ObjectiveTo study the Young's modulus obtained by the real-time shear wave elastography (SWE) in healthy adults' parotid gland and submaxillary gland and to explore the probable factors affecting the Young's modulus, such as bilateral parotid and submaxillary gland, sex, age, height and weight. MethodsThere were 35 healthy volunteers who underwent SWE in parotid gland and submaxillary gland between December 3 and 18, 2013. The difference of Young's modulus in bilateral parotid and submaxillary gland, and the modulus values of different sex, age, height and weight groups were also compared. ResultsThe Young's modulus of parotid gland was (8.14±1.78) kPa, and the Young's modulus of submaxillary gland was (11.52±2.34) kPa. The differences of Young's modulus between the two sides of parotid gland and submaxillary gland were not statistically significant (P>0.05); the differences of Young's modulus of parotid and submaxillary gland between different sex, age, height and weight groups had no statistical significance, either (P>0.05). ConclusionThe real-time shear wave elastography can be applied to evaluate the elasticity of parotid and submaxillary gland and to lay the foundation for further diagnosis of salivary lesions.
Objective To evaluate the diagnostic performance of thyroid imaging reporting and data system (TI-RADS)classification and elastography in differentiating benign and malignant thyroid nodules according to size. Methods A total of 222 thyroid nodules (209 cases) with solid or predominantly solid internal contentdiagnosed at pathological findings were enrolled in this study, all the 209 cases underwent surgery in our hospital from Jan.2014 to Jun.2014. The diagnostic performance of TI-RADS classification and elastography in differentiating benign and malignant thyroid nodules according to size nodules were evaluated (for≤1 cm and > 1 cm respectively). Results By using TI-RADS category and elastography, 178 thyroid nodules were diagnosed as malignant nodules, and 44 thyroid nodules were diagnosed as benign nodules. The high predictive factors for malignant thyroid nodules of > 1 cm were irregular shape(OR=6.376), microcalcification(OR=21.525), and capsule invasion(OR=3.852), P < 0.05. The factors for thyroid nodules of≤1 cm were anteroposterior to transverse diameter ratio≥1(OR=3.406), capsule invasion (OR=3.922), and high elastography score(OR=1.606), that suggested the possibility of malignant (P < 0.05). For nodules of > 1 cm, the sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and Youden index of TI-RADS combining with elastography were 98.3%(59/60), 68.6%(24/35), 87.4%(83/95), 84.3%(59/70), 96.0% (24/25), and 66.9% respectively; for nodules of≤1 cm, the sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and Youden index were 98.5%(67/68), 30.5%(18/59), 66.9%(85/127), 62.0%(67/108), 94.7%(18/19), and 29.0% respectively. Conclusion TI-RADS category combined with elastography for diagnosis of thyroid nodules in different size has just a bit differently diagnostic indicators, but that play a high diagnostic performance on the thyroid nodules with maximum diameter > 1 cm.
ObjectiveTo explore the value of ultrasound evaluation and marking before arteriovenous internal fistula in end-stage renal disease hemodialysis patients. MethodsTwenty-five uremia end-stage patients were admitted into our nephrology department from January 2012 to July 2012. All of the patients had encountered several times of fistula failure or had difficulty in establishing the forearm arteriovenous fistula. We focused on observing the brachial artery, radial artery, cephalic vein, the basilica vein and great saphenous vein. We measured the diameter of the vessels and marked the trend of arteries and veins in the body surface under the ultrasonic navigation. Our goal was to look for appropriate bypass vessels in the elbow and the upper arm. ResultsFourteen patients had endured several times of fistula failure. Among the 14 patients, 9 patients completed the surgery of reengineering fistula and autogenous great saphenous vein transplantation, 2 accepted artificial vascular transplantation, 1 completed the removal of blood clots in the left upper limb artificial blood vessels and arteriovenous internal fistula molding, and 2 gave up surgery. Eleven patients could not complete the arteriovenous fistula operation for the fine forearm superficial vein. Of them, 2 patients accepted artificial vascular operation, 6 underwent autogenous great saphenous vein transplantation, 1 with slender radial artery in diameter completed higher position fistula between the brachial artery and median cubital vein, and 2 gave up surgery. ConclusionArteriovenous internal fistula preoperative ultrasound assessment and marking have very important value in improving the success rate of operation in end-stage uremia patients.
ObjectiveTo establish logistic regression analysis model to evaluate the diagnostic efficacy of breast imaging report and data system (BI-RADS) ultrasound signs in forecasting malignant risk of breast lesions. MethodUltrasound graphic materials of 1 660 breast lesions diagnosed during January to September 2011 were retrospectively studied and standardized by BI-RADS. Pathology results were regarded as gold standard reference. Ultrasound signs with significant efficacy after single-factor logistic regression were evaluated in multi-factor logistic regression model to predict the malignant risk of breast lesions. ResultsEighteen ultrasound signs of breast lesions on BI-RADS were included in the final regression model. Among them, Cooper ligaments stretch, echogenic halo, skin thickening, axillary lymph node abnormalities, structural distortions and speculation had high OR values of 30 or more and had higher specificity than 90%. The diagnosis values of regressions model were high, with a sensitivity of 84.5%, specificity 95.5% and accuracy 91.4%. The area under ROC curve was 0.964 and prediction accuracy was 91.0%. ConclusionsThe logistic regression model based on BI-RADS ultrasound signs of breast lesions has high diagnostic values in detecting breast cancer.
ObjectiveTo assess the effect of short-axis and long-axis punctures of thyroid nodules on the diagnostic rate of ultrasound guided aspiration biopsy (US-FNAB). MethodsWe retrospectively analyzed the clinical data of 2 686 thyroid nodule patients who underwent US-FNAB between March 2011 and November 2014. The US-FNAB was performed by 5 beginners (571 each for Dr1-Dr4 and 402 for Dr5). Yields of US-FNAB were divided into two levels according to the classification standard of the Bethesda system:adequacy and inadequacy. Short-axis puncture technique was used by Dr2 and long-axis puncture was performed by the others. According to chronological sequence of thyroid nodules examined, we compared the inadequate diagnostic rate between Dr2 and the others for the first 200 cases and the last 200 cases, respectively. The inadequate diagnostic rate was compared among the 4 doctors who used long-axis punctures for the first 200 cases and the last 200 cases, respectively. ResultsThe inadequacy rate of US-FNAB for Dr2 was higher than that for Dr1, Dr3, Dr4 and Dr5 in the first 200 cases, with statistical significance (P=0.036,<0.001,=0.007 and <0.001, respectively). There was no significant difference in inadequate diagnostic rate among the 4 doctors who used long-axis punctures for the first 200 cases (P=0.033, 0.551, 0.011, 0.122, 0.672 and 0.050). The inadequacy rate of US-FNAB for Dr2 was higher than that for Dr5 and lower than that for Dr4 in the last 200 cases with statistical significance (P=0.027 and 0.003, respectively). The inadequacy rate of US-FNAB for Dr5 was lower than that for Dr3 (P=0.005) and Dr4 (P<0.001) among the 4 doctors who used long-axis punctures for the last 200 cases. ConclusionFor beginners, the inadequacy rate of short-axis puncture is higher than long-axis puncture. We suggest beginners learn long-axis puncture method. There is no significant difference in inadequate diagnostic rate among short-axis and long-axis punctures, when the number of operated cases reaches 200. At this point, the operator can choose either way to puncture according to the disease condition or personal interests.
Objective To investigate ultrasonography features of primary thyroid non-Hodgkin lymphoma (PT-NHL). Methods Ultrasonographic data of patients with PT-NHL(PT-NHL group) and non-Hodgkin lymphoma (control group) who were treated in our hospital from May. 2002 to Jul. 2014 were collected and analyzed. Results Compared with control group, enhancement of posterior echoes was more common in PT-NHL group (P=0.000), and difference values of transverse diameters, anteroposterior diameters, and sagittal diameters of more involved lobe to another lobe were bigger(P < 0.05), but echo pattern of gland, ultrasonographic classification of lesions, classification of vascularity, and condition of cervical lymph nodes were found no statistical difference(P > 0.05). In patients with nodular-type lesions(37 patients in PT-NHL group and 12 patients in control group), length of nodule lesions was larger in PT-NHL group (P=0.000), but there was no statistical difference in shape, boundary, orientation, and echoes of nodules between 2 groups(P > 0.05). In Pulsed-Wave(PW) Doppler between 2 groups(17 patients in PT-NHL group and 4 patients in control group), vascular resistance index(RI) was higher in PT-NHL group than those of control group (P=0.024). Conclusion The enhancement of posterior echoes was a feature in ultrasonography images of PT-NHL. Asymmetrical volume, high value of RI, and big nodule might link to PT-NHL, but diffuse heterogeneous echo with hypoechoic lesions might result in wrong diagnosis as PT-NHL.
ObjectiveTo study the expressions of BRAF gene in papillary thyroid microcarcinoma (PTMC) and papillary thyroid carcinoma (PTC) >1 cm in diameter, and the invasiveness of PTMC and PTC. MethodsThe data of 275 patients with PTC received surgical treatment and with BRAF gene mutation results in West China Hospital of Sichuan University from 2011 September to 2013 September were retrospectively analyzed. According to the size of tumors, the patients were divided into three groups, was the diameter <1 cm group, 1 cm< diameter≤2 cm group, and diameter >2 cm group,respectively. The ratio of BRAF gene mutation, and the degree of risk of extrathyroidal invasion and lymph node metastasis were compared. ResultsUnivariate analysis showed that tumor size was not related with the age, gender, and BRAF gene mutation rate (P>0.05), while the tumor size was related with the extrathyroidal invasion and lymph node metastasis (P<0.05), and the ratio of BRAF gene mutation was related with the extrathyroidal invasion and lymph node metastasis (P<0.05). Multivariate analysis showed that tumor size was associated with extrathyroidal extension (P=0.009) and lymph node metastasis (P=0.000). ConclusionsBRAF gene mutation can increase the extrathyroidal invasion and lymph node metastasis risk of PTC, and it is no significantly correlated with tumor size of PTC. The invasiveness of PTC increases with the increased of tumor size, but the PTMC of BRAF gene mutation positive is still require positive treatment.
ObjectiveTo assess the effect of the size of thyroid nodules on the diagnostic rate of ultrasound guided aspiration cytology (US-FNAB). MethodsThe data of 1 142 (performed by two doctors, 571 each) thyroid nodules between March 2011 and April 2014 in our hospital were retrospectively analyzed. Yields of US-FNAB were divided into two levels of adequacy and inadequacy according to the classification standard of the Bethesda system. The thyroid nodules were classified into five groups according to the largest diameter:≤5 mm group, 5-10 mm group,10-20 mm group, 20-30 mm group, and <30 mm group. According to the grouping of the nodules and the efficiency of US-FNAB drawed curve, the adequacy rates of alone and total of two examiners in each group were analyzed, respectively. ResultsThe adequacy rates of US-FNAB of alone and total of two examiners in≤5 mm group, 5-10 mm group,10-20 mm group, 20-30 mm group, and <30 mm group was 68.42%, 83.72%, 86.08%, 84.62%, and 73.53% (examiner 1); 68.75%, 70.53%, 81.05%, 86.15%, and 73.91% (examiner 2); 68.59%, 77.53%, 83.59%, 85.47%, and 73.75% (total of two examiners), respectively. The total adequacy rate of US-FNAB of two examiners in≤5 mm group was lower than that in 10-20 mm group (P<0.001) and 20-30 mm group (P=0.001). The adequacy rate of US-FNAB of examiner 1 in 5-10 mm group was higher than that examiner 2 (P=0.001). ConclusionsThe size of thyroid nodules significantly influences the adequate diagnostic rate of US-FNAB. The adequacy rates of US-FNAB of the largest diameter≤5 mm or <3mm were lower. The low adequacy rate of US-FNAB may be associated with cystic degeneration in the larger nodules.
Ultrasound Medicine has been through a rapid development during the past half century and has become an indispensable discipline for prophylactic medicine and clinical practice. Nowadays, the needs for ultrasound medicine diverse which leads to many challenges to the existing ultrasound physician scanning - diagnostic mode, including labor-intensiveness for the ultrasound physician, lacking of hierarchical management, contradiction of quality and quantity, irrational allocation of medical resources, and so on. This paper discussed several issues including the current situation of ultrasound education, domestic and western ultrasound work mode, necessity for ultrasound physician- sonographer integrated work mode, as well as the feasibility of standardized sonographer training. Combined with the experience of the West China Hospital, explore a Chinese way to carry out sonographer education and training program and try out ultrasound physician-sonographer integration mode.