Automatic detection of thyroid nodules with a real-time artificial intelligence system in a real clinical scenario and the associated influencing factors.

BACKGROUND: At present, most articles mainly focused on the diagnosis of thyroid nodules by using artificial intelligence (AI), and there was little research on the detection performance of AI in thyroid nodules. OBJECTIVE: To explore the value of a real-time AI based on computer-aided diagnosis system in the detection of thyroid nodules and to analyze the factors influencing the detection accuracy. METHODS: From June 1, 2022 to December 31, 2023, 224 consecutive patients with 587 thyroid nodules were prospective collected. Based on the detection results determined by two experienced radiologists (both with more than 15 years experience in thyroid diagnosis), the detection ability of thyroid nodules of radiologists with different experience levels (junior radiologist with 1 year experience and senior radiologist with 5 years experience in thyroid diagnosis) and real-time AI were compared. According to the logistic regression analysis, the factors influencing the real-time AI detection of thyroid nodules were analyzed. RESULTS: The detection rate of thyroid nodules by real-time AI was significantly higher than that of junior radiologist (P = 0.013), but lower than that of senior radiologist (P = 0.001). Multivariate logistic regression analysis showed that nodules size, superior pole, outside (near carotid artery), close to vessel, echogenicity (isoechoic, hyperechoic, mixed-echoic), morphology (not very regular, irregular), margin (unclear), ACR TI-RADS category 4 and 5 were significant independent influencing factors (all P < 0.05). With the combination of real-time AI and radiologists, junior and senior radiologist increased the detection rate to 97.4% (P < 0.001) and 99.1% (P = 0.015) respectively. CONCLUSONS: The real-time AI has good performance in thyroid nodule detection and can be a good auxiliary tool in the clinical work of radiologists.

Contrast-enhanced ultrasound features of hepatic sarcomatoid carcinoma different from hepatocellular carcinoma.

BACKGROUND: Hepatic sarcomatoid carcinoma (HSC) is a rare malignancy of the liver. The ultrasound and clinical features of HSC have not been determined. OBJECTIVE: To investigate and compare the ultrasound and clinical features of HSC and hepatocellular carcinoma (HCC), and to reveal the valuable features of HSC. METHODS: The ultrasound features and clinical data of pathologically proven HSC (n = 37) were compared with HCC (n = 92) in a matching ratio of 1:4 using the propensity score (age, gender and tumor size). RESULTS: The HSC patients were more likely to accompany with clinical symptoms and vascular invasion than HCC patients (40.5% vs 17.4%, 24.3% vs 6.5%, P < 0.05). The size of HSCs was significantly larger than that of HCCs (P < 0.05). The proportion of patients with elevated alpha-fetoprotein was significantly lower in HSC (35.1% vs 54.3%, P < 0.05). On gray-scale ultrasound images, the HSCs were more likely to demonstrate as indistinct margin and irregular shape lesions compared to HCCs (78.4% vs 48.8%; 70.3% vs 23.9%, P < 0.05). Under color Doppler flow imaging (CDFI), the blood flow signals were more frequently detected in HSC lesions (75.7% vs 56.5%, P < 0.05). Resistance index (RI) was higher in HSCs than in HCCs [0.78 (0.70,0.82) vs 0.70 (0.62,0.76), P < 0.05]. On contrast-enhanced ultrasound (CEUS), HSCs mainly showed entirety heterogeneous hyper-enhancement (48.6%), entirety homogeneous enhancement (18.9%), peripheral and internal septal enhancement (18.9%). The incidence of non-enhanced areas inside HSC lesions was higher than that inside HCC lesions (56.8% vs 31.5%, P < 0.05). During the portal venous and late phases, most of the lesions revealed hypo-enhancement in both groups, whereas earlier washout was observed in HSCs [43.0 s (30.5,58.0) vs 60.0 s (46.3,100.0), P < 0.05]. CONCLUSIONS: CEUS features are useful in preoperative and non-invasive differentiation of hepatic sarcomatoid carcinoma and hepatocellular carcinoma.

Value of contrast-enhanced ultrasonography in microwave ablation treatment of symptomatic focal uterine adenomyosis.

PURPOSE: This study evaluated the value of contrast-enhanced ultrasonography (CEUS) in the ultrasound-guided microwave ablation (MWA) treatment of symptomatic focal uterine adenomyosis. METHODS: This retrospective study was conducted between March 2020 and January 2023, enrolling 52 patients with symptomatic focal uterine adenomyosis who had undergone MWA. All patients were examined with CEUS before and after MWA. The non-perfused volume (NPV) was compared between CEUS and dynamic contrast-enhanced magnetic resonance imaging (DCEMRI) following ablation. Therapeutic efficacy and safety were evaluated at 3-, 6-, and 12-month follow-ups. Additionally, this study explored the correlations between pre-treatment CEUS features and a volume reduction ratio indicating sufficient ablation, defined as 50% or more at the 3-month follow-up. RESULTS: No significant differences in NPV were noted between CEUS and DCE-MRI immediately after MWA and during follow-up (all P>0.05). At the 3-month follow-up, the median VRRs for the uterus and adenomyosis were 33.2% and 63.9%, respectively. Sufficient ablation was achieved in 69.2% (36/52) of adenomyosis cases, while partial ablation was observed in the remaining 30.8% (16/52). The identification of non-enhancing areas on pre-treatment CEUS was associated with sufficient ablation (P=0.016). At the 12-month follow-up, significant decreases were observed in both the uterine and adenomyosis volumes (all P<0.001). Dysmenorrhea and menorrhagia were significantly alleviated at 12 months, and no major complications were encountered. CONCLUSION: CEUS can be used to evaluate the ablation zone of focal adenomyosis that has been treated with MWA, similarly to DCE-MRI. The identification of non-enhancing areas on pretreatment CEUS indicates satisfactory treatment outcomes.

The Preliminary Application of Simultaneous Display of Contrast-Enhanced Ultrasound and Micro-Flow Imaging Technology in the Diagnosis of Hepatic Tumors.

OBJECTIVES: To evaluate the value of simultaneous display of contrast-enhanced ultrasound and micro-flow imaging technology (CEUS-MFI) in intra-tumoral vessel detection and hepatic tumor diagnosis. METHODS: A total of 82 patients with 82 focal liver lesions were enrolled in this study. Each patient received ultrasound exams including color Doppler flow imaging (CDFI), micro-flow imaging (MFI), contrast-enhanced ultrasound (CEUS), and CEUS-MFI with a Philips EPIQ7 ultrasound imaging system. The intra-tumoral vessels detected by CDFI, MFI, and CEUS-MFI were compared, respectively. The accuracy and confidence of using CEUS and CEUS-MFI in diagnosing hepatic tumors were also compared. RESULTS: CEUS-MFI was capable of detecting more hepatic intra-tumoral vessels than MFI (P = .000) and CDFI (P = .000). Compared with CEUS, CEUS-MFI improved the diagnostic accuracy of hepatic lesions (P = .009). Particularly, among the correctly diagnosed hepatic lesions, the number of cases where radiologists diagnosed with great confidence was increased from 88.4% (61/69) with CEUS only to 92.4% (73/79) with CEUS-MFI (P = .041). CONCLUSIONS: CEUS-MFI is sensitive in detecting hepatic intra-tumoral vessels and can improve the accuracy and confidence of radiologists in diagnosing hepatic lesions.

Efficacy of contrast-enhanced ultrasound-guided percutaneous core needle biopsy in anterior mediastinal masses.

Objective: To evaluate the efficacy and safety of percutaneous core needle biopsy (PCNB) using ultrasound (US)-guided and contrast-enhanced ultrasound (CEUS)-guided procedures for anterior mediastinal masses (AMMs). Methods: In total, 284 consecutive patients (166 men, 118 women; mean age, 43.0 â€‹± â€‹18.4 years) who underwent PCNB for AMMs were enrolled. Patients were divided into the US-guided group (n â€‹= â€‹133) and the CEUS-guided group (n â€‹= â€‹151). PCNB was performed using a core needle (16-gauge or 18-gauge). Internal necrosis, diagnostic yield, and diagnostic accuracy were compared between the two groups. Results: The predominant final diagnosis of the cases in this study was thymoma (29.7%), lymphoma (20.5%), thymic carcinoma (13.3%), and germ cell tumour (13.3%), respectively. There was no significant difference in patient age, sex, number of percutaneous biopsies, or display rate of internal necrosis on conventional US between the two groups. The rate of internal necrosis of the lesions was significantly higher after contrast agent injection (72.2% vs. 41.7%; P â€‹< â€‹0.001). The CEUS-guided group had a higher diagnostic yield than the US-guided group (100% vs. 89.5%, P â€‹< â€‹0.001). There was no significant difference between the diagnostic accuracy of the CEUS-guided and US-guided groups (97.3% vs. 97.4%; P â€‹= â€‹1.000). None of the patients experienced adverse reactions or complications after US-guided or CEUS-guided PCNB. Conclusions: CEUS-guided PCNB can improve the diagnostic yield by optimizing the biopsy procedure.

Baseline and contrast-enhanced ultrasound features of hepatic epithelioid angiomyolipoma.

BACKGROUND: Recurrence or metastasis after surgery had been reported in hepatic epithelioid angiomylipoma (epi-AML). Most hepatic epi-AMLs were misdiagnosed with hepatocellular carcinoma or other hepatic tumors before surgery. OBJECTIVE: To describe the baseline and contrast-enhanced ultrasound (CEUS) features of hepatic epi-AMLs and to explore the potential ultrasonic features for prognosis. METHODS: The retrospective study enrolled 67 patients (56 females, 11 males) with 67 pathologically confirmed hepatic epi-AML lesions. All the lesions were examined by baseline ultrasound and 42 lesions were examined using CEUS with SonoVue (Bracco, Milan, Italy) before surgery. RESULTS: Baseline ultrasound features of hepatic epi-AMLs included heterogeneous echo (86.6%), well-defined border (68.7%), hypoecho (64.2%), regular morphology (62.7%), peripheral-tumor arc-shaped or ring-like vessels (53.7%), and low value of resistive index (0.51±0.08). CEUS features of hepatic epi-AMLs included arterial phase hyper-enhancement with smooth and well-defined margin (100%), peripheral-tumor ring-like vessels (57.1%), and intra-tumor vessels (52.4%). Some CEUS features, including arterial phase heterogeneously tortuous filling, intra-tumor vessels and peripheral-tumor ring-like vessels were more commonly found in hepatic epi-AMLs of uncertain malignant potential/malignant than in benign hepatic epi-AMLs (p < 0.05). CONCLUSIONS: Baseline ultrasound and CEUS features may be useful in diagnosis of hepatic epi-AML, and some CEUS features may be indicative of its malignant potential.

Assessment of blood flow in the hepatic tumors using non-contrast micro flow imaging: Initial experience.

PURPOSE: To evaluate micro-flow imaging (MFI) in depicting the vascular architecture of hepatocellular carcinoma (HCC) and other focal liver lesions. MATERIALS AND METHODS: A total of 81 hepatic lesions were enrolled in this study. Each patient underwent CDFI, MFI, and CEUS examinations. The blood flow was first graded into three types (grade 1, 2 and 3) based on its richness with Adeler classification method. The differences in the grade of blood flow in liver tumors were compared between CDFI and MFI. With respect to the presented morphology, the blood flow was further classified into five types (Type I, II, III, IV and V). The morphological differences in blood flow shown by MFI between malignant and benign hepatic tumors were then analyzed. RESULTS: For the total 81 lesions, MFI detected 61 lesion cases (75.31%) with blood flow grade 2 and 3, which obviously outperformed CDFI which detected 28 cases (34.57%) of grade 2 and 3 (χ2 = 35.27, P = 0.000). The MFI also showed that the most common blood flow morphology of HCC is Type-III (21/48, 43.75%) while the hepatic hemangioma (HEM) is mostly presented as Type V (5/10, 50%). Moreover, the grade of blood flow in MFI varied with different pathological subtypes of HCC (χ2 = 5.610, P = 0.018). CONCLUSIONS: Compared with traditional CDFI, MFI reveals more blood vessels in liver lesions with clearer view of blood flow distribution. Besides, MFI technology can demonstrate grade of blood flow for various differentiation stages of malignant liver tumors.

Contrast-Enhanced Ultrasound Features of Hepatic Reactive Lymphoid Hyperplasia: Correlation With Histopathologic Findings.

OBJECTIVES: To find certain specifics of hepatic reactive lymphoid hyperplasia (HRLH) on contrast-enhanced ultrasound (CEUS) imaging as diagnostic imaging clues by retrospectively analyzing its enhancement features. METHODS: From June 2010 to June 2017, 18 histopathologically confirmed HRLH lesions in 18 patients were included in this retrospective study. The lesion's location, maximum diameter, shape, margin, echogenicity, and color flow signal on conventional ultrasound (US) imaging and enhancement pattern, presence of a feeding artery, and donutlike enhancement on CEUS imaging were observed and recorded. The lesion size on CEUS imaging at peak enhancement and that on conventional US imaging were compared and recorded. RESULTS: All of the lesions showed homogeneous hypoechogenicity with a regular well-defined margin on conventional US imaging, with a mean diameter ± SD of 14.3 ± 4.6 mm (range, 8-24 mm). On CEUS imaging, all of the lesions showed "quick-wash-in and quick-wash-out," which showed complete homogeneous hyperenhancement in the arterial phase and wash-out in the second half of the arterial phase or first half of the portal phase. In 83.3% (15 of 18) of the lesions, the lesion size that was enhanced at peak was enlarged compared with the hypoechoic area on conventional US imaging, and transient donutlike enhancement appeared when the lesion showed wash-out. In 55.6% (10 of 18) of cases, the feeding artery was detected. CONCLUSIONS: Enlarged complete homogeneous hyperenhancement in the arterial phase, consequently followed by quick wash-out of the lesion and the appearance of donutlike enhancement, may be the CEUS features of HRLH.

Primary Application of Micro-Flow Imaging Technology in the Diagnosis of Hepatic Tumors.

The purpose of the study was to evaluate the vascular architecture of focal liver lesions with the newly released non-contrast micro-flow imaging (MFI) technique. Eighty patients with 80 hepatic tumors were enrolled in this study. The richness of displayed blood flow was first compared with color Doppler flow imaging using grades according to Adler's method. The results indicated that MFI outperformed color Doppler flow imaging with a statistically significant difference (p <0.0001). With the enhanced position in arterial phase of contrast-enhanced ultrasound imaging as the ground truth, the displayed blood flow distribution within tumors in MFI was further evaluated. The coincidence rate between MFI and contrast-enhanced ultrasound was 73.75% (59/80), which was higher than that of color Doppler flow imaging (52.5%, 42/80) (p < 0.0001). Moreover, for the five cases of focal nodular hyperplasia, MFI clearly revealed the spoke-wheel or radiating intra-tumoral vasculature, a finding specific to the diagnosis of focal nodular hyperplasia.

Contrast-Enhanced Ultrasound Guided Biopsy of Undetermined Abdominal Lesions: A Multidisciplinary Decision-Making Approach.

Aim. To investigate the value of contrast-enhanced ultrasound (CEUS) guided biopsy of undetermined abdominal lesions in multidisciplinary treatment (MDT) decision-making approach. Methods. Between Jan 2012 and Dec 2015, 60 consecutive patients (male, 37; female, 23; mean age, 51.3 years ± 14.6) who presented with undetermined abdominal lesions were included. CEUS and core needle percutaneous biopsy was performed under real-time CEUS guidance in all lesions. Data were recorded and compared with conventional ultrasound (US) guidance group (n = 75). All CEUS findings and clinical data were evaluated in MDT. Results. CEUS enabled the delimitation of more (88.3% versus 41.3%) and larger (14.1 ± 10.7 mm versus 32.3 ± 18.5 mm) nonenhanced necrotic areas. More inner (20.0% versus 6.7%) and surrounding (18.3% versus 2.7%) major vessels were visualized and avoided during biopsies. CEUS-guided biopsy increased the diagnostic accuracy from 93.3% to 98.3%, with correct diagnosis in 57 of 60 lesions (95.0%). The therapeutic plan was influenced by CEUS guided biopsies findings in the majority of patients (98.3%). Conclusion. The combination of CEUS guided biopsy and MDT decision-making approach is useful in the diagnostic work-up and therapeutic management.

A novel long noncoding RNA PILRLS promote proliferation through TCL1A by activing MDM2 in Retroperitoneal liposarcoma.

It is becoming evident that lncRNAs may be an important class of pervasive genes involved in carcinogenesis and metastasis. However, the biological and molecular mechanisms of lncRNAs in retroperitoneal liposarcoma have never been reported. In our study, we found a novel lncRNA PILRLS (Proliferation Interacting LncRNA in Retroperitoneal Liposarcoma), which as an oncogene significantly overexpressed in retroperitoneal liposarcoma. Functions of PILRLS on tumor progression both in vitro and in vivo have verified in this study which PILRLS knockdown significantly inhibited cell proliferation and colony formation. RNA pull-down assay found PILRLS can specific binding with TCL1A which also regulate the expression level of TCL1A. Our work for the first time demonstrated PILRLS can activating the MDM2 by binding with TCL1A which suppress the P53 pathway to promote the unlimited growth of retroperitoneal Liposarcoma cells. It suggests that PILRLS may be an important targets for retroperitoneal liposarcoma therapy.

Xanthogranulomatous cholecystitis: contrast-enhanced ultrasound features and differential diagnosis from wall-thickening gallbladder carcinoma.

OBJECTIVE: The purpose of this study is to evaluate the value of contrast-enhanced ultrasound (CEUS) in differential diagnosis of Xanthogranulomatous cholecystitis (XGC). MATERIAL AND METHODS: Patients of 17 XGCs and 43 wall-thickening gallbladder carcinomas (GBCs) were enrolled in this study. Firstly, we compared the ability of conventional ultrasound (CUS) and CEUS in detecting gallbladder (GB) features. Secondly, XGCs and GBCs features were compared on CEUS. Finally, all valuable indicators were ranked by Odds ratio. RESULTS: Significant differences were found in detecting GB wall thickness, GB stones, and hypoechoic nodules frequencies by CEUS and CUS. The mean GB wall thickness was 8.53 mm on CEUS, whereas the thickness measured 9.47 mm on CUS (p=0.011). GB stones and hypoechoic nodules were detected in 43 cases (71.7%) and 21 cases (30.0%) on CEUS, respectively, compared to 29 cases (48.3%) and 8 cases (13.3%) on CUS (p=0.009, p=0.027), respectively. Secondly, hypoenhancement time was longer in XGC (mean 78.9 s) than in GBC (mean 56.0 s) (p=0.002). Diffuse GB wall thickening, continuous inner wall, and hypoechoic nodules in the GB wall were observed in 12 patients (70.6%), 12 patients (70.6%) and 10 patients (58.8%) with XGC, respectively, compared to detection in 10 patients (23.3%), 4 patients (9.3%) and 11 patients (25.6%) by GBC (p=0.001, p=0.000 and p=0.015), respectively. Thirdly, the continuous inner wall was the most valuable indicator, with ORs of 23.4. The second valuable indicator was hypoenhancement time >80.5 s, with ORs of 11.9. CONCLUSIONS: CEUS demonstrated superior detection of GB wall thickness, GB stone and hypoechoic nodules compared to CUS. A continuous inner wall, hypoenhancement times greater than 80.5 s, diffuse thickening, and hypoechoic nodules were valuable indicators in XGCs.

Ultrasound features of hepatocellular adenoma and the additional value of contrast-enhanced ultrasound.

BACKGROUND: Hepatocellular adenoma (HCA) is a rare benign tumor of the liver. It is of clinical importance to differentiate HCA from other liver tumors, especially hepatocellular carcinoma (HCC). This study aimed to evaluate the characteristic features of HCA by conventional ultrasound and contrast-enhanced ultrasound (CEUS) findings. METHODS: Twenty-six patients (10 males and 16 females; mean age 36.2+/-5.0 years) with 26 histopathologically proven HCAs were retrospectively identified. According to the maximum diameter of HCAs, they were divided into three groups: <30 mm, 30-50 mm, and >50 mm. Ultrasound examinations were performed with C5-2 broadband curved transducer of Philips iU22 unit (Philips Bothell, WA, USA). For each lesion, a dose of 2.4 mL SonoVue® (Bracco Imaging Spa, Milan, Italy) was injected as a quick bolus into the cubital vein. Lesions' echogenicity, color-Doppler flow imaging and contrast enhancement patterns were recorded. RESULTS: Grayscale ultrasound revealed that most of HCAs were hypoechoic (73.1%, 19/26). Spotty calcifications were detected in 26.9% (7/26) of the lesions. Color-Doppler flow imaging detected centripetal bulky color flow in 46.2% (12/26) of the HCAs. CEUS showed that 73.1% (19/26) of the HCAs displayed as rapid, complete and homogenous enhancement, and 53.8% (14/26) showed decreased contrast enhancement in the late phase. There was no significant difference in enhancement patterns among different sizes of HCAs (P>0.05). Centripetal enhancement with subcapsular tortuous arteries was common in larger HCAs. CONCLUSIONS: CEUS combined with grayscale and color-Doppler flow imaging helped to improve preoperative diagnosis of HCAs. The characteristic imaging features of HCAs included: rapid homogeneous enhancement and slow wash-out pattern on CEUS; heterogeneous echogenicity on grayscale ultrasound; and centripetal enhancement with subcapsular tortuous arteries in large HCAs.

Evaluation of Liver Metastases Using Contrast-Enhanced Ultrasound: Enhancement Patterns and Influencing Factors.

BACKGROUND/AIMS: To evaluate the enhancement patterns of liver metastases and their influencing factors using dynamic contrast-enhanced ultrasound (CEUS). METHODS: A total of 240 patients (139 male and 101 female; 58.5 ± 11.2 years of age) diagnosed with liver metastases in our hospital were enrolled in this study to evaluate tumor characteristics using CEUS. A comparison of enhancement patterns with tumor size and primary tumor type was performed using the chi-square test. The differences between quantitative variables were evaluated with the independent-sample t-test and one-way analysis of variance. RESULTS: The enhancement patterns of liver metastases on CEUS were categorized as diffuse homogeneous hyperenhancement (133/240, 55.4%), rim-like hyperenhancement (80/240, 33.3%), heterogeneous hyperenhancement (10/240, 4.2%), and isoenhancement (17/240, 7.1%). There were significant differences in the enhancement patterns during the arterial phase based on the nodule size (p=0.001). A total of 231 of the nodules showed complete washout during the portal phase, and 237 nodules were hypoenhanced during the delayed phase. The washout time was correlated with tumor vascularity, with a longer washout time observed in hypervascular metastases compared to hypovascular metastases (p=0.033). CONCLUSIONS: Diffuse homogeneous hyperenhancement followed by rapid washout was the most common enhancement pattern of liver metastases on CEUS and was affected by the nodule size and tumor vascularity. Small metastases were prone to show diffuse homogeneous hyperenhancement. Hypervascular metastases showed a significantly longer washout time compared to hypovascular metastases.

Application of imaging fusion combining contrast-enhanced ultrasound and magnetic resonance imaging in detection of hepatic cellular carcinomas undetectable by conventional ultrasound.

BACKGROUND AND AIM: The aim of this study is to explore the value of volume navigation image fusion-assisted contrast-enhanced ultrasound (CEUS) in detection for radiofrequency ablation guidance of hepatocellular carcinomas (HCCs), which were undetectable on conventional ultrasound. METHODS: From May 2012 to May 2014, 41 patients with 49 HCCs were included in this study. All lesions were detected by dynamic magnetic resonance imaging (MRI) and planned for radiofrequency ablation but were undetectable on conventional ultrasound. After a bolus injection of 2.4 ml SonoVue® (Bracco, Italy), LOGIQ E9 ultrasound system with volume navigation system (version R1.0.5, GE Healthcare, Milwaukee, WI, USA) was used to fuse CEUS and MRI images. The fusion time, fusion success rate, lesion enhancement pattern, and detection rate were analyzed. RESULTS: Image fusions were conducted successfully in 49 HCCs, the technical success rate was 100%. The average fusion time was (9.2 ± 2.1) min (6-12 min). The mean diameter of HCCs was 25.2 ± 5.3 mm (mean ± SD), and mean depth was 41.8 ± 17.2 mm. The detection rate of HCCs using CEUS/MRI imaging fusion (95.9%, 47/49) was significantly higher than CEUS (42.9%, 21/49) (P < 0.05). For small HCCs (diameter, 1-2 cm), the detection rate using imaging fusion (96.9%, 32/33) was also significantly higher than CEUS (18.2%, 6/33) (P < 0.01). All HCCs displayed a rapid wash-in pattern in the arterial phase of CEUS. CONCLUSIONS: Imaging fusion combining CEUS and MRI is a promising technique to improve the detection, precise localization, and accurate diagnosis of undetectable HCCs on conventional ultrasound, especially small and atypical HCCs.

Primary non-Hodgkin's lymphoma of the liver: sonographic and CT findings.

BACKGROUND: A preoperative diagnosis of primary hepatic lymphoma (PHL) can have profound therapeutic and prognostic implications. Because of the rarity of PHL, however, there are few reports on diagnostic imaging. We reviewed the clinical and radiologic findings of 29 patients with PHL, the largest series to date, to evaluate the diagnostic features of this disease. METHODS: Clinical data and radiologic findings at presentation were retrospectively reviewed for 29 patients with pathologically confirmed PHL from January 2005 to June 2013. Imaging studies, including ultrasound (US) (n=29) and contrast-enhanced computed tomography (CECT) (n=24), were performed within 2 weeks before biopsy or surgery. RESULTS: Among the 29 patients, 23 (79%) were positive for hepatitis B virus (HBV) and 26 (90%) had a significantly elevated level of serum lactate dehydrogenase (LDH). There were two distinct types of PHL on imaging: diffuse (n=5) and nodular (n=24). Homogeneous or heterogeneous hepatomegaly was the only sign for diffuse PHL on both US and CECT, without any definite hepatic mass. For the nodular type, 63% (15/24) of patients had solitary lesions and 38% (9/24) had multiple lesions. On US, seven patients displayed patchy distribution with an indistinct tumor margin and a rich color flow signal. CECT showed rim-like enhancement (n=3) and slightly homogeneous or heterogeneous enhancement (n=14) in the arterial phase and isoenhancement (n=5) and hypoenhancement (n=12) in the portal venous and late phases. Furthermore, in five patients, CT revealed that hepatic vessels passed through the lesions and were not displaced from the abnormal area or appreciably compressed. CONCLUSIONS: The infiltration type of PHL was associated with the histologic subtype. Considered together with HBV positivity and elevated LDH, homogeneous or heterogeneous hepatomegaly may indicate diffuse PHL, whereas patchy distribution with a rich color flow signal on US or normal vessels extending through the lesion on CECT may be the diagnostic indicators of nodular PHL.

A novel simple noninvasive index to predict renal transplant acute rejection by contrast-enhanced ultrasonography.

PURPOSE: This study aimed to evaluate the application of quantitative contrast-enhanced ultrasonography (CEUS) in the assessment of renal allograft dysfunction and to establish a new noninvasive index to predict acute rejection (AR). METHODS: Fifty-seven renal transplant recipients were enrolled in this prospective study. Before renal allograft biopsy, CEUS examinations were performed.The biopsy results proved 23 cases of AR (AR group), 10 cases of acute tubular necrosis (ATN group), and 24 with normal evolution (stable group). Contrast-enhanced ultrasonography parameters including rising time (RT), time to peak (TTP), and the delta-time among regions of interest (ΔRT and ΔTTP) were analyzed. RESULTS: In the AR group, RT and TTP of interlobar artery and medulla (RTi, RTm, TTPi, and TTPm) as well as ΔRT and ΔTTP between medulla and cortex (ΔRTm-c and ΔTTPm-c) were significantly higher compared with those in the stable group. RTm and TTPm as well as ΔRTm-c and ΔTTPm-c were remarkably higher compared with those in the ATN group. ΔRTm-c and estimated glomerular filtration rate (eGFR) were identified as independent predictors by multivariate analysis (P = 0.008 and P = 0.024). On the basis of the multivariate analysis results and area under the receiver operating characteristic curves of individual markers, we constructed a new simple index, P = -0.587 + 0.286 ×ΔRTm-c − 0.028 × eGFR; new index = e(P)/(1 + e(P)), to discriminate AR, which had better area under the receiver operating characteristic curves than eGFR or individual CEUS parameters. CONCLUSION: Contrast-enhanced ultrasonography parameters are reliable markers for differentiating the perfusion status of transplanted kidneys. Furthermore, the new simple index can easily predictAR with a high degree of accuracy.

Tissue elasticity quantification by acoustic radiation force impulse for the assessment of renal allograft function.

Acoustic radiation force impulse (ARFI) quantification, a novel ultrasound-based elastography method, has been used to measure liver fibrosis. However, few studies have been performed on the use of ARFI quantification in kidney examinations. We evaluated renal allograft stiffness using ARFI quantification in patients with stable renal function (n = 52) and those with biopsy-proven allograft dysfunction (n = 50). ARFI quantification, given as shear wave velocity (SWV), was performed. The resistance index (RI) was calculated by pulsed-wave Doppler ultrasound, and clinical and laboratory data were collected. Morphologic changes in transplanted kidneys were diagnosed by an independent pathologist. Mean SWV was more significantly negatively correlated with estimated glomerular filtration rate (eGFR) (r = -0.657, p < 0.0001) than was RI (r = -0.429, p = 0.0004) in transplanted kidneys. Receiver operating characteristic curve analysis revealed that the sensitivity and specificity of quantitative ultrasound in the diagnosis of renal allograft dysfunction were 72.0% and 86.5% (cutoff value = 2.625), respectively. The latter values were better than those of RI, which were 62.0% and 69.2% (cutoff value = 0.625), respectively. The coefficient of variation for repeat SWV measurements of the middle part of transplanted kidney was 8.64%, and inter-observer agreement on SWV was good (Bland-Altman method, ICC = 0.890). In conclusion, tissue elasticity quantification by ARFI is more accurate than the RI in diagnosing renal allograft function.

Value of contrast-enhanced sonography in the diagnosis of peripheral intrahepatic cholangiocarcinoma.

BACKGROUND: To illustrate contrast-enhanced harmonic ultrasonography (CEUS) findings of peripheral intrahepatic cholangiocarcinoma (PICC) and to assess the usefulness of CEUS in the diagnosis of this disease. METHODS: This study is a retrospective analysis of 46 patients (20 men, 26 women) with PICC who underwent both preoperative CEUS and pathologic examination. Sonographic examinations were performed with sonographic instruments equipped with low mechanical index contrast imaging software. The contrast agent SonoVue was used. The wash-in and wash-out features of the lesions were documented and the enhancement patterns were analyzed by visual inspection of the real-time cine loops. RESULTS: During the hepatic arterial phase of CEUS, the majority of PICC lesions (43/46, 93.5%) showed hypervascularity compared with the liver parenchyma, whereas three lesions (3/46, 6.5%) showed hypovascularity. In the portal phases, all lesions were either isoechoic or hypoechoic, while they were all hypoechoic in the late phase. Of all the hypervascular lesions, 48.8% (21/43) showed diffuse enhancement and 51.2% (22/43) showed rim-like or thick, rim-like enhancement. In 62.8% (27/43) of cases, progressive dendritic and centripetal fill-in of the contrast agent was observed. There were 83.7% (36/43) of hypervascular nodules showing heterogeneous enhancement during peak contrast enhancement of the lesions. CEUS provided clearer visualization of lesion margins than did conventional sonography. CONCLUSIONS: CEUS examination yields some specific findings that are useful in the diagnosis of PICC.

Microwave ablation: An experimental comparative study on internally cooled antenna versus non-internally cooled antenna in liver models.

RATIONAL AND OBJECTIVES: Microwave ablation is an alternative therapy with high cost-effectiveness for liver malignancy. The authors designed this experiment to compare the effect of microwave ablation using a non-internally cooled (NIC) antenna with that using an internally cooled (IC) antenna in both an ex vivo and an in vivo liver models. MATERIALS AND METHODS: Sixty-two microwave ablations were performed in ex vivo porcine and in vivo canine liver models (NIC antenna, 28 coagulations; IC antenna, 34 coagulations). Pair comparisons were executed in terms of the coagulation parameters, including short-axis diameter (SD), long-axis diameter (LD), and spherical ratio (SR, SD/LD). The distributions of tissue temperatures were compared in ex vivo ablation. During in vivo ablation, the temperatures of antenna shaft were measured and unintended tissue coagulation were observed and compared. RESULTS: In both ex vivo and in vivo ablations, less charring areas were found around the IC antenna shaft. With a longer SD (P < .01) and a shorter LD (P < .01), the coagulations of IC antenna appeared to be more spherical than those of NIC antenna (P < .01). During ablations in vivo, the temperatures of NIC antennas shaft were up to 90 degrees C or even higher, which resulted in some unintended tissue coagulation, whereas the temperatures of IC antennas shaft were lower than 20 degrees C in all ablation processes without any unintended tissue coagulation (P < .01). CONCLUSION: The IC antenna performed better than NIC antenna in microwave ablation for liver models and might be more suitable for therapy for liver malignancy in clinical practice.