse procedimento. Objetivo Investigar a eficácia do uso simultâneo da razão de compressão e do escore de elasticidade no diagnóstico diferencial de nódulos tireoidianos, bem como avaliar a compatibilidade desses dois métodos. Método Foram incluídos no estudo 144 nódulos. O diagnóstico histopatológico final foi usado como padrão de referência. A área sob a curva sensibilidade, especificidade e valores de corte da razão de compressão e do escore de elasticidade foram determinados com a análise da curva Receiver Operating Characteristic. A compatibilidade e comparação da razão de compressão e do escore de elasticidade também foram feitas. Resultados Eram malignos 28 nódulos (19,4%). Os resultados da razão de compressão e do escore de elasticidade foram significantemente bem-sucedidos em prever a lesão maligna de nódulos da tireoide (p < 0,001 para ambos). Além disso, as áreas sob a curva para a razão de compressão e o escore de elasticidade foram de 0,944 e 0,960, respectivamente. A acurácia diagnóstica escore de elasticidade foi superior à da razão de compressão, mas essa diferença não foi estatisticamente significante (p = 0,456). Quando a compatibilidade da razão de compressão e do escore de elasticidade foi examinada, as duas avaliações mostraram-se estatisticamente consistentes (Kappa = 0,767; p < 0,001). Quando a razão de compressão e o escore de elasticidade foram usados em conjunto, a especificidade de captar o diagnóstico correto aumentou de 84,5% para 93,1%. Conclusão Quando a razão de compressão e o escore de elasticidade foram usados juntos para o diagnóstico diferencial de nódulos tireoidianos, resultados mais precisos foram obtidos. Assim, o uso combinado dos dois métodos pode ser uma opção promissora à biópsia por punção aspirativa com agulha fina e evitar intervenções cirúrgicas desnecessárias para nódulos tireoidianos suspeitos.

Value of Elastography Strain Ratio Combined with Breast Ultrasound Imaging Reporting and Data System in the Diagnosis of Breast Nodules / 中国医学科学院学报

Objective To explore the value of elastography strain ratio(SR)combined with breast ultrasound imaging reporting and data system(BI-RADS-US)in the differential diagnosis of breast nodules.Methods A total of 471 breast nodules(from 471 patients)were reclassified by SR combined with BI-RADS-US.With the pathology results as gold standard,the area under the receiver operating characteristic(ROC)curve(AUC)was employed to evaluate the diagnostic performance,and the sensitivity,specificity,and accuracy were compared between the combined method and BI-RADS-US.Results Among the 471 breast nodules,180 nodules were benign and 291 were malignant.The AUC of the combined method was statistically significantly higher than that of BI-RADS-US(0.798 vs. 0.730;Z= 2.583, P= 0.010).SR,BI-RADS-US,and the combined method for diagnosing breast nodules had the sensitivity of 86.6%,99.0%,and 96.6%,the specificity of 67.2%,47.2%,and 63.3%,and the accuracy of 79.2%,79.2%,and 83.9%,respectively.The combined method increased the specificity from 47.2%(BI-RADS-US)to 63.3%(χ

Comparison of One- and Two-Region of Interest Strain Elastography Measurements in the Differential Diagnosis of Breast Masses

OBJECTIVE: To compare the diagnostic performance and interobserver variability of strain ratio obtained from one or two regions of interest (ROI) on breast elastography.MATERIALS AND METHODS: From April to May 2016, 140 breast masses in 140 patients who underwent conventional ultrasonography (US) with strain elastography followed by US-guided biopsy were evaluated. Three experienced breast radiologists reviewed recorded US and elastography images, measured strain ratios, and categorized them according to the American College of Radiology breast imaging reporting and data system lexicon. Strain ratio was obtained using the 1-ROI method (one ROI drawn on the target mass), and the 2-ROI method (one ROI in the target mass and another in reference fat tissue). The diagnostic performance of the three radiologists among datasets and optimal cut-off values for strain ratios were evaluated. Interobserver variability of strain ratio for each ROI method was assessed using intraclass correlation coefficient values, Bland–Altman plots, and coefficients of variation.RESULTS: Compared to US alone, US combined with the strain ratio measured using either ROI method significantly improved specificity, positive predictive value, accuracy, and area under the receiver operating characteristic curve (AUC) (all p values < 0.05). Strain ratio obtained using the 1-ROI method showed higher interobserver agreement between the three radiologists without a significant difference in AUC for differentiating breast cancer when the optimal strain ratio cut-off value was used, compared with the 2-ROI method (AUC: 0.788 vs. 0.783, 0.693 vs. 0.715, and 0.691 vs. 0.686, respectively, all p values > 0.05).CONCLUSION: Strain ratios obtained using the 1-ROI method showed higher interobserver agreement without a significant difference in AUC, compared to those obtained using the 2-ROI method. Considering that the 1-ROI method can reduce performers' efforts, it could have an important role in improving the diagnostic performance of breast US by enabling consistent management of breast lesions.

Role Of Strain Elastography In The Characterization Of Benign And Malignant Nature Of The Thyroid Nodules.

Elastography is an imaging technique to measure the stiffness of tissues. Images are acquired before and after soft compression of tissues and the deformation is evaluated. Strain ratio -calculated as the ratio of stiffness between nodular tissue and surrounding normal thyroid tissue. With prior verbal and written consent patients were examined on gray-scale ultrasound on transverse images and then using elastographic ultrasonography technique. patients were followed up by fnac findings & postoperative histopathology report in cases of inconclusive FNAC reports. This is prospective study conducted on 200 subjects at Government Medical College, Department of RADIO-DIAGNOSIS, Nagpur from November 2016 to 2018. Regarding sonoelastograph, relation between elastograph scores and thyroid malignancies showing sensitivity, specificity and p value is calculated. The most accurate strain ratio cutoff value among studies calculated. RESULTS: Ultrasound Strain elastography is a promising imaging technique that is useful in the differentiating between benign and malignant thyroid nodules. Further improvements in the technique and the diagnostic criteria are necessary for this examination to provide a useful contribution to diagnosis. The use of Real Time ultrasound strain elastography would lead to low thyroid FNAC’s because of the high elasticity of being strongly associated with a benign cytology.

Clinical utility of TIRADS and ultrasound elastography in characterization of thyroid nodules

Background: Thyroid nodules are a common entity in an iodine deficient population, however malignant nodules are relatively uncommon with excellent prognosis. Ultrasound elastography is a useful tool for characterization of nodules and allows selection of tumors for FNAC. This study aimed to evaluate the diagnostic value of strain elastography and acoustic radiation force impulse (ARFI) imaging in differentiating malignant from benign thyroid nodules.Methods: This study included 100 thyroid nodules evaluated using ultrasound TIRADS classification. Strain elastography evaluated the nodules using the elasticity score and strain ratio followed by VTI and shear wave velocity generated from ARFI data to characterize the nodules. Final diagnoses were obtained from cytological and/or histological evaluation. The diagnostic performance of the two elastography methods was analyzed and compared by multiple receiver operating characteristic curve analysis.Results: Of the 100 thyroid nodules observed in 100 patients (82 females and 18 males), 22% were malignant nodules and 78% were benign. The cut off values for elasticity scores, mean SR, VTI grade and mean SWV for predicting malignant thyroid nodules were greater than or equal to score 2, 2.4, grade 3, 2.5m/s respectively. The area under the receiver operating characteristic curve for elasticity score, mean SR, VTI grade and mean SWV was 0.79, 0.78, 0.89 and 0.84, respectively (P>0.05) and the accuracy was 74, 81.6, 88 and 87.5%, respectively (P>0.05). The accuracy of the combined use of conventional sonography, strain elastography and ARFI imaging was 85.6% respectively, which was higher than that of conventional sonography (P>0.05).Conclusions: Strain elastography and ARFI imaging have high sensitivity and specificity for differentiating malignant from benign thyroid nodules and therefore have good clinical utility in evaluating these lesions.

Future of breast elastography

Both strain elastography and shear wave elastography have been shown to have high sensitivity and specificity for characterizing breast lesions as benign or malignant. Training is important for both strain and shear wave elastography. The unique feature of benign lesions measuring smaller on elastography than B-mode imaging and malignant lesions appearing larger on elastography is an important feature for characterization of breast masses. There are several artifacts which can contain diagnostic information or alert to technique problems. Both strain and shear wave elastography continue to have improvements and new techniques will soon be available for clinical use that may provide additional diagnostic information. This paper reviews the present state of breast elastography and discusses future techniques that are not yet in clinical practice.

Diagnostic Efficacy of Endoscopic Ultrasound Elastography in Differentiating Solid Pancreatic Lesions: A Single-Center Experience

BACKGROUND/AIMS: Endoscopic ultrasound (EUS) has a limited ability to determine the nature of solid pancreatic lesions (SPLs). Most recent ultrasound processors are provided with elastography software, which allows quantification of the tissue hardness. The aim of this study is to evaluate the effectiveness of the elasticity score (ES) and strain ratio (SR) in the differentiation of benign pancreatic lesions from malignant pancreatic lesions. METHODS: The study had a retrospective design; it included 97 patients with SPLs and 19 patients with inflammatory lesions. The ES and SR were determined during the examination; finally, EUS-guided fine needle aspiration was performed. RESULTS: In this 2-year study, 116 patients were enrolled (97 with malignant lesions and 19 with benign lesions). There were 69 men and 47 women. Their median age was 55.9 years. A cut-off point was detected at SR of 7.75 with a specificity of 99.9%, sensitivity of 90.7%, positive predictive value (PPV) of 99.9%, negative predictive value (NPV) of 67.9%, and accuracy of 92.2%. After adding the ES to the SR, the cut-off point at 7.75 resulted in a specificity of 94.6%, sensitivity of 99%, PPV of 98%, NPV of 98.5%, and accuracy of 97%. CONCLUSIONS: The use of the ES combined with the SR increases the accuracy of differentiation between benign and malignant SPLs and is an effective method for the evaluation of pancreatic masses.

Value of ultrasound elastography in diagnosis of cervical tuberculous lymphadenopathy / 第二军医大学学报

Objective To analyze and compare the ultrasound elastography (UE) features of various types of cervical tuberculous lymphadenopathy (CTL), and to investigate the value and limitation of UE in diagnosis of CTL. Methods A total of 70 CTL patients confirmed by pathology or diagnostic treatment who were admitted to Shanghai Pulmonary Hospital affiliated to Tongji University from Jul. 2017 to Mar. 2018 were enrolled, and the images of conventional ultrasound and UE of the largest lymph nodes in each patient were retrospectively analyzed. According to the conventional ultrasound classification criteria of tuberculous lymphadenopathy, the lesions were divided into acute inflammatory type (type), caseous necrotic type (typeⅡ), cold abscess type (type III) and healing calcification type (type ). The elasticity score and strain ratio of various types of CTL lesions were summarized and compared. Results There were 24 (34.29%) typeCTL lesions, 28 (40.00%) typeⅡ, 12 (17.14%) type III, and 6 (8.57%) type . The hardness of CTL lesions of typeand typeⅡ was high, with the elastic score being 3-4 (47/52, 90.38%) and the strain ratio being 3-5; the hardness of type III was the lowest, with the elastic score being 1-2 (10/12, 83.33%) and the strain ratio2; the hardness of type was the highest, with the elastic score being 4-5 (6/6, 100.00%) and the strain ratio5. There were significant differences in elastic score and strain ratio among the four type CTL lesions (H＝30.756, F＝23.177; both P0.001). Pairwise comparison showed that except for the differences between typeand typeⅡ lesions, there were significant differences in elastic scores and strain ratios between the four type CTL lesions (P0.05). Conclusion The value of UE in the diagnosis of CTL is limited. It may play some roles in determining whether there is an obvious granuloma formation in typelesions and the tension of type III lesions.

Application of Real-time Ultrasound Elastography for Preoperative Staging of Rectal Cancer / 中国医科大学学报

Objective To explore the role of real-time ultrasound elastography (RUE) in the staging of rectal cancer.Methods We retrospectively analyzed 41 cases of rectal cancer by both double plane transrectal conventional ultrasonography (CU) and RUE and comparatively assessed elasticity scores and strain ratios (SR) of the tumor along with postoperative pathological staging results.Results The accuracy of CU for preoperative staging of rectal tumors was 80.49％.There were significant differences between the elasticity scores and strain ratios of the T1 stage and T2,T3,and T4 stages,and also in elasticity scores and strain ratios of the T4 stage and T2 and T3 stages of rectal cancer by using RUE (P ＜ 0.05).Taking the elasticity score of 3 points as the optimal ritical value in the diagnosis of the T1 stage of rectal cancer,the sensitivity,specificity,positive predictive value,and negative predictive value were 66.67％,96.88％,85.71％,and 91.18％ respectively.Condusion Endorectal RUE can assess the elastic stiffness of rectal cancer,and it helps in the preoperative staging of rectal cancer.

Relationship of ultrasonic elastography and serologic indexes in patients with papillary thyroid carcinoma / 天津医药

Objective To evaluate the elastic score (ES) and strain ratio (SR) in papillary thyroid carcinoma patients, and analyse their relationship with serologic index. Methods Totally one hundred and six patients with thyroid neoplasm were divided into papillary thyroid carcinoma group (n=56) and thyroid adenoma group ( n=50) according to histopathology results. Another fifty cases of healthy people were chosen as normal control group at the same period. The ES and SR were evacuated by color Doppler ultrasonic diagnostic apparatus in three groups of patients. Thyroid stimulating hormone (TSH), thyroglobulin antibody (TgAb), and thyroid peroxidase antibody (TpoAb) were detected by electrochemiluminescence immunoassay. Data of galectin-3 (Gal-3), vascular endothelial growth factor (VEGF), and cytokeratin 19 fragment (Cyfra21.1) were tested by automatic optical inspection. Results Indexes of ES, SR, Gal-3, VEGF and Cyfra21.1 showed statistically increasing tendency in the control group, thyroid adenoma group and papillary thyroid carcinoma group sequentially (P<0.05). Serum levels of TSH, TgAb and TpoAb were significantly higher in the papillary thyroid carcinoma group than those in the other two groups (P<0.05). And there were no significant differences in serum TSH, TgAb and TpoAb between the control group and thyroid adenoma group (P>0.05). There were positive correlation between ES, SR and TSH, TgAb, TpoAb, Gal-3, VEGF, Cyfra21.1 in patients with papillary thyroid carcinoma (P<0.05). Conclusion Papillary thyroid carcinoma shows increased ES and SR detected by ultrasound, and which are relevant to related serological indicators. The two indices may be used for auxiliary diagnosis of papillary thyroid carcinoma.

A multicenter study to confirm further diagnostic value of strain ratio method giving to 5-point scoring by elastography for differentiation of breast lesions / 中华超声影像学杂志

Objective To confirm whether strain ratio should be added after evaluation of lesions with 5-point elasticity scoring for differentiating breast lesions on ultrasonic elastography(UE).Methods Eight hundred and forty-six consecutive female patients with 1 071 breast lesions were recruited into a multicenter retrospective study,which involved 8 centers across China.All the patients underwent the UE procedure and the strain ratios were calculated.The sensitivity,specificity,accuracy,PPV and NPV were calculated for each of the two evaluation systems and the areas under the ROC curve were compared.Results The strain ratios of 559 benign lesions(2.7±1.4)and 512 malignant lesions(8.1±5.9)were significantly different (P<0.001).When the cutoff point was 3.03,strain ratio method had 81.6% sensitivity,89.7% specificity,81.7% accuracy,80.2% PPV and 84.2% NPV.The areas under the ROC curve with the strain ratio method and 5-point scoring method were 0.865 and 0.862,respectively(P =0.622).For the lesions with elasticity score 3 and 4,the areas under the ROC curve of the two Methods were 0.71 1 and 0.629, respectively(P = 0.020).Conclusions Although the two UE Methods have similar diagnostic performance,separate calculation of the strain ratios seems compulsory,especially for the lesions with elasticity score 3 and 4.

Diagnostic value of ultrasonic elastosonography in choroidal melanoma / 中华医学超声杂志（电子版）

Objective To explore the diagnostic value of ultrasonic elastography in choroidal melanoma. Methods A total of 96 cases (97 eyes) of choroidal melanoma were included in present study from June 2016 to June 2017 in Eye Center of Beijing Tongren Hospital, Capital Medical University. The control group consisted of 18 patients with choroidal hemangioma (18 eyes). All eyes were examined by color Doppler ultrasound and ultrasonic elastosonography. The strain ratio of the tumor and surrounding normal tissue was calculated for each case. By comparing the strain ratio between choroidal melanoma and choroidal hemangioma, the diagnostic value of ultrasound elastography in choroidal melanoma was investigated. Results The strain ratios of the two groups were 39.51±15.79 for choroidal melanoma and 13.15±10.40 for choroidal hemangioma. The independent sample t-test was performed between the two sets of data. The difference of the strain ratio between choroidal melanoma and choroidal hemangioma was statistically significant (t=6.802, P<0.001). Conclusions The stiffness of ocular malignant tumor (choroidal melanoma) is significantly higher than that in intraocular benign tumor (choroidal hemangioma). Ultrasonic elastography can be used as an important examination for the diagnosis and differential diagnosis of choroidal melanoma.

Investigation of correlation between real-time ultrasound elastosonography score and autoimmunity in patients with hashimoto thyroiditis / 中国免疫学杂志

Objective:To investigate the correlation between ultrasonic elasticity score ,elasticity coefficient and autoimmune thyroid function in patients with HT ( hashimoto thyroiditis ) .Methods: Used GE LOGIQ3 type Color Doppler Ultrasound Diagnostic System to acquire satisfactory elastosonography from 216 patients with HT,and evaluated the elasticity score and elasticity coefficient;to detecte the thyroid function and the titer of Thyroid peroxidase antibody ( TPOAb ) , Thyroid globulin antibody ( TgAb ) by chemiluminescence ,respectively investigated the correlation between ultrasonic elasticity score , elasticity coefficient and autoimmune thyroid function.Results:Serum Thyroid stimulating hormone (TSH),TGA and TPO in 216 patients with HT increased significantly , TgAb and elastic coefficient were positively correlated , r=0.54 , P<0.01;TgAb and elasticity score were positively correlated , r=0.496 ,P<0.01;TPOAb and elastic coefficient were positively correlated ,r=0.77 ,P<0.01 ,TPOAb and elasticity score were positively correlated,r=0.73,P<0.01.Conclusion: Real-time ultrasound elastography in combination with measurement of autoimmune thyroid function was helpful to diagnosis of HT .

The differentiation of malignant and benign lesions of the breast by quantitative Ultrasound elastography / 医学研究生学报

Objective The widely use of ultrasound elastography has increased the detection rate of breast cancer.It has great advantage of differential diagnosis of breast tumor.Our study is to evaluate and compare the value of the quantitative ultrasound elastography parameters of AR ( area ratio) , ESR ( entire strain ratio) , LSR ( locolized strain ratio) , EFLR( entire fat to lesion ratio) and LFLR( locolized fat to lesion ratio) in the differential diagnosis of breast tumor. Methods 110 patients with 113 breast tumors were collected from Nanjing General Hospital of Nanjing Military Region between January 2015 and January 2016 who underwent breast exami-nation.The tumors were divided into two groups according to patholo-gy which acts as gold standard:benign group with 59 lesions and ma-lignant group with 54 lesions.Participants underwent quantitative ul-trasound elastography parameters examination.AR、ESR、LSR、EFLR、LFLR were compared between benign group and malignant group and ROC curve was drawn.Conventional ultrasound and ultrasound elastography parameter are combined to differentiate the benign or malignant lesion.Calculate the various parameters on the accuracy、susceptibility、specificity、positive likelihood ratio、negative likeli-hood ratio of the diagnosis of benign and malignant lesions, and determine the quantitative parameter with the highest accuracy. Results The mean value of AR、ESR、LSR、EFLR and LFLR of malignant lesions were all significantly greater than that of benign le-sions (P=0.000).Compared with the conventional ultrasound, AR、ESR、LSR、EFLR and LFLR have higher AUC in the differentia-tion of benign and malignant breast lesions;AUC of AR and ESR are higher than conventional ultrasound、LSR、EFLR and LFLR( P<0.000).Compared with conventional ultrasound(1.523) alone, conventional ultrasound combined separately with AR、ESR、EFLR and LFLR have higher positive likelihood ratio(11.581、8.272、3.482、2.458、2.100) in the differentiation of benign and malignant breast lesions, so as accuracy、susceptibility、specificity(P<0.000).The AUC of conventional ultrasound combined separately with AR and ESR[0.940(0.890~0.990)、0.941(0.891~0.990)] were higher than conventional ultrasound and conventional ultrasound com-bined separately with LSR、EFLR、LFLR[0.669(0.669~0.768)、0.837(0.759~0.915)、0.763(0.673~0.852)、0.787(0.701~0.874)],so as accuracy、susceptibility、specificity and positive likelihood ratio(P<0.000). Conclusion Quantitative ultrasound elastography may be helpful in differentiation of benign and malignant breast lesions, especially combining conventional ultrasound with AR and ESR, which were superior to combining with the other parameters and provide a more objective and credible basis to differenti-ate benign and malignant breast tumors with conventional ultrasound.

Value of ultrasound elastography versus transrectal prostatic biopsy in prostatic cancer detection / 中国基层医药

Objective To detect the impact of ultrasound elastography in diagnosis of prostatic cancer,and to evaluate its capability in differentiating benign from malignant lesions.Methods From June 2013 to February 2015, we selected 50 patients with different prostatic lesions,and suspicious for malignancy were included.All patients had a conventional B-mode ultrasound examination and color Doppler imaging,and then real time ultrasound elastography was performed in the same session.Finally,the results were compared to the histopathological results of those lesions. Results The addition of Strain ratio parameter for evaluating the elastography images showed the highest sensitivity of 74.2%,specificity of 73.7% and accuracy of 74.0% at a best cut off point of 5.5 between benign and malignant lesions.Conclusion Prostate US combined with elastography can be a helpful tool for guiding malignant lesions.Also it can help in targeting the biopsy site.

Value of strain ratio from longitudinal section and cross section in differential diagnosis of thyroid nodules using ultrasonic elastographyheng / 中华医学超声杂志（电子版）

ObjectiveTo study the value of strain ratio from longitudinal section and cross section in differential diagnosis of benign and malignant thyroid nodules using ultrasonic elastography.MethodsA total of 118 patients with 153 thyroid nodules underwent examinations with real-time ultrasonic elastography to obtain the strain ratio from longitudinal section and cross section. Receiver operating characteristic (ROC) curves were used to evaluate the value of elastography. The nodules are divided into two groups, group one included nodules which were near the isthmus and group two included other nodules. Diagnostic results were compared with pathological results.ResultsThe area under the ROC curve (AUC) of the strain ratios for differentiating benign and malignant thyroid nodules were 0.906 and 0.844. There was no statistical difference (Z=1.542,P>0.05). The best diagnostic cut-off points of the strain ratios were 3.65 and 3.58. The sensitivity, specificity, accuracy, positive predictive value, negative predictive value of the strain ratio from longitudinal section for differentiating benign and malignant thyroid nodules were 81.2%, 80.8%, 81.0%, 87.2% and 71.2% and those of strain ratio from cross section were 77.2%, 76.9%, 77.1%, 84.4% and 63.4%. In group one, the AUC were 0.903 and 0.830. There was no statistical difference (Z=1.125,P>0.05). The best diagnostic cut-off points were 3.30 and 3.28. The sensitivity, specificity, accuracy, positive predictive value, negative predictive value of the strain ratio from longitudinal section for differentiating benign and malignant thyroid nodules were 86.2%, 68.8%, 80.0%, 83.3% and 73.3% and those of strain ratio from cross section were 78.6%, 58.8%, 71.1%, 75.9% and 62.5%. In group two, the AUC were 0.906 and 0.852. There was no statistical difference (Z=0.936,P>0.05). The best diagnostic cut-off points were 3.33 and 3.71. The sensitivity, specificity, accuracy, positive predictive value, negative predictive value of the strain ratio from longitudinal section for differentiating benign and malignant thyroid nodules were 90.1%, 75.7%, 85.2%, 87.7% and 80.0% and those of strain ratio from cross section were 84.7%, 70.3%, 80.6%, 83.6% and 72.2%. ConclusionReal-time ultrasonic elastography is helpful to the differential diagnosis of thyroid nodules, but there is no statistical difference between the strain ratio from longitudinal section and cross section.

Influencing factors of real-time tissue elastosonography in differential diagnosis of benign and malignant thyroid nodules / 中华超声影像学杂志

Objective To investigate the influencing factors of strain ratio(SR) value in differential diagnosis of benign and malignant thyroid nodules by using real-time tissue elastosonography (RTE).Methods One hundred and seventy-one patients with a total of 171 thyroid nodules were analyzed retrospectively.Their images,including 2D ultrasound,color Doppler flow imaging (CDFI) and RTE were reviewed and conventional ultrasonic features (including the maximum diameter,composition,shape,magin,calcification,intranodular blood flow,depth) and SR value were recorded.Receiver-operating characteristic (ROC) curve was employed to assess the diagnostic efficiency of SR value in differentiating malignant nodules from benign ones.Firstly,the correlation between the aforementioned factors and SR value was assessed by using malignant lesions as the research subjects.And then,the multiple linear regressions (MLR) was employed to evaluate the influence of particular features which turned out to be an important disturbing factor affecting SR value of the lesion in the first step of analysis and pathological type in all nodules (benign and malignant) on SR value.Results With a cut-off point of SR value 3.67,the sensitivity and specificity of SR value in differential diagnosis of benign and malignant thyroid nodules was 85.6％ and 81.1 ％,respectively,and the area under ROC curve was 0.891.Correlation between the maximum diameter and calcification and SR value was significant(r =0.345 and 0.261 respectively,P ＜0.05).However,there was no significant correlation between other features(5 factors) and SR value(P ≥0.05).MLR indicated that the maximum diameter,calcification and the type of pathology of the nodule were associated with SR value (P ＜ 0.05).Among them,pathological nature was the most significant impact factor with a standardized coefficient 0.494).Conclusions SR value can be used to evaluate the hardness of thyroid nodules semi-quantitatively.Its value mainly depends on the pathological nature of the nodules.The maximum diameter and calcification are also the influencing factors of SR value.However,the composition,shape,margin,intranodular blood flow and depth have no obvious effect on SR value.

Relación entre el valor del ratio elastográfico y la clasificación citológica de Bethesda en la patología tiroidea / Relationship between the value of elastography ratio and the cytological classification of Bethesda in thyroid pathology

Objetivo: Presentar nuestra experiencia en la categorización de la patología tiroidea, a través de la utilización de parámetros ecográficos de malignidad y elastografía con medición del ratio de la deformación tisular, y la correlación de los hallazgos obtenidos con la clasificación citológica de Bethesda. Materiales y métodos: Se llevó a cabo un estudio prospectivo y observacional, entre septiembre de 2012 y abril de 2013, que incluyó 137 nódulos tiroideos. Se excluyeron 10 casos Bethesda III-IV. Se realizó ecografía, power Doppler, visualización de micropartículas (Micropure) y elastografía con medición del ratio elastográfico, así como también punción aspirativa con aguja fina guiada por ecografía (con el citólogo presente), utilizando la clasificación Bethesda. Los estudios fueron hechos por el mismo operador con un ecógrafo Toshiba Aplio 400 y los datos estadísticos se evaluaron con el programa IBM SPSS Statistics 20. Resultados: Se estudiaron 127 nódulos en pacientes con una edad promedio de 59±16 anos. El 82% de los casos ocurrió en mujeres. Ciento veinte nódulos (94%) fueron clasificados como Bethesda II. La media elastográfica para Bethesda I-II fue de 1,94±2,12 vs. 7,07±5,46 para V-VI (p: 0,048). El punto de corte elastográfico ≤ 2 (87 de 127) presentó una sensibilidad del 85,7% y una especificidad del 81,7% para predecir Bethesda asociada a patología benigna, con un valor predictivo negativo (VPN) del 99% y un valor predictivo positivo del 15%. Conclusiones: El ratio elastográfico permitió descartar la patología tiroidea maligna con valores ≤ 2 y un VPN del 99%, mejorando la selección de los pacientes a punzar. El incremento del ratio elastográfico se asoció a una mayor probabilidad de patología maligna, aunque no se pudo establecer un valor de corte debido al bajo número de casos con Bethesda V-VI.

Objectives: We present our experience in the categorization of thyroid pathology using the sonographic parameters of malignancy and elastography with measurement elastography strain ratio, to evaluate the relationship between the results found and the Bethesda classification. Materials and methods: Prospective observational study, included 137 thyroid nodules studied between September 2012- April 2013. We excluded 10 cases with Bethesda categories III-IV. Ultrasonography, Doppler, Micropure, elastogrphy strain ratio between the lesion and the normal tissue, fine needle aspiration cytology (FNAC),were the diagnosis methods used. The pathologist was always present and the cytological classi fication of Bethesda was used. All study was made by the same physician used Toshiba Aplio 400 ultrasound unit. Results were analyzed with IBM SPSS Statistics 20. Results: We studied 127 nodules in patients 59±16 years old, 82% were female; 120 were Bethesda II (94%). The average strain ratio for nodules Bethesda I-II was 1.94±2.12 vs. 7.07±5.46 for those nodules Bethesda V-VI (p:0,048). This means that an elastography strain ratio ≤ 2 (87 of 127 nodules) has a sensibility of 85.7% and a specificity of 81.7% of predicting Bethesda associated with benign pathology with a negative predictive value (NPV) of 99% and a positive predictive value of 15%. Conclusion: The elastography strain ratio allowed to discard malignant nodules with strain ratio ≤ 2 with a NPV of 99% improves the selection of patients for FNAC. The increment in the elastography strain ratio was associated to a higher possibility of malignant thyroid pathology, being unable to determine a limit value due to the low amount of cases with nodules Bethesda V-VI.

The value of elastography in diagnosis of thyroid malignant tumor by fine needle aspiration / 中华内分泌代谢杂志

Objective To evaluate the value of elastic strain ratio (SR) in ultrasound guided fine needle aspiration (US-FNA) of thyroid nodule.Methods A total of 222 thyroid nodules from 216 patients were reviewed and analyzed by Logistic regression of clinical data,2D ultrasound,and SR.The odds ratios of variables in the equation were compared to assess various variables,especially of SR in the diagnosis.The sensitivity,specificity,and accuracy of the SR method,US-FNA method,and combined method were calculated.Results Three statistically significant features finally entered the Logistic regression model,followed by SR,echo,and age according to the odds ratio.The sensitivity,specificity,and accuracy of the SR method,US-FNA method and combined method were 85.4％,82.1％,83.3％ ; 91.5％,82.1％,85.6％ ; 97.6％,94.3％,95.5％ respectively.Conclusions SR＜0.5 is the most important risk factor in differential diagnosis of thyroid malignant nodules from benign nodules.SR raises the sensitivity,specificity,and accuracy of US-FNA method and plays an important role in diagnosing thyroid nodules via US-FNA.