1
|
Eun NL, Lee E, Park AY, Son EJ, Kim JA, Youk JH. Artificial intelligence for ultrasound microflow imaging in breast cancer diagnosis. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2024. [PMID: 38593859 DOI: 10.1055/a-2230-2455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
PURPOSE To develop and evaluate artificial intelligence (AI) algorithms for ultrasound (US) microflow imaging (MFI) in breast cancer diagnosis. MATERIALS AND METHODS We retrospectively collected a dataset consisting of 516 breast lesions (364 benign and 152 malignant) in 471 women who underwent B-mode US and MFI. The internal dataset was split into training (n = 410) and test datasets (n = 106) for developing AI algorithms from deep convolutional neural networks from MFI. AI algorithms were trained to provide malignancy risk (0-100%). The developed AI algorithms were further validated with an independent external dataset of 264 lesions (229 benign and 35 malignant). The diagnostic performance of B-mode US, AI algorithms, or their combinations was evaluated by calculating the area under the receiver operating characteristic curve (AUROC). RESULTS The AUROC of the developed three AI algorithms (0.955-0.966) was higher than that of B-mode US (0.842, P < 0.0001). The AUROC of the AI algorithms on the external validation dataset (0.892-0.920) was similar to that of the test dataset. Among the AI algorithms, no significant difference was found in all performance metrics combined with or without B-mode US. Combined B-mode US and AI algorithms had a higher AUROC (0.963-0.972) than that of B-mode US (P < 0.0001). Combining B-mode US and AI algorithms significantly decreased the false-positive rate of BI-RADS category 4A lesions from 87% to 13% (P < 0.0001). CONCLUSION AI-based MFI diagnosed breast cancers with better performance than B-mode US, eliminating 74% of false-positive diagnoses in BI-RADS category 4A lesions.
Collapse
Affiliation(s)
- Na Lae Eun
- Radiology, Gangnam Severance Hospital, Seoul, Korea (the Republic of)
| | - Eunjung Lee
- Computational Science and Engineering, Yonsei University, Seoul, Korea (the Republic of)
| | - Ah Young Park
- Radiology, Bundang CHA Medical Center, Seongnam, Korea (the Republic of)
| | - Eun Ju Son
- Radiology, Gangnam Severance Hospital, Seoul, Korea (the Republic of)
| | - Jeong-Ah Kim
- Radiology, Gangnam Severance Hospital, Seoul, Korea (the Republic of)
| | - Ji Hyun Youk
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea, Republic of
- Radiology, Gangnam Severance Hospital, Seoul, Korea (the Republic of)
| |
Collapse
|
2
|
Kim HJ, Kim HH, Kim KH, Lee JS, Choi WJ, Chae EY, Shin HJ, Cha JH, Shim WH. Use of a commercial artificial intelligence-based mammography analysis software for improving breast ultrasound interpretations. Eur Radiol 2024:10.1007/s00330-024-10718-3. [PMID: 38570382 DOI: 10.1007/s00330-024-10718-3] [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: 01/08/2024] [Revised: 02/22/2024] [Accepted: 03/13/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVES To evaluate the use of a commercial artificial intelligence (AI)-based mammography analysis software for improving the interpretations of breast ultrasound (US)-detected lesions. METHODS A retrospective analysis was performed on 1109 breasts that underwent both mammography and US-guided breast biopsy. The AI software processed mammograms and provided an AI score ranging from 0 to 100 for each breast, indicating the likelihood of malignancy. The performance of the AI score in differentiating mammograms with benign outcomes from those revealing cancers following US-guided breast biopsy was evaluated. In addition, prediction models for benign outcomes were constructed based on clinical and imaging characteristics with and without AI scores, using logistic regression analysis. RESULTS The AI software had an area under the receiver operating characteristics curve (AUROC) of 0.79 (95% CI, 0.79-0.82) in differentiating between benign and cancer cases. The prediction models that did not include AI scores (non-AI model), only used AI scores (AI-only model), and included AI scores (integrated model) had AUROCs of 0.79 (95% CI, 0.75-0.83), 0.78 (95% CI, 0.74-0.82), and 0.85 (95% CI, 0.81-0.88) in the development cohort, and 0.75 (95% CI, 0.68-0.81), 0.82 (95% CI, 0.76-0.88), and 0.84 (95% CI, 0.79-0.90) in the validation cohort, respectively. The integrated model outperformed the non-AI model in the development and validation cohorts (p < 0.001 for both). CONCLUSION The commercial AI-based mammography analysis software could be a valuable adjunct to clinical decision-making for managing US-detected breast lesions. CLINICAL RELEVANCE STATEMENT The commercial AI-based mammography analysis software could potentially reduce unnecessary biopsies and improve patient outcomes. KEY POINTS • Breast US has high rates of false-positive interpretations. • A commercial AI-based mammography analysis software could distinguish mammograms having benign outcomes from those revealing cancers after US-guided breast biopsy. • A commercial AI-based mammography analysis software may improve interpretations for breast US-detected lesions.
Collapse
Affiliation(s)
- Hee Jeong Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea
| | - Hak Hee Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea.
| | - Ki Hwan Kim
- Lunit Inc., 15F, 27, Teheran-Ro 2-Gil, Gangnam-Gu, Seoul, 06241, South Korea
| | - Ji Sung Lee
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College, Ulsan, South Korea
| | - Woo Jung Choi
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea
| | - Eun Young Chae
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea
| | - Hee Jung Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea
| | - Joo Hee Cha
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea
| | - Woo Hyun Shim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea
| |
Collapse
|
3
|
Lee EJ, Chang YW. Prediction of complete response after neoadjuvant chemotherapy for invasive breast cancers: The utility of shear wave elastography and superb microvascular imaging in pretreatment breast ultrasound. Eur J Radiol 2024; 175:111432. [PMID: 38554672 DOI: 10.1016/j.ejrad.2024.111432] [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: 06/29/2023] [Revised: 03/03/2024] [Accepted: 03/15/2024] [Indexed: 04/02/2024]
Abstract
PURPOSE To investigate whether multiparametric parameters of pretreatment breast ultrasound (US) and clinicopathologic factors are associated with pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) for breast cancer. METHODS Between November 2018 and September 2022, 88 patients who underwent NAC and subsequent surgery were included in this study (median age, 55 years; interquartile range [IQR], 45, 59.3). Multiparametric breast US including grayscale, shear wave elastography (SWE) and superb microvascular imaging (SMI) of pathologically proven invasive breast cancers were retrospectively reviewed. Clinicopathological and multiparametric parameters of breast US, including size, SWEmax, SWEratio and vascular index on SMI (SMIVI) were compared between the groups. Univariate and multivariate logistic regression analyses were performed to determine factors predicting pCR after NAC. AUROC curve analysis was performed to determine the predictors' optimal cut-off values and diagnostic performance. RESULTS The pCR group (n = 24) showed a significantly smaller tumor size, lower SWEmax, higher Ki-67 index, higher hormone receptor negativity and negative axillary lymph node metastasis compared to the non-pCR group (n = 64). Multivariate regression analysis showed that SWEmax (adjusted odds ratio[aOR] = 0.956, 95 % confidence interval [CI] = 0.919-0.994, P = 0.025) and Ki-67 index (aOR = 1.083, 95 % CI = 1.012-1.159, P = 0.021) were independently associated with pathologically complete response. The optimal cut-off values for predicting pCR were 27.5 % for Ki-67 with an AUC of 0.743 and 134.8 kPa for SWEmax with an AUC of 0.779. A combination model including clinical factors and SWEmax showed the best diagnostic performance with an AUC of 0.876. CONCLUSION A higher Ki-67 index and lower SWEmax measured on pretreatment breast US were independently associated with pCR in invasive breast cancer after NAC.
Collapse
Affiliation(s)
- Eun Ji Lee
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Yun-Woo Chang
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea.
| |
Collapse
|
4
|
Abedi M, Sahebi L, Eslami B, Saberi A, Orouji M, Alipour S, Shahsavarhaghighi S. Using a combination of superb microvascular imaging and other auxiliary ultrasound techniques to increase the accuracy of gray-scale ultrasound for breast masses. BMC Cancer 2024; 24:224. [PMID: 38365653 PMCID: PMC10873956 DOI: 10.1186/s12885-024-11981-9] [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: 11/19/2023] [Accepted: 02/07/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Breast ultrasound is highly sensitive, but its specificity is not as high for detecting malignant lesions. Auxiliary modalities like elastography, Color and Power Doppler ultrasound are used as adjuncts to yield both a high sensitivity and specificity. Superb microvascular imaging (SMI) is a newer modality with more accuracy for detecting breast lesions. In this study, our goal was to investigate the role of SMI as an adjunct to ultrasound and find a suitable combination model for the evaluation of breast masses. METHODS In this cross-sectional study, 132 women with 172 breast masses who underwent ultrasound-guided biopsy were included.. The ultrasound features of the lesion, the strain ratio in strain elastography, the number of vessels for each lesion, their morphology and distribution in Doppler and Power Doppler ultrasound and SMI were recorded for each lesion. A vascular score and a vascular ratio were defined. RESULTS In the histologic examination, 31 lesions (18%) were malignant and 141 lesions (82%) were benign. The vascular score was more accurate than the vascular ratio in all three modalities. The predictive ability of strain ratio was higher than Doppler and Power Doppler ultrasound and SMI. Adding SMI alone to ultrasound increased the specificity from 46.10% to 61.2% and the accuracy from 55.80% to 70.11%. In the combination of ultrasound with other modalities, the best was the combination of ultrasound, strain elastography, and SMI; which yielded a specificity and sensitivity of 100% and 74.4%, respectively. CONCLUSION Adding SMI and STE modalities as adjuncts to ultrasound lowers the chance of missing malignant lesions and reduces unnecessary biopsies of breast lesions. A study with a larger sample size using this combination model to evaluate the accuracy with greater precision is recommended.
Collapse
Affiliation(s)
- Mahboubeh Abedi
- Radiology Fellow, Ballarat Base Hospital, Ballarat, VIC, Australia
| | - Leyla Sahebi
- Maternal, Fetal and Neonatal Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bita Eslami
- Breast Diseases Research Center, Cancer Institute, Tehran University of Medical Sciences, Imam Khomeini Hospital Complex, Keshavarz Blvd., Tehran, Iran
| | - Azin Saberi
- Department of Surgery, Arash Women's Hospital, Faculty of Medicine,Tehran University of Medical Sciences, Tehran, Iran
| | - Marzieh Orouji
- Department of Nursing, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sadaf Alipour
- Breast Diseases Research Center, Cancer Institute, Tehran University of Medical Sciences, Imam Khomeini Hospital Complex, Keshavarz Blvd., Tehran, Iran.
- Department of Surgery, Arash Women's Hospital, Faculty of Medicine,Tehran University of Medical Sciences, Tehran, Iran.
| | - Shirin Shahsavarhaghighi
- Breast Diseases Research Center, Cancer Institute, Tehran University of Medical Sciences, Imam Khomeini Hospital Complex, Keshavarz Blvd., Tehran, Iran
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
5
|
Zhong J, Huang L, Su M, Wu M, Lin X, Shui X, Jiang Y, Zhang X. Ultrasound Microvessel Visualization in Cervical Cancer: Association Between Novel Ultrasound Techniques and Histologic Microvessel Densities. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:2537-2547. [PMID: 37730477 DOI: 10.1016/j.ultrasmedbio.2023.08.017] [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: 02/07/2023] [Revised: 07/27/2023] [Accepted: 08/23/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVE The aim of the work described here was to evaluate the feasibility of superb microvascular imaging (SMI) and vascular endothelial growth factor receptor 2 (VEGFR2)-targeted microbubble (MBVEGFR2)-based ultrasound molecular imaging (USMI) for visualizing microvessels in cervical cancer. METHODS Hela cells were used to establish subcutaneous cervical cancer models. SMI and MBVEGFR2-based USMI were performed, and the results were compared with intratumoral microvessel density (MVD) in four groups based on tumor diameter (<3 mm, 3-5 mm, 5-7 mm and ≥7 mm). The vascularization index (VI, %) was evaluated for SMI, and the normalized intensity difference (NID) for USMI. RESULTS Tumors with diameters ranging from 3 to 5 mm had the highest VI (39.07 ± 1.58) in SMI, and VI significantly decreased with increasing tumor size (all p values <0.001). The strongest signal intensity was observed in very early tumors (d < 3 mm: 43.80 ± 3.58%) after MBVEGFR2 administration; the NID gradually decreased with increasing diameter of tumors (all p values = 0.007). However, no significant differences were observed in NID after administration of non-targeted (control) microbubbles (MBCon) (all p values = 0.125). MBVEGFR2-based USMI had the strongest correlation with MVD in displaying microvessels of cervical cancer compared with SMI and MBCon (R2 = 0.78 vs. R2 = 0.40 and R2 = 0.38). CONCLUSION These findings validate the superiority and accuracy of MBVEGFR2-based USMI for microvessel imaging and monitoring of angiogenesis in cervical cancer compared with SMI and MBCon. Nonetheless, SMI remains an alternative to microvessel imaging when ultrasonic contrast agent use is contraindicated.
Collapse
Affiliation(s)
- Junlin Zhong
- Department of Ultrasound, Laboratory of Novel Optoacoustic (Ultrasonic) Imaging, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Licong Huang
- Department of Ultrasound, Laboratory of Novel Optoacoustic (Ultrasonic) Imaging, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Manting Su
- Department of Ultrasound, Laboratory of Novel Optoacoustic (Ultrasonic) Imaging, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Manli Wu
- Department of Ultrasound, Laboratory of Novel Optoacoustic (Ultrasonic) Imaging, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xin Lin
- Department of Ultrasound, Laboratory of Novel Optoacoustic (Ultrasonic) Imaging, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xing Shui
- Department of Cardiovascular Medicine, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Ye Jiang
- Department of Pathology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xinling Zhang
- Department of Ultrasound, Laboratory of Novel Optoacoustic (Ultrasonic) Imaging, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.
| |
Collapse
|
6
|
Adler RS. Musculoskeletal ultrasound: a technical and historical perspective. J Ultrason 2023; 23:e172-e187. [PMID: 38020513 PMCID: PMC10668930 DOI: 10.15557/jou.2023.0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 08/21/2023] [Indexed: 12/01/2023] Open
Abstract
During the past four decades, musculoskeletal ultrasound has become popular as an imaging modality due to its low cost, accessibility, and lack of ionizing radiation. The development of ultrasound technology was possible in large part due to concomitant advances in both solid-state electronics and signal processing. The invention of the transistor and digital computer in the late 1940s was integral in its development. Moore's prediction that the number of microprocessors on a chip would grow exponentially, resulting in progressive miniaturization in chip design and therefore increased computational power, added to these capabilities. The development of musculoskeletal ultrasound has paralleled technical advances in diagnostic ultrasound. The appearance of a large variety of transducer capabilities and rapid image processing along with the ability to assess vascularity and tissue properties has expanded and continues to expand the role of musculoskeletal ultrasound. It should also be noted that these developments have in large part been due to a number of individuals who had the insight to see the potential applications of this developing technology to a host of relevant clinical musculoskeletal problems. Exquisite high-resolution images of both deep and small superficial musculoskeletal anatomy, assessment of vascularity on a capillary level and tissue mechanical properties can be obtained. Ultrasound has also been recognized as the method of choice to perform a large variety of interventional procedures. A brief review of these technical developments, the timeline over which these improvements occurred, and the impact on musculoskeletal ultrasound is presented below.
Collapse
Affiliation(s)
- Ronald Steven Adler
- Department of Radiology, New York University, Grossman School of Medicine, Langone Orthopedic Center, New York, USA
| |
Collapse
|
7
|
Chen SH, Xiang XZ, Che PF, Hu B, Shui DY, Zhao Y, Wang L. Superb Microvascular Imaging for the Differentiation of Benign and Malignant Breast Lesions: A System Review and Meta-Analysis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:1385-1399. [PMID: 36579829 DOI: 10.1002/jum.16159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 12/04/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To evaluate the diagnostic performance of SMI in the diagnosis of benign and malignant breast lesions. METHODS A systematic search of PubMed, EMBASE, Cochrane, OVID, SCI, and SCOPUS was performed to find relevant studies which applied SMI to differentiate benign and malignant breast lesions. All the studies were published before October 10, 2022. Only studies published in English were collected. Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool was applied to assess the quality of the included studies. Summary receiver operating characteristic (SROC) modeling was also performed to the diagnostic performance of SMI in the diagnosis of benign and malignant breast lesions. Subgroup analyses and meta-regression were performed to find out the heterogeneity. RESULTS Twenty studies which include a total of 2873 lesions (1748 benign and 1125 malignant) in 2740 patients were evaluated in this meta-analysis. The summary sensitivity and specificity were 0.82 (95% confidence interval [CI]: 0.76-0.86), 0.70 (95% CI: 0.64-0.76) for SMI vascular degree, 0.77 (95% CI: 0.67-0.84), 0.79 (95% CI: 0.75-0.83) for SMI vascular distribution, 0.78 (95% CI: 0.70-0.84), 0.75 (95% CI: 0.69-0.80) for SMI vascular morphology, 0.81 (95% CI: 0.72-0.87), 0.80 (95% CI: 0.75-0.85) SMI penetration vessel. For SMI overall vascular features, the summary sensitivity and summary specificity were 0.74 (95% CI: 0.61-0.84) and 0.80 (95% CI: 0.76-0.84). The result of subgroup analysis and meta-analysis showed malignant rate and country might be the cause of heterogeneity of diagnostic accuracy of vascular grade and morphology. CONCLUSION SMI vascular features have high sensitivity and specificity in the differentiation of benign and malignant lesions. Future international multicenter studies in various regions with large sample size are required to confirm these findings.
Collapse
Affiliation(s)
- Si-Han Chen
- Department of Ultrasonic Imaging, Affiliated Renhe Hospital, China Three Gorges University, Yichang, Hubei, China
| | - Xiao-Zhen Xiang
- Department of Ultrasonic Imaging, Affiliated Renhe Hospital, China Three Gorges University, Yichang, Hubei, China
| | - Peng-Fei Che
- Department of Ultrasonic Imaging, Affiliated Renhe Hospital, China Three Gorges University, Yichang, Hubei, China
| | - Bing Hu
- Department of Ultrasonic Imaging, Affiliated Renhe Hospital, China Three Gorges University, Yichang, Hubei, China
| | - Dian-Ya Shui
- Department of Ultrasonic Imaging, Yichang Second People's Hospital, Yichang, Hubei, China
| | - Yun Zhao
- Medical School of China, Three Gorges University, Yichang, Hubei, China
| | - Li Wang
- Department of Ultrasonic Imaging, Affiliated Renhe Hospital, China Three Gorges University, Yichang, Hubei, China
| |
Collapse
|
8
|
Cai S, Xing H, Wang Y, Wang Y, Ma W, Jiang Y, Li J, Wang H. Intraoperative shear-wave elastography and superb microvascular imaging contribute to the glioma grading. J Clin Neurosci 2023; 110:92-99. [PMID: 36848737 DOI: 10.1016/j.jocn.2023.02.012] [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: 12/19/2022] [Revised: 02/14/2023] [Accepted: 02/20/2023] [Indexed: 02/28/2023]
Abstract
BACKGROUND To explore the diagnostic value and feasibility of shear wave elastography and superb microvascular imaging in the grading diagnosis of glioma intraoperatively. MATERIALS AND METHODS Forty-nine patients with glioma were included in this study. B-mode ultrasonography, Young's modulus in shear-wave elastography (SWE) and vascular architecture in superb microvascular imaging(SMI) of tumor tissue and peritumoral tissue were analyzed. Receiver operating characteristic(ROC) curve analysis was used to evaluate the diagnostic effect of SWE. Logistic regression model was used to calculate the prediction probability of HGG diagnosis. RESULTS Compared with LGG, HGG was often characterized by peritumoral edema in B mode (P < 0.05). There was a significant difference in Young's modulus between HGG and LGG; the diagnostic threshold of HGG and LGG was 13.05 kPa, the sensitivity was 78.3%, and the specificity was 76.9%. The vascular architectures of the tumor tissue and peritumoral tissues of HGG and LGG were significantly different (P < 0.05). The vascular architectures of peritumoral tissue in HGG often characterized by distorted blood flow signals surrounding the tumor (14/26,53.8%); in the tumor tissue, HGG often presents as dilated and bent vessels(19/26,73.1%). The elasticity value of SWE and the tumor vascular architectures of SMI were correlated with the diagnosis of HGG. CONCLUSION Intraoperative ultrasound (ioUS), especially SWE, and SMI are beneficial for the differentiation of HGG and LGG and may help optimize clinical surgical procedures.
Collapse
Affiliation(s)
- Siman Cai
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China.
| | - Hao Xing
- Department of Neurosurgery Department, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Yuekun Wang
- Department of Neurosurgery Department, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China.
| | - Yu Wang
- Department of Neurosurgery Department, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China.
| | - Wenbin Ma
- Department of Neurosurgery Department, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Yuxin Jiang
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China.
| | - Jianchu Li
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China.
| | - Hongyan Wang
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China.
| |
Collapse
|
9
|
Mohindra N, Jain N, Yadav S, Agrawal V, Mishra P, Mishra A, Agarwal G. Utility of ultrasound Angio-PLUS imaging for detecting blood flow in breast masses and comparison with color Doppler for differentiating benign from malignant masses. Acta Radiol 2023; 64:2087-2095. [PMID: 36890701 DOI: 10.1177/02841851231160076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
BACKGROUND Tumor neo-angiogenesis plays an important role in the development and growth of breast cancers, but its detection by imaging is challenging. A novel microvascular imaging (MVI) technique, Angio-PLUS, promises to overcome the limitations of color Doppler (CD) in detecting low-velocity flow and small diameter vessels. PURPOSE To determine the utility of the Angio-PLUS technique for detecting blood flow in breast masses and compare it with CD for differentiating benign from malignant masses. MATERIAL AND METHODS A total of 79 consecutive women with breast masses were prospectively evaluated using CD and Angio-PLUS techniques, and biopsied as per BI-RADS recommendations. Vascular imaging scores were assigned using three factors (number, morphology, and distribution) and vascular patterns were divided into five groups: internal-dot-spot, external-dot-spot, marginal, radial, and mesh patterns. The independent samples t-test, Mann-Whitney U test, Wilcoxon signed rank test, or Fisher's exact test were used to compare the two groups as appropriate. Area under the receiver operating characteristic (ROC) curve (AUC) methods were used to assess diagnostic accuracy. RESULTS Vascular scores were significantly higher on Angio-PLUS than CD (median=11, [IQR=9-13] vs. 5 [IQR=3-9], P < 0.001). Malignant masses had higher vascular scores than benign masses on Angio-PLUS (P < 0.001). AUC was 80% (95% CI=70.3-89.7; P < 0.001) for Angio-PLUS and 51.9% for CD. Using Angio-PLUS at a cutoff value of ≥9.5, sensitivity was 80% and specificity was 66.7%. Vascular pattern descriptors on AP showed good correlation with histopathological results (PPV mesh 95.5%, radial 96.9%, and NPV of marginal orientation 90.5%). CONCLUSION Angio-PLUS was more sensitive in detecting vascularity and superior in differentiating benign from malignant masses compared to CD. Vascular pattern descriptors on Angio-PLUS were useful.
Collapse
Affiliation(s)
- Namita Mohindra
- Department of Radio-diagnosis, 30093Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, UP, India
| | - Neeraj Jain
- Department of Radio-diagnosis, 30093Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, UP, India
| | - Shubham Yadav
- Department of Radio-diagnosis, 30093Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, UP, India
| | - Vinita Agrawal
- Department of Pathology, 30093Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, UP, India
| | - Prabhakar Mishra
- Department of Biostatistics, 30093Sanjay Gandhi Post-graduate Institute of Medical Sciences (SGPGIMS), Lucknow, UP, India
| | - Anjali Mishra
- Department of Endocrine and Breast Surgery, 30093Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, UP, India
| | - Gaurav Agarwal
- Department of Endocrine and Breast Surgery, 30093Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, UP, India
| |
Collapse
|
10
|
Han H, Ji Z, Huang B, Mao L, Cao Q, Fan P, Wang W. The Preliminary Application of Simultaneous Display of Contrast-Enhanced Ultrasound and Micro-Flow Imaging Technology in the Diagnosis of Hepatic Tumors. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:729-737. [PMID: 36217761 DOI: 10.1002/jum.16111] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 08/11/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES To evaluate the value of simultaneous display of contrast-enhanced ultrasound and micro-flow imaging technology (CEUS-MFI) in intra-tumoral vessel detection and hepatic tumor diagnosis. METHODS A total of 82 patients with 82 focal liver lesions were enrolled in this study. Each patient received ultrasound exams including color Doppler flow imaging (CDFI), micro-flow imaging (MFI), contrast-enhanced ultrasound (CEUS), and CEUS-MFI with a Philips EPIQ7 ultrasound imaging system. The intra-tumoral vessels detected by CDFI, MFI, and CEUS-MFI were compared, respectively. The accuracy and confidence of using CEUS and CEUS-MFI in diagnosing hepatic tumors were also compared. RESULTS CEUS-MFI was capable of detecting more hepatic intra-tumoral vessels than MFI (P = .000) and CDFI (P = .000). Compared with CEUS, CEUS-MFI improved the diagnostic accuracy of hepatic lesions (P = .009). Particularly, among the correctly diagnosed hepatic lesions, the number of cases where radiologists diagnosed with great confidence was increased from 88.4% (61/69) with CEUS only to 92.4% (73/79) with CEUS-MFI (P = .041). CONCLUSIONS CEUS-MFI is sensitive in detecting hepatic intra-tumoral vessels and can improve the accuracy and confidence of radiologists in diagnosing hepatic lesions.
Collapse
Affiliation(s)
- Hong Han
- Department of Ultrasound, Zhongshan Hospital of Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
| | - Zhengbiao Ji
- Department of Ultrasound, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Beijian Huang
- Department of Ultrasound, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Lijuan Mao
- Department of Ultrasound, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Qiong Cao
- Department of Ultrasound, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Peili Fan
- Department of Ultrasound, Zhongshan Hospital of Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
| | - Wenping Wang
- Department of Ultrasound, Zhongshan Hospital of Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
| |
Collapse
|
11
|
Aladag Kurt S, Kayadibi Y, Onur I, Uslu Besli L, Necati Sanli A, Velidedeoglu M. Predicting axillary nodal metastasis based on the side of asymmetrical cortical thickening in breast cancer: Evaluation with grayscale and microvascular imaging findings. Eur J Radiol 2023; 158:110643. [PMID: 36535079 DOI: 10.1016/j.ejrad.2022.110643] [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: 05/12/2022] [Revised: 11/16/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE To investigate the relationship between sonographic findings and the axillary status, especially the side of thickening in the presence of cortical asymmetry. METHODS Patients with biopsy-proven axillary lymph node (ALN) metastasis were included in this study. The lymph nodes were divided into three groups depending on the type of cortical thickening as diffuse, closer (eccentric cortical thickening on the side near the tumor and/or breast) and distant (thickening on the further side) asymmetry. Longitudinal to transverse axis (L/T) ratio, the largest cortical thickness, cortex to hilum ratio (C/H), hilar status (normal/displaced/absent), orientation (parallel/vertical), capsular integrity (sharp/indistinct), vascularisation pattern (hilar/peripheral/penetrant/anarchic/avascular) on superb microvascular imaging (SMI) and presence of conglomeration were recorded for each lymph node. Axillary nodal status on 18F-FDG PET-CT/MRI scans was recorded, if available. Features of the breast lesions like size, laterality, nuclear grade, hormone receptor status and the level of Ki-67 expression have been added. RESULTS A total of 219 metastatic ALNs [diffuse (n = 122), closer asymmetry (n = 71), distant asymmetry (n = 26)] were evaluated. By the univariate analysis, ALN metastasis was significantly associated with the presence of closer asymmetrical cortical thickening (p < 0,0001), C/H ratio (p = 0.001), cortical thickness (p = 0.001), hilar status (p < 0.005) and vascular pattern (p < 0.005). L/T ratio was only a statistically significant parameter for lymph nodes with diffuse cortical enlargement in predicting metastasis, and conglomeration was also observed only in this group (p < 0.05). By multivariate analysis, nodal metastasis was significantly associated with asymmetrical cortical thickening (p = 0.001), C/H ratio (p = 0.005) and vascular pattern (p < 0.0001). CONCLUSION Asymmetrical cortical enlargement on the side closer to the breast, C/H ratio and abnormal microvascular pattern are the independent predictors of axillary nodal involvement. Closer asymmetry is an eligible, easy-to-detect grayscale US finding to decide sampling that highly predicts ALN metastasis.
Collapse
Affiliation(s)
- Seda Aladag Kurt
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Radiology, Kocamustafapasa, Istanbul 34098, Turkey.
| | - Yasemin Kayadibi
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Radiology, Kocamustafapasa, Istanbul 34098, Turkey.
| | - Irem Onur
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Pathology, Kocamustafapasa, Istanbul 34098, Turkey
| | - Lebriz Uslu Besli
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Nuclear Medicine, Kocamustafapasa, Istanbul 34098, Turkey.
| | - Ahmet Necati Sanli
- Department of General Surgery, Abdulkadir Yuksel State Hospital, Gaziantep 27090, Turkey
| | - Mehmet Velidedeoglu
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of General Surgery, Kocamustafapasa, Istanbul 34098, Turkey.
| |
Collapse
|
12
|
Giammalva GR, Viola A, Maugeri R, Giardina K, Di Bonaventura R, Musso S, Brunasso L, Cepeda S, Della Pepa GM, Scerrati A, Mantovani G, Ferini G, Gerardi RM, Pino MA, Umana GE, Denaro L, Albanese A, Iacopino DG. Intraoperative Evaluation of Brain-Tumor Microvascularization through MicroV IOUS: A Protocol for Image Acquisition and Analysis of Radiomic Features. Cancers (Basel) 2022; 14:5335. [PMID: 36358754 PMCID: PMC9656308 DOI: 10.3390/cancers14215335] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/25/2022] [Accepted: 10/27/2022] [Indexed: 08/09/2023] Open
Abstract
Microvascular Doppler (MicroV) is a new-generation Doppler technique developed by Esaote (Esaote s.p.a., Genova, Italy), which is able to visualize small and low-flow vessels through a suppression of interfering signals. MicroV uses advanced filters that are able to differentiate tissue artifacts from low-speed blood flows; by exploiting the space-time coherence information, these filters can selectively suppress tissue components, preserving the signal coming from the microvascular flow. This technique is clinically applied to the study of the vascularization of parenchymatous lesions, often with better diagnostic accuracy than color/power Doppler techniques. The aim of this paper is to develop a reproducible protocol for the recording and collection of MicroV intraoperative ultrasound images by the use of a capable intraoperative ultrasound machine and post-processing aimed at evaluation of brain-tumor microvascularization through the analysis of radiomic features. The proposed protocol has been internally validated on eight patients and will be firstly applied to patients affected by WHO grade IV astrocytoma (glioblastoma-GBM) candidates for craniotomy and lesion removal. In a further stage, it will be generally applied to patients with primary or metastatic brain tumors. IOUS is performed before durotomy. Tumor microvascularization is evaluated using the MicroV Doppler technique and IOUS images are recorded, stored, and post-processed. IOUS images are remotely stored on the BraTIoUS database, which will promote international cooperation and multicentric analysis. Processed images and texture radiomic features are analyzed post-operatively using ImageJ, a free scientific image-analysis software based on the Sun-Java platform. Post-processing protocol is further described in-depth. The study of tumor microvascularization through advanced IOUS techniques such as MicroV could represent, in the future, a non-invasive and real-time method for intraoperative predictive evaluation of the tumor features. This evaluation could finally result in a deeper knowledge of brain-tumor behavior and in the on-going adaptation of the surgery with the improvement of surgical outcomes.
Collapse
Affiliation(s)
- Giuseppe Roberto Giammalva
- Neurosurgical Clinic, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy
| | - Anna Viola
- Department of Radiation Oncology, REM Radioterapia srl, 95029 Viagrande, Italy
| | - Rosario Maugeri
- Neurosurgical Clinic, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy
| | - Kevin Giardina
- Neurosurgical Clinic, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy
| | - Rina Di Bonaventura
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00100 Rome, Italy
| | - Sofia Musso
- Neurosurgical Clinic, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy
| | - Lara Brunasso
- Neurosurgical Clinic, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy
| | - Santiago Cepeda
- Departamento de Neurocirugía, Hospital Universitario Río Hortega, 47012 Valladolid, Spain
| | - Giuseppe Maria Della Pepa
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00100 Rome, Italy
| | - Alba Scerrati
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy
- Department of Neurosurgery, Sant’Anna University Hospital of Ferrara, 44124 Ferrara, Italy
| | - Giorgio Mantovani
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy
- Department of Neurosurgery, Sant’Anna University Hospital of Ferrara, 44124 Ferrara, Italy
| | - Gianluca Ferini
- Department of Radiation Oncology, REM Radioterapia srl, 95029 Viagrande, Italy
| | - Rosa Maria Gerardi
- Neurosurgical Clinic, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy
| | - Maria Angela Pino
- Neurosurgical Clinic, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy
| | - Giuseppe Emmanuele Umana
- Trauma Center, Gamma Knife Center, Department of Neurosurgery, Cannizzaro Hospital, 95126 Catania, Italy
| | - Luca Denaro
- Academic Neurosurgery, Department of Neurosciences DNS, University of Padua, 35128 Padua, Italy
| | - Alessio Albanese
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00100 Rome, Italy
| | - Domenico Gerardo Iacopino
- Neurosurgical Clinic, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy
| |
Collapse
|
13
|
Prospective analysis of breast masses using the combined score for quantitative ultrasonography parameters. Sci Rep 2022; 12:16205. [PMID: 36171328 PMCID: PMC9519555 DOI: 10.1038/s41598-022-19971-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 09/07/2022] [Indexed: 11/09/2022] Open
Abstract
To investigate the diagnostic value of combined SWE, SMI, and B-mode US scores for distinguishing between benign and malignant masses. A total of 450 breast masses that underwent US-guided core needle biopsies were prospectively enrolled. The breast masses were assessed based on the BI-RADS and quantitative SWE and SMI parameters. The SWEmax, SWEratio, and SMIVI cutoff value were determined using Youden’s index by comparison to the pathological results. The BI-RADS categories were scored on a scale from 1 to 5, and SWEmax, SWEratio, and SMIVI were dichotomized based on each cutoff values (0 or 1). The combined scores (1 to 8) were calculated as the sum of the BI-RADS score and the quantitative scores and compared to the pathologic results using AUROC analysis. The cutoff values were 52.25 kPa for SWEmax, 5.03 for SWEratio, and 2.15% for SMIVI. In AUROC, the combined scores showed significantly better diagnostic performance compared to BI-RADS alone (p < 0.001). The combined score showed significantly increased than BI-RADS alone in specificity (p < 0.001) and accuracy (p < 0.001), but a sensitivity decreased without significance (p = 0.082). When a combined score cutoff value of 4 was used, the false negative rate was 2.7%. Using the combined score, 76.4% of the C4a lesions were considered benign also pathologically diagnosed as benign. The combined scores showed improved diagnostic performance in differentiating between benign and malignant breast masses, which could be helpful for determining a breast biopsy eligibility.
Collapse
|
14
|
Wilson A, Lim A. Microvascular imaging: new Doppler technology for assessing focal liver lesions. Is it useful? Clin Radiol 2022; 77:e807-e820. [DOI: 10.1016/j.crad.2022.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 05/08/2022] [Accepted: 05/11/2022] [Indexed: 11/09/2022]
|
15
|
The Benefit of Superb Microvascular Imaging and Shear Wave Elastography in Differentiating Metastatic Axillary Lymphadenopathy from Lymphadenitis. Clin Breast Cancer 2022; 22:515-520. [DOI: 10.1016/j.clbc.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/11/2022] [Accepted: 03/09/2022] [Indexed: 11/20/2022]
|
16
|
USLU H, TOSUN M, ALPARSLAN B, ÇAKIR Ö, ÇAM İ. Meme Kitlelerinin Vaskülaritesini Değerlendirmede Süperb Mikrovasküler Görüntülemenin Faydaları: Renkli ve Power Doppler Görüntüleme ile Tanısal Performans Karşılaştırması. KOCAELI ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2022. [DOI: 10.30934/kusbed.986984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
17
|
Hong MJ, Ahn HS, Ha SM, Park HJ, Oh J. Quantitative analysis of vascularity for thyroid nodules on ultrasound using superb microvascular imaging: Can nodular vascularity differentiate between malignant and benign thyroid nodules? Medicine (Baltimore) 2022; 101:e28725. [PMID: 35119020 PMCID: PMC8812680 DOI: 10.1097/md.0000000000028725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 01/11/2022] [Indexed: 01/04/2023] Open
Abstract
This study aimed to investigate the utility of adding superb microvascular imaging (SMI) to B-mode ultrasound (US) for distinguishing between benign and malignant thyroid nodules and evaluate the usefulness of SMI quantification of nodular vascularity for diagnosing thyroid cancer.The malignancy likelihood was scored for 3 datasets before versus after additional color Doppler imaging or SMI using 4-scale visual analysis (i.e., B-mode US alone, B-mode US + color Doppler image, and B-mode US + SMI). Further, the SMI pixel count was measured in the region of interest, including the whole nodule, on the longitudinal view. It was compared between benign and malignant nodules and analyzed according to the US patterns of thyroid nodules based on the Korean thyroid imaging reporting and data system. We calculated the area under the receiver operating characteristic curve values, sensitivities, and specificities.There was no significant difference in the area under the receiver operating characteristic curve values among B-mode, B-mode + color Doppler, and B-mode + SMI. However, the SMI pixel count was significantly higher in malignant thyroid nodules than in benign ones. The optimal cut-off value for the SMI pixel count for predicting malignant thyroid nodules obtained using a receiver operating characteristic curve was 17 (40.54% in sensitivity, 91.3% in specificity). Analysis based on the US pattern of thyroid nodules revealed significant differences in the nodules with low-to-intermediate suspicious US features between malignant and benign nodules.Quantification analysis of vascularity using SMI can differentiate malignant thyroid nodules from benign ones.
Collapse
Affiliation(s)
- Min Ji Hong
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Hye Shin Ahn
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Su Min Ha
- Department of Radiology, Seoul National University Hospital, Seoul University College of Medicine, Seoul, Republic of Korea
| | - Hyun Jeong Park
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Jiyun Oh
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
18
|
Zehui FMD, Siqi WMD, Jian ZMD, Yejun LMD, Xiaomin MMD, Ye HMD, Chong WMD, Hui CMD. Diagnostic Performance of Superb Microvascular Imaging for Breast Masses: A Systematic Review and Meta-analysis. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2022. [DOI: 10.37015/audt.2022.210028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
|
19
|
Samanci C, Ozkose B, Ustabasioglu FE, Erol BC, Sirolu S, Yılmaz F, Ozkose ZG, Yılmaz H, Kara SC, Kicik Caliskan R, Gulsen F. The Diagnostic Value of Superb Microvascular Imaging in Prediction of Uterine Artery Embolization Treatment Response in Uterine Leiomyomas. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:2607-2615. [PMID: 33599335 DOI: 10.1002/jum.15647] [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: 06/18/2020] [Revised: 12/17/2020] [Accepted: 01/09/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES We aimed to determine if superb microvascular imaging (SMI) can predict response to uterine artery embolization (UAE) as compared with power Doppler ultrasound. METHODS The blood flow and the volume of the dominant leiomyoma was evaluated by power Doppler ultrasonography (PDUS) and SMI 1 day before and 3 months after the UAE procedure. SMI and PDUS blood flow were classified to 4 grades of vascularity. The change in fibroid volume in Grades 0-2 (hypovascular group) was compared to the hypervascular Grade 3 group. RESULTS Twenty-eight women (mean age, 40.9 years; range, 33-53 years) were examined with PDUS and SMI before and 3 months after UAE. The volume reduction was statistically significantly higher hypervascular group (P < .05). When we accept 30% or more volume reduction as a good response to UAE, the positive predictive value, negative predictive value, sensitivity, specificity, and accuracy of SMI were 100, 64, 73.6, 100, and 82.1%, respectively. There was excellent agreement between the two blinded observers in SMI measurements. CONCLUSIONS SMI, with its high reproducibility, provides further microvessel information than PDUS in uterine fibroids. It may be a useful tool in prediction of response to UAE treatment and improve counseling and patient selection for UAE versus medical or surgical treatment options.
Collapse
Affiliation(s)
- Cesur Samanci
- Cerrahpasa Medical Faculty, Radiology Department, Istanbul University, Istanbul, Turkey
| | - Burak Ozkose
- Obstetrics and Gynecology Department, Yeni Yüzyıl University Gaziosmanpaşa Hospital, Istanbul, Turkey
| | | | - Burak Caglar Erol
- Cerrahpasa Medical Faculty, Radiology Department, Istanbul University, Istanbul, Turkey
| | - Sabri Sirolu
- Cerrahpasa Medical Faculty, Radiology Department, Istanbul University, Istanbul, Turkey
| | - Fatma Yılmaz
- Radiology Department, Haydarpaşa Sultan Abdülhamidhan Training and Research Hospital, Istanbul, Turkey
| | - Zeynep Gedik Ozkose
- Obstetrics and Gynecology Department, Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - Hatice Yılmaz
- Obstetrics and Gynecology Department, Istanbul Kagithane State Hospital, Istanbul, Turkey
| | - Sahra Cavuşoğlu Kara
- Obstetrics and Gynecology Department, Kartal Dr. Lütfi Kırdar Training and Research Hospital, Istanbul, Turkey
| | - Raziye Kicik Caliskan
- Obstetrics and Gynecology Department, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Fatih Gulsen
- Cerrahpasa Medical Faculty, Radiology Department, Istanbul University, Istanbul, Turkey
| |
Collapse
|
20
|
Bartolotta TV, Orlando AAM, Schillaci MI, Spatafora L, Marco MD, Matranga D, Firenze A, Cirino A, Ienzi R. Ultrasonographic Detection of Vascularity of Focal Breast Lesions: Microvascular Imaging Versus Conventional Color and Power Doppler Imaging. ULTRASONIC IMAGING 2021; 43:273-281. [PMID: 34236008 DOI: 10.1177/01617346211029542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
To compare microvascular flow imaging (MVFI) to conventional Color-Doppler (CDI) and Power-Doppler (PDI) imaging in the detection of vascularity of Focal Breast Lesions (FBLs). A total of 180 solid FBLs (size: 3.5-45.2 mm) detected in 180 women (age: 21-87 years) were evaluated by means of CDI, PDI, and MVFI. Two blinded reviewers categorized lesion vascularity in absent or present, and vascularity pattern as (a) internal; (b) vessels in rim; (c) combined. The presence of a "penetrating vessel" was assessed separately. Differences in vascularization patterns (chi2 test) and intra- and inter-observer agreement (Fleiss method) were calculated. ROC analysis was performed to assess performance of each technique in differentiating benign from malignant lesions. About 103/180 (57.2%) FBLs were benign and 77/180 (42.8%) were malignant. A statistically significant (p < .001) increase in blood flow detection was observed for both readers with MVFI in comparison to either CDI or PDI. Benign FBLs showed mainly absence of vascularity (p = .02 and p = .01 for each reader, respectively), rim pattern (p < .001 for both readers) or combined pattern (p = .01 and p = .04). Malignant lesions showed a statistically significant higher prevalence of internal flow pattern (p < .001 for both readers). The prevalence of penetrating vessels was significantly higher with MVFI in comparison to either CDI or PDI (p < .001 for both readers) and in the malignant FBLs (p < .001). ROC analysis showed MVFI (AUC = 0.70, 95%CI = [0.64-0.77]) more accurate than CDI (AUC = 0.67, 95%CI = [0.60-0.74]) and PDI (AUC = 0.67, 95%CI = [0.60-0.74]) though not significantly (p = .5436). Sensitivity/Specificity values for MVFI, PDI, and CDI were 76.6%/64.1%, 59.7%/73.8% and 58.4%/74.8%, respectively. Inter-reader agreement with MVFI was always very good (k-score 0.85-0.96), whereas with CDI and PDI evaluation ranged from good to very good. No differences in intra-observer agreement were noted. MVFI showed a statistically significant increase in the detection of the vascularization of FBLs in comparison to Color and Power-Doppler.
Collapse
Affiliation(s)
- Tommaso Vincenzo Bartolotta
- Department of Biomedicine, Neuroscience and Advanced Diagnostic (Bi.N.D.), University Hospital Policlinico P. Giaccone, Palermo, Italy
- Fondazione Istituto G.Giglio di Cefalù, Contrada Pietrapollastra, Cefalù, Italy
| | - Alessia Angela Maria Orlando
- Department of Biomedicine, Neuroscience and Advanced Diagnostic (Bi.N.D.), University Hospital Policlinico P. Giaccone, Palermo, Italy
| | - Maria Ilenia Schillaci
- Department of Biomedicine, Neuroscience and Advanced Diagnostic (Bi.N.D.), University Hospital Policlinico P. Giaccone, Palermo, Italy
| | - Luigi Spatafora
- Department of Biomedicine, Neuroscience and Advanced Diagnostic (Bi.N.D.), University Hospital Policlinico P. Giaccone, Palermo, Italy
| | - Mariangela Di Marco
- Department of Biomedicine, Neuroscience and Advanced Diagnostic (Bi.N.D.), University Hospital Policlinico P. Giaccone, Palermo, Italy
| | - Domenica Matranga
- ProMISE Department (Department of Health Promotion and Mother and Child Care, Internal Medicine and Medical Specialties), University Hospital Policlinico P. Giaccone, Palermo, Italy
| | - Alberto Firenze
- ProMISE Department (Department of Health Promotion and Mother and Child Care, Internal Medicine and Medical Specialties), University Hospital Policlinico P. Giaccone, Palermo, Italy
| | - Alessandra Cirino
- Department of Biomedicine, Neuroscience and Advanced Diagnostic (Bi.N.D.), University Hospital Policlinico P. Giaccone, Palermo, Italy
| | - Raffaele Ienzi
- Department of Biomedicine, Neuroscience and Advanced Diagnostic (Bi.N.D.), University Hospital Policlinico P. Giaccone, Palermo, Italy
| |
Collapse
|
21
|
Bian J, Zhang J, Hou X. Diagnostic accuracy of ultrasound shear wave elastography combined with superb microvascular imaging for breast tumors: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e26262. [PMID: 34160389 PMCID: PMC8238364 DOI: 10.1097/md.0000000000026262] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 05/24/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Shear wave elastography (SWE) is a new ultrasonic elastography technique for evaluating the hardness of living tissue by measuring the propagation velocity of shear wave in tissue, which is characterized by real-time, non-invasive and quantitative. The SWE technique can be used to diagnose the lesions of different tissues and organs, and the quantitative measurement of SWE is considered as more objective information about breast masses. Superb microvascular imaging (SMI) is a new noninvasive Doppler ultrasound imaging method, which can display blood flow information with high spatial resolution and high frame rate, while keeping the minimum low-speed blood flow components. Therefore, SMI can diagnose diseases closely related to angiogenesis at a relatively early stage. However, the results of these studies have been contradictory. The present meta-analysis aimed at determining the accuracy of SWE combined with SMI in the differential diagnosis between benign and malignant breast lesions. METHODS We will search PubMed, Web of Science, Cochrane Library, and Chinese biomedical databases from their inceptions to the April 18, 2021, without language restrictions. Two authors will independently carry out searching literature records, scanning titles and abstracts, full texts, collecting data, and assessing risk of bias. Review Manager 5.2 and Stata14. 0 software will be used for data analysis. RESULTS This systematic review will determine the accuracy of shear wave elastography combined with superb microvascular imaging in the differential diagnosis between benign and malignant breast tumors. CONCLUSION Its findings will provide helpful evidence for the accuracy of shear wave elastography combined with superb microvascular imaging in the differential diagnosis between benign and malignant breast tumors. SYSTEMATIC REVIEW REGISTRATION INPLASY202150075.
Collapse
Affiliation(s)
- Jinyi Bian
- The First Affiliated Hospital of Dalian Medical University
| | - Jili Zhang
- The First Affiliated Hospital of Dalian Medical University
| | - Xiukun Hou
- Ultrasound department of the First Affiliated Hospital of Dalian Medical University, Dalian, China
| |
Collapse
|
22
|
Chae EY, Yoon GY, Cha JH, Shin HJ, Choi WJ, Kim HH. Added Value of the Vascular Index on Superb Microvascular Imaging for the Evaluation of Breast Masses: Comparison With Grayscale Ultrasound. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:715-723. [PMID: 32815564 DOI: 10.1002/jum.15441] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/01/2020] [Accepted: 07/06/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To evaluate the value of the vascular index (VI) on Superb Microvascular Imaging (SMI; Canon Medical Systems Corporation, Tokyo, Japan) in comparison with grayscale ultrasound (US) alone for assessing breast masses. METHODS We evaluated a total of 70 breast masses (36 malignant and 34 benign lesions) in 70 consecutive patients using grayscale US and SMI. Two breast radiologists analyzed grayscale US alone and the combination of grayscale US and SMI. They also measured the VI based on SMI. The diagnostic performance of grayscale US alone and the combination of grayscale US and SMI was compared. The VI was compared between benign and malignant masses, and the optimal cutoff value was determined. In addition, the interobserver agreement in imaging analyses and the VI was assessed. RESULTS The interobserver agreements in imaging analyses and the VI were almost perfect. The VI of malignant breast masses was significantly higher than that of benign lesions (P < .001). The optimal cutoff value of the VI for differentiating between malignant and benign breast masses was 2.95, with sensitivity of 86.1% and specificity of 91.2%. The diagnostic performance values of grayscale US alone and the combination of grayscale US and SMI were 0.824 and 0.912, respectively, for reader 1 (P = .028) and 0.795 and 0.853 for reader 2 (P = .101). CONCLUSIONS The VI on SMI was significantly higher for malignant breast masses than for benign lesions, with high interobserver agreement. Our study suggests that the combination of grayscale US and SMI with the VI could improve the characterization of breast masses.
Collapse
Affiliation(s)
- Eun Young Chae
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ga Young Yoon
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Joo Hee Cha
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hee Jung Shin
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Woo Jung Choi
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hak Hee Kim
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| |
Collapse
|
23
|
Nas OF, Kandemirli SG, Erdemli Gursel B, Bilgin C, Korkmaz B, Yolgosteren A, Inecikli MF. Diagnostic utility of superb microvascular imaging in depiction of corkscrew collaterals in Buerger's disease. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:129-134. [PMID: 32557645 DOI: 10.1002/jcu.22880] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/07/2020] [Accepted: 05/27/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE To evaluate the corkscrew collaterals in Buerger's disease by superb microvascular imaging (SMI) and power Doppler ultrasonography (PDU). METHODS We evaluated with SMI and PDU 14 patients with Buerger's disease in whom corkscrew collaterals had been identified on digital subtraction angiography (DSA). Corkscrew collaterals were classified on DSA and PDU based on their size and morphology. RESULTS A total of 17 vascular regions of collateral vessel formation were assessed. Based on DSA classification, there were three cases of type I collaterals (arterial diameter of >2 mm with large helical pattern), seven cases of type III collaterals (arterial diameter of 1-1.5 mm with small helical pattern), and seven cases of type IV collaterals (arterial diameter of <1 mm with tiny helical pattern). On PDU, all type I collaterals on DSA appeared as "large snake" images, all type III collaterals on DSA appeared as "small snake" images, and all type IV collaterals on DSA appeared as dots. SMI imaging, both in color and monochrome mode, provided superior demonstration of the continuity of the vessel of large or small "snake" images. In cases appearing as dot pattern on PDU, color SMI was able to show continuity of the flow signal as a helical pattern. DISCUSSION SMI is a promising new Doppler imaging technique that is superior to conventional power Doppler imaging in depiction and identification of corkscrew collaterals in Buerger's disease.
Collapse
Affiliation(s)
- Omer Fatih Nas
- Faculty of Medicine, Department of Radiology, Uludag University, Bursa, Turkey
| | - Sedat Giray Kandemirli
- Faculty of Medicine, Department of Radiology, Uludag University, Bursa, Turkey
- Department of Radiology, University of Iowa Hospital and Clinics, Iowa City, IA, USA
| | | | - Cem Bilgin
- Faculty of Medicine, Department of Radiology, Uludag University, Bursa, Turkey
| | - Baris Korkmaz
- Faculty of Medicine, Department of Radiology, Uludag University, Bursa, Turkey
| | - Atif Yolgosteren
- Faculty of Medicine, Department of Cardiovascular Surgery, Uludag University, Bursa, Turkey
| | | |
Collapse
|
24
|
Park AY, Seo BK, Han MR. Breast Ultrasound Microvascular Imaging and Radiogenomics. Korean J Radiol 2021; 22:677-687. [PMID: 33569931 PMCID: PMC8076833 DOI: 10.3348/kjr.2020.1166] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/13/2020] [Accepted: 12/10/2020] [Indexed: 02/07/2023] Open
Abstract
Microvascular ultrasound (US) techniques are advanced Doppler techniques that provide high sensitivity and spatial resolution for detailed visualization of low-flow vessels. Microvascular US imaging can be applied to breast lesion evaluation with or without US contrast agents. Microvascular US imaging without a contrast agent uses a sophisticated wall filtering system to selectively obtain low-flow Doppler signals from overlapped artifacts. Microvascular US imaging with second-generation contrast agents amplifies flow signals and makes them last longer, which facilitates hemodynamic evaluation of breast lesions. In this review article, we will introduce various microvascular US techniques, explain their clinical applications in breast cancer diagnosis and radiologic-histopathologic correlation, and provide a summary of a recent radiogenomic study using microvascular US.
Collapse
Affiliation(s)
- Ah Young Park
- Department of Radiology, Bundang CHA Medical Center, CHA University, Seongnam, Korea
| | - Bo Kyoung Seo
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea.
| | - Mi Ryung Han
- Division of Life Sciences, College of Life Sciences and Bioengineering, Incheon National University, Incheon, Korea
| |
Collapse
|
25
|
Lee EJ, Chang YW. Combination of Quantitative Parameters of Shear Wave Elastography and Superb Microvascular Imaging to Evaluate Breast Masses. Korean J Radiol 2020; 21:1045-1054. [PMID: 32691540 PMCID: PMC7371619 DOI: 10.3348/kjr.2019.0765] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 04/09/2020] [Accepted: 04/15/2020] [Indexed: 12/18/2022] Open
Abstract
Objective This study aimed to evaluate the diagnostic value of combining the quantitative parameters of shear wave elastography (SWE) and superb microvascular imaging (SMI) to breast ultrasound (US) to differentiate between benign and malignant breast masses. Materials and Methods A total of 200 pathologically confirmed breast lesions in 192 patients were retrospectively reviewed using breast US with B-mode imaging, SWE, and SMI. Breast masses were assessed based on the breast imaging reporting and data system (BI-RADS) and quantitative parameters using the maximum elasticity (Emax) and ratio (Eratio) in SWE and the vascular index in SMI (SMIVI). The area under the receiver operating characteristic curve (AUC) value, sensitivity, specificity, accuracy, negative predictive value, and positive predictive value of B-mode alone versus the combination of B-mode US with SWE or SMI of both parameters in differentiating between benign and malignant breast masses was compared, respectively. Hypothetical performances of selective downgrading of BI-RADS category 4a (set 1) and both upgrading of category 3 and downgrading of category 4a (set 2) were calculated. Results Emax with a cutoff value of 86.45 kPa had the highest AUC value compared to Eratio of 3.57 or SMIVI of 3.35%. In set 1, the combination of B-mode with Emax or SMIVI had a significantly higher AUC value (0.829 and 0.778, respectively) than B-mode alone (0.719) (p < 0.001 and p = 0.047, respectively). B-mode US with the addition of Emax, Eratio, and SMIVI had the best diagnostic performance of AUC value (0.849). The accuracy and specificity increased significantly from 68.0% to 84.0% (p < 0.001) and from 46.1% to 79.1% (p < 0.001), respectively, and the sensitivity decreased from 97.6% to 90.6% without statistical loss (p = 0.199). Conclusion Combining all quantitative values of SWE and SMI with B-mode US improved the diagnostic performance in differentiating between benign and malignant breast lesions.
Collapse
Affiliation(s)
- Eun Ji Lee
- Department of Radiology, Soonchunhyang University Hospital Seoul, Seoul, Korea
| | - Yun Woo Chang
- Department of Radiology, Soonchunhyang University Hospital Seoul, Seoul, Korea.
| |
Collapse
|
26
|
Lee EJ, Chang YW, Oh E, Hwang J, Kim HJ, Hong SS. Reproducibility and diagnostic performance of the vascular index of superb microvascular imaging in real-time breast ultrasonography for evaluating breast masses. Ultrasonography 2020; 40:398-406. [PMID: 33455154 PMCID: PMC8217793 DOI: 10.14366/usg.20153] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 11/27/2020] [Indexed: 11/12/2022] Open
Abstract
Purpose This study aimed to evaluate the reproducibility and diagnostic performance of a quantitative parameter of superb microvascular imaging (SMI) in real-time breast ultrasonography (US) for differentiating benign from malignant breast masses. Methods Eighty-seven breast masses in 75 patients who underwent both B-mode US and SMI before US-guided core needle biopsy were included in this study. Two radiologists performed B-mode US and measured the vascular index (VI) of SMI respectively for each lesion in real time. Intraobserver and interobserver agreements were analyzed for the VI of SMI. The diagnostic performance of B-mode US using the Breast Imaging Reporting and Database System lexicon and combined use with the VI of SMI was evaluated compared to pathology. Results The median VI of malignant masses (n=32) was significantly higher than that of benign masses (n=55) (7.6% and 2.6%, respectively; P<0.001). The intraobserver agreement for VI was excellent regardless of the pathology, size, or depth of the lesion. The interobserver agreement for VI was excellent regardless of the presence of a measurement interval. The interobserver agreement for the final diagnostic decision was improved by combining B-mode US and VI (κ=0.883) in comparison with B-mode US only (κ=0.617). Adding VI led to significant improvements in the specificity (87.2% vs. 52.7%, 83.6% vs. 49.0%), accuracy (89.7% vs. 69.3%, 84.0% vs. 65.9%) and positive predictive value (81.5% vs. 55.1%, 75.6% vs. 52.6%) of B-mode US for both observers compared with B-mode US alone (all, P=0.001). Conclusion The VI of SMI for real-time breast US is highly reproducible and leads to improved diagnostic performance for differentiating between benign and malignant breast lesions in combination with B-mode US.
Collapse
Affiliation(s)
- Eun Ji Lee
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Yun-Woo Chang
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Eunsun Oh
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Jiyoung Hwang
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Hyun-Joo Kim
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Seong Sook Hong
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| |
Collapse
|
27
|
Lee S, Lee JY, Yoon RG, Kim JH, Hong HS. The Value of Microvascular Imaging for Triaging Indeterminate Cervical Lymph Nodes in Patients with Papillary Thyroid Carcinoma. Cancers (Basel) 2020; 12:cancers12102839. [PMID: 33019664 PMCID: PMC7601686 DOI: 10.3390/cancers12102839] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 09/27/2020] [Accepted: 09/30/2020] [Indexed: 12/11/2022] Open
Abstract
Simple Summary Papillary thyroid carcinomas (PTC) are indolent tumors associated with excellent long-term survival, albeit frequently accompanied by cervical lymph node (LN) metastasis. The imaging criteria using conventional ultrasound (US) techniques showed high diagnostic performance for the suspicious and probably benign LN categories, but showed low diagnostic performance for the indeterminate category. In this retrospective study, we aimed to assess the added value of Superb Microvascular Imaging (SMI) for detecting metastatic PTC in the indeterminate LN category. We confirmed that SMI could effectively stratify indeterminate LNs by visualizing additional vascular signals. The reclassified categories of SMI provided a high diagnostic performance to distinguish metastasis from benign LNs. Therefore, adding SMI to conventional US scans can be useful when evaluating indeterminate LNs in patients with PTC. Abstract Assessment of lymph node (LN) status in patients with papillary thyroid carcinoma (PTC) is often troublesome because of cervical LNs with indeterminate US (ultrasound) features. We aimed to explore whether Superb Microvascular Imaging (SMI) could be helpful for distinguishing metastasis from indeterminate LNs when combined with power Doppler US (PDUS). From 353 consecutive patients with PTC, LNs characterized as indeterminate by PDUS were evaluated by SMI to distinguish them from metastasis. Indeterminate LNs were reclassified according to the SMI, the malignancy risk of each category was assessed, and the diagnostic performance of suspicious findings on SMI was calculated. The incidence of US-indeterminate LNs was 26.9%. Eighty PDUS-indeterminate LNs (39 proven as benign, 41 proven as malignant) were reclassified into probably benign (n = 26), indeterminate (n = 20), and suspicious (n = 34) categories according to SMI, with malignancy risks of 19.2%, 20.0%, and 94.1%, respectively. After combining SMI with PDUS, 80.8% (21/26) of probably benign LNs and 94.1% (32/34) of suspicious LNs could be correctly diagnosed as benign and metastatic, respectively. The diagnostic sensitivity, specificity, and accuracy of categorizing LNs as suspicious based on SMI were 78.1%, 94.9%, and 86.3%, respectively. In conclusion, the combination of SMI with PDUS was helpful for the accurate stratification of indeterminate LNs based on US in patients with PTC.
Collapse
Affiliation(s)
- Seongyong Lee
- Department of Radiology, Eulji Medical Center, Eulji University College of Medicine, Seoul 01830, Korea; (S.L.); (R.G.Y.)
| | - Ji Ye Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea;
- Correspondence: ; Tel.: 82-2-2072-3696
| | - Ra Gyoung Yoon
- Department of Radiology, Eulji Medical Center, Eulji University College of Medicine, Seoul 01830, Korea; (S.L.); (R.G.Y.)
| | - Ji-hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea;
| | - Hyun Sook Hong
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon 14584, Korea;
| |
Collapse
|
28
|
Zhao L, Mao Y, Mu J, Zhao J, Li F, Zhang S, Xin X. The diagnostic value of Superb Microvascular Imaging in identifying benign tumors of parotid gland. BMC Med Imaging 2020; 20:107. [PMID: 32938423 PMCID: PMC7493138 DOI: 10.1186/s12880-020-00506-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 09/01/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We compared the ultrasound features, superb microvascular imaging (SMI) and micro vessel density (MVD) of pleomorphic adenoma (PA), Warthin's tumor (WT) and basal cell adenoma (BCA) to explore the clinic value of SMI in differential diagnosis of benign tumors of parotid gland. METHODS The vascular distributions and grade by color doppler flow imaging (CDFI) and SMI, as well as vascular index (VI) of 249 parotid gland masses from 217 patients were analyzed. RESULTS The internal echogenicity of BCA are more homogeneous in comparing with WT and PA(P < 0.05). By SMI, the vascular distribution and vascular grade in PA were mainly peripheral (33.1%) and avascular (25.7%), Grade 1 (27.8%) and Grade 0 (25.7%). WT were mainly central (31.3%) and mixed distribution (34.9%), in Grade 3 (37.3%) and Grade 2 (36.2%). BCA was mainly peripheral (33.3%) and mixed distribution (33.3%), in Grade 2 (33.3%) and Grade 3 (33.3%). The overall detection rate of SMI for vascular Grade 2 and 3 was significantly higher than that of CDFI (P < 0.05). Both VI and MVD were lowest in PA, highest in WT (P < 0.001). The VI by SMI was correlated with MVD (P < 0.001). The correlation index between vascular distribution and grade by SMI and MVD were significantly higher than CDFI. CONCLUSION SMI can provide low-velocity blood flow information, which is helpful for the differential diagnosis of common benign tumors of parotid gland, and is expected to be more widely used.
Collapse
Affiliation(s)
- Lihui Zhao
- Department of Ultrasound, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer, China; Key Laboratory of Cancer Prevention and Therapy, Tianjin;Tianjin's Clinical Research Center for Cancer, Binshuixi Road, Hexi District, Tianjin, 300060, China
| | - Yiran Mao
- Department of Ultrasound, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer, China; Key Laboratory of Cancer Prevention and Therapy, Tianjin;Tianjin's Clinical Research Center for Cancer, Binshuixi Road, Hexi District, Tianjin, 300060, China
| | - Jie Mu
- Department of Ultrasound, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer, China; Key Laboratory of Cancer Prevention and Therapy, Tianjin;Tianjin's Clinical Research Center for Cancer, Binshuixi Road, Hexi District, Tianjin, 300060, China
| | - Jing Zhao
- Department of Ultrasound, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer, China; Key Laboratory of Cancer Prevention and Therapy, Tianjin;Tianjin's Clinical Research Center for Cancer, Binshuixi Road, Hexi District, Tianjin, 300060, China
| | - Fangxuan Li
- Department of Cancer Prevention, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Sheng Zhang
- Department of Ultrasound, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer, China; Key Laboratory of Cancer Prevention and Therapy, Tianjin;Tianjin's Clinical Research Center for Cancer, Binshuixi Road, Hexi District, Tianjin, 300060, China.
| | - Xiaojie Xin
- Department of Ultrasound, Tianjin Medical University Cancer Institute and Hospital; National Clinical Research Center for Cancer, China; Key Laboratory of Cancer Prevention and Therapy, Tianjin;Tianjin's Clinical Research Center for Cancer, Binshuixi Road, Hexi District, Tianjin, 300060, China
| |
Collapse
|
29
|
Abstract
Screening for breast cancer reduces breast cancer-related mortality and earlier detection facilitates less aggressive treatment. Unfortunately, current screening modalities are imperfect, suffering from limited sensitivity and high false-positive rates. Novel techniques in the field of breast imaging may soon play a role in breast cancer screening: digital breast tomosynthesis, contrast material-enhanced spectral mammography, US (automated three-dimensional breast US, transmission tomography, elastography, optoacoustic imaging), MRI (abbreviated and ultrafast, diffusion-weighted imaging), and molecular breast imaging. Artificial intelligence and radiomics have the potential to further improve screening strategies. Furthermore, nonimaging-based screening tests such as liquid biopsy and breathing tests may transform the screening landscape. © RSNA, 2020 Online supplemental material is available for this article.
Collapse
Affiliation(s)
- Ritse M Mann
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Geert Grooteplein 10, PO Box 9101, 6500 HB, Nijmegen, the Netherlands (R.M.M.); Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands (R.M.M.); Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (R.H.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Southwoods Imaging, Youngstown, Ohio (R.G.B.); Department of Radiology, New York University Langone School of Medicine, New York, NY (L.M.); and Department of Radiology, New York University Grossman School of Medicine, Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.)
| | - Regina Hooley
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Geert Grooteplein 10, PO Box 9101, 6500 HB, Nijmegen, the Netherlands (R.M.M.); Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands (R.M.M.); Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (R.H.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Southwoods Imaging, Youngstown, Ohio (R.G.B.); Department of Radiology, New York University Langone School of Medicine, New York, NY (L.M.); and Department of Radiology, New York University Grossman School of Medicine, Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.)
| | - Richard G Barr
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Geert Grooteplein 10, PO Box 9101, 6500 HB, Nijmegen, the Netherlands (R.M.M.); Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands (R.M.M.); Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (R.H.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Southwoods Imaging, Youngstown, Ohio (R.G.B.); Department of Radiology, New York University Langone School of Medicine, New York, NY (L.M.); and Department of Radiology, New York University Grossman School of Medicine, Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.)
| | - Linda Moy
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Geert Grooteplein 10, PO Box 9101, 6500 HB, Nijmegen, the Netherlands (R.M.M.); Department of Radiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands (R.M.M.); Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (R.H.); Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio (R.G.B.); Southwoods Imaging, Youngstown, Ohio (R.G.B.); Department of Radiology, New York University Langone School of Medicine, New York, NY (L.M.); and Department of Radiology, New York University Grossman School of Medicine, Center for Advanced Imaging Innovation and Research, Laura and Isaac Perlmutter Cancer Center, New York, NY (L.M.)
| |
Collapse
|
30
|
Kloth C, Kratzer W, Schmidberger J, Beer M, Clevert DA, Graeter T. Ultrasound 2020 - Diagnostics & Therapy: On the Way to Multimodal Ultrasound: Contrast-Enhanced Ultrasound (CEUS), Microvascular Doppler Techniques, Fusion Imaging, Sonoelastography, Interventional Sonography. ROFO-FORTSCHR RONTG 2020; 193:23-32. [PMID: 32731265 DOI: 10.1055/a-1217-7400] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Ultrasound as a non-ionizing imaging procedure is one of the most important diagnostic procedures in everyday clinical practice. The technology is widely used. Due to constant technical innovations, sonographic procedures, such as contrast-enhanced ultrasound (CEUS), sonoelastography, new microvascular Doppler modalities and, as an example of interventional procedures, sonographically controlled microwave ablation (MWA), are becoming increasingly important in diagnostic imaging and interventional medicine alongside CT and MRI. However, this also requires greater expertise, specialization and qualification on the part of users. METHOD This review article provides information about the range of technical innovations in ultrasound in recent years and describes the underlying technology, the clinical applications, and their diagnostic value. These are presented in the context of the current literature, explaining their advantages and disadvantages and their clinical value. RESULTS AND CONCLUSION Contrast-enhanced ultrasound (CEUS), microvascular Doppler modalities, fusion imaging and elastography complement B-scan ultrasound and conventional Doppler procedures for various problems. Microwave ablation (MWA) has a firm place as an ablative procedure for local tumor therapy in different organ systems and can be performed under ultrasound guidance. Thanks to new developments, the possibilities of ultrasound are now greater than ever. Knowledge of the technology, indications, and possible applications of newer procedures is essential for adequate patient care. KEY POINTS · Contrast-enhanced ultrasound (CEUS) allows an increase in sensitivity and specificity in the assessment of parenchymal lesions.. · CEUS allows the microperfusion to be visualized and quantified. For larger vessels, CEUS is an important instrument in diagnosing endoleak after stenting.. · Microvascular Doppler techniques with clutter suppression algorithms allow a more accurate representation of the smallest vessels than regular color or power Doppler.. · Elastography of the liver in diffuse hepatopathies is a noninvasive diagnostic tool to exclude higher grade fibrosis/cirrhosis.. · Microwave ablation (MWA) also offers sonographically controlled ablation of tumors.. CITATION FORMAT · Kloth C, Kratzer W, Schmidberger J et al. Ultrasound 2020 - Diagnostics & Therapy: On the Way to Multimodal Ultrasound: Contrast-Enhanced Ultrasound (CEUS), Microvascular Doppler Techniques, Fusion Imaging, Sonoelastography, Interventional Sonography . Fortschr Röntgenstr 2021; 193: 23 - 32.
Collapse
Affiliation(s)
- Christopher Kloth
- Department of Interventional and Diagnostic Radiology, University Hospital Ulm, Germany
| | - Wolfgang Kratzer
- Department of Internal Medicine I, University Hospital Ulm, Germany
| | | | - Meinrad Beer
- Department of Interventional and Diagnostic Radiology, University Hospital Ulm, Germany
| | - Dirk Andre Clevert
- Department of Clinical Radiology, University Hospital Munich Campus Großhadern, München, Germany
| | - Tilmann Graeter
- Department of Interventional and Diagnostic Radiology, University Hospital Ulm, Germany
| |
Collapse
|
31
|
Guazzaroni M, Ferrari D, Lamacchia F, Marisi V, Tatulli D, Marsico S, Orlacchio A, Floris R, Bianchi L, Dattola A. Shear wave elastography and microvascular ultrasound in response evaluation to calcipotriol+betamethasone foam in plaque psoriasis. Postgrad Med J 2020; 97:16-22. [PMID: 32646970 DOI: 10.1136/postgradmedj-2020-138150] [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: 05/12/2020] [Revised: 06/10/2020] [Accepted: 06/13/2020] [Indexed: 11/03/2022]
Abstract
Psoriasis (PsO) is a chronic skin disease. This study aims to evaluate clinical and subclinical response to calcipotriol+betamethasone foam, in patients with PsO, comparing, for the first time, data from microvascular ultrasound (MicroV) and shear wave elastography (SWE) with Psoriasis Area and Severity Index (PASI). METHODS Between November 2018 and April 2019 in Tor Vergata Hospital (Roma, Italy), we enrolled 26 patients with PsO who were ageds 20-75 years, with PASI score ≥4, candidated for calcipotriol+betamethasone foam treatment. They underwent MicroV and SWE evaluation at baseline (T0) and after 4 weeks of treatment (T4). Clinical follow-up was carried on at T4, T8 and T12. Student's t-test (p values<0.05 statistically significant) was used to compare SWE and PASI values. RESULTS At T0, SWE stiffness values of target plaques (61.5% on elbows, 23% knees, 7.7% sacrum,7.7% legs) were significantly higher than values under healthy skin. At T4, all patients showed a significant reduction of PASI; MicroV showed reduction in vascularisation of responsive plaques in 85% of cases, only in 15%, the vascularisation degree remained stable; and SWE values of target plaques were significantly lower compared with T0. Only in 7.7%, there was a relapse at T12. CONCLUSIONS Calcipotriol+betamethasone foam is a very effective topical treatment in a short-medium term follow-up in patients with PsO. MicroV and SWE evaluate response to treatment (in term of plaque vascularisation and stiffness), so they could represent promising early indicators of therapeutic response and help the physician to establish a better clinical-therapeutic management of patients with PsO.
Collapse
Affiliation(s)
- Manlio Guazzaroni
- Department of Surgical Science, University of Rome Tor Vergata, Roma, Italy
| | - Donatella Ferrari
- Department of Biomedicine and Prevention, UOC of Diagnostic Imaging, University of Rome Tor Vergata, Roma, Italy
| | - Feliciana Lamacchia
- Department of Biomedicine and Prevention, UOC of Diagnostic Imaging, University of Rome Tor Vergata, Roma, Italy
| | - Vanessa Marisi
- Department of Dermatology, University of Rome Tor Vergata, Roma, Italy
| | - Doriana Tatulli
- Department of Biomedicine and Prevention, UOC of Diagnostic Imaging, University of Rome Tor Vergata, Roma, Italy
| | - Salvatore Marsico
- Department of Biomedicine and Prevention, UOC of Diagnostic Imaging, University of Rome Tor Vergata, Roma, Italy
| | - Antonio Orlacchio
- Department of Surgical Science, University of Rome Tor Vergata, Roma, Italy
| | - Roberto Floris
- Department of Biomedicine and Prevention, UOC of Diagnostic Imaging, University of Rome Tor Vergata, Roma, Italy
| | - Luca Bianchi
- Department of Dermatology, University of Rome Tor Vergata, Roma, Italy
| | | |
Collapse
|
32
|
Zhao L, Mu J, Mao Y, Xin X. Diagnostic Value of Superb Microvascular Imaging in Parotid Tumors. Med Sci Monit 2020; 26:e921813. [PMID: 32507848 PMCID: PMC7297036 DOI: 10.12659/msm.921813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background The aim of this study was to evaluate the clinical diagnostic value of superb microvascular imaging (SMI) in assessing vascular distribution, vascularity, and vessel morphology of parotid tumors (PTs). Material/Methods PT patients confirmed by postoperative histopathological detection and who underwent color Doppler flow imaging (CDFI), microvascular imaging (MVI), and SMI examination were recruited. PTs were classified into 3 groups: pleomorphic adenoma (PA), Warthin tumor (WT), and malignant PT (MT). The tumor vascular distribution, vascularity, and vessel morphology recorded by CDFI, MVI, and SMI were compared among PA, WT, and MT group. PT diagnosis was performed using histopathological detection. Fisher’s exact test was used to compare the diagnostic sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and accuracy between SMI and MVI examination in PTs. Results We enrolled 198 PTs consisting of 114 PAs, 56 WTs, and 28 MTs into our study. CDFI examination found no significant differences in vascular distribution and vascularity among the PA, WT, and WT groups. SMI examination found significant differences in vascular distribution and vascularity among the 3 groups. MVI found significant differences in vessel morphology, including uneven distribution of blood flow, arborization, and irregular blood flow among the PA, WT, and MT groups. SMI found significant differences in arborization and irregular blood flow, but none of the differences in uneven distribution of blood flow among the 3 groups were significant. The diagnostic sensitivity, specificity, and accuracy of SMI and MVI in PTs showed no significant differences. Conclusions SMI more accurately evaluated the vascular distribution and vascularity of PTs than CDFI. SMI might be a potential non-invasive diagnostic method for PTs in clinical practice.
Collapse
Affiliation(s)
- Lihui Zhao
- Department of Ultrasound Diagnosis and Treatment, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China (mainland).,Tianjin's Clinical Research Center for Cancer, Tianjin Medical University, Tianjin, China (mainland)
| | - Jie Mu
- Department of Ultrasound Diagnosis and Treatment, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China (mainland).,Tianjin's Clinical Research Center for Cancer, Tianjin Medical University, Tianjin, China (mainland)
| | - Yiran Mao
- Department of Ultrasound Diagnosis and Treatment, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China (mainland).,Tianjin's Clinical Research Center for Cancer, Tianjin Medical University, Tianjin, China (mainland)
| | - Xiaojie Xin
- Department of Ultrasound Diagnosis and Treatment, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China (mainland).,Tianjin's Clinical Research Center for Cancer, Tianjin Medical University, Tianjin, China (mainland)
| |
Collapse
|
33
|
Liang M, Ou B, Wu J, Xiao X, Ruan J, Tian J, Xu X, Wang B, Yang H, Luo B. Combined use of strain elastography and superb microvascular imaging with grayscale ultrasound according to the BI-RADS classification for differentiating benign from malignant solid breast masses. Clin Hemorheol Microcirc 2020; 74:391-403. [PMID: 31683470 DOI: 10.3233/ch-190693] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Affiliation(s)
- Ming Liang
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Bing Ou
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jiayi Wu
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoyun Xiao
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jingliang Ruan
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jing Tian
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaolin Xu
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Bin Wang
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Haiyun Yang
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Baoming Luo
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
34
|
Bayramoglu Z, Kandemirli SG, Akyol Sarı ZN, Kardelen AD, Poyrazoglu S, Bas F, Darendeliler F, Adaletli I. Superb Microvascular Imaging in the Evaluation of Pediatric Graves Disease and Hashimoto Thyroiditis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:901-909. [PMID: 31705696 DOI: 10.1002/jum.15171] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 10/07/2019] [Accepted: 10/13/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES We aimed to investigate the differences between spectral Doppler and Superb Microvascular Imaging (SMI; Canon Medical Systems, Tokyo, Japan) findings in children with Hashimoto thyroiditis (HT) and Graves disease (GD) compared to healthy control participants. METHODS The study included 34 patients with GD, 37 patients with HT, and 22 healthy volunteers. All patients with HT and 11 patients with GD were euthyroid; 23 patients with GD had symptoms of hyperthyroidism and had thyrotropin values of less than 0.5 mIU/L. Thyroid volumes, mean resistive indices, and peak systolic velocities along with vascularity indices (VIs) on Superb Microvascular Imaging were measured. RESULTS Patients with GD had a significantly higher mean thyroid volume (P < .001; right lobe, 11.80 mL; left lobe, 9.10 mL) and peak systolic velocity (right, 32.5 cm/s; left, 30 cm/s) with a lower resistive index (right, 0.48%; left, 0.48%) compared to patients with HT (right, 8.78 mL, 20 cm/s, 0.55%; left, 7.41 mL, 20 cm/s, 0.55%, respectively) and also control participants (right, 4.59 mL, 15 cm/s, 0.56%; left, 3.52 mL, 15 cm/s, 0.54%). Patients with GD had a significantly higher median VI (right, 25%; left, 26%) compared to patients with HT (right, 11%; left, 13%) and control participants (right, 8%; left, 8%). When patients with GD were categorized as euthyroid and hyperthyroid based on thyrotropin levels and clinical symptoms, both euthyroid and hyperthyroid patients with GD had significantly higher thyroid volumes compared to patients with HT (P < .001). Hyperthyroid patients with GD had higher thyroid volumes compared to euthyroid patients with GD; however, the difference failed to reach statistical significance. A significant strong positive correlation with the VI and thyrotropin receptor autoantibody levels (r = 0.696) was found. The highest area under the curve was obtained for the right lobe VI (0.885), followed by the left lobe VI (0.872), right lobe volume (0.828), and peak systolic velocity (0.810). The optimal cutoff VI value for distinguishing between HT and GD was 17.35% with sensitivity, specificity, and diagnostic accuracy of 85.3%, 78.4%, and 81.7%, respectively. CONCLUSIONS Superb Microvascular Imaging is a new method that can detect subtle vascularity changes with higher accuracy compared to spectral Doppler parameters in distinguishing between HT and GD.
Collapse
Affiliation(s)
- Zuhal Bayramoglu
- Departments of Radiology, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| | | | - Zeynep Nur Akyol Sarı
- Departments of Radiology, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| | - Aslı Derya Kardelen
- Pediatric Endocrinology, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| | - Sukran Poyrazoglu
- Pediatric Endocrinology, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| | - Firdevs Bas
- Pediatric Endocrinology, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| | - Feyza Darendeliler
- Pediatric Endocrinology, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| | - Ibrahim Adaletli
- Department of Radiology, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey
| |
Collapse
|
35
|
Son MJ, Kim S, Jung HK, Ko KH, Koh JE, Park AY. Can Ultrasonographic Vascular and Elastographic Features of Invasive Ductal Breast Carcinoma Predict Histologic Aggressiveness? Acad Radiol 2020; 27:487-496. [PMID: 31300357 DOI: 10.1016/j.acra.2019.06.009] [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: 04/19/2019] [Revised: 06/07/2019] [Accepted: 06/15/2019] [Indexed: 01/15/2023]
Abstract
RATIONALE AND OBJECTIVES To investigate if preoperative ultrasonographic vascular and shear-wave elastographic examinations can predict histologic aggressiveness. MATERIALS AND METHODS Preoperative ultrasonographic vascular features and shear-wave elasticities were retrospectively evaluated for 147 invasive ductal carcinomas. Vascular feature was assessed using four-tier vascularity score. Mean and maximum elasticities (Emean and Emax), and the lesion-to-fat ratio (Eratio) were documented. Histologic parameters were reviewed for tumor size, multiplicity, axillary lymph node status, lymphovascular invasion, histologic grade, estrogen receptor, progesterone receptor, human epidermal growth factor receptor2 (HER2), Ki-67, p53, and histologic subtype. Vascularity score and elasticities were correlated with histologic parameters and histologic parameters were compared between the group with low vascularity score and elasticities and the group with high vascularity score and elasticities using ANOVA, chi-squared test, and regression analysis. RESULTS Vascularity score was independently associated with tumor size (p = 0.010) and HER2 (p = 0.007). Emean and Emax were associated with tumor size, histologic grade, and lymphovascular invasion, and Eratio was associated with tumor size, histologic grade, estrogen receptor, progesterone receptor, Ki-67, and histologic subtype (p < 0.05). Emean and Emax were independently associated with tumor size (p < 0.001). The group with high vascularity score and Eratio showed large tumor size (p < 0.001) and HER2 positivity (p = 0.039) in comparison to the group with low vascularity score and Eratio. CONCLUSION Ultrasonographic vascular features were associated with tumor size and HER2. SWE elasticities were associated with tumor size, histologic grade, hormonal receptor, and histologic subtype. Therefore, preoperative vascular and elastographic examinations could predict histologic aggressiveness of invasive ductal breast carcinoma.
Collapse
|
36
|
Park AY, Kwon M, Woo OH, Cho KR, Park EK, Cha SH, Song SE, Lee JH, Cha J, Son GS, Seo BK. A Prospective Study on the Value of Ultrasound Microflow Assessment to Distinguish Malignant from Benign Solid Breast Masses: Association between Ultrasound Parameters and Histologic Microvessel Densities. Korean J Radiol 2020; 20:759-772. [PMID: 30993927 PMCID: PMC6470080 DOI: 10.3348/kjr.2018.0515] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 12/22/2018] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To investigate the value of ultrasound (US) microflow assessment in distinguishing malignant from benign solid breast masses as well as the association between US parameters and histologic microvessel density (MVD). MATERIALS AND METHODS Ninety-eight breast masses (57 benign and 41 malignant) were examined using Superb Microvascular Imaging (SMI) and contrast-enhanced US (CEUS) before biopsy. Two radiologists evaluated the quantitative and qualitative vascular parameters on SMI (vascular index, morphology, distribution, and penetration) and CEUS (time-intensity curve analysis and enhancement characteristics). US parameters were compared between benign and malignant masses and the diagnostic performance was compared between SMI and CEUS. Subgroup analysis was performed according to lesion size. The effect of vascular parameters on downgrading Breast Imaging Reporting and Data System (BI-RADS) category 4A masses was evaluated. The association between histologic MVD and US parameters was analyzed. RESULTS Malignant masses were associated with a higher vascular index (15.1 ± 7.3 vs. 5.9 ± 5.6), complex vessel morphology (82.9% vs. 42.1%), central vascularity (95.1% vs. 59.6%), penetrating vessels (80.5% vs. 31.6%) on SMI (all, p < 0.001), as well as higher peak intensity (37.1 ± 25.7 vs. 17.0 ± 15.8, p < 0.001), slope (10.6 ± 11.2 vs. 3.9 ± 4.2, p = 0.001), area (1035.7 ± 726.9 vs. 458.2 ± 410.2, p < 0.001), hyperenhancement (95.1% vs. 70.2%, p = 0.005), centripetal enhancement (70.7% vs. 45.6%, p = 0.023), penetrating vessels (65.9% vs. 22.8%, p < 0.001), and perfusion defects (31.7% vs. 3.5%, p < 0.001) on CEUS (p ≤ 0.023). The areas under the receiver operating characteristic curve (AUCs) of SMI and CEUS were 0.853 and 0.841, respectively (p = 0.803). In 19 masses measuring < 10 mm, central vascularity on SMI was associated with malignancy (100% vs. 38.5%, p = 0.018). Considering all benign SMI parameters on the BI-RADS assessment, unnecessary biopsies could be avoided in 12 category 4A masses with improved AUCs (0.500 vs. 0.605, p < 0.001). US vascular parameters associated with malignancy showed higher MVD (p ≤ 0.016). MVD was higher in malignant masses than in benign masses, and malignant masses negative for estrogen receptor or positive for Ki67 had higher MVD (p < 0.05). CONCLUSION US microflow assessment using SMI and CEUS is valuable in distinguishing malignant from benign solid breast masses, and US vascular parameters are associated with histologic MVD.
Collapse
Affiliation(s)
- Ah Young Park
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea.,Department of Radiology, Bundang CHA Medical Center, CHA University, Seongnam, Korea
| | - Myoungae Kwon
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Ok Hee Woo
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Kyu Ran Cho
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Eun Kyung Park
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Sang Hoon Cha
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Sung Eun Song
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Ju Han Lee
- Department of Pathology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - JaeHyung Cha
- Medical Science Research Center, Korea University Ansan Hospital, Ansan, Korea
| | - Gil Soo Son
- Division of Breast Endocrine Surgery, Department of General Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Bo Kyoung Seo
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea.
| |
Collapse
|
37
|
Zhu YC, Shan J, Zhang Y, Jiang Q, Wang YB, Deng SH, Qu QH, Li Q. Prostate Cancer Vascularity: Superb Microvascular Imaging Ultrasonography with Histopathology Correlation. Med Sci Monit 2019; 25:8571-8578. [PMID: 31723116 PMCID: PMC6873636 DOI: 10.12659/msm.918318] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background The aim of this study was to evaluate the association between prostate cancer (PCa) vascularity detected by superb microvascular imaging (SMI) and Gleason score in biopsy specimens. Material/Methods A total of 119 patients with suspected PCa before biopsy underwent gray-scale ultrasound (US), color Doppler ultrasound (CDUS), and SMI imaging between June 2018 and March 2019. Vascularity quantity was assessed by SMI and compared with that of CDUS. The vessel parameter was also compared with the Gleason score. The sensitivity of PCa was compared between transrectal ultrasound guided systematic biopsy (SB) and SMI-guided targeted biopsy (SMI-guided TB). Results Pathology confirmed 74 of 119 patients had PCa. The microvascular quantity of PCa patients was significantly higher than that of non-malignant patients. SMI detected blood vessels in 97.3% (72/74) in the malignant group, while CDUS identified blood flow signals in 90.5% (67/74) of the PCa group. SMI visualized enriched microvascular in PCa of Gleason 8 (54.5%) and Gleason 9 (92.3%). There was a positive correlation between microvascular quantity detected by SMI and Gleason score, with a correlation coefficient of 0.373 (P<0.001). SMI-guided TB cores were significantly more likely than SB cores to detect PCa (OR=12.83, P<0.001). Conclusions SMI could be promising as a useful imaging technique in the detection and characterization of PCa. There was a positive correlation between microvascular quantity detected by SMI and Gleason score.
Collapse
Affiliation(s)
- Yi-Cheng Zhu
- Department of Ultrasound, Pudong New Area Peoples' Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China (mainland)
| | - Jun Shan
- Department of Ultrasound, Pudong New Area Peoples' Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China (mainland)
| | - Yuan Zhang
- Department of Ultrasound, Pudong New Area Peoples' Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China (mainland)
| | - Quan Jiang
- Department of Ultrasound, Pudong New Area Peoples' Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China (mainland)
| | - Yong-Bing Wang
- Department of General Surgery, Pudong New Area Peoples' Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China (mainland)
| | - Shu-Hao Deng
- Department of Ultrasound, Pudong New Area Peoples' Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China (mainland)
| | - Qing-Hua Qu
- Department of Urology, Pudong New Area Peoples' Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China (mainland)
| | - Qing Li
- Department of Pathology, Pudong New Area Peoples' Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China (mainland)
| |
Collapse
|
38
|
Jiang ZZ, Huang YH, Shen HL, Liu XT. Clinical Applications of Superb Microvascular Imaging in the Liver, Breast, Thyroid, Skeletal Muscle, and Carotid Plaques. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:2811-2820. [PMID: 30953387 DOI: 10.1002/jum.15008] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 02/21/2019] [Accepted: 02/25/2019] [Indexed: 06/09/2023]
Abstract
This article reviews the clinical applications of Superb Microvascular Imaging (SMI; Canon Medical Systems, Otawara, Japan) in the liver, breast, thyroid, skeletal muscle, and carotid plaques. Diseases that are closely associated with angiogenesis can be diagnosed by SMI in a relatively early phase, and using SMI can prevent adverse reactions associated with the contrast agents used in contrast-enhanced ultrasound. Super Microvascular Imaging also shows particular value in grading disease activities and monitoring therapeutic responses. Although SMI has some limitations, such as a lack of clinical standards, it can add information to conventional ultrasound examinations and may become a noninvasive alternative to invasive diagnostic procedures for many clinical conditions.
Collapse
Affiliation(s)
- Zhen-Zhen Jiang
- Department of Ultrasound, Shaoxing People's Hospital, Shaoxing Hospital, Zhejiang University School of Medicine, Shaoxing, China
| | - Yan-Hua Huang
- Department of Ultrasound, Shaoxing People's Hospital, Shaoxing Hospital, Zhejiang University School of Medicine, Shaoxing, China
| | - Hua-Liang Shen
- Department of Ultrasound, Shaoxing People's Hospital, Shaoxing Hospital, Zhejiang University School of Medicine, Shaoxing, China
| | - Xia-Tian Liu
- Department of Ultrasound, Shaoxing People's Hospital, Shaoxing Hospital, Zhejiang University School of Medicine, Shaoxing, China
| |
Collapse
|
39
|
Sim JK, Lee JY, Hong HS. Differentiation Between Malignant and Benign Lymph Nodes: Role of Superb Microvascular Imaging in the Evaluation of Cervical Lymph Nodes. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:3025-3036. [PMID: 30945325 DOI: 10.1002/jum.15010] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 02/21/2019] [Accepted: 03/10/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES This study aimed to assess the value of Superb Microvascular Imaging (SMI; Canon Medical Systems, Otawara, Japan) for distinguishing between benign and malignant cervical lymph nodes (LNs) and to compare SMI with power Doppler ultrasound (PDUS). METHODS Power Doppler ultrasound and SMI examinations were performed for patients' cervical LNs. The distribution of feeding vessels, number, and appearance of internal vessels were analyzed by 2 readers, and the results of PDUS and SMI were compared. Interobserver agreement was assessed. A subgroup analysis was performed to assess differences in vascular patterns between metastasis and tuberculous lymphadenitis and between Kikuchi disease and lymphoma. The diagnostic performance for distinguishing between benign and malignant LNs was calculated. RESULTS In total, 147 patients with 147 cervical LNs (85 benign and 62 malignant) were assessed. Interobserver agreement was moderate to strong for SMI. There were significant differences in the vascular patterns between benign and malignant LNs on SMI (distribution, number, and appearance, all P < .001), but not on PDUS. In the subgroup analysis, SMI showed a significant difference in the vascular patterns observed between metastasis and tuberculous lymphadenitis (distribution, P = .012; number, P = .014; and appearance, P = .005). Superb Microvascular Imaging detected significantly greater numbers of vessels in lymphoma than in Kikuchi disease (P = .012). The sensitivity of SMI was significantly greater than that of PDUS in distinguishing malignant from benign LNs (86.9% versus 54.1%; P < .001). CONCLUSIONS Superb Microvascular Imaging yields more detailed information about nodal vessels than does PDUS by enabling visualization of small nodal vessels. Superb Microvascular Imaging is useful and feasible for differentiating between malignant and benign cervical LNs.
Collapse
Affiliation(s)
- Joo Kyung Sim
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Ji Ye Lee
- Department of Radiology, Eulji Medical Center, Eulji University College of Medicine, Seoul, Korea
| | - Hyun Sook Hong
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| |
Collapse
|
40
|
Jabak S, Vigneswaran TV, Charakida M, Kasapoglu T, de Jesus Cruz J, Simpson JM, Zidere V. Initial Experience of Superb Microvascular Imaging for Key Cardiac Views in Foetal Assessment before 15 Weeks Gestation. Fetal Diagn Ther 2019; 47:268-276. [PMID: 31597155 DOI: 10.1159/000502839] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 08/21/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND In the first trimester, ultrasound confirmation of normal or abnormal cardiac anatomy is difficult. B-mode and colour flow Doppler (CFD) are used to assess the foetal heart. Superb microvascular imaging (SMI) can visualise blood flow within the heart and vessels in early gestation. OBJECTIVE We report an initial experience of SMI for visualisation of normal and abnormal cardiac anatomy in the first trimester. METHODS Transabdominal foetal echocardiography was performed between 11 + 6 and 14 + 3 weeks (Aplio 500 US system, Toshiba Medical Systems, Tokyo, Japan) from January 2017 to December 2017. All scans were performed at a tertiary foetal cardiology unit. To assess the potential utility of the technique for early gestation screening, normal scans were reviewed by foetal medicine trainees with respect to the B-mode, CFD and SMI. Three key views were selected to compare modalities: the 4-chamber view, outflow tracts and the 3-vessel and trachea view (VTV). Visualisation rates of key echocardiographic features of significant cardiac abnormalities by SMI were reviewed. RESULTS Fifty-five normal echocardiograms and 34 cardiac abnormalities were included. In the normal heart, when B-mode, CFD and SMI were assessed separately, SMI had the highest rate of visualisation of 4-chamber, outflow tracts and 3-VTV (93, 85 and 83%, respectively). Intra-observer reliability was moderate for SMI of the 3 standard views (kappa 1, 0.64 and 0.64); inter-observer for 4-chamber and outflow tract views was moderate (kappa 0.64 and 0.77). In 29/34 abnormal cases, SMI showed key features, enhancing greyscale visualisation. CONCLUSION SMI has potential to become a useful, complementary modality for early foetal echocardiography. Further prospective studies are warranted to establish the place of the technique in assessment of the first trimester foetal heart.
Collapse
Affiliation(s)
- Salma Jabak
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, United Kingdom
| | - Trisha V Vigneswaran
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, United Kingdom.,Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St. Thomas' Hospitals, London, United Kingdom
| | - Marietta Charakida
- School of Biomedical Engineering and Imaging Sciences, Kings College London, NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Taner Kasapoglu
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, United Kingdom
| | | | - John M Simpson
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, United Kingdom.,Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St. Thomas' Hospitals, London, United Kingdom
| | - Vita Zidere
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, United Kingdom, .,Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St. Thomas' Hospitals, London, United Kingdom,
| |
Collapse
|
41
|
Mack LM, Mastrobattista JM, Gandhi R, Castro EC, Burgess APH, Lee W. Characterization of Placental Microvasculature Using Superb Microvascular Imaging. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:2485-2491. [PMID: 30620078 DOI: 10.1002/jum.14919] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 11/16/2018] [Accepted: 11/29/2018] [Indexed: 06/09/2023]
Abstract
Superb Microvascular Imaging (SMI; Canon Medical Systems, Tustin, CA) uses clutter suppression to extract flow signals at rapid frame rates, which provides high-resolution vessel-branching details without the need for contrast agents. The potential diagnostic benefits of SMI, as described in other areas of medicine, requires further exploration during pregnancy. In this pictorial essay, we demonstrate the complementary use of SMI compared to conventional Doppler ultrasound and how it may improve our ability to characterize placental microvascular patterns without the need for ultrasound contrast agents.
Collapse
Affiliation(s)
- Lauren M Mack
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Joan M Mastrobattista
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Rajshi Gandhi
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Eumenia C Castro
- Department of Anatomic Pathology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Angela P H Burgess
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Wesley Lee
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| |
Collapse
|
42
|
Zhu YC, Zhang Y, Deng SH, Jiang Q, Shi XR, Feng LL. Evaluation of plasma cell mastitis with superb microvascular imaging. Clin Hemorheol Microcirc 2019; 72:129-138. [PMID: 30636730 DOI: 10.3233/ch-180468] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Affiliation(s)
- Yi-Cheng Zhu
- Department of Ultrasound, Pudong New Area People’s Hospital affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Yuan Zhang
- Department of Ultrasound, Pudong New Area People’s Hospital affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Shu-Hao Deng
- Department of Ultrasound, Pudong New Area People’s Hospital affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Quan Jiang
- Department of Ultrasound, Pudong New Area People’s Hospital affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Xiu-Rong Shi
- Department of Ultrasound, Pudong New Area People’s Hospital affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Ling-Ling Feng
- Department of Gynaecology & Obstetrics, Pudong New Area People’s Hospital affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China
| |
Collapse
|
43
|
A comparative study on superb microvascular imaging and conventional ultrasonography in differentiating BI-RADS 4 breast lesions. Oncol Lett 2019; 18:3202-3210. [PMID: 31452797 PMCID: PMC6676576 DOI: 10.3892/ol.2019.10603] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 06/11/2019] [Indexed: 11/06/2022] Open
Abstract
This prospective study aimed to explore the diagnostic value of superb microvascular imaging (SMI) in differentiating Breast Imaging Reporting and Data System (BI-RADS) 4 breast lesions compared with conventional ultrasonography (US). A total of 111 patients with 116 breast lesions underwent grayscale ultrasound (US), colour Doppler flow imaging (CDFI) and SMI breast imaging between February 2016 and May 2018. CDFI and SMI were performed to evaluate vascular quantity, morphology, and distribution characteristics. The detection of malignancy was compared between grayscale US alone, US + CDFI and US + SMI in terms of the BI-RADS stratification system. SMI was observed to be significantly more accurate in distinguishing malignant breast lesions (86.67%) compared with CDFI (80.00%) (P<0.001). Among malignant lesions, SMI detected 80.00% of those that contained ≥4 vessels, while CDFI only detected 56.67%. Penetrating and branching vessels were identified by SMI in 53.33% of malignant breast lesions and by CDFI in 10.00%. There was no significant difference in vascular distribution by SMI (P=0.094) and by CDFI (P=0.087). US + SMI was associated with higher sensitivity, specificity, and accuracy rates (86.67, 83.72 and 84.48%, respectively) compared with US + CDFI (80.00, 72.09 and 74.14%, respectively). The area under the curve values from receiver operating characteristic analysis of US + SMI, US + CDFI and US alone were 0.852 [95% confidence interval (CI): 0.768–0.936)] 0.760 (95% CI: 0.660–0.860), 0.698 (95% CI: 0.589–0.807), respectively (P<0.001). SMI yielded more detailed vascular information associated with malignant breast masses when compared with conventional US. Therefore, as an adjunct to grayscale, SMI exhibited a markedly improved diagnostic capability in distinguishing malignant and benign breast lesions, particularly those of BI-RADS category 4.
Collapse
|
44
|
Adaletli I, Bayramoglu Z, Caliskan E, Yilmaz R, Akyol Sari ZN, Bas F, Kardelen AD, Poyrazoglu S, Darendeliler F. Multi-parametric Ultrasound Evaluation of Pediatric Thyroid Dyshormonogenesis. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:1644-1653. [PMID: 31031038 DOI: 10.1016/j.ultrasmedbio.2019.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 02/01/2019] [Accepted: 03/05/2019] [Indexed: 06/09/2023]
Abstract
The aim of this study was to assess the diagnostic contribution of gray-scale ultrasonography, color Doppler, superb microvascular imaging and shear wave elastography in thyroid dyshormonogenesis (TD). From October 2017 to February 2018, the prospective study included 31 patients (13.6 y; 11-14 y) diagnosed with TD based on thyroid scintigraphy and perchlorate discharge tests and 40 healthy pediatric volunteers (12.8 y; 10-16 y). Median resistive indices (RIs), peak systolic and end-diastolic velocities, vascularity indices (VIs) via superb microvascular imaging and shear wave elastography parameters were evaluated. Median VI values were significantly higher and median RI values were significantly lower in the study group than the control group. No significant difference was found between shear wave elastography parameters of the TD and control group. VI was significantly correlated with median total thyroid gland volumes (p = 0.002, r = 0.28), medication dosage (p = 0.03, r = 0.48) and 2-h radioactive iodine uptake values (p = 0.008, r = 0.57). VI is a clinically significant and novel parameter useful for diagnosing TD.
Collapse
Affiliation(s)
- Ibrahim Adaletli
- Istanbul Medical Faculty, Radiology Department, Istanbul University, Istanbul, Turkey
| | - Zuhal Bayramoglu
- Istanbul Medical Faculty, Radiology Department, Istanbul University, Istanbul, Turkey.
| | - Emine Caliskan
- Radiology Department, Seyhan State Hospital, Adana, Turkey
| | - Ravza Yilmaz
- Istanbul Medical Faculty, Radiology Department, Istanbul University, Istanbul, Turkey
| | - Zeynep Nur Akyol Sari
- Istanbul Medical Faculty, Radiology Department, Istanbul University, Istanbul, Turkey
| | - Firdevs Bas
- Istanbul Medical Faculty, Pediatric Endocrinology Department, Istanbul University, Istanbul, Turkey
| | - Aslı Derya Kardelen
- Istanbul Medical Faculty, Pediatric Endocrinology Department, Istanbul University, Istanbul, Turkey
| | - Sukran Poyrazoglu
- Istanbul Medical Faculty, Pediatric Endocrinology Department, Istanbul University, Istanbul, Turkey
| | - Feyza Darendeliler
- Istanbul Medical Faculty, Pediatric Endocrinology Department, Istanbul University, Istanbul, Turkey
| |
Collapse
|
45
|
Zhang XY, Zhang L, Li N, Zhu QL, Li JC, Sun Q, Wang HY, Jiang YX. Vascular index measured by smart 3-D superb microvascular imaging can help to differentiate malignant and benign breast lesion. Cancer Manag Res 2019; 11:5481-5487. [PMID: 31354354 PMCID: PMC6580120 DOI: 10.2147/cmar.s203376] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 05/14/2019] [Indexed: 12/12/2022] Open
Abstract
Purpose: The purpose of our study was to prospectively evaluate the diagnostic performance of the vascular index (VI, defined as the ratio of Doppler signal pixels to pixels in the total lesion) measured via Smart 3-D superb microvascular imaging (SMI) for breast lesions. Patients and methods: Two hundred and thirty-two consecutive patients with 236 breast lesions referred for biopsy at Peking Union Medical College Hospital were enrolled in the study from December 2016 to November 2017. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of VI were calculated with histopathologic results as the reference standard. Results: Of the 236 breast lesions, 121 were malignant and 115 were benign. The mean VI was significantly higher in malignant lesions (9.7±8.2) than that in benign ones (3.4±3.3) (P<0.0001). Sensitivity, specificity, PPV, NPV and accuracy of VI (4.0 as the threshold) were respectively: 76.0%, 66.1%, 70.2%, 72.4% and 71.2% (P<0.05). Conclusion: Smart three-dimensional (3-D) SMI is a noninvasive tool using two-dimensional (2-D) scanning to generate 3-D vascular architecture with a high-resolution image of micro-vessels. This can be used as a qualitative guide to identify the optimal 2-D SMI plane with the most abundant vasculature to guide VI quantitative measurements of breast lesions. Smart 3-D SMI may potentially serve as a noninvasive tool to accurately characterize benign versus malignant breast lesions.
Collapse
Affiliation(s)
- Xiao-Yan Zhang
- Department of Diagnostic Ultrasound, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, People's Republic of China
| | - Li Zhang
- Department of Diagnostic Ultrasound, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, People's Republic of China
| | - Na Li
- Department of Diagnostic Ultrasound, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, People's Republic of China
| | - Qing-Li Zhu
- Department of Diagnostic Ultrasound, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, People's Republic of China
| | - Jian-Chu Li
- Department of Diagnostic Ultrasound, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, People's Republic of China
| | - Qiang Sun
- Department of Breast Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, People's Republic of China
| | - Hong-Yan Wang
- Department of Diagnostic Ultrasound, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, People's Republic of China
| | - Yu-Xin Jiang
- Department of Diagnostic Ultrasound, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, People's Republic of China
| |
Collapse
|
46
|
Bayramoglu Z, Kandemirli SG, Caliskan E, Yilmaz R, Kardelen AD, Poyrazoglu S, Bas F, Adaletli I, Darendeliler F. Assessment of paediatric Hashimoto's thyroiditis using superb microvascular imaging. Clin Radiol 2018; 73:1059.e9-1059.e15. [PMID: 30139503 DOI: 10.1016/j.crad.2018.07.099] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 07/09/2018] [Indexed: 01/21/2023]
Abstract
AIM To evaluate the role of superb microvascular imaging along with greyscale and Doppler imaging for thyroid gland evaluation in Hashimoto's thyroiditis (HT) versus control subjects. MATERIALS AND METHODS The study included 33 healthy volunteers with normal ultrasound and laboratory findings and 70 patients with HT based on laboratory and sonographic findings who were undergoing follow-up and receiving medical treatment. HT patients were classified based on the modification of the scheme proposed by Sostre and Reyes that incorporates the extent of hypoechoic foci or patchy infiltration as grade A (foci involving <50% of the gland) and B (foci involving >50% of the gland). Thyroid volume, mean resistive indices, peak-systolic and end-diastolic velocities based on Doppler imaging, and vascularity index via superb microvascular imaging were obtained using a Canon Aplio 500 ultrasound device using a linear 10-14 MHz transducer. RESULTS Patients with HT had significantly higher median thyroid volume and peak-systolic velocities (7.32 ml and 19 cm/s, respectively) compared to control subjects (4.62 ml and 16 cm/s, respectively). HT patients had significantly higher median vascularity index (VI; 13.5%) compared to control subjects (7.95%). A significant fair positive correlation with VI and anti-thyroglobulin antibody levels (r=0.356, p<0.05) and significant moderate positive correlation with VI and anti-thyroid peroxidase antibody levels (r=0.503, p<0.05) were found. In HT diagnosis, the optimal VI cut-off value was 10.58% with a sensitivity and specificity of 67.1% and 90%, respectively. CONCLUSION Superb microvascular imaging appears to allow assessment of subtle vascularity changes in early HT stages that cannot be detected by Doppler parameters. This technique demonstrates excellent visualization of the microvascular structures and quantitative assessment based on a novel parameter such as VI.
Collapse
Affiliation(s)
- Z Bayramoglu
- Department of Radiology, Istanbul Medical Faculty, Istanbul University, Fatih Istanbul, Turkey.
| | - S G Kandemirli
- Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Fatih Istanbul, Turkey
| | - E Caliskan
- Department of Radiology, Istanbul Medical Faculty, Istanbul University, Fatih Istanbul, Turkey
| | - R Yilmaz
- Department of Radiology, Istanbul Medical Faculty, Istanbul University, Fatih Istanbul, Turkey
| | - A D Kardelen
- Department of Pediatric Endocrinology, Istanbul Medical Faculty, Istanbul University, Fatih Istanbul, Turkey
| | - S Poyrazoglu
- Department of Pediatric Endocrinology, Istanbul Medical Faculty, Istanbul University, Fatih Istanbul, Turkey
| | - F Bas
- Department of Pediatric Endocrinology, Istanbul Medical Faculty, Istanbul University, Fatih Istanbul, Turkey
| | - I Adaletli
- Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Fatih Istanbul, Turkey
| | - F Darendeliler
- Department of Pediatric Endocrinology, Istanbul Medical Faculty, Istanbul University, Fatih Istanbul, Turkey
| |
Collapse
|