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.

Reliability of ultrasound ovarian-adnexal reporting and data system amongst less experienced readers before and after training

BACKGROUND The 2018 ovarian-adnexal reporting and data system(O-RADS)guidelines are aimed at providing a system for consistent reports and risk stratification for ovarian lesions found on ultrasound.It provides key characteristics and findings for lesions,a lexicon of descriptors to communicate findings,and risk characterization and associated follow-up recommendation guidelines.However,the ORADS guidelines have not been validated in North American institutions or amongst less experienced readers.AIM To evaluate the diagnostic accuracy and inter-reader reliability of ultrasound ORADS risk stratification amongst less experienced readers in a North American institution with and without pre-test training.METHODS A single-center retrospective study was performed using 100 ovarian/adnexal lesions of varying O-RADS scores.Of these cases,50 were allotted to a training cohort and 50 to a testing cohort via a non-randomized group selection process in order to approximately equal distribution of O-RADS categories both within and between groups.Reference standard O-RADS scores were established through consensus of three fellowship-trained body imaging radiologists.Three PGY-4 residents were independently evaluated for diagnostic accuracy and inter-reader reliability with and without pre-test O-RADS training.Sensitivity,specificity,positive predictive value,negative predictive value(NPV),and area under the curve(AUC)were used to measure accuracy.Fleiss kappa and weighted quadratic(pairwise)kappa values were used to measure inter-reader reliability.Statistical significance was P<0.05.RESULTS Mean patient age was 40±16 years with lesions ranging from 1.2 to 22.5 cm.Readers demonstrated excellent specificities(85%-100%pre-training and 91%-100%post-training)and NPVs(89%-100%pre-training and 91-100%post-training)across the O-RADS categories.Sensitivities were variable(55%-100%pre-training and 64%-100%post-training)with malignant ORADS 4 and 5 Lesions pre-training and post-training AUC values of 0.87-0.95 and 0.94-098,respectively(P<0.001).Nineteen of 22(86%)misclassified cases in pre-training were related to mischaracterization of dermoid features or wall/septation morphology.Fifteen of 17(88%)of posttraining misclassified cases were related to one of these two errors.Fleiss kappa inter-reader reliability was‘good’and pairwise inter-reader reliability was‘very good’with pre-training and post-training assessment(k=0.76 and 0.77;and k=0.77-0.87 and 0.85-0.89,respectively).CONCLUSION Less experienced readers in North America achieved excellent specificities and AUC values with very good pairwise inter-reader reliability.They may be subject to misclassification of potentially malignant lesions,and specific training around dermoid features and smooth vs irregular inner wall/septation morphology may improve sensitivity.

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.

Ductal carcinoma in situ within a fibroadenoma:A case report and review of literature

BACKGROUND Fibroadenoma(FA)is the most common tumor found in young women,although it can occur in any age group.Ductal carcinoma in situ(DCIS)that is confined in a FA is rare;it is most frequently reported as an incidental finding.CASE SUMMARY We report a case of DCIS within a FA in a 46-year-old female without cancerrelated personal and family histories.The patient was diagnosed with a breast conglomerate of nodules and was followed for 1 year.In the current control image study,we found suspicious microcalcification,as a new finding,within one of the nodules.Consequently,a core biopsy of the tumor,which appeared hypoechoic,oval,and circumscribed,was performed.The pathological diagnosis was ductal carcinoma in situ within a fibroepithelial lesion.The patient underwent breastconserving surgery and received radiotherapy as well as endocrine therapy(tamoxifen).CONCLUSION We recommend a multidisciplinary approach for adequate treatment and followup.

Can contrast enhanced ultrasound differentiate intrahepatic cholangiocarcinoma from hepatocellular carcinoma?

BACKGROUND Hepatocellular carcinoma(HCC)and intrahepatic cholangiocarcinoma(ICC)differ in treatment and prognosis,warranting an effective differential diagnosis between them.The LR-M category in the contrast-enhanced ultrasound(CEUS)liver imaging reporting and data system(LI-RADS)was set up for lesions that are malignant but not specific to HCC.However,a substantial number of HCC cases in this category elevated the diagnostic challenge.AIM To investigate the possibility and efficacy of differentiating ICC from HCC classified in the LR-M category according to the CEUS LI-RADS.METHODS Patients with complete CEUS records together with pathologically confirmed ICC and LR-M HCC(HCC classified in the CEUS LI-RADS LR-M category)between January 2015 and October 2018 were included in this retrospective study.Each ICC was assigned a category as per the CEUS LI-RADS.The enhancement pattern,washout timing,and washout degree between the ICC and LR-M HCC were compared using theχ2 test.Logistic regression analysis was used for prediction of ICC.Receiver operating characteristic(ROC)curve analysis was used to investigate the possibility of LR-M criteria and serum tumor markers in differentiating ICC from LR-M HCC.RESULTS A total of 228 nodules(99 ICCs and 129 LR-M HCCs)in 228 patients were included.The mean sizes of ICC and LR-M HCC were 6.3±2.8 cm and 5.5±3.5 cm,respectively(P=0.03).Peripheral rim-like arterial phase hyperenhancement(APHE)was detected in 50.5%(50/99)of ICCs vs 16.3%(21/129)of LR-M HCCs(P<0.001).Early washout was found in 93.4%(93/99)of ICCs vs 96.1%(124/129)of LR-M HCCs(P>0.05).Marked washout was observed in 23.2%(23/99)of ICCs and 7.8%(10/129)of LR-M HCCs(P=0.002),while this feature did not show up alone either in ICC or LR-M HCC.Homogeneous hyperenhancement was detected in 15.2%(15/99)of ICCs and 37.2%(48/129)of LR-M HCCs(P<0.001).The logistic regression showed that rim APHE,carbohydrate antigen 19-9(CA 19-9),and alpha fetoprotein(AFP)had significant correlations with ICC(r=1.251,3.074,and-2.767,respectively;P<0.01).Rim APHE presented the best enhancement pattern for diagnosing ICC,with an area under the ROC curve(AUC)of 0.70,sensitivity of 70.4%,and specificity of 68.8%.When rim hyperenhancement was coupled with elevated CA 19-9 and normal AFP,the AUC and sensitivity improved to 0.82 and 100%,respectively,with specificity decreasing to 63.9%.CONCLUSION Rim APHE is a key predictor for differentiating ICC from LR-M HCC.Rim APHE plus elevated CA 19-9 and normal AFP is a strong predictor of ICC rather than LR-M HCC.Early washout and marked washout have limited value for the differentiation between the two entities.

Novel model combining contrast-enhanced ultrasound with serology predicts hepatocellular carcinoma recurrence after hepatectomy

BACKGROUND Surgery is the primary curative option in patients with hepatocellular carcinoma(HCC).However,recurrence within 2 years is observed in 30%–50%of patients,being a major cause of mortality.AIM To construct and verify a non-invasive prediction model combining contrastenhanced ultrasound(CEUS)with serology biomarkers to predict the early recurrence of HCC.METHODS Records of 744 consecutive patients undergoing first-line curative surgery for HCC in one institution from 2016–2018 were reviewed,and 292 local patients were selected for analysis.General characteristics including gender and age,CEUS liver imaging reporting and data system(LIRADS)parameters including wash-in time,wash-in type,wash-out time,and wash-out type,and serology biomarkers including alanine aminotransferase,aspartate aminotransferase,platelets,and alpha-fetoprotein(AFP)were collected.Univariate analysis and multivariate Cox proportional hazards regression model were used to evaluate the independent prognostic factors for tumor recurrence.Then a nomogram called CEUS model was constructed.The CEUS model was then used to predict recurrence at 6 mo,12 mo,and 24 mo,the cut-off value was calculate by X-tile,and each C-index was calculated.Then Kaplan-Meier curve was compared by logrank test.The calibration curves of each time were depicted.RESULTS A nomogram predicting early recurrence(ER),named CEUS model,was formulated based on the results of the multivariate Cox regression analysis.This nomogram incorporated tumor diameter,preoperative AFP level,and LIRADS,and the hazard ratio was 1.123(95%confidence interval[CI]:1.041-1.211),1.547(95%CI:1.245-1.922),and 1.428(95%CI:1.059-1.925),respectively.The cut-off value at 6 mo,12 mo,and 24 mo was 100,80,and 50,and the C-index was 0.748(95%CI:0.683-0.813),0.762(95%CI:0.704-0.820),and 0.762(95%CI:0.706-0.819),respectively.The model showed satisfactory results,and the calibration at 6 mo was desirable;however,the calibration at 12 and 24 mo should be improved.CONCLUSION The CEUS model enables the well-calibrated individualized prediction of ER before surgery and may represent a novel tool for biomarker research and individual counseling.

Differentiating malignant and benign focal liver lesions in children using CEUS LI-RADS combined with serum alpha-fetoprotein

BACKGROUND Contrast-enhanced ultrasound(CEUS)can be used to diagnose focal liver lesions(FLLs)in children.The America College of Radiology developed the CEUS liver imaging reporting and data system(LI-RADS)for standardizing CEUS diagnosis of FLLs in adult patients.Until now,no similar consensus or guidelines have existed for pediatric patients to improve imaging interpretation as adults.AIM To evaluate the performance of CEUS LI-RADS combined with alpha-fetoprotein(AFP)in differentiating benign and malignant FLLs in pediatric patients.METHODS Between January 2011 and January 2021,patients≤18 years old who underwent CEUS for FLLs were retrospectively evaluated.The following criteria for diagnosing malignancy were proposed:Criterion I considered LR-4,LR-5,or LRM lesions as malignancies;criterion II regarded LR-4,LR-5 or LR-M lesions with simultaneously elevated AFP(≥20 ng/mL)as malignancies;criterion III took LR-4 Lesions with elevated AFP or LR-5 or LR-M lesions as malignancies.The sensitivity,specificity,accuracy and area under the receiver operating characteristic curve(AUC)were calculated to determine the diagnostic value of the aforementioned criteria.RESULTS The study included 63 nodules in 60 patients(mean age,11.0±5.2 years;26 male).There were no statistically significant differences between the specificity,accuracy,or AUC of criterion II and criterion III(95.1%vs 80.5%,84.1%vs 87.3%,and 0.794 vs 0.902;all P>0.017).Notably,criterion III showed a higher diagnostic sensitivity than criterion II(100%vs 63.6%;P<0.017).However,both the specificity and accuracy of criterion I was inferior to those of criterion II and criterion III(all P<0.017).For pediatric patients more than 5 years old,the performance of the three criteria was overall similar when patients were subcategorized by age when compared to all patients in aggregate.CONCLUSION CEUS LI-RADS combined with AFP may be a powerful diagnostic tool in pediatric patients.LR-4 with elevated AFP,LR-5 or LR-M lesions is highly suggestive of malignant tumors.

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.

卵巢-附件超声报告和数据风险分层系统结合卵巢恶性肿瘤风险算法诊断卵巢癌的价值分析

目的探讨卵巢-附件超声报告和数据风险分层系统(O-RADS US)结合卵巢恶性肿瘤风险算法(ROMA)鉴别卵巢-附件肿瘤良恶性的价值。方法回顾性分析2021年6月至2023年5月于青岛市市立医院妇产科住院治疗的卵巢-附件肿瘤患者89例的临床资料。采用经阴道超声观察病灶的大小、回声、形态、内部分隔及血流分布等超声特征,按照O-RADS US对病灶进行分类,并通过糖类抗原125(CA125)和人附睾蛋白4(HE4)表达水平计算ROMA值。采用受试者操作特征(ROC)曲线分析O-RADS US、ROMA及其联合诊断卵巢癌的效能。结果本研究共收集到93个病灶,卵巢癌病灶的最大径及ROMA值均高于良性病灶,差异有统计学意义(P<0.05)。O-RADS US分类为2、3、4、5类的病灶分别占21.5%(20/93)、26.9%(25/93)、33.3%(31/93)和18.3%(17/93);联合ROMA对O-RADS US分类进行校正,则O-RADS US分类为2、3、4、5类的病灶分别占34.4%(32/93)、29.0%(27/93)、14.0%(13/93)、22.6%(21/93)。联合ROMA后,O-RADS US 2、3、4类卵巢-附件病灶分别有4、6、9个升级为O-RADS US 3、4、5类;同样,O-RADS US 5、4、3类卵巢-附件病灶分别有5、20、16个降级为O-RADS US 4、3、2类。O-RADS US诊断卵巢癌的敏感度、特异度、准确度、曲线下面积分别为80.0%、75.3%、76.3%、0.861。ROMA诊断绝经前和绝经后患者卵巢癌的敏感度、特异度、准确度及曲线下面积分别为85.0%、82.2%、82.8%、0.876及90.0%、89.0%、89.2%、0.904。O-RADS US联合ROMA诊断卵巢癌的敏感度、特异度、准确度及曲线下面积分别为95.0%、91.8%、92.5%、0.926。以O-RADS US联合ROMA诊断卵巢癌的曲线下面积最大,其次是ROMA,差异有统计学意义(P<0.05)。结论O-RADS US分类系统可以有效识别卵巢癌,与ROMA联合应用,能够克服单独应用的不足,提高卵巢癌诊断的性能,减少不必要的穿刺活检。

超声C-TIRADS联合血清miR-107检测对甲状腺结节性质的诊断价值

目的探讨超声甲状腺影像报告和数据系统(C-TIRADS)联合血清微小RNA-107(miR-107)检测对甲状腺结节性质的诊断价值。方法选取2022年4月至2024年1月新疆医科大学附属肿瘤医院患甲状腺结节的患者98例(共113个结节)作为研究对象,均进行C-TIRADS分类,并检测血清miR-107水平。根据手术病理是否出现恶性结节分恶性组、良性组。分析超声C-TIRADS分类、血清miR-107水平与甲状腺结节良恶性的关系及其对甲状腺结节的诊断价值,并进行校准曲线分析。结果98例甲状腺结节患者(113个结节)中有83个良性结节,包括结节性甲状腺肿49个、甲状腺腺瘤24个、桥本甲状腺炎10个,其余30个恶性结节均为甲状腺乳头状癌。恶性结节均位于包膜下,结节内部钙化,C-TIRADS分类为4b或4c。恶性组患者血清miR-107水平高于良性组(P<0.05)。行Logistic多因素回归分析结果显示结节位置位于包膜下、结节内部钙化、C-TIRADS分类为4b或4c、miR-107是恶性甲状腺结节的独立危险因素(P<0.05)。超声C-TIRADS联合血清miR-107水平诊断甲状腺结节性质的曲线下面积(AUC)值为0.907,大于二者单独诊断甲状腺结节性质的AUC值(0.702和0.835)(Z=3.300,P=0.001;Z=2.410,P=0.016)。超声C-TIRADS联合血清miR-107水平诊断甲状腺结节性质的预测值与真实值一致性较好,Brier得分为0.114,校准斜率为0.809,校准度良好。结论超声C-TIRADS联合血清miR-107水平在诊断甲状腺结节性质方面具有较高临床应用价值。

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。

卵巢-附件超声报告和数据系统分类联合超声图像特征对卵巢附件良恶性肿块的鉴别诊断价值

目的 探讨卵巢-附件超声报告和数据系统(O-RADS)分类联合超声图像特征对卵巢附件良恶性肿块的鉴别诊断价值。方法 选取O-RADS分类为3~5类的140例卵巢附件肿块患者,所有患者均接受彩色多普勒超声检查。以病理检查结果为金标准,绘制受试者工作特征曲线,计算曲线下面积(AUC),分析O-RADS分类、多项超声图像特征单独及联合检查对卵巢附件恶性肿块的诊断价值。结果 病理检查结果显示,140例患者中共147个卵巢附件肿块,恶性56个(包括交界性肿瘤),良性91个;O-RADS分类3类46个,4类61个,5类40个。O-RADS分类联合肿块实性部分最大径、血流评分、肿块形态诊断卵巢附件恶性肿块的AUC为0.959,高于各指标单独检查的0.738、0.882、0.913、0.894。结论 在O-RADS分类定性诊断卵巢附件肿块的基础上,结合肿块实性部分最大径线、血流评分、肿块形态等彩色多普勒超声图像特征可进一步提高卵巢附件良恶性肿块的鉴别诊断效能。

超声O-RADS分类联合血清指标CA125及HE4诊断附件肿物良恶性的研究

目的:探讨卵巢-附件影像报告和数据系统(O-RADS)分类联合血清糖类抗原125(CA125)和人附睾分泌蛋白4(HE4)在附件肿物良恶性诊断中的应用价值。方法:回顾性分析2022年7月至2023年8月在安徽省立医院诊断并经病理证实的114例附件肿物患者,所有患者术前均行常规超声检查及血清CA125和HE4检测,以病理结果为“金标准”,将其分为良性组(87例)和恶性组(27例)。比较两组超声O-RADS分级及血清指标,采用受试者工作特征(ROC)曲线分析各项检测指标鉴别附件肿物良恶性的诊断效能。结果:良性组87例患者中超声O-RADS分类1类2例,2类22例,3类34例,4类29例,5类0例。恶性组27例患者中超声O-RADS分类1类0例,2类0例,3类2例,4类13例,5类12例。恶性组患者血清CA125中位数21.5(13.2,78.3)U/ml、HE4中位数49.0(31.3,70.5)pmol/L,其水平均高于良性组,差异有统计学意义(Z=-2.121、-2.021,P<0.05)。所有患者超声O-RADS分级、血清CA125、HE4以及联合诊断的准确率分别为71%、66%、78%和88%。经受试者工作特征(ROC)曲线分析,超声O-RADS分级、血清CA125、HE4以及联合诊断附件肿物良恶性的ROC曲线下面积(AUC)分别为0.870、0.556、0.594和0.898(95%CI:0.825~0.970)。结论:与单一的指标相比,O-RADS分类联合血清学指标CA125、HE4在附件肿物良恶性的诊断中有更高的应用价值,可提高诊断准确率。

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。

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。