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Thứ Ba, 26 tháng 11, 2013

JUM 12-2013



1.    Abstract 1 of 8 Original Research
Predicting Coverage of Transverse Subcostal Sonography With the Use of Previous Computed Tomography Before a Sonographic Liver Examination
A Prospective Study
Objectives—The purpose of this study was to assess the coverage of transverse subcostal sonography in the supine position by using computed tomography (CT) performed before a sonographic liver examination as a predictor of sonographic coverage.
Methods—A total of 124 patients (87 men and 37 women; mean age, 55.55 years; range, 24–79 years) who underwent abdominal CT and subsequent liver sonography were enrolled. All patients were assessed for the coverage of transverse subcostal sonography in the supine position by consensus of 2 radiologists. We evaluated the correlation between the level of the posterior rib against the liver dome on axial CT and a sonographic coverage scoring system using Spearman partial correlation analysis. The optimal cutoff value of the liver position and other potential factors associated with sonographic coverage were analyzed.
Results—Among age, sex, body mass index, interposition of bowel around the gallbladder fossa, atrophic changes from cirrhotic liver, and liver position, liver position was the only independent factor associated with sonographic coverage (P < .001). Liver position and the sonographic coverage score were moderately negatively correlated, with statistical significance (r = −0.44; P < .001). The optimal cutoff value for the level of the hepatic dome was at the 10th posterior rib on axial CT.
Conclusions —Liver position is the only independent factor associated with the coverage of transverse subcostal sonography in the supine position. If it is above the 10th posterior rib level, we can predict difficulty in adequate sonographic coverage of the liver.
Received January 9, 2013.
o    Revision received February 26, 2013.
o    Accepted April 23, 2013.
o    © 2013 by the American Institute of Ultrasound in Medicine
2.    Abstract 2 of 8 Original Research
Sonographic Findings Predictive of Central Lymph Node Metastasis in Patients With Papillary Thyroid Carcinoma
Influence of Associated Chronic Lymphocytic Thyroiditis on the Diagnostic Performance of Sonography
Objectives—To analyze sonographic findings suggesting central lymph node metastasis of papillary thyroid carcinoma and to evaluate the influence of associated chronic lymphocytic thyroiditis on the diagnostic performance of sonography for predicting central lymph node metastasis.
Methods—A total of 124 patients (101 female and 23 male; mean age, 47.5 years; range, 21–74 years) underwent sonographically guided fine-needle aspiration in central lymph nodes from January 2008 to July 2011. Sonographic features of size, shape, margin, thickening of the cortex, cortical echogenicity, presence of a hilum, cystic changes, calcification, and vascularity of enlarged lymph nodes were analyzed before fine-needle aspiration and classified into 2 categories (probably benign and suspicious). Sonographic findings were correlated with the pathologic diagnosis and associated chronic lymphocytic thyroiditis. Receiver operating characteristic curve analysis was performed to assess the diagnostic performance of sonography for predicting central lymph node metastasis according to the associated thyroiditis.
Results—Fifty-one lymph nodes (39.5%) were malignant, and 73 (60.5%) were benign. On univariate analysis, size, shape, margin, cortical thickening, cortical echogenicity, cystic changes, calcification, and vascularity were significantly different between the benign and metastatic nodes (P < .05). On multivariate analysis, eccentric cortical thickening (odds ratio, 26.59; 95% confidence interval [CI], 3.26–216.66) and hyper echogenicity of the cortex (odds ratio, 18.46; 95% CI, 2.44–139.64) were significantly associated with malignant nodes (P < .05). The area under the curve values for sonography for predicting metastasis were 0.756 (95% CI, 0.618–0.894) in chronic lymphocytic thyroiditis–positive patients and 0.971 (95% CI, 0.938–1.000) in negative patients.
Conclusions—Eccentric cortical thickening and cortical hyperechogenicity were the sonographic findings predictive of central lymph node metastasis from papillary thyroid carcinoma. The diagnostic performance of sonography for predicting metastasis was superior in chronic lymphocytic thyroiditis–negative patients than in positive patients.
o    Received April 1, 2013.
o    Revision received April 15, 2013.
o    Accepted April 18, 2013.
o    © 2013 by the American Institute of Ultrasound in Medicine
3.    Abstract 3 of 8 Original Research
Low Nondiagnostic Rate for Fine-Needle Capillary Sampling Biopsy of Thyroid Nodules
A Singular Experience
Objectives—This study examined the hypothesis that sonographically guided fine-needle capillary thyroid biopsies performed by an experienced operator and with constant technique on nodules that meet the Society of Radiologists in Ultrasound criteria warranting biopsy can result in a nondiagnostic rate that is significantly lower than prior published reports.
Methods—We retrospectively reviewed the sonographic and pathologic reports from 228 consecutive sonographically guided fine-needle capillary thyroid biopsies performed during a 3-year interval by a single operator with more than 15 years of experience performing fine-needle capillary thyroid biopsies. There were no exclusion criteria. Sonographic and pathologic reports from all nodules biopsied were included in the analysis. The radiologist’s protocol included 6 fine-needle capillary biopsies, each with 20 passes of the needle into the periphery and/or solid components of the nodule. The cytologic specimens were reviewed off-site in adherence with the Bethesda system for reporting thyroid cytopathologic findings and classified as diagnostic or nondiagnostic. The nondiagnostic rate in this study was compared with the nondiagnostic rates in prior published reports.
Results—Among the 228 fine-needle capillary thyroid biopsies performed during the study interval, cytologic analysis showed 1 nondiagnostic biopsy, yielding a nondiagnostic rate of 0.4%. This rate was significantly lower than previously published reports (P < .001).
Conclusions—Sonographically guided fine-needle capillary biopsies of the thyroid performed by an experienced radiologist can result in a nondiagnostic rate of less than 1%. This finding warrants further investigation into the reasons for the discrepancy between the results of this study and other previous reports.
o    Received February 13, 2013.
o    Revision received March 7, 2013.
o    Accepted April 29, 2013.
o    © 2013 by the American Institute of Ultrasound in Medicine
4.    Abstract 4 of 8 Original Research
Shear Wave Elastography for Differentiation of Benign and Malignant Thyroid Nodules
A Meta-analysis
Objectives—The purpose of this study was to assess the performance of shear wave elastography for identification of benign and malignant thyroid nodules using meta-analysis.
Methods—PubMed, MEDLINE, Embase, the Cochrane Library, and the China National Knowledge Infrastructure were searched. Patients’ clinical characteristics, sensitivity, specificity, positive predictive value, and negative predictive value were extracted. The diagnostic odds ratio and summary receiver operating characteristic curve were used to examine the accuracy of shear wave elastography. A meta-analysis was performed to evaluate the clinical utility of shear wave elastography for identification of benign and malignant thyroid nodules.
Results—The summary sensitivity and specificity for the diagnosis of malignant thyroid nodules by shear wave elastography were 0.84 (95% confidence interval [CI], 0.76–0.90) and 0.90 (95% CI, 0.87–0.92), respectively. The pooled positive likelihood ratio was 7.39 (95% CI, 4.09–13.35), and the negative likelihood ratio was 0.20 (95% CI, 0.13–0.29). The summary diagnostic odds ratio was 41.35 (95% CI, 17.38–98.41), and the summary area under the receiver operating characteristic curve was 0.92 (Q* = 0.8538).
Conclusions—Shear wave elastography has high sensitivity and specificity in the evaluation of thyroid nodules and can potentially reduce unnecessary fine-needle aspiration biopsies.
o    Received February 26, 2013.
o    Revision received March 18, 2013.
o    Accepted April 22, 2013.
o    © 2013 by the American Institute of Ultrasound in Medicine
5.    Abstract 5 of 8 Original Research
Application of Real-time Ultrasound Elastography for Differential Diagnosis of Breast Tumors
Objectives—The purpose of this study was to explore the clinical value of real-time ultrasound elastography in differentiating malignant from benign breast tumors and to determine an optimal cutoff for the traced area ratio by receiver operator characteristic (ROC) analysis for differential diagnosis between malignant and benign breast masses.
Methods—From October 2010 to June 2011, 102 patients with 192 breast tumors were enrolled. Conventional sonograms and real-time elastograms were obtained from the patients. The sensitivity, specificity, and accuracy rates for sonography and elastography were calculated, and an ROC analysis was performed.
Results—Tumors with an elasticity grade of 4 or higher were defined as malignant. The sensitivity, specificity, and accuracy of elastography were 92.65%, 73.39%, and 81.25%, respectively. These values were similar to those for conventional sonography. However, when the techniques were combined, the sensitivity, specificity, and accuracy increased to 88.23%, 95.97%, and 93.23%. A value of 1.65 was determined to be the traced area ratio cutoff by the ROC analysis and was used in this study for differential diagnosis. The sensitivity, specificity, and accuracy of this value were 76.47%, 96.77%, and 89.58%, respectively.
Conclusions—Both conventional sonography and ultrasound elastography could be used to differentiate malignant and benign breast tumors. If these techniques were combined, the diagnostic values would improve. In addition, a traced area ratio of 1.65 could be used as a cutoff to differentiate benign and malignant breast tumors.
o    Received April 8, 2013.
o    Revision received April 22, 2013.
o    Accepted April 29, 2013.
o    © 2013 by the American Institute of Ultrasound in Medicine
6.    Abstract 6 of 8 Original Research
Comparison of Sonography With Sonographically Guided Fine-Needle Aspiration Biopsy and Core-Needle Biopsy for Initial Axillary Staging of Breast Cancer
Objectives—The purpose of this study was to determine the roles of sonography and sonographically guided fine-needle aspiration biopsy and core-needle biopsy for initial axillary staging of breast cancer.
Methods—Of 220 patients with breast cancer who underwent preoperative or prechemotherapy sonography for axillary staging, 52 patients who underwent sonographically guided fine-needle aspiration biopsy and core-needle biopsy for cortical thickening or a compressed hilum of lymph nodes on sonography were prospectively enrolled. Sonography and fine-needle aspiration biopsy/core-needle biopsy findings were compared with final pathologic results from sentinel lymph node biopsy or axillary lymph node dissection.
Results—Forty-eight patients met the final study criteria; we excluded 4 who had received primary systemic chemotherapy and showed negative fine-needle aspiration biopsy/core-needle biopsy results and negative final postoperative pathologic results. The positive predictive value of axillary sonography was 54%. The sensitivity and specificity of fine-needle aspiration biopsy were 73% and 100%, respectively, and those of core-needle biopsy were 77% and 100%. Results did not differ significantly between sonographically guided core-needle biopsy and fine-needle aspiration biopsy. The complication rates of fine-needle aspiration biopsy and core-needle biopsy were both 4%, and fine-needle aspiration biopsy and core-needle biopsy cost $180 and $350, respectively.
Conclusions—Both sonographically guided fine-needle aspiration biopsy and core-needle biopsy were useful for axillary staging of breast cancer with high sensitivity. However, fine-needle aspiration biopsy is recommended based on the advantages of low cost and minimal invasiveness.
o    Received March 18, 2013.
o    Revision received April 16, 2013.
o    Accepted April 29, 2013.
o    © 2013 by the American Institute of Ultrasound in Medicine
7.    Abstract 7 of 8  Technical Innovation
Automated B-Line Scoring on Thoracic Sonography
With the proliferation of portable sonography and the increase in nontraditional users, there is an increased need for automated decision support to standardize results. We developed algorithms to evaluate the presence or absence of “B-lines” on thoracic sonography as a marker for interstitial fluid. Algorithm performance was compared against an average of scores from 2 expert clinical sonographers. On the set for algorithm development, 90% of the scores matched the average expert scores with differences of 1 or less. On the independent set, a perfect match was achieved. We believe that these are the first reported results in computerized B-line scoring.
o     
o    Received March 18, 2013.
o    Revision received April 16, 2013.
o    Accepted May 14, 2013.
o    © 2013 by the American Institute of Ultrasound in Medicine
8.    Abstract 8 of 8  Technical Innovation
Sonographically Guided Lumbar Puncture in Pediatric Patients
Our aim with this study was to develop a user-friendly method for pediatric sonographically guided lumbar punctures so that we can visualize intrathecal anatomy, confirm intrathecal injection at the time of injection, and, most importantly, avoid ionizing radiation to a child’s already radiosensitive pelvis. Sonographically guided lumbar puncture was prospectively performed in children aged 7 weeks to 16 years. All attempts (n = 9) were successful. We were able to identify relevant anatomy (including the conus in children 10 years and younger), confirm intrathecal injection, visualize intrathecal hematoma, and avoid radiation. Sonography is a promising modality for image-guided lumbar punctures without radiation in children.
o    Received February 5, 2013.
o    Revision received February 25, 2013.
o    Accepted April 22, 2013.
o    © 2013 by the American Institute of Ultrasound in Medicine

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