ABSTRACT
BACKGROUND: Perianal fistulas pose dual challenges to Crohn's disease (CD) patients. Low patient compliance due to the complexity of existing examination methods plagues the treatment and follow-up management of perianal CD. AIM: To determine the accuracy of endoanal ultrasound (EUS) and shear wave elastography (SWE) for evaluating perianal fistulizing CD (PFCD) activity. METHODS: This was a retrospective cohort study. A total of 67 patients from August 2022 to December 2023 diagnosed with CD were divided into three groups: Non-anal fistula group (n = 23), low-activity perianal fistulas [n = 19, perianal disease activity index (PDAI) ≤ 4], high-activity perianal fistulas (n = 25, PDAI > 4) based on the PDAI. All patients underwent assessments including EUS + SWE, pelvic magnetic resonance [pelvic magnetic resonance imaging (MRI)], C-reactive protein, fecal calprotectin, CD activity index, PDAI. RESULTS: The percentage of fistulas indicated by pelvic MRI and EUS was consistent at 82%, and there was good consistency in the classification of perianal fistulas (Kappa = 0.752, P < 0.001). Significant differences were observed in the blood flow Limberg score (χ 2 = 8.903, P < 0.05) and shear wave velocity (t = 2.467, P < 0.05) between group 2 and 3. Shear wave velocity showed a strong negative correlation with magnetic resonance novel index for fistula imaging in CD (Magnifi-CD) score (r = -0.676, P < 0.001), a weak negative correlation with the PDAI score (r = -0.386, P < 0.05), and a weak correlation between the Limberg score and the PDAI score (r = 0.368, P < 0.05). CONCLUSION: EUS combined with SWE offers a superior method for detecting and quantitating the activity of perianal fistulas in CD patients. It may be the ideal tool to assess PFCD activity objectively for management strategies.
ABSTRACT
The aim of the study described here was to assess the evaluation of tissue stiffness around lesions by sound touch shear wave elastography (STE) in breast malignancy diagnosis. This was an institutional ethics committee-approved, single-center study. A total of 90 women with breast masses examined with conventional ultrasound and STE were eligible for enrollment from December 2020 to July 2021. The maximum and mean elastic values of masses, Emax and Emean, were determined. Shell function was used to measure the maximum and mean elastic values of tissues around masses in annular shells 0.5, 1.0, 1.5 and 2.0 mm wide, recorded as corresponding Emax-shell and Emean-shell. All parameters were analyzed and compared with histopathologic results. Receiver operating characteristic curves were constructed to assess diagnostic performance. Logistic regression analysis was conducted to determine the best diagnostic model. Collagen fiber content of tissues around breast lesions was evaluated using Masson staining and ImageJ software. Ninety women with breast masses were included in this study; 50 had benign (mean diameter 15.84 ± 4.39 mm) and 40 had malignant (mean diameter 17.40 ± 5.42 mm) masses. The diagnostic value of Emax-shell-2.0 was the highest (area under the curve = 0.930) with a sensitivity of 87.5% and specificity of 88%. According to stepwise logistic regression analysis, Emax-shell-2.0 and age were independent predictors of malignancy. Emax-shell-2.0 was also found to be highly correlated with the collagen fiber content of tissue in the malignant group (r = 0.877). Tissue stiffness around lesions measured by STE is a useful metric in identifying malignant breast masses by reflecting collagen fiber content, and Emax-shell-2.0 performs best.
Subject(s)
Breast Neoplasms , Elasticity Imaging Techniques , Breast/diagnostic imaging , Breast/pathology , Breast Neoplasms/diagnostic imaging , Breast Neoplasms/pathology , Collagen , Diagnosis, Differential , Elasticity Imaging Techniques/methods , Female , Humans , Sensitivity and Specificity , Ultrasonography, Mammary/methodsABSTRACT
Aim: Annual T1 stage papillary thyroid carcinoma (PTC) incidence rates continue to rise, yet the optimal treatment for this cancer type remains controversial. Central lymph node metastasis (CLNM) is a critical determinant in the context of treatment decision-making. While several prior studies have evaluated patients with clinica l T1a(cT1a) stage PTC, there have been fewer analyses of clinical T1b(cT1b) disease to date. The present study was thus formulated to explore predictors of CLNM in patients with cT1a and cT1b stage PTC. Methods: A retrospective analysis of data including clinicopathological characteristics and BRAFV600E mutation status was conducted for 452 PTC patients undergoing surgical treatment. Logistic univariate and multivariate analyses were performed to identify risk factors associated with CLNM in particular patients' characteristics and the accuracy of the established logistic regression models was evaluated using the R software platform. Results: Respective CLNM incidence rates in cT1a and cT1b disease were 39.39% and 67.21%. Factors associated with a higher risk of CLNM among PTC(cT1a) patients included male sex, young age, tumor size, contact with capsule, and multifocality as determined through comparisons of the area under the curve for logistic regression models. Whereas male sex and age were associated with CLNM risk in PTC(cT1b) patients in univariate and multivariate analyses, age was the only risk factor associated with CLNM incidence among women with PTC(cT1b). Conclusion: Predictors of CLNM differ between PTC patients with cT1a and cT1b stage disease, and a comprehensive assessment of these risk factors should thus be conducted when designing individualized treatment regimens for PTC patients.
Subject(s)
Carcinoma, Papillary , Thyroid Neoplasms , Carcinoma, Papillary/pathology , Female , Humans , Lymphatic Metastasis , Male , Retrospective Studies , Risk Factors , Thyroid Cancer, Papillary/pathology , Thyroid Cancer, Papillary/surgery , Thyroid Neoplasms/epidemiology , Thyroid Neoplasms/genetics , Thyroid Neoplasms/surgeryABSTRACT
BACKGROUND: Treatments for hepatic sinusoidal obstruction syndrome (HSOS) are limited. AIM: To evaluate transjugular intrahepatic portosystemic shunting (TIPS) as a treatment for pyrrolidine alkaloid-related HSOS (PA-HSOS). METHODS: This retrospective analysis included patients with PA-HSOS admitted to the First Affiliated Hospital of the University of Science and Technology of China (June 2015 to January 2019). Baseline clinical characteristics and follow-up data were extracted from the medical records. All patients included in this study experienced failure of initial therapy. Patients were divided into the TIPS and conservative treatment groups according to the therapy they received. Liver function, maximal ascites depth, imaging characteristics, pathology findings, and survival were compared between groups. RESULTS: The TIPS group included 37 patients (28 males), and the conservative treatment group included 17 patients (11 males). Baseline characteristics were similar between groups. There were two deaths in the TIPS group and seven deaths in the conservative treatment group during follow-up (3-48 mo). The 3-, 6-, 12- and 24-mo survival rates were 94.6%, 94.6%, 94.6% and 94.6%, respectively, in the TIPS group and 70.6%, 57.8%, 57.8% and 57.8%, respectively, in the conservative treatment group. Kaplan-Meier analysis revealed significantly longer survival for the TIPS group than for the conservative treatment group (P = 0.001). Compared with the pre-treatment value, maximal ascites depth was significantly lower at 1 wk, 2 wk, 1 mo, and 3 mo for the TIPS group (all P < 0.05) but not in the conservative treatment group. Contrast-enhanced computed tomography demonstrated the disappearance of patchy liver enhancement after TIPS. Pathology showed that liver congestion and hepatocyte swelling improved with time after TIPS placement. CONCLUSION: TIPS may achieve better outcomes than conventional symptomatic treatment in patients with PA-HSOS.
Subject(s)
Hepatic Veno-Occlusive Disease , Portasystemic Shunt, Transjugular Intrahepatic , Pyrrolizidine Alkaloids , Ascites , China , Hepatic Veno-Occlusive Disease/drug therapy , Hepatic Veno-Occlusive Disease/etiology , Humans , Male , Portasystemic Shunt, Transjugular Intrahepatic/adverse effects , Retrospective Studies , Treatment OutcomeABSTRACT
@#ObjectiveTo investigate the value of conventional ultrasonography (US) and contrast-enhanced ultrasound (CEUS) in the differential diagnosis of intrahepatic cholangiocellular carcinoma (ICC) and hepatocellular carcinoma (HCC) by establishing a logistic regression model with the variables of US features and CEUS enhancement pattern (circumferential ring enhancement). MethodsA retrospective analysis was performed for the US and CEUS features of 55 ICC patients and 42 HCC patients, and the results of surgical pathology or biopsy were used as the golden standard for diagnosis. A logistic regression analysis was used to evaluate the value of four US features, lesion echo, blood supply type, bile duct dilatation, and circumferential ring enhancement of CEUS, in the differential diagnosis of ICC and HCC. The t-test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. A binary logistic regression analysis was performed for the factors with statistical significance in univariate analysis. Likelihood ratio was used to evaluate the fitting of the whole model, and the feature with the highest likelihood ratio in the qualitative diagnosis of ICC was screened out. The receiver operating characteristic (ROC) curve was plotted for the logistic regression model in the qualitative diagnosis of ICC, and the area under the ROC curve (AUC) was calculated. ResultsThere were significant differences between the two groups in lesion echo (χ2=4.813, P<0.05), blood supply type (χ2=10.222, P<0.01), bile duct dilatation (χ2=40.669, P<001), and circumferential ring enhancement of CEUS (χ2=8.180, P<0.01), and these four features had a sensitivity of 58.15%, 7273%, 67.27%, and 6909%, respectively, and a specificity of 64.29%, 59.52%, 66.4%, and 95.24%, respectively, all P<005, in the differential diagnosis of ICC and HCC. Type of lesion echo, blood supply, circumferential ring enhancement of CEUS, and presence or absence of bile duct dilatation had an odds ratio of 3.556, 4.107, 4.223, and 5.776, respectively. The binary logistic regression equation was Logistic (P)=-2.761+1.272X1+1.430X2+1.538X3+1.743X4. The likelihood-ratio test of this model showed a significant difference in this regression equation (χ2=94.691, P<0.001). In the qualitative diagnosis of ICC, this regression equation had a sensitivity of 743%, a specificity of 822%, and an AUC of 0.856. There was a significant difference in time to peak between the two groups (t=8497, P<001). ConclusionThe logistic regression model and CEUS qualitative analysis can improve the qualitative diagnosis of ICC.