Experimental study on monitoring microwave ablation efficacy by real-time shear wave elastography in ex vivo porcine brain.

Objective: Glioma constitutes the most common primary malignant tumor in the central nervous system. In recent years, microwave ablation (MWA) was expected to be applied in the minimally invasive treatment of brain tumors. This study aims to evaluate the feasibility and accuracy of microwave ablation in ex vivo brain tissue by Shear Wave Elastography (SWE) to explore the application value of real-time SWE in monitoring the process of MWA of brain tissue.Methods: Thirty ex vivo brain tissues were treated with different microwave power and ablation duration. The morphologic and microscopic changes of MWA tissues were observed, and the diameter of the ablation areas was measured. In this experiment, SWE is used to quantitatively evaluate brain tissue's degree of thermal injury immediately after ablation.Results: This study It is found that the ablation range measured by SWE after ablation is in good consistency with the pathological range [ICCSWEL1-L1 = 0.975(95% CI:0.959 - 0.985), ICCSWEL2-L2 = 0.887(95% CI:0.779 - 0.938)]. At the same time, the SWE value after ablation is significantly higher than before (mean ± SD,9.88 ± 2.64 kPa vs.23.6 ± 13.75 kPa; p < 0.001). In this study, the SWE value of tissues in different pathological states was further analyzed by the ROC curve (AUC = 0.86), and the threshold for distinguishing normal tissue from tissue after ablation was 13.7 kPa. The accuracy of evaluating ablation tissue using SWE can reach 84.72%, providing data support for real-time quantitative observation of the ablation range.Conclusion: In conclusion the accurate visualization and real-time evaluation of the organizational change range of the MWA process can be realized by real-time SWE.

Multimodal ultrasound-based carotid plaque risk biomarkers predict poor functional outcome in patients with ischemic stroke or TIA.

BACKGROUND: Carotid vulnerable plaque is an important risk factor for stroke occurrence and recurrence. However, the relationship between risk parameters related to carotid vulnerable plaque (plaque size, echogenicity, intraplaque neovascularization, and plaque stiffness) and neurological outcome after ischemic stroke or TIA is unclear. This study investigates the value of multimodal ultrasound-based carotid plaque risk biomarkers to predict poor short-term functional outcome after ischemic stroke or TIA. METHODS: This study was a single-center, prospective, continuous, cohort study to observe the occurrence of adverse functional outcomes (mRS 2-6/3-6) 90 days after ischemic stroke or TIA in patients, where the exposure factors in this study were carotid plaque ultrasound risk biomarkers and the risk factors were sex, age, disease history, and medication history. Patients with ischemic stroke or TIA (mRS ≤3) whose ipsilateral internal carotid artery stenosis was ≥50% within 30 days were included. All patients underwent multimodal ultrasound at baseline, including conventional ultrasound, superb microvascular imaging (SMI), and shear wave elastography (SWE). Continuous variables were divided into four groups at interquartile spacing for inclusion in univariate and multifactorial analyses. After completion of a baseline ultrasound, all patients were followed up at 90 days after ultrasound, and patient modified neurological function scores (mRSs) were recorded. Multivariate Cox regression and ROC curves were used to assess the risk factors and predictive power for predicting poor neurological function. RESULTS: SMI revealed that 20 (30.8%) patients showed extensive neovascularization in the carotid plaque, and 45 (69.2%) patients showed limited neovascularization in the carotid plaque. SWE imaging showed that the mean carotid plaque stiffness was 51.49 ± 18.34 kPa (23.19-111.39 kPa). After a mean follow-up of 90 ± 14 days, a total of 21 (32.3%) patients had a mRS of 2-6, and a total of 10 (15.4%) patients had a mRS of 3-6. Cox regression analysis showed that the level of intraplaque neovascularization and plaque stiffness were independent risk factors for a mRS of 2-6, and the level of intraplaque neovascularization was an independent risk factor for a mRS of 3-6. After correcting for confounders, the HR of intraplaque neovascularization level and plaque stiffness predicting a mRS 2-6 was 3.06 (95% CI 1.05-12.59, P = 0.041) and 0.51 (95% CI 0.31-0.83, P = 0.007), respectively; the HR of intraplaque neovascularization level predicting a mRS 3-6 was 6.11 (95% CI 1.19-31.45, P = 0.031). For ROC curve analysis, the mRSs for intraplaque neovascularization level, plaque stiffness, and combined application to predict 90-day neurological outcome ranged from 2 to 6, with AUCs of 0.73 (95% CI 0.59-0.87), 0.76 (95% CI 0.64-0.89) and 0.85 (95% CI 0.76-0.95), respectively. The mRSs for the intraplaque neovascularization level to predict 90-day neurological outcome ranged from 3 to 6, with AUCs of 0.79 (95% CI 0.63-0.95). CONCLUSION: Intraplaque neovascularization level and plaque stiffness may be associated with an increased risk of poor short-term functional outcome after stroke in patients with recent anterior circulation ischemic stroke due to carotid atherosclerosis. The combined application of multiple parameters has efficacy in predicting poor short-term functional outcome after stroke.

Decorin inhibits the formation of hard nodules after microwave ablation by inhibiting the TGF-ß1/SMAD and MAPK signaling pathways: in a Bama miniature pig model of mammary gland hyperplasia.

BACKGROUND: Benign breast lesions are often associated with hard nodule formation after microwave ablation (MWA), which persists for a long time and causes problems in patients. The aim of this study was to evaluate the efficacy of decorin in the treatment of hard nodule formation and its potential mechanism of action. METHODS: Using a Bama miniature pig model of mammary gland hyperplasia, immunohistochemistry, Masson's trichrome and western blotting were firstly applied to compare the extent of fibrosis and activation of key members of the TGF-ß1/SMAD and MAPK signaling pathways of hard nodule in the control and MWA groups, and then the extent of fibrosis and expression of signaling pathways in hard nodule were examined after application of decorin. RESULTS: The results showed that the MWA group had increased levels of TGF-ß1, p-SMAD2/3, p-ERK1/2, and collagen I proteins and increased fibrosis at 2 weeks, 4 weeks, and 3 months after MWA. After decorin treatment, the expression levels of each protein were significantly downregulated, and the degree of fibrosis was reduced at 2 weeks, 4 weeks, and 3 months after MWA compared with the MWA group. CONCLUSION: In conclusion, these results suggest that activation of TGF-ß1 may play an important role in hard nodule formation and that decorin may reduce hard nodule formation after MWA in a model of mammary gland hyperplasia by inhibiting the TGF-ß1/SMAD and MAPK signaling pathways.

Quantitative assessment of thenar to evaluate hand function after stroke by Bayes discriminant.

BACKGROUND: The incidence rate of stroke or cerebrovascular accidents ranks first in China. More than 85% of stroke patients have residual upper limb motor dysfunction, especially hand dysfunction. Normalizing the rehabilitation evaluation process and standard quantitative evaluation method is a complex and key point in rehabilitation therapy. The study aimed to establish a function model based on the Bayes discriminant by measuring the thenar stiffness with shear wave elastography (SWE) to quantitatively evaluate the hand motor function of hemiplegic patients after stroke. METHODS: This study collected 60 patients diagnosed with hemiplegia after stroke from October 2021 to October 2022. Therapists used the Brunnstrom assessment (BA)scale to divide the patients into the stage. All the patients underwent the measurement of SWE examination of abductor pollicis brevis (APB), opponens pollicis (OP), flexor pollicis long tendon (FPLT), and flexor pollicis brevis (FPB) by two sonographers. The SWE change rate of four parts of the thenar area was calculated prospectively with the non-hemiplegic side as the reference, the function equation was established by the Bayes discriminant method, and the evaluation model was fitted according to the acquired training set data. Lastly, the model was verified by self-validation, cross-validation, and external data validation methods. The classification performance was evaluated regarding the area under the ROC curve (AUC), sensitivity, and specificity. RESULTS: The median SWE values of the hemiplegic side of patients were lower than those of the non-hemiplegic side. According to the BA stage and SWER of APB, OP, FPLT, and FPB, our study established the Bayes discriminative model and validated it via self-validation and cross-validation methods. Then, the discriminant equation was used to validate 18 patients prospectively, the diagnostic coincidence rate was about 78.8%, and the misjudgment rate was approximately 21.2%. The AUC of the discriminant model for diagnosing BA stage I-VI was 0.928(95% CI: 0.839-1.0),0.858(95% CI: 0.748-0.969),1.0(95% CI: 1.0-1.0), 0.777(95% CI: 0.599-0.954),0.785(95% CI: 0.593-0.977) and 0.985(95% CI: 0.959-1.0), respectively. CONCLUSION: This Bayes discriminant model built by measuring thenar stiffness was of diagnostic value and can provide an objective basis for evaluating clinical rehabilitation.

Laser speckle contrast imaging for blood flow monitoring in predicting outcomes after cerebral ischemia-reperfusion injury in mice.

BACKGROUND: In the treatment of ischemic cerebral stroke (ICS), most conventional treatments, including carotid endarterectomy and carotid artery stenting, may cause cerebral ischemia-reperfusion injury (CIRI). For treated ICS patients, changes in cerebral blood flow are directly related to brain function. At present, computed tomography perfusion, dynamic susceptibility contrast-enhanced perfusion weighted imaging and magnetic resonance arterial spin labeling perfusion imaging are used to monitor cerebral blood flow, but they still have some limitations. Our study aimed to monitor the changes in cerebral cortical blood flow by laser speckle contrast imaging (LSCI) in CIRI model mice and to propose a new method for predicting outcomes after CIRI. C57BL/6 N mice were used to establish a mouse CIRI model based on a modified thread-occlusion method and divided into a good outcome group and a poor outcome group according to survival within 7 days. The cerebral cortical blood flow of the area supplied by the left middle cerebral artery was monitored by LSCI at baseline (before modeling), 1 h after ischemia, immediately after reperfusion and 24 h after reperfusion. Then, the brains of the mice were removed immediately and stained with hematoxylin and eosin to observe the pathological changes in brain neurons. RESULTS: The cerebral cortical blood flow in the poor outcome group was obviously reduced compared with that less in the good outcome group at 24 h after reperfusion (180.8 ± 20.9 vs. 113.9 ± 6.4, p = 0.001), and at 24 h after reperfusion, the cerebral cortical blood flow was negatively correlated with the severity of brain tissue injury (p = - 0.710, p = 0.010). CONCLUSIONS: LSCI can monitor the changes in cerebral cortical blood flow during CIRI in mice and could be used as a feasible method for predicting outcomes after CIRI in mice.

Ultrasound-guided thermal ablation for hyperparathyroidism: current status and prospects.

BACKGROUND: Hyperparathyroidism (HPT) is classified into primary HPT (PHPT), secondary HPT (SHPT), tertiary HPT (THPT), and pseudohyperparathyroidism. Parathyroid surgery is generally reserved for patients with symptomatic PHPT and asymptomatic patients who meet the surgical guideline criteria. However, the risk of complications and mortality after parathyroid gland surgery increases with increasing patient age. AIM: This study aimed to review existing research on laser ablation, radiofrequency ablation, microwave ablation, and high-intensity focused ultrasound in the treatment of HPT and analyze its application prospects. CONCLUSIONS: Thermal ablation is a good alternative treatment for patients with parathyroid hyperplasia who do not meet the criteria or decline surgery. Being a type of minimally invasive treatment, ultrasound-guided thermal ablation has the advantages of easy operation, rapid recovery, and reusability and is used widely.

Ideal Cardiovascular Health and Incidence of Carotid Plaque among Middle-Aged and Elderly Adults.

BACKGROUND: The ideal cardiovascular health (CVH) has been reported to be associated with reduced risk of ischemic stroke (IS). Atherosclerosis is a fundamental precursor in progression to IS. This study aimed to investigate the association of CVH score and atherosclerosis defined by carotid plaque in a community-based cohort. METHODS: Data came from the Asymptomatic Polyvascular Abnormalities Community study. After exclusions for missing data and original carotid plaque, 1938 subjects were included. At baseline (2010), the 7 CVH factors were quantified on a 14-point scale with 2 points awarded for ideal status, 1 point for intermediate, and 0 point for poor. The incidence of carotid plaque from 2010 to 2012 was evaluated from bilateral common, internal, and external carotid arteries, and carotid bifurcations using high-resolution B-mode ultrasounds. Multivariable logistic models were used to assess the association between CVH score and carotid plaque incidence. RESULTS: After 2 years' follow-up, 350 (18.06%) subjects developed carotid plaque. After adjusting for age, sex, education, and income, we observed a significant inverse association between the CVH score and incident carotid plaque. For every CVH score increase, the risk of carotid plaque incidence decreased by 8.10%. Stratified analysis showed the above association had no difference between sexes and age. CONCLUSIONS: Chinese subjects with a higher CVH score had a lower risk of developing carotid plaque after 2 years. The ideal CVH concept should be further promoted for protecting the arteries from atherosclerosis.

Association between features of intraoperative ultrasound and magnetic resonance imaging in the diagnosis of dysembryoplastic neuroepithelial tumor.

Background: To analyze the characteristics of images from intraoperative ultrasound (IoUS) and preoperative magnetic resonance imaging (MRI) and their relationship with pathological components of dysembryoplastic neuroepithelial tumor (DNT) and to discuss the role of IoUS in detecting tumor residues. Methods: The clinical and image data of 24 patients with postoperative pathology-confirmed DNT were analyzed retrospectively. Baseline characteristics, imaging features, and intraoperative residues were recorded for further analysis. Cohen's kappa consistency evaluation was performed on the echo and signal characteristics of the lesions. Results: Cohen's kappa coefficient between the echo and signal of the lesion was 0.832. The characteristics of IoUS were gyrus or mass hyperechoic solid nodules located under the cortex, insufficient blood flow signals, and clear boundaries, in addition to mixed cystic and solid echo nodules. The solid part of the lesion consisted of pathologically nodular specific glioneuronal element (SGE) or was combined with glial nodules and focal cortical dysplasia (FCD), which was characterized by a high echo or long T1 long T2 signal and uniform or uneven distribution. The cystic part consisted of a mucinous matrix, showing echoless or long T1 long T2 on fluid attenuated inversion recovery (FLAIR), which was higher than that in cerebrospinal fluid but lower than that in the cerebral cortex. The residual lesion discovered using IoUS was confirmed with postoperative MRI. Conclusions: The IoUS characteristics of DNT are strongly consistent with MRI, and its imaging features are related to pathological components. IoUS can assist the operator to judge the mode and scope of tumor resection, detect residual tumor, and improve the rate of total tumor resection.

Ferrostatin-1 alleviates cerebral ischemia/reperfusion injury through activation of the AKT/GSK3ß signaling pathway.

Ischemic stroke is the major cause of disability and death worldwide, but post-stroke neuronal death and related mechanisms remain unclear. Ferroptosis, a newly identified type of regulated cell death, has been shown to be associated with neurological disorders, yet the exact relationship between ferroptosis and ischemic stroke has not been elucidated. The purpose of this study is to investigate the effects of ferroptosis-specific inhibitor ferrostatin-1 (Fer-1) on neuronal injury after cerebral ischemia/reperfusion (I/R) and the underlying mechanism. In this study, we demonstrated that ferroptosis does occur in the stroke model. We found that Fer-1 reduced the levels of iron and malondialdehyde, and increased the content of glutathione and the expression of solute carrier family 7 member 11 and glutathione peroxidase 4 in cerebral I/R models. Additionally, Fer-1 significantly reduced the infarct volume and improved neurobehavioral outcomes. Moreover, we found that Fer-1 increased the levels of phosphorylated AKT and GSK3ß following cerebral I/R. To further investigate the functional role of the AKT in the neuroprotective effects of Fer-1, MCAO models and oxygen-glucose deprivation-induced HT22 cells were pretreated with the AKT inhibitor MK-2206 before treatment with Fer-1 and the protective effects of Fer-1 were reversed. In conclusion, Fer-1 has protective effects on cerebral I/R injury by activating the AKT/GSK3ß pathway, indicating that ferroptosis may become a novel target in the treatment of ischemic stroke.

Noninvasive assessment of carotid plaque with subharmonic aided pressure estimation from a US contrast agent: A preliminary study.

Stroke is closely associated with carotid plaques. The assessment of carotid plaque is still the key issue of stroke prevention in clinical practice. This prospective cross-sectional study included patients with carotid plaque evaluated by ultrasonography (US). The intima-media thickness (IMT), lumen stenosis severity, thickness, and length of carotid plaque were measured by the routine US, and the amplitudes of subharmonics in the upstream shoulder, top, and downstream shoulder of all plaques and corresponding lumens were observed by Subharmonic Aided Pressure Estimation (SHAPE) US examination from the US contrast agent perflubutane microbubbles (Sonazoid), which analyzed the clinical parameters of patients, the subharmonic amplitude characteristics of all plaques and lumens, and the parameter differences between the ischemic stroke (IS) group and control group. From May 2021 to February 2022, 46 carotid plaques of 23 patients were included. For plaques, the subharmonic amplitude in the plaque (-60.52 ± 4.46) was lower than that in the opposing level lumen (-56.82 ± 5.68 dB), the subharmonic gradient across the plaque cap was negatively correlated with plaque thickness (r = -0.51, p < 0.001), and with the lumen stenosis severity (r = -0.42, p = 0.003). The median IMT of the IS group was thicker than the control group. The subharmonic gradient of the intraplaque of the IS group was larger than the control group (p = 0.004). In this analysis, we use the receiver operating characteristic (ROC) curve to establish the cutoff value of the difference to predict a new monitoring method for plaque without invasion to predict IS. It still needs a large-scale study with long-term follow-up to validate these findings.

Radiomics in Carotid Plaque: A Systematic Review and Radiomics Quality Score Assessment.

Imaging modalities provide information on plaque morphology and vulnerability; however, they are operator dependent and miss a great deal of microscopic information. Recently, many radiomics models for carotid plaque that identify unstable plaques and predict cardiovascular outcomes have been proposed. This systematic review was aimed at assessing whether radiomics is a reliable and reproducible method for the clinical prediction of carotid plaque. A systematic search was conducted to identify studies published in PubMed and Cochrane library from January 1, 2001, to September 30, 2022. Both retrospective and prospective studies that developed and/or validated machine learning models based on radiomics data to classify or predict carotid plaques were included. The general characteristics of each included study were selected, and the methodological quality of radiomics reports and risk of bias were evaluated using the radiomics quality score (RQS) tool and Quality Assessment of Diagnostic Accuracy Studies-2, respectively. Two investigators independently reviewed each study, and the consensus data were used for analysis. A total of 2429 patients from 16 studies were included. The mean area under the curve of radiomics models for diagnostic or predictive performance of the included studies was 0.88 ± 0.02, with a range of 0.741-0.989. The mean RQS was 9.25 (standard deviation: 6.04), representing 25.7% of the possible maximum value of 36, whereas the lowest point was -2, and the highest score was 22. Radiomics models have revealed additional information on patients with carotid plaque, but with respect to methodological quality, radiomics reports are still in their infancy, and many hurdles need to be overcome.

Ultrasound parameters associated with stroke in patients with moyamoya disease: a logistic regression analysis.

BACKGROUND: Moyamoya disease can lead to stroke with devastating consequences, it is necessary to find a non-invasive and effective approach to identify the occurrence of stroke. In this study, we aim to analyze the association between ultrasound parameters and ipsilateral cerebral hemisphere stroke in patients with moyamoya disease by logistic regression analysis. METHODS: In this retrospective case-control study, 88 patients with MMD (153 cerebral hemispheres) hospitalized in Beijing Tiantan Hospital, Capital Medical University from November 2020 to October 2021 were analyzed. According to the occurrence of stroke, the 153 cerebral hemispheres were divided into a stroke group and a non-stroke group. Clinical data and ultrasound parameters of the ipsilateral internal carotid artery, superficial temporal artery, maxillary artery, and posterior cerebral artery were recorded. The ultrasound parameters were divided into four groups according to interquartile range, and then they were compared between the stroke group and the non-stroke group. Those with significant differences were scored by multivariate logistic regression analysis. RESULTS: There were 75 cerebral hemispheres (49.0%) in the stroke group and 78 cerebral hemispheres (51.0%) in the non-stroke group. Logistic regression analysis showed that the internal diameter of the internal carotid artery, peak systolic velocity of the internal carotid artery and peak systolic velocity of the posterior cerebral artery were independently correlated factors for stroke in patients with MMD. The fourth quartile group of the above three ultrasound parameters was taken as the reference group, and the odds ratio of the first quartile group were 11.679 (95% CI 2.918-46.749, P = 0.001), 19.594 (95% CI 4.973-77.193, P < 0.001), and 11.657 (95% CI 3.221-42.186, P < 0.001), respectively. CONCLUSION: Ultrasound parameters are independently correlated with ipsilateral cerebral stroke in patients with MMD. Ultrasound provides a new way to identify stroke in MMD patients. Future prospective cohort studies are needed to verify the clinical value of ultrasound in identifying patients with MMD at high risk of stroke.

Noninvasive assessment of intracranial pressure using subharmonic-aided pressure estimation: An experimental study in canines.

BACKGROUND: Intracranial hypertension is a common clinicopathological syndrome in neurosurgery, and a timely understanding of the intracranial pressure (ICP) may help guide clinical treatment. We aimed to investigate the correlation between subharmonic contrast-enhanced ultrasound (SHCEUS) parameters and ICP in experimental canines. METHODS: A dynamic model of ICP change from 11 mm Hg to 50 mm Hg was established in experimental canines by placing a latex balloon into the epidural space and injecting saline into the balloon. In addition, a pressure sensor was placed in the brain parenchyma to record the changes in ICP. When the ICP stabilized after each increase, subharmonic-aided pressure estimation (SHAPE) technology was performed to obtain the SHCEUS parameters, including the basal venous and adjacent intracranial arterial subharmonic amplitude and SHAPE gradient (subharmonic amplitude in the intracranial artery minus that in the basal vein). The correlation between these parameters and ICP was analyzed. RESULTS: The subharmonic amplitude of the basal vein was negatively correlated with the ICP (r = -0.798), and the SHAPE gradient was positively correlated with the ICP (r = 0.628). According to the guidelines for ICP monitoring in patients with traumatic brain injury, we defined 20 mm Hg, 25 mm Hg, and 30 mm Hg as the cutoff ICP levels. The area under the receiver operating characteristic curve of the basal venous subharmonic amplitude for diagnosing intracranial hypertension ≥20 mm Hg, ≥25 mm Hg, and ≥30 mm Hg was 0.867 (95% confidence interval [CI], 0.750-0.943), 0.884 (95% CI, 0.770-0.954), and 0.875 (95% CI, 0.759-0.948), respectively. The area under the receiver operating characteristic curve of the SHAPE gradient for diagnosing intracranial hypertension ≥20 mm Hg, ≥25 mm Hg, and ≥30 mm Hg was 0.839 (95% CI, 0.716-0.924), 0.842 (95% CI, 0.720-0.926), and 0.794 (95% CI, 0.665-0.890), respectively. CONCLUSION: SHCEUS parameters are correlated with ICP. The SHAPE technique can assist in evaluating ICP changes in canines, which provides a new idea and method for evaluating ICP.

Diagnostic performance of simplified TI-RADS for malignant thyroid nodules: comparison with 2017 ACR-TI-RADS and 2020 C-TI-RADS.

BACKGROUND: The aim of this study is to propose a new TI-RADS and compare it with the American College of Radiology (2017 ACR)-TI-RADS and the 2020 Chinese (2020 C)-TI-RADS. METHODS: A retrospective analysis of 749 thyroid nodules was performed. Based on the calculated odds ratio of ultrasonic signs between benign and malignant nodules, a new thyroid nodule score and malignancy rate were calculated. A receiver operating characteristic curve was drawn to analyze the new system's effectiveness in the differential diagnosis of benign and malignant thyroid nodules and was compared with the 2020 C-TI-RADS and 2017 ACR-TI-RADS. Five ultrasound physicians with different qualifications graded another 123 thyroid nodules according to the 2017ACR-TI-RADS, 2020 C-TI-RADS, and the newly proposed TI-RADS. Intergroup and intragroup consistency was evaluated using the Kappa test and intraclass correlation coefficient (ICC) test. RESULTS: 1) The new thyroid nodule score was divided into 0, 1, 2, 3, 4, and 5 points, with malignancy rates of 1.52%, 7.69%, 38.24%, 76.00%, 90.75%, and 93.75%, respectively. Using 3 points as the cutoff value to diagnose benign and malignant thyroid nodules, the sensitivity and specificity were 94.03% and 67.39%, respectively, which were higher than those of the 2017 ACR-TI-RADS and 2020 C-TI-RADS. The simplified TI-RADS, namely, sTI-RADS, was established as follows: sTI-RADS 3 (0 points), malignancy rate < 2%; sTI-RADS 4a (1 point), malignancy rate 2-10%; sTI-RADS 4b (2 points), malignancy rate 10-50%; sTI-RADS 4 (3 points), malignancy rate 50-90%; and sTI-RADS 5 (4 and 5 points), malignancy rate > 90%. 2) Five ultrasound doctors graded thyroid nodules by the 2017 ACR-TI-RADS, 2020C-TI-RADS and sTI-RADS. Intragroup consistency was good among all tests; ICC were 0.86 (0.82-0.90), 0.84 (0.78-0.88), and 0.88 (0.84-0.91), respectively, while only sTI-RADS had good intergroup consistency. CONCLUSION: In summary, we proposed a new TI-RADS, namely, sTI-RADS, which was obtained using a simple assignment method with higher specificity, accuracy, positive predictive value, and Youden index than the 2017 ACR-TI-RADS and 2020 C-TI-RADS.

Application of intraoperative B-mode ultrasound and shear wave elastography for glioma grading.

BACKGROUND: To evaluate the value of intraoperative B-mode ultrasound and shear wave elastography (SWE) in differentiating low-grade and high-grade gliomas. METHODS: A total of 172 patients with glioma were examined by B-mode ultrasound to obtain a tumor sonogram. Intraoperative SWE was performed on 52 patients to obtain Young's modulus values of peritumor tissue and tumor tissue, and the differences in conventional B-mode signs and Young's modulus values of gliomas of different grades were then compared. The diagnostic performance of SWE in glioma grading was assessed by receiver operating characteristic (ROC) curve analysis, and the intra- and interobserver reliability of SWE was analyzed by the intraclass correlation coefficient (ICC). RESULTS: For B-mode ultrasound, patient age, cystic degeneration, and peritumor edema were independent risk factors for high-grade glioma (P<0.05, OR >1). For SWE, Young's modulus values of peritumor tissue, low-grade glioma, and high-grade glioma tissues were 8.20 (7.50, 9.70) kPa, 19.65 (15.30, 24.75) kPa, and 9.55 (8.50, 13.80) kPa, respectively. The area under the ROC curve for the diagnosis of high-grade glioma by SWE was 0.859 (95% CI: 0.758-0.961, P<0.05), and the optimal cutoff value was 12.1 kPa, with 89.3% sensitivity and 75.0% specificity. The intra- and interobserver reliability of SWE in grading gliomas was excellent, with ICCs ranging from 0.921 to 0.965. CONCLUSIONS: High-grade glioma is associated with significantly more severe necrotic cystic degeneration and peritumoral edema on B-mode ultrasound and lower stiffness on SWE. Further, SWE exhibits excellent intra- and interobserver reliability. Intraoperative B-mode ultrasound combined with SWE helps differentiate different grades of gliomas.

Association Between Ultrasound Parameters and History of Ischemic or Hemorrhagic Stroke in Patients With Moyamoya Disease.

Objective: To explore the association between ultrasound parameters and previous ischemic or hemorrhagic stroke in patients with moyamoya disease (MMD), and develop an ultrasound-based nomogram to identify stroke in patients with MMD. Methods: We prospectively enrolled 52 consecutive patients (92 hemispheres) with MMD at the Beijing Tiantan Hospital. Thirty-six patients (65 hemispheres) were assigned to the training dataset from September 2019 to February 2020, and 16 patients (27 hemispheres) were assigned to the validation dataset from March 2020 to July 2020. Multivariate logistic regression analysis was applied to identify ultrasound parameters associated with previous history of ipsilateral stroke in patients with MMD, and a nomogram was subsequently constructed to identify stroke in patients with MMD. The performance of the nomogram was evaluated with respect to discrimination, calibration, and clinical usefulness. Results: Multivariate analysis indicated that the flow volume (FV) of the extracranial internal carotid artery (EICA) and the peak systolic velocity (PSV) of the posterior cerebral artery (PCA) were independently associated with ipsilateral stroke in patients with MMD, a nomogram incorporating these two parameters was constructed to identify stroke patients. The area under the receiver operating characteristic (AUROC) curves was 0.776 (95% CI, 0.656-0.870) in the training dataset and 0.753 (95% CI, 0.550-0.897) in the validation dataset suggested that the model had good discrimination ability. The calibration plot showed good agreement in both the two datasets. The decision curve analysis (DCA) revealed that the nomogram was clinically useful. Conclusions: Ultrasound parameters of EICA and PCA are independently associated with history of previous ipsilateral ischemic or hemorrhagic stroke in patients with MMD. The present ultrasound-based nomogram might provide information to identify MMD patients with high risk of stroke. Future long-term follow-up studies are needed to prove the predictive value in other independent cohorts. Clinical Trial Registration: http://www.chictr.org.cn/index.aspx. Unique Identifier: ChiCTR1900026075.

Ultrasound-guided percutaneous needle biopsy skill for peripheral lung lesions and complications prevention.

BACKGROUND: To investigate puncture skills and complications prevention in ultrasound-guided percutaneous needle biopsy for peripheral lung lesions. METHODS: Ninety-two peripheral lung lesions in 92 patients, detected via computed tomography (CT) and also visible on ultrasound, were retrospectively analyzed. All patients underwent percutaneous peripheral lung lesion needle biopsy under traditional ultrasound or contrast enhanced ultrasound (CEUS) guidance paying attention to avoiding necrotic areas and large blood vessels. All the specimens were examined histopathologically. Preprocedure all 92 lesions were performed by traditional ultrasonography to evaluate the size, the echogenecity, liquefaction areas and blood flow on color Doppler imaging, some of which were performed by CEUS for evaluating non-enhanced necrosis areas, contrast agent arrival time (AT) and characteristics of blood perfusion. RESULTS: The histopathologic results of all 92 lesions were as follows: 67 malignant tumors (including 28 adenocarcinomas, 19 squamous cell carcinomas, 6 bronchoalveolar carcinomas, 5 small cell carcinomas, 5 metastatic cancers, 3 poorly differentiated cancers and 1 malignant mesothelioma), 20 benign lesions (including 9 pneumonia, 6 inflammatory pseudotumors and 5 tuberculomas), 5 undetermined lesions. Of 52 lesions by CEUS guidance, 7 lesions showed enhancement in the pulmonary arterial-phase (including 6 pneumonia and 1 malignant tumors), 45 lesions showed enhancement in the bronchial artery phase (including 37 malignant tumors, 3 inflammatory pseudotumors, 4 tuberculomas and 1 undetermined lesion). According to needle insertion angle along linear path, a total of 92 lesions were divided into two groups, 49 lesions at an angle of 70°-80° needle insertion and 43 lesions at an angle of 80°-90° needle insertion. In the study, linear and non-linear two puncture paths were used, we first tried to puncture along linear path in all lesions, if an attempt to insert into the lesions failed due to be blocked by the ribs and then changed to puncture along non-linear path instead. The success rate of biopsy procedure along linear puncture was significantly higher at an angle of 80°-90°group (93.0% vs. 20.4%, P<0.01), and the adoption rate of non-linear path biopsy for solving the puncture needle blocked by the ribs was significantly higher at angle of 70°-80°group (79.6% vs. 7.0%, P<0.01). Of 52 lesions by CEUS guidance, 27 (51.9%) showed non enhanced necrosis areas on CEUS, only 5 showed liquefaction necrosis areas on gray-scale ultrasound. Of 40 lesions by traditional ultrasound guidance, 4 showed necrosis areas on gray-scale ultrasound. There were no significant differences in lesion size, the average number of biopsy attempts and complication rates between CEUS guidance group and traditional ultrasound guidance group (P>0.05), the pathological confirmation rate in CEUS guidance group was higher than that in traditional ultrasound guidance group, but without significant difference (98.1% vs. 90.0%, P>0.05). Of all 92 cases, 3 cases (3.3%) had mild pneumothorax and 4 cases (4.3%) had hemoptysis. CONCLUSIONS: In ultrasound-guided needle biopsy for peripheral lung lesions, using a combination of linear and non-linear puncture techniques and keeping away from necrotic areas and large blood vessels, may help to increase the success rate and reduce the incidence of complications further.

Corrigendum to "Intraoperative Contrast Enhanced Ultrasound Evaluates the Grade of Glioma".

[This corrects the article DOI: 10.1155/2016/2643862.].

Ultrasound Strain Elastography in Assessment of Muscle Stiffness in Acute Levodopa Challenge Test: A Feasibility Study.

To evaluate the feasibility of ultrasound strain elastography in assessing the response of muscle stiffness to the acute levodopa test, we prospectively performed strain elastography on the biceps brachii muscle (BBM) of 18 patients to diagnose Parkinson's disease. BBM and subcutaneous tissue strains (deformations) were produced by external compression with an ultrasound transducer and estimated using 2-D speckle tracking. We used the strain ratio (SR = BBM strain/reference strain) to assess BBM stiffness. The rate of increase in SR [rate = (SR after levodopa-SR before levodopa)/SR before levodopa] was used to assess the muscle stiffness response to levodopa. SR significantly increased after levodopa administration in 11 patients with Parkinson's disease (p = 0.02), whereas it did not in 7 patients with parkinsonian syndrome (from non-Parkinson's causes) (p = 0.14). The area under the receiver operating characteristic curve for the rate of increase in SR in determining Parkinson's disease was 0.96. The rate of increase in SR seems to be feasible in evaluating the effect of levodopa on muscle stiffness in the diagnosis of Parkinson's disease.

Ultrasound strain elastography in assessment of resting biceps brachii muscle stiffness in patients with Parkinson's disease: a primary observation.

The aim of this study was to evaluate the feasibility of ultrasound strain elastography (SE) for the assessment of resting biceps brachii muscle (BBM) stiffness in patients with Parkinson's diseases (PD). From May 2014 to December 2014, we prospectively performed SE of BBM in 14 patients with PD and 10 healthy controls. Based on the Unified Parkinson's Disease Rating Scale for scoring muscle rigidity (UPDRS, part III), muscle rigidity scores in 14 patients with PD included 3 patients with high rigidity (UPDRS III-IV) and 11 patients with low rigidity (UPDRS I-II). Ultrasound strain was represented by the deformation of the BBM and subcutaneous soft tissues that was produced by external compression with a sand bag (1.5 kg) tied onto an ultrasound transducer. Deformation was estimated with two-dimensional speckle tracking. The difference in strain ratio (SR, defined as mean BBM strain divided by mean subcutaneous soft tissue strain) between PD and healthy controls was tested by unpaired t test. The correlation between SR and muscle rigidity score was analyzed by Pearson correlation coefficient. The reliability of SR in assessment of BBM stiffness was tested using intraclass correlation coefficient. In our result, the SR in PD and healthy controls measured 2.65±0.36 and 3.30±0.27, respectively. A significant difference in SR was noted between the healthy controls and PD (P=.00011). A negative correlation was found between SR and UPDRS rigidity score (r=-0.78). Our study suggests that the SR of BBM to reference tissue can be used as a quantitative biomarker in assessing resting muscle stiffness associated with muscle rigidity in PD.