Can the Smart detect™ in breast ultrasound provide a second opinion?

Background

Ultrasound and mammography alone may not always identify malignant breast lesions. Samsung Medison has added the Smart detect? (S-detect?) program to its ultrasound features, and this may improve the identification of benign and malignant breast lesions.

Is B-mode ultrasound alone a sufficient screening tool for carotid stenosis? A pilot study

Background

Carotid ultrasound is performed solely in hospital ultrasound departments or outpatient labs, using both B- and Doppler modes. We hypothesize that B-mode without Doppler can be used to classify patients as having carotid stenosis (CS) above or below 50%. Our objective is to determine the frequency with which a CS >50% is found using Doppler when no such stenosis was visible using B-mode.

Methods

This was a retrospective study of 100 patients referred to the stroke clinic and 100 patients referred for carotid endarterectomy (CEA). All patients had an elective carotid ultrasound done at Health Sciences North. The ultrasound reports were mixed together and blinded. Investigators determined if there was a CS of greater or less than 50% based on the carotid diagram. These results were compared to the degree of CS found on Doppler.

Results

In the CEA group, there were 198 ultrasounds, with 153 showing a CS of >50%. Only one case of CS >50% was missed by B-mode. In the clinic group, 32 of 192 ultrasounds showed a CS of >50%. None were missed by B-mode. B-mode had a sensitivity and negative predictive value of 100% and a specificity of 65%.

Conclusion

This study supports the theory that it may be possible to use B-mode ultrasound without Doppler to reliably determine if there is CS above or below 50%. Further research is required before carotid ultrasound using B-mode alone can be recommended.     

Is point-of-care ultrasound disruptive innovation? Formulating why POCUS is different from conventional comprehensive ultrasound

Background

Point-of-care ultrasound (PoCUS) is spreading throughout Emergency Medicine, Critical Care and Pre-hospital Care. However, there is an underlying inherited conflict with the established specialties performing comprehensive examinations. It has been stated that PoCUS is disruptive innovation. If this is true the definition might open up for a new perspective on differentiating comprehensive ultrasound from PoCUS. PoCUS in the light of disruptive innovation is a different perspective on ultrasound that has not before been academically scrutinized.

Methods

In this paper we investigate if PoCUS is in fact disruptive innovation. This is done by comparative analysis with the point of departure in disruptive innovation theory known from the business world.

Results

We find that a disruptive innovation process is happening. This new knowledge allows us to put forward advice for the stakeholders in the field of ultrasound. It also allows us to challenge the conventional pyramid of expertise used to describe different types of ultrasound. The perspective of this paper is mutual understanding of similarities and differences between conventional and point-of-care ultrasound. Only with this understanding the stakeholders can collaborate and use the full spectrum of ultrasound for the benefit of the patient.

     

Real-time ultrasound elastography: Does it improve B-mode ultrasound characterization of solid breast lesions?

Introduction

Elastography is a non-invasive medical imaging technique that detects tumors based on their stiffness (elasticity). Strain images display the relative stiffness of lesions compared with the stiffness of surrounding tissue as cancerous tumors tend to be many times stiffer than the normal tissue, which “gives” under compression. An image in which different degrees of stiffness show as different shades of light and dark is called an elastogram.

Purpose

To prospectively evaluate the sensitivity and specificity of the real-time sonoelastography as compared with B-mode US for distinguishing between benign and malignant solid breast masses. The density of the glandular breast tissue was taken in consideration in addition to the Breast Imaging Reporting and Data System (BI-RADS) categories of the lesions, with biopsy results as the reference standard.

Methods

A total of 216 candidate solid lesions (123 benign and 93 malignant) in 188 patients were examined with 2-dimensional ultrasonography, elastosonography and mammography (for 147 patients). The lesions were classified according to the density of the glandular breast tissue into low density group (D1) and a high density group (D2) and were categorized with the BIRADS score. Elastographic images were assigned an elasticity score of 1 to 5 (1–3, benign; 4 and 5, malignant) according to the Multi-Center Team of Study and the strain ratios of the lesions were measured. Concordance between the imaging findings and histopathologic results was documented. Statistical analysis was performed and sensitivity, specificity and positive and negative predictive values for both elastography and conventional sonography were calculated.

Results

Elastography showed less sensitivity but higher specificity than conventional sonography in the differentiation of benign from malignant solid lesions: B-mode sonography had sensitivity of 85.1%, specificity of 93.9%, a positive predictive value of 92.5% and a negative predictive value of 87.8%, compared with the sensitivity of 80.1%, specificity of 97.1%, a positive predictive value of 96.8% and a negative predictive value of 82.1% for elastography. Elastography was superior to B-mode US in diagnosing solid lesions in the low density group (D1) (96.6% vs. 92.4% specificity) and less in the dense glandular tissue (97.8% vs. 95.9% specificity).

Conclusions

Real-time sonoelastography is an useful technique for the characterization of benign and malignant solid lesions as it increases the diagnostic specificity comparable to B-mode ultrasound, particularly in both ACR 1 and 2, thus reducing the false-positive rate.     

COVID-19 pneumonia—ultrasound,radiographic, and computed tomography findings: a comprehensive pictorial essay

Emergency Radiology - Ultrasound, chest X-ray, and computed tomography (CT) have been used with excellent results in diagnosis, first assessment, and follow-up of COVID-19 confirmed and suspected...     

Does a joint ultrasound guided cytology clinic optimize the cytological evaluation of head and neck masses?

AIM: To compare the results of fine-needle aspiration (FNA) of head and neck masses performed in an ultrasound-guided cytology clinic (USGCC) staffed by a radiologist and pathologist to those obtained with specimens sent from other sources. METHODS: Comparison of broad-category FNA diagnoses (malignant, uncertain, benign or inadequate) with the patient's ultimate clinical or pathological outcome. Because FNA outcomes are semi-quantitative, accuracy of the procedure (the proportion of all tests resulting in a true- positive or negative fine-needle aspirate) is a better measure than sensitivity or specificity. Specimens (n = 292) from the first 2 years of the USGCC are compared with 600 specimens received from other sources over the previous 4 years. RESULTS: Accuracy was 23.4% better for specimens from the USGCC compared with those obtained by clinician guided aspiration (83.9%, 95% CI 79.7-88.1%, vs 60.5%, 95% CI 56.6-64.4%). There was an 84% reduction in inadequate specimens (from 21.5% to 3.4%). The proportion resulting in an uncertain result did not alter; 12.0% for USGCC and 11.9% for clinician-derived specimens. Improvement in accurate identification of salivary gland, lymph node, soft tissue and thyroid pathology was 27.0%, 21.2%, 18.3% and 15.8% respectively. CONCLUSIONS: The common practice of FNA performed by clinicians produces sub-optimal results in head and neck masses. A combined approach of ultrasound-guided fine-needle aspiration of head and neck masses, with immediate assessment of the material by a pathologist, is more accurate than with specimens obtained in other ways. If the results of FNA are to be incorporated into clinical decision making, the samples are best obtained using the USGCC model.     

Carotid stenosis in the real world--can Doppler ultrasound replace angiography in a district general hospital setting?

Large trials have confirmed the benefit of carotid endarterectomy in the prevention of stroke in patients with transient ischaemic attacks and > or =70% stenosis of the ipsilateral internal carotid artery. Invasive confirmatory angiography carries some risk, but these patients can be identified by Doppler ultrasound. Non-invasive confirmatory testing with spiral computed tomographic angiography or magnetic resonance angiography is not easily available in many hospitals. In this study, criteria have been developed for use in this unit to identify significant carotid artery stenosis and enable selection for surgery after Doppler ultrasound alone, with known degrees of sensitivity, specificity and accuracy. Carotid arteriography is reserved for a minority of cases.     

Popliteal artery–tibial plateau relationship before and after total knee replacement: a prospective ultrasound study

It seems to be a general belief that knee flexion releases the tension on the popliteal artery (PA) and displaces it posteriorly. Furthermore, there are opinions suggesting that previous surgery may result in fibrosis and rigidity of the vessels in the posterior knee region, which can lead to tethering of the PA, bringing it closer to the posterior tibia and making it more vulnerable during revision knee surgery. The aim of this study was to assess the distance between the PA and the tibial plateau in extension and flexion of the knee before and after surgery with total knee replacement (TKR). We studied 40 consecutive patients who were about to undergo TKR. The distance between the PA and tibial plateau was measured by ultrasound bilaterally in full knee extension without quadriceps contraction and in 90° knee flexion, both preoperatively and 15 weeks postoperatively. The mean preoperative distances in flexion and in extension were 7 mm (3–12) and 8 mm (4–13), respectively (p < 0.05). Postoperatively, the distances were significantly increased both in flexion, 9 mm (4–14) (p < 0.001) and in extension 9 mm (3–15) (p < 0.01). Assessment of the contralateral legs where 14 previously had been operated with TKR showed no significant difference either between flexion and extension or between pre- and postoperative measurements. In conclusions, knee flexion does not increase the distance between the artery and the proximal tibia in this osteoarthritis patient group. At 15 weeks post-TKR, there was an increased distance from the PA to the posterior tibia and assessment of the contralateral knee where previous TKR had been performed showed equal distance to the ipsi-lateral preoperative knee, suggesting that the postoperative changes at 15 weeks were due to capsular swelling.     

Ultrasound during dissection of cadaveric specimens: a new method for obtaining ultrasound–anatomic correlations in musculoskeletal radiology

We report a new technique for ultrasound–anatomic correlations consisting of dissection of embalmed specimens during ultrasound examination. Our method consists of performing ultrasound during the different stages of dissection. The technique was developed by making observations of selected structures in two embalmed and two non-embalmed cadaver hands. The image quality was subjectively graded by consensus of two investigators, before and after denudation of the selected structures of the hand. As an example, the technique is demonstrated for the flexors at the metacarpophalangeal joint level, the extensor complex at the level of the proximal phalanx, and the dorsal hood of the second to fourth fingers. Before dissection the image quality in fresh specimens was graded moderate, and in embalmed specimens good. After dissection the image quality was good in fresh specimens and excellent in embalmed specimens. Our method is simple and does not require sophisticated material. Our results indicate that embalmed specimens could be better than non-embalmed specimens, because of the presence of artefacts in the non-embalmed specimens (gas deposits). The described methodology can yield excellent results regarding precise identification of different interfaces and structures, as observed at ultrasound.