The ultrasonographic diagnosis of lymph node varicose veins in the groin - an overlooked missing link in chronic venous disease?

AIM: Chronic venous disease is a common pathology characterized by valvular incompetence and venous hypertension. The venous network of the lymph nodes at the Scarpa triangle connects the superficial and the deep venous systems. This study aimed to describe infrainguinal intranodal venous dilatations and to evaluate the connection with peripheral venous disease. MATERIAL AND METHODS: The study included 183 subjects (116 women, 67 men) who underwent Doppler ultrasound examinations of the venous system of the inferior limb in the context of chronic venous disease. The diagnosis of lymph node varices was based on well-defined criteria and the severity of the lymph node varices was established using an original classification. RESULTS: There was a statistically significant, moderately strong association, between the presence of intranodal varices and the great saphenous vein reflux (φ=0.341, p=0.000). There was a moderate-to-high positive correlation between intranodal varices and the chronic venous disease stage (rrb=0.457, p=0.000). CONCLUSIONS: Patients with more advanced stages of chronic venous insufficiency have a higher probability of presenting intranodal varices. Lymph node venous network identification could considerably impact clinical decision-making and treatment choices.

The Role of an MRI-Based Radiomic Signature in Predicting Malignancy of Parotid Gland Tumors.

The aim of this study was to assess the ability of MRI radiomic features to differentiate between benign parotid gland tumors (BPGT) and malignant parotid gland tumors (MPGT). This retrospective study included 93 patients who underwent MRI examinations of the head and neck region (78 patients presenting unique PGT, while 15 patients presented double PGT). A total of 108 PGT with histological confirmation were eligible for the radiomic analysis and were assigned to a training group (n = 83; 58 BPGT; 25 MPGT) and a testing group (n = 25; 16 BPGT; 9 MPGT). The radiomic features were extracted from 3D segmentations of the PGT on the T2-weighted and fat-saturated, contrast-enhanced T1-weighted images. Following feature reduction techniques, including LASSO regression analysis, a radiomic signature (RS) was built with five radiomic features. The RS presented a good diagnostic performance in differentiating between PGT, achieving an area under the curve (AUC) of 0.852 (p < 0.001) in the training set and 0.786 (p = 0.017) in the testing set. In both datasets, the RS proved to have lower values in the BPGT group as compared to MPGT group (p < 0.001 and p = 0.023, respectively). The multivariate analysis revealed that RS was independently associated with PGT malignancy, together with the ill-defined margin pattern (p = 0.031, p = 0.001, respectively). The complex model, using clinical data, MRI features and the RS, presented a higher diagnostic performance (AUC of 0.976) in comparison to the RS alone. MRI-based radiomic features could be considered potential additional imaging biomarkers able to discriminate between benign and malignant parotid gland tumors.

Whole-Tumor ADC Texture Analysis Is Able to Predict Breast Cancer Receptor Status.

There are different breast cancer molecular subtypes with differences in incidence, treatment response and outcome. They are roughly divided into estrogen and progesterone receptor (ER and PR) negative and positive cancers. In this retrospective study, we included 185 patients augmented with 25 SMOTE patients and divided them into two groups: the training group consisted of 150 patients and the validation cohort consisted of 60 patients. Tumors were manually delineated and whole-volume tumor segmentation was used to extract first-order radiomic features. The ADC-based radiomics model reached an AUC of 0.81 in the training cohort and was confirmed in the validation set, which yielded an AUC of 0.93, in differentiating ER/PR positive from ER/PR negative status. We also tested a combined model using radiomics data together with ki67% proliferation index and histological grade, and obtained a higher AUC of 0.93, which was also confirmed in the validation group. In conclusion, whole-volume ADC texture analysis is able to predict hormonal status in breast cancer masses.

Radiomic Features Associated with Lymphoma Development in the Parotid Glands of Patients with Primary Sjögren's Syndrome.

Non-Hodgkin Lymphoma (NHL) represents a severe complication and the main cause of morbidity in patients with primary Sjögren's syndrome (pSS). This study aimed to assess the role of textural analysis (TA) in revealing lymphoma-associated imaging parameters in the parotid gland (PG) parenchyma of patients with pSS. This retrospective study included a total of 36 patients (54.93 ± 13.34 years old; 91.6% females) diagnosed with pSS according to the American College of Rheumatology and the European League Against Rheumatism criteria (24 subjects with pSS and no lymphomatous proliferation; 12 subjects with pSS and NHL development in the PG, confirmed by the histopathological analysis). All subjects underwent MR scanning between January 2018 and October 2022. The coronal STIR PROPELLER sequence was employed to segment PG and perform TA using the MaZda5 software. A total of 65 PGs underwent segmentation and texture feature extraction (48 PGs were included in the pSS control group, and 17 PGs were included in the pSS NHL group). Following parameter reduction techniques, univariate analysis, multivariate regression, and receiver operating characteristics (ROC) analysis, the following TA parameters proved to be independently associated with NHL development in pSS: CH4S6_Sum_Variance and CV4S6_Inverse_Difference_Moment, with an area under ROC of 0.800 and 0.875, respectively. The radiomic model (resulting by combining the two previously independent TA features), presented 94.12% sensitivity and 85.42% specificity in differentiating between the two studied groups, reaching the highest area under ROC of 0.931 for the chosen cutoff value of 1.556. This study suggests the potential role of radiomics in revealing new imaging biomarkers that might serve as useful predictors for lymphoma development in patients with pSS. Further research on multicentric cohorts is warranted to confirm the obtained results and the added benefit of TA in risk stratification for patients with pSS.

Predicting the Early Response to Neoadjuvant Therapy with Breast MR Morphological, Functional and Relaxometry Features-A Pilot Study.

Aim: To evaluate the role of MR relaxometry and derived proton density analysis in the prediction of early treatment response after two cycles of neoadjuvant therapy (NAT), in patients with breast cancer. Methods: This was a prospective study that included 59 patients with breast cancer, who underwent breast MRI prior (MRI1) and after two cycles of NAT (MRI2). The MRI1 included a sequential acquisition with five different TE's (50, 100, 150, 200 and 250 ms) and a TR of 5000 ms. Post-processing was used to obtain the T2 relaxometry map from the MR acquisition. The tumor was delineated and seven relaxometry and proton density parameters were extracted. Additional histopathology data, T2 features and ADC were included. The response to NAT was reported based on the MRI2 as responders: partial response (>30% decreased size) and complete response (no visible tumor stable disease (SD); and non-responders: stable disease or progression (>20% increased size). Statistics was done using Medcalc software. Results: There were 50 (79.3%) patients with response and 13 (20.7%) non-responders to NAT. Age, histologic type, "in situ" component, tumor grade, estrogen and progesterone receptors, ki67% proliferation index and HER2 status were not associated with NAT response (all p > 0.05). The nodal status (N) 0 was associated with early response, while N2 was associated with non-response (p = 0.005). The tumor (T) and metastatic (M) stage were not statistically significant associated with response (p > 0.05). The margins, size and ADC values were not associated with NAT response (p-value > 0.05). The T2 min relaxometry value was associated with response (p = 0.017); a cut-off value of 53.58 obtained 86% sensitivity (95% CI 73.3−94.2), 69.23 specificity (95% CI 38.6−90.9), with an AUC = 0.715 (p = 0.038). The combined model (T2 min and N stage) achieved an AUC of 0.826 [95% CI: 0.66−0.90, p-value < 0.001]. Conclusions: MR relaxometry may be a useful tool in predicting early treatment response to NAT in breast cancer patients.

Multiparametric MRI Features of Breast Cancer Molecular Subtypes.

Background and Objectives: Breast cancer (BC) molecular subtypes have unique incidence, survival and response to therapy. There are five BC subtypes described by immunohistochemistry: luminal A, luminal B HER2 positive and HER2 negative, triple negative (TNBC) and HER2-enriched. Multiparametric breast MRI (magnetic resonance imaging) provides morphological and functional characteristics of breast tumours and is nowadays recommended in the preoperative setting. Aim: To evaluate the multiparametric MRI features (T2-WI, ADC values and DCE) of breast tumours along with breast density and background parenchymal enhancement (BPE) features among different BC molecular subtypes. Materials and Methods: This was a retrospective study which included 344 patients. All underwent multiparametric breast MRI (T2WI, ADC and DCE sequences) and features were extracted according to the latest BIRADS lexicon. The inter-reader agreement was assessed using the intraclass coefficient (ICC) between the ROI of ADC obtained from the two breast imagers (experienced and moderately experienced). Results: The study population was divided as follows: 89 (26%) with luminal A, 39 (11.5%) luminal B HER2 positive, 168 (48.5%) luminal B HER2 negative, 41 (12%) triple negative (TNBC) and 7 (2%) with HER2 enriched. Luminal A tumours were associated with special histology type, smallest tumour size and persistent kinetic curve (all p-values < 0.05). Luminal B HER2 negative tumours were associated with lowest ADC value (0.77 × 10−3 mm2/s2), which predicts the BC molecular subtype with an accuracy of 0.583. TNBC were associated with asymmetric and moderate/marked BPE, round/oval masses with circumscribed margins and rim enhancement (all p-values < 0.05). HER2 enriched BC were associated with the largest tumour size (mean 37.28 mm, p-value = 0.02). Conclusions: BC molecular subtypes can be associated with T2WI, ADC and DCE MRI features. ADC can help predict the luminal B HER2 negative cases.

Rare Case of Intravascular Myopericytoma-Imaging Characteristics and Review of the Literature.

Myopericytoma is a rare vessel wall tumor, a subtype of hemangiopericytoma that usually develops subcutaneously. Intravascular myopericytoma is a rarer subtype, with only few cases reported in the literature and even fewer with imaging modalities included. We report the case of a 36-year-old man who was referred to our institution with a painless, palpable mass in the right arm and was evaluated with MRI, grey-scale and Doppler-mode ultrasound. Tumor histopathology and imaging characteristics are presented together with the role that each imaging modality played in the management of the patient.

Viscosity Plane-Wave UltraSound (Vi PLUS) in the Evaluation of Thyroid Gland in Healthy Volunteers-A Preliminary Study.

Viscosity and elasticity represent biomechanical properties of soft tissues that suffer changes during the pathophysiological alterations of the tissue in various conditions. This study aimed to determine average viscosity values for the thyroid gland and to evaluate the potential influences of age, gender and body mass index (BMI), using a recent technique Viscosity Plane-wave UltraSound (Vi PLUS). A total of 85 healthy Caucasian volunteers (56 women and 29 men, median age of 29 years, range 17−81 years) were included in this prospective monocentric study conducted between January 2022 and March 2022. Thyroid viscosity was measured using the SuperSonic MACH 30® Ultrasound system (Aixplorer, SuperSonic Imagine, Aix-en-Provence, France), equipped with a curvilinear C6-IX transducer that allows simultaneous quantification of the viscosity and stiffness. The mean thyroid viscosity measurement value was 2.63 ± 0.47 Pa.s. No statistically significant differences were detected between the left and the right lobes of the thyroid gland. A significant positive correlation was found between thyroid viscosity and elasticity (r = 0.685, p < 0.0001). There was no statistically significant correlation between body mass index (BMI) and thyroid gland viscosity and elasticity values (r = 0.215, p = 0.053; r = 0.106, p = 0.333). No correlation between viscosity and gender was established (p > 0.05). Vi PLUS represents a new and promising ultrasonographic technique that can provide helpful information for evaluating the thyroid parenchyma, similar to elastography. The effect of the potential confounding factors on thyroid viscosity was negligible, except for BMI.

Shear-Wave Elastography and Viscosity PLUS for the Assessment of Peripheric Muscles in Healthy Subjects: A Pre- and Post-Contraction Study.

Viscosity is a novel parameter, recently introduced in the use of elastographic techniques, correlating to shear-wave dispersion. The purpose of this study was to provide normal reference viscosity values for the peripheral muscles in healthy volunteers. This prospective study included 38 subjects who underwent US examinations between November 2021 and January 2022. Measurements were taken on the calf and the deltoid muscles in both pre- and post-contraction states. The age range was 21-29 years, with a median of 26 years. The SWE and ViPLUS values in the deltoid muscles were significantly higher than in the soleus muscles in both pre- and post-contraction sets (p = 0.002). There were statistically significant differences between the pre- and post-contraction values for both the SWE and ViPLUS values in the subgroup analysis. The ICC estimates and the 95% confidence intervals were based on a mean rating (k = 2), an absolute agreement, and a two-way random-effects model, demonstrating excellent agreement between the measurements taken by the two examiners.

Radiomic Signatures Derived from Hybrid Contrast-Enhanced Ultrasound Images (CEUS) for the Assessment of Histological Characteristics of Breast Cancer: A Pilot Study.

The purpose of this study was to evaluate the diagnostic performance of radiomic features extracted from standardized hybrid contrast-enhanced ultrasound (CEUS) data for the assessment of hormone receptor status, human epidermal growth factor receptor 2 (HER2) status, tumor grade and Ki-67 in patients with primary breast cancer. METHODS: This prospective study included 72 patients with biopsy-proven breast cancer who underwent CEUS examinations between October 2020 and September 2021. RESULTS: A radiomic analysis found the WavEnHH_s_4 parameter as an independent predictor associated with the HER2+ status with 76.92% sensitivity, and 64.41% specificity and a prediction model that could differentiate between the HER2 entities with 76.92% sensitivity and 84.75% specificity. The RWavEnLH_s-4 parameter was an independent predictor for estrogen receptor (ER) status with 55.93% sensitivity and 84.62% specificity, while a prediction model (RPerc01, RPerc10 and RWavEnLH_s_4) could differentiate between the progesterone receptor (PR) status with 44.74% sensitivity and 88.24% specificity. No texture parameter showed statistically significant results at the univariate analysis when comparing the Nottingham grade and the Ki-67 status. CONCLUSION: Our preliminary data indicate a potential that hybrid CEUS radiomic features allow the discrimination between breast cancers of different receptor and HER2 statuses with high specificity. Hybrid CEUS radiomic features might have the potential to provide a noninvasive, easily accessible and contrast-agent-safe method to assess tumor biology before and during treatment.

Functional Evaluation of Major Salivary Glands Using Viscosity PLUS and 2D Shear-Wave PLUS Elastography Techniques in Healthy Subjects-A Pilot Study.

Biological soft tissues are characterized by viscoelastic properties. The propagation of shear waves within tissues is influenced by both elasticity, which is linked to the shear wave speed, and viscosity, which is linked to the shear wave dispersion. This study aimed to functionally assess the parotid glands (PG) and submandibular glands (SMG) in a group of 40 healthy subjects using the novel Viscosity PLUS (Vi.PLUS) and 2D Shear-Wave Elastography PLUS (2D-SWE.PLUS) techniques. The viscosity and stiffness of PG and SMG were measured before and after gustatory stimulation with a sialagogue agent (commercially available lemon juice) using the new SuperSonic MACH 30 ultrasound system equipped with a curvilinear C6-1X transducer. PG presented a mean basal viscosity and elasticity of 2.10 ± 0.19 Pa.s and 11.32 ± 1.91 kPa, respectively, which significantly increased poststimulation to 2.39 ± 0.17 Pa.s (p < 0.001) and 12.58 ± 1.92 kPa (p < 0.001), respectively. SMG did not present statistically increased values of viscosity and elasticity following stimulation (2.31 ± 015 Pa.s vs. 2.37 ± 0.18 Pa.s, p = 0.086, and 10.40 ± 1.64 kPa vs. 10.90 ± 1.98 kPa, p = 0.074, respectively). Vi.PLUS measurements presented a good positive correlation with 2D-SWE.PLUS values for PG and SMG, before and after stimulation. Gender and BMI were not confounding factors for these two parameters. Vi.PLUS represents an innovative non-invasive imaging technique that, together with 2D-SWE.PLUS proves to be useful in functionally assessing the major salivary glands in healthy subjects.

Elastography in the Urological Practice: Urinary and Male Genital Tract, Prostate Excluded-Review.

The aim of this article is to review the utility of elastography in the day-to-day clinical practice of the urologist. An electronic database search was performed on PubMed and Cochrane Library with a date range between January 2000 and December 2021. The search yielded 94 articles that passed the inclusion and exclusion criteria. The articles were reviewed and discussed by organ, pathology and according to the physical principle underlying the elastographic method. Elastography was used in the study of normal organs, tumoral masses, chronic upper and lower urinary tract obstructive diseases, dysfunctions of the lower urinary tract and the male reproductive system, and as a pre- and post-treatment monitoring tool. Elastography has numerous applications in urology, but due to a lack of standardization in the methodology and equipment, further studies are required.

Are Mutation Carrier Patients Different from Non-Carrier Patients? Genetic, Pathology, and US Features of Patients with Breast Cancer.

The purpose of this study is to evaluate the relationship between the pathogenic/likely pathogenic mutations, US features, and histopathologic findings of breast cancer in mutation carriers compared to non-carrier patients. Methods: In this retrospective study, we identified 264 patients with breast cancer and multigene panel testing admitted to our clinic from January 2018 to December 2020. Patient data US findings, US assessment of the axilla, multigene panel tests, histopathology, and immunochemistry reports were reviewed according to the BI-RADS lexicon. Results: The study population was comprised of 40% pathogenic mutation carriers (BRCA1, BRCA2, CHEK2, ATM, PALB, TP 53, NBN, MSH, BRIP 1 genes) and 60% mutation-negative patients. The mean patient age was 43.5 years in the carrier group and 44 years in the negative group. Carrier patients developed breast cancer with benign morphology (acoustic enhancement, soft elastography appearance) compared to non-carriers (p < 0.05). A tendency towards specific US features was observed for each mutation. BRCA1 carriers were associated with BC with microlobulated margins, hyperechoic rim, and soft elastography appearance (p < 0.05). Estrogen receptor (ER)-negative tumors were associated with BRCA1, TP53, and RAD mutations, while BRCA2 and CHEK2 were associated with ER-positive tumors. Conclusions: Patients with pathogenic mutations may exhibit BC with benign US features compared to negative, non-carrier patients. BRCA1, TP53, and RAD carriers account for up to one third of the ER tumors from the carrier group. Axillary US performed worse in depicting involved lymph nodes in carrier patients, compared to negative patients.

Comparison of Linear and Convex-Array Transducers in Assessing the Enhancement Characteristics of Suspicious Breast Lesions at Contrast-Enhanced Ultrasound (CEUS).

The purpose of this study was to determine the observer agreement in assessing the enhancement pattern of suspicious breast lesions with contrast-enhanced ultrasound (CEUS) using high and low frequency transducers. Methods: This prospective study included 70 patients with suspicious breast lesions detected at mammography and/or ultrasound and classified according to the American College of Radiology (ACR) Breast Imaging-Reporting and Data System (BI-RADS) in 4A, 4B, 4C, or 5, who underwent CEUS examinations between October 2020 and August 2021. Results: Participants' ages ranged from 28 to 83 years (48.5 + 6.36, mean age + SD). We obtained a substantial agreement for the first reader (kappa = 0.614, p < 0.001) and a perfect agreement for the second and third reader (kappa = 1, p < 0.001) between the two transducers for the uptake pattern. A moderate agreement for the second and third reader (kappa = 0.517 and 0.538, respectively, p < 0.001) and only a fair agreement (kappa = 0.320, p < 0.001) in the case of the first reader for the perilesional enhancement was observed. We obtained an excellent inter-observer agreement (Cronbach's Alpha coefficient = 0.960, p < 0.001) for the degree of enhancement, a good inter-observer agreement for the uptake pattern and perilesional enhancement (Cronbach's Alpha coefficient = 0.831 and 0.853, respectively, p < 0.001), and a good and acceptable inter-observer agreement for internal homogeneity, perfusion defects and margins of the lesions (Cronbach's Alpha coefficient = 0.703, 0.703 and 0.792, respectively, p < 0.001) concerning the evaluation of breast lesions with the linear-array transducer. Conclusions: The evaluation of suspicious breast lesions by three experts with high-frequency linear-array transducer and low-frequency convex-array transducer was comparable in terms of uptake pattern and perilesional enhancement. The agreement regarding the evaluation of the degree of enhancement, the internal homogeneity, and the perfusion defects varied between fair and substantial. For all CEUS characteristics, the inter-observer agreement was superior for linear-array transducer, which leads to more a homogeneous and reproducible interpretation.

Associating Automated Breast Ultrasound (ABUS) and Digital Breast Tomosynthesis (DBT) with Full-Field Digital Mammography (FFDM) in Clinical Practice in Cases of Women with Dense Breast Tissue.

The purpose of the present study was to evaluate the value of full-field digital mammography (FFDM) and automated breast ultrasound (ABUS) in the diagnosis of breast cancer compared to FFDM associated with digital breast tomosynthesis (DBT). Methods: This retrospective study included 50 female patients with a denser framework of connective tissue fibers, characteristic of young women who underwent FFDM, DBT, handheld ultrasound (HHUS), and ABUS between January 2017 and October 2018. The sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), and accuracy of FFDM+ABUS were 81.82% (95% CI [48.22-97.72]), 89.74% (95% CI [75.78-97.13]), 69.23% (95% CI [46.05-85.57]), 94.59% (95% CI [83.26-98.40]), and 88% (95% CI [75.69-95.47]), while for FFDM+DBT, the values were as follows: 91.67% (95% CI [61.52-99.79]), 71.79% (95% CI [55.13-85.00]), 50% (95% CI [37.08-62.92]), 96.55% (95% CI [80.93-99.46]), 76.47% (95% CI [62.51-87.21]). We found an almost perfect agreement between the two readers regarding FFDM associated with ABUS, and substantial agreement regarding FFDM+DBT, with a kappa coefficient of 0.896 and 0.8, respectively; p < 0.001. Conclusions: ABUS and DBT are suitable as additional diagnostic imaging techniques to FFDM in women at an intermediate risk of developing breast cancer through the presence of dense breast tissue. In this study, DBT reduced the number of false negative results, while the use of ABUS resulted in an increase in specificity.

Viscosity Plane-wave UltraSound (ViPLUS) in the assessment of parotid and submandibular glands in healthy subjects - preliminary results.

AIMS: Viscosity is an important mechanical property directly linked to the shear wave dispersion within tissues. The purpose of this study was to establish the normal viscosity value of the parotid gland (PG) and submandibular gland (SMG) in a group of healthy subjects, using the novel Viscosity Plane-wave UltraSound (ViPLUS) technique, and to assess its potential dependence on gender and age. MATERIAL AND METHODS: The study group included a total of 49 healthy volunteers (median age 31, 65% females) prospectively examined between February 2021 and March 2021. The viscosity of both PG and SMG was measured using the new Aixplorer MACH 30 ultrasound system (SuperSonic Imagine, Aix-en-Provence, France) equipped with a curvilinear C6-1X transducer. The mean value of three valid measurements was considered (quantified in Pa.s). RESULTS: The mean viscosity value for the PG was 2.13±0.23 Pa.s, significantly lower than the mean viscosity value of the SMG 2.44±0.35 Pa.s (p<0.0001). A negative low correlation between SMG viscosity and age was found (rho=-0.38, p=0.006). Viscosity values of the SMG were significantly lower in the age group between 35-77 years (2.12±0.35 Pa.s) than in the age groups 25-34 years (2.52±0.36 Pa.s), and 20-24 years (2.53±0.24 Pa.s), respectively (p<0.05). Viscosity values of both salivary glands did not differ significantly between gender groups. CONCLUSIONS: Supersonic ViPLUS represents an innovative and useful non-invasive method to assess the viscosity of the parotid and submandibular glands. Age is a potential confounding factor in the evaluation of normal SMG viscosity.

Magnetic Resonance Assessment of Ejection Fraction Versus Echocardiography for Cardioverter-Defibrillator Implantation Eligibility.

BACKGROUND: The aim of this study was to investigate the potential impact of performing two-dimensional echocardiography (2DE) compared to cardiovascular magnetic resonance (CMR) for left ventricular ejection fraction (LVEF) on implantable cardioverter defibrillator (ICD) eligibility. METHODS: A prospective cohort of 166 consecutive patients with nonischemic cardiomyopathy (NICM) was designed to compare transthoracic 2DE and CMR imaging. RESULTS: Echocardiography measurements have important differences and large limits of agreement compared to CMR, especially when assessing ventricle volumes, and smaller but relevant differences when assessing LVEF. The agreement between CMR and 2DE regarding the identification of subjects with EF <= 35, respectively <= 30, and thus eligible for an ICD measured by Cohen's Kappa was 0.78 (95% CI: 0.68-0.88), p < 0.001, respectively 0.65 (95% CI: 0.52-0.78), p < 0.001. The disagreement represented 7.9%/11.3% of the subjects who had EF < 35%/< 30% as observed by CMR, who would have been classified as eligible for an ICD, resulting in an additional need to use an ICD. Moreover, 2.6%/3.3% would have been deemed eligible by echocardiography for an ICD. CONCLUSIONS: These measurement problems result in incorrect assignments of eligibility that may have serious implications on the quality of life and the prevention of death events for patients assessed for eligibility of an ICD.

Differentiating Breast Tumors from Background Parenchymal Enhancement at Contrast-Enhanced Mammography: The Role of Radiomics-A Pilot Reader Study.

BACKGROUND: The purpose of this study was to assess the effectiveness of the radiomic analysis of contrast-enhanced spectral mammography (CESM) in discriminating between breast cancers and background parenchymal enhancement (BPE). METHODS: This retrospective study included 38 patients that underwent CESM examinations for clinical purposes between January 2019-December 2020. A total of 57 malignant breast lesions and 23 CESM examinations with 31 regions of BPE were assessed through radiomic analysis using MaZda software. The parameters that demonstrated to be independent predictors for breast malignancy were exported into the B11 program and a k-nearest neighbor classifier (k-NN) was trained on the initial groups of patients and was tested using a validation group. Histopathology results obtained after surgery were considered the gold standard. RESULTS: Radiomic analysis found WavEnLL_s_2 parameter as an independent predictor for breast malignancies with a sensitivity of 68.42% and a specificity of 83.87%. The prediction model that included CH1D6SumAverg, CN4D6Correlat, Kurtosis, Perc01, Perc10, Skewness, and WavEnLL_s_2 parameters had a sensitivity of 73.68% and a specificity of 80.65%. Higher values were obtained of WavEnLL_s_2 and the prediction model for tumors than for BPEs. The comparison between the ROC curves provided by the WaveEnLL_s_2 and the entire prediction model did not show statistically significant results (p = 0.0943). The k-NN classifier based on the parameter WavEnLL_s_2 had a sensitivity and specificity on training and validating groups of 71.93% and 45.16% vs. 60% and 44.44%, respectively. CONCLUSION: Radiomic analysis has the potential to differentiate CESM between malignant lesions and BPE. Further quantitative insight into parenchymal enhancement patterns should be performed to facilitate the role of BPE in personalized clinical decision-making and risk assessment.

Pros and Cons for Automated Breast Ultrasound (ABUS): A Narrative Review.

Automated breast ultrasound (ABUS) is an ultrasound technique that tends to be increasingly used as a supplementary technique in the evaluation of patients with dense glandular breasts. Patients with dense breasts have an increased risk of developing breast cancer compared to patients with fatty breasts. Furthermore, for this group of patients, mammography has a low sensitivity in detecting breast cancers, especially if it is not associated with architectural distortion or calcifications. ABUS is a standardized examination with many advantages in both screening and diagnostic settings: it increases the detection rate of breast cancer, improves the workflow, and reduces the examination time. On the other hand, like any imaging technique, ABUS has disadvantages and even some limitations. Many disadvantages can be diminished by additional attention and training. Disadvantages regarding image acquisition are the inability to assess the axilla, the vascularization, and the elasticity of a lesion, while concerning the interpretation, the disadvantages are the artifacts due to poor positioning, lack of contact, motion or lesion related. This article reviews and discusses the indications, the advantages, and disadvantages of the method and also the sources of error in the ABUS examination.

Inter- and intraobserver reproducibility of Strain and 2D Shear Wave Elastography - a phantom study.

AIMS: To analyse the intra- and interobserver variability of two elastographic methods of quantification available on the same machine, the technical factors that may influence variability as well as the intra- and interobserver variability for the same indices between two different ultrasound machines in an in vitro experimental setting. MATERIAL AND METHODS: Three different types of silicone experimental devices (ED) were conceived for the purpose of this study. Two observers performed repeated measurements on two ultrasound machines. Strain elastography, with strain ratio determination between the ED was performed on both machines. Shear wave ratio was also assessed. The data obtained were used to calculate intra- and interobservervariability. Reproducibility was assessed in relation to the size of the elastographic region of interest (ROI) and to the difference in stiffness between the ED, through the value of the ICCs (Intraclass Correlation Coefficient). RESULTS: Strain ratio had high inter- and intraobserver reproducibility, regardless of the machine used, on a large number of determinations.The choice of a small ROI diameter (5 mm) over a large ROI diameter (15mm) increased reproducibility (ICC = 0.87 vs 0.78, p=0.000). It is observed that, by Shear Wave Elastography, only when analysing structures with a large difference in hardness, significance is obtained in terms of interobserver reproducibility (ICC = 0.75, p=0.000). CONCLUSIONS: On a large number of determinations, both techniques are inter- and intraobserver reproducible. It is preferable to opt for a smaller ROI diameter in order to increase interobserver reproducibility. SWE Ratio provides significant reproducibility only when analysing structureswith large difference in hardness.