Quantitative analysis of contrast-enhanced ultrasonography in rat models of hepatic acute graft-versus-host disease

Background

Hepatic acute graft-versus-host disease (aGVHD) is a major life-threatening complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT). We hypothesized that contrast-enhanced ultrasound (CEUS) could serve as a new imaging biomarker in early diagnosis of hepatic aGVHD by detecting liver microcirculation.

Methods

Thirty Wistar rats received allo-HSCT were finally included after excluding 9 rats, and they were randomly divided into 5 groups (1- to 5-week groups, 6 per group). Six rats were used for the control group without any intervention. We observed the clinical scores, serum liver enzyme levels and liver CEUS parameters of rats in each group. Hepatic aGVHD was finally confirmed by histopathologic analysis. The diagnostic performance of CEUS parameters in detecting GVHD was evaluated by comparing the area under the receiver operating curve (AUC) values.

Results

After HSCT, the rats developed ruffling of fur, maculopapular rash, weight loss, accompanied by increased clinical scores. Serum liver enzymes were significantly higher than those in the control group from the third week, especially alkaline phosphatase, while CEUS parameters, peak intensity (PI) and mean transit time (MTT), changed in the second week (P<0.001). Compared with non-aGVHD group, the PI was significantly decreased while time to peak and MTT were prolonged in aGVHD group. CEUS parameters were more strongly correlated with pathological grade than serology. PI was an independent predictor for hepatic aGVHD. The AUC of CEUS parameters for diagnosing hepatic aGVHD was 0.933 (95% CI: 0.779-0.992), which was higher than that of clinical scores (AUC =0.748, 95% CI: 0.557-0.888, P=0.032) and serological markers (AUC =0.902, 95% CI: 0.737-0.980, P=0.694).

Conclusions

CEUS exhibits promising applications as a quantitative method to detect hepatic aGVHD and early liver damage.

Automatic knowledge extraction from Chinese electronic medical records and rheumatoid arthritis knowledge graph construction

Background

Knowledge graphs are a powerful tool for organizing knowledge, processing information and integrating scattered information, effectively visualizing the relationships among entities and supporting further intelligent applications. One of the critical tasks in building knowledge graphs is knowledge extraction. The existing knowledge extraction models in the Chinese medical domain usually require high-quality and large-scale manually labeled corpora for model training. In this study, we investigate rheumatoid arthritis (RA)-related Chinese electronic medical records (CEMRs) and address the automatic knowledge extraction task with a small number of annotated samples from CEMRs, from which an authoritative RA knowledge graph is constructed.

Methods

After constructing the domain ontology of RA and completing manual labeling, we propose the MC-bidirectional encoder representation from transformers-bidirectional long short-term memory-conditional random field (BERT-BiLSTM-CRF) model for the named entity recognition (NER) task and the MC-BERT + feedforward neural network (FFNN) model for the entity extraction task. The pretrained language model (MC-BERT) is trained with many unlabeled medical data and fine-tuned using other medical domain datasets. We apply the established model to automatically label the remaining CEMRs, and then an RA knowledge graph is constructed based on the entities and entity relations, a preliminary assessment is conducted, and an intelligent application is presented.

Results

The proposed model achieved better performance than that of other widely used models in knowledge extraction tasks, with mean F1 scores of 92.96% in entity recognition and 95.29% in relation extraction. This study preliminarily confirmed that using a pretrained medical language model could solve the problem that knowledge extraction from CEMRs requires a large number of manual annotations. An RA knowledge graph based on the above identified entities and extracted relations from 1,986 CEMRs was constructed. Experts verified the effectiveness of the constructed RA knowledge graph.

Conclusions

In this paper, an RA knowledge graph based on CEMRs was established, the processes of data annotation, automatic knowledge extraction, and knowledge graph construction were described, and a preliminary assessment and an application were presented. The study demonstrated the viability of a pretrained language model combined with a deep neural network for knowledge extraction tasks from CEMRs based on a small number of manually annotated samples.

Role of Multiparametric Ultrasound in Evaluating Hepatic Acute Graft-versus-Host Disease: An Animal Study

OBJECTIVE

Hepatic acute graft-versus-host disease (aGVHD) is a serious complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT) and is one of the leading causes of early non-recurrent death. The current diagnosis is based mainly based on clinical diagnosis, and there is a lack of non-invasive quantitative diagnosis methods. We propose a multiparametric ultrasound (MPUS) imaging method and explore its effectiveness in evaluating hepatic aGVHD.

METHODS

In this study, 48 female Wistar rats were used as receptors and 12 male Fischer 344 rats were used as donors for allo-HSCT to establish aGVHD models. After transplantation, 8 rats were randomly selected for ultrasonic examination weekly, including color Doppler ultrasound, contrast-enhanced ultrasound (CEUS) and shear wave dispersion (SWD) imaging. The values of nine ultrasonic parameters were obtained. Hepatic aGVHD was subsequently diagnosed by histopathological analysis. A classification model for predicting hepatic aGVHD was established using principal component analysis and support vector machines.

RESULTS

According to the pathological results, the transplanted rats were categorized into the hepatic aGVHD and non-GVHD (nGVHD) groups. All parameters obtained by MPUS differed statistically between the two groups. The first three contributing percentages of principal component analysis results were resistivity index, peak intensity and shear wave dispersion slope, respectively. The accuracy of classifying aGVHD and nGVHD using support vector machines reached 100%. The accuracy of the multiparameter classifier was significantly higher than that of the single parameter.

CONCLUSION

The MPUS imaging method has proven to be useful in detecting hepatic aGVHD.

Assessment of ultrasound shear wave elastography: An animal ex-vivo study

OBJECTIVES

To explore the influence of the surrounding environment of the target tissue, lesion size, and rectangular sampling box size on shear wave speed (SWS).

METHODS

The tendon SWS was acquired ex-vivo. Then the tendons were dissected and buried in the couplant (gel) and evaluated by two-dimensional shear wave elastography (2D-SWE). Finally, the tendons were placed in the isolated muscles to simulate the intramuscular lesions, and their elasticity was tested under two rectangular sampling box conditions. The isolated complete liver SWS was acquired. Similarly, the large and small pieces of livers were cut out, placed in the muscles, and assessed by SWE under two rectangular sampling box conditions. The SWS acquired under different conditions was compared. Variability was evaluated using the coefficient of variation (CV). The intraclass correlation coefficient (ICC) was used to evaluate repeatability.

RESULTS

The SWS of the tendons ex-vivo, buried in the couplant and placed in the isolated muscles showed significant differences (p < 0.001). The ex-vivo condition produced the highest SWS and CV values. There were significant differences in SWS of livers with different sizes placed in muscles (p < 0.001). The highest SWS value was associated with small pieces of livers. No significant difference was found in SWS acquired under different rectangular box sizes (p > 0.05).

CONCLUSIONS

Under the present study conditions, the surrounding environment of the target tissue makes a big difference to lesion SWS values. The lesion size will affect the assessment of its inherent elasticity. The size of the sampling frame has no significant effect on the tissue SWS.

Efficacy of shear wave dispersion imaging for viscoelastic assessment of the liver in acute graft-versus-host disease rats

BACKGROUND

To investigate the feasibility of using shear wave dispersion (SWD) imaging to evaluate hepatic acute graft-versus-host disease (aGVHD) in a rat model.

METHODS

To establish an aGVHD model, 30 Wistar rats were subjected to bone marrow transplantation, 10 Fischer 344 rats were used as donors, and 6 Wistar rats were used as the control group. Each week, 6 rats were randomly chosen and divided into groups of 1 week (1 w) to 5 weeks (5 w). For each subgroup, the rats received a clinical index assessment and shear wave dispersion (SWD) examination with 2 quantitative values, shear wave (SW) speed and SWD slope. The histological characteristics were then used as the reference standard to divide the rats into the aGVHD group and the no aGVHD (nGVHD) group.

RESULTS

In the 2 weeks (2 w) group, only SWD slope [median: 7.26, interquartile range (IQR): 7.04 to 7.31] showed a significant increase in the measured value (P<0.05). The value of the 3 weeks (3 w) group (median: 7.88, IQR: 7.84 to 8.49) significantly increased compared with the 2 w value (P<0.05). Although the value increased gradually from week 3 to week 5, it had no statistical significance (P>0.05). The SW speed [mean ± standard deviation (SD): 1.54±0.11, 95% confidence interval (CI): 1.48 to 1.59] and SWD slope (mean ± SD: 8.29±0.56, 95% CI: 7.99 to 8.59) of the aGVHD group were higher than those of the control group and the nGVHD group (P<0.001). The correlation of SWD slope with pathological grade was the highest (r=0.798, P<0.01), followed by SW speed (r=0.785, P<0.01), and the correlation of clinical index with pathological grade was the lowest (r=0.751, P<0.01). In addition, the area under the receiver operating characteristic (ROC) curve (AUC) value of aGVHD using the SWD slope was 0.844 (95% CI: 0.67 to 0.95, sensitivity: 93.75%, specificity: 78.57%), which was higher than the AUC of both SW speed and clinical index, and the difference was statistically significant compared to the AUC of the clinical index.

CONCLUSIONS

The SWD slope could show significant abnormalities earlier than SW speed and clinical index and is also more consistent with the change in aGVHD severity level. The SWD slope may help in detecting hepatic aGVHD during ultrasound SWD examination.

Viscoelasticity assessment for in vivo quantification of muscle contusion injury in rats using shear wave elastography

The aim of the study described here was to investigate the role of viscoelasticity in assessing muscle fibrosis and inflammation in a rat model of contusion using quantitative shear wave elastography (SWE). Unilateral gastrocnemius muscle contusion was induced in 32 male rats using an impactor apparatus. The contralateral muscles served as the control group. SWE was applied to the control group and rats 1, 3, 14 and 21 d after successful modeling (each time point group, n = 8). Histologic features were used as reference standards. The degree of fibrosis was moderately correlated with shear wave speed (r = 0.53), whereas the degree of inflammation was well correlated with shear wave dispersion (SWD) slope (r = 0.74). The area under the receiver operating characteristic curve (AUC) for the dispersion slope for muscle inflammation and fibrosis assessment was 0.87 (95% confidence interval: 0.705-0.963), which exceeded that of the shear wave speed (0.68, 95% confidence interval: 0.494-0.834). The larger decline in dispersion slope in the fibrotic stage than in the inflammation stage (1-d group vs. 14-d group or 21-d group, p &lt; 0.05) indicated better predictive performance than the shear wave speed.

Clinical value of ultrasound for the evaluation of local recurrence of primary bone tumors

Background

Early detection of local recurrence would improve the survival rate of patients with recurrent bone tumors. There is still no consensus on how to follow up after surgery of primary malignant bone tumors. Therefore, the purpose of this study is to evaluate the diagnostic value of ultrasound (US) for local recurrence after limb salvage by comparing it with other imaging modalities.

Methods

We retrospectively reviewed the medical records of patients who were regularly examined by US in our hospital after primary bone tumor surgery from January 2016 to December 2019, some of which underwent x-ray, computed tomography (CT), or ⁹⁹mTc-MDP bone scan. Recurrence was determined by pathologic confirmation. The cases were considered a true negative for no recurrence if no clinical or pathologic evidence for recurrence was found at least 6 months after the US examination. The Chi-square test or Fisher exact test was used to compare categorical data. p-values < 0.0083 were considered statistically significant.

Results

A total of 288 cases were finally enrolled in our research, including 66 cases with pathologic results. The sensitivity of US was 95.0%, higher than that of x-ray (29.6%) (p = 0.000). The accuracy of US was 96.9%, higher than that of x-ray (85.6%) (p = 0.000).

Conclusion

As a nonradiative and cost-effective examination, US may be used as a routine imaging method for postoperative surveillance of primary bone tumors, especially those with metal implants, if more multicenter prospective studies can be done in the future.

Ultrasound Evaluation of Subclavian Artery and Internal Thoracic Artery Before Coronary Artery Bypass Grafting as Part of Preoperative Vascular Assessment

RATIONALE AND OBJECTIVES

Noninvasive diagnostic imaging of subclavian artery (SCA) and internal thoracic artery (ITA) is crucial to the patients planning to use ITA for coronary artery bypass grafting (CABG). The guidelines have not yet provided guidance on screening high-risk groups. The present study aimed to evaluate the contribution of ultrasonography in the assessment of SCA and ITA, especially for the patients referred for CABG who planned to use ITA graft.

MATERIALS AND METHODS

Patients diagnosed with multivessel coronary heart disease were enrolled and some of them planned CABG. Bilateral SCAs and ITAs were routinely evaluated by color Doppler ultrasound (CDUS) before operation. The luminal diameter and the peak systolic velocity of the proximal and distal parts of SCA and ITA were measured. Depending on the Doppler waveform, the lumen narrowing rate was calculated.

RESULTS

The final analysis was carried out in 572 patients. Thirty-five patients had moderate (50%-69%), severe (70%-99%) stenosis or occlusion in the SCA (left-sided in 21 and right-sided in 14). One patient had severe proximal stenosis in left ITA and one patient had no flow in left ITA due to the occlusion in left SCA. One patient had anatomic variation of isolated right aortic arch with aberrant left SCA. All of those cases were confirmed with multidetector computed tomography angiography.

CONCLUSION

CDUS could be used for the evaluation of SCA and ITA before CABG as part of presurgical vascular assessment and provide an import basis for the imaging diagnosis and surgical plan.

Assessment of ultrasound shear wave elastography within muscles using different region of interest sizes, manufacturers, probes and acquisition angles: an ex vivo study

BACKGROUND

The application of shear wave elastography (SWE) in assessment of the musculoskeletal system is affected by various factors. This study aimed to explore the influence of machines, probes, region of interest (ROI) sizes, and the acquisition angles on muscle shear wave speed (SWS).

METHODS

The SWS of ex vivo isolated muscles were acquired using 3 different machines (Aixplorer system, SuperSonic Imagine; Acuson S3000, Siemens Healthcare; Resona 7, Mindray) and 2 linear probes (Aixplorer system, SL 10-2 and SL 15-4). Also, 4 different ROI sizes (diameter 1-10 mm) and 9 different acquisition angles (0-40°) were tested. The SWS acquired under different conditions were compared, and the intra-class correlation coefficients (ICC) were used to evaluate reproducibility.

RESULTS

There was a significant difference in SWS acquired using the 3 different machines (P<0.001) or with 9 different angles (P=0.008). There was no significant difference in SWS acquired using 2 probes (P=0.053) or 4 different ROI sizes (P=0.874, 0.778, and 0.865 for 3 operators, respectively). All machines produced substantial intra-system reproducibility (ICC, 0.61-0.80). Both probes demonstrated an almost perfect degree of intra-system agreement (ICC, >0.80), and nearly all ROI sizes demonstrated an almost perfect degree of intra- and inter-operator agreement (ICC, >0.80). The measurement reliability was higher when the acquisition angles were no more than 20°.

CONCLUSIONS

The 3 machines had different SWS values. Attention should be paid when comparing SWS results using different machines. For the Aixplorer system, the ROI size had no effect on the SWS values. Angles larger than 25° will lead to SWS measurements with greater variability compared to smaller angles (≤20°).

Benefits of Contrast-Enhanced Ultrasonography to the Differential Diagnosis of TI-RADS 4-5 Thyroid Nodules

Objective

The early detection, diagnosis, and treatment of thyroid cancer are of great significance to the prognosis for patients. This study was aimed at exploring the benefits of contrast-enhanced ultrasonography (CEUS) to the differential diagnosis of thyroid nodules classified as TI-RADS class 4 or 5.

Method

A total of 46 patients with TI-RADS 4-5 thyroid nodules admitted in Peking University People's Hospital from January 2019 to January 2021 were selected to study. The sensitivity, specificity, accuracy, and positive and negative predictive values of conventional ultrasonography (US) and conventional ultrasonography combined with contrast-enhanced ultrasonography (US + CEUS) in the diagnosis of benign and malignant thyroid nodules were compared by referring to the results of the surgical pathology report, which is seen as the "gold standard" for diagnosis, followed by the construction of receiver operating characteristic curves (ROCs).

Result

Among 57 thyroid nodules, there were statistically significant differences between benign and malignant thyroid nodules in terms of echogenicity, margin characteristics, aspect ratio, and calcification (P < 0.01). In the case of CEUS, there was no statistically significant difference among contrast agent perfusion patterns in distinguishing between benign and malignant thyroid nodules (P > 0.05). However, there were statistically significant differences among different enhancement degrees, enhanced borders, and enhancement patterns. By comparing the CEUS results of TI-RADS 4-5 thyroid nodules with the results of pathology report, the malignancy rate was found to pathology report results, the malignancy rate was 53.85% in TI-RADS class 4 thyroid nodules and 100.00% in TI-RADS class 5 thyroid nodules. Among thyroid nodules diagnosed using US, 6 benign nodules were misdiagnosed as malignant and 7 malignant nodules were misdiagnosed as benign. Among those diagnosed using US + CEUS, 2 benign nodules were misdiagnosed as malignant and 2 malignant nodules were misdiagnosed as benign. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of UN + CEUS significantly outperformed those of UN alone in diagnosing thyroid nodules (P < 0.05). The ROC curve analysis showed that the area under the curve (AUC) derived from US + CEUS was 0.849, while the AUC from US was only 0.726.

Conclusion

Using US + CEUS to diagnose thyroid nodules classified as TI-RADS category 4 or 5 can further improve distinguishing between benign and malignant nodules. The CEUS is of important value to clinical applications as it can provide effective supplementary information and quantitative analysis for the differentiation between benign and malignant thyroid nodules.

Quantification of Nerve Viscosity Using Shear Wave Dispersion Imaging in Diabetic Rats: A Novel Technique for Evaluating Diabetic Neuropathy

Objective

Viscoelasticity is an essential feature of nerves, although little is known about their viscous properties. The discovery of shear wave dispersion (SWD) imaging has presented a new approach for the non-invasive evaluation of tissue viscosity. The present study investigated the feasibility of using SWD imaging to evaluate diabetic neuropathy using the sciatic nerve in a diabetic rat model.

Materials and Methods

This study included 11 diabetic rats in the diabetic group and 12 healthy rats in the control group. Bilateral sciatic nerves were evaluated 3 months after treatment with streptozotocin. We measured the nerve cross-sectional area (CSA), nerve stiffness using shear wave elastography (SWE), and nerve viscosity using SWD imaging. The motor nerve conduction velocity (MNCV) was also measured. These four indicators and the histology of the sciatic nerves were then compared between the two groups. The performance of CSA, SWE, and SWD imaging in distinguishing the two groups was assessed using receiver operating characteristic (ROC) analysis.

Results

Nerve CSA, stiffness, and viscosity in the diabetic group was significantly higher than those in the control group (all p < 0.05). The results also revealed a significantly lower MNCV in the diabetic group (p = 0.005). Additionally, the density of myelinated fibers was significantly lower in the diabetic group (p = 0.004). The average thickness of the myelin sheath was also lower in the diabetic group (p = 0.012). The area under the ROC curve for distinguishing the diabetic neuropathy group from the control group was 0.876 for SWD imaging, which was significantly greater than 0.677 for CSA (p = 0.030) and 0.705 for SWE (p = 0.035).

Conclusion

Sciatic nerve viscosity measured using SWD imaging was significantly higher in diabetic rats. The viscosity measured using SWD imaging performed well in distinguishing the diabetic neuropathy group from the control group. Therefore, SWD imaging may be a promising method for the evaluation of diabetic neuropathy.

Sonographic features of the lateral femoral cutaneous nerve in meralgia paresthetica

Background

The diagnosis of meralgia paresthetica (MP) is usually based on clinical symptoms and physical examination. Therefore, the present study aimed to investigate the lateral femoral cutaneous nerve (LFCN) sonographic features in MP patients.

Methods

A total of 86 clinically suspected MP patients and 40 asymptomatic volunteers were prospectively recruited in the study. The sonographic features of the LFCN were observed by 18 MHz high-frequency ultrasound. At the level of the anterior superior iliac spine, the cross-sectional area of the LFCN was measured.

Results

Of the 86 clinically suspected MP patients, 82 (95.3%) had sonographic findings positive for MP. There were 54, 63, and 44 cases of abrupt caliber change, indistinct perineurium, and abnormal intraneural vascularity. The average value of the cross-sectional area of the LFCN at the level of the anterior superior iliac spine was 4.47±2.64 mm², and the cut-off value was 2.65 mm².

Conclusions

The sonographic diagnosis of MP may be achieved based on the following signs: nerve abrupt caliber change, indistinct perineurium of the nerve, intraneural vascularity, or increased cross-sectional area.

Predictive role of ultrasound remission for progressive ultrasonography-detected structural damage in patients with rheumatoid arthritis

Regarding the persistence of subclinical synovitis, the concept of ultrasound remission has been proposed in addition to clinical remission. However, there have been no studies that explored the different time points of ultrasound remission to predict non-progressive structural damage. Given this, the aim of our study is to explore whether early ultrasound remission in patients with rheumatoid arthritis (RA) has predictive value for non-progressive structural damage in the subsequent 12 months. Sixty-one patients with RA were prospectively studied. Synovial hypertrophy, power Doppler (PD) signal, and bone erosions of bilateral wrists, metacarpophalangeal joints I-V, and proximal interphalangeal joints II-III were assessed by ultrasonography at baseline and at 3, 6, and 12 months. Ultrasound remission was defined as no PD signal. Clinical remission was defined as Disease Activity Score in 28 Joints <2.6. Ultrasonography-detected joint damage progression was defined as increase in bone erosion score of ≥1 in the subsequent 12 months. Baseline ultrasonographic factors were not significantly correlated with progressive ultrasonography-detected joint damage in patients with RA at 12 months (all p>0.05). Ultrasound remission at 3 and 6 months was significantly correlated with non-progressive ultrasonography-detected structural damage at 12 months (p=0.006 and p=0.004), with relatively low sensitivity and high specificity. Clinical remission at 3 months was significantly correlated with non-progression of ultrasonography-detected structural damage at 12 months (p=0.029), with relatively low sensitivity and moderate specificity. Ultrasound remission at 3 and 6 months has high specificity in predicting non-progressive structural damage in patients with RA at 12 months; however, the sensitivity is limited.

Differential diagnosis between small breast phyllodes tumors and fibroadenomas using artificial intelligence and ultrasound data

Background

It is challenging to differentiate between phyllodes tumors (PTs) and fibroadenomas (FAs). Artificial intelligence (AI) can provide quantitative information regarding the morphology and textural features of lesions. This study attempted to use AI to evaluate the ultrasonic images of PTs and FAs and to explore the diagnostic performance of AI features in the differential diagnosis of PTs and FAs.

Methods

A total of 40 PTs and 290 FAs <5 cm in maximum diameter found in female patients were retrospectively analyzed. All tumors were segmented by doctors, and the features of the lesions were collated, including circularity, height-to-width ratio, margin spicules, margin coarseness (MC), margin indistinctness, margin lobulation (ML), internal calcification, angle between the long axis of the lesion and skin, energy, grey entropy, and grey mean. The differences between PTs and FAs were analyzed, and the diagnostic performance of AI features in the differential diagnosis of PTs and FAs was evaluated.

Results

Statistically significant differences (P<0.05) were found in the height-to-width ratio, ML, energy, and grey entropy between the PTs and FAs. Receiver operating characteristic (ROC) curve analysis of single features showed that the area under the curve [(AUC) 0.759] of grey entropy was the largest among the four features with statistically significant differences, and the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 0.925, 0.459, 0.978, and 0.190, respectively. When considering the combinations of the features, the combination of height-to-width ratio, margin indistinctness, ML, energy, grey entropy, and internal calcification was the most optimal of the combinations of features with an AUC of 0.868, and a sensitivity, specificity, PPV, and NPV of 0.734, 0.900, 0.982, and 0.316, respectively.

Conclusions

Quantitative analysis of AI can identify subtle differences in the morphology and textural features between small PTs and FAs. Comprehensive consideration of multiple features is important for the differential diagnosis of PTs and FAs.

Application of ultrasound artificial intelligence in the differential diagnosis between benign and malignant breast lesions of BI-RADS 4A

Background

The classification of Breast Imaging Reporting and Data System 4A (BI-RADS 4A) lesions is mostly based on the personal experience of doctors and lacks specific and clear classification standards. The development of artificial intelligence (AI) provides a new method for BI-RADS categorisation. We analysed the ultrasonic morphological and texture characteristics of BI-RADS 4A benign and malignant lesions using AI, and these ultrasonic characteristics of BI-RADS 4A benign and malignant lesions were compared to examine the value of AI in the differential diagnosis of BI-RADS 4A benign and malignant lesions.

Methods

A total of 206 lesions of BI-RADS 4A examined using ultrasonography were analysed retrospectively, including 174 benign lesions and 32 malignant lesions. All of the lesions were contoured manually, and the ultrasonic morphological and texture features of the lesions, such as circularity, height-to-width ratio, margin spicules, margin coarseness, margin indistinctness, margin lobulation, energy, entropy, grey mean, internal calcification and angle between the long axis of the lesion and skin, were calculated using grey level gradient co-occurrence matrix analysis. Differences between benign and malignant lesions of BI-RADS 4A were analysed.

Results

Significant differences in margin lobulation, entropy, internal calcification and ALS were noted between the benign group and malignant group (P = 0.013, 0.045, 0.045, and 0.002, respectively). The malignant group had more margin lobulations and lower entropy compared with the benign group, and the benign group had more internal calcifications and a greater angle between the long axis of the lesion and skin compared with the malignant group. No significant differences in circularity, height-to-width ratio, margin spicules, margin coarseness, margin indistinctness, energy, and grey mean were noted between benign and malignant lesions.

Conclusions

Compared with the naked eye, AI can reveal more subtle differences between benign and malignant BI-RADS 4A lesions. These results remind us carefully observation of the margin and the internal echo is of great significance. With the help of morphological and texture information provided by AI, doctors can make a more accurate judgment on such atypical benign and malignant lesions.

A measurement method of knee joint space width by ultrasound: a large multicenter study

Background

Although plain radiology is the primary method for assessing joint space width (JSW), it has poor sensitivity to change over time in regards to determining longitudinal progression. We, therefore, developed a new ultrasound (US) measurement method of knee JSW and aimed to provide a monitoring method for the change of JSW in the future.

Methods

A multicenter study was promoted by the Professional Committee of Musculoskeletal Ultrasound, the Ultrasound Society, and the Chinese Medical Doctor Association. US study of knee specimens determined the landmarks for ultrasonic measurement of knee JSW. The US of 1,272 participants from 27 centers was performed to discuss the feasibility and possible influencing factors of knee JSW. The landmarks for US measurement of knee JS, the inflection point of medial femoral epicondyle and the proximal end of the tibia, were determined.

Results

The mean knee JSW1 (medial knee JSW) was 8.57±1.95 mm in females and 9.52±2.31 mm in males. The mean knee JSW2 (the near medial knee JSW) was 9.07±2.24 mm in females and 10.17±2.35 mm in males. The JSW values of males were significantly higher than those of females, with a statistical difference. JSW values were negatively correlated with age and body mass index (BMI) to different degrees and positively correlated with height.

Conclusions

The novel US measurement method can be used to measure knee JSW.

A quantitative evaluation of sciatic nerve stiffness after compression by shear wave elastography in diabetic rats

Background

Our study investigates the feasibility of using quantitative evaluation for nerve entrapment visualization by shear wave elastography (SWE) in diabetic rats.

Methods

A total of 24 male Sprague-Dawley (SD) rats were included in this study. Before injection of streptozotocin (STZ), the experimental groups were assigned as the diabetic nerve compression (DNC) group (DNC, n=18) and the control group (CON, n=6). The DNC model was created by wrapping a silicone tube around the nerve, and then the DNC group was divided into the DNC 2-week (DNC2W, n=6), 4-week (DNC4W, n=6), and 8-week (DNC8W, n=6) groups according to the different duration time of sciatic nerve compression. The nerve stiffness was detected by SWE. Meanwhile, motor nerve conduction velocity (MNCV) was detected. These 2 indicators and histology of sciatic nerves were compared across the different groups.

Results

The stiffness of the nerve depicted by SWE at the compression site increased markedly along with the duration time of compression (P<0.01). The MNCV decreased along with the duration time of nerve compression (P<0.05). The nerve stiffness depicted by SWE was negatively correlated with MNCV (r=−0.926; P<0.01). Myelinated fiber density significantly decreased as the duration time of nerve compression increased (P<0.01). Some differences were found between DNC4W and DNC8W groups, and CON and DNC2W groups (P<0.05) in average axon diameter, myelin sheath thickness, and g ratio.

Conclusions

The increased values of SWE, along with the increased duration of nerve compression, could reflect the severity of nerve entrapment in diabetic rats. Therefore, SWE may be used as a noninvasive and effective method to quantitatively evaluate the severity of diabetic nerve entrapment.

Effect of acquisition depth and precompression from probe and couplant on shear wave elastography in soft tissue: an in vitro and in vivo study

Background

Shear wave elastography is a promising method to diagnose early musculoskeletal lesions. We aimed to explore the feasible depth and acceptable precompression applied by probe and couplant for soft tissues in the present system.

Methods

Ex-vivo muscles were evaluated at depths of 0.5-6 cm by 3 operators, using 1-5 mm couplant thickness and 0-3.0 kPa probe pressure. We compared the shear wave speed (SWS) and used intraclass correlation coefficients to assess reproducibility. In vivo skin and subcutaneous superficial fascia from volunteers were tested at depths ranging from 0.1-0.5 cm with 1-20 mm couplant thickness.

Results

The SWS of ex-vivo muscles varied and increased with depth, and could not be acquired at 6 cm because the shear wave failed to be detected. Furthermore, while the SWS of ex-vivo muscles were not affected by the couplant thickness, it was affected by probe pressure. Most cases demonstrated a satisfactory agreement degree of the intraoperator reproducibility (ICC, 0.81-0.95) and a substantial interoperator reproducibility (ICC >0.60). Inter- and intra-operator reproducibility was better at a depth of 0.5-4 cm than at 5 cm. In the in vivo study, when tissues within a 0.2 cm depth were evaluated, the SWS that was acquired using a couplant thickness of >10 mm was different from that acquired using other thicknesses.

Conclusions

The SWS acquired at a depth of ≤3 cm with a suitable amount of couplant is recommended.

Evaluation of treatment response in oral chronic graft-versus-host patients by power doppler ultrasound: a prospective study

OBJECTIVE

To date, imaging and non-invasive examination methods for evaluating the oral tissue of patients who with oral chronic graft-versus-host disease (GVHD) are still lacking. Herein, we assessed the ultrasonography imaging characteristics of chronic GVHD patients' buccal soft tissue and evaluated the response to treatment using gray-scale and power Doppler (PD) ultrasound. The overall objective of the study was to determine the potential of ultrasonography to provide an early and objective indication of a therapeutic response to treatment intervention in oral chronic GVHD.

METHODS

Buccal mucosa in 21 patients with clinically diagnosis of oral chronic GVHD were assessed before and after 14 day treatment between 2016 and 2018. Ultrasonography assessment included thickness and echogenicity evaluation, and PD. Echogenicity and PD were measured and scored according to a semi-quantitative method. Ultrasonography parameters were compared with clinical activity assessments of disease activity and patient-reported measures.

RESULTS

Following 14 day therapy, a significant decrease in PD scores and patient-reported measures was observed (p < 0.01), and clinical assessment scores also decreased (p < 0.05). Changes from baseline PD scores correlated significantly with patient-reported measures (r = 0.85, p < 0.01). Changes in PD scores correlated moderately with the changes in the clinical assessments from baseline (r = 0.46, p < 0.05). A significant decrease in PD scores was observed in the buccal soft tissue of patients that responded clinically to the treatment. A significant decrease in PD scores was also observed in patients that were failed to show clinical improvement (p < 0.05).

CONCLUSION

Ultrasonography is a novel and feasible imaging technique for measurement of the response of oral chronic GVHD to therapy. Ultrasonography yields additional information about buccal mucosa and is a complementaty to clinical examination.

Ultrasound remission can predict future good structural outcome in collagen-induced arthritis rats

Regarding the persistence of subclinical synovitis, the concept of ultrasound remission has been proposed in addition to clinical remission. The present study aims to explore whether ultrasound remission has predictive value and ultrasound remission at which time point has predictive value for good structural outcome. Collagen-induced arthritis (CIA) was induced in 32 rats by immunizing with bovine type II collagen. Twenty-four CIA rats were treated with rhTNFR:Fc, and 8 rats were left untreated. Ultrasonography was performed to assess synovial hypertrophy, power Doppler (PD) signal, and bone erosion of the ankle joints of both hindpaws every week following the booster immunization. In the treated group, the scores for synovial hypertrophy, PD signal and bone erosions decreased from baseline to the end. Synovial hypertrophy, PD signal, and bone erosion at baseline were not significantly associated with good structural outcome. Ultrasound remission from 4 to 6 weeks after treatment was significantly associated with good outcome and had the highest area under the curve, sensitivity, specificity, and positive and negative predictive values. Therefore, we conclude that ultrasound remission from 4 to 6 weeks after treatment has a high value for predicting good structural outcome in CIA rats.

The value of contrast-enhanced ultrasonography to detect the sacroiliac joint for predicting relapse after discontinuation of anti-tumor necrosis factor therapy in patients with ankylosing spondylitis

BACKGROUND

Ankylosing spondylitis (AS) is a chronic inflammatory disease characterized by high relapse. Therefore, the present study aimed to investigate the ultrasonographic features of contrast-enhanced ultrasonography (CEUS) in the sacroiliac joint (SIJ) in patients with AS in remission after discontinuation of anti-tumor necrosis factor (TNF) therapy, and also examined the role of CEUS in predicting relapse.

METHODS

In this prospective observational study, 130 SIJs in 65 patients with AS (according to modified New York criteria) satisfying Ankylosing Spondylitis Disease Activity Score (ASDAS) inactive disease after discontinuation of anti-TNF therapy were investigated on color Doppler ultrasonography (CDUS) and CEUS. Vascularization and the resistive index (RI) of the SIJ were observed and measured. We defined no blood flow, high RI of arterial blood flow (RI ≥0.7), the reversed phase in the diastolic phase or venous blood flow in the bilateral SIJs, as negative CDUS/CEUS; meanwhile, low RI of arterial blood flow (RI <0.7) in the unilateral or bilateral SIJs was defined as positive CDUS/CEUS. All the patients were followed up for 52 weeks until relapse. Relapse was defined as an increase of two or more items in comparison with the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) at the time of anti-TNF withdrawal.

RESULTS

After 52 weeks, 46 of the 65 patients (70.8%) had relapse. The mean time to relapse was 31.4 weeks (±8.4 weeks, range 20 to 52). After discontinuation of anti-TNF therapy, positive CEUS accounted for 61.5%; this was significantly more than positive CDUS (13.8%). The vascularization detected by CEUS for patients of relapse was significantly different from that of patients with remission (P<0.05). In addition, patients with negative CEUS had a longer duration of remission than the patients with positive CEUS (P=0.005). A Cox proportional hazards regression analysis found that the disease duration could also be regarded as a factor predictive of relapse in patients with AS.

CONCLUSIONS

The use of CEUS distinctly improved the detection of vascularization in the SIJ in patients with AS in remission after anti-TNF withdrawal. The presence of vascularization in the SIJ detected by CEUS at the time of anti-TNF withdrawal could yield a valuable predictor of relapse in patients with AS. A significant limit of this study is the lack of magnetic resonance imaging (MRI) as the standard reference.

Buccal Mucosa Assessed by Ultrasonography in Healthy Adults: Methodology and Determination of Normal Appearance

The aim of the work described here was to compare intra-oral and transcutaneous ultrasonography (US) scanning and to determine the normal values of buccal mucosa thickness and echogenicity. A total of 190 volunteers underwent US examination of the buccal mucosa. The thickness of the buccal epithelial layer was recorded in 19 subjects via both intra-oral and transcutaneous methods. Overall, 171 healthy adults were examined through intra-oral US. Buccal epithelial layer measurement was unreliable via the transcutaneous method (p = 0.001). The mean time required for visualizing the buccal mucosa was 75 and 171s with intra-oral and transcutaneous US, respectively (p < 0.001). The thickness of the buccal epithelial layers significantly differed with age and sex (p < 0.001), and was positively correlated with height, weight and body surface area. Intra-oral US was proposed as a conventional method for examination of the buccal mucosa. Normal buccal epithelial thickness in adults is associated with age, sex, height, weight and body surface area.

Ultrasound morphological changes in the carotid wall of Takayasu's arteritis: monitor of disease progression

BACKGROUND

The aims of this study were to examine ultrasound morphological changes in the carotid wall in cases of Takayasu's arteritis and to thereby determine the value of ultrasound for assessments of Takayasu's arteritis disease activity and follow-up studies.

METHODS

We used high-frequency ultrasound to analyze morphological changes in 51 Takayasu's arteritis patients and compared the findings with clinical and laboratory parameters. A follow-up study of 20 patients was performed.

RESULTS

Five types of ultrasonographic images were observed in the carotid walls of Takayasu's arteritis patients. Type III and type IV images were observed in younger patients; smaller wall thicknesses and less luminal stenosis were observed in these images. Type II and type IV images were more frequently obtained in cases involving active patients, whereas type I and type III images were more often acquired in cases involving inactive patients with significantly lower Indian Takayasu clinical activity scores. During follow-up, the wall thickness and outer diameter of the carotid increased in patients who relapsed and decreased in patients who remained in remission.

CONCLUSIONS

The five types of carotid ultrasound images reveal Takayasu's arteritis-related morphological changes in the vessel wall, which reflect anatomical changes. Carotid ultrasound should play a central role in monitoring the progression of Takayasu's arteritis.

Assessment of the Stiffness of Major Salivary Glands in Primary Sjögren's Syndrome through Quantitative Acoustic Radiation Force Impulse Imaging

The purpose of the study described here was to evaluate salivary gland stiffness in primary Sjögren's syndrome (pSS) via acoustic radiation force impulse imaging, including Virtual Touch tissue quantification (VTQ) and Virtual Touch tissue imaging quantification (VTIQ). Twenty-one patients with pSS and 11 healthy patients were included, and the paired parotid and submandibular glands of all of the patients were examined using VTQ and VTIQ. Differences between the two groups were compared with independent and paired t-tests. The VTQ value for the parotid in the pSS group was significantly higher than that obtained for the control group (1.33 ± 0.22 and 1.18 ± 0.04 m/s, respectively, p < 0.01). The VTIQ values for the parotid and submandibular gland were both significantly higher in the pSS group than in the control group (p < 0.05). In the pSS group, a positive correlation was observed between the VTQ and VTIQ results for the parotid and submandibular glands. In summary, the stiffness of the major salivary glands in patients with pSS was increased compared with that of patients with normal glands. This finding indicates that VTQ and VTIQ imaging may be valuable adjuncts to gray-scale ultrasonography for the clinical diagnosis of pSS.