Can diffusion weighted image and apparent diffusion coefficient (ADC) differentiate benign from malignant cervical adenopathy?

Background

Cervical adenopathy is a common problem and the differentiation of benign and malignant node is of crucial importance for therapy management.

Objective

This prospective study aimed to know if Diffusion weighted images (DWI) and apparent diffusion coefficient (ADC) can differentiate benign from malignant cervical lymphadenopathy.

Patients and methods

Thirty patients with cervical adenopathy were included in this study. Doppler ultrasound, DWI and ADC maps were automatically reconstructed and used for the measurement of ADC values.

Results

The sensitivity and specificity of the RI cut-off value <0.69 in differentiation between benign and malignant cervical L.Ns was 88.8% and 71.4%, respectively. The optimal ADC cut off value for differentiation between benign and malignant lymph nodes was ?1.0 × 10⁻³ mm²/s with an accuracy 96.7%, a sensitivity 100%, a specificity 88.9%, PPV 95.4% and NPV 100% and statistically significant P-value = 0.000.

Conclusion

DWI and ADC were useful for differentiation between benign and malignant cervical lymphadenopathy and recommended to decrease the need of invasive biopsies. However, CDUS techniques can be used as preliminary technique but, they had potential pitfalls in diagnosis of malignant cervical lymphadenopathy cases.     

Can ultrasound elastography distinguish metastatic from reactive lymph nodes in patients with primary head and neck cancers?

Objectives

The purpose of this study was to evaluate the diagnostic utility of real-time elastography (RTE) in differentiating between reactive and metastatic cervical lymph nodes (LN) in patients with primary head and neck cancer in comparison with the conventional B mode and power Doppler parameters.

Methods

A total of 127 lymph nodes in 78 patients with primary head and neck cancer were examined by B-mode sonography, power Doppler ultrasound and elastography. Elastographic patterns were determined on the distribution and percentage of the lymph node area with low elasticity (hard), with pattern 1 being an absent or very small hard area to pattern 5, a hard area occupying the entire lymph node. Patterns 3–5 were considered metastatic. Ultrasound guided aspiration cytology was done for 57 lymph nodes. Excision biopsy was done for 52 lymph nodes. Eighteen lymph nodes responded to conservative treatment, and were considered reactive.

Results

The majority (85.3%) of the metastatic lymph nodes had elastography pattern 3–5. This finding was observed in only 5% of the benign lymph nodes (P < 0.001). The elastography pattern had sensitivity of 85.3%, specificity of 95.5%, PPV of 97.2%, NPV of 78.1% and overall accuracy of 88.9% in differentiation between benign and malignant lymph nodes. On the other hand, for the B mode criteria, the best accuracy was given to abnormal hilum (83%). The accuracy of power Doppler ultrasound pattern was 70.8%.

Conclusions

The accuracy of sonoelastography is higher than usual B mode and power Doppler ultrasound parameters in differentiation between benign and malignant nodes. The integration of lymph node sonoelastography in the follow up of patients with known head and neck cancer may reduce the number of biopsies.     

Clinical utility of three-dimensional contrast-enhanced ultrasound in the differentiation between noninvasive and invasive neoplasms of urinary bladder

Objectives

The purpose of this study was to evaluate the effectiveness of three-dimensional contrast-enhanced ultrasound in differentiating invasive and noninvasive neoplasms of urinary bladder.

Methods

A total of 60 lesions in 60 consecutive patients with bladder tumors received three dimensional ultrasonography, low acoustic power contrast enhanced ultrasonography and low acoustic power three-dimensional contrast-enhanced ultrasound examination. The IU22 ultrasound scanner and a volume transducer were used and the ultrasound contrast agent was SonoVue. The contrast-specific sonographic imaging modes were PI (pulse inversion) and PM (power modulation). The three dimensional ultrasonography, contrast enhanced ultrasonography, and three-dimensional contrast-enhanced ultrasound images were independently reviewed by two readers who were not in the images acquisition. Images were analyzed off-site. A level of confidence in the diagnosis of tumor invasion of the muscle layer was assigned on a 5° scale. Receiver operating characteristic analysis was used to assess overall confidence in the diagnosis of muscle invasion by tumor. Kappa values were used to assess inter-readers agreement. Histologic diagnosis was obtained for all patients.

Results

Final pathologic staging revealed 44 noninvasive tumors and 16 invasive tumors. Three-dimensional contrast-enhanced ultrasound depicted all 16 muscle-invasive tumors. The diagnostic performance of three-dimensional contrast-enhanced ultrasound was better than those of three dimensional ultrasonography and contrast enhanced ultrasonography. The receiver operating characteristic curves were 0.976 and 0.967 for three-dimensional contrast-enhanced ultrasound, those for three dimensional ultrasonography were 0.881 and 0.869, those for contrast enhanced ultrasonography were 0.927 and 0.929. The kappa values in the three dimensional ultrasonography, contrast enhanced ultrasonography and three-dimensional contrast-enhanced ultrasound for inter-reader agreements were 0.717, 0.794 and 0.914.

Conclusion

Three-dimensional contrast-enhanced ultrasound imaging, with contrast-enhanced spatial visualization is clinical useful for differentiating invasive and noninvasive neoplasms of urinary bladder objectively.     

The value of strain ratio in differential diagnosis of thyroid solid nodules

Objective

To assess the clinical value of strain ratio in differentiating thyroid solid nodules and explore its distribution characters based on pathological results.

Materials and methods

The study was approved by the ethic committee and the informed consents were signed. Ninety nine solid thyroid nodules (67 benign and 32 malignant) from 71 female (mean age 46.3 ± 9.8 years) and 28 male (mean age 54.9 ± 11.7 years) patients were evaluated. Five radiologists evaluated the nodules based on a four-degree elastography score system. Strain ratio was calculated on-line. Diagnostic performances of the two evaluations were compared using Receiver Operating Characteristic (ROC) curves. Values of different pathological nodules were compared by one-way ANOVA.

Results

Areas under the ROC curve (AUC) of the five readers were 0.82, 0.81, 0.79, 0.73 and 0.83, respectively. The AUC of strain ratio evaluation was higher (0.88 vs. 0.79, p < 0.001) than that of the ES score evaluation. Best cut-off points of the two evaluations were 3.5 (82% sensitivity, 72% specificity) and 4.225 (81% sensitivity, 83% specificity), respectively. Both the ES score and strain ratio were higher for malignant nodules than that for benign ones (p < 0.001).

Conclusions

Strain ratio was a useful index in differential diagnosis of thyroid solid nodules. It can provide quantitative information on thyroid nodule characterization and improve diagnostic confidence. The best cut-off point for benign and malignant nodules was 4.2.     

Evaluation of the role of sono-elastography in diagnosis of enlarged cervical lymph nodes

Purpose

Evaluation of the role of real-time elastography in differentiating between benign and malignant cervical lymph nodes (LNs), comparison with B-mode and Doppler Ultrasonography.

Comparison between ultrasonography and MR imaging for discriminating squamous cell carcinoma nodes with extranodal spread in the neck

Objective

To compare the diagnostic ability of ultrasonography (US) and MR imaging for discriminating squamous cell carcinoma (SCC) nodes with extranodal spread (ENS) in the neck.

Methods

US and MR imaging was retrospectively evaluated for differentiating ENS-positive (n = 28) from ENS-negative (n = 26) SCC nodes (>10 mm short-axis diameter) in 50 patients with head and neck SCCs. We assessed nodal size on US and MR images; irregular nodal margin on US; and vanishing nodal border, flare, and shaggy nodal margin signs on T1-, fat-suppressed T2-, and contrast-enhanced T1-weighted MR images, respectively. US and MR images were analyzed by 3 radiologists in consensus and the results were compared between ENS-positive and ENS-negative SCC nodes.

Results

The nodal sizes of ENS-positive nodes (21 ± 9 mm) were significantly larger than those of ENS-negative SCC nodes (14 ± 4 mm) (p < 0.001). Irregular nodal margins were more frequently observed in ENS-positive SCC nodes (75%) than in ENS-negative SCC nodes (12%). The vanishing nodal margin, flare, and shaggy nodal margin signs were more frequently observed in ENS-positive SCC nodes (93%, 89%, and 82%, respectively) than in ENS-negative nodes (46%, 19%, and 19%, respectively). A combination of size (≥22 mm) and imaging criteria (irregular margin or flare sign) best discriminated ENS-positive SCC nodes with 82% sensitivity, 89% specificity, and 85% accuracy for US and 89% sensitivity, 81% specificity, and 85% accuracy for MR imaging.

Conclusion

US discriminated ENS-positive from ENS-negative SCC nodes with comparable accuracy and higher specificity than MR imaging.     

Power Doppler sonography: Anything to add to BI-RADS US in solid breast masses?

Objective

To evaluate the contribution of power Doppler ultrasonography (PDUS) to breast imaging reporting and data system ultrasonography (BI-RADS US) categorization of solid breast masses.

Materials and methods

Totally 94 solid lesions with histopathological results in 49 patients were included in the study. US features of the lesions were classified according to American College of Radiologists (ACR) BI-RADS US lexicon. Lesions were evaluated qualitatively according to their PDUS properties and quantitatively with spectral analysis. Hypervascularity, penetration of vessels into the mass or branching-disordered course and resistivity index values higher than 0.85 were accepted as probable malignant criteria.

Results

Fifty-five of 94 lesions were benign (58.5%), while 39 (41.5%) were malignant histopathologically. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of US and PDUS in the diagnosis of malignant lesions were 100%, 58.2%, 62.9%, 100% and 71.8%, 81.8%, 73.7%, 80.4%, respectively. Criteria used for the distinction of malignant and benign lesions like number of vessels (p < 0.05), distribution of tumoral vessels, morphology of vessels and resistivity index values higher than 0.85 showed statistically significant difference (p < 0.001). When sonographic findings were combined with PDUS and spectral analysis findings, sensitivity, specificity, PPV and NPV were 100%, 52.7%, 60% and 100%, respectively.

Conclusion

PDUS and spectral analysis have no contribution to BI-RADS US. For the spectral analysis, when RI value is one or greater, malignancy risk significantly increases.     

Diagnostic accuracy of diffusion weighted MRI in cervical lymphadenopathy cases correlated with pathology results

Introduction

Diffusion weighted magnetic resonance imaging (DW MRI) is an imaging technique showing molecular diffusion. Cell size, density and integrity influence the signal intensity seen on diffusion-weighted images. This technique is a helpful complementary tool to distinguish tumoral from non tumoral tissue.The aim of this prospective study is to define the diagnostic accuracy of DWI to differentiate benign from malignant cervical lymph nodes.

Patients and methods

Twenty six patients who presented with 32 nodes were included in this study, 9 males (35.6%) and 17 females (65.4%). Their age ranged from: 6 to 76 years, mean age 45 ± 18.8 years referred to the radiology department of NCI, complaining of neck swelling, ultrasound showed cervical nodes.

Results

According to histopathological analysis we divided the examined lymph nodes (n = 32) into 2 categories: malignant lymph nodes 75% (n = 24) benign lymph nodes 25% (n = 8). DWI and ADC (apparent diffusion coefficient) values revealed 27 malignant lesions (84%), 5 benign (16%). The accuracy of the DWMRI was 89%. A significant difference between benign and malignant cervical nodes on DWI and on ADC maps is reported.The results obtained were 24 true positive, 3 false positive, 5 true negative. No false negative cases were identified, yielding a sensitivity of 100%, specificity of 62.5%, NPV = 100% and PPV = 89%. The difference between the mean ADC values between benign and malignant lesions was statistically significant (P < 0.0001).

Conclusion

MR diffusion imaging could be an important supportive tool in differentiation between benign and malignant lymph nodes, can to a lesser extent differentiate between the types of malignant lymphadenopathy and can be used as an indicator for improvement and recurrence post chemo and radiotherapy.     

Combined sonoelastographic scoring and strain ratio in evaluation of breast masses

Aim of the work

To detect the diagnostic performance of the combined use of sonoelastographic scoring and strain ratio in differentiation of benign and malignant breast masses with the histopathology is the standard reference.

Patients and methods

One hundred and seventy-two women with 190 breast masses were enrolled in this prospective study. Conventional US (B-mode and color Doppler US) and sonoelastography (elasticity score “ES” and calculation of strain ratio “SR”) were performed. B-mode images were classified according to the Breast Imaging Recording and Data System. The hardness was determined with 5-point scoring method and SRs of the lesions were calculated. Receiver operating characteristic (ROC) curves were performed and the cutoff point for differentiation of benign and malignant masses was detected.

Results

There was a significant difference (P = 0.02) in the mean SRs between benign and malignant breast masses. The area under the curve (AUC) for combination of ES and SR (0.964) was higher than for ES alone (0.852) and B-mode US (0.823). A cutoff value of 3.6 for the SR allowed the best differentiation of benign and malignant breast lesions.

Conclusion

The combined use of elasticity score and strain ratio of sonoelastography increased the diagnostic performance in distinguishing benign from malignant breast masses.     

Vascular patterns in nodules of intraductal papillary mucinous neoplasms depicted under contrast-enhanced ultrasonography are helpful for evaluating malignant potential

Objectives

The purpose of this study is to evaluate the feasibility of contrast-enhanced ultrasonography (CE-US) to differentiate between benign and malignant intraductal papillary mucinous neoplasms (IPMN).

Patients and methods

Contrast-enhanced ultrasonography with a contrast agent was performed on 22 consecutive patients with IPMN suspected of being malignant. This revealed 10 carcinomas, 1 borderline lesion and 11 adenomas. All patients underwent surgery, and the histological diagnosis was confirmed by examination of resected specimens. CE-US was performed using a contrast agent. The detection rates of mural nodules were compared between CE-US and contrast-enhanced computed tomography (CE-CT), and the imaging of mural nodules depicted under CE-US was analyzed.

Results

Seventeen of 22 resected specimens (77.3%) had mural nodules. There was no significant difference in the detection rate between CE-US (n = 15; 88.2%) and CE-CT (n = 12; 70.6%). In 12 (80.0%) of these patients, CE-US revealed small vessels in the mural nodule. The spotty or linear-shaped pattern was detected in 4 patients and the branch-shaped pattern in 8. The branch-shaped pattern lesion was associated with carcinoma. These mural nodules were 10 mm or more in height. In the perfusion image phase, cystic walls and mural nodules were also enhanced in all cases.

Conclusion

The vessel shapes of the mural nodules depicted under CE-US were associated with size and pathological findings. These results suggested that CE-US with a contrast agent is a powerful modality with which to evaluate the malignant potential of IPMN.     

Value of contrast-enhanced sonographic micro flow imaging for prostate cancer detection with t-PSA level of 4-10ng/mL

Objectives

To compare the efficiency of contrast-enhanced ultrasonographic micro flow imaging (MFI) with conventional transrectal ultrasound (TRUS) in detecting prostate cancer with serum total prostate-specific antigen (t-PSA) of 4.0–10.0 ng/mL. To evaluate the value of contrast-enhanced ultrasonographic MFI in detecting prostate cancer with t-PSA in diagnostic gray zone.

Methods

47 patients with t-PSA 4.0–10.0 ng/mL underwent gray scale, power Doppler TRUS and MFI examinations before ultrasound guided biopsies. Biopsies were performed at twelve sites in the base, the mid-gland and the apex of the prostate in each patient, when there was no abnormal ultrasound finding. When an abnormality was present at MFI, the biopsy specimen from the corresponding site was directed toward the abnormal finding. With histological results of prostate biopsy as reference standards, we assessed the cancer detection of these three methods.

Results

564 specimens were collected in this study, in which 101 were prostate cancer confirmed histologically. 152 of 564 specimens were demonstrated abnormal on MFI images, in which 71 were malignant and 81 were benign confirmed histologically. The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) for MFI in detecting prostate caner were 70.3%, 82.5%, 80.3%, 46.7% and 92.7%, respectively. The sensitivity and NPV for MFI were significantly better than gray scale (38.6%, 86.9%) and power Doppler (32.7%, 86.0%) (P < 0.001) TRUS.

Conclusions

Contrast-enhanced ultrasonographic MFI could significantly improve the detection rate of prostate cancer with t-PSA in diagnostic gray zone (4–10 ng/mL) than conventional ultrasound.     

Diagnostic value of chemical shift artifact in distinguishing benign lymphadenopathy

Purpose

Today, distinguishing metastatic lymph nodes from secondary benign inflammatory ones via using non-invasive methods is increasingly favorable. In this study, the diagnostic value of chemical shift artifact (CSA) in magnetic resonance imaging (MRI) was evaluated to distinguish benign lymphadenopathy.

Subjects and methods

A prospective intraindividual internal review board-approved study was carried out on 15 men and 15 women having lymphadenopathic lesions in different locations of the body who underwent contrast-enhanced dynamic MR imaging at 1.5 T. Then, the imaging findings were compared with pathology reports, using the statistics analyses.

Results

Due to the findings of the CSA existence in MRI, a total of 56.7% of the studied lesions (17 of 30) were identified as benign lesions and the rest were malignant, whereas the pathology reports distinguished twelve malignant and eighteen benign cases. Furthermore, the CSA findings comparing the pathology reports indicated that CSA, with confidence of 79.5%, has a significant diagnostic value to differentiate benign lesions from malignant ones.

Conclusion

Our study demonstrated that CSA in MR imaging has a suitable diagnostic potential nearing readiness for clinical trials. Furthermore, CSA seems to be a feasible tool to differentiate benign lymph nodes from malignant ones; however, further studies including larger numbers of patients are required to confirm our results.     

Characterization of breast lesions with CE-MR multimodal morphological and kinetic analysis: comparison with conventional mammography and high-resolution ultrasound

Objective

Evaluation of the diagnostic value of magnetic resonance mammography and comparison with conventional mammography and ultrasonography in cases of women with suspicious breast lesions.

Subjects and methods

Sixty-nine women (age range 39–68 years) with 78 focal breast lesions were examined with mammography, ultrasonography and dynamic magnetic resonance mammography. The lesions were classified according to the Breast Imaging Reporting and Data System (BI-RADS) lexicon of the American College of Radiology for each diagnostic method. Histological reports were available after biopsy or surgical excision of the lesions.

Results

Pathological examination confirmed that 53 lesions were malignant and 25 benign. Conventional mammography estimated a total of 59/78 lesions as malignant with 44 true positive lesions, ultrasonography estimated a total of 50/78 lesions as malignant with 44 true positive lesions and magnetic resonance mammography estimated a total of 66/78 lesions as malignant with 52 true positive lesions. Sensitivity and specificity of magnetic resonance mammography in the diagnosis of malignancy was 98.1% and 44%, of conventional mammography 83% and 40% and of ultrasonography 83% and 76%. Negative predictive value for magnetic resonance mammography was 91.7%, for ultrasonography 67.9% and for mammography 52.6% for malignancies.

Conclusion

Magnetic resonance mammography has the highest negative predictive value compared with mammography and ultrasound in cases of suspicious breast lesions. The combination of morphologic and enhancement criteria can improve the diagnostic capability of magnetic resonance mammography (MRM) in breast lesion characterization.     

Value of combined real time sonoelastography and apparent diffusion coefficient value measurement in differentiation of enlarged neck lymph nodes

Purpose

To evaluate the role of real-time sonoelastography (UE) and apparent diffusion coefficient (ADC) value measurement in differentiating benign versus malignant enlarged neck lymph nodes.

Materials and methods

This study included 26 patients presented with 32 enlarged neck lymph nodes (LNs), underwent real-time UE and diffusion weighted MRI (DWI). ADC maps are generated from DWI and ADC values were calculated. Both UE and ADC findings were compared with histopathological results.

Results

The LNs were 12 benign lymphadenopathy (37.5%, seen in 10 patients), 10 metastatic (31.25% seen in 8 patients) and 10 lymphoma (31.25%, seen in 8 patients) including 4 LNs with Hodgkin’s lymphoma (HL, seen in 3 patients) and 6 LNs with non Hodgkin’s lymphoma (NHL, seen in 5 patients). On UE 10 of the 12 benign LNs had pattern of 1–2 (83.3%) and 18 of 20 neoplastic LNs (90%) had pattern of 4–5. The mean ADC values of the benign, metastases and lymphoma groups were 1.52 ± 0.37, 0.90 ± 0.15 and 0.72 ± 0.12 × 10⁻³ (mm²/s), respectively.

Conclusion

Combined real-time UE and ADC value measurement are non invasive techniques useful for differentiation of enlarged neck lymph. The combination potentially could reduce unnecessary biopsy especially for elasticity pattern 1–2.     

Use of fusion imaging combining contrast-enhanced ultrasonography with a perflubutane-based contrast agent and contrast-enhanced computed tomography for the evaluation of percutaneous radiofrequency ablation of hypervascular hepatocellular carcinoma

Objective

We evaluated the efficacy of fusion imaging, which fuses contrast-enhanced ultrasonography images with arterial-phase, contrast-enhanced CT images as a reference on a single screen in real time, for the evaluation of the effectiveness of radiofrequency ablation for treatment of hypervascular hepatocellular carcinoma.

Materials and methods

Eighty hepatocellular carcinoma lesions with a maximum diameter of between 1 and 3 cm that were scheduled for treatment with radiofrequency ablation were enrolled in this prospective study. After bolus injection of perflubutane-based contrast agent, fusion imaging combining contrast-enhanced ultrasonography images and arterial-phase, contrast-enhanced CT images was performed one day after radiofrequency ablation. We used two functions, which were subsets of the fusion imaging, to confirm the location of the hepatocellular carcinoma lesions in the ablated areas and to evaluate the presence or absence of an adequate safety margin. Contrast-enhanced CT was performed one month after the ablation. Two blinded observers reviewed the images obtained using both modalities to evaluate the effect of ablation.

Results

When the one-month contrast-enhanced CT images were used as the reference standard, the sensitivity, specificity, and accuracy of the one-day fusion imaging for the diagnosis of adequate ablation were 97%, 83%, and 96%, respectively; the kappa value for the agreement between the findings obtained using the two modalities was 0.75.

Conclusion

Fusion imaging combining contrast-enhanced ultrasonography images and arterial-phase, contrast-enhanced CT images as a reference appears to be a useful method for the early evaluation of the efficacy of radiofrequency ablation for the treatment of hypervascular hepatocellular carcinoma.     

Regional nodal staging with 18F-FDG PET-CT in non-small cell lung cancer: Additional diagnostic value of CT attenuation and dual-time-point imaging

Background

[Fluorine-18]-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET–CT) is widely performed in the regional nodal staging of non-small cell lung cancer (NSCLC). However, the uptake of ¹⁸F-FDG by tubercular granulomatous tissues may lead to false-positive diagnosis. This is of special concern in China, where tubercular granulomatous disease is epidemic. Herein, we evaluated the efficacy of an additional CT attenuation and a dual-time-point scan in determining the status of lymph nodes.

Methods

Eighty NSCLC patients underwent curative surgical resection after ¹⁸F-FDG PET–CT and separate breath-hold CT examinations. The initial images were analyzed by two methods. In method 1, nodal status was determined by ¹⁸F-FDG uptake only. In Method 2, nodal status was determined by ¹⁸F-FDG uptake associated with CT attenuation. For dual-time-point imaging, the retention index (RI) of benign and malignant nodal groups with positive uptake in the initial scan was examined.

Results

A total of 265 nodal groups were documented. On a per-nodal-group basis, the diagnostic sensitivity, specificity, and accuracy of Method 1 were 66.7%, 89.7%, and 85.3%, respectively, whereas those of Method 2 were 64.7%, 96.7%, and 90.6%, respectively. The improvement in diagnostic specificity and accuracy associated with the addition of CT attenuation in Method 2 as compared to Method 1 was statistically significant (p < 0.01). Thirty-nine nodal groups with positive uptake in the initial scan underwent dual-time-point imaging and the difference in the RI between benign and malignant groups showed no statistical significance (p > 0.05).

Conclusion

¹⁸F-FDG PET–CT has high diagnostic value for preoperative lymph-node (N) staging of NSCLC patients. We show that ¹⁸F-FDG uptake combined with CT attenuation improves the diagnostic specificity and accuracy of nodal diagnosis in NSCLC. For the lymph nodes with positive uptake in the initial scan, dual-time-point imaging has limited effect in differentiation.     

Gray-scale contrast-enhanced utrasonography in detecting sentinel lymph nodes: An animal study

Objective

To investigate the usefulness of gray-scale contrast-enhanced ultrasonography for detecting sentinel lymph nodes.

Methods

Contrast-enhanced ultrasonography was performed in five normal dogs (four female and one male) after subcutaneous administration of a sonographic contrast agent (Sonovue, Bracco, Milan, Italy). Four distinct regions in each animal were examined. After contrast-enhanced ultrasonography, 0.8 ml of blue dye was injected into the same location as Sonovue and the sentinel lymph nodes were detected by surgical dissection. The findings of contrast-enhanced ultrasonography were compared with those of the blue dye.

Results

Twenty-one sentinel lymph nodes were detected by contrast-enhanced ultrasonography while 23 were identified by blue dye with surgical dissection. Compared with the blue dye, the detection rate of enhanced ultrasonography for the sentinel lymph nodes is 91.3% (21/23). Two patterns of enhancement in the sentinel lymph nodes were observed: complete enhancement (5 sentinel lymph nodes) and partial enhancement (16 sentinel lymph nodes). The lymphatic channels were demonstrated as hyperechoic linear structures leading from the injection site and could be readily followed to their sentinel lymph nodes. Histopathologic examination showed proliferation of lymphatic follicles or lymphatic sinus in partial enhanced sentinel lymph nodes while normal lymphatic tissue was demonstrated in completely enhanced sentinel lymph nodes.

Conclusions

Sonovue combined with gray-scale contrast-enhanced ultrasonography may provide a feasible method for detecting sentinel lymph nodes.     

Diagnostic performance of combined elastosonography scoring and high-resolution ultrasonography for the differentiation of benign and malignant thyroid nodules

Aim

To evaluate the diagnostic performance of the combined use of elstosonography (USE) scoring and high-resolution ultrasonography (HRUS) for the differentiation of benign and malignant thyroid nodule.

Patients and methods

Forty-seven consecutive patients with 66 thyroid nodules were enrolled in the present study. Thyroid surgery had been already planned for all the patients. All of them were submitted to high-resolution ultrasonography and elastography scoring at the same sitting. The latter was determined with 5-point scoring method. The examination results were compared against pathological findings as the gold standard of reference.

Results

The sensitivity, specificity, accuracy, positive predictive, and negative predictive values of HRUS in the differential diagnosis of thyroid nodules were 92.0%, 72.9%, 60.1%, 95.0%, and 63.1%, respectively, while that of ultrasound elastography scoring were 75.4%, 85.5%, 86.7%, 71.4%, and 90.5%, respectively. Combined use of both US techniques resulted in a higher diagnostic performance as it showed 95.4%, 94.8%, 95.2%, 82.3% and 98.8% sensitivity, specificity, accuracy, positive predictive, and negative predictive values, respectively.

Conclusions

The use of combined USE and HRS for the differentiation of benign and malignant thyroid nodules resulted in a high diagnostic performance and a significant statistical difference as compared to HRUS or USE alone (P = 0.003).     

Incremental value of real-time ultrasound elastography in differentiating breast masses

Aim of the work

To evaluate the value of real-time ultrasound elastography (RTE) in differentiating benign from malignant breast masses.

Materials and methods

This study included, whether palpable or non-palpable, 145 sonographically proven breast masses in 121 patients, imaged by conventional B-mode US, color-flow Doppler US and RTE with histopathological analysis considered as the golden standard reference.

Results

Lesions were differentiated into benign and malignant by conventional B-mode US (79; 45.5% and 66; 54.5%, respectively), RTE (80; 55.2% and 65; 44.8% respectively), and histopathology (82; 56.6% and 63; 43.4%, respectively). The mean difference in the mass size was significant between B-mode US and RTE in malignant masses (P = 0.002), while not significant among benign masses (P = 0.153). The B-mode US depicted sensitivity of 92.06%, specificity of 90.24%, PPV of 87.88%, NPV of 93.67% and accuracy of 91.03%, while the RTE showed sensitivity of 98.41%, specificity of 96.34%, PPV of 95.38%, NPV of 98.75% and accuracy of 97.24%.

Conclusion

Combined use of RTE can complement conventional B-mode US with improving its diagnostic performance in differentiating breast lesions with subsequent reduction in the rate of unnecessary biopsies in benign lesions.     

Real-time contrast-enhanced ultrasound in diagnosing of focal spleen lesions

Objective

To investigate the features of focal spleen lesions (FSLs) on contrast-enhanced ultrasound (CEUS) imaging.

Materials and methods

CEUS with a blot injection of SonoVue was performed in 48 patients with 75 FSLs (median diameter 2.6 cm) and their perfusion characteristics were analyzed by using contrast pulse sequences (CPS) technique.

Results

Among 19 malignant lesions (10 metastases, 7 lymphoma, 1 hemangiosarcoma, 1 epithelioid hemangioendothelioma) and 56 benign lesion (23 hemangiomas, 14 cysts, 8 infarctions, 4 splenic ruptures, 3 tuberculosis, 2 abscess, 1 pseudoaneurysm, 1 lymphangioma), 25 benign lesions were demonstrated nonenhancement. For malignancy, 50.0% (5/10) metastases and 57.1% (4/7) lymphomas were showed hypoenhancement in the arterial phase, and 18 (94.7%) of malignant lesions were hypo-enhancement in the parenchymal phase. Among 31 benign lesions with enhancement, 27 (87.1%) were showed isoenhancement or hyperenhancement in the arterial phase and 22 (71.0%) lesions were isoenhancement or hyperenhancement in the parenchymal phase. The sensitivity, specificity and accuracy of diagnosis for FSLs were 91.1%, 95.0% and 92.0% for CEUS and 75.0%, 84.2% and 77.3% respectively, for the conventional baseline ultrasound (BUS).

Conclusion

Real-time CEUS can provide valuable information for the diagnosis and differential diagnosis of FSLs.