Ultrasound analysis for pancreatic panniculitis: A case report. / èƒ°è ºæ€§è„‚è†œç‚Ž­­è¶ 声个案分析.

Pancreatic panniculitis (PP) is a necrotizing inflammation of subcutaneous fat that is a rare complication of pancreatic disease appearing in 2% to 3% of all patients. It is more common in the elderly and often affects the extremities. It presents as skin inflammation with pain and erythema nodules. We report a case of acute pancreatitis associated with PP in an old female. She was admitted for vomiting and abdominal pain for 3 days and presented with a 2-week history of erythematous subcutaneous nodules on her legs. Laboratory and ultrasonic findings revealed acute pancreatitis. High frequency ultrasound showed hypoechoic foci in subcutaneous soft tissue layer and adipose layer. Histopathological examination confirmed the diagnosis of PP. Nodules disappeared with the resolution of acute pancreatic inflammation. PP may be the first manifestation of pancreatic disease. Imaging features of this pathology are seldom described and ultrasonic diagnosis experience is worth to be accumulated.

A Safety Study of the Effects of 2-Dimensional Shear Wave Elastography on Synaptic Morphologic Characteristics and Function in the Hippocampus of Neonatal Mice.

OBJECTIVES: The aim of this study was to determine the effects of 2-dimensional (2D) shear wave elastography (SWE) on synaptic morphologic characteristics and function in the neonatal mouse hippocampus and whether it affects the capacity for learning and memory later in life. METHODS: We divided neonatal mice into a control group and a 2D SWE group scanned for 10, 20, or 30 minutes. Hippocampal morphologic characteristics were assessed by hematoxylin-eosin and Nissl staining. Ultrastructures of hippocampal neurons were visualized by electron microscopy. Protein and messenger RNA expression levels of synaptophysin, N-methyl-d-aspartate receptor 1 (NMDAR1), NMDAR2A, and NMDAR2B were quantified by a western blot and polymerase chain reaction, respectively. Learning and memory of adult mice were evaluated by the Morris water maze and the novel object recognition task. RESULTS: Compared with the control group, the hippocampal morphologic characteristics of the experimental groups did not differ under light microscopy, and the synaptic structures assessed by electron microscopy appeared normal. Western blot and polymerase chain reaction results showed that expression of synaptophysin, NMDAR1, NMDAR2A, and NMDAR2B were downregulated after exposure to 2D SWE, but there were no statistical differences between the experimental groups. This downregulation disappeared within 24 hours. The results of the Morris water maze and novel object recognition suggested that the 2D SWE scanning on neonatal mice had no effect on learning and memory in adulthood. CONCLUSIONS: This study demonstrated that when the mice were exposed to neonatal cranial ultrasound by 2D SWE lasting for longer than 10 minutes, the expression of genes involved in synaptic function was affected, but this effect lasted no longer than 24 hours and did not affect learning and memory in adulthood.

Effects of 2D-Shear Wave Elastography on Brain-Derived Neurotrophic Factor (BDNF) in the Brains of Neonatal Mice and Exploration of the Mechanism.

BACKGROUND The aim of this study was to explore the effect and duration of 2-dimensional shear wave elastography (2D-SWE) irradiation on the expression of brain-derived neurotrophic factor (BDNF) in the brains of neonatal mice and to preliminarily investigate whether its mechanism is neuronal apoptosis. MATERIAL AND METHODS Neonatal mice (within 48 hours of birth) were subjected to 2D-SWE irradiation of the brain for 10 minutes (group S1), 20 minutes (group S2), and 30 minutes (group S3). The mice were sacrificed immediately after irradiation or 24 hours after irradiation. Brains were collected for real-time polymerase chain reaction (RT-PCR) and western blot experiments to determine the expression of BDNF in each group. TdT-mediated dUTP nick-end labeling (TUNEL) was performed to observe neuronal apoptosis in the brain. RESULTS The results of PCR and western blots from the brains of neonatal mice that were sacrificed immediately after irradiation show that S1, S2, and S3 were significantly different from those in the control group. The PCR and western blot results of brain tissues from neonatal mice sacrificed at 24 hours after irradiation showed that there was no significant difference between the S1, S2, S3, and control groups. The results of TUNEL experiments showed that there was no statistically significant difference in the number of apoptotic neurons between the S1, S2, S3, and control groups. CONCLUSIONS 2D-SWE irradiation of neonatal mice for more than 10 minutes downregulated the expression of BDNF. This effect disappeared within 24 hours after the irradiation, and the 2D-SWE scan seemed not to induce neuronal apoptosis.

Precise visual distinction of brain glioma from normal tissues via targeted photoacoustic and fluorescence navigation.

The vexing difficulty in distinguishing glioma from normal tissues is a major obstacle to prognosis. In an attempt to solve this problem, we used a joint strategy that combined targeted-cancer stem cells nanoparticles with precise photoacoustic and fluorescence navigation. We showed that traditional magnetic resonance imaging (MRI) did not represent the true morphology of tumors. Targeted nanoparticles specifically accumulated in the tumor area. Glioma was precisely revealed at the cellular level. Tumors could be non-invasively detected through the intact skull by fluorescence molecular imaging (FMI) and photoacoustic tomography (PAT). Moreover, PAT can be used to excise deep gliomas. Histological correlation confirmed that FMI imaging accurately delineated scattered tumor cells. The combination of optical PAT and FMI navigation fulfilled the promise of precise visual imaging in glioma detection and resection. This detection method was deeper and more intuitive than the current intraoperative pathology.

[Value of Thermal Tomography in Early Diagnosis of Breast Cancer in Animal Models].

Objective To obtain ultrasound and thermal tomography images of breast cancer during its growth and to assess the value of thermal tomography in detecting breast cancer. Methods Breast cancer models were established with NOD/SCID mice and SD rats. These animal models were examined by thermal tomography,plain ultrasound,and contrast-enhanced ultrasound. Tumor tissues were stained with CD34 to explore the relationship between tumor heat production and vascular pathology. Results Thermal tomography detected breast cancer 2-4 days earlier than ultrasound. The expression of CD34 in tumor tissues was increased,along with thickened,increased,and irregular blood vessels. Conclusion Thermal tomography can detect early breast cancer and is a promising tool for screening breast cancer.

Breast cancer research and treatment reconstruction of unilateral breast structure using three-dimensional ultrasound imaging to assess breast neoplasm.

PURPOSE: To develop and evaluate the accuracy of a three-dimensional (3D) US method for assessing unilateral breast reconstruction and discuss the feasibility of breast ultrasound 3D reconstruction of the unilateral breast compared with 3D MRI. METHODS: Sixty-four breast lesions were collected for surgical resection. (1) MRI and US imaging were used to reconstruct the 3D models of the breast neoplasm. The diameters for maximum length, width, and depth of the negative tumor margins were used as the primary standards for comparison. (2) The measurement direction was determined by the largest gravity change between the two body positions. (3) The vertical distance from the midpoint of breast neoplasm to the ipsilateral nipple was calculated via MRI and US reconstruction. RESULTS: (1) Comparison of the measured size and histopathology of the breast neoplasm showed that US, MRI, and histopathology were highly correlated (p < 0.001). (2) When compared with the other two vertical directions, the direction with the largest gravity change had the greatest difference between MRI and US measurements. (3) The vertical distance from the breast neoplasm to the ipsilateral nipple and skin junction was significantly different (p > 0.05). CONCLUSIONS: We have presented a novel US 3D reconstruction method for evaluating tumor size, which can provide a basis for investigated advanced visualization techniques for assessing breast tissue such as holographic presentation of 3D image data. These methods can provide physicians with a novel approach for making accurate surgical plans, for better communication with patients, and for more effective navigating throughout the operation.

Value of Computer Software for Assisting Sonographers in the Diagnosis of Thyroid Imaging Reporting and Data System Grade 3 and 4 Thyroid Space-Occupying Lesions.

OBJECTIVES: To analyze the ability of thyroid ultrasound computer-aided diagnosis (CAD) detection software (AmCAD-UT; AmCAD BioMed Corporation, Taipei, Taiwan) to assist sonographers in diagnosing Thyroid Imaging Reporting and Data System grade 3 and 4 space-occupying lesions and to provide evidence for ultrasound doctors (UDs) to use the diagnostic recommendations of the AmCAD system to inform clinical decisions. METHODS: In group 1, a retrospective study was performed on 234 cases of thyroid lesions confirmed by surgical pathology. The sensitivities, specificities, and accuracies of the diagnoses determined by the same UD independent of the software (UD) and after consulting the CAD software (UD + CAD) and by the software alone (CAD) were compared. In group 2, a prospective study was performed on 220 individuals with thyroid space-occupying lesions recommended by physicians from our hospital to undergo needle biopsy to confirm the diagnosis. Ultrasound images were imported into AmCAD, and recommendations for needle biopsy or periodic follow-up were obtained. According to the pathologic results of needle biopsy, consistency and coincidence rates of diagnostic recommendations for AmCAD were obtained. RESULTS: In group 1, CAD and UD + CAD diagnoses achieved significantly higher sensitivities and accuracies of diagnosis than did independent diagnosis by the UD (P < .05). In group 2, the software showed an overall intraclass correlation (κ = 0.786) and a diagnosis coincidence rate of 93.6% with needle biopsy results. CONCLUSIONS: AmCAD-UT Detection improved the ability of UDs to diagnose Thyroid Imaging Reporting and Data System grade 3 and 4 space-occupying lesions. Diagnostic recommendations of AmCAD are relatively consistent with needle biopsy results and can reduce the rate of unnecessary diagnostic needle biopsies.

Inhibition of hepatocellular carcinoma cell proliferation, migration, and invasion by a disintegrin and metalloproteinase-17 inhibitor TNF484.

BACKGROUND: The aim of this study was to test the effect of TNF484 on cell proliferation, migration, and invasion of hepatocellular carcinoma (HCC) cells. MATERIALS AND METHODS: Various doses (0, 1, 10, 50, and 100 nM) of TNF484 were applied to the HepG2 and Bel7402 cells, and cell proliferation was measured by using 3-(4,5-dimethylthiazol-2-yl)-2,5 diphenyl tetrazolium bromide assay after 72 h. Cell migration rate was measured using the xCELLigence system, and the cell invasion ability was examined by the three-dimensional spheroid BME cell invasion assay. The expression level of ADAM17 was also measured with RT-PCR. RESULTS: With the treatment of TNF484, the cell proliferation of HepG2 and Bel7402 cells was inhibited in a dose-dependent manner. Moreover, under TNF484 treatment, the cell migration rate as well as cell invasion ability of the HepG2 and Bel7402 cells were suppressed. CONCLUSION: TNF484 could inhibit the cell proliferation, migration, and invasion of some HCC cell lines, making it a potential therapeutic option for liver cancer treatment.

Research on the correlation between ultrasonographic features of breast cancer and expressions of ER, CD34 and p53.

PURPOSE: To investigate the expressions of estrogen receptor (ER), highly glycosylated type I transmembrane glycoprotein (CD34) and p53 in breast cancer tissue and analyze their correlation with color Doppler ultrasonographic features. METHODS: 86 patients who were admitted to our hospital with confirmed breast cancer diagnosis from January 2016 to December 2016 were selected. The expressions of ER, CD34 and p53 in cancer tissue and corresponding canceradjacent normal tissue were detected by immunohistochemical staining, and the color Doppler ultrasonographic features of patients were observed and analysed by Spearman correlation test. RESULTS: The positive rates of ER, CD34 and p53 expressions in cancer tissue of the case group were 46.5, 50 and 52.3%, respectively, significantly higher than 1.7% of the control group (p<0.05). The expressions of ER, CD34 and p53 in the cancer tissue of case group were correlated with the existence of calcification, spicule sign and lymph node metastasis detected by Doppler ultrasound (p<0.05), but not associated with tumor diameter and morphology (p>0.05). Spearman correlation test indicated positive correlation between expressions of ER and CD34 in cancer tissue of the case group (r=0.703, p<0.05); ER expression was positively associated with p53 expression (r=0.716, p<0.05) and CD34 expression was positively related to p53 expression (r=0.684, p<0.05). CONCLUSIONS: The expressions of ER, CD34 and p53 have significant roles in the occurrence and development of breast cancer. There is a certain correlation between expressions of ER, CD34 and p53 of breast cancer and color Doppler ultrasonographic features. The expression levels of ER, CD34 and p53 in breast cancer tissue can be evaluated by color Doppler ultrasonographic features, which is conducive to assessing the prognosis of these patients.

Value of Contrast-enhanced Ultrasound and Conventional Ultrasound in the Diagnosis of Papillary Thyroid Carcinoma with Cervical Lymph Node Metastases.

Objective To compare the ultrasound features of papillary thyroid carcinoma with or without cervical lymph node metastasis (LNM). Methods Patients suspected of thyroid cancer underwent the conventional ultrasound and contrast-enhanced ultrasound (CEUS) examinations. Patients' age,sex,and ultrasound characteristics of lesions were recorded. With the surgical pathology as the golden standard,the ultrasound features were compared between the cervical LNM group and non-LNM group. Results Of 144 patients,51 had cervical LNM and 93 did not. Patients' ages,sex and number of lesions had no significant difference between two groups (all P>0.05). Tumor with LNM had maximum size greater than 0.85 cm,ill-defined margin (P=0.000),irregular shape (P=0.007),internal heterogeneous echogenicity (P=0.007),microcalcification (P=0.020),internal heterogeneous low-enhancement (P=0.002),peripheral non-enhancement ring (P=0.030),and extracapsular extension (P=0.000). Conclusion Conventional ultrasound and CEUS are helpful for predicting the cervical LNM of PTC. CEUS can obtain more accurate diagnostic results for the extracapsular extension,which contributes to the prediction of cervical LNM.

Diagnostic Accuracy of Real-Time Shear Wave Elastography for Staging of Liver Fibrosis: A Meta-Analysis.

BACKGROUND The present meta-analysis, based on previous studies, was aimed to evaluate the test accuracy of real-time shear wave elastography (SWE) for the staging of liver fibrosis. MATERIAL AND METHODS A systematic search on MEDLINE, PubMed, Embase, and Google Scholar databases was conducted, and data on SWE tests and liver fibrosis staging were collected. For each cut-off stage of fibrosis (F≥2, F≥3, and F≥4), pooled results of sensitivity, specificity, and area under summary receiver operating characteristic (SROC) curve were analyzed. The study heterogeneity was evaluated by χ2 and I2 tests. I2>50% or P≤0.05 indicates there was heterogeneity, and then a random-effects model was applied. Otherwise, the fixed-effects model was used. The publication bias was evaluated using Deeks funnel plots asymmetry test and Fagan plot analysis was performed. RESULTS Finally, 934 patients from 8 published studies were included in the analysis. The pooled sensitivity and specificity of SWE for F≥2 were 85.0% (95% CI, 82-88%) and 81% (95% CI, 71-88%), respectively. The area under the SROC curve with 95% CI was presented as 0.88 (95% CI, 85-91%). The pooled sensitivity and specificity of SWE for F≥3 were 90.0% (95% CI, 83.0-95.0%) and 81.0% (95% CI, 75.0-86.0%), respectively, corresponding to an area of SROC of 0.94 (95% CI, 92-96%). The pooled sensitivity and specificity of SWE for F≥4 were 87.0% (95% CI, 80.0-92.0%) and 88.0% (95% CI, 80.0-93.0%), respectively, corresponding to an area of SROC of 0.92 (95% CI, 89-94%). CONCLUSIONS The overall accuracy of SWE is high and clinically useful for the staging of liver fibrosis. Compared to the results of meta-analyses on other tests, such as RTE, TE, and ARFI, the performance of SWE is nearly identical in accuracy for the evaluation of cirrhosis. For the evaluation of significant liver fibrosis (F≥2), the overall accuracy of SWE seems to be similar to ARFI, but more accurate than RTE and TE.

Diagnostic Accuracy of Contrast-Enhanced Ultrasound Enhancement Patterns for Thyroid Nodules.

BACKGROUND The aim of this study was to investigate the accuracy of contrast-enhanced ultrasound (CEUS) enhancement patterns in the assessment of thyroid nodules. MATERIAL AND METHODS A total of 158 patients with suspected thyroid cancer underwent conventional ultrasound (US) and CEUS examinations. The contrast enhancement patterns of the lesions, including the peripheries of the lesions, were assessed by CEUS scans. The relationship between the size of the lesions and the degree of enhancement was also studied. US- and/or CEUS-guided biopsy was used to obtain specimens for histopathological diagnosis. RESULTS The final data included 148 patients with 157 lesions. Seventy-five patients had 82 malignant lesions and 73 patients had 75 benign lesions. Peripheral ring enhancement was seen in 40 lesions. The differences of enhancement patterns and peripheral rings between benign and malignant nodules were significant (p=0.000, 0.000). The diagnostic sensitivity, specificity, and accuracy for malignant were 88%, 65.33%, and 88.32%, respectively, for CEUS, whereas they were 98.33%, 42.67%, and 71.97%, respectively, for TC by conventional US. The misdiagnosis rate by conventional US was 57.33% and 34.67% by CEUS (p=0.005). With regard to the size of lesions, a significant difference was found between low-enhancement, iso-enhancement, high-enhancement, iso-enhancement with no-enhancement area and no-enhancement (p=0.000). CONCLUSIONS In patients with suspicious US characteristics, CEUS had high specificity and contributed to establishing the diagnosis. Therefore, CEUS could avoid unnecessary biopsy.

Compression Real-time Elastography for Evaluation of Salivary Gland Lesions: A Meta-analysis.

OBJECTIVES: To evaluate the performance of compression real-time elastography for differentiation between benign and malignant salivary gland lesions. METHODS: A systematic literature database search was conducted. Pooled sensitivity, specificity, positive likelihood ratio (LR+), and negative likelihood ratio (LR-) values for real-time elastography were analyzed. Summary receiver operating characteristic (ROC) curves were also constructed. Heterogeneity was evaluated by χ(2) and I(2) tests. I(2) > 50% or P < .05 indicated heterogeneity, and then a random-effects model was applied. A Deek funnel plot was used to assess publication bias. Fagan plot analysis was performed to evaluate the clinical utility of real-time elastography. When heterogeneity was found, subgroup analyses were used to explore the sources of heterogeneity. A sensitivity analysis was conducted by omitting 1 study at a time and examining the influence of each individual study on the overall results. RESULTS: Nine articles with 581 lesions were included. The pooled sensitivity and specificity of real-time elastography for differentiation between benign and malignant lesions were 76% (95% confidence interval [CI], 65%-85%; 95% prediction interval [PI], 29%-95%) and 73% (95% CI, 62%-81%; 95% PI, 24%-96%), respectively. The LR+ and LR- were 2.81 (95% CI, 1.79-4.39; 95% PI, 0.65-12.16) and 0.33 (95% CI, 0.20-0.55; 95% PI, 0.07-1.69). The area under the ROC curve was 0.81 (95% CI, 0.77-0.84). No publication bias was detected, according to the Deek funnel plot (P = .51). The Fagan plot showed that when pretest probabilities were 25%, 50%, and 75%, positive posttest probabilities were 48%, 74%, and 89%, and negative probabilities were 10%, 25%, and 50%. CONCLUSIONS: Real-time elastography is a novel supplementary adjunct to conventional sonography for evaluation of salivary gland lesions. However, its overall accuracy is less promising, and biopsy may still be necessary in routine clinical practice.

Percutaneous Removal of Benign Breast Lesions with an Ultrasound-guided Vacuum-assisted System: Influence Factors in the Hematoma Formation.

Objective To explore the influence factors in hematoma formation after removing benign breast lesions with an ultrasound-guided vacuum-assisted system.Methods A total of 232 females with 312 benign breast masses received excisional biopsy with ultrasound- guided vacuum-assisted system. The pathology of patients, Results of hematoma development and outcome, influence factors for hematoma occurrence (nodule size, nodule location, number of nodule, breast shape, menstrual period, efficacy time of bandage, and application of hemostatic agents during the procedure) were recorded.Results Pathologic examination revealed fibroadenomas in 138 lesions, fibroadenosis in 127 lesions, intraductal papillomas in 39 lesions, inflammatory change in 4 lesions, retention cyst of the breast in 3 lesions, and benign phyllodes tumor in 1 lesion. Thirty hematomas were observed in patients (9.6%). Finally, 97.0% hematomas were absorbed completely within 6 months follow-up. The incidence rates of hematoma were increased by 24.7%, 10.0%, 63.2%, 13.9% in the nodule diameter larger or equal to 25 mm group, removal of larger or equal to two nodules once time from one patient group, menstrual period group, and larger and loose breast group, respectively (all P<0.05). However, the incidences were decreased by 60.6% in the bandage performed for 12-24 hours or beyond 24 hours group (P<0.05). The multiple logistic regression models revealed that nodule size (χ2=15.227, P<0.001), number of nodule (χ2=7.767, P=0.005), menstrual period (χ2=24.530, P<0.001), and breast shape (χ2=9.559, P=0.002) were independent risk factors associated with hematoma occurrence, but efficacy time of bandage was a protective factor associated with hematoma occurrence.Conclusion The occurrence of hematoma after the minimally invasive operation was associated with nodule size, number of nodule, menstrual period, breast shape, and efficacy time of bandage.

[Construction of Nude Mouse Model of Triple Negative Breast Cancer and Value of Thermal Tomography].

OBJECTIVE: To explore the early detection of breast cancer by ultrasonic imaging and thermal tomography of luciferase or green fluorescent protein (GFP)-labeled MDA-MB-231 breast cancer cell line-xenografts in nude mice. METHODS: Fluorescence-tagged lentiviral vectors were transfected into the triple-negative breast cancer cell line MDA-MB-231. These cells were implanted either subcutaneously under the right breast pad or intravenously into the tail vein of nude BALB/C mice. Thermal tomography and ultrasound imaging were used to detect tumor formation and to monitor tumor growth and metastasis in vivo. RESULTS: Triple negative breast cancer cell line-xenografts were used to successfully construct an orthotopic nude mice model of breast cancer metastasis in the peritoneum. Thermal tomography and ultrasound imaging were used together to detect small tumors. Thermal tomography imaging detected small tumors earlier than ultrasound imaging. CONCLUSIONS: Thermal tomography can be used to monitor changes in tumor growth and detect abnormal tissue. Therefore, it can serve as a convenient,rapid,sensitive, and reliable technique for early screening of human breast cancer.

Application of B+M-Mode Ultrasonography in Assessing Deglutitive Tongue Movements in Healthy Adults.

BACKGROUND: The purpose of this study was to evaluate tongue movements during swallowing in healthy adults using the B+M-mode ultrasonography, and to determine a common feature in the M-mode traces for quantitative measurement and individual comparison of tongue movements. MATERIAL AND METHODS: Ninety healthy subjects were divided into 3 groups according to age (20-39, 40-59, and 60-80 years). The tongue movements during 3 saliva swallows were examined using real-time B+M-mode ultrasonography. The M-mode traces of tongue movements were recorded and evaluated. RESULTS: Both intra-individual and inter-individual differences were detected in the M-mode traces during the 3 saliva swallows. Characteristic types were seen during the individual swallowing phases of M-mode traces: 2 activity types in phase I, 2 types in phase IIb, and 3 types in phase III. However, no variations were seen during phase IIa, in which all subjects displayed a continuous upsloping trace. The average range of swallow-related tongue radial displacement during phase IIa decreased gradually with age, while the average duration of tongue movement during phase IIa increased gradually with age. These 2 trends were not statistically significant across age groups. However, differences between sexes were found in both the range of tongue radial displacement and the duration of deglutitive lingual actions during phase IIa in all 3 age groups (P<0.05). CONCLUSIONS: B+M-mode ultrasonography may offer a quick and safe alternative for the preliminary evaluation of deglutitive tongue movements.

Performance of Ultrasonic Shear Wave Elastography in Assessing Benign and Malignant Breast Lesions.

OBJECTIVE: To determine the best shear wave elastography (SWE) quantitative parameters including the maximum elasticity (Emax), mean elasticity(Emean), minimum elasticity, standard deviation and ratio of Emean (Eratio) in assessing benign and malignant breast lesions. METHODS: Totally 302 breast lesions underwent conventional ultrasound and SWE. Each lesion was classified according to ultrasound Breast Imaging Reporting and Data System (BI-RADS). The receiver operating characteristic(ROC) curves were used to determine the cut-off values of SWE quantitative parameters and to suggest breast lesions as benign or malignant. The sensitivity,specificity and the Youden index (sum of sensitivity and specificity minus 1) of SWE quantitative parameters were compared,and then the sensitivity,specificity and the Youden index of the combinations of each SWE parameters in assessing breast lesions were compared. RESULTS: The sensitivity,specificity and the Youden index of the Emax were 0.87,0.97 and 0.84,which were higher than other SWE parameters (all P<0.01). The sensitivity, specificity and the Youden index of Emax combined with ultrasound BI-RADS were 0.86,0.97 and 0.83, which were higher than other combinations (all P<0.01). CONCLUSIONS: Compared with other parameters, Emax has the best performance in assessing breast lesions. It can be used as an important quantitative indicator for the evaluation of benign and malignant breast lesions.

Prediction of malignant risk stratification model for parotid gland nodules based on clinical and conventional ultrasound features: construction and validation.

Background: Ultrasound is widely used in the examination of the parotid gland, but no single ultrasound feature has demonstrated satisfactory diagnostic performance in predicting the nature of parotid nodules. Unlike the established and widely used grading systems for breast and thyroid nodules, a universally adopted and clinically accepted risk stratification system for malignancy in parotid gland nodules remains absent at present. This study aims to establish a malignant risk stratification model for parotid nodules by analyzing patients' clinical features and conventional ultrasound image characteristics. Methods: In this study, clinical data and ultrasound images of 736 patients with parotid nodules were retrospectively analyzed. Pathological results served as the gold standard, and the patients were randomly divided into training and validation groups in a 7:3 ratio. Clinical and ultrasound features of parotid nodules in the training group were compared. Multifactor logistic regression analysis was employed to screen for risk factors of malignant nodules and quantify scores. The probability of malignant risk was assessed and classified into five grades (Grade 1, normal parotid; Grade 2, definitive benign; Grade 3, possibly benign; Grade 4, suspicious malignant; Grade 5, high probability of malignancy). The diagnostic performance of the model was assessed by using calibration curves, receiver operating characteristic curves, decision curves, and clinical impact curves. Results: Facial symptoms, unclear margin, irregular shape, microcalcification, and abnormal cervical lymph nodes were independent risk factors for malignant parotid nodules. The area under the curve of the model was 0.850 [95% confidence interval (CI): 0.816-0.879] in the training group and 0.846 (95% CI: 0.791-0.891) in the validation group. Conclusions: The malignancy risk stratification model based on clinical and ultrasound image features has a good differentiation between benign and malignant parotid nodules, which is helpful for diagnosis and guiding clinical treatment.

[The value of age-adjusted D-dimer cut-off value in diagnosing deep vein thrombosis in elderly patients].

OBJECTIVE: To validate the value of age-adjusted D-dimer combined with clinical probability to confirm or exclude deep vein thrombosis (DVT) in elderly patients. METHOD: Elderly patients ( ≥ 65 years) suspected with DVT were evaluated by Wells score and D-dimer test. All patients underwent ultrasonography examination except for patients with Wells score < 2 and negative D-dimer test results. Conventional cut-off value is 500 µg/L, while age-adjusted cut-off value is set as patient's age×10 µg/L. We compared the sensitivity and specificity using the 2 cut-off values in confirming or excluding the diagnoses of DVT. RESULTS: The study population consisted of 624 patients [mean age(76.4 ± 19.3) years], DVT was confirmed in 192 (30.8%) patients. Using Wells score model, 326 patients (52.2%) were scored as unlikely DVT and DVT was confirmed by ultrasonography in 44 patients (13.5%), and 298 patients as likely DVT patients and DVT was confirmed in 148 patients (55.0%). The sensitivity, specificity, positive predictive value, and negative predictive value by conventional and age-adjusted D-dimer cut-off value for diagnosing DVT in low-risk patients evaluated by Wells score model were 95.5%, 40.4%, 20.0%, 98.3% and 95.5%, 61.0%, 27.6%, 87.1%, respectively, and which were 89.9%, 67.3%, 73.1%, 87.1% and 89.2%, 89.3%, 89.2%, 89.3%, respectively, in high-risk patients evaluated by Wells score model. Thus, specificity increased about 20% using age-adjusted D-dimer cut-off value compared with conventional D-dimer cut-off value. CONCLUSION: The age-adjusted D-dimer cut-off value combined with clinical probability evaluation could increase diagnosing specificity of DVT in elderly patients.

Development and validation of a prediction model for the diagnosis of breast cancer based on clinical and ultrasonic features.

Background: The aim of this study was to develop a simple and effective prediction model for calculating the probability of breast cancer by selecting clinical and sonographic features associated with breast cancer. Methods: A total of 402 lesions from 304 adult females from the ultrasound department of of PLA General Hospital from March 1st, 2020 to April 1st, 2021, were prospectively collected as the development group. The validation group included 121 lesions from 98 patients in our physical examination center from April 1st, 2021 to March 1st, 2022. Least absolute shrinkage and selection operator (LASSO) was applied to select clinical and ultrasonic variables, and R language was applied to build a web version of the interactive dynamic column line graph. The prediction model was validated by the validation group and the Breast Imaging Reporting and Data System (BI-RADS) categories. Calibration, differentiation and effectiveness were evaluated by R2, receiver operating characteristic (ROC) and decision curve analysis (DCA), respectively. Results: One hundred and seventy-nine malignant lesions and 223 benign lesions were included in the development group after exclusion and follow-up, whereas 62 malignant lesions and 59 benign lesions were enrolled in the validation group. Age, bloody nipple discharge, irregular shape, irregular border, heterogeneous echo, microcalcification, attenuation effects, decreased echo in surrounding tissues, lesions in ducts, abnormal lymph node morphology, nourishing vessel and nourishing vessel's resistance index (RI) greater than 0.70 were selected as independent risk factors. There was no significant difference in the area under the curve (AUC) of the development group between the prediction model and the BI-RADS category (0.959 vs. 0.953, P>0.05), and so as the validation group (0.952 vs. 0.932, P>0.05). For the prediction model, R2 of the development and validation group was 0.78 and 0.72. The DCA showed that the net benefits (NB) of the development group were higher than that of the validation group (0-100% vs. 0-90%). Conclusions: A prediction model was developed with the clinical and ultrasonic features for the precise and intuitive probability of breast cancer. This could provide a reliable reference for further examination.