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Noebauer-Huhmann IM, Vanhoenacker FM, Vilanova JC, Lalam RK, Bloem JL. Reply to Letter to the Editor: "Soft tissue tumor imaging in adults: European Society of Musculoskeletal Radiology-Guidelines 2023-overview, and primary local imaging: how and where?". Eur Radiol 2024:10.1007/s00330-024-10879-1. [PMID: 38995376 DOI: 10.1007/s00330-024-10879-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 03/28/2024] [Accepted: 04/10/2024] [Indexed: 07/13/2024]
Affiliation(s)
- Iris-Melanie Noebauer-Huhmann
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Vienna, Austria.
| | - Filip M Vanhoenacker
- Department of Radiology AZ Sint Maarten Mechelen, University Hospital Antwerp, Antwerp, Belgium
- Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
| | - Joan C Vilanova
- Department of Radiology, Clínica Girona, Institute of Diagnostic Imaging (IDI) Girona, University of Girona, Girona, Spain
| | - Radhesh K Lalam
- Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK
| | - Johan L Bloem
- Department of Radiology, LUMC, Leiden, The Netherlands
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Middleton WD, Jacobson JA, Dahiya N. Letter to the Editor: "Soft tissue tumor imaging in adults: European Society of Musculoskeletal Radiology-Guidelines 2023-overview, and primary local imaging: how and where?". Eur Radiol 2024:10.1007/s00330-024-10878-2. [PMID: 38995377 DOI: 10.1007/s00330-024-10878-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 02/29/2024] [Accepted: 04/10/2024] [Indexed: 07/13/2024]
Affiliation(s)
- William Dana Middleton
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO, USA.
| | - Jon A Jacobson
- Lenox Hill Radiology, University of California, San Diego, CA, USA
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Gülmez AO, Çetin T, Aydın S, Binay UD. Ultrasound and ultrasound shear-wave elastography evaluation of ulceroglandular type of tularemia. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024. [PMID: 38887811 DOI: 10.1002/jcu.23745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/09/2024] [Accepted: 04/24/2024] [Indexed: 06/20/2024]
Abstract
INTRODUCTION Ultrasound (US) has an important place in imaging ulceroglandular type patients with tularemia. This study is a case series addressing the imaging findings of US and US shear-wave elastography in ulceroglandular type tularemia. DESCRIPTION Three patients, two women, and one man, were included in our case series. The patients were admitted to our hospital with neck swelling, pain, and a palpable mass. After the diagnosis of tularemia was made as a result of the examinations performed on the patients, they were evaluated again with US and US shear-wave elastography. DISCUSSION Since there are many diagnoses including ulceroglandular tularemia in the differential diagnosis of swelling, pain, and palpable mass in the neck, the patient must undergo a thorough evaluation process. US shear-wave elastography can provide significant benefits in identification and treatment follow-up in order to understand the ulceroglandular mass formation observed in the neck in tularemia and the stiffness and morphology of the tissues in the lymph nodes where involvement is observed and to distinguish them from the surrounding tissue.
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Affiliation(s)
- Ali Osman Gülmez
- School of Medicine, Department of Radiology, Erzincan University, Erzincan, Turkey
| | - Türkhun Çetin
- School of Medicine, Department of Radiology, Erzincan University, Erzincan, Turkey
| | - Sonay Aydın
- School of Medicine, Department of Radiology, Erzincan University, Erzincan, Turkey
| | - Umut Devrim Binay
- School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Erzincan University, Erzincan, Turkey
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Asif MA, Zahid AS, Naseer A, Khan MUU, Bhatti Z, Khan MWW, Nizami MFK, Shehzad K, Younas UA, Ahmad H, Mehmood Qadri H, Bilal S. Structured Reporting of Superficial Soft Tissue Masses on Ultrasonography: A Closed-Loop Clinical Audit From a Tertiary Care Hospital in Pakistan. Cureus 2024; 16:e61884. [PMID: 38975542 PMCID: PMC11227745 DOI: 10.7759/cureus.61884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2024] [Indexed: 07/09/2024] Open
Abstract
Background Among all the modalities of diagnostic radiology, ultrasonography is considered the least invasive one. However, this benefit usually comes at the cost of its subjective evaluation since it is purely a dynamic diagnostic modality. Thus, instead of ultrasonography, most clinicians usually rely on the report written by the radiologist. Objective The objective of this study is to evaluate the clinical practices of ultrasound reporting of superficial soft tissue masses. Materials and methods A closed-loop retrospective and prospective study was conducted at the Department of Radiology and Medical Imaging, Jinnah Hospital, Lahore between December 2023 and March 2024. In the pre-intervention phase, a randomly collected sample of 100 ultrasound reports documenting superficial soft tissue masses were included in the study and judged against standard criteria set by the Royal College of Radiologists (RCR). The intervention phase included regular presentations, identification of problems, and designing of preformed reporting forms. Post-intervention assessments were based on the judgment of 100 ultrasound reports in each cycle twice. Intervention and post-intervention assessments were done twice to correct the ongoing practices. Results During the pre-intervention phase, the ultrasound reports issued by the department of study showed only 41.5% compliance with the RCR structured reporting guidelines. However, after the first and second post-intervention phases, this percentage increased up to 98.3%. Overall, we observed a compliance difference of 56.5% between the pre-intervention and second post-intervention phases. Conclusion Integration of methods, such as briefing the residents on RCR guidelines, displaying parameters, and making structured report templates available, can greatly increase adherence to RCR guidelines for structured ultrasonography reporting. It also greatly enhances the comprehensiveness and reliability of ultrasonography reports for clinicians. Clinical audits should be routinely practiced in the settings of radiology.
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Affiliation(s)
| | | | - Ayesha Naseer
- Radiology and Medical Imaging, Jinnah Hospital, Lahore, PAK
| | | | | | | | | | | | | | | | | | - Saira Bilal
- Radiology and Medical Imaging, Jinnah Hospital, Lahore, PAK
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Awali M, Middleton WD, Daggumati L, Phillips CH, Caserta MP, Fetzer DT, Dahiya N, Chong WK, Wasnik AP, Burgan CM, Morgan T, Itani M. Ultrasound of palpable lesions: a pictorial review. Abdom Radiol (NY) 2024:10.1007/s00261-024-04249-0. [PMID: 38763936 DOI: 10.1007/s00261-024-04249-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 05/21/2024]
Abstract
Ultrasound (US) is the imaging modality of choice for evaluation of superficial palpable lesions. A large proportion of these lesions have characteristic sonographic appearance and can be confidently diagnosed with US without the need for biopsy or other intervention. The Society of Radiologists in Ultrasound (SRU) recently published a Consensus Conference Statement on superficial soft tissue masses. The goal of this manuscript is (a) to serve as a sonographic pictorial review for palpable lesions based on the SRU statement, (b) present the typical sonographic features of palpable lesions that can be confidently diagnosed with US, and (c) provide an overview of other palpable lesions with a framework to interpret the US studies and advise on appropriate further management.
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Affiliation(s)
- Mohamed Awali
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 S Kingshighway Blvd, St. Louis, MO, 63110, USA
| | - William D Middleton
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 S Kingshighway Blvd, St. Louis, MO, 63110, USA
| | - Lasya Daggumati
- University of Missouri Kansas City School of Medicine, 2411 Holmes St, Kansas City, MO, 64108, USA
| | - Catherine H Phillips
- Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN, 37232, USA
| | - Melanie P Caserta
- Mayo Clinic Florida, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - David T Fetzer
- UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Nirvikar Dahiya
- Mayo Clinic Arizona, 5777 E. Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Wui K Chong
- University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030, USA
| | - Ashish P Wasnik
- University of Michigan-Michigan Medicine, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Constantine M Burgan
- University of Alabama at Birmingham, 625 19 Street South JT N338A, Birmingham, AL, 35233, USA
| | - Tara Morgan
- Mayo Clinic Arizona, 5777 E. Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Malak Itani
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 S Kingshighway Blvd, St. Louis, MO, 63110, USA.
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Rodriguez AB, Kripfgans OD, Kozloff KM, Samal A, Woo JM, Shehabeldin M, Chan HL. Ultrasound-based jawbone surface quality evaluation after alveolar ridge preservation. J Periodontol 2024. [PMID: 38742564 DOI: 10.1002/jper.23-0370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 04/06/2024] [Accepted: 04/10/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Bone readiness for implant placement is typically evaluated by bone quality/density on 2-dimensional radiographs and cone beam computed tomography at an arbitrary time between 3 and 6 months after tooth extraction and alveolar ridge preservation (ARP). The aim of this study is to investigate if high-frequency ultrasound (US) can classify bone readiness in humans, using micro-CT as a reference standard to obtain bone mineral density (BMD) and bone volume fraction (BVTV) of healed sockets receiving ARP in humans. METHODS A total of 27 bone cores were harvested during the implant surgery from 24 patients who received prior extraction with ARP. US images were taken immediately before the implant surgery at a site co-registered with the tissue biopsy collection location, made possible with a specially designed guide, and then classified into 3 tiers using B-mode image criteria (1) favorable, (2) questionable, and (3) unfavorable. Bone mineral density (hydroxyapatite) and BVTV were obtained from micro-CT as the gold standard. RESULTS Hydroxyapatite and BVTV were evaluated within the projected US slice plane and thresholded to favorable (>2200 mg/cm3; >0.45 mm3/mm3), questionable (1500-2200 mg/cm3; 0.4-0.45 mm3/mm3), and unfavorable (<1500 mg/cm3; <0.4 mm3/mm3). The present US B-mode classification inversely scales with BMD. Regression analysis showed a significant relation between US classification and BMD as well as BVTV. T-test analysis demonstrated a significant correlation between US reader scores and the gold standard. When comparing Tier 1 with the combination of Tier 2 and 3, US achieved a significant group differentiation relative to mean BMD (p = 0.004, true positive 66.7%, false positive 0%, true negative 100%, false negative 33.3%, specificity 100%, sensitivity 66.7%, receiver operating characteristics area under the curve 0.86). Similar results were found between US-derived tiers and BVTV. CONCLUSION Preliminary data suggest US could classify jawbone surface quality that correlates with BMD/BVTV and serve as the basis for future development of US-based socket healing evaluation after ARP.
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Affiliation(s)
- Amanda B Rodriguez
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
| | - Oliver D Kripfgans
- Department of Radiology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Kenneth M Kozloff
- Department of Biomedical Engineering, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Department of Orthopedic Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Ankita Samal
- Department of Radiology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Jae-Man Woo
- Department of Radiology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Mostafa Shehabeldin
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
| | - Hsun-Liang Chan
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
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Pappas TC, Roy Choudhury M, Chacko BK, Twiggs LB, Fritsche H, Elias KM, Phan RT. Neural network-derived multivariate index assay demonstrates effective clinical performance in longitudinal monitoring of ovarian cancer risk. Gynecol Oncol 2024; 187:21-29. [PMID: 38703674 DOI: 10.1016/j.ygyno.2024.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 03/28/2024] [Accepted: 04/21/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVE We recently characterized the clinical performance of a multivariate index assay (MIA3G) to assess ovarian cancer risk for adnexal masses at initial presentation. This study evaluated how MIA3G varies when applied longitudinally to monitor risk during clinical follow-up. METHOD The study evaluated women presenting with adnexal masses from eleven centers across the US. Patients received an initial blood draw at enrollment and at the standard-of-care follow-up visits. MIA3G was determined for all visits but physicians did not have access to MIA3G scores to determine clinical management. The primary outcome was the relative change value (RCV) of MIA3G over the period of clinical observation. RESULTS A total of 510 patients of 785 enrolled met study criteria. Of these, 30.8% had a second, 25.4% a third and 22.2% a fourth blood draw following initial collection. The median duration from initial draw was 131 d to second draw, 301.5 d to the third draw and 365.5 d to the fourth draw. MIA3G RCV of >50% was observed in 22-26% patients, whereas 70-75% patients had MIA3G RCV >5%. An empirical baseline RCV of 56% - transformed to 1 in logarithmic scale - was calculated from averaging RCVs of all patients who had no malignancy risk after 210 days. RCV > 1 log was associated with higher incidence of surgical intervention (29.6%) compared to RCV < 1 log (16.9%). CONCLUSIONS Variation in MI3AG does not change the accuracy of the test for excluding malignancy, while marked changes may be associated with a slightly higher likelihood of surgical intervention. In addition to MIA3G score itself, the MIA3G RCV may be important for clinical management.
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Affiliation(s)
- Todd C Pappas
- Department of Research & Development, Aspira Women's Health, Austin, TX, United States of America
| | - Manjusha Roy Choudhury
- Department of Research & Development, Aspira Women's Health, Austin, TX, United States of America
| | - Balu K Chacko
- Aspira Labs, Aspira Women's Health, Austin, TX, United States of America
| | - Leo B Twiggs
- Division of Clinical Operations and Medical Affairs, Aspira Women's Health, Austin, TX, United States of America
| | - Herbert Fritsche
- Aspira Labs, Aspira Women's Health, Austin, TX, United States of America
| | - Kevin M Elias
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston, United States of America; Harvard Medical School, Boston, United States of America
| | - Ryan T Phan
- Department of Research & Development, Aspira Women's Health, Austin, TX, United States of America; Aspira Labs, Aspira Women's Health, Austin, TX, United States of America; Division of Clinical Operations and Medical Affairs, Aspira Women's Health, Austin, TX, United States of America.
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Pal D, Roy SG, Singh R, Hayeri MR. Imaging features of soft-tissue infections. Skeletal Radiol 2024:10.1007/s00256-024-04694-4. [PMID: 38702530 DOI: 10.1007/s00256-024-04694-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 04/07/2024] [Accepted: 04/22/2024] [Indexed: 05/06/2024]
Abstract
Skin and soft tissues are among the most common sites of infections. Infections can involve the superficial epidermis to deep muscles and bones. Most infections spread through contiguous structures, although hematogenous spread can occur in the setting of an immunocompromised state and with atypical infections. While clinical diagnosis of infections is possible, it often lacks specificity, necessitating the use of imaging for confirmation. Cross-sectional imaging with US, CT, and MRI is frequently performed not just for diagnosis, but to delineate the extent of infection and to aid in management. Nonetheless, the imaging features have considerable overlap, and as such, it is essential to integrate imaging features with clinical features for managing soft tissue infections. Radiologists must be aware of the imaging features of different infections and their mimics, as well as the pros and cons of each imaging technique to properly use them for appropriate clinical situations. In this review, we summarize the most recent evidence-based features of key soft tissue infections.
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Affiliation(s)
- Devpriyo Pal
- North Bengal Medical College, Siliguri, West Bengal, India
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Yi PH, Garner HW, Hirschmann A, Jacobson JA, Omoumi P, Oh K, Zech JR, Lee YH. Clinical Applications, Challenges, and Recommendations for Artificial Intelligence in Musculoskeletal and Soft-Tissue Ultrasound: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2024; 222:e2329530. [PMID: 37436032 DOI: 10.2214/ajr.23.29530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Abstract
Artificial intelligence (AI) is increasingly used in clinical practice for musculoskeletal imaging tasks, such as disease diagnosis and image reconstruction. AI applications in musculoskeletal imaging have focused primarily on radiography, CT, and MRI. Although musculoskeletal ultrasound stands to benefit from AI in similar ways, such applications have been relatively underdeveloped. In comparison with other modalities, ultrasound has unique advantages and disadvantages that must be considered in AI algorithm development and clinical translation. Challenges in developing AI for musculoskeletal ultrasound involve both clinical aspects of image acquisition and practical limitations in image processing and annotation. Solutions from other radiology subspecialties (e.g., crowdsourced annotations coordinated by professional societies), along with use cases (most commonly rotator cuff tendon tears and palpable soft-tissue masses), can be applied to musculoskeletal ultrasound to help develop AI. To facilitate creation of high-quality imaging datasets for AI model development, technologists and radiologists should focus on increasing uniformity in musculoskeletal ultrasound performance and increasing annotations of images for specific anatomic regions. This Expert Panel Narrative Review summarizes available evidence regarding AI's potential utility in musculoskeletal ultrasound and challenges facing its development. Recommendations for future AI advancement and clinical translation in musculoskeletal ultrasound are discussed.
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Affiliation(s)
- Paul H Yi
- University of Maryland Medical Intelligent Imaging Center, University of Maryland School of Medicine, Baltimore, MD
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD
| | | | - Anna Hirschmann
- Imamed Radiology Nordwest, Basel, Switzerland
- Department of Radiology, University of Basel, Basel, Switzerland
| | - Jon A Jacobson
- Lenox Hill Radiology, New York, NY
- Department of Radiology, University of California, San Diego Medical Center, San Diego, CA
| | - Patrick Omoumi
- Department of Radiology, Lausanne University Hospital, Lausanne, Switzerland
- Department of Radiology, University of Lausanne, Lausanne, Switzerland
| | - Kangrok Oh
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
| | - John R Zech
- Department of Radiology, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, NY
| | - Young Han Lee
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
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Mueller CT, Aman M, Grünfelder F, Haug V, Thomas B, Bollmann C, Kneser U, Harhaus L. Ultrasound-An Easy Available and Useful Point-of-Care Adjunct for Clinical Decision-Making in Hand Infections: Review of the Literature and a Case Series. Ultrasound Q 2024; 40:20-26. [PMID: 37801592 DOI: 10.1097/ruq.0000000000000666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Abstract
ABSTRACT Initial findings of hand infections warrant a thorough treatment strategy depending on the progress of the infection. The decision for surgical treatment can be unclear. Searching to improve the quality of diagnostics, we reviewed the literature regarding the use of point-of-care ultrasound (PCUS) in hand infections and analyzed patients undergoing decision-making with PCUS. We searched PubMed, Scopus, Cochrane Register, and Google Scholar for the use of PCUS in therapy planning in infections of the hand. In addition, we screened our patients from July 1, 2020, to November 30, 2020, to validate the potential benefit of ultrasound examination in suspected hand infections. We evaluated initial clinical examinations versus blinded sonographic assessments in the context of correct decision to proceed with surgery or conservative treatment. Two thousand forty-eight studies within the topic were identified, but only 9 studies were found eligible to be included with a total of 88 patients. The studies illustrate that ultrasound can be performed on all patients, including children and pregnant women, and can be performed in a timely manner. In our retrospective analysis of 20 patients with suspected hand infection, the clinical and ultrasound assessment led to surgery in 13 cases. Of those 13 patients, 7 revealed intraoperative pus. By retrospective assessment of solely the ultrasound images, surgery would have been indicated in 9 cases, including all 7 cases with intraoperative pus. Clinical examination and ultrasound can help in detecting infections of the hand. Ultrasound examination, however, seems to yield a lower false-positive rate than clinical examination. Ultrasound could be a valuable addition to clinical examination.
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Affiliation(s)
| | | | | | - Valentin Haug
- BG Klinik Ludwigshafen, Plastische und Rekonstruktive Chirurgie, Mikrochirurgie, Schwerbrandverletztenzentrum, Universität Heidelberg, Heidelberg
| | - Benjamin Thomas
- BG Klinik Ludwigshafen, Plastische und Rekonstruktive Chirurgie, Mikrochirurgie, Schwerbrandverletztenzentrum, Universität Heidelberg, Heidelberg
| | | | - Ulrich Kneser
- BG Klinik Ludwigshafen, Plastische und Rekonstruktive Chirurgie, Mikrochirurgie, Schwerbrandverletztenzentrum, Universität Heidelberg, Heidelberg
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Park HY, Chung HW, Yoon MA, Chee CG, Kim W, Lee JS. Enhancing local recurrence detection in patients with high-grade soft tissue sarcoma: value of short-term Ultrasonography added to post-operative MRI surveillance. Cancer Imaging 2024; 24:12. [PMID: 38243293 PMCID: PMC10797984 DOI: 10.1186/s40644-023-00645-9] [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: 07/20/2023] [Accepted: 12/04/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Limited data exist on the optimal postoperative surveillance protocol for high-grade soft tissue sarcoma, particularly regarding the optimal imaging modality and imaging interval for detecting local recurrence. This study aimed to assess the benefit of short-term postoperative ultrasonography (USG) for detecting local recurrence in patients with high-grade soft tissue sarcoma. METHODS Patients with newly diagnosed high-grade soft tissue sarcoma who underwent surgical resection between January 2010 and June 2020 were included. Short-term USG was added to the follow-up protocol as a surveillance tool alongside routine magnetic resonance imaging (MRI). The primary outcome was the additional detection rate of short-term USG compared with routine MRI surveillance for early local recurrence detection. Subgroup analysis was performed to evaluate factors influencing USG detection rate. The additional detection rate of short-term USG for detection of metastatic lymph nodes was also evaluated. The secondary outcome was the false referral rate of short-term USG. RESULTS In total, 198 patients (mean age ± standard deviation: 52.1 ± 15.8 years; 94 women) were included. Local recurrence occurred in 20 patients (10.1%; 20/198). Short-term USG detected local recurrence in advance of routine MRI visits in 7 out of 198 patients, resulting in an additional detection rate of 3.5% (95% CI: 1.7-7.1%). Subgroup analysis showed no significant difference in the short-term USG detection rate based on initial tumor characteristics, and receipt of radiotherapy or chemotherapy. Short-term USG additionally detected five of seven patients with metastatic lymph nodes [2.5% (95% CI, 1.1-5.8%, 5/198)]. The false referral rate of short-term USG was 3.5% (95% CI: 1.7-7.1%; 7/198). CONCLUSIONS Short-term USG as part of postoperative surveillance for high-grade soft tissue sarcoma can enhance early detection of local tumor recurrence and metastatic lymphadenopathy. Early detection of local tumor recurrence could lead to a prompt surgical resection and aid in local disease control.
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Affiliation(s)
- Ho Young Park
- 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, Republic of Korea
| | - Hye Won Chung
- 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, Republic of Korea.
| | - Min A Yoon
- 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, Republic of Korea
| | - Choong Guen Chee
- 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, Republic of Korea
| | - Wanlim Kim
- Department of Orthopedic Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jong-Seok Lee
- Department of Orthopedic Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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Sharma A, Oluyemi E, Myers K, Ambinder E, Bell MAL. Spatial Coherence Approaches to Distinguish Suspicious Mass Contents in Fundamental and Harmonic Breast Ultrasound Images. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2024; 71:70-84. [PMID: 37956000 PMCID: PMC10851341 DOI: 10.1109/tuffc.2023.3332207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
When compared to fundamental B-mode imaging, coherence-based beamforming, and harmonic imaging are independently known to reduce acoustic clutter, distinguish solid from fluid content in indeterminate breast masses, and thereby reduce unnecessary biopsies during a breast cancer diagnosis. However, a systematic investigation of independent and combined coherence beamforming and harmonic imaging approaches is necessary for the clinical deployment of the most optimal approach. Therefore, we compare the performance of fundamental and harmonic images created with short-lag spatial coherence (SLSC), M-weighted SLSC (M-SLSC), SLSC combined with robust principal component analysis with no M-weighting (r-SLSC), and r-SLSC with M-weighting (R-SLSC), relative to traditional fundamental and harmonic B-mode images, when distinguishing solid from fluid breast masses. Raw channel data acquired from 40 total breast masses (28 solid, 7 fluid, 5 mixed) were beamformed and analyzed. The contrast of fluid masses was better with fundamental rather than harmonic coherence imaging, due to the lower spatial coherence within the fluid masses in the fundamental coherence images. Relative to SLSC imaging, M-SLSC, r-SLSC, and R-SLSC imaging provided similar contrast across multiple masses (with the exception of clinically challenging complicated cysts) and minimized the range of generalized contrast-to-noise ratios (gCNRs) of fluid masses, yet required additional computational resources. Among the eight coherence imaging modes compared, fundamental SLSC imaging best identified fluid versus solid breast mass contents, outperforming fundamental and harmonic B-mode imaging. With fundamental SLSC images, the specificity and sensitivity to identify fluid masses using the reader-independent metrics of contrast difference, mean lag one coherence (LOC), and gCNR were 0.86 and 1, 1 and 0.89, and 1 and 1, respectively. Results demonstrate that fundamental SLSC imaging and gCNR (or LOC if no coherence image or background region of interest is introduced) have the greatest potential to impact clinical decisions and improve the diagnostic certainty of breast mass contents. These observations are additionally anticipated to extend to masses in other organs.
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Chiu CH, Luo SD, Chiang PL, Lin AN, Wang CK, Chou CK, Chi SY, Chen MH, Lin WC. Factors Influencing a Favorable Outcome for RFA of Huge Benign Thyroid Nodules: Preliminary Results and Short-Term Evaluation. Int J Endocrinol 2023; 2023:9021903. [PMID: 38131035 PMCID: PMC10735726 DOI: 10.1155/2023/9021903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/18/2023] [Accepted: 11/22/2023] [Indexed: 12/23/2023] Open
Abstract
Objective This study aimed to investigate potentially favorable factors influencing the therapeutic success of radiofrequency ablation (RFA) of huge benign thyroid nodules (BTNs) (volume >100 ml) and to evaluate the feasibility of RFA as an alternative treatment modality for patients unable or unwilling to undergo surgery. Methods This retrospective study evaluated a total of 868 patients, of which 22 patients had huge BTNs who underwent ultrasound-guided moving shot RFA treatment between May 2017 and January 2022. The huge BTNs were categorized into two groups according to a post-RFA treatment volume reduction ratio (VRR) of >80% and <80% at 6 months. Factors influencing these huge BTNs were reviewed, analyzed, and correlated with treatment effectiveness between the two groups. Results The factors influencing an effective VRR included huge BTNs located on the left side (OR 7.875, p = 0.03), predominant solid/spongiform nodules (OR 7.875, p = 0.03), and higher initial ablation rate (IAR) (p = 0.028). Multivariable logistic regression revealed predominant solid/spongiform nodule and the higher IAR were associated with the advanced VRR. Conclusion RFA was effective at decreasing the volume of huge BTNs with an acceptable complication rate. The BTN characteristics correlated with a better VRR at the 6-month short-term follow-up were predominant solid/spongiform BTNs and those with the first time ablation treatment initial ablation rate. Nevertheless, regarding the higher regrowth rate of these groups of patients who may need to be treated more times, RFA can only be a feasible alternative treatment modality for patients unable or unwilling to undergo operation.
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Affiliation(s)
- Chun-Hua Chiu
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sheng-Dean Luo
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Pi-Ling Chiang
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - An-Ni Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheng-Kang Wang
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chen-Kai Chou
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shun-Yu Chi
- Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Meng-Hsiang Chen
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei-Che Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Department of Radiology, Jen-Ai Hospital, Taichung, Taiwan
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Deka JB, Shah R, Jiménez M, Bhatnagar N, Bravo-Sánchez A, Piñas-Bonilla I, Abián-Vicén J, Jiménez F. A Retrospective Analysis of High Resolution Ultrasound Evaluation of the "Split Fat Sign" in Peripheral Nerve Sheath Tumors. Healthcare (Basel) 2023; 11:3147. [PMID: 38132037 PMCID: PMC10742399 DOI: 10.3390/healthcare11243147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023] Open
Abstract
Peripheral nerve sheath tumors (PNST) comprise schwannomas and neurofibromas. The finding of increased adipose tissue around benign PNSTs has been described as the "split fat sign" on magnetic resonance imaging exams, which is suggestive of an intramuscular or intermuscular location of the tumor. However, few studies have described this sign as a salient ultrasound feature of PNSTs. The main purpose of this study was to retrospectively evaluate the presence of increased fatty tissue deposition around benign PNSTs diagnosed by high-resolution ultrasound. In addition, we aimed to corroborate the presence of vascularization around the affected area. A retrospective analysis of ten cases of PNSTs and two cases of post-traumatic neuromas diagnosed by high-resolution ultrasound was performed with a Logiq® P8 ultrasound with a 2-11 MHz multifrequency linear probe L3-12-D (central frequency: 10 MHz). Localized types of neurofibromas and schwannomas in any location were seen as predominantly hypoechoic tumors with an oval or fusiform shape. Exiting and entering nerves (tail sign) were observed in six cases, showing localized lesions both in intermuscular and subcutaneous locations. The presence of increased hyperechoic tissue (the split fat sign) was noted in cases of solitary intermuscular and intramuscular peripheral nerve sheath tumors, mainly the schwannomas. Though small tumors did not demonstrate the tail sign, the increase in adipose tissue and vascularity on US was well demonstrated. In conclusion, the nerve in continuity forms the basis of the ultrasonographic diagnosis of PNSTs. However, high-resolution US can convincingly demonstrate the increased presence of fat in the upper and lower poles as well as circumferentially in intermuscular or intramuscular benign PNSTs.
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Affiliation(s)
- Jeena B. Deka
- Dispur Polyclinic and Hospitals Pvt. Ltd., Guwahati 781006, India;
- Faculty of Health Sciences, San Antonio Catholic University, 30107 Murcia, Spain; (N.B.); (F.J.)
| | - Ritu Shah
- Seth GS. Medical College and King Edward Memorial Hospital, Mumbai 400012, India;
| | | | - Nidhi Bhatnagar
- Faculty of Health Sciences, San Antonio Catholic University, 30107 Murcia, Spain; (N.B.); (F.J.)
- Radiology Department, Mata Devi Hospital Max Hospital, Panchsheel, New Delhi 110058, India
| | - Alfredo Bravo-Sánchez
- Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, 28223 Pozuelo de Alarcón, Spain
| | | | - Javier Abián-Vicén
- Performance and Sport Rehabilitation Laboratory (DEPORSALUD), Faculty of Sport Sciences, University of Castilla-La Mancha, 13001 Toledo, Spain
| | - Fernando Jiménez
- Faculty of Health Sciences, San Antonio Catholic University, 30107 Murcia, Spain; (N.B.); (F.J.)
- Performance and Sport Rehabilitation Laboratory (DEPORSALUD), Faculty of Sport Sciences, University of Castilla-La Mancha, 13001 Toledo, Spain
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Hu J, Xia B, Yuan X, Chen H, Ou F, Huang L, Xu L, Feng X. Neuroblastoma with superficial soft tissue mass as the first symptom: case reports with atypical ultrasonic image and literature review. Braz J Med Biol Res 2023; 56:e12975. [PMID: 38088674 PMCID: PMC10712279 DOI: 10.1590/1414-431x2023e12975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 11/07/2023] [Indexed: 12/18/2023] Open
Abstract
Neuroblastoma is one of the most common tumors in children. Cases where an isolated soft-tissue metastasis mass is the initial symptom are rare, with only four such cases reported to date. We describe the imaging findings of ten cases of neuroblastoma patients in our hospital with superficial soft tissue mass (SSTM) as the primary symptom. The main ultrasound finding of SSTM was hypoechoic masses or scattered speck-like hyperechoic masses. However, when this type of SSTM is caused by soft tissue metastasis, the location is often atypical, and ultrasound findings are difficult to distinguish from other benign diseases. Therefore, this research should remind clinicians to recognize atypical presentations of this common childhood malignant tumor. Radiologists should also consider the possibility of neuroblastoma when finding this type of SSTM with atypical ultrasound features.
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Affiliation(s)
- Jiale Hu
- Department of Ultrasound, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
- China Medical University, Shenyang, Liaoning, China
| | - Bei Xia
- Department of Ultrasound, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Xiuli Yuan
- China Medical University, Shenyang, Liaoning, China
- Department of Hematology and Oncology, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Haixing Chen
- Department of Ultrasound, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Fuxiang Ou
- Department of Ultrasound, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Longlong Huang
- Department of Ultrasound, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Lei Xu
- Department of Ultrasound, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
- China Medical University, Shenyang, Liaoning, China
| | - Xia Feng
- Department of Ultrasound, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
- China Medical University, Shenyang, Liaoning, China
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Zhang Y, Zhao C, Lv H, Dong L, Xie L, Tian Y, Wu W, Luo H, Yang Q, Liu L, Sun D, Xie H. Benefit of Using Both Ultrasound Imaging and Clinical Information for Predicting Malignant Soft Tissue Tumors. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:2459-2468. [PMID: 37704557 DOI: 10.1016/j.ultrasmedbio.2023.08.005] [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: 05/16/2023] [Revised: 07/16/2023] [Accepted: 08/08/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVE Ultrasonography (US) is the primary imaging method for soft tissue tumors (STTs), the diagnostic performance of which still requires improvement. To achieve an accurate evaluation of STTs, we built the diagnostic nomogram for STTs using the clinical and US features of patients with STTs. METHODS A total of 613 patients with 195 malignant and 418 benign STTs were retrospectively recruited. We used a blend of clinical and ultrasonic features, as well as exclusively US features, to develop two distinct diagnostic models for STTs: the clinical-US model and the US-only model, respectively. The two models were evaluated and compared by measuring their areas under the receiver operating characteristic curve (AUC), calibration, integrated discrimination improvement (IDI) and decision curve analysis. The performance of the clinical-US model was also compared with that of two radiologists. RESULTS The clinical-US model had better diagnostic performance than the model based on US imaging features alone (AUCs of the clinical-US and US-only models: 0.95 [0.93-0.97] vs. 0.89 [0.87-0.92], p < 0.001; IDI of the two models: 0.15 ± 0.03, p < 0.001). The clinical-US model was also superior to the two radiologists in diagnosing STTs (AUCs of clinical-US model and two radiologists: 0.95 [0.93-0.97] vs. 0.79 [0.75-0.82] and 0.83 [0.80-0.85], p < 0.001). CONCLUSION The diagnostic model based on clinical and US imaging features had high diagnostic performance in STTs, which could help identify malignant STTs for radiologists.
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Affiliation(s)
- Yusen Zhang
- Department of Ultrasonography, Peking University Shenzhen Hospital, Shenzhen, China
| | - Chenyang Zhao
- Department of Ultrasonography, Peking University Shenzhen Hospital, Shenzhen, China
| | - Heng Lv
- Department of Ultrasonography, Peking University Shenzhen Hospital, Shenzhen, China
| | - Licong Dong
- Department of Ultrasonography, Peking University Shenzhen Hospital, Shenzhen, China
| | - Lu Xie
- Department of Ultrasonography, Peking University Shenzhen Hospital, Shenzhen, China
| | - Yun Tian
- Department of Ultrasonography, Peking University Shenzhen Hospital, Shenzhen, China
| | - Wangjie Wu
- Department of Ultrasonography, Peking University Shenzhen Hospital, Shenzhen, China
| | - Haiyu Luo
- Department of Ultrasonography, Peking University Shenzhen Hospital, Shenzhen, China
| | - Qi Yang
- Department of Ultrasonography, Peking University Shenzhen Hospital, Shenzhen, China
| | - Li Liu
- Department of Ultrasonography, Peking University Shenzhen Hospital, Shenzhen, China
| | - Desheng Sun
- Department of Ultrasonography, Peking University Shenzhen Hospital, Shenzhen, China
| | - Haiqin Xie
- Department of Ultrasonography, Peking University Shenzhen Hospital, Shenzhen, China.
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Inarejos Clemente EJ, Diaz Leyva J, Karakas SP, Duarte AM, Mas TR, Restrepo R. Radiologic and Clinical Features of Infantile Hemangioma: Potential Pitfalls and Differential Diagnosis. Radiographics 2023; 43:e230064. [PMID: 37883305 DOI: 10.1148/rg.230064] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Infantile hemangioma (IH) is the most common neoplasm in children, but it may mimic other types of vascular anomalies or nonvascular benign and malignant tumors. In most cases, the clinical appearance, time of onset, and pattern of involution facilitate its diagnosis. Imaging evaluation is not always needed since the IH features at clinical presentation are usually characteristic, but when needed, US and frequently MRI are the imaging modalities of choice. Clinical photography or photographic documentation plays a central role in monitoring these lesions over their clinical course. Photographic documentation can also add confidence and alert the radiologist when interpreting imaging studies. Some vascular anomalies, especially vascular malformations, are a frequent source of confusion, as these may resemble IHs clinically and at imaging. The lack of uniform terminology also hinders an accurate diagnosis. To unify the terminology and minimize confusion, the International Society for the Study of Vascular Anomalies created a helpful classification in 1994. In addition, radiologists need to be aware of and become familiar with other neoplasms in children that may resemble IH to avoid misdiagnosis and unnecessary procedures. Fibrous and lipomatous tumors are examples of benign tumors that can mimic IHs clinically and at imaging, whereas rhabdomyosarcoma, infantile fibrosarcoma, neuroblastoma, and lymphoproliferative disorders are examples of malignant neoplasms. The authors review the features of IH at clinical presentation and imaging evaluation, highlighting its different phases of evolution and stressing the importance of photographic documentation. The authors also review pitfalls of IH with helpful pearls for differentiation. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material. See the invited commentary by Khanna and Briones in this issue.
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Affiliation(s)
- Emilio J Inarejos Clemente
- From the Department of Diagnostic Imaging, Hospital Sant Joan de Deu, Av. Sant Joan de Deu 2, CP 08950 Esplugues de Llobregat, Barcelona, Spain (E.J.I.C.); Department of Diagnostic Imaging (J.D.L., S.P.K., R.R.) and Children Skin Center (A.M.D.), Miami Children's Hospital, Miami, Fla; and Ross University School of Medicine, Miramar, Fla (T.R.M.)
| | - Joana Diaz Leyva
- From the Department of Diagnostic Imaging, Hospital Sant Joan de Deu, Av. Sant Joan de Deu 2, CP 08950 Esplugues de Llobregat, Barcelona, Spain (E.J.I.C.); Department of Diagnostic Imaging (J.D.L., S.P.K., R.R.) and Children Skin Center (A.M.D.), Miami Children's Hospital, Miami, Fla; and Ross University School of Medicine, Miramar, Fla (T.R.M.)
| | - S Pinar Karakas
- From the Department of Diagnostic Imaging, Hospital Sant Joan de Deu, Av. Sant Joan de Deu 2, CP 08950 Esplugues de Llobregat, Barcelona, Spain (E.J.I.C.); Department of Diagnostic Imaging (J.D.L., S.P.K., R.R.) and Children Skin Center (A.M.D.), Miami Children's Hospital, Miami, Fla; and Ross University School of Medicine, Miramar, Fla (T.R.M.)
| | - Ana Margarita Duarte
- From the Department of Diagnostic Imaging, Hospital Sant Joan de Deu, Av. Sant Joan de Deu 2, CP 08950 Esplugues de Llobregat, Barcelona, Spain (E.J.I.C.); Department of Diagnostic Imaging (J.D.L., S.P.K., R.R.) and Children Skin Center (A.M.D.), Miami Children's Hospital, Miami, Fla; and Ross University School of Medicine, Miramar, Fla (T.R.M.)
| | - Thomas R Mas
- From the Department of Diagnostic Imaging, Hospital Sant Joan de Deu, Av. Sant Joan de Deu 2, CP 08950 Esplugues de Llobregat, Barcelona, Spain (E.J.I.C.); Department of Diagnostic Imaging (J.D.L., S.P.K., R.R.) and Children Skin Center (A.M.D.), Miami Children's Hospital, Miami, Fla; and Ross University School of Medicine, Miramar, Fla (T.R.M.)
| | - Ricardo Restrepo
- From the Department of Diagnostic Imaging, Hospital Sant Joan de Deu, Av. Sant Joan de Deu 2, CP 08950 Esplugues de Llobregat, Barcelona, Spain (E.J.I.C.); Department of Diagnostic Imaging (J.D.L., S.P.K., R.R.) and Children Skin Center (A.M.D.), Miami Children's Hospital, Miami, Fla; and Ross University School of Medicine, Miramar, Fla (T.R.M.)
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de Moraes FCA, Dal Moro L, Pessoa FR, Passos ESDR, Campos RALS, de Souza DDSM, Feio D, Rodríguez Burbano RM, Fernandes MR, dos Santos NPC. Malignant Neoplasms Arising in the Cardiac Pacemaker Cavity: A Systematic Review. Cancers (Basel) 2023; 15:5206. [PMID: 37958380 PMCID: PMC10647525 DOI: 10.3390/cancers15215206] [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: 09/01/2023] [Revised: 09/20/2023] [Accepted: 09/27/2023] [Indexed: 11/15/2023] Open
Abstract
Cancer is the abnormal proliferation of physiologically inadequate cells. Studies have identified the cardiac pacemaker pocket as a site of rare neoplasms. To evaluate the clinical outcomes, treatment, prognosis, and individualized management of tumors originating in the cardiac pacemaker pocket, a systematic review was conducted using case reports and case series available in the PubMed/Medline, Science Direct, Cochrane Central, LILACS, and Scientific Electronic Library Online (Scielo) databases. Pacemaker pocket tumors affected patients with a mean age of 72.9 years, with a higher incidence in males (76.9%, n = 10). The average time for neoplasm development was 4.4 years (54.07 months). The most prevalent model was Medtronic (38.4%, n = 5), with titanium (83.3%) being the most common metal composition. Chemotherapy was the most performed procedure among patients (38.4%), followed by radiation therapy (38.4%) and surgical tumor resection (30.7%). Six analyzed cases (46.1%) resulted in death, and four patients (30.7%) achieved a cure. Patients with pacemakers should be routinely evaluated for the occurrence of malignant tumors at the site of device implantation.
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Affiliation(s)
- Francisco Cezar Aquino de Moraes
- Oncology Research Center, University Hospital João de Barros Barreto, Belém 66073-005, PA, Brazil; (D.F.); (M.R.F.); (N.P.C.d.S.)
| | - Lucca Dal Moro
- Department of Medicine, Federal University of Pará, Belém 66075-110, PA, Brazil; (L.D.M.); (F.R.P.); (E.S.d.R.P.); (R.A.L.S.C.); (D.d.S.M.d.S.)
| | - Fernando Rocha Pessoa
- Department of Medicine, Federal University of Pará, Belém 66075-110, PA, Brazil; (L.D.M.); (F.R.P.); (E.S.d.R.P.); (R.A.L.S.C.); (D.d.S.M.d.S.)
| | - Ellen Sabrinna dos Remédios Passos
- Department of Medicine, Federal University of Pará, Belém 66075-110, PA, Brazil; (L.D.M.); (F.R.P.); (E.S.d.R.P.); (R.A.L.S.C.); (D.d.S.M.d.S.)
| | - Raul Antônio Lopes Silva Campos
- Department of Medicine, Federal University of Pará, Belém 66075-110, PA, Brazil; (L.D.M.); (F.R.P.); (E.S.d.R.P.); (R.A.L.S.C.); (D.d.S.M.d.S.)
| | - Dilma do Socorro Moraes de Souza
- Department of Medicine, Federal University of Pará, Belém 66075-110, PA, Brazil; (L.D.M.); (F.R.P.); (E.S.d.R.P.); (R.A.L.S.C.); (D.d.S.M.d.S.)
- Gaspar Vianna State Public Hospital of Clinical Foundation, Belém 66083-106, PA, Brazil
| | - Danielle Feio
- Oncology Research Center, University Hospital João de Barros Barreto, Belém 66073-005, PA, Brazil; (D.F.); (M.R.F.); (N.P.C.d.S.)
| | | | - Marianne Rodrigues Fernandes
- Oncology Research Center, University Hospital João de Barros Barreto, Belém 66073-005, PA, Brazil; (D.F.); (M.R.F.); (N.P.C.d.S.)
| | - Ney Pereira Carneiro dos Santos
- Oncology Research Center, University Hospital João de Barros Barreto, Belém 66073-005, PA, Brazil; (D.F.); (M.R.F.); (N.P.C.d.S.)
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Long B, Zhang H, Zhang H, Chen W, Sun Y, Tang R, Lin Y, Fu Q, Yang X, Cui L, Wang K. Deep learning models of ultrasonography significantly improved the differential diagnosis performance for superficial soft-tissue masses: a retrospective multicenter study. BMC Med 2023; 21:405. [PMID: 37880716 PMCID: PMC10601110 DOI: 10.1186/s12916-023-03099-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 09/29/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Most of superficial soft-tissue masses are benign tumors, and very few are malignant tumors. However, persistent growth, of both benign and malignant tumors, can be painful and even life-threatening. It is necessary to improve the differential diagnosis performance for superficial soft-tissue masses by using deep learning models. This study aimed to propose a new ultrasonic deep learning model (DLM) system for the differential diagnosis of superficial soft-tissue masses. METHODS Between January 2015 and December 2022, data for 1615 patients with superficial soft-tissue masses were retrospectively collected. Two experienced radiologists (radiologists 1 and 2 with 8 and 30 years' experience, respectively) analyzed the ultrasound images of each superficial soft-tissue mass and made a diagnosis of malignant mass or one of the five most common benign masses. After referring to the DLM results, they re-evaluated the diagnoses. The diagnostic performance and concerns of the radiologists were analyzed before and after referring to the results of the DLM results. RESULTS In the validation cohort, DLM-1 was trained to distinguish between benign and malignant masses, with an AUC of 0.992 (95% CI: 0.980, 1.0) and an ACC of 0.987 (95% CI: 0.968, 1.0). DLM-2 was trained to classify the five most common benign masses (lipomyoma, hemangioma, neurinoma, epidermal cyst, and calcifying epithelioma) with AUCs of 0.986, 0.993, 0.944, 0.973, and 0.903, respectively. In addition, under the condition of the DLM-assisted diagnosis, the radiologists greatly improved their accuracy of differential diagnosis between benign and malignant tumors. CONCLUSIONS The proposed DLM system has high clinical application value in the differential diagnosis of superficial soft-tissue masses.
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Affiliation(s)
- Bin Long
- Institute of Medical Technology, Peking University Health Science Center, Beijing, 100191, China
- Department of Diagnostic Ultrasound, Peking University Third Hospital, Beijing, China
| | - Haoyan Zhang
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China
- School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China
| | - Han Zhang
- Department of Ultrasound, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wen Chen
- Department of Diagnostic Ultrasound, Peking University Third Hospital, Beijing, China
| | - Yang Sun
- Department of Diagnostic Ultrasound, Peking University Third Hospital, Beijing, China
| | - Rui Tang
- Institute of Medical Technology, Peking University Health Science Center, Beijing, 100191, China
- Department of Diagnostic Ultrasound, Peking University Third Hospital, Beijing, China
| | - Yuxuan Lin
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Qiang Fu
- Department of Ultrasound, Beijing Civil Aviation General Hospital, Beijing, China
| | - Xin Yang
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China
- School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China
| | - Ligang Cui
- Institute of Medical Technology, Peking University Health Science Center, Beijing, 100191, China.
- Department of Diagnostic Ultrasound, Peking University Third Hospital, Beijing, China.
| | - Kun Wang
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China.
- School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China.
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20
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Griffith JF. Practical approach to ultrasound of soft tissue tumors and the added value of MRI: how I do it. J Ultrason 2023; 23:e299-e312. [PMID: 38020510 PMCID: PMC10668928 DOI: 10.15557/jou.2023.0036] [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: 06/21/2023] [Accepted: 09/28/2023] [Indexed: 12/01/2023] Open
Abstract
This review outlines a practical approach to the everyday assessment of both non-neoplastic and neoplastic soft tissue tumors, focusing on ultrasound examination, though emphasizing the added benefit of magnetic resonance imaging in certain instances. Ultrasound approach and assessment, practical scenarios, reporting, biopsy, and follow-up are covered, as well as the criteria used to distinguish benign from malignant tumors. The potential benefits and current limitations of elastography and contrast-enhanced ultrasound in assessment are also addressed. Examples of commonly encountered soft tissue tumors are shown. Ultrasound can characterize most soft tissue masses based on their ultrasound appearance alone. Following ultrasound examination, three potential scenarios usually exist in clinical practice: (a) confident regarding diagnosis, (b) indeterminate mass with no evidence of malignancy, and (c) indeterminate mass with possibility of malignancy. A diagnostic pathway for each of these scenarios is provided. Magnetic resonance imaging is generally not helpful in further characterizing masses which are indeterminate on ultrasound assessment, though it is helpful in addressing other issues such as exact tumor location and neurovascular bundle involvement that may not be fully resolved on ultrasound examination. In these situations, magnetic resonance imaging examination can be tailored to address those specific questions that have not been adequately addressed on ultrasound examination. In this sense, both examinations are highly complementary. Tips for undertaking magnetic resonance imaging examinations are provided.
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Affiliation(s)
- James Francis Griffith
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shenzhen, Hong Kong
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Picasso R, Zaottini F, Pistoia F, Perez MM, Macciò M, Bianco D, Rinaldi S, Pansecchi M, Rossi G, Tovt L, Martinoli C. Ultrasound of the palmar aspect of the hand: normal anatomy and clinical applications of intrinsic muscles imaging. J Ultrason 2023; 23:e122-e130. [PMID: 37732107 PMCID: PMC10508329 DOI: 10.15557/jou.2023.0021] [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: 02/16/2023] [Accepted: 04/11/2023] [Indexed: 09/22/2023] Open
Abstract
Intrinsic hand muscles play a fundamental role in tuning the fine motricity of the hand and may be affected by several pathologic conditions, including traumatic injuries, atrophic changes induced by denervation, and space-occupying masses. Modern hand surgery techniques allow to target several hand muscle pathologies and, as a direct consequence, requests for hand imaging now carry increasingly complex diagnostic questions. The progressive refinement of ultrasound technology and the current availability of high and ultra-high frequency linear transducers that allow the investigation of intrinsic hand muscles and tendons with incomparable resolution have made this modality an essential tool for the evaluation of pathological processes involving these tiny structures. Indeed, intrinsic hand muscles lie in a superficial position and are amenable to investigation by means of transducers with frequency bands superior to 20 MHz, offering clear advantages in terms of resolution and costs compared to magnetic resonance imaging. In addition, ultrasound allows to perform dynamic maneuvers that can critically enhance its diagnostic power, by examining the questioned structure during stress tests that simulate the conditions eliciting clinical symptoms. The present article aims to review the anatomy, the ultrasound scanning technique, and the clinical application of thenar, hypothenar, lumbricals and interossei muscles imaging, also showing some examples of pathology involving these structures.
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Affiliation(s)
- Riccardo Picasso
- Department of Radiology, IRCCS Policlinico San Martino, Genoa, Italy
| | - Federico Zaottini
- Department of Radiology, IRCCS Policlinico San Martino, Genoa, Italy
| | - Federico Pistoia
- Department of Radiology, IRCCS Policlinico San Martino, Genoa, Italy
| | - Maribel Miguel Perez
- Unit of Human Anatomy and Embryology, Department of Pathology and Experimental Therapeutics, Faculty of Medicine and Health Sciences, University of Barcelona, Hospitalet de Llobrega, L’Hospitalet de Llobrega, Spain
| | - Marta Macciò
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Deborah Bianco
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Simone Rinaldi
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Michelle Pansecchi
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Gabriele Rossi
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Luca Tovt
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Carlo Martinoli
- Department of Radiology, IRCCS Policlinico San Martino, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
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22
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Miao Y, Ren W, Yang F, Li L, Wu L, Dan Shan D, Chen Z, Wang L, Wang Q, Guo L. Diagnostic value of high-frequency ultrasound (HFUS) in evaluation of subcutaneous lesions. Skin Res Technol 2023; 29:e13464. [PMID: 37753674 PMCID: PMC10493336 DOI: 10.1111/srt.13464] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 08/30/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND It is unknown whether high-frequency ultrasound (HFUS) can evaluate invisible subcutaneous lesions. We aimed to investigate the diagnostic value of HFUS in invisible subcutaneous lesions. METHOD Patients with invisible subcutaneous lesions were prospectively recruited from two centres. Before undergoing biopsy or surgery, each lesion was independently evaluated by two clinicians. One provides a clinical diagnosis by only clinical examination and the other provides an integrated diagnosis by combining clinical examination and HFUS information. Diagnoses were classified as correct, wrong, and indeterminate. A total of 391 lesions from 355 patients were enrolled, including 225 epidermoid cysts, 77 lipomas, 25 pilomatrixomas, 21 haemangiomas, 19 dermatofibromas, 11 dermatofibrosarcoma protuberans (DFSP), 7 neurofibromas, and 6 leiomyomas. Using pathological results as the gold standard, diagnostic performance was compared. RESULTS The number of correct diagnoses increased from 185 (47.3%) by clinical examination alone to 316 (80.8%) after the addition of HFUS (P < 0.05). Meanwhile, the indeterminate diagnosis rate decreased from 143 (36.6%) to 10 (2.6%). Using HFUS, the accuracy improved significantly for epidermoid cysts (59.6% vs. 86.7%), lipomas (50.6% vs. 94.8%), pilomatrixomas (0% vs. 48.0%), haemangiomas (23.8% vs. 57.1%), and DFSPs (0% vs. 81.8%) (all p < 0.05). However, HFUS did not significantly improve the diagnostic accuracy of dermatofibromas (15.8% vs. 21.1%, p > 0.999), neurofibromas (42.9% vs. 71.4%, p = 0.625), or leiomyomas (16.7% vs. 100%, p = 0.063). CONCLUSION Combining HFUS and clinical examination can generally improve the diagnostic accuracy and decrease the indeterminacy of invisible subcutaneous lesions, especially epidermoid cysts, lipomas, pilomatrixomas, haemangiomas, and DFSPs. However, for some rare lesions, HFUS cannot provide useful information.
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Affiliation(s)
- Yao Miao
- Department of Medical UltrasoundShanghai Tenth People's Hospital; Shanghai Engineering Research Center of Ultrasound Diagnosis and TreatmentSchool of MedicineTongji UniversityShanghaiChina
- Department of Medical UltrasoundShanghai Skin Disease HospitalSchool of MedicineTongji UniversityShanghaiChina
| | - Wei‐Wei Ren
- Department of Medical UltrasoundShanghai Tenth People's Hospital; Shanghai Engineering Research Center of Ultrasound Diagnosis and TreatmentSchool of MedicineTongji UniversityShanghaiChina
- Department of Medical UltrasoundShanghai Skin Disease HospitalSchool of MedicineTongji UniversityShanghaiChina
| | - Fei‐Yue Yang
- Department of Medical UltrasoundShanghai Tenth People's Hospital; Shanghai Engineering Research Center of Ultrasound Diagnosis and TreatmentSchool of MedicineTongji UniversityShanghaiChina
| | - Liang Li
- Department of Dermatological SurgeryShanghai Skin Disease HospitalSchool of MedicineTongji UniversityShanghaiChina
| | - Ling Wu
- Department of Dermatological SurgeryShanghai Skin Disease HospitalSchool of MedicineTongji UniversityShanghaiChina
| | - Dan‐ Dan Shan
- Department of Medical UltrasoundShanghai Tenth People's Hospital; Shanghai Engineering Research Center of Ultrasound Diagnosis and TreatmentSchool of MedicineTongji UniversityShanghaiChina
- Department of Medical UltrasoundShanghai Skin Disease HospitalSchool of MedicineTongji UniversityShanghaiChina
| | - Zi‐Tong Chen
- Department of Medical UltrasoundShanghai Tenth People's Hospital; Shanghai Engineering Research Center of Ultrasound Diagnosis and TreatmentSchool of MedicineTongji UniversityShanghaiChina
- Department of Medical UltrasoundShanghai Skin Disease HospitalSchool of MedicineTongji UniversityShanghaiChina
| | - Li‐Fan Wang
- Department of UltrasoundZhongshan HospitalFudan UniversityShanghaiChina
| | - Qiao Wang
- Department of Medical UltrasoundShanghai Tenth People's Hospital; Shanghai Engineering Research Center of Ultrasound Diagnosis and TreatmentSchool of MedicineTongji UniversityShanghaiChina
- Department of Medical UltrasoundShanghai Skin Disease HospitalSchool of MedicineTongji UniversityShanghaiChina
| | - Le‐Hang Guo
- Department of Medical UltrasoundShanghai Tenth People's Hospital; Shanghai Engineering Research Center of Ultrasound Diagnosis and TreatmentSchool of MedicineTongji UniversityShanghaiChina
- Department of Medical UltrasoundShanghai Skin Disease HospitalSchool of MedicineTongji UniversityShanghaiChina
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23
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Siraj S, Nijrabi MM, Hakimi A, Zaki A, Hares R. Primary intramuscular thigh hydatid cyst: A case report. Int J Surg Case Rep 2023; 109:108589. [PMID: 37517254 PMCID: PMC10407430 DOI: 10.1016/j.ijscr.2023.108589] [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: 06/22/2023] [Revised: 07/22/2023] [Accepted: 07/24/2023] [Indexed: 08/01/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Hydatid cyst is a parasitic infection caused by Echinococcus granulosis. It mostly involves the liver and lungs; however, muscle involvement is an uncommon event. The diagnosis of such cystic masses is still a challenge due to the presence of more common pathological conditions in soft tissue. Imaging is useful and can identify a definitive diagnosis. CASE PRESENTATION We present a case of a 32-year-old woman with history of close contact with dogs and cats, who complained of an isolated swelling in the right upper thigh growing gradually over a period of 3 years. Ultrasound reported intramuscular hydatid cyst in the right thigh. Hydatid cyst was completely excised. The outcome was good, with no recurrence in one year. CLINICAL DISCUSSION Ultrasonography is an excellent and cost-effective imaging modality with a high negative predictive value in the evaluation of palpable superficial soft-tissue masses and hydatid cysts. CONCLUSION Isolated intramuscular hydatid cyst is rarely reported, even in endemic areas of the disease, so the diagnosis should be considered in any cystic masses of soft tissue, particularly in subjects from high-endemic zones. Although the treatment of choice in such cases is surgical excision but prevention is more favorable to fight against hydatid disease.
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Affiliation(s)
- Salahuddin Siraj
- Department of Orthopaedic, French Medical Institute for Mothers and Children, Kabul, Afghanistan
| | - Mirza Mohammad Nijrabi
- Department of Orthopaedic, French Medical Institute for Mothers and Children, Kabul, Afghanistan
| | - Ahmadullah Hakimi
- Department of Pathology and Clinical Laboratory, French Medical Institute for Mothers and Children, Kabul, Afghanistan
| | - Adil Zaki
- Department of Radiology, French Medical Institute for Mothers and Children, Kabul, Afghanistan
| | - Roohullah Hares
- Department of Paediatric Surgery, French Medical Institute for Mothers and Children, Kabul, Afghanistan.
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Garner HW, Wessell DE, Lenchik L, Ahlawat S, Baker JC, Banks J, Demertzis JL, Moon BS, Pierce JL, Scott JA, Sharda NK, Surasi DS, Temporal M, Chang EY. ACR Appropriateness Criteria® Soft Tissue Masses: 2022 Update. J Am Coll Radiol 2023; 20:S234-S245. [PMID: 37236746 DOI: 10.1016/j.jacr.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 05/28/2023]
Abstract
Imaging should be performed in patients with a suspected soft tissue mass that cannot be clinically confirmed as benign. Imaging provides essential information necessary for diagnosis, local staging, and biopsy planning. Although the modalities available for imaging of musculoskeletal masses have undergone progressive technological advancements in recent years, their overall purpose in the setting of a soft tissue mass remains unchanged. This document identifies the most common clinical scenarios related to soft tissue masses and the most appropriate imaging for their assessment on the basis of the current literature. It also provides general guidance for those scenarios that are not specifically addressed. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | | | - Leon Lenchik
- Panel Vice-Chair, Wake Forest University School of Medicine, Winston Salem, North Carolina
| | - Shivani Ahlawat
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jonathan C Baker
- Mallinckrodt Institute of Radiology Washington University School of Medicine, Saint Louis, Missouri
| | - James Banks
- Nova Southeastern University, Fort Lauderdale, Florida
| | | | - Bryan S Moon
- The University of Texas MD Anderson Cancer Center, Houston, Texas; American Academy of Orthopaedic Surgeons
| | | | - Jinel A Scott
- SUNY Downstate Health Sciences University, Brooklyn, New York
| | - Neema K Sharda
- Duke University School of Medicine, Durham, North Carolina; American Geriatrics Society
| | - Devaki Shilpa Surasi
- The University of Texas MD Anderson Cancer Center, Houston, Texas; Commission on Nuclear Medicine and Molecular Imaging
| | - Michael Temporal
- Billings Clinic, Billings, Montana; American Academy of Family Physicians
| | - Eric Y Chang
- Specialty Chair, VA San Diego Healthcare System, San Diego, California
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25
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de Vries ISA, van Ewijk R, Adriaansen LME, Bohte AE, Braat AJAT, Fajardo RD, Hiemcke-Jiwa LS, Hol MLF, Ter Horst SAJ, de Keizer B, Knops RRG, Meister MT, Schoot RA, Smeele LE, van Scheltinga ST, Vaarwerk B, Merks JHM, van Rijn RR. Imaging in rhabdomyosarcoma: a patient journey. Pediatr Radiol 2023; 53:788-812. [PMID: 36843091 PMCID: PMC10027795 DOI: 10.1007/s00247-023-05596-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/06/2022] [Accepted: 01/10/2023] [Indexed: 02/28/2023]
Abstract
Rhabdomyosarcoma, although rare, is the most frequent soft tissue sarcoma in children and adolescents. It can present as a mass at nearly any site in the body, with most common presentations in the head and neck, genitourinary tract and extremities. The optimal diagnostic approach and management of rhabdomyosarcoma require a multidisciplinary team with multimodal treatment, including chemotherapy and local therapy. Survival has improved over the last decades; however, further improvement in management is essential with current 5-year overall survival ranging from 35% to 100%, depending on disease and patient characteristics. In the full patient journey, from diagnosis, staging, management to follow-up after therapy, the paediatric radiologist and nuclear physician are essential members of the multidisciplinary team. Recently, guidelines of the European paediatric Soft tissue sarcoma Study Group, the Cooperative Weichteilsarkom Studiengruppe and the Oncology Task Force of the European Society of Paediatric Radiology (ESPR), in an ongoing collaboration with the International Soft-Tissue Sarcoma Database Consortium, provided guidance for high-quality imaging. In this educational paper, given as a lecture during the 2022 postgraduate ESPR course, the multi-disciplinary team of our national paediatric oncology centre presents the journey of two patients with rhabdomyosarcoma and discusses the impact on and considerations for the clinical (paediatric) radiologist and nuclear physician. The key learning points of the guidelines and their implementation in clinical practice are highlighted and up-to-date insights provided for all aspects from clinical suspicion of rhabdomyosarcoma and its differential diagnosis, to biopsy, staging, risk stratification, treatment response assessment and follow-up.
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Affiliation(s)
| | - Roelof van Ewijk
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Laura M E Adriaansen
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Anneloes E Bohte
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Arthur J A T Braat
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Raquel Dávila Fajardo
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Radiotherapy, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Laura S Hiemcke-Jiwa
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Pathology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Marinka L F Hol
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Otorhinolaryngology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Simone A J Ter Horst
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Bart de Keizer
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Rutger R G Knops
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Michael T Meister
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Oncode Institute, Utrecht, the Netherlands
| | - Reineke A Schoot
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Ludi E Smeele
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute (NCI), Amsterdam, the Netherlands
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Bas Vaarwerk
- Department of Paediatrics, Amsterdam UMC - Emma Children's Hospital, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Rick R van Rijn
- Department of Radiology and Nuclear Medicine, Amsterdam UMC - Emma Children's Hospital, University of Amsterdam, Suite C1-423.1, Meibergdreef 9, 1105AZ, Amsterdam, the Netherlands.
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26
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Koo M, Wi YC, Kim J, Lee SW. Subcutaneous Myoepithelioma in the Extremity: A Potential Pitfall in the Differential Diagnosis of Subcutaneous Tumors. Medicina (B Aires) 2023; 59:medicina59040667. [PMID: 37109625 PMCID: PMC10143696 DOI: 10.3390/medicina59040667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/03/2023] [Accepted: 03/27/2023] [Indexed: 03/30/2023] Open
Abstract
We present a rare case of myoepithelioma in the subcutaneous layer of the shoulder with ultrasonography (US) and magnetic resonance imaging (MRI). US showed a lobulated hyperechoic mass, leading to an impression of lipoma. MRI showed the mass with low signal intensity on T1-weighted images (T1WI), high signal intensity on fat-suppressed T2-weighted images (T2WI), intermediate signal intensity on T2WI, and intense enhancement with adjacent fascial thickening. Imaging findings of soft tissue myoepithelioma have not been established. We report its US and MRI features mimicking features from a lipomatous tumor to infiltrative malignancy. Although soft tissue myoepithelioma has nonspecific image findings to confirm its diagnosis, some findings may help to make the differential diagnosis. Preoperative pathologic confirmation is recommended in a soft tissue neoplasm.
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Affiliation(s)
- Minsun Koo
- Department of Radiology, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 1021, Tongil-ro, Eunpyeong-gu, Seoul 03312, Republic of Korea
| | - Young Chan Wi
- Department of Pathology, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 1021, Tongil-ro, Eunpyeong-gu, Seoul 03312, Republic of Korea
| | - Jimin Kim
- Department of Radiology, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 1021, Tongil-ro, Eunpyeong-gu, Seoul 03312, Republic of Korea
- Correspondence: (J.K.); (S.-W.L.)
| | - Sheen-Woo Lee
- Department of Radiology, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 1021, Tongil-ro, Eunpyeong-gu, Seoul 03312, Republic of Korea
- Correspondence: (J.K.); (S.-W.L.)
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27
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Review of primary superficial soft tissue mesenchymal tumors of malignant or intermediate biological potential. Skeletal Radiol 2023; 52:435-445. [PMID: 35867123 DOI: 10.1007/s00256-022-04127-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 07/10/2022] [Accepted: 07/12/2022] [Indexed: 02/02/2023]
Abstract
The majority of the sarcomas are deep in location, larger than 5 cm in size, and heterogenous in imaging appearance. However, when sarcomas occur superficially, these typical features may be absent, failing to alert the radiologist to a malignancy and mimicking one of the more numerous benign superficial tumors that make up the bulk of soft tissue mass evaluations. This manuscript will discuss the current role of imaging in recognizing features concerning for superficial soft tissue sarcomas. Provided is an overview of the demographic, clinical, and imaging features of the most commonly encountered superficial soft tissue sarcomas, including undifferentiated pleomorphic, leiomyosarcoma, synovial sarcoma, liposarcoma, myxofibrosarcoma, dermatofibrosarcoma protuberans, epithelioid sarcoma, and angiosarcoma. A less common but primary superficial tumor, angiomatoid fibrous histiocytoma, is also reviewed as the diagnosis may be confounding both clinically and on imaging studies.
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28
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Moy L. Top Publications in Radiology, 2022. Radiology 2023; 306:e222914. [PMID: 36625749 DOI: 10.1148/radiol.222914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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29
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Liu A, Jia X, Zhang L, Huang X, Chen W, Chen L. Diagnostic performance of preoperative ultrasound for traumatic brachial plexus root injury: A comparison study with an electrophysiology study. Front Neurol 2023; 13:1077830. [PMID: 36686523 PMCID: PMC9852902 DOI: 10.3389/fneur.2022.1077830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 11/28/2022] [Indexed: 01/07/2023] Open
Abstract
Purpose Accurate preoperative assessment for traumatic brachial plexus injury (BPI) is critical for clinicians to establish a treatment plan. The objective of this study was to investigate the diagnostic performance of preoperative ultrasound (US) through comparison with an electrophysiology study (EPS) in the assessment of traumatic brachial plexus (BP) root injury. Materials and methods We performed a retrospective study in patients with traumatic BPI who had preoperative US and EPS, excluding obstetric palsy and other nontraumatic neuropathies. US examination was performed on an EPIQ 5 color Doppler equipment. EPS was performed on a Keypoint 9033A07 Electromyograph/Evoked Potentials Equipment, testing electromyography (EMG), nerve conduction studies (NCS), and somatosensory evoked potentials (SEP). Each BP root of all patients was assessed by US and EPS as completely injured or incompletely injured, respectively. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated based on the correlation with intraoperative findings. The accuracy of US and EPS were compared using the McNemar test. The added benefit of US was evaluated by comparing the sensitivity and specificity between the combined tests with EPS using the McNemar test. Results This study included 49 patients with traumatic BPI who underwent BP surgeries from October 2018 to September 2022. Surgical exploration confirmed 89 completely injured BP roots in 28 patients. US correctly detected 80 completely injured BP roots (sensitivity, 0.899; specificity, 0.981; PPV, 0.964; NPV, 0.944; accuracy, 0.951). EPS correctly detected 75 completely injured BP roots (sensitivity, 0.843; specificity, 0.929; PPV, 0.872; NPV, 0.912; accuracy, 0.898). US showed significantly higher accuracy than EPS (p = 0.03). When combining US and EPS for completely injured BP root detection, the sensitivity of the inclusive combination (0.966) was significantly higher than EPS alone (p = 0.000977), and the specificity of the exclusive combination (1.000) was significantly higher than EPS alone (p = 0.000977). Conclusion Preoperative US is an effective diagnostic tool in the assessment of traumatic BP root injury. US had higher accuracy than EPS in this study. Sensitivity and specificity were significantly higher than EPS when US was combined with EPS.
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Affiliation(s)
- Ailin Liu
- Department of Medical Ultrasound, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaotian Jia
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Li Zhang
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaoyun Huang
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Weimin Chen
- Department of Medical Ultrasound, Huashan Hospital, Fudan University, Shanghai, China,*Correspondence: Weimin Chen ✉
| | - Lin Chen
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China,Lin Chen ✉
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30
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Crombé A, Kind M, Fadli D, Miceli M, Linck PA, Bianchi G, Sambri A, Spinnato P. Soft-tissue sarcoma in adults: Imaging appearances, pitfalls and diagnostic algorithms. Diagn Interv Imaging 2022; 104:207-220. [PMID: 36567193 DOI: 10.1016/j.diii.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/08/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
This article provides an overview of the current knowledge regarding diagnostic imaging of patients with soft-tissue sarcomas, which is a heterogeneous group of rare mesenchymal malignancies. After an initial contextualization, diagnostic flow-chart based on initial radiological findings of soft-tissue masses (with specific focus on adipocytic soft-tissue tumors [STTs], hemorragic STTs and retroperitoneal STTs) are provided considering relevant results from novel researches, guidelines, and experts' viewpoints, with the aim to help radiologists and clinicians in their practice. Particularly, the central place of sarcoma reference centers in the diagnostic and therapeutic management is highlighted, as well as the pivotal role that radiologists should play to correctly identify patients with soft-tissue sarcoma at the initial stage of the disease. Indications and methods for performing imaging-guided biopsies are also discussed, as well as clues to improve soft-tissue sarcoma grading with conventional and quantitative imaging.
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Affiliation(s)
- Amandine Crombé
- Department of Musculoskeletal Imaging, Pellegrin University Hospital, Bordeaux 33076, France; Department of Diagnostic and Interventional Oncological Imaging, Institut Bergonié, Regional Comprehensive Cancer of Nouvelle-Aquitaine, Bordeaux 33076, France; Models in Oncology (MONC) Team, INRIA Bordeaux Sud-Ouest, CNRS UMR 5251 & Bordeaux University, 33400 Talence, France.
| | - Michèle Kind
- Department of Diagnostic and Interventional Oncological Imaging, Institut Bergonié, Regional Comprehensive Cancer of Nouvelle-Aquitaine, Bordeaux 33076, France
| | - David Fadli
- Department of Musculoskeletal Imaging, Pellegrin University Hospital, Bordeaux 33076, France
| | - Marco Miceli
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna 40136, Italy
| | - Pierre-Antoine Linck
- Department of Diagnostic and Interventional Oncological Imaging, Institut Bergonié, Regional Comprehensive Cancer of Nouvelle-Aquitaine, Bordeaux 33076, France
| | - Giuseppe Bianchi
- Orthopedic Musculoskeletal Oncology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna 40136, Italy
| | - Andrea Sambri
- Orthopedics and Traumatology Department, IRCCS Azienda Ospedaliero Universitaria di Bologna, Via Massarenti 9, Bologna 40138, Italy
| | - Paolo Spinnato
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna 40136, Italy
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31
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Malik DG, Dahiya N, Young SW, Heng LXX, Patel MD. Non-Vascular Considerations When Interpreting Extremity Arterial and Venous Examinations. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:3145-3158. [PMID: 35984099 DOI: 10.1002/jum.16087] [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: 06/13/2022] [Revised: 07/29/2022] [Accepted: 08/02/2022] [Indexed: 06/15/2023]
Abstract
Peripheral arterial and venous examinations are performed regularly in vascular labs and interpreted by physicians of different specialities. Many vascular examinations have nonvascular pathology that is either inadvertently imaged by the sonographer or imaged with intent as it relates to patient's symptoms. It is prudent for every reader of vascular studies to be acquainted with the sonographic appearance of these non-vascular lesions to enable appropriate and optimal interpretation that has a direct bearing on patient's clinical care. Our review includes a discussion of the nonvascular pathologies like lymph nodes, soft tissue edema, soft tissue fluid collections, musculotendinous injuries, soft tissue masses, and joint and bursal pathologies that may be encountered during interpretation of vascular exams. The pictorial essay includes a discussion of their sonographic appearances and pitfalls in interpretation. Multiple illustrative examples and sonographic images of the non-vascular pathologies found during interpretation of vascular studies have been utilized to highlight their appearances.
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Affiliation(s)
- Dania G Malik
- Department of Radiology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Nirvikar Dahiya
- Department of Radiology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Scott W Young
- Department of Radiology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | | | - Maitray D Patel
- Department of Radiology, Mayo Clinic Arizona, Phoenix, Arizona, USA
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A Machine Learning Applied Diagnosis Method for Subcutaneous Cyst by Ultrasonography. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:1526540. [PMID: 36299601 PMCID: PMC9592196 DOI: 10.1155/2022/1526540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/19/2022] [Accepted: 09/28/2022] [Indexed: 11/18/2022]
Abstract
For decades, ultrasound images have been widely used in the detection of various diseases due to their high security and efficiency. However, reading ultrasound images requires years of experience and training. In order to support the diagnosis of clinicians and reduce the workload of doctors, many ultrasonic computer aided diagnostic systems have been proposed. In recent years, the success of deep learning in image classification and segmentation has made more and more scholars realize the potential performance improvement brought by the application of deep learning in ultrasonic computer-aided diagnosis systems. This study is aimed at applying several machine learning algorithms and develop a machine learning method to diagnose subcutaneous cyst. Clinical features are extracted from datasets and images of ultrasonography of 132 patients from Hunan Provincial People's Hospital in China. All datasets are separated into 70% training and 30% testing. Four kinds of machine learning algorithms including decision tree (DT), support vector machine (SVM), K-nearest neighbors (KNN), and neural networks (NN) had been approached to determine the best performance. Compared with all the results from each feature, SVM achieved the best performance from 91.7% to 100%. Results show that SVM performed the highest accuracy in the diagnosis of subcutaneous cyst by ultrasonography, which provide a good reference in further application to clinical practice of ultrasonography of subcutaneous cyst.
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