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Up-to-date Doppler techniques for breast tumor vascularity: superb microvascular imaging and contrast-enhanced ultrasound.

Ah Young PARK ; Bo Kyoung SEO

Ultrasonography.2018;37(2):98-106. doi:10.14366/usg.17043

Ultrasonographic Doppler techniques have improved greatly over the years, allowing more sophisticated evaluation of breast tumor vascularity. Superb microvascular imaging (SMI) and contrast-enhanced ultrasound (CEUS) with second-generation contrast agents are two representative up-to-date techniques. SMI is a sensitive Doppler technique that adopts an intelligent filter system to separate low-flow signals from artifacts. With the development of second-generation contrast agents, CEUS has also emerged as a useful Doppler technique for evaluating tumor microcirculation. Both techniques can improve the diagnostic performance of gray-scale ultrasonography by providing vascular information useful not only for the morphologic assessment of microvessels, but also for the quantitative analysis of perfusion. In this review, we explain the imaging principles and previous research underlying these two vascular techniques, and describe our clinical experiences.
Artifacts ; Breast Neoplasms* ; Breast* ; Contrast Media ; Microcirculation ; Microvessels ; Perfusion ; Ultrasonography* ; Ultrasonography, Doppler

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The efficacy and safety of high-intensity focused ultrasound ablation of benign thyroid nodules.

Brian H LANG ; Arnold L H WU

Ultrasonography.2018;37(2):89-97. doi:10.14366/usg.17057

High-intensity focused ultrasound (HIFU) is a promising form of thermal ablation of benign thyroid nodules, but evidence supporting its use is scarce. The present review evaluated the efficacy and safety of single-session HIFU treatment of benign thyroid nodules. As reported in the literature, the extent of nodule shrinkage following treatment ranged from 48.8% to 68.8%. Like other forms of ablation, the shrinkage rate was greatest in the first 3-6 months, and the best responders were patients with small (≤10 mL) nodules. Complications were uncommon, but temporary vocal cord palsy occurred in 3%-4% of patients, and was related to the distance between the HIFU beam and the recurrent laryngeal nerve. Despite being safe and efficacious, a larger-scale prospective trial is required.
Ablation Techniques ; Goiter, Nodular ; High-Intensity Focused Ultrasound Ablation* ; Humans ; Hyperthermia, Induced ; Prospective Studies ; Recurrent Laryngeal Nerve ; Thyroid Gland* ; Thyroid Nodule* ; Ultrasonography ; Ultrasonography, Interventional ; Vocal Cord Paralysis

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Diagnosing ectopic pregnancy in the emergency setting.

Robert LEE ; Carolyn DUPUIS ; Byron CHEN ; Andrew SMITH ; Young H KIM

Ultrasonography.2018;37(1):78-87. doi:10.14366/usg.17044

Ectopic pregnancy is the implantation of a fertilized egg outside the uterine endometrial cavity. For women presenting to the emergency department with abdominal pain and/or vaginal bleeding, ectopic pregnancy is an important diagnostic consideration. The diagnosis is made based on laboratory values and ultrasound imaging findings. The ultrasound appearance of both normal early pregnancy and ectopic pregnancy are variable and often subtle, presenting diagnostic challenges for radiologists. This pictorial essay describes and illustrates the sonographic findings of ectopic pregnancy and reviews the differential diagnoses that can mimic ectopic pregnancy on ultrasound. With the possibility of medical management, the value of early detection and prompt initiation of treatment has increased in improving clinical outcomes and preventing the complications of ectopic pregnancy.
Abdominal Pain ; Diagnosis ; Diagnosis, Differential ; Emergencies* ; Emergency Service, Hospital ; Female ; Humans ; Methotrexate ; Pregnancy ; Pregnancy, Ectopic* ; Ultrasonography ; Uterine Hemorrhage ; Zygote

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Ultrasonographic features differentiating thyroglossal duct cysts from dermoid cysts.

Hyoung In CHOI ; Young Hun CHOI ; Jung Eun CHEON ; Woo Sun KIM ; In One KIM

Ultrasonography.2018;37(1):71-77. doi:10.14366/usg.17027

PURPOSE: The purpose of this study was to identify ultrasonographic features that can be used to differentiate between thyroglossal duct cysts (TGDCs) and dermoid cysts (DCs). METHODS: We searched surgical pathology reports completed between January 2004 and October 2015 and identified 66 patients with TGDCs or DCs who had undergone preoperative ultrasonography. The ultrasound images were reviewed by two radiologists who were blinded to the pathological diagnosis. They evaluated the following parameters: dimensions, shape, margin, location in relation to the midline, level in relation to the hyoid bone, attachment to the hyoid bone, the depth of the lesion in relation to the strap muscles, internal echogenicity, internal echogenic dots, multilocularity, the presence of a longitudinal extension into the tongue base, posterior acoustic enhancement, the presence of internal septae, and intralesional vascularity. RESULTS: There were 50 TGDCs and 16 DCs. TGDCs were significantly more likely than DCs to have an irregular shape, an ill-defined margin, attachment to the hyoid bone, an intramuscular location, heterogeneous internal echogenicity, multilocularity, and longitudinal extension into the tongue base. CONCLUSION: Ultrasound findings may inform the differential diagnosis between TGDCs and DCs.
Acoustics ; Dermoid Cyst* ; Diagnosis ; Diagnosis, Differential ; Humans ; Hyoid Bone ; Muscles ; Pathology, Surgical ; Pediatrics ; Thyroglossal Cyst* ; Tongue ; Ultrasonography

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Comparison between 3-dimensional cranial ultrasonography and conventional 2-dimensional cranial ultrasonography in neonates: impact on reinterpretation.

Yu Jin KIM ; Young Hun CHOI ; Hyun Hae CHO ; So Mi LEE ; Ji Eun PARK ; Jung Eun CHEON ; Woo Sun KIM ; In One KIM

Ultrasonography.2018;37(1):63-70. doi:10.14366/usg.17009

PURPOSE: The aim of this study was to evaluate impact of 3-dimensional cranial ultrasonography (3DUS) on reinterpretation of cranial ultrasonography images in neonates in comparison with 2-dimensional cranial ultrasonography (2DUS). METHODS: We retrospectively enrolled 50 young infants who simultaneously underwent both 2DUS and 3DUS scanning from February to March 2015. Two pediatric radiologists independently reviewed both scans for overall image quality on a 5-point scale. Five features were evaluated in both scans: the presence of germinal matrix hemorrhage (GMH), intraventricular hemorrhage (IVH), ventriculomegaly (VM), abnormality of periventricular echogenicity (PVE), and focal parenchymal lesions (FL). The concordance rate between the two scanning modes was calculated. The confidence level for each finding on a 3-point scale and the scanning time were compared between the two scanning modes. Interobserver agreement was evaluated using kappa statistics. RESULTS: Both scans demonstrated similar overall image quality in terms of reinterpretation (mean scores for 2DUS and 3DUS, 4.0±0.5 and 4.0±0.7 in reviewer 1, 3.9±0.6 and 4.0±0.8 in reviewer 2, respectively). GMH, IVH, VM, and FL showed perfect concordance, while PVE showed a concordance rate of 91.4% between the two modes by both reviewers. 3DUS was associated with a higher diagnostic confidence in the evaluation of GMH, IVH, and FL than 2DUS (P < 0.05) for both reviewers. For PVE, 3DUS received a significantly higher confidence score than 2DUS from one of the reviewers. The mean scanning time for 2DUS and 3DUS was 92.75 seconds and 36 seconds, respectively. Interobserver agreement for qualitative scoring was almost perfect. CONCLUSION: In reinterpretation, 3DUS showed very high concordance with 2DUS and a similar image quality. 3DUS also increased diagnostic confidence for several image findings and significantly decreased scan time.
Brain ; Hemorrhage ; Humans ; Infant ; Infant, Newborn* ; Retrospective Studies ; Ultrasonography*

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Ultrasonography-guided 14-gauge core biopsy of the breast: results of 7 years of experience.

Inha JUNG ; Min Jung KIM ; Hee Jung MOON ; Jung Hyun YOON ; Eun Kyung KIM

Ultrasonography.2018;37(1):55-62. doi:10.14366/usg.17028

PURPOSE: This study assessed the outcomes of ultrasound (US)-guided core needle biopsies (CNBs) of breast lesions with at least 2 years of follow-up to determine the false-negative rate and to evaluate the diagnostic accuracy of CNB. METHODS: We retrospectively analyzed 13,254 consecutive US-guided 14-gauge CNBs for breast lesions. We excluded biopsies if non-malignant biopsy result was not confirmed by surgical excision or US-guided vacuum-assisted biopsy, or fewer than 2 years of follow-up data were available. A total of 4,186 biopsies were excluded, and 9,068 breast masses from 7,039 women were included. The pathologic findings from each CNB were assessed using the standard diagnostic reference, defined based on the results of surgical excision, vacuum-assisted biopsy, or at least 2 years of long-term imaging follow-up. The false-negative rate and underestimation rate were calculated. RESULTS: Of the 9,068 CNBs, benign pathology was found in 64.2%, high-risk results in 3.5%, and malignant results in 32.3%. Of the 5,821 benign CNBs, an additional malignancy was found at excision in 63 lesions, leading to a false-negative rate of 2.0% (63 of 3,067). The underestimation rate was 33.6% (111 of 330) for ductal carcinoma in situ and 24.5% (79 of 322) for high-risk results at surgical excision. Most false-negative diagnoses (84.1%, 53 of 63) were recognized through imaging-histology correlations, and immediate rebiopsies were performed. Ten malignancies (15.9%, 10 of 63) had delayed diagnoses and showed progression in follow-up US imaging. CONCLUSION: US-guided 14-gauge CNB provided optimal diagnostic information. Imaging-histology correlations and appropriate imaging follow-up should be performed to avoid delayed diagnoses.
Biopsy* ; Biopsy, Large-Core Needle ; Breast* ; Carcinoma, Intraductal, Noninfiltrating ; Delayed Diagnosis ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Image-Guided Biopsy ; Pathology ; Retrospective Studies ; Ultrasonography

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Clinical significance of renal cortical thickness in patients with chronic kidney disease.

Mehmet KORKMAZ ; Bekir ARAS ; Serkan GÜNEYLI ; Mümtaz YILMAZ

Ultrasonography.2018;37(1):50-54. doi:10.14366/usg.17012

PURPOSE: The aim of this study was to evaluate the correlations between laboratory findings and ultrasonographic measurements of renal length and cortical thickness in patients receiving follow-up for chronic kidney disease (CKD). METHODS: A total of 41 CKD patients (18 males and 23 females; mean age, 65.2 years; range, 42 to 85 years) with a low glomerular filtration rate who did not require renal replacement therapy were included in this prospective study. Patients were followed up with laboratory assays at bimonthly intervals and with ultrasonography performed twice a year. Renal cortical thickness, renal length, and estimated glomerular filtration rate (eGFR) values were compared using the paired-samples t test. Additionally, Pearson correlation analysis was conducted between renal length and cortical thickness measurements and eGFR values to assess kidney function. RESULTS: At the beginning of the study and after 24 months, mean eGFR values of the 41 patients were 35.92 mL/min and 28.38 mL/min, respectively. The mean renal length was 91.29 mm at the beginning of the study and 90.24 mm at the end of the study. The mean cortical thickness was 5.76±2.05 mm at the beginning of the study and 5.28±1.99 mm at the end of the study. A statistically significant positive association was found between eGFR and mean renal length (r=0.66, P < 0.01) and between eGFR and mean cortical thickness (r=0.85, P < 0.01), with the latter being more prominent. CONCLUSION: Our study suggests that ultrasonographic cortical thickness measurements may be an important imaging technique in the follow-up care of patients with CKD.
Female ; Follow-Up Studies ; Glomerular Filtration Rate ; Humans ; Kidney ; Male ; Prospective Studies ; Renal Insufficiency, Chronic* ; Renal Replacement Therapy ; Ultrasonography

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Hemodynamic analysis of radiation-induced damage in common carotid arteries by using color Doppler ultrasonography.

Alireza MOHAMMADKARIM ; Manijhe MOKHTARI-DIZAJI ; Ali KAZEMIAN ; Hazhir SABERI

Ultrasonography.2018;37(1):43-49. doi:10.14366/usg.17016

PURPOSE: The aim of this study was to assess vascular changes and blood flow abnormalities in the common carotid arteries of patients with head and neck cancers after external radiotherapy, using color Doppler ultrasonography. METHODS: We studied 24 patients treated with external radiotherapy for various head and neck cancers. In order to study the acute effects of irradiation on common carotid blood flow and arterial diameter changes, color Doppler ultrasonography parameters such as peak systolic velocity, end diastolic velocity, mean velocity, systolic-to-diastolic velocity (S/D) ratio, pulsatility index (PI), resistive index (RI), and instantaneous diameter changes were evaluated before and after external radiotherapy. Additionally, the blood volume flow (VF) values in the peak systolic and end diastolic phases, as well as mean velocity, were evaluated throughout three cardiac cycles using B-mode ultrasonic image processing. RESULTS: The findings showed significant changes in the S/D ratio, PI, and RI of the common carotid arteries before and after external radiotherapy (P < 0.05). Moreover, a significant decrease in artery diameter and blood VF was observed after radiotherapy relative to the pretreatment values. A significant correlation was found between the blood VF values estimated using ultrasonic measurements and mathematical methods throughout three cardiac cycles. CONCLUSION: The hemodynamic parameters of the common carotid arteries changed during radiotherapy. These arterial changes may lead to late adverse effects of radiotherapy, such as ischemic strokes and ischemic attacks.
Arteries ; Blood Volume ; Carotid Artery, Common* ; Head ; Hemodynamics* ; Humans ; Neck ; Radiotherapy ; Stroke ; Ultrasonics ; Ultrasonography ; Ultrasonography, Doppler, Color*

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Logistic LASSO regression for the diagnosis of breast cancer using clinical demographic data and the BI-RADS lexicon for ultrasonography.

Sun Mi KIM ; Yongdai KIM ; Kuhwan JEONG ; Heeyeong JEONG ; Jiyoung KIM

Ultrasonography.2018;37(1):36-42. doi:10.14366/usg.16045

PURPOSE: The aim of this study was to compare the performance of image analysis for predicting breast cancer using two distinct regression models and to evaluate the usefulness of incorporating clinical and demographic data (CDD) into the image analysis in order to improve the diagnosis of breast cancer. METHODS: This study included 139 solid masses from 139 patients who underwent a ultrasonography-guided core biopsy and had available CDD between June 2009 and April 2010. Three breast radiologists retrospectively reviewed 139 breast masses and described each lesion using the Breast Imaging Reporting and Data System (BI-RADS) lexicon. We applied and compared two regression methods-stepwise logistic (SL) regression and logistic least absolute shrinkage and selection operator (LASSO) regression-in which the BI-RADS descriptors and CDD were used as covariates. We investigated the performances of these regression methods and the agreement of radiologists in terms of test misclassification error and the area under the curve (AUC) of the tests. RESULTS: Logistic LASSO regression was superior (P < 0.05) to SL regression, regardless of whether CDD was included in the covariates, in terms of test misclassification errors (0.234 vs. 0.253, without CDD; 0.196 vs. 0.258, with CDD) and AUC (0.785 vs. 0.759, without CDD; 0.873 vs. 0.735, with CDD). However, it was inferior (P < 0.05) to the agreement of three radiologists in terms of test misclassification errors (0.234 vs. 0.168, without CDD; 0.196 vs. 0.088, with CDD) and the AUC without CDD (0.785 vs. 0.844, P < 0.001), but was comparable to the AUC with CDD (0.873 vs. 0.880, P=0.141). CONCLUSION: Logistic LASSO regression based on BI-RADS descriptors and CDD showed better performance than SL in predicting the presence of breast cancer. The use of CDD as a supplement to the BI-RADS descriptors significantly improved the prediction of breast cancer using logistic LASSO regression.
Area Under Curve ; Biopsy ; Breast Neoplasms* ; Breast* ; Diagnosis* ; Humans ; Information Systems ; Logistic Models ; Retrospective Studies ; Subject Headings ; Ultrasonography*

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Contrast-enhanced ultrasonography of the liver using SonoVue.

Giovanna FERRAIOLI ; Maria Franca MELONI

Ultrasonography.2018;37(1):25-35. doi:10.14366/usg.17037

This review focuses on the use of contrast-enhanced ultrasonography (CEUS) with SonoVue (Bracco Imaging) for the diagnosis of focal liver lesions (FLLs), guidance during ablative treatment, and follow-up of liver tumors. Multicenter trials have shown that the performance of CEUS for the characterization of FLLs is similar to that of contrast-enhanced computed tomography or contrast-enhanced magnetic resonance imaging. CEUS with SonoVue has been effectively used for guiding the percutaneous treatment of malignant liver tumors that are invisible or poorly visualized in traditional gray-scale ultrasonography. Postprocedural CEUS may be used to detect and retreat residual viable tissue in the same ablative session. The use of CEUS for the assessment of diffuse liver disease is also discussed.
Carcinoma, Hepatocellular ; Diagnosis ; Follow-Up Studies ; Liver Diseases ; Liver* ; Magnetic Resonance Imaging ; Multicenter Studies as Topic ; Ultrasonography*

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