What’s new in Ultrasonography – April 2021

3 weeks ago

Primary Research

Role of Sonographic Characteristics of Thyroid Bed Lesions Identified Following Thyroidectomy in the Diagnosis or Exclusion of Recurrent Cancer

Frates MC, Parziale MP, Alexander EK, Barletta JA, Benson CB.

Radiology. 2021

https://doi.org/10.1148/radiol.2021201596

Background: Small lesions are often seen on US in the thyroid bed after thyroidectomy for malignancy. The significance of these lesions is often in question.
Question:
Are there certain features of thyroid bed nodules that would predict cancer recurrence?
Inclusion criteria:
All patients who had an indication of post-thyroidectomy and had a follow-up ultrasound.
Design: Retrospective study with measurements and features of thyroid bed lesions analyzed.
Results:
3163 thyroid bed lesions were reported in which half were ≥6mm in size. 144 of the lesions had pathology from fine needle aspiration (FNA).

FNA pathology (n = 144) Punctate echogenicity in the lesion Positive lymph nodes at thyroidectomy
Malignant 42% (61) 46% (28/61) 72% (44/61)
Benign 23% (33) 9% (3/33) 30% (10/33)
Nondiagnostic 35% (50) 24% (12/50) 38% (19/50)
Significance P<0.001 P<0.001

Conclusions and remarks: Most small nodules found in the post-thyroidectomy resection bed are benign. Risk of malignancy may be higher if the nodules have punctate echogenicity or if the patient had lymph node metastasis at thyroidectomy.

 

Primary Research

Inter-reader agreement of CEUS LI-RADS among radiologists with different levels of experience

Li W, Li L, Zhuang BW, Ruan SM, Hu HT, Huang Y, Lin MX, Xie XY, Kuang M, Lu MD, Chen LD, Wang W.

Eur Radiol. 2021 Mar 6.

https://doi.org/10.1007/s00330-021-07777-1

Background: Liver Imaging Reporting and Data System (LI-RADS) allows for characterization of liver lesions using CEUS.
Question:
Are there differences in interpretation based on level of experience when using CEUS LI-RADS version 2017?
Inclusion criteria:
Patients at high risk for hepatocellular carcinoma (HCC) who underwent a CEUS.
Design: Retrospective study with lesions characterized using LI-RADS version 2017 by six radiologists at different levels of experience (2 residents, 2 fellows, and 2 specialists).
Results: The inter-reader agreement between the groups had a Ki of 0.60-0.80, which is moderate to substantial. For LR-5 lesions the area under the curve (AUC) was highest for specialists (0.78), lower for fellows (0.72), and lowest for residents (0.67). The differences in sensitivity, accuracy, and AUC were significant between residents and specialists (P<0.05).
Conclusions and remarks:
There is good diagnostic consistency between radiologists at different levels of experience when using LI-RADS for CEUS.

 

Primary Research

Evaluation of thyroid micro-carcinoma using shear wave elastography: Initial experience with qualitative and quantitative analysis

Tan S, Sun PF, Xue H, Fu S, Zhang ZP, Mei F, Miao LY, Wang XH.

Eur J Radiol. 2021 Jan 29.

https://doi.org/10.1016/j.ejrad.2021.109571

Background: Shear Wave Elastography (SWE) is useful to detect stiffness in a number of organs.
Question:
What is the diagnostic performance of SWE in assessing thyroid nodules before FNA?
Inclusion criteria:
Patients who underwent conventional ultrasound and SWE before FNA or surgical excision.
Design: Retrospective study calculating sensitivity, specificity, accuracy, and AUC for both SWE and conventional ultrasound. Quantitative features of SWE were also evaluated.
Results: There were 69 nodules of which 52 (83%) were malignant and 12 (17%) were benign. The maximum elastic modulus was higher in the malignant nodules than the benign (P < 0.05) with an optimal cut-off value of ≥ 28.2 Kpa. When SWE was combined with conventional US, the rate of nodules recommended for FNA decreased from 75% to 25%.
Conclusions and remarks:
SWE has the potential to decrease the number of FNAs for thyroid nodules when combined with conventional US.

 

Primary Research (open access)

Two-dimensional Shear Wave Elastography Predicts Survival in Advanced Chronic Liver Disease

Trebicka J, Gu W, de Ledinghen V, et al.

Gut. 2021.

https://doi.org/10.1136/gutjnl-2020-323419

Background: The model for end-stage liver disease (MELD) is often used clinically to stratify liver disease into outcomes but performs best in decompensated cirrhosis. There have been no prior studies examining SWE as a prognostic factor in liver disease.
Questions: Can liver stiffness measurements (LSMs) from elastography be used to predict outcomes in liver disease?
Inclusion criteria:
Patients with advanced chronic liver disease. Patients then had baseline LSMs recorded from SWE and 28 days of follow up.
Design: Prospective study performed at 16 institutions from 2007-2017. Clinical and laboratory data were also recorded at baseline. ROC curve was used to assess optimal cut-off values based on sensitivity, specificity, positive predictive value, and negative predictive value. Using the cut-off values a stratification algorithm using MELD and SWE was created to risk stratify patients.
Results: 1827 patients were included after meeting the criteria. The median liver stiffness was 11.8 kPa and median MELD score was 8. Using optimal cut-off patients were stratified into prognostic groups (below) with statistically different survival rates between the categories (p<0.001) in compensated patients. Intermediate prognostic group was defined as not fitting into the other categories based on the stiffness and MELD cut-offs.

M10LS20 Algorithm
Poor Prognosis Group Good Prognosis Group
Stiffness (SWE) ≥20 kPa ≤20 kPa
MELD Score ≥10 ≤10
2-year mortality 36.9% 1.1%
2-year decompensation rate 61.8% 3.5%

Conclusions and remarks: Risk stratification can be performed in advanced chronic liver disease patients using the M10LS20 (MELD 10; Liver Stiffness 20) algorithm with cut-offs of 20 kPa and MELD score of 10.

 

Review

Contrast-enhanced ultrasound in evaluation of adrenal lesions with CT/MRI correlation

Aggarwal A, Das CJ.

Br J Radiol. 2021 Jan 13.

https://doi.org/10.1259/bjr.20201170

Although multiphasic CT and MRI are the work horses of adrenal imaging, CEUS may be helpful as a modality to screen for adrenal masses and to differentiate from benign and malignant lesions. CEUS may particularly be useful in patients with renal failure or a contrast allergy. This article reviews the appearance of various adrenal masses on CEUS and correlates them with CT and MRI.

 

Primary Research

Diagnostic performance of 2D shear wave elastography in predicting liver fibrosis in patients with chronic hepatitis B and C: a histopathological correlation study

Aksakal M, Oktar SO, Sendur HN, Esendagli G, Ozenirler S, Cindoruk M, Hizel K.

Abdominal Radiology.

https://doi.org/10.1007/s00261-021-03019-6

Background: SWE can be used to detect liver fibrosis but biopsy is the gold standard. Cutoff values to detect fibrosis are often calculated from mixed etiology liver diseases.
Question:
Is SWE effective in detecting fibrosis from hepatitis B and hepatitis C, and what are the optimal cut off values?
Inclusion criteria:
103 adults with chronic hepatitis B or C who had a liver biopsy within three months of elastography.
Design: Prospective study which excluded patients with coinfection and decompensated cirrhosis. Evaluation between liver stiffness measurements and METAVIR scores was performed.
Results: There was a positive correlation between elastography values and the degree of fibrosis in both patients with hepatitis B and hepatitis C at biopsy (P = 0.0001).

METAVIR Stage Optimal stiffness cut off values on SWE (KPa)
Hepatitis B Hepatitis C
F ≥ 1 5.92 6.09
F ≥ 2 7.69 7.81
F ≥ 3 8.97 9.0
F ≥ 4 12.15 12.47

Conclusions and remarks: SWE may be helpful to reduce liver biopsies in selected patients with hepatitis B or C when grading fibrosis.

 

Primary Research

Multiparametric transvaginal ultrasound in the diagnosis of endometrial cancer in post-menopausal bleeding: diagnostic performance of a transvaginal algorithm and reproducibility amongst less experienced observers

Abdalla S, Abou-Taleb H, Badary DM, Ali WA.

Br J Radiol. 2021 Mar 1.

https://doi.org/10.1259/bjr.20201195

Background: Grayscale ultrasound, power Doppler features, and gel infusion sonography can all be used to diagnose endometrial cancer.
Questions: Are there performance differences between these sonographic techniques in evaluating endometrial cancer? How does real time diagnosis compare with offline analysis?
Inclusion criteria:
Patients with post-menopausal bleeding and an endometrial thickness on US of ≥ 4 mm.
Design: Prospective retrospective design in which two radiologists scanned in real time and two less experienced radiologists reviewed stored images later.
Results: 88 of the 152 patients had endometrial cancer on pathology. The real time ultrasound evaluating vessel morphology and grayscale features had a 92% diagnostic efficiency and 96% accuracy. The accuracy for offline analysis by the less experienced radiologists was comparable at 92%.
Conclusions and remarks:
Real-time ultrasound with good technique is highly accurate in diagnosing endometrial cancer and is reproducible.

 

Primary Research

Ultrasound Findings and Laboratory Predictors of Early Mortality in Patients With Severe Yellow Fever

Neves YCS, Castro-Lima VAC, Solla DJF, Ogata VSM, Pereira FL, Araujo JM, Ho YL, Chammas MC.

AJR Am J Roentgenol. 2021 Mar 11.

https://doi.org/10.2214/AJR.20.23455

Background: Yellow fever is a hemorrhagic viral illness which has occasional outbreaks, particularly in South American and Africa.
Questions: What are the abdominal imaging findings in patients with severe yellow fever and how do they correlate with clinical data?
Inclusion criteria:
Patients who had a positive PCR for yellow fever and were admitted to the ICU with an abdominal US performed within 48 hours of admission.
Design: Retrospective design examining imaging features and laboratory data with a multivariable logistic regression analysis to identify 30-day mortality predictors.
Results: 46 patients were included, in which 26 (56.5%) died within 30 days of admission. Increased echogenicity of the kidneys was associated with an increased 30-day mortality (P = 0.048) and an independent predictor of mortality.

Ultrasound feature Percentage of cases
Gallbladder wall thickening 80.4%
Increased renal cortical echogenicity 71.7%
Increased liver echogenicity 65.2%
Perirenal fluid 52.2%
Ascites 30.4%


Conclusions and remarks:
Several sonographic features in yellow fever may be associated with severe disease.

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