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Xu W, Jia X, Mei Z, Gu X, Lu Y, Fu CC, Zhang R, Gu Y, Chen X, Luo X, Li N, Bai B, Li Q, Yan J, Zhai H, Guan L, Gong B, Zhao K, Fang Q, He C, Zhan W, Luo T, Zhang H, Dong Y, Zhou J. Generalizability and Diagnostic Performance of AI Models for Thyroid US. Radiology 2023; 307:e221157. [PMID: 37338356 DOI: 10.1148/radiol.221157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Background Artificial intelligence (AI) models have improved US assessment of thyroid nodules; however, the lack of generalizability limits the application of these models. Purpose To develop AI models for segmentation and classification of thyroid nodules in US using diverse data sets from nationwide hospitals and multiple vendors, and to measure the impact of the AI models on diagnostic performance. Materials and Methods This retrospective study included consecutive patients with pathologically confirmed thyroid nodules who underwent US using equipment from 12 vendors at 208 hospitals across China from November 2017 to January 2019. The detection, segmentation, and classification models were developed based on the subset or complete set of images. Model performance was evaluated by precision and recall, Dice coefficient, and area under the receiver operating characteristic curve (AUC) analyses. Three scenarios (diagnosis without AI assistance, with freestyle AI assistance, and with rule-based AI assistance) were compared with three senior and three junior radiologists to optimize incorporation of AI into clinical practice. Results A total of 10 023 patients (median age, 46 years [IQR 37-55 years]; 7669 female) were included. The detection, segmentation, and classification models had an average precision, Dice coefficient, and AUC of 0.98 (95% CI: 0.96, 0.99), 0.86 (95% CI: 0.86, 0.87), and 0.90 (95% CI: 0.88, 0.92), respectively. The segmentation model trained on the nationwide data and classification model trained on the mixed vendor data exhibited the best performance, with a Dice coefficient of 0.91 (95% CI: 0.90, 0.91) and AUC of 0.98 (95% CI: 0.97, 1.00), respectively. The AI model outperformed all senior and junior radiologists (P < .05 for all comparisons), and the diagnostic accuracies of all radiologists were improved (P < .05 for all comparisons) with rule-based AI assistance. Conclusion Thyroid US AI models developed from diverse data sets had high diagnostic performance among the Chinese population. Rule-based AI assistance improved the performance of radiologists in thyroid cancer diagnosis. © RSNA, 2023 Supplemental material is available for this article.
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Affiliation(s)
- WenWen Xu
- From the Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, 200025, Shanghai, China (W.W.X., X.H.J., Z.H.M., W.W.Z., T.L., H.T.Z., Y.J.D., J.Q.Z.); Department of Scientific Research, Shanghai Aitrox Technology Corporation Limited, Shanghai, China (X.L.G., Y.L., C.C.F., K.Y.Z., Q.F., C.H.); Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (R.F.Z.); Department of Medical Ultrasound, Affiliated Hospital of Guizhou Medical University, Guiyang, China (Y.G., X.C.); Department of Medical Ultrasound, Yunnan Cancer Hospital & The Third Affiliated Hospital of Kunming Medical University, Kunming, China (X.M.L.); Department of Ultrasound, Yunnan Kungang Hospital, The Seventh Affiliated Hospital of Dali University, Anning, China (N.L.); Department of Ultrasound, Affiliated Hospital of Yan'an University, Yan'an, China (B.Y.B.); Department of Ultrasound, Tangdu Hospital, Fourth Military Medical University, Xi'an, China (Q.Y.L.); Department of Ultrasound, Shanxi Provincial People's Hospital, Taiyuan, China (J.P.Y.); Department of Ultrasound, Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region, China (H.Z.); Department of Ultrasound, Gansu Provincial Cancer Hospital, Lanzhou, China (L.G.); Department of Ultrasound, Jilin Central General Hospital, Jilin, China (B.G.); and College of Health Science and Technology, Shanghai Jiaotong University School of Medicine, Shanghai, China (J.Q.Z.)
| | - XiaoHong Jia
- From the Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, 200025, Shanghai, China (W.W.X., X.H.J., Z.H.M., W.W.Z., T.L., H.T.Z., Y.J.D., J.Q.Z.); Department of Scientific Research, Shanghai Aitrox Technology Corporation Limited, Shanghai, China (X.L.G., Y.L., C.C.F., K.Y.Z., Q.F., C.H.); Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (R.F.Z.); Department of Medical Ultrasound, Affiliated Hospital of Guizhou Medical University, Guiyang, China (Y.G., X.C.); Department of Medical Ultrasound, Yunnan Cancer Hospital & The Third Affiliated Hospital of Kunming Medical University, Kunming, China (X.M.L.); Department of Ultrasound, Yunnan Kungang Hospital, The Seventh Affiliated Hospital of Dali University, Anning, China (N.L.); Department of Ultrasound, Affiliated Hospital of Yan'an University, Yan'an, China (B.Y.B.); Department of Ultrasound, Tangdu Hospital, Fourth Military Medical University, Xi'an, China (Q.Y.L.); Department of Ultrasound, Shanxi Provincial People's Hospital, Taiyuan, China (J.P.Y.); Department of Ultrasound, Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region, China (H.Z.); Department of Ultrasound, Gansu Provincial Cancer Hospital, Lanzhou, China (L.G.); Department of Ultrasound, Jilin Central General Hospital, Jilin, China (B.G.); and College of Health Science and Technology, Shanghai Jiaotong University School of Medicine, Shanghai, China (J.Q.Z.)
| | - ZiHan Mei
- From the Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, 200025, Shanghai, China (W.W.X., X.H.J., Z.H.M., W.W.Z., T.L., H.T.Z., Y.J.D., J.Q.Z.); Department of Scientific Research, Shanghai Aitrox Technology Corporation Limited, Shanghai, China (X.L.G., Y.L., C.C.F., K.Y.Z., Q.F., C.H.); Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (R.F.Z.); Department of Medical Ultrasound, Affiliated Hospital of Guizhou Medical University, Guiyang, China (Y.G., X.C.); Department of Medical Ultrasound, Yunnan Cancer Hospital & The Third Affiliated Hospital of Kunming Medical University, Kunming, China (X.M.L.); Department of Ultrasound, Yunnan Kungang Hospital, The Seventh Affiliated Hospital of Dali University, Anning, China (N.L.); Department of Ultrasound, Affiliated Hospital of Yan'an University, Yan'an, China (B.Y.B.); Department of Ultrasound, Tangdu Hospital, Fourth Military Medical University, Xi'an, China (Q.Y.L.); Department of Ultrasound, Shanxi Provincial People's Hospital, Taiyuan, China (J.P.Y.); Department of Ultrasound, Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region, China (H.Z.); Department of Ultrasound, Gansu Provincial Cancer Hospital, Lanzhou, China (L.G.); Department of Ultrasound, Jilin Central General Hospital, Jilin, China (B.G.); and College of Health Science and Technology, Shanghai Jiaotong University School of Medicine, Shanghai, China (J.Q.Z.)
| | - XiaoLin Gu
- From the Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, 200025, Shanghai, China (W.W.X., X.H.J., Z.H.M., W.W.Z., T.L., H.T.Z., Y.J.D., J.Q.Z.); Department of Scientific Research, Shanghai Aitrox Technology Corporation Limited, Shanghai, China (X.L.G., Y.L., C.C.F., K.Y.Z., Q.F., C.H.); Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (R.F.Z.); Department of Medical Ultrasound, Affiliated Hospital of Guizhou Medical University, Guiyang, China (Y.G., X.C.); Department of Medical Ultrasound, Yunnan Cancer Hospital & The Third Affiliated Hospital of Kunming Medical University, Kunming, China (X.M.L.); Department of Ultrasound, Yunnan Kungang Hospital, The Seventh Affiliated Hospital of Dali University, Anning, China (N.L.); Department of Ultrasound, Affiliated Hospital of Yan'an University, Yan'an, China (B.Y.B.); Department of Ultrasound, Tangdu Hospital, Fourth Military Medical University, Xi'an, China (Q.Y.L.); Department of Ultrasound, Shanxi Provincial People's Hospital, Taiyuan, China (J.P.Y.); Department of Ultrasound, Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region, China (H.Z.); Department of Ultrasound, Gansu Provincial Cancer Hospital, Lanzhou, China (L.G.); Department of Ultrasound, Jilin Central General Hospital, Jilin, China (B.G.); and College of Health Science and Technology, Shanghai Jiaotong University School of Medicine, Shanghai, China (J.Q.Z.)
| | - Yang Lu
- From the Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, 200025, Shanghai, China (W.W.X., X.H.J., Z.H.M., W.W.Z., T.L., H.T.Z., Y.J.D., J.Q.Z.); Department of Scientific Research, Shanghai Aitrox Technology Corporation Limited, Shanghai, China (X.L.G., Y.L., C.C.F., K.Y.Z., Q.F., C.H.); Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (R.F.Z.); Department of Medical Ultrasound, Affiliated Hospital of Guizhou Medical University, Guiyang, China (Y.G., X.C.); Department of Medical Ultrasound, Yunnan Cancer Hospital & The Third Affiliated Hospital of Kunming Medical University, Kunming, China (X.M.L.); Department of Ultrasound, Yunnan Kungang Hospital, The Seventh Affiliated Hospital of Dali University, Anning, China (N.L.); Department of Ultrasound, Affiliated Hospital of Yan'an University, Yan'an, China (B.Y.B.); Department of Ultrasound, Tangdu Hospital, Fourth Military Medical University, Xi'an, China (Q.Y.L.); Department of Ultrasound, Shanxi Provincial People's Hospital, Taiyuan, China (J.P.Y.); Department of Ultrasound, Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region, China (H.Z.); Department of Ultrasound, Gansu Provincial Cancer Hospital, Lanzhou, China (L.G.); Department of Ultrasound, Jilin Central General Hospital, Jilin, China (B.G.); and College of Health Science and Technology, Shanghai Jiaotong University School of Medicine, Shanghai, China (J.Q.Z.)
| | - Chi-Cheng Fu
- From the Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, 200025, Shanghai, China (W.W.X., X.H.J., Z.H.M., W.W.Z., T.L., H.T.Z., Y.J.D., J.Q.Z.); Department of Scientific Research, Shanghai Aitrox Technology Corporation Limited, Shanghai, China (X.L.G., Y.L., C.C.F., K.Y.Z., Q.F., C.H.); Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (R.F.Z.); Department of Medical Ultrasound, Affiliated Hospital of Guizhou Medical University, Guiyang, China (Y.G., X.C.); Department of Medical Ultrasound, Yunnan Cancer Hospital & The Third Affiliated Hospital of Kunming Medical University, Kunming, China (X.M.L.); Department of Ultrasound, Yunnan Kungang Hospital, The Seventh Affiliated Hospital of Dali University, Anning, China (N.L.); Department of Ultrasound, Affiliated Hospital of Yan'an University, Yan'an, China (B.Y.B.); Department of Ultrasound, Tangdu Hospital, Fourth Military Medical University, Xi'an, China (Q.Y.L.); Department of Ultrasound, Shanxi Provincial People's Hospital, Taiyuan, China (J.P.Y.); Department of Ultrasound, Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region, China (H.Z.); Department of Ultrasound, Gansu Provincial Cancer Hospital, Lanzhou, China (L.G.); Department of Ultrasound, Jilin Central General Hospital, Jilin, China (B.G.); and College of Health Science and Technology, Shanghai Jiaotong University School of Medicine, Shanghai, China (J.Q.Z.)
| | - RuiFang Zhang
- From the Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, 200025, Shanghai, China (W.W.X., X.H.J., Z.H.M., W.W.Z., T.L., H.T.Z., Y.J.D., J.Q.Z.); Department of Scientific Research, Shanghai Aitrox Technology Corporation Limited, Shanghai, China (X.L.G., Y.L., C.C.F., K.Y.Z., Q.F., C.H.); Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (R.F.Z.); Department of Medical Ultrasound, Affiliated Hospital of Guizhou Medical University, Guiyang, China (Y.G., X.C.); Department of Medical Ultrasound, Yunnan Cancer Hospital & The Third Affiliated Hospital of Kunming Medical University, Kunming, China (X.M.L.); Department of Ultrasound, Yunnan Kungang Hospital, The Seventh Affiliated Hospital of Dali University, Anning, China (N.L.); Department of Ultrasound, Affiliated Hospital of Yan'an University, Yan'an, China (B.Y.B.); Department of Ultrasound, Tangdu Hospital, Fourth Military Medical University, Xi'an, China (Q.Y.L.); Department of Ultrasound, Shanxi Provincial People's Hospital, Taiyuan, China (J.P.Y.); Department of Ultrasound, Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region, China (H.Z.); Department of Ultrasound, Gansu Provincial Cancer Hospital, Lanzhou, China (L.G.); Department of Ultrasound, Jilin Central General Hospital, Jilin, China (B.G.); and College of Health Science and Technology, Shanghai Jiaotong University School of Medicine, Shanghai, China (J.Q.Z.)
| | - Ying Gu
- From the Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, 200025, Shanghai, China (W.W.X., X.H.J., Z.H.M., W.W.Z., T.L., H.T.Z., Y.J.D., J.Q.Z.); Department of Scientific Research, Shanghai Aitrox Technology Corporation Limited, Shanghai, China (X.L.G., Y.L., C.C.F., K.Y.Z., Q.F., C.H.); Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (R.F.Z.); Department of Medical Ultrasound, Affiliated Hospital of Guizhou Medical University, Guiyang, China (Y.G., X.C.); Department of Medical Ultrasound, Yunnan Cancer Hospital & The Third Affiliated Hospital of Kunming Medical University, Kunming, China (X.M.L.); Department of Ultrasound, Yunnan Kungang Hospital, The Seventh Affiliated Hospital of Dali University, Anning, China (N.L.); Department of Ultrasound, Affiliated Hospital of Yan'an University, Yan'an, China (B.Y.B.); Department of Ultrasound, Tangdu Hospital, Fourth Military Medical University, Xi'an, China (Q.Y.L.); Department of Ultrasound, Shanxi Provincial People's Hospital, Taiyuan, China (J.P.Y.); Department of Ultrasound, Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region, China (H.Z.); Department of Ultrasound, Gansu Provincial Cancer Hospital, Lanzhou, China (L.G.); Department of Ultrasound, Jilin Central General Hospital, Jilin, China (B.G.); and College of Health Science and Technology, Shanghai Jiaotong University School of Medicine, Shanghai, China (J.Q.Z.)
| | - Xia Chen
- From the Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, 200025, Shanghai, China (W.W.X., X.H.J., Z.H.M., W.W.Z., T.L., H.T.Z., Y.J.D., J.Q.Z.); Department of Scientific Research, Shanghai Aitrox Technology Corporation Limited, Shanghai, China (X.L.G., Y.L., C.C.F., K.Y.Z., Q.F., C.H.); Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (R.F.Z.); Department of Medical Ultrasound, Affiliated Hospital of Guizhou Medical University, Guiyang, China (Y.G., X.C.); Department of Medical Ultrasound, Yunnan Cancer Hospital & The Third Affiliated Hospital of Kunming Medical University, Kunming, China (X.M.L.); Department of Ultrasound, Yunnan Kungang Hospital, The Seventh Affiliated Hospital of Dali University, Anning, China (N.L.); Department of Ultrasound, Affiliated Hospital of Yan'an University, Yan'an, China (B.Y.B.); Department of Ultrasound, Tangdu Hospital, Fourth Military Medical University, Xi'an, China (Q.Y.L.); Department of Ultrasound, Shanxi Provincial People's Hospital, Taiyuan, China (J.P.Y.); Department of Ultrasound, Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region, China (H.Z.); Department of Ultrasound, Gansu Provincial Cancer Hospital, Lanzhou, China (L.G.); Department of Ultrasound, Jilin Central General Hospital, Jilin, China (B.G.); and College of Health Science and Technology, Shanghai Jiaotong University School of Medicine, Shanghai, China (J.Q.Z.)
| | - XiaoMao Luo
- From the Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, 200025, Shanghai, China (W.W.X., X.H.J., Z.H.M., W.W.Z., T.L., H.T.Z., Y.J.D., J.Q.Z.); Department of Scientific Research, Shanghai Aitrox Technology Corporation Limited, Shanghai, China (X.L.G., Y.L., C.C.F., K.Y.Z., Q.F., C.H.); Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (R.F.Z.); Department of Medical Ultrasound, Affiliated Hospital of Guizhou Medical University, Guiyang, China (Y.G., X.C.); Department of Medical Ultrasound, Yunnan Cancer Hospital & The Third Affiliated Hospital of Kunming Medical University, Kunming, China (X.M.L.); Department of Ultrasound, Yunnan Kungang Hospital, The Seventh Affiliated Hospital of Dali University, Anning, China (N.L.); Department of Ultrasound, Affiliated Hospital of Yan'an University, Yan'an, China (B.Y.B.); Department of Ultrasound, Tangdu Hospital, Fourth Military Medical University, Xi'an, China (Q.Y.L.); Department of Ultrasound, Shanxi Provincial People's Hospital, Taiyuan, China (J.P.Y.); Department of Ultrasound, Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region, China (H.Z.); Department of Ultrasound, Gansu Provincial Cancer Hospital, Lanzhou, China (L.G.); Department of Ultrasound, Jilin Central General Hospital, Jilin, China (B.G.); and College of Health Science and Technology, Shanghai Jiaotong University School of Medicine, Shanghai, China (J.Q.Z.)
| | - Ning Li
- From the Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, 200025, Shanghai, China (W.W.X., X.H.J., Z.H.M., W.W.Z., T.L., H.T.Z., Y.J.D., J.Q.Z.); Department of Scientific Research, Shanghai Aitrox Technology Corporation Limited, Shanghai, China (X.L.G., Y.L., C.C.F., K.Y.Z., Q.F., C.H.); Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (R.F.Z.); Department of Medical Ultrasound, Affiliated Hospital of Guizhou Medical University, Guiyang, China (Y.G., X.C.); Department of Medical Ultrasound, Yunnan Cancer Hospital & The Third Affiliated Hospital of Kunming Medical University, Kunming, China (X.M.L.); Department of Ultrasound, Yunnan Kungang Hospital, The Seventh Affiliated Hospital of Dali University, Anning, China (N.L.); Department of Ultrasound, Affiliated Hospital of Yan'an University, Yan'an, China (B.Y.B.); Department of Ultrasound, Tangdu Hospital, Fourth Military Medical University, Xi'an, China (Q.Y.L.); Department of Ultrasound, Shanxi Provincial People's Hospital, Taiyuan, China (J.P.Y.); Department of Ultrasound, Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region, China (H.Z.); Department of Ultrasound, Gansu Provincial Cancer Hospital, Lanzhou, China (L.G.); Department of Ultrasound, Jilin Central General Hospital, Jilin, China (B.G.); and College of Health Science and Technology, Shanghai Jiaotong University School of Medicine, Shanghai, China (J.Q.Z.)
| | - BaoYan Bai
- From the Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, 200025, Shanghai, China (W.W.X., X.H.J., Z.H.M., W.W.Z., T.L., H.T.Z., Y.J.D., J.Q.Z.); Department of Scientific Research, Shanghai Aitrox Technology Corporation Limited, Shanghai, China (X.L.G., Y.L., C.C.F., K.Y.Z., Q.F., C.H.); Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (R.F.Z.); Department of Medical Ultrasound, Affiliated Hospital of Guizhou Medical University, Guiyang, China (Y.G., X.C.); Department of Medical Ultrasound, Yunnan Cancer Hospital & The Third Affiliated Hospital of Kunming Medical University, Kunming, China (X.M.L.); Department of Ultrasound, Yunnan Kungang Hospital, The Seventh Affiliated Hospital of Dali University, Anning, China (N.L.); Department of Ultrasound, Affiliated Hospital of Yan'an University, Yan'an, China (B.Y.B.); Department of Ultrasound, Tangdu Hospital, Fourth Military Medical University, Xi'an, China (Q.Y.L.); Department of Ultrasound, Shanxi Provincial People's Hospital, Taiyuan, China (J.P.Y.); Department of Ultrasound, Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region, China (H.Z.); Department of Ultrasound, Gansu Provincial Cancer Hospital, Lanzhou, China (L.G.); Department of Ultrasound, Jilin Central General Hospital, Jilin, China (B.G.); and College of Health Science and Technology, Shanghai Jiaotong University School of Medicine, Shanghai, China (J.Q.Z.)
| | - QiaoYing Li
- From the Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, 200025, Shanghai, China (W.W.X., X.H.J., Z.H.M., W.W.Z., T.L., H.T.Z., Y.J.D., J.Q.Z.); Department of Scientific Research, Shanghai Aitrox Technology Corporation Limited, Shanghai, China (X.L.G., Y.L., C.C.F., K.Y.Z., Q.F., C.H.); Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (R.F.Z.); Department of Medical Ultrasound, Affiliated Hospital of Guizhou Medical University, Guiyang, China (Y.G., X.C.); Department of Medical Ultrasound, Yunnan Cancer Hospital & The Third Affiliated Hospital of Kunming Medical University, Kunming, China (X.M.L.); Department of Ultrasound, Yunnan Kungang Hospital, The Seventh Affiliated Hospital of Dali University, Anning, China (N.L.); Department of Ultrasound, Affiliated Hospital of Yan'an University, Yan'an, China (B.Y.B.); Department of Ultrasound, Tangdu Hospital, Fourth Military Medical University, Xi'an, China (Q.Y.L.); Department of Ultrasound, Shanxi Provincial People's Hospital, Taiyuan, China (J.P.Y.); Department of Ultrasound, Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region, China (H.Z.); Department of Ultrasound, Gansu Provincial Cancer Hospital, Lanzhou, China (L.G.); Department of Ultrasound, Jilin Central General Hospital, Jilin, China (B.G.); and College of Health Science and Technology, Shanghai Jiaotong University School of Medicine, Shanghai, China (J.Q.Z.)
| | - JiPing Yan
- From the Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, 200025, Shanghai, China (W.W.X., X.H.J., Z.H.M., W.W.Z., T.L., H.T.Z., Y.J.D., J.Q.Z.); Department of Scientific Research, Shanghai Aitrox Technology Corporation Limited, Shanghai, China (X.L.G., Y.L., C.C.F., K.Y.Z., Q.F., C.H.); Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (R.F.Z.); Department of Medical Ultrasound, Affiliated Hospital of Guizhou Medical University, Guiyang, China (Y.G., X.C.); Department of Medical Ultrasound, Yunnan Cancer Hospital & The Third Affiliated Hospital of Kunming Medical University, Kunming, China (X.M.L.); Department of Ultrasound, Yunnan Kungang Hospital, The Seventh Affiliated Hospital of Dali University, Anning, China (N.L.); Department of Ultrasound, Affiliated Hospital of Yan'an University, Yan'an, China (B.Y.B.); Department of Ultrasound, Tangdu Hospital, Fourth Military Medical University, Xi'an, China (Q.Y.L.); Department of Ultrasound, Shanxi Provincial People's Hospital, Taiyuan, China (J.P.Y.); Department of Ultrasound, Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region, China (H.Z.); Department of Ultrasound, Gansu Provincial Cancer Hospital, Lanzhou, China (L.G.); Department of Ultrasound, Jilin Central General Hospital, Jilin, China (B.G.); and College of Health Science and Technology, Shanghai Jiaotong University School of Medicine, Shanghai, China (J.Q.Z.)
| | - Hong Zhai
- From the Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, 200025, Shanghai, China (W.W.X., X.H.J., Z.H.M., W.W.Z., T.L., H.T.Z., Y.J.D., J.Q.Z.); Department of Scientific Research, Shanghai Aitrox Technology Corporation Limited, Shanghai, China (X.L.G., Y.L., C.C.F., K.Y.Z., Q.F., C.H.); Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (R.F.Z.); Department of Medical Ultrasound, Affiliated Hospital of Guizhou Medical University, Guiyang, China (Y.G., X.C.); Department of Medical Ultrasound, Yunnan Cancer Hospital & The Third Affiliated Hospital of Kunming Medical University, Kunming, China (X.M.L.); Department of Ultrasound, Yunnan Kungang Hospital, The Seventh Affiliated Hospital of Dali University, Anning, China (N.L.); Department of Ultrasound, Affiliated Hospital of Yan'an University, Yan'an, China (B.Y.B.); Department of Ultrasound, Tangdu Hospital, Fourth Military Medical University, Xi'an, China (Q.Y.L.); Department of Ultrasound, Shanxi Provincial People's Hospital, Taiyuan, China (J.P.Y.); Department of Ultrasound, Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region, China (H.Z.); Department of Ultrasound, Gansu Provincial Cancer Hospital, Lanzhou, China (L.G.); Department of Ultrasound, Jilin Central General Hospital, Jilin, China (B.G.); and College of Health Science and Technology, Shanghai Jiaotong University School of Medicine, Shanghai, China (J.Q.Z.)
| | - Ling Guan
- From the Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, 200025, Shanghai, China (W.W.X., X.H.J., Z.H.M., W.W.Z., T.L., H.T.Z., Y.J.D., J.Q.Z.); Department of Scientific Research, Shanghai Aitrox Technology Corporation Limited, Shanghai, China (X.L.G., Y.L., C.C.F., K.Y.Z., Q.F., C.H.); Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (R.F.Z.); Department of Medical Ultrasound, Affiliated Hospital of Guizhou Medical University, Guiyang, China (Y.G., X.C.); Department of Medical Ultrasound, Yunnan Cancer Hospital & The Third Affiliated Hospital of Kunming Medical University, Kunming, China (X.M.L.); Department of Ultrasound, Yunnan Kungang Hospital, The Seventh Affiliated Hospital of Dali University, Anning, China (N.L.); Department of Ultrasound, Affiliated Hospital of Yan'an University, Yan'an, China (B.Y.B.); Department of Ultrasound, Tangdu Hospital, Fourth Military Medical University, Xi'an, China (Q.Y.L.); Department of Ultrasound, Shanxi Provincial People's Hospital, Taiyuan, China (J.P.Y.); Department of Ultrasound, Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region, China (H.Z.); Department of Ultrasound, Gansu Provincial Cancer Hospital, Lanzhou, China (L.G.); Department of Ultrasound, Jilin Central General Hospital, Jilin, China (B.G.); and College of Health Science and Technology, Shanghai Jiaotong University School of Medicine, Shanghai, China (J.Q.Z.)
| | - Bing Gong
- From the Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, 200025, Shanghai, China (W.W.X., X.H.J., Z.H.M., W.W.Z., T.L., H.T.Z., Y.J.D., J.Q.Z.); Department of Scientific Research, Shanghai Aitrox Technology Corporation Limited, Shanghai, China (X.L.G., Y.L., C.C.F., K.Y.Z., Q.F., C.H.); Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (R.F.Z.); Department of Medical Ultrasound, Affiliated Hospital of Guizhou Medical University, Guiyang, China (Y.G., X.C.); Department of Medical Ultrasound, Yunnan Cancer Hospital & The Third Affiliated Hospital of Kunming Medical University, Kunming, China (X.M.L.); Department of Ultrasound, Yunnan Kungang Hospital, The Seventh Affiliated Hospital of Dali University, Anning, China (N.L.); Department of Ultrasound, Affiliated Hospital of Yan'an University, Yan'an, China (B.Y.B.); Department of Ultrasound, Tangdu Hospital, Fourth Military Medical University, Xi'an, China (Q.Y.L.); Department of Ultrasound, Shanxi Provincial People's Hospital, Taiyuan, China (J.P.Y.); Department of Ultrasound, Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region, China (H.Z.); Department of Ultrasound, Gansu Provincial Cancer Hospital, Lanzhou, China (L.G.); Department of Ultrasound, Jilin Central General Hospital, Jilin, China (B.G.); and College of Health Science and Technology, Shanghai Jiaotong University School of Medicine, Shanghai, China (J.Q.Z.)
| | - KeYang Zhao
- From the Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, 200025, Shanghai, China (W.W.X., X.H.J., Z.H.M., W.W.Z., T.L., H.T.Z., Y.J.D., J.Q.Z.); Department of Scientific Research, Shanghai Aitrox Technology Corporation Limited, Shanghai, China (X.L.G., Y.L., C.C.F., K.Y.Z., Q.F., C.H.); Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (R.F.Z.); Department of Medical Ultrasound, Affiliated Hospital of Guizhou Medical University, Guiyang, China (Y.G., X.C.); Department of Medical Ultrasound, Yunnan Cancer Hospital & The Third Affiliated Hospital of Kunming Medical University, Kunming, China (X.M.L.); Department of Ultrasound, Yunnan Kungang Hospital, The Seventh Affiliated Hospital of Dali University, Anning, China (N.L.); Department of Ultrasound, Affiliated Hospital of Yan'an University, Yan'an, China (B.Y.B.); Department of Ultrasound, Tangdu Hospital, Fourth Military Medical University, Xi'an, China (Q.Y.L.); Department of Ultrasound, Shanxi Provincial People's Hospital, Taiyuan, China (J.P.Y.); Department of Ultrasound, Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region, China (H.Z.); Department of Ultrasound, Gansu Provincial Cancer Hospital, Lanzhou, China (L.G.); Department of Ultrasound, Jilin Central General Hospital, Jilin, China (B.G.); and College of Health Science and Technology, Shanghai Jiaotong University School of Medicine, Shanghai, China (J.Q.Z.)
| | - Qu Fang
- From the Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, 200025, Shanghai, China (W.W.X., X.H.J., Z.H.M., W.W.Z., T.L., H.T.Z., Y.J.D., J.Q.Z.); Department of Scientific Research, Shanghai Aitrox Technology Corporation Limited, Shanghai, China (X.L.G., Y.L., C.C.F., K.Y.Z., Q.F., C.H.); Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (R.F.Z.); Department of Medical Ultrasound, Affiliated Hospital of Guizhou Medical University, Guiyang, China (Y.G., X.C.); Department of Medical Ultrasound, Yunnan Cancer Hospital & The Third Affiliated Hospital of Kunming Medical University, Kunming, China (X.M.L.); Department of Ultrasound, Yunnan Kungang Hospital, The Seventh Affiliated Hospital of Dali University, Anning, China (N.L.); Department of Ultrasound, Affiliated Hospital of Yan'an University, Yan'an, China (B.Y.B.); Department of Ultrasound, Tangdu Hospital, Fourth Military Medical University, Xi'an, China (Q.Y.L.); Department of Ultrasound, Shanxi Provincial People's Hospital, Taiyuan, China (J.P.Y.); Department of Ultrasound, Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region, China (H.Z.); Department of Ultrasound, Gansu Provincial Cancer Hospital, Lanzhou, China (L.G.); Department of Ultrasound, Jilin Central General Hospital, Jilin, China (B.G.); and College of Health Science and Technology, Shanghai Jiaotong University School of Medicine, Shanghai, China (J.Q.Z.)
| | - Chuan He
- From the Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, 200025, Shanghai, China (W.W.X., X.H.J., Z.H.M., W.W.Z., T.L., H.T.Z., Y.J.D., J.Q.Z.); Department of Scientific Research, Shanghai Aitrox Technology Corporation Limited, Shanghai, China (X.L.G., Y.L., C.C.F., K.Y.Z., Q.F., C.H.); Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (R.F.Z.); Department of Medical Ultrasound, Affiliated Hospital of Guizhou Medical University, Guiyang, China (Y.G., X.C.); Department of Medical Ultrasound, Yunnan Cancer Hospital & The Third Affiliated Hospital of Kunming Medical University, Kunming, China (X.M.L.); Department of Ultrasound, Yunnan Kungang Hospital, The Seventh Affiliated Hospital of Dali University, Anning, China (N.L.); Department of Ultrasound, Affiliated Hospital of Yan'an University, Yan'an, China (B.Y.B.); Department of Ultrasound, Tangdu Hospital, Fourth Military Medical University, Xi'an, China (Q.Y.L.); Department of Ultrasound, Shanxi Provincial People's Hospital, Taiyuan, China (J.P.Y.); Department of Ultrasound, Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region, China (H.Z.); Department of Ultrasound, Gansu Provincial Cancer Hospital, Lanzhou, China (L.G.); Department of Ultrasound, Jilin Central General Hospital, Jilin, China (B.G.); and College of Health Science and Technology, Shanghai Jiaotong University School of Medicine, Shanghai, China (J.Q.Z.)
| | - WeiWei Zhan
- From the Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, 200025, Shanghai, China (W.W.X., X.H.J., Z.H.M., W.W.Z., T.L., H.T.Z., Y.J.D., J.Q.Z.); Department of Scientific Research, Shanghai Aitrox Technology Corporation Limited, Shanghai, China (X.L.G., Y.L., C.C.F., K.Y.Z., Q.F., C.H.); Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (R.F.Z.); Department of Medical Ultrasound, Affiliated Hospital of Guizhou Medical University, Guiyang, China (Y.G., X.C.); Department of Medical Ultrasound, Yunnan Cancer Hospital & The Third Affiliated Hospital of Kunming Medical University, Kunming, China (X.M.L.); Department of Ultrasound, Yunnan Kungang Hospital, The Seventh Affiliated Hospital of Dali University, Anning, China (N.L.); Department of Ultrasound, Affiliated Hospital of Yan'an University, Yan'an, China (B.Y.B.); Department of Ultrasound, Tangdu Hospital, Fourth Military Medical University, Xi'an, China (Q.Y.L.); Department of Ultrasound, Shanxi Provincial People's Hospital, Taiyuan, China (J.P.Y.); Department of Ultrasound, Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region, China (H.Z.); Department of Ultrasound, Gansu Provincial Cancer Hospital, Lanzhou, China (L.G.); Department of Ultrasound, Jilin Central General Hospital, Jilin, China (B.G.); and College of Health Science and Technology, Shanghai Jiaotong University School of Medicine, Shanghai, China (J.Q.Z.)
| | - Ting Luo
- From the Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, 200025, Shanghai, China (W.W.X., X.H.J., Z.H.M., W.W.Z., T.L., H.T.Z., Y.J.D., J.Q.Z.); Department of Scientific Research, Shanghai Aitrox Technology Corporation Limited, Shanghai, China (X.L.G., Y.L., C.C.F., K.Y.Z., Q.F., C.H.); Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (R.F.Z.); Department of Medical Ultrasound, Affiliated Hospital of Guizhou Medical University, Guiyang, China (Y.G., X.C.); Department of Medical Ultrasound, Yunnan Cancer Hospital & The Third Affiliated Hospital of Kunming Medical University, Kunming, China (X.M.L.); Department of Ultrasound, Yunnan Kungang Hospital, The Seventh Affiliated Hospital of Dali University, Anning, China (N.L.); Department of Ultrasound, Affiliated Hospital of Yan'an University, Yan'an, China (B.Y.B.); Department of Ultrasound, Tangdu Hospital, Fourth Military Medical University, Xi'an, China (Q.Y.L.); Department of Ultrasound, Shanxi Provincial People's Hospital, Taiyuan, China (J.P.Y.); Department of Ultrasound, Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region, China (H.Z.); Department of Ultrasound, Gansu Provincial Cancer Hospital, Lanzhou, China (L.G.); Department of Ultrasound, Jilin Central General Hospital, Jilin, China (B.G.); and College of Health Science and Technology, Shanghai Jiaotong University School of Medicine, Shanghai, China (J.Q.Z.)
| | - HuiTing Zhang
- From the Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, 200025, Shanghai, China (W.W.X., X.H.J., Z.H.M., W.W.Z., T.L., H.T.Z., Y.J.D., J.Q.Z.); Department of Scientific Research, Shanghai Aitrox Technology Corporation Limited, Shanghai, China (X.L.G., Y.L., C.C.F., K.Y.Z., Q.F., C.H.); Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (R.F.Z.); Department of Medical Ultrasound, Affiliated Hospital of Guizhou Medical University, Guiyang, China (Y.G., X.C.); Department of Medical Ultrasound, Yunnan Cancer Hospital & The Third Affiliated Hospital of Kunming Medical University, Kunming, China (X.M.L.); Department of Ultrasound, Yunnan Kungang Hospital, The Seventh Affiliated Hospital of Dali University, Anning, China (N.L.); Department of Ultrasound, Affiliated Hospital of Yan'an University, Yan'an, China (B.Y.B.); Department of Ultrasound, Tangdu Hospital, Fourth Military Medical University, Xi'an, China (Q.Y.L.); Department of Ultrasound, Shanxi Provincial People's Hospital, Taiyuan, China (J.P.Y.); Department of Ultrasound, Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region, China (H.Z.); Department of Ultrasound, Gansu Provincial Cancer Hospital, Lanzhou, China (L.G.); Department of Ultrasound, Jilin Central General Hospital, Jilin, China (B.G.); and College of Health Science and Technology, Shanghai Jiaotong University School of Medicine, Shanghai, China (J.Q.Z.)
| | - YiJie Dong
- From the Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, 200025, Shanghai, China (W.W.X., X.H.J., Z.H.M., W.W.Z., T.L., H.T.Z., Y.J.D., J.Q.Z.); Department of Scientific Research, Shanghai Aitrox Technology Corporation Limited, Shanghai, China (X.L.G., Y.L., C.C.F., K.Y.Z., Q.F., C.H.); Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (R.F.Z.); Department of Medical Ultrasound, Affiliated Hospital of Guizhou Medical University, Guiyang, China (Y.G., X.C.); Department of Medical Ultrasound, Yunnan Cancer Hospital & The Third Affiliated Hospital of Kunming Medical University, Kunming, China (X.M.L.); Department of Ultrasound, Yunnan Kungang Hospital, The Seventh Affiliated Hospital of Dali University, Anning, China (N.L.); Department of Ultrasound, Affiliated Hospital of Yan'an University, Yan'an, China (B.Y.B.); Department of Ultrasound, Tangdu Hospital, Fourth Military Medical University, Xi'an, China (Q.Y.L.); Department of Ultrasound, Shanxi Provincial People's Hospital, Taiyuan, China (J.P.Y.); Department of Ultrasound, Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region, China (H.Z.); Department of Ultrasound, Gansu Provincial Cancer Hospital, Lanzhou, China (L.G.); Department of Ultrasound, Jilin Central General Hospital, Jilin, China (B.G.); and College of Health Science and Technology, Shanghai Jiaotong University School of Medicine, Shanghai, China (J.Q.Z.)
| | - JianQiao Zhou
- From the Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, 200025, Shanghai, China (W.W.X., X.H.J., Z.H.M., W.W.Z., T.L., H.T.Z., Y.J.D., J.Q.Z.); Department of Scientific Research, Shanghai Aitrox Technology Corporation Limited, Shanghai, China (X.L.G., Y.L., C.C.F., K.Y.Z., Q.F., C.H.); Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (R.F.Z.); Department of Medical Ultrasound, Affiliated Hospital of Guizhou Medical University, Guiyang, China (Y.G., X.C.); Department of Medical Ultrasound, Yunnan Cancer Hospital & The Third Affiliated Hospital of Kunming Medical University, Kunming, China (X.M.L.); Department of Ultrasound, Yunnan Kungang Hospital, The Seventh Affiliated Hospital of Dali University, Anning, China (N.L.); Department of Ultrasound, Affiliated Hospital of Yan'an University, Yan'an, China (B.Y.B.); Department of Ultrasound, Tangdu Hospital, Fourth Military Medical University, Xi'an, China (Q.Y.L.); Department of Ultrasound, Shanxi Provincial People's Hospital, Taiyuan, China (J.P.Y.); Department of Ultrasound, Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region, China (H.Z.); Department of Ultrasound, Gansu Provincial Cancer Hospital, Lanzhou, China (L.G.); Department of Ultrasound, Jilin Central General Hospital, Jilin, China (B.G.); and College of Health Science and Technology, Shanghai Jiaotong University School of Medicine, Shanghai, China (J.Q.Z.)
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