The Value of Thyroid Ultrasound Computer-Aided Diagnosis System in the Evaluation of Thyroid Nodules With Concurrent Hashimoto's Thyroiditis.

OBJECTIVE: To investigate the value of computer-aided diagnosis (CAD) system in assessing thyroid nodules concurrent with Hashimoto's thyroiditis (HT). METHODS: Totally 148 patients with 193 thyroid nodules were enrolled. A radiologist assessed the nodules using a thyroid ultrasound CAD system. Additionally, the nodules were evaluated by one experienced radiologist alone, and one training radiologist without and with CAD assistance. The diagnostic performance was compared between the CAD system and the experienced radiologist, and the training radiologist without and with CAD assistance. RESULTS: The CAD system demonstrated a similar sensitivity to that of the experienced radiologist in diagnosing thyroid cancers (89.8% versus 92.4%, P > .05). The specificity and accuracy of the CAD system were lower than that of the experienced radiologist in assessing the nodules with diffusedly altered glands (specificity, 60.0% versus 81.7%, P = .007; accuracy, 77.5% versus 88.1%, P = .011). With CAD assistance, the training radiologist had improved sensitivity and accuracy that increased to 87.9% and 86.8% in classifying nodules with sonographically evident HT (both P = .012). CONCLUSION: The CAD system has comparable sensitivity, but lower specificity compared with the experienced radiologist in diagnosing thyroid malignancies concurrent with HT. For a radiologist with less experience, the CAD system can help improve the diagnostic performance by increasing sensitivity and accuracy in assessing thyroid nodules with diffusely altered parenchyma.

Ultrasound Surveillance of Abnormal Cervical Lymph Nodes in Patients With Papillary Thyroid Carcinoma After Surgery.

OBJECTIVES: To document the changing trends of abnormal cervical lymph nodes (LNs) in patients with papillary thyroid carcinoma (PTC) who had serial follow-up ultrasound (US) scans after surgery and to determine how these node abnormalities progress in real time. METHODS: Ultrasound findings from 568 consecutive patients with PTC who were monitored postoperatively were reviewed. Abnormal LNs were classified as either suspicious or indeterminate according to the European Thyroid Association guidelines. Outcomes from US monitoring of the LNs were recorded and analyzed. RESULTS: Seventy-six (13.4%) of 568 patients were identified with abnormal LNs. Among them, 55 (72.4%) were initially found to have suspicious LNs, and the other 21 (27.6%) had indeterminate lesions. Of the 55 suspicious LNs, final scans showed that 38 (69.1%) lesions were still suspicious, whereas the remaining 17 (30.9%) nodes were shown to have resolved after a median follow-up of 36 months. Of the 21 indeterminate node abnormalities, final scans showed that 16 (76.2%) LNs remained indeterminate, whereas the other 5 (23.8%) nodes had developed into suspicious LNs after a median follow-up of 44 months. Loss of the fatty hilum and peripheral or diffusedly increased vascularity were more likely to be linked to persistent suspicious LNs (P = .02 and .04, respectively). Suspicious LNs with echogenic foci but a lack of other abnormal features were more frequently found to have resolved thereafter (P = .03). CONCLUSIONS: Abnormal LNs detected after PTC surgery can often remain indolent during US surveillance, and a small portion of the nodes would have resolved over time.

Cervical Extension of the Normal Thymus in Children and Adolescents: Sonographic Features and Prevalence.

OBJECTIVE: This study aims to confirm the prevalence of incidental cervical extension of normal thymus in children and adolescents undergoing neck ultrasound and describe the ultrasound appearance to minimize future misdiagnosis. MATERIALS AND METHODS: This retrospective study was conducted in a single institution. Thyroid and lower neck ultrasound images of the consecutive pediatric subjects between January 1, 2011 and September 30, 2017 were independently reviewed by 2 radiologists for the presence of cervical thymus. When identified on sonographic images, cervical thymus was described on the basis of echogenicity, location, and shape. RESULTS: In 278 consecutive cases, the 2 reviewers identified 105 (37.8%) and 103 (37.1%) cases respectively as having sonographically visible tissue in the expected location of cervical extension of the thymus. The internal echotexture was variable with 38.1% of cases being hypoechoic, 37.1% mixed, and 24.8% hyperechoic. Cervical extension of the thymus was most commonly (65.0%) to the left of the trachea or (30.9%) bilateral/anterior to the trachea; isolated right paratracheal thymus was uncommon. Thymic shape was variable: quadrilateral (30.9%), oval (29.9%), triangular (25.8%), and other (13.4%). The logistic regression model including age, gender, and BMI z-scores showed that, when controlled for sex and BMI z-scores, younger age was a predictor for the presence of cervical thymic extension (p < .001). CONCLUSION: Cervical thymic extension is sonographically visible as a soft tissue mass of variable appearance in about a third of children and adolescents undergoing neck ultrasonography with decreasing prevalence with age. Sonographically visible cervical thymic tissue is more common in younger patients.

Study of the Ultrasound Appearance of the Normal Parathyroid Using an Intraoperative Procedure.

OBJECTIVES: This study was designed to confirm the echogenicity of normal parathyroid glands using intraoperative ultrasound (US). METHODS: Between October 2015 and January 2016, normal parathyroid glands were examined with an intraoperative US transducer during thyroidectomy procedures in 13 patients with thyroid disease. According to the findings from intraoperative US, routine percutaneous US of normal parathyroid glands was performed in a group of adults. On the basis of previous information on normal parathyroid echogenicity, a series of parathyroid diseases that were proved by surgery and histopathologic analyses were retrospectively reviewed. The presence of residual normal parathyroid in the lesion on US imaging, which was defined as the residual parathyroid sign in this study, was reviewed and correlated with histopathologic results. RESULTS: In the intraoperative US group, 23 parathyroid glands were scanned intraoperatively, and 21 (91.3%) were hyperechoic, homogeneous in texture, and oval. In the routine percutaneous US group, 106 parathyroid glands were found in total, and 96 (90.5%) of the glands had hyperechoic and homogeneous echogenicity, with 75 (70.8%) being oval. In the review of parathyroid diseases, 33 parathyroid glands in 30 cases were reviewed, with a positive residual parathyroid sign in 7 (21.2%) parathyroid glands, presenting with a hyperechoic rim in the margin, and 4 of them (12.1%) were confirmed by histopathologic results. CONCLUSIONS: The normal parathyroid had hyperechoic echogenicity on both intraoperative and percutaneous US imaging. Residual tissue of parathyroid glands can also be observed in some parathyroid abnormalities with an echogenic appearance on US imaging and confirmed by histopathologic results.

Shear Wave Elastography to Assess False Vocal Folds in Healthy Adults: A Feasibility Study.

OBJECTIVES: The aim of the study was to investigate the feasibility of using ultrasound shear wave elastography to quantify mechanical properties and movement symmetry of false vocal folds positioned in adduction and abduction. METHODS: We prospectively measured the shear wave velocity (SWV) within the bilateral false vocal folds in 10 healthy adults using acoustic radiation force impulse imaging. From a transcutaneous approach at the level of thyroid cartilage, 5 SWV measurements were obtained within each side of the false vocal folds twice in adduction and again in abduction for each participant. Configuration-related differences in the SWV within false vocal folds were compared between adduction and abduction, in addition to differences between the right and left false vocal folds and between men and women, by a paired t test. We developed an SWV index [(SWVgreater - SWVlesser )/SWVgreater ] to assess movement symmetry between the right and left false vocal folds. Intraobserver agreement on repeated measures was examined by the intraclass correlation coefficient. RESULTS: The 10 participants included 5 men and 5 women. We observed that the SWV within false vocal folds was significantly higher in adduction than in abduction (P < .001). The SWV within false vocal folds in adduction was also significantly higher in women compared to men (P < .001). There was no significant difference in the SWV between the right and left false vocal folds in adduction or in abduction or between men and women in abduction (P > .05). The mean SWV index was 0.05 (range, 0.03-0.07). The intraclass correlation coefficient for intraobserver agreement was 0.89 (P < .001). CONCLUSIONS: Shear wave elastography seems to be feasible to quantify mechanical properties and evaluate the symmetry of false vocal folds in healthy adults.

Retraction notice to "The role of laryngeal ultrasound in diagnosis of infant laryngomalacia" [Int. J. Pediatr. Otorhinolaryngol. 124 (2019) 111-115].

This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). This article has been retracted at the request of the Authors and the Editor-in-Chief. After a thorough investigation, the Editor-in-Chief has concluded that details in the origin of data and permissions integral to the article's acceptance in the journal necessitate a retraction. A single hospital was mentioned in the article but this was not where the data was collected. Reviewers would have assumed that informed consent was received and properly reviewed by this institution, as it was not otherwise specified. Several oversights within the article that were brought forward by the Authors make it clear that the article that was accepted had misrepresentation of key data. While the Authors presented some differences of opinion about how these concerns about the key data originated, it is clear that when the manuscript was accepted that Reviewers and Editors would not have had knowledge of these difficulties, and this may have created a different review process and outcome for this manuscript. One of the Authors has requested an ability to provide additional information to address the concerns. However, the Editor-in-Chief has decided that this would not follow the process for accepted manuscripts or address some of the concerns presented and, therefore, has settled on the retraction of the manuscript as the final decision regarding this paper.

The role of laryngeal ultrasound in diagnosis of infant laryngomalacia.

OBJECTIVE: The purpose of this study was to evaluate the role of laryngeal ultrasound in diagnosis of infant laryngomalacia. METHODS: Forty consecutive infant patients with inspiratory stridor or other laryngeal symptoms underwent flexible fiberoptic nasopharyngolaryngoscopy and laryngeal ultrasound examination from January 2014 to May 2014. The curling angle of the epiglottis and/or arytenoid tissue collapses on laryngeal ultrasound during inspiration were used to diagnose infant laryngomalacia. The value of laryngeal ultrasound in diagnosis of infant laryngomalacia was evaluated and further compared to that of flexible fiberoptic nasopharyngolaryngoscopy. RESULTS: The mean angle of the curling epiglottis in 26 patients with laryngomalacia was 69.1 ±â€¯8.1 degrees, while the mean angle of the slightly curling epiglottis in 12 patients without laryngomalacia was 89.6 ±â€¯9.7 degrees (p < 0.0001). Arytenoid tissue collapses were found in 24 patients with laryngomalacia and only one patient without laryngomalacia had a local collapse of arytenoid tissue (p < 0.0001). Twenty six of the 28 patients with laryngomalacia diagnosed by flexible fiberoptic nasopharyngolaryngoscopy were detected by laryngeal ultrasound. There was an excellent consistency between laryngeal ultrasound and flexible fiberoptic nasopharyngolaryngoscopy in the detection of infant laryngomalacia (κ = 0.826). Laryngeal ultrasound had a sensitivity of 96.3%, a specificity of 84.6%, a positive predictive value of 92.9%, and a negative predictive value of 91.7% in diagnosing infant laryngomalacia. CONCLUSIONS: Laryngeal ultrasound can help diagnose infant laryngomalacia through visualizing omega-shaped epiglottis and/or arytenoid tissue collapse during inspiration. The modality has an excellent consistency with flexible fiberoptic nasopharyngolaryngoscopy in diagnosis of the disease.

Ultrasound strain imaging in assessment of false vocal folds in adults: A feasibility study.

PURPOSE: The aim of the study is to investigate the feasibility of ultrasound strain imaging (USI) in assessing magnitude and symmetry of false vocal folds (FVF) deformation as a quantitative marker for estimating FVF movement. METHODS: From October 2016 to July 2017, we performed USI of FVF in 44 adults [33 healthy controls and 11 subjects with unilateral vocal fold motion impairment (VFMI), 17 men and 27 women, mean age 43 years]. Real time ultrasound data of FVF in different configuration (abduction and adduction) was acquired through transcutaneous anterior-mid neck. Peak to valley strain (strain magnitude of maximum to minimum) representing the largest FVF deformation was estimated using 2-D speckle tracking. We developed peak to valley strain index [(Peak to valley strain right - Peak to valley strain left)/Peak to valley strain maximum] to assess the symmetry of FVF deformation. RESULTS: The difference in peak to valley strain between left and right FVF was significant in subjects with VFMI, whereas it was not in healthy controls. The peak to valley strain index was small (≤0.25) in symmetric FVF deformation in healthy controls whereas it was large (≥0.53) in asymmetric FVF deformation in subjects with VFMI. The area under receiver operating characteristics for peak to valley strain index in the determining asymmetric FVF deformation was 1. CONCLUSION: Our results suggest that USI seems feasible to quantify both magnitude and symmetry of FVF deformation in adults. Further validation of USI in assessing VFMI is warranted.

Sonography used in the infantile desmoid fibromatosis of postcricoid area: A case report.

RATIONALE: Infantile desmoid fibromatosis of the postcricoid area is a rare disease and is characterized by a proliferation of fibrous tissue with non-metastasis, local infiltration, and a high rate of recurrence after surgical resection. Currently, ultrasound is scarcely used in the hypopharynx and larynx area. PATIENT CONCERNS: A 4-year-old boy presented with hoarseness, deep voice and snoring for 2∼4 years without any surgical history. On sonography, the lesion was found in the postcricoid area, and the left larynx showed impaired mobility in real time observation. Complete excision with a negative margin in this pivotal anatomic area is impossible, and necessitates a long-time surveillance. DIAGNOSES: Infantile desmoid fibromatosis of the postcricoid area was diagnosed according to surgery and histopathology. INTERVENTIONS: Local excision was carried out to relieve the upper airway narrowing. OUTCOMES: Relieved hoarseness and snoring were reported on the latest follow-up. A residual lesion was seen in the surgical bed and maintained a stable extent on ultrasound and MR imaging after a year. LESSONS: Considering the non-radiation merit and diagnostic ability, ultrasonography is advocated as a valuable supplementary imaging method to CT, MR and laryngoscopy in the juvenile larynx and hypopharynx.

Comparative Study of Three Regimens of Bowel Preparation Before Transabdominal Ultrasonography of the Colon.

The objective of the study was to compare the efficacy of three bowel preparation regimens for transabdominal colon ultrasonography. A total of 192 consecutive patients were given one of three regimens (senna, magnesium sulfate or polyethylene glycol electrolyte powder) before ultrasonographic examinations. The cleaning grade (I = emptying; II = filled or filled + empty; III = I or II with some retention; and IV = retention [grades I and II were termed "qualified"]) and cleaning range (A = all seven colon sections were qualified; B = four to six sections were qualified; C = three or less sections were qualified) were evaluated retrospectively. Senna was found more effective than polyethylene glycol in terms of cleaning grade (p < 0.001), qualified rate (p < 0.001) and cleaning range (p = 0.003). Senna was better than magnesium sulfate in cleaning grade (p < 0.001). Our results suggest that senna seems to be the preferred regimen for bowel preparation before transabdominal colonic ultrasonography.

The value and limitations of contrast-enhanced transrectal ultrasonography for the detection of prostate cancer.

OBJECTIVES: To evaluate the role of contrast-enhanced transrectal ultrasonography (CE-TRUS) for detecting prostate carcinoma. METHODS: Sixty-five patients with elevated serum prostate-specific antigen (PSA) and/or abnormal digital rectal examination (DRE) were assessed using transrectal ultrasound (TRUS) and CE-TRUS. In all the patients, CE-TRUS was performed with intravenous injection of contrast agent (SonoVue, 2.4 ml) before biopsy. The cancer detection rates of the two techniques were compared. False-positive and false-negative findings related to CE-TRUS were analyzed in comparison to the pathological results of biopsy or radical prostatectomy. The targeted biopsy to abnormal CE-TRUS areas was also compared to systematic biopsy. RESULTS: Prostate cancer was detected in 29 of the 65 patients. CE-TRUS showed rapid focal enhancement or asymmetric vessels of peripheral zones in 28 patients; 23 of them had prostate cancer. CE-TRUS had 79.3% sensitivity, compared to 65.5% of TRUS (P<0.05). There were five false-positive and six false-negative findings from CE-TRUS. Benign prostate hyperplasia, and acute and chronic prostatitis were important causes related to the false-positive results of CE-TRUS. Prostate cancer originating from the transition zone or peripheral zone with lower PSA levels, small-size foci, and moderately or well-differentiated tumor was missed by CE-TRUS. The cancer detection rate of targeted biopsy (75%, 33/44 cores) was significantly higher than one of systematic biopsy (48.2%, 162/336) in those 28 cases (P<0.05). In addition, no significant correlation was found between the cancer detection rate with CE-TRUS and serum PSA levels. CONCLUSION: CE-TRUS may improve the detection rate of prostate cancer through targeted biopsy of contrast-enhanced abnormalities. Our findings indicate that systematic biopsies should not be eliminated on the basis of false-positive and false-negative findings related to CE-TRUS.

Sonographic evaluation of proximal gastric accommodation in patients with functional dyspepsia.

AIM: To assess the value of ultrasonography (US) in evaluation of proximal gastric accommodation disorder in patients with functional dyspepsia (FD). METHODS: Between April 2011 and March 2012, 45 patients with FD and 27 healthy volunteers were enrolled in this study. Two-dimensional ultrasound (2DUS) and 3-dimensional ultrasound (3DUS) were performed sequentially to measure proximal gastric area (PGA), maximal proximal gastric diameter (MPGD), and proximal gastric volume (PGV). These values were measured separately in the two groups every other 5 min for a duration of 25 min after the beginning of ingestion of a test meal. Air pocket grading was done separately for images of 2DUS and blocks of 3DUS obtained at five scanning time points. RESULTS: Both PGA and PGV of patients were significantly smaller than healthy controls (P = 0.000 and 0.002, respectively). Comparing the two parameters between the groups at each time point, the differences were also statistically significant (P = 0.000-0.013), except at 10 min for the PGV (P = 0.077). However, no overall difference was found between the groups in the MPGD measurements (P = 0.114), though it was statistically significant at a 20-minute examination point (P = 0.026). A total of 360 sets or blocks of images were obtained for both 2DUS and 3DUS. For the images analyzed by 2DUS, none were excluded because of gastric gas, and 50 (13.9%) and 310 (86.1%) sets were determined as air pockets grades 1 and 2, respectively. For the images analyzed by 3DUS, 23 (6.4%) blocks were excluded from the measurement due to presence of a large fundus air pocket (grade 3); fifty (13.9%) and 287 (79.7%) blocks were also graded as 1 and 2, respectively. CONCLUSION: Measurement of both PGA and PGV by 2DUS and 3DUS could be useful for assessment of the proximal gastric accommodation.