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To explore the predictive value of the nomogram model based on multimodal ultrasound features for benign and malignant thyroid nodules of C-TIRADS category 4. A retrospective analysis was conducted on the general conditions and ultrasound features of patients who underwent thyroid ultrasound examination and fine needle aspiration biopsy (FNA) or thyroidectomy at the Affiliated Hospital of Zunyi Medical University from April 2020 to April 2023. Predictive signs for benign and malignant nodules of thyroid C-TIRADS category 4 were screened through LASSO regression and multivariate logistic regression analysis to construct a nomogram prediction model. The predictive efficiency and accuracy of the model were assessed through ROC curves and calibration curves. Seven independent risk factors in the predictive model for benign and malignant thyroid nodules of C-TIRADS category 4 were growth pattern, morphology, microcalcifications, SR, arterial phase enhancement intensity, initial perfusion time, and PE [%]. Based on these features, the area under the curve (AUC) of the constructed prediction model was 0.971 (p ＜.001, 95% CI: 0.952–0.989), with a prediction accuracy of 93.1%. Internal validation showed that the nomogram calibration curve was consistent with reality, and the decision curve analysis indicated that the model has high clinical application value. The nomogram prediction model constructed based on the multimodal ultrasound features of thyroid nodules of C-TIRADS category 4 has high clinical application value. [ABSTRACT FROM AUTHOR]

Background: It is challenging to correctly identify and diagnose breast nonmass lesions. This study aimed to explore the multimodal ultrasound features associated with malignant breast nonmass lesions (NMLs), and evaluate their combined diagnostic performance. Methods: This retrospective analysis was conducted on 573 breast NMLs, including 309 were benign and 264 were malignant, their multimodal ultrasound features (B-mode, color Doppler and strain elastography) were assessed by two experienced radiologists. Univariate and multivariate logistic regression analysises were used to explore multimodal ultrasound features associated with malignancy, and a nomogram was developed. Diagnostic performance and clinical utility were evaluated and validated by the receiver operating characteristic (ROC) curve, calibration curve and decision curve in the training and validation cohorts. Results: Multimodal ultrasound features including linear (odds ratio [OR] = 4.69) or segmental distribution (OR = 7.67), posterior shadowing (OR = 3.14), calcification (OR = 7.40), hypovascularity (OR = 0.38), elasticity scored 4 (OR = 7.00) and 5 (OR = 15.77) were independent factors associated with malignant breast NMLs. The nomogram based on these features exhibited diagnostic performance in the training and validation cohorts were comparable to that of experienced radiologists, with superior specificity (89.4%, 89.5% vs. 81.2%) and positive predictive value (PPV) (89.2%, 90.4% vs. 82.4%). The nomogram also demonstrated good calibration in both training and validation cohorts (all P > 0.05). Decision curve analysis indicated that interventions guided by the nomogram would be beneficial across a wide range of threshold probabilities (0.05-1 in the training cohort and 0.05–0.93 in the validation cohort). Conclusions: The combined use of linear or segmental distribution, posterior shadowing, calcification, hypervascularity and high elasticity score, displayed as a nomogram, demonstrated satisfied diagnostic performance for malignant breast NMLs, which may contribute to the imaging interpretation and clinical management of tumors. [ABSTRACT FROM AUTHOR]

Objective:To explore the value of multimodal ultrasound combined assessment of carotid artery plaque vulnerability in patients with coronary heart disease. Methods: From February 2022 to December 2023, 110 patients with coronary artery stenosis caused by coronary atherosclerosis who were diagnosed by coronary angiography in the Neurodiagnostic Department of the Second Affiliated Hospital of Chengde Medical College were selected as the research objects. According to the plaque nature, carotid plaque was divided into vulnerable plaque group (n=35) and stable plaque group (n=75). The properties of carotid plaque were studied by conventional carotid ultrasound, shear wave elastography and contrast-enhanced ultrasound, and the differences of different parameters were compared; Multivariate logistic regression analysis was conducted to identify independent risk factors for the vulnerability of carotid artery plaques in coronary heart disease, and ROC curves were plotted. Results: There was a statistically significant difference in age, history of hypertension, smoking history, LDL-C, Hcy, and hs CRP between the two groups of patients (P<0.05); The difference in echo, extremely low echo, calcification, and calcified nodules between the two groups of patients was statistically significant (P<0.05); The average, minimum, and maximum Young's modulus of the stable plaque group were higher than those of the control group, and the difference was statistically significant (P<0.05); Age, history of hypertension, smoking history, LDL-C, Hcy, hs CRP, degree of contrast-enhanced ultrasound, calcified nodules, plaque echo, and mean shear wave elastic Young's modulushave an impact on the vulnerability of carotid plaques in coronary heart disease. Conclusion: The combined application of multimodal ultrasound can effectively improve the vulnerability of carotid plaques in patients with coronary heart disease, providing important reference for clinical diagnosis and treatment. [ABSTRACT FROM AUTHOR]

This study included 468 patients and aimed to use multimodal ultrasound radiomic technology to predict the malignancy of TI-RADS 4-5 thyroid nodules. First, radiomic features are extracted from conventional two-dimensional ultrasound (transverse ultrasound and longitudinal ultrasound), strain elastography (SE), and shear-wave-imaging (SWE) images. Next, the least absolute shrinkage and selection operator (LASSO) is used to screen out features related to malignant tumors. Finally, a support vector machine (SVM) is used to predict the malignancy of thyroid nodules. The Shapley additive explanation (SHAP) method was used to intuitively analyze the specific contributions of radiomic features to the model's prediction. Our proposed model has AUCs of 0.971 and 0.856 in the training and testing sets, respectively. Our proposed model has a higher prediction accuracy compared to those of models with other modal combinations. In the external validation set, the AUC of the model is 0.779, which proves that the model has good generalization ability. Moreover, SHAP analysis was used to examine the overall impacts of various radiomic features on model predictions and local explanations for individual patient evaluations. Our proposed multimodal ultrasound radiomic model can effectively integrate different data collected using multiple ultrasound sensors and has good diagnostic performance for TI-RADS 4-5 thyroid nodules. [ABSTRACT FROM AUTHOR]

Abstract Background It is challenging to correctly identify and diagnose breast nonmass lesions. This study aimed to explore the multimodal ultrasound features associated with malignant breast nonmass lesions (NMLs), and evaluate their combined diagnostic performance. Methods This retrospective analysis was conducted on 573 breast NMLs, including 309 were benign and 264 were malignant, their multimodal ultrasound features (B-mode, color Doppler and strain elastography) were assessed by two experienced radiologists. Univariate and multivariate logistic regression analysises were used to explore multimodal ultrasound features associated with malignancy, and a nomogram was developed. Diagnostic performance and clinical utility were evaluated and validated by the receiver operating characteristic (ROC) curve, calibration curve and decision curve in the training and validation cohorts. Results Multimodal ultrasound features including linear (odds ratio [OR] = 4.69) or segmental distribution (OR = 7.67), posterior shadowing (OR = 3.14), calcification (OR = 7.40), hypovascularity (OR = 0.38), elasticity scored 4 (OR = 7.00) and 5 (OR = 15.77) were independent factors associated with malignant breast NMLs. The nomogram based on these features exhibited diagnostic performance in the training and validation cohorts were comparable to that of experienced radiologists, with superior specificity (89.4%, 89.5% vs. 81.2%) and positive predictive value (PPV) (89.2%, 90.4% vs. 82.4%). The nomogram also demonstrated good calibration in both training and validation cohorts (all P > 0.05). Decision curve analysis indicated that interventions guided by the nomogram would be beneficial across a wide range of threshold probabilities (0.05-1 in the training cohort and 0.05–0.93 in the validation cohort). Conclusions The combined use of linear or segmental distribution, posterior shadowing, calcification, hypervascularity and high elasticity score, displayed as a nomogram, demonstrated satisfied diagnostic performance for malignant breast NMLs, which may contribute to the imaging interpretation and clinical management of tumors.

Background: Sentinel lymph node metastasis (SLNM) is a critical factor in the prognosis and treatment planning for breast cancer (BC), as it indicates the potential spread of cancer to other parts of the body. The accurate prediction and diagnosis of SLNM are essential for improving clinical outcomes and guiding treatment decisions. Objective: This study aimed to construct a Lasso regression model by integrating multimodal ultrasound (US) techniques, including US, shear wave elastography (SWE), and contrast-enhanced ultrasound (CEUS), to improve the predictive accuracy of sentinel lymph node metastasis in breast cancer and provide more precise guidance for clinical treatment. Results: A total of 253 eligible samples were screened, of which 148 were group benign and 105 were group malignant. There were statistically significant differences (p < 0.05) between group malignant patients in terms of age, palpable mass, body mass index, distance to nipple, maximum diameter, blood flow, microcalcification, 2D border, 2D morphology, and 2D uniformity and group benign. The Lasso regression model was useful in the diagnosis of benign and malignant nodules with an AUC of 0.966 and in diagnosing SLNM with an AUC of 0.832. Conclusion: In this study, we successfully constructed and validated a Lasso regression model based on the multimodal ultrasound technique for predicting whether SLNM occurs in BCs, showing high diagnostic accuracy. [ABSTRACT FROM AUTHOR]

Papillary thyroid carcinoma (PTC), the predominant pathological type among thyroid malignancies, is responsible for the sharp increase in thyroid cancer. Although PTC is an indolent tumor with good prognosis, 60–70% of patients still have early cervical lymph node metastasis, typically in the central compartment. Whether there is central lymph node metastasis (CLNM) or not directly affects the formulation of preoperative surgical procedures, given that such metastases have been tied to compromised overall survival and local recurrence. However, detecting CLNM before operation can be challenging due to the limited sensitivity of preoperative approaches. Prophylactic central lymph node dissection (PCLND) in the absence of clinical evidence of CLNM poses additional surgical risks. This study aims to provide a comprehensive review of the risk factors related to CLNM in PTC patients. A key focus is on utilizing multimodal ultrasound (US) for accurate prognosis of preoperative CLNM and to highlight the distinctive role of US-based characteristics for predicting CLNM. [ABSTRACT FROM AUTHOR]

We report a case of a 48‐year‐old man with testicular infarction caused by epididymo‐orchitis (EO). Multimodal ultrasound showed extensive necrosis of the testis, and the patient underwent right orchiectomy. Postoperative pathology confirmed extensive necrosis of the testis. After 3 months of follow‐up, the examination of scrotal ultrasound showed that the left testis and epididymis had no obvious abnormality. [ABSTRACT FROM AUTHOR]

Purpose: Idiopathic granulomatous mastitis (IGM) poses diagnostic challenges due to its diverse clinical and radiological presentations, often mimicking malignancies. This study aimed to assess the diagnostic efficacy of multimodal ultrasound for mass and non-mass enhancements in Dynamic Contrast-Enhanced MRI (DCE-MRI) of IGM and breast cancer. Methods: A retrospective analysis involved patients confirmed histopathologically with IGM and BC. All patients underwent conventional ultrasound (C-US), ultrasound elastography (UE), contrast-enhanced ultrasound (CEUS), and DCE-MRI examinations. Blinded experienced radiologists assessed imaging findings. Diagnostic accuracy, sensitivity, and specificity were calculated for mass and non-mass enhancements. Results: For mass enhancements (ME), multimodal ultrasound demonstrated strong efficacy (AUC = 0.8651, 95 % CI: 0.7431 to 0.9871), exhibiting high sensitivity (83.3 %) and specificity (92.4 %) in differentiating IGM from breast cancer. However, for non-mass enhancements (NME), multimodal ultrasound showed limited accuracy (AUC = 0.6306) with lower sensitivity (65.6 %) and specificity (81.2 %) in distinguishing between IGM and breast cancer. Conclusion: Multimodal ultrasound displayed good diagnostic efficacy for mass enhancements in DCE-MRI for IGM and breast cancer, while for non-mass enhancement patterns, DCE-MRI remains the most valuable radiological modality for comprehensively assessing this condition's complexities.

Secretory carcinoma of the breast (SCB) is a rare and specific type of breast cancer. Owing to its rarity, the number of SCB reports available is limited, with most of them focusing on clinical and pathological characteristics but no reports on its multimodal ultrasound (US) features. Thus, we present a rare case of SCB, retrospectively analyzing manifestations of US and contrast-enhanced US, as well as its pathological basis, aiming to enhance the understanding of US image features of SCB and provide more valuable information for clinical diagnosis. Moreover, the treatment strategy adopted for this patient may serve as a template for future management of SCB. [ABSTRACT FROM AUTHOR]

A cohort of 60 breast cancer patients undergoing neoadjuvant chemotherapy (NAC) from January 2021 to December 2022 was studied at the First Affiliated Hospital of Xinjiang Medical University. Multimodal ultrasound examinations were conducted before and after NAC. Levels of B-lymphocytoma-2 (BCL-2) and Ki-67 were assessed through immunohistochemistry both before NAC and during radical mastectomy. Based on the Miller-Payne system, the efficacy of NAC in these patients was categorized into pathologic complete remission (pCR) and non-complete remission (npCR). It was found that: Pathological evaluation postoperatively revealed that 26 patients achieved pCR, while 34 experienced npCR following NAC. In both pCR and npCR groups, significant reductions in lesion diameter, peak intensity (PI), area under the curve (AUC) and elasticity score were observed post-NAC, as well as an increase in Strain Ratio (SR). These changes were more pronounced in the pCR group, with statistically significant differences (p < 0.05). Post-NAC, an increase in BCL-2 and a decrease in Ki-67 expression were observed in both groups, although these changes were not statistically significant (p>0.05). Receiver operating characteristic (ROC) curves and multifactorial regression analysis identified lesion diameter, PI and AUC as significant predictors of NAC efficacy in breast cancer patients. [ABSTRACT FROM AUTHOR]

Abstract Background Ultrasonography (US) still has some limitations in the differentiation of benign and malignant breast masses. Therefore, we introduced new technologies such as S-Detect, microvascular flow imaging (MVFI), and strain elastography (SE) into the examination and compared the multimodal method with Breast Imaging Reporting and Data System (BI-RADS). Objectives This prospective study aimed to evaluate the value of multimodal diagnostic methods that add S-Detect, MFI, and SR to US in differentiating benign from malignant breast masses. Methods We recruited 186 patients with 189 masses between July 2021 and March 2022. The masses were examined using US, S-Detect, SR, and MFI before biopsy, and the benign and malignant differentiation value of each and their combination were assessed compared with surgical pathology results using the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Subgroup analysis by lesion size was also performed. Results The respective optimal cutoff values of SR and MFI for differentiating benign from malignant masses were 3.15 and 2.45, respectively, and the sensitivity and specificity were 79.3% and 85.6% and 94.6% and 69.1%, respectively. The multimodal AUC (0.907), sensitivity (97.8%), accuracy (90.5%), PPV (84.9%), and NPV (97.6%) were larger than those of each modality (p

Background Not only should resistance to neoadjuvant chemotherapy (NAC) be considered in patients with breast cancer but also the possibility of achieving a pathologic complete response (PCR) after NAC. Our study aims to develop 2 multimodal ultrasound deep learning (DL) models to noninvasively predict resistance and PCR to NAC before treatment. Methods From January 2017 to July 2022, a total of 170 patients with breast cancer were prospectively enrolled. All patients underwent multimodal ultrasound examination (grayscale 2D ultrasound and ultrasound elastography) before NAC. We combined clinicopathological information to develop 2 DL models, DL_Clinical_resistance and DL_Clinical_PCR, for predicting resistance and PCR to NAC, respectively. In addition, these 2 models were combined to stratify the prediction of response to NAC. Results In the test cohort, DL_Clinical_resistance had an AUC of 0.911 (95%CI, 0.814-0.979) with a sensitivity of 0.905 (95%CI, 0.765-1.000) and an NPV of 0.882 (95%CI, 0.708-1.000). Meanwhile, DL_Clinical_PCR achieved an AUC of 0.880 (95%CI, 0.751-0.973) and sensitivity and NPV of 0.875 (95%CI, 0.688-1.000) and 0.895 (95%CI, 0.739-1.000), respectively. By combining DL_Clinical_resistance and DL_Clinical_PCR, 37.1% of patients with resistance and 25.7% of patients with PCR were successfully identified by the combined model, suggesting that these patients could benefit by an early change of treatment strategy or by implementing an organ preservation strategy after NAC. Conclusions The proposed DL_Clinical_resistance and DL_Clinical_PCR models and combined strategy have the potential to predict resistance and PCR to NAC before treatment and allow stratified prediction of NAC response. [ABSTRACT FROM AUTHOR]

Objectives To build a predictive model for central lymph node metastasis (CLNM) in unifocal papillary thyroid carcinoma (UPTC) using a combination of clinical features and multimodal ultrasound (MUS). Methods This retrospective study, included 390 UPTC patients who underwent MUS between January 2017 and October 2022 and were divided into a training cohort (n  = 300) and a validation cohort (n  = 90) based on a cut-off date of June 2022. Independent indicators for constructing the predictive nomogram models were identified using multivariate regression analysis. The diagnostic yield of the 3 predictive models was also assessed using the area under the receiver operating characteristic curve (AUC). Results Both clinical factors (age, diameter) and MUS findings (microcalcification, virtual touch imaging score, maximal value of virtual touch tissue imaging and quantification) were significantly associated with the presence of CLNM in the training cohort (all P  < .05). A predictive model (MUS + Clin), incorporating both clinical and MUS characteristics, demonstrated favourable diagnostic accuracy in both the training cohort (AUC = 0.80) and the validation cohort (AUC = 0.77). The MUS + Clin model exhibited superior predictive performance in terms of AUCs over the other models (training cohort 0.80 vs 0.72, validation cohort 0.77 vs 0.65, P  < .01). In the validation cohort, the MUS + Clin model exhibited higher sensitivity compared to the CLNM model for ultrasound diagnosis (81.2% vs 21.6%, P  < .001), while maintaining comparable specificity to the Clin model alone (62.3% vs 47.2%, P  = .06). The MUS + Clin model demonstrated good calibration and clinical utility across both cohorts. Conclusion Our nomogram combining non-invasive features, including MUS and clinical characteristics, could be a reliable preoperative tool to predict CLNM treatment of UPTC. Advances in knowledge Our study established a nomogram based on MUS and clinical features for predicting CLNM in UPTC, facilitating informed preoperative clinical management and diagnosis. [ABSTRACT FROM AUTHOR]

This study included 468 patients and aimed to use multimodal ultrasound radiomic technology to predict the malignancy of TI-RADS 4-5 thyroid nodules. First, radiomic features are extracted from conventional two-dimensional ultrasound (transverse ultrasound and longitudinal ultrasound), strain elastography (SE), and shear-wave-imaging (SWE) images. Next, the least absolute shrinkage and selection operator (LASSO) is used to screen out features related to malignant tumors. Finally, a support vector machine (SVM) is used to predict the malignancy of thyroid nodules. The Shapley additive explanation (SHAP) method was used to intuitively analyze the specific contributions of radiomic features to the model’s prediction. Our proposed model has AUCs of 0.971 and 0.856 in the training and testing sets, respectively. Our proposed model has a higher prediction accuracy compared to those of models with other modal combinations. In the external validation set, the AUC of the model is 0.779, which proves that the model has good generalization ability. Moreover, SHAP analysis was used to examine the overall impacts of various radiomic features on model predictions and local explanations for individual patient evaluations. Our proposed multimodal ultrasound radiomic model can effectively integrate different data collected using multiple ultrasound sensors and has good diagnostic performance for TI-RADS 4-5 thyroid nodules.

Papillary thyroid carcinoma (PTC), the predominant pathological type among thyroid malignancies, is responsible for the sharp increase in thyroid cancer. Although PTC is an indolent tumor with good prognosis, 60–70% of patients still have early cervical lymph node metastasis, typically in the central compartment. Whether there is central lymph node metastasis (CLNM) or not directly affects the formulation of preoperative surgical procedures, given that such metastases have been tied to compromised overall survival and local recurrence. However, detecting CLNM before operation can be challenging due to the limited sensitivity of preoperative approaches. Prophylactic central lymph node dissection (PCLND) in the absence of clinical evidence of CLNM poses additional surgical risks. This study aims to provide a comprehensive review of the risk factors related to CLNM in PTC patients. A key focus is on utilizing multimodal ultrasound (US) for accurate prognosis of preoperative CLNM and to highlight the distinctive role of US-based characteristics for predicting CLNM.

Abstract Background There is a recognized need for additional approaches to improve the accuracy of extrathyroidal extension (ETE) diagnosis in papillary thyroid carcinoma (PTC) before surgery. Up to now, multimodal ultrasound has been widely applied in disease diagnosis. We investigated the value of radiomic features extracted from multimodal ultrasound in the preoperative prediction of ETE. Methods We retrospectively pathologically confirmed PTC lesions in 235 patients from January 2019 to April 2022 in our hospital, including 45 ETE lesions and 205 non-ETE lesions. MaZda software was employed to obtain radiomics parameters in multimodal sonography. The most valuable radiomics features were selected by the Fisher coefficient, mutual information, probability of classification error and average correlation coefficient methods (F + MI + PA) in combination with the least absolute shrinkage and selection operator (LASSO) method. Finally, the multimodal model was developed by incorporating the clinical records and radiomics features through fivefold cross-validation with a linear support vector machine algorithm. The predictive performance was evaluated by sensitivity, specificity, accuracy, F1 scores and the area under the receiver operating characteristic curve (AUC) in the training and test sets. Results A total of 5972 radiomics features were extracted from multimodal sonography, and the 13 most valuable radiomics features were selected from the training set using the F + MI + PA method combined with LASSO regression. The multimodal prediction model yielded AUCs of 0.911 (95% CI 0.866–0.957) and 0.716 (95% CI 0.522–0.910) in the cross-validation and test sets, respectively. The multimodal model and radiomics model showed good discrimination between ETE and non-ETE lesions. Conclusion Radiomics features based on multimodal ultrasonography could play a promising role in detecting ETE before surgery.

Objective: To investigate the diagnostic utility of multimodal ultrasound for fetal bowel dilatation (FBD) in different parts of the bowel and to examine its prognostic potential in FBD. Methods: This retrospective study analyzed 86 fetuses with a dilated bowel identified via ultrasound in a 10-month postnatal follow-up. Both two- and three dimensional (2D and 3D, respectively) ultrasound volume imaging were used to characterize dilation across different bowel sections. The optimal intestinal diameter cut-off values for pathological bowel dilatation were determined and a predictive model for neonatal surgery was developed. Results: The 86 cases of dilatation were distributed as follows: duodenal (n = 36); jejunum/ileum (n = 35); and colonic (n = 15). Duodenal dilatations presented the earliest during pregnancy compared to the other 2 groups (24.4 versus [vs.] 29 vs. 33.7 weeks respectively; p

Recent advances in the field of ultrasonography offer promising tools for the evaluation of liver tumors. We aim to assess the value of multimodal ultrasound in differentiating hepatocellular carcinomas (HCCs) from other liver lesions. We prospectively included 66 patients with 72 liver tumors. The histological analysis was the reference standard for the diagnosis of malignant liver lesions, and partially for benign tumors. All liver lesions were assessed by multiparametric ultrasound: standard ultrasound, contrast-enhanced ultrasound (CEUS), the point shear wave elastography (pSWE) using shear wave measurement (SWM) method and real-time tissue elastography (RTE). To diagnose HCCs, CEUS achieved a sensitivity, specificity, accuracy and positive predictive value (PPV) of 69.05%, 92.86%, 78.57% and 93.55%, respectively. The mean shear-wave velocity (Vs) value in HCCs was 1.59 ± 0.29 m/s, which was lower than non-HCC malignancies (p < 0.05). Using a cut-off value of 1.58 m/s, SWM achieved a sensitivity of 54.76%, and 82.35% specificity, for differentiating HCCs from other malignant lesions. The combination of SWM and CEUS showed higher sensitivity (79.55%) compared with each technique alone, while maintaining a high specificity (89.29%). In RTE, most HCCs (61.53%) had a mosaic pattern with dominant blue areas corresponding to type "c" elasticity. Elasticity type "c" was 70.59% predictive for HCCs. In conclusion, combining B-mode ultrasound, CEUS, pSWE and RTE can provide complementary diagnostic information and potentially decrease the requirements for other imaging modalities. [ABSTRACT FROM AUTHOR]

Artificial intelligence (AI)-based radiomics has attracted considerable research attention in the field of medical imaging, including ultrasound diagnosis. Ultrasound imaging has unique advantages such as high temporal resolution, low cost, and no radiation exposure. This renders it a preferred imaging modality for several clinical scenarios. This review includes a detailed introduction to imaging modalities, including Brightness-mode ultrasound, color Doppler flow imaging, ultrasound elastography, contrast-enhanced ultrasound, and multi-modal fusion analysis. It provides an overview of the current status and prospects of AI-based radiomics in ultrasound diagnosis, highlighting the application of AI-based radiomics to static ultrasound images, dynamic ultrasound videos, and multi-modal ultrasound fusion analysis. [ABSTRACT FROM AUTHOR]

Objective To investigate the difference of multimodal ultrasound parameters between thyroid carcinoma and benign thyroid nodules in imaging and the independent risk factors of malignant nodules. Methods Sixty patients with thyroid carcinoma who underwent surgical treatment and confirmed by postoperative pathology in Baoding No.2 Central Hospital from January 2020 to December 2022 were retrospectively selected as the malignant group, and sixty patients with benign thyroid nodules during the same period were selected as the nodule group. Conventional ultrasound signs, contrast-enhanced ultrasound (CEUS) signs, and shear wave elastography (SWE) signs were compared between the two groups, and a multivariate logistic regression analysis was performed to identify independent risk factors for thyroid malignant nodules. Results There were significant differences in nodule morphology, echo, composition, aspect ratio, boundary, calcification, cervical lymph node characteristics and blood flow of conventional ultrasound signs between the two groups (P＜0.05). There were significant differences in enhancement pattern, enhancement boundary, enhancement level, enhancement uniformity, enhancement mode and exit mode of CEUS between two groups (P＜0.05). The maximum and average values of SWE Young's modulus in the longitudinal and transverse sections of the malignant group were higher than those of the nodule group (P＜0.05). There was statistical difference in SWE image classification between the two groups (P＜0.05). Logistic regression analysis showed that conventiona ultrasound signs micro-calcification (OR=6.435, 95% CI: 4.115-10.063), CEUS centripetal enhancement (OR=5.257, 95%CI:2.857-9.674), and higher SWE Young's modulus longitudinal maximum value (OR=5.120, 95% CI： 3.026-8.663) were independent risk factors for malignant nodules (P＜0.05). Conclusion Conventional ultrasound signs micro-calcification, CEVS enhanced centrality and high maximum profile of SWE Young's modulus are independent ultrasonic risk factors of thyroid nodules. The combined application of ultrasonic multimode is expected to further improve the accuracy of qualitative diagnosis of thyroid nodules.

Background: There is a recognized need for additional approaches to improve the accuracy of extrathyroidal extension (ETE) diagnosis in papillary thyroid carcinoma (PTC) before surgery. Up to now, multimodal ultrasound has been widely applied in disease diagnosis. We investigated the value of radiomic features extracted from multimodal ultrasound in the preoperative prediction of ETE. Methods: We retrospectively pathologically confirmed PTC lesions in 235 patients from January 2019 to April 2022 in our hospital, including 45 ETE lesions and 205 non-ETE lesions. MaZda software was employed to obtain radiomics parameters in multimodal sonography. The most valuable radiomics features were selected by the Fisher coefficient, mutual information, probability of classification error and average correlation coefficient methods (F + MI + PA) in combination with the least absolute shrinkage and selection operator (LASSO) method. Finally, the multimodal model was developed by incorporating the clinical records and radiomics features through fivefold cross-validation with a linear support vector machine algorithm. The predictive performance was evaluated by sensitivity, specificity, accuracy, F1 scores and the area under the receiver operating characteristic curve (AUC) in the training and test sets. Results: A total of 5972 radiomics features were extracted from multimodal sonography, and the 13 most valuable radiomics features were selected from the training set using the F + MI + PA method combined with LASSO regression. The multimodal prediction model yielded AUCs of 0.911 (95% CI 0.866–0.957) and 0.716 (95% CI 0.522–0.910) in the cross-validation and test sets, respectively. The multimodal model and radiomics model showed good discrimination between ETE and non-ETE lesions. Conclusion: Radiomics features based on multimodal ultrasonography could play a promising role in detecting ETE before surgery. [ABSTRACT FROM AUTHOR]

Abstract Background Carotid vulnerable plaque is an important risk factor for stroke occurrence and recurrence. However, the relationship between risk parameters related to carotid vulnerable plaque (plaque size, echogenicity, intraplaque neovascularization, and plaque stiffness) and neurological outcome after ischemic stroke or TIA is unclear. This study investigates the value of multimodal ultrasound-based carotid plaque risk biomarkers to predict poor short-term functional outcome after ischemic stroke or TIA. Methods This study was a single-center, prospective, continuous, cohort study to observe the occurrence of adverse functional outcomes (mRS 2–6/3–6) 90 days after ischemic stroke or TIA in patients, where the exposure factors in this study were carotid plaque ultrasound risk biomarkers and the risk factors were sex, age, disease history, and medication history. Patients with ischemic stroke or TIA (mRS ≤3) whose ipsilateral internal carotid artery stenosis was ≥50% within 30 days were included. All patients underwent multimodal ultrasound at baseline, including conventional ultrasound, superb microvascular imaging (SMI), and shear wave elastography (SWE). Continuous variables were divided into four groups at interquartile spacing for inclusion in univariate and multifactorial analyses. After completion of a baseline ultrasound, all patients were followed up at 90 days after ultrasound, and patient modified neurological function scores (mRSs) were recorded. Multivariate Cox regression and ROC curves were used to assess the risk factors and predictive power for predicting poor neurological function. Results SMI revealed that 20 (30.8%) patients showed extensive neovascularization in the carotid plaque, and 45 (69.2%) patients showed limited neovascularization in the carotid plaque. SWE imaging showed that the mean carotid plaque stiffness was 51.49 ± 18.34 kPa (23.19–111.39 kPa). After a mean follow-up of 90 ± 14 days, a total of 21 (32.3%) patients had a mRS of 2–6, and a total of 10 (15.4%) patients had a mRS of 3–6. Cox regression analysis showed that the level of intraplaque neovascularization and plaque stiffness were independent risk factors for a mRS of 2–6, and the level of intraplaque neovascularization was an independent risk factor for a mRS of 3–6. After correcting for confounders, the HR of intraplaque neovascularization level and plaque stiffness predicting a mRS 2–6 was 3.06 (95% CI 1.05–12.59, P = 0.041) and 0.51 (95% CI 0.31–0.83, P = 0.007), respectively; the HR of intraplaque neovascularization level predicting a mRS 3–6 was 6.11 (95% CI 1.19–31.45, P = 0.031). For ROC curve analysis, the mRSs for intraplaque neovascularization level, plaque stiffness, and combined application to predict 90-day neurological outcome ranged from 2 to 6, with AUCs of 0.73 (95% CI 0.59–0.87), 0.76 (95% CI 0.64–0.89) and 0.85 (95% CI 0.76–0.95), respectively. The mRSs for the intraplaque neovascularization level to predict 90-day neurological outcome ranged from 3 to 6, with AUCs of 0.79 (95% CI 0.63–0.95). Conclusion Intraplaque neovascularization level and plaque stiffness may be associated with an increased risk of poor short-term functional outcome after stroke in patients with recent anterior circulation ischemic stroke due to carotid atherosclerosis. The combined application of multiple parameters has efficacy in predicting poor short-term functional outcome after stroke.

Medullary thyroid carcinoma is a rare malignant neuroendocrine tumor. Distant metastasis is difficult to detect early. It is most common in lung, liver, bone and brain. This case was reported as liver metastasis of medullary thyroid carcinoma in an elderly woman, but routine ultrasound findings were atypical. After a series of relevant imaging examinations, contrast-enhanced ultrasound and ultrasound-guided puncture biopsy were used to confirm the nature of the intrahepatic lesions. Therefore, we believe that multimodal ultrasound is of great value in the diagnosis of liver metastasis of medullary thyroid carcinoma.

Objective: To explore the clinical features, multimodal ultrasound features and multimodal ultrasound imaging features in predicting lymph node metastasis in the central cervical region of papillary thyroid carcinoma. Methods: A total of 129 patients with papillary thyroid carcinoma (PTC) confirmed by pathology were selected from our hospital from September 2020 to December 2022. According to the pathological results of cervical central lymph nodes, these patients were divided into metastatic group and non‐metastatic group. Patients were randomly sampled and divided into training group (n = 90) and verification group (n = 39) according to the ratio of 7:3. The independent risk factors for central lymph node metastasis (CLNM) were determined by least absolute shrinkage and selection operator and multivariate logistic regression. Based on independent risk factors to build a prediction model, select the best diagnostic effectiveness of the prediction model sketch line chart, and finally, the line chart calibration and clinical benefits were evaluated. Results: A total of 8, 11 and 17 features were selected from conventional ultrasound images, shear wave elastography (SWE) images and contrast‐enhanced ultrasound (CEUS) images to construct the Radscore of conventional ultrasound, SWE and CEUS, respectively. After univariate and multivariate logistic regression analysis, male, multifocal, encapsulation, iso‐high enhancement and multimodal ultrasound imaging score were independent risk factors for cervical CLNM in PTC patients (p < 0.05). Based on independent risk factors, a clinical combined with multimodal ultrasound feature model was constructed, and multimodal ultrasound Radscore were added to the clinical combined with multimodal ultrasound feature model to form a joint prediction model. In the training group, the diagnostic efficacy of combined model (AUC = 0.934) was better than that of clinical combined with multimodal ultrasound feature model (AUC = 0.841) and multimodal ultrasound radiomics model (AUC = 0.829). In training group and validation group, calibration curves show that the joint model has good predictive ability for cervical CLNM of PTC patients; The decision curve shows that most of the net benefits of the nematic chart are higher than those of clinical + multimodal ultrasound feature model and multimodal ultrasound radiomics model within a reasonable risk threshold range. Conclusion: Male, multifocal, capsular invasion and iso‐high enhancement are independent risk factors of CLNM in PTC patients, and the clinical plus multimodal ultrasound model based on these four factors has good diagnostic efficiency. The joint prediction model after adding multimodal ultrasound Radscore to clinical and multimodal ultrasound features has the best diagnostic efficiency, high sensitivity and specificity, which is expected to provide objective basis for accurately formulating individualized treatment plans and evaluating prognosis. [ABSTRACT FROM AUTHOR]

PurposeIn order to research the value of multimodal ultrasonography in evaluating therapeutic response of cervical tuberculous lymphadenitis to anti-tuberculosis drugs.Materials and methodsSixty-one patients with cervical tuberculous lymphadenitis were enrolled in this study. Ultrasound examination was performed before systemic standard anti-tuberculosis treatment and within 1–2 months after treatment, and the patients were divided into effective group and ineffective group according to the follow-up at the sixth month. The multimodal ultrasound signs of the two groups were compared and analyzed.ResultsIn the effective group, there were significant differences in the maximum diameter of lymph nodes, the echo of the surrounding tissue and the enlargement of the contrast area before and after treatment (p

Objective: To investigate the effect of transrectal multimodal ultrasound combined with serum prostate-specific antigen (PSA)-related indicators and machine learning for the diagnosis of clinically significant prostate cancer. Methods: Based on Gleason score of postoperative pathological results, the subjects were divided into clinically significant prostate cancer groups(GS>6)and non-clinically significant prostate cancer groups(GS ≤ 6). The independent risk factors were obtained by univariate logistic analysis. Artificial neural network (ANN), logistic regression (LR), support vector machine (SVM), decision tree (DT), random forest (RF), and K-nearest neighbor (KNN) machine learning models were combined with clinically significant prostate cancer risk factors to establish the machine learning model, calculate the model evaluation indicators, construct the receiver operating characteristic curve (ROC), and calculate the area under the curve (AUC). Results: Independent risk factor items (P< 0.05) were entered into the machine learning model. A comparison of the evaluation indicators of the model and the area under the ROC curve showed the ANN model to be best at predicting clinically significant prostate cancer, with a sensitivity of 80%, specificity of 88.6%, F1 score of 0.897, and the AUC was 0.855. Conclusion: Establishing a machine learning model by rectal multimodal ultrasound and combining it with PSA-related indicators has definite application value in predicting clinically significant prostate cancer. [ABSTRACT FROM AUTHOR]

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Goal of the study was the assessment of AI-assisted diagnosis of solid thyroid foci with multimodal modern ultrasound imaging. 50 patients (26–81 years, 54.7±13.1 years) were included in the study. Multimodal ultrasound imaging by means of B-mode with linear probe (4–12 MHz) with option of automated documentation of findings by means of AI, with supplementary Ultra MicroAngiography (UMA) was used. Macrovascularisation was assessed by dynamic contrast ultrasonography (CEUS) with parametric evaluation and perfusion analysis, and microvascularization was assessed by combined strain and shear wave elastography on a novel high-performance ultrasound system (Resona R9/Mindray) by an experienced examiner with independent reading. The evaluation was performed according to TI-RADS III-V. The volume of the thyroid lobes on both sides averaged 39 ml±5 ml (27 to 69 ml). The 13 cases of histologically confirmed thyroid carcinomas (8 papillary, 2 medullary, 2 microfollicular, 1 anaplastic CA) with a mean size of 15 mm±6 mm (9–21 mm) were correctly evaluated by TI-RADS V on the basis of irregular shape, induration > 2.5 m/s or > 30kPA and striking wash-out kinetics. Tumor lymph nodes could only be correctly detected preoperatively in one case of medullary carcinoma according to the surgical findings, based on irregular vascularization with UMA in roundish shape with cortex > 4 mm, transverse diameter up to 11 mm. In 25 cases of inhomogeneous nodular goiter an evaluation with TI-RADS III was performed in 31 cases, in 4 cases with incomplete marginal contour, partial marginal vascularization with UMA and partial wash out with indurations up to 2.5 m/s 30 kPA an evaluation with TI-RADS IV and surgical excision for nodular goiter. In 12 cases regressive nodular changes without relevant malignancy criteria resulted in nodular goiter, with focal changes up to 1.5 cm in diameter, classified as requiring control with TI-RADS III. There were no relevant changes in findings in the controls after 6 months. From the AI tool, the 20/25 goiter nodes were assessed as TI-RADS III, 7/12 adenomas, 5 goiter nodes, and 5 adenomas as TI-RADS IV, 5/13 carcinomas as TI-RADS IV, and 8/13 carcinomas as TI-RADS V. Multimodal ultrasound diagnostics supported by AI has a high diagnostic potential for the evaluation of solid thyroid lesions and standardizes the reporting with digital representative image documentation. CEUS perfusion and modern elastography techniques allow targeted follow-up of TI-RADS III findings. [ABSTRACT FROM AUTHOR]

Background: Carotid vulnerable plaque is an important risk factor for stroke occurrence and recurrence. However, the relationship between risk parameters related to carotid vulnerable plaque (plaque size, echogenicity, intraplaque neovascularization, and plaque stiffness) and neurological outcome after ischemic stroke or TIA is unclear. This study investigates the value of multimodal ultrasound-based carotid plaque risk biomarkers to predict poor short-term functional outcome after ischemic stroke or TIA. Methods: This study was a single-center, prospective, continuous, cohort study to observe the occurrence of adverse functional outcomes (mRS 2–6/3–6) 90 days after ischemic stroke or TIA in patients, where the exposure factors in this study were carotid plaque ultrasound risk biomarkers and the risk factors were sex, age, disease history, and medication history. Patients with ischemic stroke or TIA (mRS ≤3) whose ipsilateral internal carotid artery stenosis was ≥50% within 30 days were included. All patients underwent multimodal ultrasound at baseline, including conventional ultrasound, superb microvascular imaging (SMI), and shear wave elastography (SWE). Continuous variables were divided into four groups at interquartile spacing for inclusion in univariate and multifactorial analyses. After completion of a baseline ultrasound, all patients were followed up at 90 days after ultrasound, and patient modified neurological function scores (mRSs) were recorded. Multivariate Cox regression and ROC curves were used to assess the risk factors and predictive power for predicting poor neurological function. Results: SMI revealed that 20 (30.8%) patients showed extensive neovascularization in the carotid plaque, and 45 (69.2%) patients showed limited neovascularization in the carotid plaque. SWE imaging showed that the mean carotid plaque stiffness was 51.49 ± 18.34 kPa (23.19–111.39 kPa). After a mean follow-up of 90 ± 14 days, a total of 21 (32.3%) patients had a mRS of 2–6, and a total of 10 (15.4%) patients had a mRS of 3–6. Cox regression analysis showed that the level of intraplaque neovascularization and plaque stiffness were independent risk factors for a mRS of 2–6, and the level of intraplaque neovascularization was an independent risk factor for a mRS of 3–6. After correcting for confounders, the HR of intraplaque neovascularization level and plaque stiffness predicting a mRS 2–6 was 3.06 (95% CI 1.05–12.59, P = 0.041) and 0.51 (95% CI 0.31–0.83, P = 0.007), respectively; the HR of intraplaque neovascularization level predicting a mRS 3–6 was 6.11 (95% CI 1.19–31.45, P = 0.031). For ROC curve analysis, the mRSs for intraplaque neovascularization level, plaque stiffness, and combined application to predict 90-day neurological outcome ranged from 2 to 6, with AUCs of 0.73 (95% CI 0.59–0.87), 0.76 (95% CI 0.64–0.89) and 0.85 (95% CI 0.76–0.95), respectively. The mRSs for the intraplaque neovascularization level to predict 90-day neurological outcome ranged from 3 to 6, with AUCs of 0.79 (95% CI 0.63–0.95). Conclusion: Intraplaque neovascularization level and plaque stiffness may be associated with an increased risk of poor short-term functional outcome after stroke in patients with recent anterior circulation ischemic stroke due to carotid atherosclerosis. The combined application of multiple parameters has efficacy in predicting poor short-term functional outcome after stroke. [ABSTRACT FROM AUTHOR]

Aim: Ovarian serous surface papillary borderline tumor (OSSPBT) is very rare. Combined with clinical and pathological features, we aim to investigate the multimodal ultrasound features of OSSPBT. Patients and Methods: There were only 18 patients diagnosed with OSSPBT among the 142 patients who were diagnosed with borderline serous ovarian tumor by pathology from June 2008 to December 2020 in our hospital. Their clinical data, conventional ultrasound, two-dimensional contrast-enhanced ultrasound (2D-CEUS), three-dimensional contrast-enhanced ultrasound (3D-CEUS) characteristics, pathology, and prognosis were retrospectively analyzed. Results: The 18 patients had no specific clinical symptoms. Multiple implantable nodules were found in 8 patients (44.4%), ascites in 13 patients (72.2%), and elevated carbohydrate antigen 125 (CA125) in 15 patients (83.3%). After excluding 2 misdiagnosed patients from 18 patients, 26 tumors in 16 patients (6 unilateral and 10 bilateral) were studied. Conventional ultrasound findings of OSSPBT showed that large solid masses around normal ovary without capsule, and numerous small dense anechoic areas were observed in the parenchyma of the lesion, with strong speckle echo (?blizzard? sign) of varying degrees. The 2D-CEUS and 3D-CEUS showed a normal ovary in the center surrounded by a radial blood supply of OSSPBT with thick and irregular branches. Histopathologically, the papillary fibrous stalk of OSSPBT had a large number of sand bodies and tortuous dilated microvessels. All patients had no recurrence after surgery, and two of them delivered successfully through assisted reproductive technology. Conclusion: OSSPBT has a good prognosis. Its conventional ultrasound is characterized by irregular solid masses surrounding normal ovaries and a large number of ?blizzard? signs. It showed low enhancement of eccentricity with irregular radial branches centered on the ovary by CEUS.

Idiopathic granulomatous mastitis (IGM) poses diagnostic challenges due to its diverse clinical and radiological presentations, often mimicking malignancies. This study aimed to assess the diagnostic efficacy of multimodal ultrasound for mass and non-mass enhancements in Dynamic Contrast-Enhanced MRI (DCE-MRI) of IGM and breast cancer. A retrospective analysis involved patients confirmed histopathologically with IGM and BC. All patients underwent conventional ultrasound (C-US), ultrasound elastography (UE), contrast-enhanced ultrasound (CEUS), and DCE-MRI examinations. Blinded experienced radiologists assessed imaging findings. Diagnostic accuracy, sensitivity, and specificity were calculated for mass and non-mass enhancements. For mass enhancements (ME), multimodal ultrasound demonstrated strong efficacy (AUC = 0.8651, 95 % CI: 0.7431 to 0.9871), exhibiting high sensitivity (83.3 %) and specificity (92.4 %) in differentiating IGM from breast cancer. However, for non-mass enhancements (NME), multimodal ultrasound showed limited accuracy (AUC = 0.6306) with lower sensitivity (65.6 %) and specificity (81.2 %) in distinguishing between IGM and breast cancer. Multimodal ultrasound displayed good diagnostic efficacy for mass enhancements in DCE-MRI for IGM and breast cancer, while for non-mass enhancement patterns, DCE-MRI remains the most valuable radiological modality for comprehensively assessing this condition's complexities. • High efficacy of multimodal ultrasound for differentiating IGM from BC in mass enhancements. • Significant differences in morphology, UE Score, TTP, and WIS between IGM and BC in mass enhancements. • Limited performance of multimodal ultrasound for non-mass enhancements. • DCE-MRI remains crucial for assessing non-mass enhancement complexities in IGM. [ABSTRACT FROM AUTHOR]

Recent advances in the field of ultrasonography offer promising tools for the evaluation of liver tumors. We aim to assess the value of multimodal ultrasound in differentiating hepatocellular carcinomas (HCCs) from other liver lesions. We prospectively included 66 patients with 72 liver tumors. The histological analysis was the reference standard for the diagnosis of malignant liver lesions, and partially for benign tumors. All liver lesions were assessed by multiparametric ultrasound: standard ultrasound, contrast-enhanced ultrasound (CEUS), the point shear wave elastography (pSWE) using shear wave measurement (SWM) method and real-time tissue elastography (RTE). To diagnose HCCs, CEUS achieved a sensitivity, specificity, accuracy and positive predictive value (PPV) of 69.05%, 92.86%, 78.57% and 93.55%, respectively. The mean shear-wave velocity (Vs) value in HCCs was 1.59 ± 0.29 m/s, which was lower than non-HCC malignancies (p < 0.05). Using a cut-off value of 1.58 m/s, SWM achieved a sensitivity of 54.76%, and 82.35% specificity, for differentiating HCCs from other malignant lesions. The combination of SWM and CEUS showed higher sensitivity (79.55%) compared with each technique alone, while maintaining a high specificity (89.29%). In RTE, most HCCs (61.53%) had a mosaic pattern with dominant blue areas corresponding to type “c” elasticity. Elasticity type “c” was 70.59% predictive for HCCs. In conclusion, combining B-mode ultrasound, CEUS, pSWE and RTE can provide complementary diagnostic information and potentially decrease the requirements for other imaging modalities.

Traditionally, computed tomography angiography has been considered the gold standard for diagnosing renal arteriovenous malformation (AVM). Despite the sensitivity of ultrasound in detecting AVM through Doppler techniques, it often lacks the ability to provide detailed insights into the lesion. In this narrative, we present a case of unexplained hematuria accompanied by flank pain, which was conclusively diagnosed as congenital renal AVM via multimodal ultrasound. The pivotal contributions of color Doppler ultrasound and contrast-enhanced ultrasound are that they are instrumental in enabling an early and markedly precise diagnostic pathway., (© 2024 Wiley Periodicals LLC.)

Background: Pre-operative assessment of non-melanoma skin cancers via advanced ultrasound techniques may potentially provide additional information to tumour margins and morphology compared to current assessment via dermoscopy or optical coherence tomography. In this case series, the findings of multimodal ultrasonography of non-melanoma skin cancer are described, with histological correlation., Methods: Consecutive patients with clinical suspicion of malignant skin lesions underwent multimodal ultrasonography, comprising B-mode, colour Doppler imaging, superb microvascular imaging, strain elastography, and shear-wave elastography, followed by surgical excision. Images were reviewed by two radiologists., Results: There were 8 female and 3 male patients, whose age ranged from 66 to 98 years. A total of 11 malignant skin tumours (basal cell carcinoma, n = 6; squamous cell carcinoma, n = 5) were reviewed. Tumour depth measured via ultrasound assessment ranged from 1.20 to 7.00 mm (mean ± standard deviation: 4.35 ± 1.99 mm). Tumours were located within dermis (n = 1) and abutting subcutaneous layer (n = 10) sonographically. Where corresponding histological reports for tumour depth were available, ultrasound correlated well with histology. Ultrasound also correctly predicted the deepest layer of involvement for all lesions. The sonographic features observed in all malignant skin tumours (11/11:100%) are solid, hypoechoic, with abundant neovascularity on colour Doppler imaging and superb microvascular imaging, and appeared stiff on strain elastography and shear-wave elastography. In some cases, the microvascular network of intra-tumoural flow were better demonstrated on superb microvascular imaging., Conclusion: Multimodal ultrasound can potentially be a useful and quick adjunctive tool for the pre-operative assessment of skin cancer by delineating the tumour depth and deepest skin layer involvement, ensuring complete excision of tumour., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Objective: To determine the diagnostic value of multimodal ultrasound combined with tumor markers in breast cancer (BC)., Methods: A retrospective analysis was conducted on 198 patients with breast lesions treated at the Affiliated Wuxi People's Hospital of Nanjing Medical University between May 2020 and May 2023. All patients underwent multimodal ultrasound and tumor marker testing. Among the 198 patients, 88 patients were pathologically diagnosed with benign disease (benign group) and 110 patients were pathologically diagnosed with malignant disease (malignant group). With the pathological results as the gold standard, the benign and malignant results from different diagnostic methods were compared, focusing on specificity, sensitivity and accuracy., Results: The areas under the curves (AUCs) of carbohydrate antigen 153 (CA153), CA125, and carcinoembryonic antigen (CEA) for diagnosing BC were 0.810, 0.812, and 0.790, respectively. When these tumor markers were used in combination for diagnosing BC, the AUC increased to 0.928. The AUC of multimodal ultrasound alone in diagnosing BC was 0.845. Additionally, the AUC of multimodal ultrasound combined with tumor markers in diagnosing BC reached 0.971, with the corresponding specificity, sensitivity and accuracy of 90.00%, 94.43% and 91.92%, respectively., Conclusion: In patients with early BC, the combination of multimodal ultrasound and tumor marker detection significantly improves the accuracy of diagnosing benign and malignant breast lesions compared to using either modality alone., Competing Interests: None., (AJTR Copyright © 2024.)

Objective　To explore the application value of multi-mode ultrasound in post-liver transplantation monitoring by combining two-dimensional gray scale ultrasound， CDFI， Spectral Doppler and CEUS in gray scale，blood flow and microperfusion examination after the liver transplantation. Methods　In this study，57 patients with liver transplants donated by those after brain death （DBD） in our hospital from January 2018 to December 2021 were selected. All the patients underwent the real-time，dynamic and continuous monitoring by conventional ultrasound after the liver transplantation. Results　 There were 7 cases of vascular complications， including 2 cases of hepatic artery stenosis （3.5%），2 cases of portal vein thrombosis （3.5%），1 case of inferior vena cava thrombosis （1.2%），and 2 cases of inferior vena cava stenosis （3.5%）. There were 4 biliary complications （ 7.0%）， including 3 biliary stenosis （ 5.2%） and 1 choleoma （ 1.2%）， which were clinically confirmed. The common complications were pleural and abdominal effusion in 57 cases （ 100%）， intrahepatic and perihepatic hematoma in 31 cases （54.3%）. False aneurysm of hepatic artery was missed by multimodal ultrasound in 1 case （ 1.2%） . Conclusion　As the first choice after the liver transplantation，multimodal ultrasound can accurately diagnose the complications after the liver transplantation. [ABSTRACT FROM AUTHOR]

Objectives: To establish a preoperative nomogram based on the multimodal ultrasonographic features and biopsy results of primary lesion to predict the risk of sentinel lymph node metastasis (SLNM) in patients with T1-2N0 breast cancer. Methods: This study included 114 patients with T1-2N0 breast cancer who underwent ultrasound-guided core needle biopsy and multimodal ultrasound (Gray scale, Elastography, and Contrast-enhanced ultrasound) preoperatively. The pathological results of SLN were obtained from sentinel lymph node biopsy. Factors associated with sentinel lymph node metastasis were studied. Results: The regression analysis identified the maximum diameter of tumor (p = 0.003), Doppler resistive index (p = 0.030), HER-2 status (p = 0.016) and the extended range of enhancement lesion (p = 0.010), which were used to establish a nomogram. The prediction model indicated that the value of area under the receiver-operating characteristic curve was 0.798. The calibration curve revealed that the nomogram possesses an excellent consistency between the predicted value and the actual value of SLNM (Hosmer–Lemeshow test: p = 0.436). Conclusions: The preoperative nomogram can effectively guide clinicians in predicting SLNM of breast cancer, and assist management of breast cancer patients through intuitive risk values to develop personalized treatment strategies. [ABSTRACT FROM AUTHOR]

Objective To evaluate the value of multimodal ultrasound in monitoring renal function and postoperative complications of DBD transplantation. Methods 67 cases of brain dead organ donor kidney transplantation（DBD） in Ganmei Hospital Affiliated to Kunming Medical University from July 2019 to June 2021 were selected to evaluate the transplanted kidney by multimodal ultrasound. The transplanted kidneys were divided into normal function group and abnormal group according to blood creatinine. The abnormal group was divided into acute rejection group, chronic rejection group, viral nephropathy group, fibrosis group and drug injury group according to puncture pathology. The correlation between arterial peak velocity（PSV）,diastolic velocity（EDV）,resistance index（RI） and serum creatinine was analyzed. To compare the diagnostic efficacy of contrast-enhanced ultrasound with pathology or DSA in renal transplantation complications,and to analyze the correlation between contrast-enhanced ultrasound parameters and renal transplantation function. Rank sum test was used to compare the young’s modulus between abnormal group and normal group. The ROC curve was drawn,and the young’s modulus at the highest yoden index was used as the cut-off value to distinguish normal and abnormal transplanted kidneys,and the corresponding sensitivity and specificity were calculated. Results The correlation between blood flow parameters of transplanted kidney and serum creatinine was general,and the correlation coefficients were less than0.5. The arrival time and peak time of chronic rejection group（8 cases） were significantly longer than those of normal group（10 cases）,and the difference was statistically significant. Two cases of pseudoaneurysm,two cases of graft ischemia and one case of graft venous thrombosis were diagnosed by contrast-enhanced ultrasonography, which were confirmed by pathology or DSA. According to the serum creatinine value,62 cases of transplanted kidney were divided into 22 cases in the normal group and 40 cases in the abnormal group（5 cases in the acute rejection group,11 cases in the chronic rejection group,10 cases in the viral nephropathy group,10 cases in the fibrosis group and4 cases in the drug injury group）. The RI of renal aorta in acute rejection group was higher than that in normal group,the RI of interlobar artery in chronic rejection group was higher than that in normal group,the EDV of main and interlobar artery was lower than that in normal group,the PSV of interlobar artery was lower than that in normal group, and the main PSV of fibrosis group was lower than that in normal group. The above differences were statistically significant（P < 0.05）;There was no significant difference in parameters between viral nephropathy,drug injury group and normal group（P > 0.05）. The young’s modulus of ste in abnormal group and normal group were 22.550（17.1,28.1） and 13.370（11.8,15.9） kPa,respectively（P < 0.01）. When the cut-off value =17.31 kpa,the sensitivity and specificity of shear wave elastography in the diagnosis of renal allograft lesions were75% and 91%. The young’s modulus of STQ in abnormal group and normal group were 21.760（16.4,33.4） and13.870（ 10.5, 16.8） kPa, respectively, with significant difference（ P < 0.01）. When the cut-off value =18.16 kpa,the sensitivity and specificity of shear wave elastography in the diagnosis of renal allograft lesions were70% and 91%. The young’s modulus of ste in acute rejection group,chronic rejection group,viral nephropathy group,fibrosis group and drug injury group were 13.370 (11.8,15.9),15.550 (13.4,16.6),26.870（21.6,38.6）,26.660 (19.5,34.2),16.310（13.2,23.1） and 27.690（24.6,29.2) respectively;The young’s modulus values of STQ were 13.870 (10.5,16.8),16.330（15.5,17.4）,23.780 (19.2,40.7), 22.760 (19.9,36.0),16.540 (14.5,26.0) and 33.355 (29.1,35.4) respectively. There was significant difference among the groups（P <0.05）. The chronic rejection group,viral nephropathy group and drug injury group were significantly higher than those in the normal group (P < 0.05), but there was no significant difference between the acute rejection group,fibrosis group and the normal group (P > 0.05). The elastic value of viral nephropathy was higher than that of acute rejection,ste:26.660 (19.5,34.2) vs 15 550（13.4,16.6）kPa（P<0.01）,STQ:22.760（19.9,36.0）vs16.330（15.5, 17.4) kPa (P < 0.01), the difference was statistically significant. Conclusions The blood flow parameters of transplanted kidney can early evaluate the function of transplanted kidney, and have guiding significance for the differentiation of normal,acute and chronic rejection and viral nephropathy. Contrast-enhanced ultrasound has guiding significance in the differentiation of renal transplant complications. Elastography can noninvasively evaluate the hardness of transplanted kidney,and has a certain clinical value in the timely detection of transplanted kidney complications and differential diagnosis. [ABSTRACT FROM AUTHOR]

Background: Risk stratification of asymptomatic carotid plaque remains an issue in stroke prevention in clinical practice. Purpose: To investigate whether a multimodal ultrasound (MMU) model would help plaque risk stratification in patients with asymptomatic carotid stenosis. Material and Methods: A prospective study was conducted of symptomatic and asymptomatic patients with > 50% proximal internal carotid artery (ICA) stenosis. All patients underwent MMU examination. Multivariable regression analyses were performed to identify parameters associated with ischemic vascular events (IVE). These parameters were used to develop a scoring nomogram to assess the probability of IVE. We elaborated the diagnostic performance of the MMU nomogram using receiver operating characteristic (ROC) curves. Results: From December 2018 to December 2019, 98 patients (75 men, mean age 67 ± 8 years) were included; 50 were symptomatic and 48 were asymptomatic. Multivariable regression analyses revealed that plaque surface morphology (PSM) (odds ratio [OR] 2.99, 95% confidence interval [CI] 1.26–7.12, P = 0.013), intraplaque neovascularization (IPN) grades (OR 3.23, 95% CI 1.77–5.89, P <0.001), and carotid stenosis degree (CSD) (OR 4.12, 95% CI 1.47–11.55, P = 0.007) were independently associated with IVE. For the nomogram, the area under the ROC curve was 0.85 (95% CI 0.77–0.92) and the Hosmer-Lemeshow test P value was 0.822. Conclusions: In patients with proximal ICA > 50%, PSM, IPN grades, and CSD were independent variables associated with IVE. The MMU nomogram provided favorable value to risk stratification of IVE. Future large-scale studies with long-term follow-up are needed to validate these findings. [ABSTRACT FROM AUTHOR]

Background: Sentinel lymph node metastasis (SLNM) is a critical factor in the prognosis and treatment planning for breast cancer (BC), as it indicates the potential spread of cancer to other parts of the body. The accurate prediction and diagnosis of SLNM are essential for improving clinical outcomes and guiding treatment decisions., Objective: This study aimed to construct a Lasso regression model by integrating multimodal ultrasound (US) techniques, including US, shear wave elastography (SWE), and contrast-enhanced ultrasound (CEUS), to improve the predictive accuracy of sentinel lymph node metastasis in breast cancer and provide more precise guidance for clinical treatment., Results: A total of 253 eligible samples were screened, of which 148 were group benign and 105 were group malignant. There were statistically significant differences ( p < 0.05) between group malignant patients in terms of age, palpable mass, body mass index, distance to nipple, maximum diameter, blood flow, microcalcification, 2D border, 2D morphology, and 2D uniformity and group benign. The Lasso regression model was useful in the diagnosis of benign and malignant nodules with an AUC of 0.966 and in diagnosing SLNM with an AUC of 0.832., Conclusion: In this study, we successfully constructed and validated a Lasso regression model based on the multimodal ultrasound technique for predicting whether SLNM occurs in BCs, showing high diagnostic accuracy., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Li, Chen, Liu, Bao, Zhang and Xu.)

The purpose of this study was to develop, validate and test a prediction model for discriminating malignant from benign breast lesions using conventional ultrasound (US), US elastography of strain elastography and contrast-enhanced ultrasound (CEUS). The study included 454 patients with breast imaging-reporting and data system (BI-RADS) category 4 breast lesions identified on histologic examinations. Firstly, 228 breast lesions (cohort 1) were analyzed by logistic regression analysis to identify the risk factors, and a breast malignancy prediction model was created. Secondly, the prediction model was validated in cohort 2 (84 patients) and tested in cohort 3 (142 patients) by using analysis of the area under the receiver operating characteristic curve (AUC). Univariate regression indicated that age ≥40 y, taller than wide shape on US, early hyperenhancement on CEUS and enlargement of enhancement area on CEUS were independent risk factors for breast malignancy (all p < 0.05). The logistic regression equation was established as follows: p = 1/1+Exp∑[-5.066 + 3.125 x (if age ≥40 y) + 1.943 x (if taller than wide shape) + 1.479 x (if early hyperenhancement) + 4.167 x (if enlargement of enhancement area). The prediction model showed good discrimination performance with an AUC of 0.967 in cohort 1, 0.948 in cohort 2 and 0.920 in cohort 3. By using the prediction model to selectively downgrade category 4a lesions, the re-rated BI-RADS yield an AUC of 0.880 (95% confidence interval [CI], 0.794-0.965) in cohort 2 and 0.870 (95% CI, 0.801-0.939) in cohort 3. The specificity increased from 0.0% (0/35) to 80.0% (28/35) without loss of sensitivity (from 100.0% to 95.9%, p = 0.153) in cohort 2. Similarly, the specificity increased from 0.0% (0/58) to 77.6% (45/58) without loss of sensitivity (from 100.0% to 96.4%, p = 0.081) in cohort 3. Multimodal US showed good diagnostic performance in predicting breast malignancy of BI-RADS category 4 lesions. Although the loss of sensitivity was existing, the addition of multimodal US to US BI-RADS could improve the specificity in BI-RADS category 4 lesions, which reduced unnecessary biopsies. [ABSTRACT FROM AUTHOR]

Fine needle aspiration (FNA) is recommended as the final evaluation in diagnosing thyroid nodules. Intermediate cytology is observed in about 15%–25% of the FNA results and has divergent recommendations: follow-up or surgery, either hemi- or total thyroidectomy. The present study aimed to assess the benefit of multimodal ultrasound (US) evaluation in clarifying the attitude in cases with intermediate cytology on FNA. Sixty-four successive cases with Bethesda III or IV cytology results were evaluated using two-dimensional B-mode US (2B), qualitative strain elastography, as well as planar and volumetric (3D) color Doppler using both a linear multifrequency probe and a linear volumetric probe (Hitachi Preirus Machine, Hitachi Inc. Japan). The analyzed nodules were all categorized as low, intermediate, or high risk, based on the following US criteria: taller-than-wide shape, marked hypoechogenicity, irregular borders, inhomogeneity, microcalcifications, or the presence of suspicious adenopathy. Elastographic criteria included stiff lesions, while volumetric Doppler criteria included moderate and marked perinodular vascularization, as suspicious for malignancy. The gold standard for the analysis was the result of the pathology report after thyroidectomy. Our results showed that the prevalence of cancer was 25% (16 cases). In five cases, borderline follicular neoplasia was identified, group which requires watchful waiting. These lesions were also considered as malignant in the final analysis, with a total number of 21 neoplasm cases. Sixteen of the 21 malignant nodules presented with high stiffness, while 15/21 had increased perinodular vascularization. Eight of the 21 cases displayed both important stiffness and perinodular vascularization. Cancer prevalence increased both with severity of stiffness (9.0%–15.0%–66.6%–80.0%) and intensity of vascularization in the adjacent perinodular parenchyma (18.2%–27.7%–35.29%–50.0%). Combining the use of grayscale US, elastography, and 3D Doppler in the evaluation of intermediate cytology cases showed a sensitivity of 85.7%, a specificity of 88.3%, and an accuracy of 90.3% in detecting thyroid cancer cases. We can conclude that the identification of highly suspicious US characteristics observed in 2B, qualitative elastography, and volumetric Doppler increases the risk of malignancy. [ABSTRACT FROM AUTHOR]

Purpose: Zenker's diverticulum (ZD) incidentally detected on neck ultrasound (US) could be easily misdiagnosed as a thyroid nodule and unnecessarily removed by surgical operation. It is a critical issue to identify the characteristics of ZD in clinical practice. Methods: We reported 10 cases of ZD diagnosed using multimodal US, and discussed the features of its multimodal US images extracted from grayscale sonograms, color Doppler flow imaging (CDFI), three-dimensional US (3D-US), and contrast-enhanced US (CEUS). Results: All lesions were heterogeneous in the posterior of the left thyroid. CDFI showed no blood flow within the lesions. The shapes and internal echoes of the masses changed when patients swallowed or drank. Performing CEUS or 3D-US for those with atypical US findings was complementary to make the final diagnosis. Importantly, multimodal US helped to diagnose suspected small lesions in three cases in which the barium esophagram tests proved negative. Conclusions: The US features of ZD detected by multiple modes of US can help in the collection of comprehensive imaging information on ZD, which should be used proactively to facilitate the correct diagnosis and to avoid misdiagnosis of ZD. [ABSTRACT FROM AUTHOR]