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Wu M, Wang Y, Su M, Wang R, Sun X, Zhang R, Mu L, Xiao L, Wen H, Liu T, Meng X, Huang L, Zhang X. Integrating Contrast-enhanced US to O-RADS US for Classification of Adnexal Lesions with Solid Components: Time-intensity Curve Analysis versus Visual Assessment. Radiol Imaging Cancer 2024; 6:e240024. [PMID: 39392388 DOI: 10.1148/rycan.240024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2024]
Abstract
Purpose To compare the diagnostic performance of time-intensity curve (TIC) analysis and subjective visual assessment of contrast-enhanced US (CEUS) when integrated with the Ovarian-Adnexal Reporting and Data System (O-RADS) US risk stratification system for characterizing adnexal lesions with solid components. Materials and Methods In this prospective multicenter study conducted from September 2021 to December 2022, female individuals with suspected adnexal lesions containing solid components detected at routine US were enrolled. All participants underwent preoperative CEUS examinations. Histopathologic findings were used as the reference standard for diagnosis. Lesions were classified according to the O-RADS US system. Enhancement of solid tissue compared with the outer myometrium was evaluated using both TIC analysis and subjective visual assessment. The diagnostic performance of O-RADS alone and each CEUS assessment method when integrated with the O-RADS US system was assessed and compared using receiver operating characteristic curve analysis. Results A total of 180 lesions (80 malignant and 100 benign histopathologic outcomes) in 175 participants (median age, 47 years [IQR, 33-56]) were analyzed. Incorporating CEUS (assessed through both TIC analysis and subjective visual assessment) with O-RADS US showed significantly improved diagnostic performance over O-RADS US alone, with an area under the receiver operating characteristic curve (AUC) of 0.86 (95% CI: 0.80, 0.91) compared with 0.78 (95% CI: 0.71, 0.84). No evidence of a difference was observed between the AUCs of TIC analysis and subjective visual assessment in the enhancement evaluation of solid tissue with CEUS for adnexal malignancy categorization (P = .83). Conclusion Subjective visual assessment and TIC analysis of CEUS features when integrated with the O-RADS US scoring system showed comparable diagnostic performance in assigning adnexal malignancy risk. Keywords: Adnexal Lesions, Contrast-enhanced US, O-RADS, Time-intensity Curve Analysis Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
- Manli Wu
- From the Department of Ultrasound, the Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou 510630, Guangdong, China (M.W., Y.W., M.S., L.H., X.Z.); Department of Ultrasound, Henan Provincial People's Hospital, Zhengzhou, China (R.W.); Department of Ultrasound, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (X.S.); Department of Ultrasound, Children's Hospital of Shanxi (Women Health Center of Shanxi), Taiyuan, China (R.Z.); Ultrasound Diagnosis Center, Shaanxi Provincial People's Hospital, Xi'an, China (L.M.); Department of Ultrasound, The Fifth People's Hospital of Chengdu, Chengdu, China (L.X.); Department of Ultrasound, Huizhou Central People's Hospital, Huizhou, China (H.W.); Department of Ultrasound Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, China (T.L.); and Department of Ultrasound, The Third Hospital of BaoGang Group, Maternity Hospital of Bao Tou, Baotou, China (X.M.)
| | - Ying Wang
- From the Department of Ultrasound, the Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou 510630, Guangdong, China (M.W., Y.W., M.S., L.H., X.Z.); Department of Ultrasound, Henan Provincial People's Hospital, Zhengzhou, China (R.W.); Department of Ultrasound, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (X.S.); Department of Ultrasound, Children's Hospital of Shanxi (Women Health Center of Shanxi), Taiyuan, China (R.Z.); Ultrasound Diagnosis Center, Shaanxi Provincial People's Hospital, Xi'an, China (L.M.); Department of Ultrasound, The Fifth People's Hospital of Chengdu, Chengdu, China (L.X.); Department of Ultrasound, Huizhou Central People's Hospital, Huizhou, China (H.W.); Department of Ultrasound Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, China (T.L.); and Department of Ultrasound, The Third Hospital of BaoGang Group, Maternity Hospital of Bao Tou, Baotou, China (X.M.)
| | - Manting Su
- From the Department of Ultrasound, the Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou 510630, Guangdong, China (M.W., Y.W., M.S., L.H., X.Z.); Department of Ultrasound, Henan Provincial People's Hospital, Zhengzhou, China (R.W.); Department of Ultrasound, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (X.S.); Department of Ultrasound, Children's Hospital of Shanxi (Women Health Center of Shanxi), Taiyuan, China (R.Z.); Ultrasound Diagnosis Center, Shaanxi Provincial People's Hospital, Xi'an, China (L.M.); Department of Ultrasound, The Fifth People's Hospital of Chengdu, Chengdu, China (L.X.); Department of Ultrasound, Huizhou Central People's Hospital, Huizhou, China (H.W.); Department of Ultrasound Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, China (T.L.); and Department of Ultrasound, The Third Hospital of BaoGang Group, Maternity Hospital of Bao Tou, Baotou, China (X.M.)
| | - Ruili Wang
- From the Department of Ultrasound, the Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou 510630, Guangdong, China (M.W., Y.W., M.S., L.H., X.Z.); Department of Ultrasound, Henan Provincial People's Hospital, Zhengzhou, China (R.W.); Department of Ultrasound, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (X.S.); Department of Ultrasound, Children's Hospital of Shanxi (Women Health Center of Shanxi), Taiyuan, China (R.Z.); Ultrasound Diagnosis Center, Shaanxi Provincial People's Hospital, Xi'an, China (L.M.); Department of Ultrasound, The Fifth People's Hospital of Chengdu, Chengdu, China (L.X.); Department of Ultrasound, Huizhou Central People's Hospital, Huizhou, China (H.W.); Department of Ultrasound Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, China (T.L.); and Department of Ultrasound, The Third Hospital of BaoGang Group, Maternity Hospital of Bao Tou, Baotou, China (X.M.)
| | - Xiaofeng Sun
- From the Department of Ultrasound, the Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou 510630, Guangdong, China (M.W., Y.W., M.S., L.H., X.Z.); Department of Ultrasound, Henan Provincial People's Hospital, Zhengzhou, China (R.W.); Department of Ultrasound, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (X.S.); Department of Ultrasound, Children's Hospital of Shanxi (Women Health Center of Shanxi), Taiyuan, China (R.Z.); Ultrasound Diagnosis Center, Shaanxi Provincial People's Hospital, Xi'an, China (L.M.); Department of Ultrasound, The Fifth People's Hospital of Chengdu, Chengdu, China (L.X.); Department of Ultrasound, Huizhou Central People's Hospital, Huizhou, China (H.W.); Department of Ultrasound Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, China (T.L.); and Department of Ultrasound, The Third Hospital of BaoGang Group, Maternity Hospital of Bao Tou, Baotou, China (X.M.)
| | - Rui Zhang
- From the Department of Ultrasound, the Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou 510630, Guangdong, China (M.W., Y.W., M.S., L.H., X.Z.); Department of Ultrasound, Henan Provincial People's Hospital, Zhengzhou, China (R.W.); Department of Ultrasound, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (X.S.); Department of Ultrasound, Children's Hospital of Shanxi (Women Health Center of Shanxi), Taiyuan, China (R.Z.); Ultrasound Diagnosis Center, Shaanxi Provincial People's Hospital, Xi'an, China (L.M.); Department of Ultrasound, The Fifth People's Hospital of Chengdu, Chengdu, China (L.X.); Department of Ultrasound, Huizhou Central People's Hospital, Huizhou, China (H.W.); Department of Ultrasound Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, China (T.L.); and Department of Ultrasound, The Third Hospital of BaoGang Group, Maternity Hospital of Bao Tou, Baotou, China (X.M.)
| | - Liang Mu
- From the Department of Ultrasound, the Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou 510630, Guangdong, China (M.W., Y.W., M.S., L.H., X.Z.); Department of Ultrasound, Henan Provincial People's Hospital, Zhengzhou, China (R.W.); Department of Ultrasound, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (X.S.); Department of Ultrasound, Children's Hospital of Shanxi (Women Health Center of Shanxi), Taiyuan, China (R.Z.); Ultrasound Diagnosis Center, Shaanxi Provincial People's Hospital, Xi'an, China (L.M.); Department of Ultrasound, The Fifth People's Hospital of Chengdu, Chengdu, China (L.X.); Department of Ultrasound, Huizhou Central People's Hospital, Huizhou, China (H.W.); Department of Ultrasound Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, China (T.L.); and Department of Ultrasound, The Third Hospital of BaoGang Group, Maternity Hospital of Bao Tou, Baotou, China (X.M.)
| | - Li Xiao
- From the Department of Ultrasound, the Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou 510630, Guangdong, China (M.W., Y.W., M.S., L.H., X.Z.); Department of Ultrasound, Henan Provincial People's Hospital, Zhengzhou, China (R.W.); Department of Ultrasound, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (X.S.); Department of Ultrasound, Children's Hospital of Shanxi (Women Health Center of Shanxi), Taiyuan, China (R.Z.); Ultrasound Diagnosis Center, Shaanxi Provincial People's Hospital, Xi'an, China (L.M.); Department of Ultrasound, The Fifth People's Hospital of Chengdu, Chengdu, China (L.X.); Department of Ultrasound, Huizhou Central People's Hospital, Huizhou, China (H.W.); Department of Ultrasound Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, China (T.L.); and Department of Ultrasound, The Third Hospital of BaoGang Group, Maternity Hospital of Bao Tou, Baotou, China (X.M.)
| | - Hong Wen
- From the Department of Ultrasound, the Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou 510630, Guangdong, China (M.W., Y.W., M.S., L.H., X.Z.); Department of Ultrasound, Henan Provincial People's Hospital, Zhengzhou, China (R.W.); Department of Ultrasound, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (X.S.); Department of Ultrasound, Children's Hospital of Shanxi (Women Health Center of Shanxi), Taiyuan, China (R.Z.); Ultrasound Diagnosis Center, Shaanxi Provincial People's Hospital, Xi'an, China (L.M.); Department of Ultrasound, The Fifth People's Hospital of Chengdu, Chengdu, China (L.X.); Department of Ultrasound, Huizhou Central People's Hospital, Huizhou, China (H.W.); Department of Ultrasound Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, China (T.L.); and Department of Ultrasound, The Third Hospital of BaoGang Group, Maternity Hospital of Bao Tou, Baotou, China (X.M.)
| | - Tingting Liu
- From the Department of Ultrasound, the Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou 510630, Guangdong, China (M.W., Y.W., M.S., L.H., X.Z.); Department of Ultrasound, Henan Provincial People's Hospital, Zhengzhou, China (R.W.); Department of Ultrasound, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (X.S.); Department of Ultrasound, Children's Hospital of Shanxi (Women Health Center of Shanxi), Taiyuan, China (R.Z.); Ultrasound Diagnosis Center, Shaanxi Provincial People's Hospital, Xi'an, China (L.M.); Department of Ultrasound, The Fifth People's Hospital of Chengdu, Chengdu, China (L.X.); Department of Ultrasound, Huizhou Central People's Hospital, Huizhou, China (H.W.); Department of Ultrasound Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, China (T.L.); and Department of Ultrasound, The Third Hospital of BaoGang Group, Maternity Hospital of Bao Tou, Baotou, China (X.M.)
| | - Xiaotao Meng
- From the Department of Ultrasound, the Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou 510630, Guangdong, China (M.W., Y.W., M.S., L.H., X.Z.); Department of Ultrasound, Henan Provincial People's Hospital, Zhengzhou, China (R.W.); Department of Ultrasound, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (X.S.); Department of Ultrasound, Children's Hospital of Shanxi (Women Health Center of Shanxi), Taiyuan, China (R.Z.); Ultrasound Diagnosis Center, Shaanxi Provincial People's Hospital, Xi'an, China (L.M.); Department of Ultrasound, The Fifth People's Hospital of Chengdu, Chengdu, China (L.X.); Department of Ultrasound, Huizhou Central People's Hospital, Huizhou, China (H.W.); Department of Ultrasound Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, China (T.L.); and Department of Ultrasound, The Third Hospital of BaoGang Group, Maternity Hospital of Bao Tou, Baotou, China (X.M.)
| | - Licong Huang
- From the Department of Ultrasound, the Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou 510630, Guangdong, China (M.W., Y.W., M.S., L.H., X.Z.); Department of Ultrasound, Henan Provincial People's Hospital, Zhengzhou, China (R.W.); Department of Ultrasound, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (X.S.); Department of Ultrasound, Children's Hospital of Shanxi (Women Health Center of Shanxi), Taiyuan, China (R.Z.); Ultrasound Diagnosis Center, Shaanxi Provincial People's Hospital, Xi'an, China (L.M.); Department of Ultrasound, The Fifth People's Hospital of Chengdu, Chengdu, China (L.X.); Department of Ultrasound, Huizhou Central People's Hospital, Huizhou, China (H.W.); Department of Ultrasound Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, China (T.L.); and Department of Ultrasound, The Third Hospital of BaoGang Group, Maternity Hospital of Bao Tou, Baotou, China (X.M.)
| | - Xinling Zhang
- From the Department of Ultrasound, the Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou 510630, Guangdong, China (M.W., Y.W., M.S., L.H., X.Z.); Department of Ultrasound, Henan Provincial People's Hospital, Zhengzhou, China (R.W.); Department of Ultrasound, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (X.S.); Department of Ultrasound, Children's Hospital of Shanxi (Women Health Center of Shanxi), Taiyuan, China (R.Z.); Ultrasound Diagnosis Center, Shaanxi Provincial People's Hospital, Xi'an, China (L.M.); Department of Ultrasound, The Fifth People's Hospital of Chengdu, Chengdu, China (L.X.); Department of Ultrasound, Huizhou Central People's Hospital, Huizhou, China (H.W.); Department of Ultrasound Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, China (T.L.); and Department of Ultrasound, The Third Hospital of BaoGang Group, Maternity Hospital of Bao Tou, Baotou, China (X.M.)
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Wang R, Liu H, Tang J, Geng J. The application value of two-dimensional ultrasound combined with contrast-enhanced ultrasound in the differential diagnosis of benign, borderline, and malignant ovarian epithelial tumors. J Ovarian Res 2024; 17:191. [PMID: 39342318 PMCID: PMC11438069 DOI: 10.1186/s13048-024-01514-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Accepted: 09/11/2024] [Indexed: 10/01/2024] Open
Abstract
OBJECTIVE The aim of this study was to explore the clinical application value of two-dimensional ultrasound (2D-US) combined with contrast-enhanced ultrasonography (CEUS) in the differential diagnosis of benign, borderline ovarian tumors (BOTs), and malignant ovarian epithelial tumors (OETs). METHODS The clinical data of 108 patients who underwent surgery for pathologically confirmed of OETs at Peking University People's Hospital between December 2018 and November 2023 were retrospectively studied. The diagnostic value of 2D-US combined with CEUS for diagnosing OETs was analyzed using chi-square tests, receiver operating characteristic (ROC) curves, and random forest models. RESULTS Among the 108 cases of OETs, 23 were benign, 34 were BOTs, and 51 were malignant. Chi-square tests confirmed that the perfusion pattern of the contrast agent plays an important role in the differential diagnosis of OETs. Compared with those in the benign group, the BOTs were not significantly different in terms of perfusion phase and enhancement intensity, but the regression time of the BOTs was earlier (P < 0.05). Compared with the BOTs, the malignant tumors group showed earlier perfusion and higher enhancement intensity, with no significant difference in regression time. The ROC curve results indicated that the combined diagnostic efficiency of 2D-US and CEUS in distinguishing OETs was significantly higher than that of a single diagnostic technique in terms of sensitivity, specificity, accuracy, and AUC. The random forest model results revealed that among the various parameters used in the differential diagnosis of OETs, the perfusion pattern was the most significant factor. CONCLUSION 2D-US combined with CEUS helps improve the differential diagnostic efficiency for benign, BOTs, and malignant OETs.
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Affiliation(s)
- Rongli Wang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, 100044, China
| | - Huiping Liu
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, 100044, China
| | - Jun Tang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, 100044, China
| | - Jing Geng
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, 100044, China.
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Zhang B, Han X. Diagnostic Value of Contrast-Enhanced Ultrasound in Benign and Malignant Adnexal Masses: A Meta-Analysis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024. [PMID: 39315743 DOI: 10.1002/jum.16580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 08/28/2024] [Accepted: 09/09/2024] [Indexed: 09/25/2024]
Abstract
In the diagnosis of gynecological tumors, determining the benign or malignant nature of adnexal masses is a crucial and complex issue. Contrast-enhanced ultrasound (CEUS) is a relatively novel and increasingly used diagnostic method. Therefore, this study evaluated the diagnostic value of CEUS in differentiating benign and malignant adnexal masses through meta-analysis and systematic review. We systematically searched PubMed, Embase, Web of Science, and the Cochrane Library for studies published up to April 2024 regarding the use of CEUS in diagnosing benign and malignant adnexal masses. STATA 14.0 software was used for data analysis, pooling the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio (DOR) of eligible studies. After initial screening, 305 studies were identified, 13 of which met the inclusion criteria and were analyzed in this meta-analysis. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and DOR of CEUS for the diagnosis of benign and malignant adnexal masses were 0.92 (95% confidence interval [CI]: 0.88-0.95), 0.88 (95% CI: 0.82-0.93), 8.00 (95% CI: 5.00-12.90), 0.09 (95% CI: 0.06-0.14), and 91.00 (95% CI: 45.00-185.00), respectively. The area under the summary receiver operating characteristic curve (AUC) was 0.95 (95% CI: 0.93-0.97). CEUS is a noninvasive, nonradiative imaging modality with high accuracy and reliability in the diagnosis of benign and malignant adnexal masses. To provide an effective adjunct tool in the clinic, future studies can further explore the specific application value of CEUS and its performance in different populations.
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Affiliation(s)
- Boyang Zhang
- Department of Ultrasound, The First Affiliated Hospital of Hainan Medical College, Haikou, China
| | - Xiao Han
- Department of Ultrasound, The First Affiliated Hospital of Hainan Medical College, Haikou, China
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Lu B, He W, Liu C, Wang P, Yang P, Zhao Z, Qi J, Huang B. Differentiating Benign From Malignant Ovarian Masses With Solid Components: Diagnostic Performance of CEUS Combined With IOTA Simple Rules and O-RADS. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:1449-1458. [PMID: 38876911 DOI: 10.1016/j.ultrasmedbio.2024.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 05/19/2024] [Accepted: 05/22/2024] [Indexed: 06/16/2024]
Abstract
OBJECTIVE This study aimed to apply the International Ovarian Tumor Analysis (IOTA) Simple Rules (SR), the Ovarian-Adnexal Reporting and Data System (O-RADS) and contrast-enhanced ultrasound (CEUS) in an identical cohort of Chinese patients and to analyze their performance in discrimination of ovarian masses with solid components. METHODS This was a two-center retrospective study that included a total of 94 ovarian lesions in 86 women enrolled from January 2018 to February 2023. The lesions were classified by using the IOTA terminology and CEUS was performed for the lesions exhibiting solid components on ultrasonography, IOTA SR and O-RADS were applied, and CEUS images were analyzed retrospectively. We assessed the time to wash-in, time to peak intensity (PI), PI compared to myometrium, and time to wash-out, and observed statistically significant differences between benign and malignant lesions in the first three parameters. CEUS characteristics were employed to determine CEUS scores for benign (score 0) and malignant (score 3) lesions. Subsequently, the lesions were reassessed based on the IOTA SR and O-RADS classifications and CEUS scores. The sensitivity, specificity, and area under the receiver-operating-characteristics curve (AUC) of the different models were also determined. RESULTS Among the 94 ovarian lesions, 46 (48.9%) were benign and 48 (51.1%) were malignant. It was found that in the 60 lesions to which the SR could be applied, the sensitivity, specificity, and AUC was 0.900, 0.667, and 0.783, respectively. The sensitivity, specificity, and AUC of O-RADS was observed to be 1.000, 0.283 and 0.641, respectively. When SR and O-RADS were combined with CEUS, their sensitivity, specificity, and AUC values were increased to 0.917, 0.891, 0.904, and 0.958, 0.783, 0.871, respectively. CONCLUSION IOTA SR and O-RADS exhibited relatively low specificity in differentiating malignant from benign ovarian lesions with the solid components, and their diagnostic performance can be significantly improved when combined with CEUS.
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Affiliation(s)
- Beilei Lu
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Medical Imaging, Shanghai, China; Institute of Medical Ultrasound and Engineering, Fudan University, Shanghai, China
| | - Wanyuan He
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Medical Imaging, Shanghai, China; Institute of Medical Ultrasound and Engineering, Fudan University, Shanghai, China
| | - Chang Liu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Educational Institute, Tongji University School of Medicine, Shanghai, China
| | - Pan Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ping Yang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhengyong Zhao
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China; The Third People's Hospital of Honghe Hani and Yi Autonomous Prefecture, Yunnan, China
| | - Jiuling Qi
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Medical Imaging, Shanghai, China; Institute of Medical Ultrasound and Engineering, Fudan University, Shanghai, China.
| | - Beijian Huang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Medical Imaging, Shanghai, China; Institute of Medical Ultrasound and Engineering, Fudan University, Shanghai, China
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Wu M, Zhang M, Qu E, Sun X, Zhang R, Mu L, Xiao L, Wen H, Wang R, Liu T, Meng X, Wu S, Chen Y, Su M, Wang Y, Gu J, Zhang X. A modified CEUS risk stratification model for adnexal masses with solid components: prospective multicenter study and risk adjustment. Eur Radiol 2024; 34:5978-5988. [PMID: 38374482 DOI: 10.1007/s00330-024-10639-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/20/2023] [Accepted: 01/27/2024] [Indexed: 02/21/2024]
Abstract
OBJECTIVES To evaluate the additional advantages of integrating contrast-enhanced ultrasound (CEUS) into the Ovarian-Adnexal Reporting and Data System (O-RADS) ultrasound (US) for the characterization of adnexal lesions with solid components. MATERIALS AND METHODS This prospective multicenter study recruited women suspected of having adnexal lesions with solid components between September 2021 and December 2022. All patients scheduled for surgery underwent preoperative CEUS and US examinations. The lesions were categorized according to the O-RADS US system, and quantitative CEUS indexes were recorded. Pathological results served as the reference standard. Univariable and multivariable analyses were performed to identify risk factors for malignancy in adnexal lesions with solid components. Receiver operating characteristic (ROC) curve analysis was employed to assess diagnostic performance. RESULTS A total of 180 lesions in 175 women were included in the study. Among these masses, 80 were malignant and 100 were benign. Multivariable analysis revealed that serum CA-125, the presence of acoustic shadowing, and peak intensity (PI) ratio (PImass/PIuterus) of solid components on CEUS were independently associated with adnexal malignancy. The modified CEUS risk stratification model demonstrated superior diagnostic value in assessing adnexal lesions with solid components compared to O-RADS US (AUC: 0.91 vs 0.78, p < 0.001) and exhibited comparable performance to the Assessment of Different NEoplasias in the adnexa (ADNEX) model (AUC 0.91 vs 0.86, p = 0.07). CONCLUSION Our findings underscore the potential value of CEUS as an adjunctive tool for enhancing the precision of diagnostic evaluations of O-RADS US. CLINICAL RELEVANCE STATEMENT The promising performance of the modified CEUS risk stratification model suggests its potential to mitigate unnecessary surgeries in the characterization of adnexal lesions with solid components. KEY POINTS • The additional value of CEUS to O-RADS US in distinguishing between benign and malignant adnexal lesions with solid components requires further evaluation. • The modified CEUS risk stratification model displayed superior diagnostic value and specificity in characterizing adnexal lesions with solid components when compared to O-RADS US. • The inclusion of CEUS demonstrated potential in reducing the need for unnecessary surgeries in the characterization of adnexal lesions with solid components.
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Affiliation(s)
- Manli Wu
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Man Zhang
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Enze Qu
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiaofeng Sun
- Department of Ultrasound, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rui Zhang
- Department of Ultrasound, Children's Hospital of Shanxi (Women Health Center of Shanxi), Taiyuan, China
| | - Liang Mu
- Ultrasound Diagnosis Center, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Li Xiao
- Department of Ultrasound, The Fifth People's Hospital of Chengdu, Chengdu, China
| | - Hong Wen
- Department of Ultrasound, Huizhou Central People's Hospital, Huizhou, China
| | - Ruili Wang
- Department of Ultrasound, Henan Provincial People's Hospital, Zhengzhou, China
| | - Tingting Liu
- Department of Ultrasound Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xiaotao Meng
- Department of Ultrasound, The Third Hospital of BaoGang Group, The Maternity Hospital Of Bao Tou, Baotou, China
| | - Shuangyu Wu
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ying Chen
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Manting Su
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ying Wang
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jian Gu
- Department of Gynecology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
| | - Xinling Zhang
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
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Hu Z, Fan S, Feng X, Liu L, Zhou J, Wu Z, Zhou L. Performance of grayscale combined with contrast-enhanced ultrasound in differentiating benign and malignant pediatric ovarian masses. Eur Radiol 2024:10.1007/s00330-024-11011-z. [PMID: 39120792 DOI: 10.1007/s00330-024-11011-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 05/26/2024] [Accepted: 07/23/2024] [Indexed: 08/10/2024]
Abstract
OBJECTIVES To evaluate grayscale US combined with contrast-enhanced ultrasound (CEUS) in the preoperative differentiation between benign and malignant ovarian masses in a pediatric population. MATERIALS AND METHODS This retrospective study enrolled patients who underwent grayscale US and CEUS before surgery because of ovarian masses between July 2018 and September 2023, with available histopathologic or follow-up results. Two senior radiologists summarized the grayscale US and CEUS characteristics of all ovarian masses, including percentage of solidity, ascites, vascularity, and enhanced vessel morphology. These characteristics were then independently reviewed by radiologists with different experience to assess interobserver agreement. Diagnostic performance was evaluated using the area under the receiver operating characteristic curve (AUC), while interobserver agreement was evaluated by intraclass correlation coefficient (ICC). RESULTS A total of 26 children (median age: 10.1 [7.5, 11.7] years; age range: 0-14 years; benign: 15 patients) were included. The main characteristics of malignant ovarian tumors were abundant blood flow and twisted blood vessels within the mass, enhanced portion of the mass over 50 percent (all p < 0.001). The grayscale US combined with CEUS showed better diagnostic performance than the grayscale US alone (AUC = 0.99 [95% CI: 0.95, 1.00] vs AUC = 0.70 [95% CI: 0.50, 0.90] p < 0.001). A statistically significant AUC before and after CEUS was also shown between two junior radiologists (0.75 vs 0.92 and 0.69 vs 0.86, respectively, both p < 0.05). ICC of CEUS was better than that of grayscale US among radiologists. CONCLUSION The combination of grayscale US and CEUS might improve the diagnostic accuracy in differentiating benign and malignant pediatric ovarian masses. CLINICAL RELEVANCE STATEMENT Grayscale ultrasound combined with contrast-enhanced ultrasound can improve the diagnostic performance in the preoperative differentiation of benign and malignant ovarian lesions in a pediatric population. KEY POINTS Correctly distinguishing benign from malignant ovarian masses in pediatric patients is critical for determining treatments. Grayscale combined with contrast-enhanced ultrasound (CEUS) differentiated benign and malignant pediatric ovarian masses better than grayscale US alone. Junior radiologists' diagnostic performances could be and were significantly improved with the application of CEUS.
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Affiliation(s)
- Zehang Hu
- Department of Ultrasound, Shenzhen Children's Hospital, 7019 Yitian Road, Futian District, 518026, Shenzhen, P.R. China
| | - Shumin Fan
- Department of Ultrasound, Shenzhen Children's Hospital, 7019 Yitian Road, Futian District, 518026, Shenzhen, P.R. China
| | - Xia Feng
- Department of Ultrasound, Shenzhen Children's Hospital, 7019 Yitian Road, Futian District, 518026, Shenzhen, P.R. China
| | - Lei Liu
- Department of Ultrasound, Shenzhen Children's Hospital, 7019 Yitian Road, Futian District, 518026, Shenzhen, P.R. China
| | - Jingran Zhou
- Department of Ultrasound, Shenzhen Children's Hospital, 7019 Yitian Road, Futian District, 518026, Shenzhen, P.R. China
| | - Zhixia Wu
- Department of Ultrasound, Shenzhen Children's Hospital, 7019 Yitian Road, Futian District, 518026, Shenzhen, P.R. China
| | - Luyao Zhou
- Department of Ultrasound, Shenzhen Children's Hospital, 7019 Yitian Road, Futian District, 518026, Shenzhen, P.R. China.
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Patel-Lippmann KK, Wasnik AP, Akin EA, Andreotti RF, Ascher SM, Brook OR, Eskander RN, Feldman MK, Jones LP, Martino MA, Patel MD, Patlas MN, Revzin MA, VanBuren W, Yashar CM, Kang SK. ACR Appropriateness Criteria® Clinically Suspected Adnexal Mass, No Acute Symptoms: 2023 Update. J Am Coll Radiol 2024; 21:S79-S99. [PMID: 38823957 DOI: 10.1016/j.jacr.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 02/28/2024] [Indexed: 06/03/2024]
Abstract
Asymptomatic adnexal masses are commonly encountered in daily radiology practice. Although the vast majority of these masses are benign, a small subset have a risk of malignancy, which require gynecologic oncology referral for best treatment outcomes. Ultrasound, using a combination of both transabdominal, transvaginal, and duplex Doppler technique can accurately characterize the majority of these lesions. MRI with and without contrast is a useful complementary modality that can help characterize indeterminate lesions and assess the risk of malignancy is those that are suspicious. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | | | - Esma A Akin
- The George Washington University Medical Center, Washington, District of Columbia; Commission on Nuclear Medicine and Molecular Imaging
| | | | - Susan M Ascher
- MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Olga R Brook
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Ramez N Eskander
- University of California, San Diego, San Diego, California; American College of Obstetricians and Gynecologists
| | | | - Lisa P Jones
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Martin A Martino
- Ascension St. Vincent's, Jacksonville, Florida; University of South Florida, Tampa, Florida, Gynecologic oncologist
| | | | - Michael N Patlas
- Department of Medical Imaging, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Margarita A Revzin
- Yale University School of Medicine, New Haven, Connecticut; Committee on Emergency Radiology-GSER
| | | | - Catheryn M Yashar
- University of California, San Diego, San Diego, California; Commission on Radiation Oncology
| | - Stella K Kang
- Specialty Chair, New York University Medical Center, New York, New York
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8
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Ren Q, Yuan M, Wang G. Role of ultrasonography in the evaluation of disease severity and treatment efficacy in adenomyosis. Arch Gynecol Obstet 2024; 309:363-371. [PMID: 37115275 DOI: 10.1007/s00404-023-07034-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/01/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Adenomyosis is a benign disorder characterized by the presence of ectopic endometrial glands and stroma within the myometrium. The main clinical manifestations of adenomyosis are dysmenorrhea, menorrhagia, and infertility, which affect patients' quality of life. Recently, with advancements in imaging techniques, magnetic resonance imaging, and ultrasonography have become the main diagnostic tools for adenomyosis. In addition to the diagnosis and differential diagnosis of adenomyosis, ultrasonography can also be used to evaluate the severity of adenomyosis. The emergence of new techniques, such as elastography and contrast-enhanced ultrasonography (CEUS), has significantly improved the accuracy of ultrasound-based diagnosis of adenomyosis. These two imaging tools can also be used for the differential diagnosis of adenomyosis and the evaluation of treatment efficacy after medication or ablation procedure. OBJECTIVE we review the efficacy of ultrasonography as a diagnostic tool for adenomyosis. We also aim to introduce the potential of ultrasound imaging in the evaluation of the severity of this disease, as well as the application of elastography and contrast-enhanced ultrasonography (CEUS) in its diagnosis. RESULTS AND CONCLUSION Our findings reveal the potential value of ultrasonography combined with elastography and/or CEUS as medication guidance and efficacy evaluation tools in the long-term management of adenomyosis.
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Affiliation(s)
- Qianhui Ren
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital, Jinan, 250000, Shandong, China
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Ming Yuan
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital, Jinan, 250000, Shandong, China
- Gynecology Laboratory, Shandong Provincial Hospital, Jinan, Shandong, China
| | - Guoyun Wang
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital, Jinan, 250000, Shandong, China.
- Gynecology Laboratory, Shandong Provincial Hospital, Jinan, Shandong, China.
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9
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Xu J, Huang Z, Zeng J, Zheng Z, Cao J, Su M, Zhang X. Value of Contrast-Enhanced Ultrasound Parameters in the Evaluation of Adnexal Masses with Ovarian-Adnexal Reporting and Data System Ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:1527-1534. [PMID: 37032238 DOI: 10.1016/j.ultrasmedbio.2023.02.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/15/2023] [Accepted: 02/23/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE The aim of this study was to determine whether incorporating qualitative parameters of contrast-enhanced ultrasound (CEUS) can increase the accuracy of adnexal lesion assessments with Ovarian-Adnexal Reporting and Data System (O-RADS) ultrasound category 4 or 5. METHODS Retrospective analysis of patients with adnexal masses who underwent conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS) examinations between January and August of 2020. The study investigators reviewed and analyzed the morphological features of each mass before categorizing the US images independently according to the O-RADS system published by the American College of Radiology. In the CEUS analysis, the initial time and intensity of enhancement involving the wall and/or septation of the mass were compared with the uterine myometrium. Internal components of each mass were observed for signs of enhancement. The sensitivity, specificity, and Youden's index were calculated as the contrast variables and O-RADS. RESULTS Receiver operating characteristic curve analysis revealed that the best cutoff value was higher than O-RADS 4. When information on the extent of enhancement was applied to selectively upgrade O-RADS category 4 and selectively downgrade O-RADS category 5, the overall sensitivity increased to 90.2%, while the level of specificity (91.3%) remained the same. CONCLUSION Incorporating additional information from CEUS with respect to the extent of enhancement helped to improve the sensitivity of O-RADS category 4 and 5 masses without loss of specificity.
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Affiliation(s)
- Jing Xu
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Zeping Huang
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Jie Zeng
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Zhijuan Zheng
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Junyan Cao
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Manting Su
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Xinling Zhang
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China.
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Wang T, Cui W, Nie F, Huang X, Huang L, Liu L, Zhu Y, Zheng R. Comparative Study of the Efficacy of the Ovarian-Adnexa Reporting and Data System Ultrasound Combined With Contrast-Enhanced Ultrasound and the ADNEX MR Scoring System in the Diagnosis of Adnexal Masses. ULTRASOUND IN MEDICINE & BIOLOGY 2023:S0301-5629(23)00170-9. [PMID: 37321953 DOI: 10.1016/j.ultrasmedbio.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/23/2023] [Accepted: 05/22/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVE The aims of this study were to develop the Ovarian-Adnexa Reporting and Data System (O-RADS) and O-RADS + contrast-enhanced ultrasound (O-RADS CEUS) scoring system to distinguish adnexal masses (AMs) and to compare the diagnostic efficacy of these systems with that of a magnetic resonance imaging scoring system (ADNEX MR). METHODS We retrospectively evaluated 278 ovarian masses from 240 patients between May 2017 and July 2022. Pathology and adequate follow-up were used as reference standards for comparing the validity of O-RADS, O-RADS CEUS and ADNEX MR scoring to diagnose AMs. Area under the curve (AUC), sensitivity and specificity were calculated. The inter-class correlation coefficient (ICC) was calculated to evaluate inter-reader agreement (IRA) between the two sonographers and two radiologists who analyzed the findings with the three modalities. RESULTS The AUCs of O-RADS, O-RADS CEUS and ADNEX MR scores were 0.928 (95% confidence interval [CI]: 0.895-0.956), 0.951(95% CI: 0.919-0.973) and 0.964 (95% CI: 0.935-0.983), respectively. Their sensitivities were 95.7%, 94.3 and 91.4%, and their specificities were 81.3%, 92.3% and 97.1%, respectively. The three modalities had accuracies of 84.9%, 92.8% and 95.7%, respectively. O-RADS had the highest sensitivity but significantly lower specificity (p < 0.001), whereas the ADNEX MR scoring had the highest specificity (p < 0.001) but lower sensitivity (p < 0.001). O-RADS CEUS had intermediate sensitivity and specificity (p < 0.001). CONCLUSION The addition of CEUS significantly improves the efficacy of O-RADS in diagnosing AMs. The diagnostic efficacy of the combination is comparable to that of the ADNEX MR scoring system.
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Affiliation(s)
- Ting Wang
- Ultrasound Medical Center, Lanzhou University Second Hospital, Cuiyingmen No.82, Chengguan District, Lanzhou 730030, China; Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China; Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Lanzhou, China
| | - Wenjun Cui
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Gansu, China
| | - Fang Nie
- Ultrasound Medical Center, Lanzhou University Second Hospital, Cuiyingmen No.82, Chengguan District, Lanzhou 730030, China; Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China; Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Lanzhou, China.
| | - Xiao Huang
- Ultrasound Medical Center, Lanzhou University Second Hospital, Cuiyingmen No.82, Chengguan District, Lanzhou 730030, China; Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China; Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Lanzhou, China
| | - Lele Huang
- Department of Nuclear Medicine, Lanzhou University Second Hospital, Gansu, China
| | - Luping Liu
- Ultrasound Medical Center, Lanzhou University Second Hospital, Cuiyingmen No.82, Chengguan District, Lanzhou 730030, China; Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China; Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Lanzhou, China
| | - Yangyang Zhu
- Ultrasound Medical Center, Lanzhou University Second Hospital, Cuiyingmen No.82, Chengguan District, Lanzhou 730030, China; Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China; Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Lanzhou, China
| | - Rongfang Zheng
- Department of Gynaecology, Lanzhou University Second Hospital, Gansu, China
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11
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Lu B, Liu C, Qi J, He W, Shi T, Zhu Y, Huang B. Comparison of contrast-enhanced ultrasound, IOTA simple rules and O-RADS for assessing the malignant risk of sonographically appearing solid ovarian masses. J Gynecol Obstet Hum Reprod 2023; 52:102564. [PMID: 36868504 DOI: 10.1016/j.jogoh.2023.102564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 02/02/2023] [Accepted: 02/26/2023] [Indexed: 03/05/2023]
Abstract
PURPOSE To explore the diagnostic accuracy of ovarian solid tumors by 2D ultrasound and contrast-enhanced ultrasound (CEUS). MATERIALS AND METHODS We retrospectively evaluated the CEUS characteristics of prospectively enrolled 16 benign and 19 malignant ovarian solid tumors. We performed International Ovarian Tumor Analysis (IOTA) simple rules and Ovarian-Adnexal Reporting and Data System (O-RADS) for all lesions, and evaluated their characteristics on CEUS. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of IOTA simple rules, O-RADS and CEUS in the diagnosis of ovarian solid malignancies were calculated. RESULTS The combination of time to wash-in earlier than or equal to the myometrium, time to PI earlier than or equal to the myometrium and the intensity at peak were higher than or equal to myometrium with sensibility of 0.947, specificity of 0.938, and PPV of 0.947, NPV of 0.938 which were higher than IOTA simple rules and O-RADS. According to the definition of ovarian solid tumor, the diagnostic accuracy of O-RADS 3 and CEUS were both 100%, CEUS improved the accuracy of O-RADS 4 from 47.4% to 87.5%, the accuracy of solid smooth CS 4 in O-RADS 5 and CEUS were both 100%, CEUS improved the accuracy of solid irregular in O-RADS 5 from 70% to 87.5%. CONCLUSION For ovarian solid tumors that are difficult to distinguish between benign and malignant, the introduction of CEUS on the basis of 2D classification criteria can significantly improve the diagnostic accuracy.
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Affiliation(s)
- Beilei Lu
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, PR China; Shanghai Institute of Medical Imaging, Shanghai 200032, PR China; Institute of Medical Ultrasound and Engineering, Fudan University, Shanghai 200032, PR China
| | - Chang Liu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Shanghai 200072, PR China
| | - Jiuling Qi
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, PR China; Shanghai Institute of Medical Imaging, Shanghai 200032, PR China; Institute of Medical Ultrasound and Engineering, Fudan University, Shanghai 200032, PR China.
| | - Wanyuan He
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, PR China; Shanghai Institute of Medical Imaging, Shanghai 200032, PR China; Institute of Medical Ultrasound and Engineering, Fudan University, Shanghai 200032, PR China.
| | - Tingyan Shi
- Ovarian Cancer Program, Division of Gynecology Oncology, Department of Obstetrics and Gynecology, Zhongshan Hospital, Fudan University, 200032 PR China
| | - Yuli Zhu
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, PR China; Shanghai Institute of Medical Imaging, Shanghai 200032, PR China; Institute of Medical Ultrasound and Engineering, Fudan University, Shanghai 200032, PR China
| | - Beijian Huang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, PR China; Shanghai Institute of Medical Imaging, Shanghai 200032, PR China; Institute of Medical Ultrasound and Engineering, Fudan University, Shanghai 200032, PR China.
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12
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Liu C, Li Y, Zhu Y, Lu M. The Value of IOTA Simple Rules Combined With CEUS Scoring System in the Diagnosis of Benign and Malignant Ovarian Masses and Its Correlation With MVD and VEGF: A Preliminary Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:2983-2992. [PMID: 35481545 DOI: 10.1002/jum.15999] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 03/23/2022] [Accepted: 04/17/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To investigate the diagnostic value of International Ovarian Tumor Analysis (IOTA) simple rules combined with contrast-enhanced ultrasound (CEUS) scoring system in the differential diagnosis of ovarian tumors, and the correlations of the scoring system with microvessel density (MVD) and vascular endothelial growth factor (VEGF). METHODS One hundred eighty-nine patients with ovarian tumors were examined by routine ultrasound and CEUS. The enhanced characteristics of CEUS were observed, and the masses were classified by IOTA simple rules. To compare the diagnostic value of IOTA simple rules combined with CEUS scoring system and IOTA simple rules in the diagnosis of ovarian tumors. Immunohistochemistry was used to detect the expression of MVD and VEGF in postoperative tissue samples. The correlations between the new scoring system with MVD and VEGF were analyzed. RESULTS The sensitivity (93.98%), specificity (94.34%), positive predictive value (92.86%), negative predictive value (95.24%), and accuracy (94.18%) of IOTA simple rules combined with CEUS scoring system in the diagnosis of ovarian tumors were higher than those of IOTA simple rules alone (all P < .05). The score system was significantly positively correlated with MVD and VEGF, and the r values were 0.77 and 0.63, respectively (P < .001). CONCLUSIONS IOTA simple rules combined with CEUS scoring system was helpful to improve the accuracy of ultrasound diagnosis of ovarian tumors, which was significantly correlated with MVD and VEGF. It could provide important reference information for treatment scheme formulation and prognosis evaluation.
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Affiliation(s)
- Chun Liu
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yuan Li
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yi Zhu
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Man Lu
- Department of Ultrasound, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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Sun M, Zhang B. Contrast‑enhanced ultrasound of ovarian steroid cell tumor, not otherwise specified: A case report. Oncol Lett 2022; 24:370. [PMID: 36238839 PMCID: PMC9494617 DOI: 10.3892/ol.2022.13490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/03/2022] [Indexed: 11/07/2022] Open
Abstract
Ovarian steroid cell tumor is a rare type of ovarian tumor, accounting for ~0.1% of all neoplasms of the ovary. Patients suffering from this type of tumor exhibit virilization due to high testosterone levels. The present study reported a case of an elderly female patient with high testosterone serum levels, resulting in hirsutism and deepening of the voice. Magnetic resonance imaging did not reveal any solid ovarian tumor. However, gray-scale ultrasound indicated suspicious solid nodules on the right ovary. A clear outline of the tumor, characterized by ring-shaped uniform enhancement, was revealed by contrast-enhanced ultrasound (CEUS) scanning. In addition, laparoscopic resection of both fallopian tubes and ovaries confirmed the right ovarian steroid cell tumor. After the operation, the patient's symptoms were completely relieved and testosterone levels returned to normal. In the present study, a case of ovarian steroid tumor diagnosed by CEUS was reported, supporting the significant role of CEUS in the detection of adnexal tumors.
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Affiliation(s)
- Mai Sun
- Department of Ultrasound, China‑Japan Friendship Hospital, Beijing 100029, P.R. China
| | - Bo Zhang
- Department of Ultrasound, China‑Japan Friendship Hospital, Beijing 100029, P.R. China
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Xun L, Zhai L, Xu H. Comparison of conventional, doppler and contrast-enhanced ultrasonography in differential diagnosis of ovarian masses: a systematic review and meta-analysis. BMJ Open 2021; 11:e052830. [PMID: 34952878 PMCID: PMC8710872 DOI: 10.1136/bmjopen-2021-052830] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To assess the value of conventional, Doppler and contrast-enhanced ultrasonography (CEUS) (conventional ultrasonography (US), Doppler US and CEUS) for diagnosing ovarian cancer. DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed, Embase and the Cochrane Library were conducted for studies published until October 2021. ELIGIBILITY CRITERIA Studies assessed the diagnostic value of conventional US, Doppler US or CEUS for detecting ovarian cancer, with no restrictions placed on published language and status. DATA EXTRACTION AND SYNTHESIS The study selection and data extraction were performed by two independent authors. The sensitivity, specificity, positive and negative likelihood ratio (PLR and NLR), diagnostic OR (DOR) and area under the receiver operating characteristic curve (AUC) were pooled using the bivariate generalised linear mixed model and random effects model. RESULTS The meta-analysis included 72 studies and involved 9296 women who presented with ovarian masses. The pooled sensitivity, specificity, PLR, NLR, DOR and AUC for conventional US were 0.91 (95% CI: 0.87 to 0.94) and 0.87 (95% CI: 0.82 to 0.91), 6.87 (95% CI: 4.98 to 9.49) and 0.10 (95% CI: 0.07 to 0.15), 57.52 (95% CI: 36.64 to 90.28) and 0.95 (95% CI: 0.93 to 0.97), respectively. The sensitivity, specificity, PLR, NLR, DOR and AUC for Doppler US were 0.93 (95% CI: 0.91 to 0.95) and 0.85 (95% CI: 0.80 to 0.89), 6.10 (95% CI: 4.59 to 8.11) and 0.08 (95% CI: 0.06 to 0.11), 61.76 (95% CI: 39.99 to 95.37) and 0.96 (95% CI: 0.94 to 0.97), respectively. The pooled sensitivity, specificity, PLR, NLR, DOR and AUC for CEUS were 0.97 (95% CI: 0.92 to 0.99) and 0.92 (95% CI: 0.85 to 0.95), 11.47 (95% CI: 6.52 to 20.17) and 0.03 (95% CI: 0.01 to 0.09), 152.11 (95% CI: 77.77 to 297.51) and 0.99 (95% CI: 0.97 to 0.99), respectively. Moreover, the AUC values for conventional US (p=0.002) and Doppler US (p=0.005) were inferior to those of CEUS. CONCLUSIONS Conventional US, Doppler US and CEUS have a relatively high differential diagnostic value for differentiating between benign and malignant ovarian masses. The diagnostic performance of CEUS was superior to that of conventional US and Doppler US.
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Affiliation(s)
- Lizhang Xun
- Medical Examination Center, Huaian City Second People's Hospital, Huaian, Jiangsu, China
| | - Lamei Zhai
- Department of Radiology, Huaian City Second People's Hospital, Huaian, Jiangsu, China
| | - Hui Xu
- Medical Examination Center, Huaian City Second People's Hospital, Huaian, Jiangsu, China
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Xu A, Nie F, Liu T, Dong T, Bu L, Yang D. Adnexal masses: Diagnostic performance of contrast-enhanced ultrasound using the simple rules from the International Ovarian Tumor Analysis group. Int J Gynaecol Obstet 2021; 157:568-573. [PMID: 34510439 DOI: 10.1002/ijgo.13926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/28/2021] [Accepted: 09/08/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To evaluate the role of the Simple Rules (SR) from the International Ovarian Tumor Analysis group in contrast-enhanced ultrasound (CEUS) of for the differential diagnosis of benign and malignant adnexal tumors. METHODS A total of 180 patients with suspected malignant adnexal masses admitted to Lanzhou University Second Hospital were included, all of whom received conventional ultrasound (US) and CEUS examination before surgery. All masses were assessed using SR in US and SR in CEUS. To compare the diagnostic performance, the sensitivity, specificity, negative and positive predictive values, Youden index, and area under the curves values of SR in US and SR in CEUS were obtained. RESULTS Sensitivity, negative predictive values, Youden index, and area under the curves were better for SR in CEUS than SR in US. The specificity and negative predictive value of SR in CEUS were lower than that of SR in US. Compared with SR in US, SR in CEUS significantly reduced the number of uncertain masses (21, 36.7% vs. 66, 11.7%). CONCLUSION We concluded that SR in CEUS performed well in the diagnosis of malignant adnexal masses. SR in CEUS is a supplement to SR in US.
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Affiliation(s)
- Ailing Xu
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China
| | - Fang Nie
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China
| | - Ting Liu
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China
| | - Tiantian Dong
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China
| | - Lan Bu
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China
| | - Dan Yang
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China
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Glutig K, Alhussami I, Krüger PC, Waginger M, Eckoldt F, Mentzel HJ. Case Report: Report of 2 Different Cases of Ovarian Teratoma Evaluated by Dynamic Contrast-Enhanced Ultrasound. Front Pediatr 2021; 9:681404. [PMID: 34178898 PMCID: PMC8226026 DOI: 10.3389/fped.2021.681404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/19/2021] [Indexed: 12/23/2022] Open
Abstract
Ovarian masses are not easily differentiated on transabdominal ultrasound in children. A useful supplement in various pediatric applications is dynamic contrast-enhanced ultrasound (dynCEUS). It can be performed quickly and easily. However, the literature for dynCEUS on pediatric ovarian masses is limited. We compared two cases with ovarian teratoma in which dynCEUS was a helpful additional tool.
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Affiliation(s)
- Katja Glutig
- Section for Pediatric Radiology, Institute for Diagnostic and Interventional Radiology, University Hospital Jena, Jena, Germany
| | - Ilmi Alhussami
- Pediatric Surgery Clinic, University Hospital Jena, Jena, Germany
| | - Paul-Christian Krüger
- Section for Pediatric Radiology, Institute for Diagnostic and Interventional Radiology, University Hospital Jena, Jena, Germany
| | - Matthias Waginger
- Section for Pediatric Radiology, Institute for Diagnostic and Interventional Radiology, University Hospital Jena, Jena, Germany
| | | | - Hans-Joachim Mentzel
- Section for Pediatric Radiology, Institute for Diagnostic and Interventional Radiology, University Hospital Jena, Jena, Germany
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Wang P, Wu M, Li A, Ye X, Li C, Xu D. Diagnostic Value of Contrast-Enhanced Ultrasound for Differential Diagnosis of Malignant and Benign Soft Tissue Masses: A Meta-Analysis. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:3179-3187. [PMID: 32907771 DOI: 10.1016/j.ultrasmedbio.2020.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 07/22/2020] [Accepted: 08/07/2020] [Indexed: 06/11/2023]
Abstract
This meta-analysis was aimed at investigating the value of using contrast-enhanced ultrasound (CEUS) in the differential diagnosis of benign and malignant soft tissue masses (STMs). Relevant studies published before March 24, 2020 were identified through a comprehensive search of PubMed, Ovid, Cochrane and Web of Science. According to the inclusion criteria, five studies were selected comprising 746 patients. In the differential diagnosis of benign and malignant STMs, the pooled sensitivity and specificity of CEUS were 76% (95% confidence interval [CI]: 71%-81%; heterogeneity [I2] = 74.5%) and 67% (95% CI: 62%-71%; I2 = 36.5%), respectively. The diagnostic odds ratio was 7.37 (95% CI: 3.78%-14.35; I2 = 66.6%). The overall area under the curve was 0.77 (standard error: 0.0392). Subgroup analysis revealed that different index tests of CEUS resulted in different diagnostic performance. Importantly, CEUS is an effective method for the differential diagnosis between benign and malignant STMs.
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Affiliation(s)
- Pingping Wang
- Department of Ultrasound, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Mengjie Wu
- Department of Ultrasound, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ao Li
- Department of Ultrasound, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xinhua Ye
- Department of Ultrasound, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Cuiying Li
- Department of Ultrasound, First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
| | - Di Xu
- Department of Ultrasound, First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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Li Z, Zhang P, Shen H, Ding B, Wang H, Li J, Shen Y. Clinical value of contrast-enhanced ultrasound for the differential diagnosis of specific subtypes of uterine leiomyomas. J Obstet Gynaecol Res 2020; 47:311-319. [PMID: 33073436 DOI: 10.1111/jog.14527] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 08/10/2020] [Accepted: 09/28/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To improve the accuracy of clinical diagnosis by analyzing different contrast-enhanced ultrasound (CEUS) imagines of specific subtypes of uterine leiomyomas. METHODS A total of 147 female patients received preoperative CEUS examination. The scanning plane of the biggest tumors for CEUS was found by common B-mode ultrasonographic scanning on pelvic cavity, then 1.5 mL SonoVue were injected into the median cubital vein. According to the CEUS images, the lesion enhanced time, enhanced level and enhanced morphology were recorded. The time-intensity curve was acquired and analyzed, meanwhile, the relevant parameters were calculated, including rise time (RT), peak intensity (PI), time to peak (TTP) and mean transit time (MTT). RESULTS In cellular uterine leiomyoma group, the percentage of high enhancement, early enhancement was higher, equal enhancement and synchronic enhancement were lower than those in the common uterine leiomyomas group. In hysteromyoma with hyaline degeneration group, the percentage of high enhancement, early enhancement was lower, while low enhancement and delayed enhancement were higher than those in the common uterine leiomyomas group. The ratio of PI in cellular uterine leiomyoma group was the highest, but the ratios of RT, TTP and MTT were the lowest of the three benign groups. The ratio of PI in hysteromyoma with hyaline degeneration group was the lowest, while the ratios of RT and TTP was the highest among the three benign groups. CONCLUSION Different pathological types of uterine leiomyomas have their own signal performance on CEUS. CEUS can be used to infer their pathological types and help differential diagnosis.
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Affiliation(s)
- Zemin Li
- Department of Obstetrics and Gynaecology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Peili Zhang
- Department of Obstetrics and Gynaecology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Huiming Shen
- Department of Ultrasound, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Bo Ding
- Department of Obstetrics and Gynaecology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Haili Wang
- Department of Obstetrics and Gynaecology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Jia Li
- Department of Ultrasound, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Yang Shen
- Department of Obstetrics and Gynaecology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
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Zhang H, Wang J, Guo R. Application Value of Color Doppler Ultrasound and Ultrasound Contrast in the Differential Diagnosis of Ovarian tumor. Pak J Med Sci 2020; 36:80-84. [PMID: 32063936 PMCID: PMC6994900 DOI: 10.12669/pjms.36.2.847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To study the value of color Doppler ultrasound and ultrasound contrast in differential diagnosis of ovarian tumors. Methods: Ninety-six patients with ovarian tumors who were treated in our hospital from May 2017 to July 2018 and confirmed by pathological examination were selected as the research subjects. All patients were examined by color Doppler ultrasound and ultrasound contrast. The sensitivity, specificity and accuracy of the two methods were compared, and the parameters of ultrasound contrast in the diagnosis of benign and malignant tumors were observed and compared. Results: The sensitivity, specificity and accuracy of ultrasound contrast in the diagnosis of ovarian tumors were higher than those of color Doppler ultrasound (P<0.05). There were significant differences in the time of initiation enhancement, time to peak and perfusion intensity in the diagnosis of benign and malignant lesions by ultrasound contrast (P<0.05). Conclusion: In the differential diagnosis of ovarian tumors, ultrasound contrast has more advantages than color Doppler ultrasound in displaying the blood perfusion information of tumors. It has high diagnostic accuracy and clinical application value.
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Affiliation(s)
- Haijing Zhang
- Haijing Zhang, Department of Ultrasonic Medicine, Binzhou People's Hospital, Shandong, 256610, China
| | - Jinming Wang
- Jinming Wang, Department of Ultrasonic Medicine, Binzhou People's Hospital, Shandong, 256610, China
| | - Rui Guo
- Rui Guo, Department of Ultrasonic Medicine, Binzhou People's Hospital, Shandong, 256610, China
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Wang X, Yang S, Lv G, Liao J, Wu S, Zhang W. Combination of GI-RADS and 3D-CEUS for differential diagnosis of ovarian masses. ACTA ACUST UNITED AC 2019; 65:959-964. [PMID: 31389505 DOI: 10.1590/1806-9282.65.7.959] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 08/05/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The purpose of this study is to evaluate the efficacy of the combination of gynecologic imaging reporting and data system (GI-RADS) ultrasonographic stratification and three-dimensional contrast-enhanced ultrasonography (3D-CEUS) in order to distinguish malignant from benign ovarian masses. METHODS In this study, 102 patients with ovarian masses were examined by both two-dimensional ultrasound(2D-US) and 3D-CEUS. Sonographic features of ovarian masses obtained from 3D-CEUS were analyzed and compared with 2D-US. All patients with ovarian masses were confirmed by operational pathology or long-term follow-up results. RESULTS (1)The Chi-square test and multiple Logistic regression analysis confirmed that there were only eight independent predictors of malignant masses, including thick septa (≥3mm), thick papillary projections(≥7mm), solid areas, presence of ascites, central vascularization, contrast enhancement, distribution of contrast agent, and vascular characteristics of the solid part and their odds ratios which were 5.52, 5.39, 4.94, 4.34, 5.92, 7.44, 6.09, and 7.67, respectively (P<0.05). (2)These eight signs were used to combine the GI-RADS with 3D-CEUS scoring system in which the corresponding value of the area under the curve (AUC) was 0.969, which was superior to using GI-RADS lonely (Z-value=1.64, P<0.025). Using 4 points as the cut-off, the scoring system showed the performance was clearly better than using GI-RADS alone (P<0.05). (3) The Kappa value was 0.872 for two different clinicians with equal experience. CONCLUSIONS The combination of GI-RADS and 3D-CEUS scoring system would be a more effective method to distinguish malignant from benign ovarian masses.
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Affiliation(s)
- Xiali Wang
- Department of Clinical Medicine, Quanzhou Medical College, Quanzhou 362000, China.,Department of Ultrasound, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, China
| | - Shuping Yang
- Department of Ultrasound, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, China
| | - Guorong Lv
- Department of Clinical Medicine, Quanzhou Medical College, Quanzhou 362000, China.,Department of Ultrasound, the Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, China.,Department of Ultrasound, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, China
| | - Jianmei Liao
- Department of Ultrasound, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, China
| | - Shufen Wu
- Department of Ultrasound, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, China
| | - Weina Zhang
- Department of Ultrasound, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, China
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Cheng Y, Wang M, Ma B, Ma X. Potential role of contrast-enhanced ultrasound for the differentiation of malignant and benign gallbladder lesions in East Asia: A meta-analysis and systematic review. Medicine (Baltimore) 2018; 97:e11808. [PMID: 30113470 PMCID: PMC6112946 DOI: 10.1097/md.0000000000011808] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The purpose of this study was to systematically review and evaluate the diagnostic accuracy of contrast-enhanced ultrasound (CEUS) in differentiating malignant and benign gallbladder lesions. METHODS We conducted a comprehensive search on PubMed, Embase, and Cochrane Library for all potential relevant articles published before December 2017. The pooled sensitivity, specificity, diagnostic odds ratio (DOR) and area under the curve (AUC) of summary receiver operating characteristic (SROC) were calculated by Meta-Disc Version 1.4 and STATA 12.0. RESULTS Twelve eligible studies were included in our study. A total of 1044 patients were assessed. The pooled sensitivity and specificity were 0.81 (95% confidence interval [CI], 0.77-0.84; inconsistency index [I] = 84.5%) and 0.87 (95% CI, 0.85-0.89; I = 94.4%), respectively. The pooled DOR was 58.84 (95% CI, 32.39-106.88; I = 51.9%). The AUC was 0.9371. According to Deek funnel plot asymmetry test, there was no significant publication bias (P = .31). CONCLUSIONS The results yielded from the available evidence suggest that CEUS is a promising and adjuvant imaging technique to conventional ultrasound for the differential diagnosis of benign and malignant gallbladder lesions.
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Affiliation(s)
- Yuan Cheng
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center
| | - Manni Wang
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center
| | - Buyun Ma
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Xuelei Ma
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center
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