Added value of ratio of cross diameters of the appendix in ultrasound diagnosis of acute appendicitis

BACKGROUND The maximum outer diameter(MOD)of the appendix is an essential parameter for diagnosing acute appendicitis,but there is space for improvement in ultrasound(US)diagnostic performance.AIM To investigate whether combining the ratio of the cross diameters(RATIO)of the appendix with MOD of the appendix can enhance the diagnostic performance of acute appendicitis.METHODS A retrospective study was conducted,and medical records of 233 patients with acute appendicitis and 112 patients with a normal appendix were reviewed.The MOD and RATIO of the appendix were calculated and tested for their diagnostic performance of acute appendicitis,both individually and in combination.RESULTS The RATIO for a normal appendix was 1.32±0.16,while for acute appendicitis it was 1.09±0.07.The cut-off value for RATIO was determined to be≤1.18.The area under the receiver operating characteristic curve(AUC)for diagnosing acute appendicitis using RATIO≤1.18 and MOD>6 mm was 0.870 and 0.652,respectively.There was a significant difference in AUC between RATIO≤1.18 and MOD>6 mm(P<0.0001).When comparing the combination of RATIO≤1.18 and MOD>6 mm with MOD>6 mm alone,the combination showed increased specificity,positive predictive value(PPV),and AUC.However,the sensitivity and negative predictive value decreased.CONCLUSION Combining RATIO of the appendix≤1.18 and MOD>6 mm can significantly improve the specificity,PPV,and AUC in the US diagnosis of acute appendicitis.

The Application Value of Ultrasound Imaging in the Differential Diagnosis of Benign and Malignant Breast Nodules of BI-RADS 3 and Above

Objective:To explore the diagnostic value of ultrasound imaging for breast nodules of breast imaging-reporting and data system(BI-RADS)category 3 and above.Methods:From June 2021 to July 2022,163 patients with breast nodules of BI-RADS 3 or above were selected as the research subjects.After pathological diagnosis,24 cases were malignant breast nodules of BI-RADS 3 or above,while 139 cases were benign breast nodules of BI-RADS 3 or above.The diagnosis rate of malignant and benign breast nodules of BI-RADS 3 or above,including 95%CI,was observed and analyzed.Results:The malignant and benign detection rates of conventional ultrasound were 88.63%and 75.00%,respectively,and the malignant and benign detection rates of ultrasound imaging were 93.18%and 87.50%,respectively,with 95%CIs greater than 0.7.Conclusion:Ultrasound imaging can help improve the diagnostic accuracy of benign and malignant breast nodules of BI-RADS 3 and above and reduce the misdiagnosis rate.

Research Progress of Ultrasound Radiomics in The Diagnosis and Treatment of Breast Cancer

With the advancement of medical research in recent years and the frequent occurrence of different types of cancer, breast cancer has gradually attracted the public’s attention. The incidence of breast cancer is rising, mainly affecting women with a high mortality rate. According to the clinical treatment effect, early diagnosis and early treatment can effectively control the mortality of breast cancer and improve patient’s quality of life. Ultrasound radiomics is an emerging field that can extract quantitative high-dimensional data from ultrasound images. Recently, ultrasound radiomics has been widely used in the clinical treatment of breast cancer. This paper analyzed the research progress of ultrasound radiomics in the diagnosis and treatment of breast cancer.

Value of ultrasound and magnetic resonance imaging combined with tumor markers in the diagnosis of ovarian tumors

BACKGROUND Compare the diagnostic performance of ultrasound(US),magnetic resonance imaging(MRI),and serum tumor markers alone or in combination for detecting ovarian tumors.AIM To investigate the diagnostic value of US,MRI combined with tumor markers in ovarian tumors.METHODS The data of 110 patients with ovarian tumors,confirmed by surgery and pathology,were collected in our hospital from February 2018 to May 2023.The dataset included 60 cases of benign tumors and 50 cases of malignant tumors.Prior to surgery,all patients underwent preoperative US and MRI examinations,as well as serum tumor marker tests[carbohydrate antigen 125(CA125),human epididymis protein 4(HE4)].The aim of the study was to compare the diagnostic performance of these three methods individually and in combination for ovarian tumors.RESULTS This study found statistically significant differences in the ultrasonic imaging characteristics between benign and malignant tumors.These differences include echo characteristics,presence or absence of a capsule,blood flow resistance index,clear tumor shape,and blood flow signal display rate(P<0.05).The apparent diffusion coefficient values of the solid and cystic parts in benign tumors were found to be higher compared to malignant tumors(P<0.05).Additionally,the time-intensity curve image features of benign and malignant tumors showed significant statistical differences(P<0.05).The levels of serum CA125 and HE4 in benign tumors were lower than those in malignant tumors(P<0.05).The combined use of US,MRI,and tumor markers in the diagnosis of ovarian tumors demonstrates higher accuracy,sensitivity,and specificity compared to using each method individually(P<0.05).CONCLUSION US,MRI,and tumor markers each have their own advantages and disadvantages when it comes to diagnosing ovarian tumors.However,by combining these three methods,we can significantly enhance the accuracy of ovarian tumor diagnosis,enabling early detection and identification of the tumor’s nature,and providing valuable guidance for clinical treatment.

Automatic detection of breast lesions in automated 3D breast ultrasound with cross-organ transfer learning

Background Deep convolutional neural networks have garnered considerable attention in numerous machine learning applications,particularly in visual recognition tasks such as image and video analyses.There is a growing interest in applying this technology to diverse applications in medical image analysis.Automated three dimensional Breast Ultrasound is a vital tool for detecting breast cancer,and computer-assisted diagnosis software,developed based on deep learning,can effectively assist radiologists in diagnosis.However,the network model is prone to overfitting during training,owing to challenges such as insufficient training data.This study attempts to solve the problem caused by small datasets and improve model detection performance.Methods We propose a breast cancer detection framework based on deep learning(a transfer learning method based on cross-organ cancer detection)and a contrastive learning method based on breast imaging reporting and data systems(BI-RADS).Results When using cross organ transfer learning and BIRADS based contrastive learning,the average sensitivity of the model increased by a maximum of 16.05%.Conclusion Our experiments have demonstrated that the parameters and experiences of cross-organ cancer detection can be mutually referenced,and contrastive learning method based on BI-RADS can improve the detection performance of the model.

Velamentous Cord Insertion: Interest of Antenatal Diagnosis and Review of the Literature

Velamentous insertion of the umbilical cord corresponds to the insertion of the cord directly on amniotic membranes. It is a rare situation whose frequency varies from 0.5% to 1.69% of single pregnancies. It must be diagnosed during the morphological ultrasound of the 2nd trimester, actively looking for the association with a vasa previa, due to the risk of fetal haemorrhagic threat. We report an antenatal diagnosis of velamentous cord insertion and its management with literature review.

Endoscopic ultrasound for the diagnosis of chronic pancreatitis

Endoscopic ultrasound(EUS) has become a well accepted test for the diagnosis of chronic pancreatitis.Advantages include its ability to detect subtle and severe changes of the pancreatic duct and parenchyma,and its relative safety compared with endoscopic retrograde cholangiopancreatography.Limitations include inter-and intraobserver variability,operator dependence,and an incomplete understanding of its true accuracy.The Rosemont classif ication has recently been proposed as a weighted,standardized method that may improve EUS chronic pancreatitis scoring.This paper reviews the published evidence regarding the accuracy of EUS in chronic pancreatitis diagnosis,and enumerates the emerging technologies that have been recently studied which may ultimately improve endosonographic imaging of the pancreas.

Diagnosis of liver cirrhosis with contrast-enhanced ultrasound

The assessment of the extent of liver fibrosis is very important for the prognosis and clinical management of chronic liver diseases.Although liver biopsy is the gold standard for the assessment of liver fibrosis,new non-invasive diagnostic methods are urgently needed in clinical work due to certain limitations and complications of biopsy.Noninvasive imaging studies play an important role in the diagnosis of focal liver disease and diffuse liver diseases.Among them,ultrasonography is the first choice for study of the liver in clinical work.With the development of ultrasound contrast agents and contrast specific imaging techniques,contrastenhanced ultrasound(CEUS) shows good performance and great potential in the evaluation of liver fibrosis.Researchers have tried different kinds of contrast agent and imaging method,such as arrival time of contrast agent in the hepatic vein,and quantitative analysis of the enhancement level of liver parenchyma,to evaluate the degree of liver fibrosis during the past 10 years.This review mainly summarizes the clinical studies concerning the assessment of liver fibrosis using CEUS.

Application of ultrasound contrast in identification and diagnosis of ocular spaceoccupying lesions

AIM: To analyze the application significance of ultrasound contrast agent in identification and diagnosis of ocular spaceoccupying lesions, and mainly analyze its advantages and problems. METHODS: Thirty-two representative literatures about the application of ultrasound contrast agent in diagnosis of spaceoccupying lesions at home and abroad were collected after focused on sorting the literature reporting the application of ultrasound contrast diagnostic technology in the diagnosis and identification of ocular spaceoccupying lesions in recent years. Its advantages and problems were retrospectively analyzed, and reasonable assessment on Existing problems was made and possible solutions to the problems were proposed. RESULTS: As a new imaging diagnostic technique, the contrast-enhanced ultrasound, which can enhance the display of tumor microcirculation vessels and improve the tumor's ultrasound diagnostic capability, was analyzed. Through sorting and comprehensively analyzing the collected literatures, the positive rate of ocular spaceoccupying lesion diagnosis could be significantly improved with ultrasound contrast technology. Thus, the vascular perfusion in normal tissues and lesions was reflected objectively. According to the lesion's perfusion characteristics of the contrast agent plus with the performance features of two-dimensional ultrasound, the ocular spaceoccupying lesions can be accurately diagnosed, and this could provide clinicians with reliable research basis in this field. CONCLUSION: Ultrasound contrast examination is a new testing method, and ultrasound contrast agent can significantly enhance the ultrasonic detection signal, clearly show the blood perfusion in vessels and tissues, increase the image contrast resolution, and improve the lesion's detection capability in the microcirculation perfusion level, especially its important value in the diagnosis of ocular tumor.

Ultrasound diagnosis of fractures in mass casualty incidents

The role of point-of-care ultrasound in mass casualty incidents(MCIs)is still evolving.Occasionally,hospitals can be destroyed by disasters resulting in large number of trauma patients.CAVEAT and FASTER ultrasound protocols,which are used in MCIs,included extremity ultrasound examination as part of them.The literature supports the use of ultrasound in diagnosing extremity fractures both in hospitals and MCIs.The most recent systematic review which was reported by Douma-den Hamer et al in 2016 showed that the pooled ultrasound sensitivity and specificity for detecting distal forearm fractures was 97% and 95% respectively.Nevertheless,majority of these studies were in children and they had very high heterogeneity.The portability,safety,repeatability,and cost-effectiveness of ultrasound are great advantages when treating multiply injured patients in MCIs.Its potential in managing fractures in MCIs needs to be further defined.The operator should master the technique,understand its limitations,and most importantly correlate the sonographic findings with the clinical ones to be useful.This editorial critically reviews the literature on this topic,describes its principles and techniques,and includes the author’s personal learned lessons so that trauma surgeons will be encouraged to use ultrasound to diagnose fractures in their own clinical practice.

Role of endoscopic ultrasound in diagnosis and therapy of pancreatic adenocarcinoma

Since its advent more than 20 years ago, endoscopic ultrasound (EUS) has undergone evolution from an experimental to a diagnostic instrument and is now established as a therapeutic tool for endoscopists. Endoscopic ultrasound cannot accurately distinguish benign from malignant changes in the primary lesion or lymph node on imaging alone. With the introduction of the curved linear array echoendoscope in the 1990s, the indications for EUS have expanded. The curved linear array echoendoscope enables the visualization of a needle as it exits from the biopsy channel in the same plane of ultrasound imaging in real time. This allows the endoscopist to perform a whole range of interventional applications ranging from fine needle aspiration (FNA) of lesions surrounding the gastrointestinal tract to celiac plexus block and drainage of pancreatic pseudocyst. This article reviews the current role of EUS and EUS-FNA in diagnosis, staging and interventional application of solid pancreatic cancer.

The potential value of intravascular ultrasound imaging in diagnosis of aortic intramural hematoma

Objective To evaluate the potential value of intravascular ultrasound(IVUS)imaging in the diagnosis of aortic intramural hematoma(AIH).Methods From September 2002 to May 2005,a consecutive series of 15 patients with suspected aortic dissection(AD)underwent both IVUS imaging and spiral computed tomography(CT).Six patients diagnosed as acute type B AIH by CT or IVUS composed the present study group.Results The study group consisted of five males and one female with mean age of 66 years old.All of them had chest or back pain.In one patient,CT omitted a localized AIH and an associated penetrating atherosclerotic ulcer(PAU),which were detected by IVUS.In another patient,CT mistaken a partly thrombosed false lumen as an AIH,whereas IVUS detected a subtle intimal tear and slow moving blood in the false lumen.In the four rest patients,both CT and IVUS made the diagnosis of AIH,however,IVUS detected three PAUs in three of them,only one of them was also detected by CT,and two of them escaped initial CT and were confirmed by follow up CT or magnetic resonance imaging.Conclusions IVUS imaging is a safe examination and has high accuracy in the diagnosis of AIH,particularly for diagnosing localized AIH,distinguishing AIH with thrombosed classic AD and detecting accompanied small PAUs.

Diagnosis of upper gastrointestinal perforation complicated with fistula formation and subphrenic abscess by contrast-enhanced ultrasound:A case report

BACKGROUND Gastrointestinal perforation complicated by subphrenic abscess is a surgical emergency.Its diagnosis relies mainly on X-ray or computed tomography(CT),while the value of ultrasound,especially contrast-enhanced ultrasound(CEUS),has been underestimated.CASE SUMMARY A 37-year-old man presented with fever and edema of the lower extremities for 10 d.He had a history of laparoscopic repair of gastroduodenal perforation 6 mo prior.His first-time intravenous CEUS indicated a diagnosis of subphrenic abscess.He received antibiotic therapy and ultrasound-guided percutaneous drainage of the abscess.However,second-time intravenous CEUS revealed an unsatisfactory therapeutic effect.Intracavitary CEUS was proposed,and this examination detected communication between the abscess and the stomach.Upper gastrointestinal perforation complicated by fistula formation and subphrenic abscess was diagnosed with the help of CEUS.Abdominal CT and esophagogastroduodenoscopy confirmed the diagnosis.The patient recovered after the perforation was repaired by surgery.CONCLUSION Intravenous and intracavitary CEUS provides helpful information for the diagnosis of upper gastrointestinal perforation complicated by fistula formation and subphrenic abscess.

Endoscopic ultrasound-guided diagnosis and treatment of gastric varices

Gastric varices(GV)represent a common and severe complication in patients with portal hypertension,commonly seen in patients with cirrhosis and severe pancreatic disease.Endoscopic ultrasonography is a safe and efficacious approach that can perform real-time ultrasonic scanning and intervention for the gastrointestinal submucosa,portal vein and its tributaries,and collateral circulations during direct endoscopic observation.Recently,various studies have been published about endoscopic ultrasound(EUS)-guided management of GV,mainly including diagnosis,treatment,and prognostic analysis.This article reviews published articles and guidelines to present the development process and current management of EUS-guided GV procedures.

Diagnosis of pancreatic tumors by endoscopic ultrasound-guided fine-needle aspiration

AIM: To evaluate the diagnostic accuracy of endoscopic ultrasound-guided fi ne-needle aspiration (EUS-FNA) for pancreatic solid tumors larger or smaller than 3 cm, and cystic lesions. METHODS: From January/1997 to December/2006, 611 patients with pancreatic tumors were subjected to EUS-FNA. The fi nal diagnosis was obtained either by surgery (356 cases) or after a mean clinical follow-up of 11.8 mo in the remaining patients. RESULTS: There were 405 solid tumors, 189 cystic lesions and 17 mixed. Pancreatic specimens for cytological assessment were successfully obtained by EUS-FNA in 595 (97.4/) cases. There were 352 (57.6/) malignancies and 259 (42.4/) benign tumors. Among the malignancies, pancreatic adenocarcinomas accounted for 67/ of the lesions. Overall, the sensitivity, specifi city, positive and negative predictive values, and accuracy of EUS-FNA were, respectively, 78.4/, 99.2/, 99.3/, 77.2/ and 87.2/. Specif ically for solid tumors, the same parameters for neoplasms larger and smaller than 3 cm were, respectively, 78.8/ vs 82.4/, 100/ vs 98.4/, 100/ vs 99/, 54.8/ vs 74.1/ and 83.1/ vs 87.8/. For cystic lesions, the values were, respectively, 72.2/, 99.3/, 97.5/, 91/ and 92.2/. CONCLUSION: EUS-FNA can be used to sample pancreatic tumors in most patients. Even though the negative predictive value is inadequate for large solid tumors, the results are rather good for small solid tumors, especially concerning the sensitivity, negative predictive value and diagnostic accuracy. Among all pancreatic lesions, EUS-FNA for cystic lesions canreveal the best negative predictive value and diagnostic accuracy, both higher than 90/.

Early ultrasound diagnosis of conjoined twins at eight weeks of pregnancy: A case report

BACKGROUND Conjoined twins are a rare occurrence,and the majority of these malformations are detected during second trimester screening.CASE SUMMARY Herein we report a case of conjoined twins,which was diagnosed by ultrasound at 8 wk gestation and was normal at 7 wk gestation.The two fetuses shared one heart and were diagnosed as thoracopagus twins.This is the first report of conjoined twins diagnosed at 8 wk gestation.The pregnancy was terminated electively at 9 wk gestation.Because some congenital malformations can be diagnosed earlier,a prenatal ultrasound examination at an early gestational stage cannot be dismissed.CONCLUSION This case demonstrates that a 7-8 wk gestation might be the earliest period when conjoined twins can be diagnosed by ultrasound.

Diagnosis of spontaneous isolated superior mesenteric artery dissection with ultrasound:A case report

BACKGROUND Spontaneous isolated superior mesenteric artery dissection(SISMAD)is a rare disease that originates from the superior mesenteric artery,without the presence of aortic and other arterial dissections.Most cases are diagnosed using contrastenhanced computed tomography(CECT),whereas the application of ultrasound is less common.CASE SUMMARY Here,we report a case of SISMAD with sudden epigastric pain that worsened as the main symptom after eating.The patient had a long history of hypertension with unknown blood pressure control but no history of smoking or alcohol consumption.This case was initially diagnosed using ultrasound and the results were later confirmed by CECT.After admission,the patient fasted,followed by parenteral nutrition support and fluid supplementation to maintain electrolyte and acid–base balance.Metoprolol succinate sustained-release tablets and aspirin were given as nonoperative treatments.After 1 wk,the symptoms improved,and the patient was discharged.During telephone follow-up,the patient did not develop similar symptoms.CONCLUSION Whether ultrasound can be used as a routine and noninvasive imaging method for the diagnosis of SISMAD needs further exploration.

Clinical study in diagnosis of placental implantation abnormality with transabdominal Doppler ultrasound

Objective: To evaluate the ultrasonographic charateristics and the diagnostic value in placental implantation abnormality (PIA) with transabdominal Doppler ultrasound, and improve the rate of diagnosis accuracy in the prenatal and postnatal of PIA with transabdominal Doppler ultrasound, for early diagnosis and treatment, to avoid hysterectomy caused by fatal bleeding. Methods: There were 61 cases complicated with PIA by operation and pathologically confirmed in our hospital. 33 cases were prenatal PIA, and 28 cases were postnatal PIA. The sonographic characteristics of PIA were summarized, the sensitivity and false negative rate of transabdominal Doppler ultrasound were analyzed with the results of surgical and pathological diagnosis. Results: In the images of prenatal PIA, the incidence of abundant blood flow signals in muscular layer of the placenta was the highest, which could reached 85.7%, followed by placenta 'vortex' and placenta previa;placental remnants were major sonographic performance in postnatal PIA, the incidence rate was 100%, followed by abundant blood flow signals in muscular layer of the placenta and disappeared boundary between myometrium and placenta. 14 cases could be diagnosed as prenatal PIA accurately by transabdominal Doppler ultrasound, the sensitivity was 42.4%, and the false negative rate was 57.6%. 21 cases could be diagnosed as postnatal PIA accurately by transabdominal Doppler ultrasound, the sensitivity was 75.0%, and the false negative rate was 25.0%. Conclusions: The specificity was low in prenatal PIA by transabdominal Doppler ultrasound, but the false negative rate was high. If necessary, the diagnostic accuracy could be improved combined with MRI. The specificity was much higher in postnatal PIA, and the false negative rate was low. The ultrasonography of PIA has some certain characteristics, we should strengthen the consciousness of the diagnosis in PIA, especially in the prenatal PIA, and improve the auxiliary diagnosis.