Ovarian-adnexal reporting and data system ultrasound evaluation and pathological characteristics of ovarian collision tumor

BACKGROUND Collision tumor are neoplasms,including two histologically distinct tumors that coexist in the same mass without histological admixture.The incidence of collision tumor is low and is rare clinically.AIM To investigate ultrasound images and application of ovarian-adnexal reporting and data system(O-RADS)to evaluate the risk and pathological characteristics of ovarian collision tumor.METHODS This study retrospectively analyzed 17 cases of ovarian collision tumor diagnosed pathologically from January 2020 to December 2023.All clinical features,ultrasound images and histopathological features were collected and analyzed.The O-RADS score was used for classification.The O-RADS score was determined by two senior doctors in the gynecological ultrasound group.Lesions with O-RADS score of 1-3 were classified as benign tumors,and lesions with O-RADS score of 4 or 5 were classified as malignant tumors.RESULTS There were 17 collision tumors detected in 16 of 6274 patients who underwent gynecological surgery.The average age of 17 women with ovarian collision tumor was 36.7 years(range 20-68 years),in whom,one occurred bilaterally and the rest occurred unilaterally.The average tumor diameter was 10 cm,of which three were 2-5 cm,11 were 5-10 cm,and three were>10 cm.Five(29.4%)tumors with O-RADS score 3 were endometriotic cysts with fibroma/serous cystadenoma,and unilocular or multilocular cysts contained a small number of parenchymal components.Eleven(64.7%)tumors had an O-RADS score of 4,including two in category 4A,six in category 4B,and three in category 4C;all of which were multilocular cystic tumors with solid components or multiple papillary components.One(5.9%)tumor had an O-RADS score of 5.This case was a solid mass,and a small amount of pelvic effusion was detected under ultrasound.The pathology was high-grade serous cystic cancer combined with cystic mature teratoma.There were nine(52.9%)tumors with elevated serum carbohydrate antigen(CA)125 and two(11.8%)with elevated serum CA19-9.Histological and pathological results showed that epithelial-cell-derived tumors combined with other tumors were the most common,which was different from previous results.CONCLUSION The ultrasound images of ovarian collision tumor have certain specificity,but diagnosis by preoperative ultrasound is difficult.The combination of epithelial and mesenchymal cell tumors is one of the most common types of ovarian collision tumor.The O-RADS score of ovarian collision tumor is mostly≥4,which can sensitively detect malignant tumors.

Contrast-enhanced ultrasound improved performance of breast imaging reporting and data system evaluation of critical breast lesions

AIM: To determine whether contrast-enhanced ultrasound(CEUS) can improve the precision of breast imaging reporting and data system(BI-RADS) categorization. METHODS: A total of 230 patients with 235 solid breast lesions classified as BI-RADS 4 on conventional ultrasound were evaluated. CEUS was performed within one week before core needle biopsy or surgical resection and a revised BI-RADS classification was assigned based on 10 CEUS imaging characteristics. Receiver operating characteristic curve analysis was then conducted to evaluate the diagnostic performance of CEUS-based BI-RADS assignment with pathological examination as reference criteria. RESULTS: The CEUS-based BI-RADS evaluation classified 116/235(49.36%) lesions into category 3, 20(8.51%), 13(5.53%) and 12(5.11%) lesions into categories 4A, 4B and 4C, respectively, and 74(31.49%) into category 5. Selecting CEUS-based BI-RADS category 4A as an appropriate cut-off gave sensitivity and specificity values of 85.4% and 87.8%, respectively, for the diagnosisof malignant disease. The cancer-to-biopsy yield was 73.11% with CEUS-based BI-RADS 4A selected as the biopsy threshold compared with 40.85% otherwise, while the biopsy rate was only 42.13% compared with 100% otherwise. Overall, only 4.68% of invasive cancers were misdiagnosed.CONCLUSION: This pilot study suggests that evaluation of BI-RADS 4 breast lesions with CEUS results in reduced biopsy rates and increased cancer-to-biopsy yields.

Predictive model for contrast-enhanced ultrasound of the breast: Is it feasible in malignant risk assessment of breast imaging reporting and data system 4 lesions?

AIM: To build and evaluate predictive models for contrast-enhanced ultrasound(CEUS) of the breast to distinguish between benign and malignant lesions. METHODS: A total of 235 breast imaging reporting and data system(BI-RADS) 4 solid breast lesions were imaged via CEUS before core needle biopsy or surgical resection. CEUS results were analyzed on 10 enhancing patterns to evaluate diagnostic performance of three benign and three malignant CEUS models, with pathological results used as the gold standard. A logistic regression model was developed basing on the CEUS results, and then evaluated with receiver operating curve(ROC). RESULTS: Except in cases of enhanced homogeneity, the rest of the 9 enhancement appearances were statistically significant(P < 0.05). These 9 enhancement patterns were selected in the final step of the logistic regression analysis, with diagnostic sensitivity and specificity of 84.4% and 82.7%, respectively, and the area under the ROC curve of 0.911. Diagnostic sensitivity, specificity, and accuracy of the malignant vs benign CEUS models were 84.38%, 87.77%, 86.38% and 86.46%, 81.29% and 83.40%, respectively. CONCLUSION: The breast CEUS models can predict risk of malignant breast lesions more accurately, decrease false-positive biopsy, and provide accurate BIRADS classification.

Contrast-enhanced ultrasound Liver Imaging Reporting and Data System:Lights and shadows in hepatocellular carcinoma and cholangiocellular carcinoma diagnosis

BACKGROUND Contrast-enhanced ultrasound(CEUS)is considered a secondary examination compared to computed tomography(CT)and magnetic resonance imaging(MRI)in the diagnosis of hepatocellular carcinoma(HCC),due to the risk of misdiagnosing intrahepatic cholangiocarcinoma(ICC).The introduction of CEUS Liver Imaging Reporting and Data System(CEUS LI-RADS)might overcome this limitation.Even though data from the literature seems promising,its reliability in real-life context has not been well-established yet.AIM To test the accuracy of CEUS LI-RADS for correctly diagnosing HCC and ICC in cirrhosis.METHODS CEUS LI-RADS class was retrospectively assigned to 511 nodules identified in 269 patients suffering from liver cirrhosis.The diagnostic standard for all nodules was either biopsy(102 nodules)or CT/MRI(409 nodules).Common diagnostic accuracy indexes such as sensitivity,specificity,positive predictive value(PPV),and negative predictive value(NPV)were assessed for the following associations:CEUS LR-5 and HCC;CEUS LR-4 and 5 merged class and HCC;CEUS LR-M and ICC;and CEUS LR-3 and malignancy.The frequency of malignant lesions in CEUS LR-3 subgroups with different CEUS patterns was also determined.Inter-rater agreement for CEUS LI-RADS class assignment and for major CEUS pattern identification was evaluated.RESULTS CEUS LR-5 predicted HCC with a 67.6%sensitivity,97.7%specificity,and 99.3%PPV(P<0.001).The merging of LR-4 and 5 offered an improved 93.9%sensitivity in HCC diagnosis with a 94.3%specificity and 98.8%PPV(P<0.001).CEUS LR-M predicted ICC with a 91.3%sensitivity,96.7%specificity,and 99.6%NPV(P<0.001).CEUS LR-3 predominantly included benign lesions(only 28.8%of malignancies).In this class,the hypo-hypo pattern showed a much higher rate of malignant lesions(73.3%)than the iso-iso pattern(2.6%).Inter-rater agreement between internal raters for CEUS-LR class assignment was almost perfect(n=511,k=0.94,P<0.001),while the agreement among raters from separate centres was substantial(n=50,k=0.67,P<0.001).Agreement was stronger for arterial phase hyperenhancement(internal k=0.86,P<2.7×10-214;external k=0.8,P<0.001)than washout(internal k=0.79,P<1.6×10-202;external k=0.71,P<0.001).CONCLUSION CEUS LI-RADS is effective but can be improved by merging LR-4 and 5 to diagnose HCC and by splitting LR-3 into two subgroups to differentiate iso-iso nodules from other patterns.

Interobserver agreement for contrast-enhanced ultrasound of liver imaging reporting and data system:A systematic review and metaanalysis

BACKGROUND Hepatocellular carcinoma is the most common primary liver malignancy.From the results of previous studies,Liver Imaging Reporting and Data System(LIRADS)on contrast-enhanced ultrasound(CEUS)has shown satisfactory diagnostic value.However,a unified conclusion on the interobserver stability of this innovative ultrasound imaging has not been determined.The present metaanalysis examined the interobserver agreement of CEUS LI-RADS to provide some reference for subsequent related research.AIM To evaluate the interobserver agreement of LI-RADS on CEUS and analyze the sources of heterogeneity between studies.METHODS Relevant papers on the subject of interobserver agreement on CEUS LI-RADS published before March 1,2020 in China and other countries were analyzed.The studies were filtered,and the diagnostic criteria were evaluated.The selected references were analyzed using the“meta”and“metafor”packages of R software version 3.6.2.RESULTS Eight studies were ultimately included in the present analysis.Meta-analysis results revealed that the summary Kappa value of included studies was 0.76[95%confidence interval,0.67-0.83],which shows substantial agreement.Higgins I2 statistics also confirmed the substantial heterogeneity(I2=91.30%,95%confidence interval,85.3%-94.9%,P<0.01).Meta-regression identified the variables,including the method of patient enrollment,method of consistency testing,and patient race,which explained the substantial study heterogeneity.CONCLUSION CEUS LI-RADS demonstrated overall substantial interobserver agreement,but heterogeneous results between studies were also obvious.Further clinical investigations should consider a modified recommendation about the experimental design.

Effect of training on resident inter-reader agreement with American College of Radiology Thyroid Imaging Reporting and Data System

BACKGROUND The American College of Radiology Thyroid Imaging Reporting and Data System(ACR TI-RADS)was introduced to standardize the ultrasound characterization of thyroid nodules.Studies have shown that ACR-TIRADS reduces unnecessary biopsies and improves consistency of imaging recommendations.Despite its widespread adoption,there are few studies to date assessing the inter-reader agreement amongst radiology trainees with limited ultrasound experience.We hypothesize that in PGY-4 radiology residents with no prior exposure to ACR TIRADS,a statistically significant improvement in inter-reader reliability can be achieved with a one hour training session.AIM To evaluate the inter-reader agreement of radiology residents in using ACR TIRADS before and after training.METHODS A single center retrospective cohort study evaluating 50 thyroid nodules in 40 patients of varying TI-RADS levels was performed.Reference standard TI-RADS scores were established through a consensus panel of three fellowship-trained staff radiologists with between 1 and 14 years of clinical experience each.Three PGY-4 radiology residents(trainees)were selected as blinded readers for this study.Each trainee had between 4 to 5 mo of designated ultrasound training.No trainee had received specialized TI-RADS training prior to this study.Each of the readers independently reviewed the 50 testing cases and assigned a TI-RADS score to each case before and after TI-RADS training performed 6 wk apart.Fleiss kappa was used to measure the pooled inter-reader agreement.The relative diagnostic performance of readers,pre-and post-training,when compared against the reference standard.RESULTS There were 33 females and 7 males with a mean age of 56.6±13.6 years.The mean nodule size was 19±14 mm(range from 5 to 63 mm).A statistically significant superior inter-reader agreement was found on the post-training assessment compared to the pre-training assessment for the following variables:1.“Shape”(k of 0.09[slight]pre-training vs 0.67[substantial]post-training,P<0.001),2.“Echogenic foci”(k of 0.28[fair]pre-training vs 0.45[moderate]post-training,P=0.004),3.‘TI-RADS level’(k of 0.14[slight]pre-training vs 0.36[fair]post-training,P<0.001)and 4.‘Recommendations’(k of 0.36[fair]pre-training vs 0.50[moderate]post-training,P=0.02).No significant differences between the preand post-training assessments were found for the variables'composition','echogenicity'and'margins'.There was a general trend towards improved pooled sensitivity with TI-RADS levels 1 to 4 for the post-training assessment while the pooled specificity was relatively high(76.6%-96.8%)for all TI-RADS level.CONCLUSION Statistically significant improvement in inter-reader agreement in the assigning TI-RADS level and recommendations after training is observed.Our study supports the use of dedicated ACR TI-RADS training in radiology residents.

Contrast-enhanced ultrasound in association with serum biomarkers for differentiating combined hepatocellular-cholangiocarcinoma from hepatocellular carcinoma and intrahepatic cholangiocarcinoma

BACKGROUND Combined hepatocellular-cholangiocarcinoma(CHC)is a rare type of primary liver cancer.Due to its complex histopathological characteristics,the imaging features of CHC can overlap with those of hepatocellular carcinoma(HCC)and intrahepatic cholangiocarcinoma(ICC).AIM To investigate the possibility and efficacy of differentiating CHC from HCC and ICC by using contrast-enhanced ultrasound(CEUS)Liver Imaging Reporting and Data System(LI-RADS)and tumor biomarkers.METHODS Between January 2016 and December 2019,patients with histologically confirmed CHC,ICC and HCC with chronic liver disease were enrolled.The diagnostic formula for CHC was as follows:(1)LR-5 or LR-M with elevated alphafetoprotein(AFP)and carbohydrate antigen 19-9(CA19-9);(2)LR-M with elevated AFP and normal CA19-9;or(3)LR-5 with elevated CA19-9 and normal AFP.The sensitivity,specificity,accuracy and area under the receiver operating characteristic curve were calculated to determine the diagnostic value of the criteria.RESULTS After propensity score matching,134 patients(mean age of 51.4±9.4 years,108 men)were enrolled,including 35 CHC,29 ICC and 70 HCC patients.Based on CEUS LI-RADS classification,74.3%(26/35)and 25.7%(9/35)of CHC lesions were assessed as LR-M and LR-5,respectively.The rates of elevated AFP and CA19-9 in CHC patients were 51.4%and 11.4%,respectively,and simultaneous elevations of AFP and CA19-9 were found in 8.6%(3/35)of CHC patients.The sensitivity,specificity,positive predictive value,negative predictive value,accuracy and area under the receiver operating characteristic curve of the aforementioned diagnostic criteria for discriminating CHC from HCC and ICC were 40.0%,89.9%,58.3%,80.9%,76.9%and 0.649,respectively.When considering the reported prevalence of CHC(0.4%-14.2%),the positive predictive value and NPV were revised to 1.6%-39.6%and 90.1%-99.7%,respectively.CONCLUSION CHCs are more likely to be classified as LR-M than LR-5 by CEUS LI-RADS.The combination of the CEUS LI-RADS classification with serum tumor markers shows high specificity but low sensitivity for the diagnosis of CHC.Moreover,CHC could be confidently excluded with high NPV.

Imaging related to underlying immunological and pathological processes in COVID-19

The introduction of coronavirus disease-2019(COVID-19)as a global pandemic has contributed to overall morbidity and mortality.With a focus on understanding the immunology and pathophysiology of the disease,these features can be linked with the respective findings of imaging studies.Thus,the constellation between clinical presentation,histological,laboratory,immunological,and imaging results is crucial for the proper management of patients.The purpose of this article is to examine the role of imaging during the particular stages of severe acute respiratory syndrome coronavirus 2 infection–asymptomatic stage,typical and atypical COVID-19 pneumonia,acute respiratory distress syndrome,multiorgan failure,and thrombosis.The use of imaging methods to assess the severity and duration of changes is crucial in patients with COVID-19.Radiography and computed tomography are among the methods that allow accurate characterization of changes.

基于临床与超声特征构建的列线图模型在超声医师修饰甲状腺中国(超声)甲状腺影像报告和数据系统分类结果中的应用价值

目的分析基于甲状腺临床与超声特征构建的列线图模型在超声医师修饰甲状腺中国(超声)甲状腺影像报告和数据系统(C-TI-RADS)分类结果中的应用价值。方法回顾性分析2021年1月—2022年12月四川省人民医院(训练集,n=841)以及四川绵阳四0四医院(外部验证集,n=295)外科手术切除的甲状腺结节患者的临床病理及超声资料,并利用术前甲状腺超声进行甲状腺结节C-TI-RADS分类。通过单因素及多因素Logistic回归分析在训练集中筛选独立预测因子并构建列线图模型,通过Bootstrap重抽样进行内部验证;四川绵阳四0四医院超声医师根据构建的列线图模型进行外部验证。绘制受试者工作特征(ROC)曲线及校准曲线,评估模型效能及在超声医师修饰C-TI-RADS分类结果中的临床价值。结果单因素及多因素Logistic回归分析结果显示,性别、年龄、结节最大径、结节数目、颈部淋巴结超声异常和C-TI-RADS分类是预测超声医师修饰C-TI-RADS分类结果的独立因素(P<0.05)。基于上述因素构建的列线图模型的一致性指数为0.842(95%CI:0.816~0.867),曲线下面积(AUC)为0.842,基于最佳截断值的敏感度为92.9%,特异度为63.7%,准确率为75.9%。在训练集和外部验证集中,构建的列线图模型的预测结果与实际情况均具有较好的一致性。结论基于甲状腺临床与超声特征构建的列线图模型在超声医师修饰C-TI-RADS分类结果中显示出良好的预测准确性,具有潜在的临床应用价值。

C-TIRADS与K-TIRADS对甲状腺结节良恶性鉴别诊断的对比分析

目的:对比分析中国甲状腺影像报告和数据系统(C-TIRADS)和韩国TIRADS(K-TIRADS)两种甲状腺影像报告与数据系统对甲状腺结节良恶性鉴别诊断的价值。方法:回顾性分析2017年3月—2023年3月在青岛大学附属泰安市中心医院经组织病理学证实的582个甲状腺结节的超声图像。分别按照C-TIRADS、K-TIRADS标准进行分类,以病理结果作为金标准,分析两种方法的诊断效能。结果:所得到的两种方法各分层的甲状腺结节的实际恶性率与指南所推荐的恶性率一致。C-TIRADS与K-TIRADS的AUC面积分别为0.899、0.897,两者比较差异无统计学意义(P>0.05)。C-TIRADS最佳截断值为4B类,K-TIRADS最佳截断值为5类。两者的灵敏度、特异度分别为0.925、0.872;0.818、0.889。结论:C-TIRADS与K-TIRADS对甲状腺结节的良恶性鉴别诊断均具有较高的价值,诊断效能相当,C-TIRADS更适合中国国情。

C-TIRADS联合超声造影评估桥本甲状腺炎4类结节

目的 评估甲状腺结节超声恶性危险分层中国指南(Chinese-thyroid imaging reporting and data system,C-TIRADS)联合超声造影(contrast-enhancedultrasound,CEUS)评估桥本甲状腺炎4类结节。方法 回顾性分析2022年6月至12月于益阳市中心医院就诊的79例桥本甲状腺炎患者的120个C-TIRADS4类甲状腺结节资料。CEUS检查时如结节表现可疑的1种或多种良/恶性特征,均采取降/升一级的处理,以最终手术病理结果为金标准。绘制受试者操作特征曲线(receiver operating characteristic curve,ROC曲线),比较诊断效能。结果 CEUS后再次分级的C-TIRADS诊断甲状腺结节良恶性的敏感度、特异性和准确性分别为93.0%、87.8%和90.8%(P<0.05)。ROC曲线下面积分别为0.811和0.904(P<0.05)。结论 C-TIRADS联合CEUS评估桥本甲状腺炎4类结节具有更好的诊断效能。

自动乳腺容积超声成像在BI-RADS4A类乳腺结节诊断中的价值

目的探讨自动乳腺容积超声成像(ABUS)在乳腺影像报告和数据系统(BI-RADS)4A类乳腺结节良、恶性诊断中的应用价值。方法回顾性分析广东省中医院2018年1月至2022年9月经ABUS发现乳腺BI-RADS 4A类结节的202例女性患者,共216个乳腺结节[结节最大径(17.92±11.60)mm],年龄23~72岁。患者均接受ABUS、常规超声、乳腺X线摄影,并根据美国放射学会(ACR)建立的2013年版BI-RADS进行分类,以术后病理结果作为金标准,分析3种检查方法的诊断效能。计数资料的比较采用χ^(2)检验或Fisher确切概率法。结果经手术病理证实,178个结节为良性,38个结节为恶性,ABUS、常规超声、乳腺X线摄影诊断BI-RADS 4A类结节的恶性构成比分别为17.59%(38/216)、12.94%(22/170)、19.61%(10/51),3种检查诊断BI-RADS 4A类结节的恶性构成比进行组间比较(ABUS与常规超声、ABUS与X线、常规超声与X线),差异均无统计学意义(χ^(2)=1.568、0.114、1.408,均P>0.05)。结论ABUS对BI-RADS 4A类乳腺结节的诊断效能与常规超声、乳腺X线摄影相仿,ABUS在早期乳腺癌筛查中有一定临床价值,有利于基层单位乳腺疾病筛查及疾病分级管理。

超声造影联合年龄在乳腺BI-RADS 4类结节再分类中的应用价值

目的 探讨超声造影联合年龄在乳腺影像学报告及数据系统(BI-RADS)4类结节再分类中的应用价值。方法 收集成都市第三人民医院常规超声分类为BI-RADS 4类,且经过超声造影评分并有病理结果的116个乳腺结节患者的临床资料。以病理诊断为金标准,构建受试者工作特征(ROC)曲线,计算超声造影评分及年龄诊断乳腺良恶性结节的最佳截断值,并分析其诊断价值。利用超声造影评分及年龄的最佳截断值,对116个BI-RADS 4类结节重新进行分类调整。结果 通过绘制ROC曲线得到超声造影评分的最佳截断值为3.5分,年龄的最佳截断值为50.5岁。超声造影评分的ROC曲线下面积为0.887,其诊断乳腺结节良恶性的敏感性及特异性分别为80.8%、96.7%;年龄的ROC曲线下面积为0.793,其诊断乳腺结节良恶性的敏感性及特异性分别为73.1%、85.6%。BI-RADS 4类结节经超声造影评分联合年龄临界值重新调整后,59个结节降为3类,病理结果均为良性;11个结节升为4c类,病理结果均为恶性。结论 超声造影评分联合年龄对BI-RADS 4类结节进行重新分类后可有效提高乳腺结节诊断的准确性,能为临床诊疗提供参考。

基于临床资料、超声造影LI-RADS联合异常凝血酶原的肝癌微血管侵犯列线图模型的构建及验证

目的基于临床资料、超声造影肝脏影像报告和数据系统(LI-RADS)联合异常凝血酶原前体蛋白(PIVKA-Ⅱ)的肝癌微血管侵犯(MVI)列线图模型的构建,并对所构建的列线图模型进行验证。方法选取2019年1月至2023年12月该院收治的312例肝癌患者作为研究对象,按照2∶1分为建模集组(208例)和验证集组(104例)。以单因素和多因素Logistic回归分析肝癌MVI的影响因素,采用R3.6.1软件绘制肝癌MVI预测列线图模型;以预测风险能力指数(C-index)、校准曲线、受试者工作特征(ROC)曲线评价列线图模型的预测能力,以决策曲线评价列线图模型的临床效用。结果建模集组与验证集组MVI发生率分别为32.21%(67/208)、27.88%(29/104),建模集组与验证集组年龄、性别、体质量指数等基线资料及MVI发生情况比较,差异均无统计学意义(P>0.05)。单因素分析结果显示,建模集组中MVI组中国肝癌分期为Ⅱ~Ⅲ期患者占比及甲胎蛋白水平均高于无MVI组,差异均有统计学意义(P<0.05);建模集组中MVI组肿瘤最大径大于无MVI组,LI-RADS分级为5级患者占比及PIVKA-Ⅱ水平均高于无MVI组,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,甲胎蛋白水平升高、肿瘤最大径增大、LI-RADS分级为5级患者占比较高、PIVKA-Ⅱ水平升高均为肝癌MVI的独立危险因素(P<0.05)。预测肝癌MVI的列线图模型的C-index为0.936(95%CI:0.894~0.965),区分度良好。Bootstrap内部验证和外部验证结果显示,列线图模型在建模集和验证集中的一致性指数分别为0.859、0.840。ROC曲线分析结果显示,列线图模型预测肝癌MVI的AUC为0.936,高于单独的甲胎蛋白(0.839)、肿瘤最大径(0.792)、LI-RADS分级(0.705)、PIVKA-Ⅱ(0.813)。决策曲线分析结果显示,当建模集高风险阈值为0.00~0.93、验证集高风险阈值为0.00~0.78时该列线图模型具有较好的临床净收益。结论甲胎蛋白、肿瘤最大径、LI-RADS分级和PIVKA-Ⅱ与肝癌MVI均有关,均可作为肝癌MVI的联合预测因子,可提高术前诊断肝癌MVI的效能,为临床肝癌的诊断和治疗提供客观准确的决策支持。

多模态超声校正BI-RADS 4类乳腺肿块的价值

目的 探讨乳腺自动容积成像(ABVS)、超声弹性评分(UES)及两者联合在校正乳腺影像报告和数据系统分级(BI-RADS) 4类乳腺肿块BI-RADS分级中的应用价值。方法 收集我院经常规超声诊断为BI-RADS 4类的乳腺肿块患者109例,共113个肿块。经ABVS及UES校正BI-RADS分级后,与病理结果对比,绘制ROC曲线,比较常规超声、ABVS、UES、ABVS联合UES诊断BI-RADS 4类乳腺肿块的差异。结果 109例患者113个肿块中包含良性78个,恶性35个,ABVS联合UES校正后的敏感度、特异性、准确性、ROC曲线下面积分别为94.29%、93.59%、93.80%、0.975。结论 ABVS联合UES有助于提高BI-RADS 4类肿块的总体诊断效能。两者联合诊断可以取长补短,提高诊断率。

比较O-RADS、ADNEX模型、GI-RADS在附件肿瘤良恶性筛查中的诊断价值

目的 探讨比较O-RADS、ADNEX模型、GI-RADS在附件肿瘤良恶性筛查中的诊断价值。方法 选取在我院进行超声检查并行附件肿瘤手术的患者114例,应用O-RADS与ADNEX模型、GI-RADS评估附件肿瘤的良恶性,以病理结果为金标准,计算3种方法的诊断效能并绘制ROC曲线获得曲线下面积。结果 114例附件肿瘤患者中,良性78例,恶性36例,O-RADS与ADNEX模型、GI-RADS诊断附件肿瘤良恶性的敏感性分别为97.22%、94.44%、97.22%,特异性分别为70.51%、80.77%、60.26%,O-RADS、ADNEX模型、GI-RADS预测附件肿瘤良恶性的AUC分别为0.910、0.876、0.853(P均<0.05),2位不同年资超声医师诊断结果一致性好,K值分别为0.912、0.841、0.705(P<0.01)。结论O-RADS、ADNEX模型、GI-RADS在鉴别附件肿瘤良恶性诊断效能较高且不同年资超声医师间有较好的一致性,其中,O-RADS预测附件肿瘤良恶性的诊断效能及不同医师间的运用中,在一定程度上更优于ADNEX模型、GI-RADS。

2013年版超声BI-RADS出版10年:回顾与展望

自2013年美国放射学会出版第二版乳腺影像报告和数据系统(Breast Imaging Reporting and Data System,BI-RADS)后,乳腺超声的临床实践与科学研究均从中获益。本文总结了2013年版超声BI-RADS出版这10年间,乳腺超声影像技术临床应用与革新、存在的问题与面临的挑战及未来的发展机遇,以期为临床诊治、指南推广与应用提供帮助。

CEUS联合2DUS对乳腺良恶性病变的诊断价值

目的:以病理学检查为“金标准”,探讨超声造影(contrast-enhanced ultrasound,CEUS)联合二维超声(2D ultrasound,2DUS)对乳腺良恶性病变的鉴别诊断价值。方法:收集2018年2月—2023年8月于同济大学附属第十人民医院行乳腺2DUS及CEUS检查并经病理学检查确诊的1 299例女性乳腺病变患者。患者进行2DUS乳腺影像报告和数据系统(Breast Imaging Reporting and Data System,BI-RADS)分类和CEUS联合2DUS检查,对比分析乳腺良恶性病变的CEUS特征,以及两种检查方式下的灵敏度、特异度、准确度、阳性预测值和阴性预测值。结果:根据病理学检查结果将1 299例患者分为良性病变组807例和恶性病变组492例,与2DUS BI-RADS分类检查相比较,CEUS联合2DUS检查的灵敏度(96.1%)及准确度(88.8%)均明显提高,并且针对BI-RADS 4类病变良恶性检出具有较高的灵敏度(95.9%)。结论:CEUS联合2DUS能够显著提高对乳腺良恶性病变的鉴别诊断效能,具有较高的诊断价值。

ATA指南、Kwak TI-RADS、ACR TI-RADS及C TI-RADS对儿童甲状腺结节的诊断效能比较

目的:对比2011年Kwak版甲状腺影像报告和数据系统(Thyroid Imaging Reporting and Data System,TIRADS),2015年美国甲状腺协会(American Thyroid Association,ATA)《成人甲状腺结节与分化型甲状腺癌指南》(ATA指南),2017年美国放射学会(American College of Radiology,ACR)TI-RADS及2020年中华医学会超声医学分会发布的《2020甲状腺结节恶性危险分层的中国指南:C TI-RADS》这4种甲状腺结节分级系统对儿童甲状腺良恶性结节的诊断效能。方法:收集2008年1月1日—2021年12月31日在复旦大学附属儿科医院超声科行超声检查并经甲状腺穿刺活检或术后病理学检查确诊的80例甲状腺结节患儿,根据Kwak TI-RADS、ATA指南、ACR TI-RADS以及C TI-RADS对甲状腺结节超声图像进行回顾性分级,以最终病理学检查结果为金标准,计算不同风险分层的恶性百分比,并绘制受试者工作特征(receiver operating characteristic,ROC)曲线,比较这4种分级系统ROC曲线的曲线下面积(area under curve,AUC)、诊断灵敏度及特异度。结果:ATA指南、Kwak TI-RADS、ACR TI-RADS及C TI-RADS的灵敏度分别为85.7%、74.3%、71.4%及77.1%,特异度分别为64.4%、66.7%、80.0%及69.3%,AUC分别为0.764、0.772、0.809及0.770。这4种检测方法对儿童甲状腺结节均具有较高的诊断效能,其中ACR TI-RADS诊断效能稍高于其他3种指南(P<0.05)。这4种检查方法的最佳截断值分别为ACR TI-RADS 4级,Kwak TI-RADS 4c,ATA指南中的高度可疑恶性以及C TI-RADS中的4C(高度可疑恶性)。结论:将4种成人甲状腺超声风险评级标准应用于儿童,均有较好的诊断效能,其中ACR TI-RADS诊断效能高于其他3种。

常规超声联合超声弹性成像检查对乳腺黏液癌的诊断价值

目的:分析乳腺黏液癌的临床特征及超声表现,探讨常规超声联合弹性成像技术对乳腺黏液癌的诊断价值。方法:回顾并分析2014年—2022年南京大学医学院附属鼓楼医院经病理学检查证实为乳腺黏液癌的患者63例(共63个肿块),并随机选取同期经病理学检查证实为乳腺纤维腺瘤的50例患者(共50个肿块)为对照组。113个肿块均行乳腺常规超声及应变式弹性成像检查,观察记录肿块大小、形状、边界、弹性评分等,并根据乳腺影像报告和数据系统(Breast Imaging Reporting and Data System,BI-RADS)分类标准分类。其中78例肿块应用剪切波弹性成像技术定量分析。比较两组患者的临床与超声特征差异。结果:常规超声联合应变式弹性成像检查的灵敏度(85.71%vs 65.07%)、特异度(94.00%vs 88.00%)、阳性预测值(94.73%vs 87.23%)、阴性预测值(83.93%vs 66.67%)及准确度(89.38%vs 75.22%)均高于常规超声。常规超声联合应变式弹性成像检查的诊断一致性Kappa指数高于常规超声(0.787 vs 0.514)。剪切波弹性成像技术检查提示两组肿块的剪切波速度(shear wave velocity,SWV)最大值、最小值、平均值分别为(7.26±2.41)m/s vs(3.77±1.79)m/s、(3.16±1.09)m/s vs(2.23±0.79)m/s、(4.82±1.39)m/s vs(2.91±1.02)m/s,差异有统计学意义(P<0.05)。结论:常规超声联合弹性成像技术在乳腺黏液癌诊断中具有一定临床价值。