Abdominal Imaging
Primary Research
The Role of Multiparametric US of the Liver for the Evaluation of Nonalcoholic Steatohepatitis
Sugimoto, Katsutoshi, et al. “The Role of Multiparametric US of the Liver for the Evaluation of Nonalcoholic Steatohepatitis.” Radiology (2020): 192665.
https://doi.org/10.1148/radiol.2020192665
Background: Nonalcoholic fatty liver disease (NAFLD), an increasingly common form of chronic liver disease, can lead to nonalcoholic steatohepatitis (NASH). NASH can rapidly progress to fibrosis and liver cirrhosis.
Question: Can shear-wave elastography (SWE) measurements help in the diagnosis of NASH and associated features?
Location: Tokyo, Japan
Participants and inclusion criteria: 111 adults who had a liver biopsy for NAFLD (9 patients excluded)
Design: Prospective design; Patients who had a liver biopsy underwent an US with SWE measuring dispersion slope, attenuation coefficient, and shear-wave speed. Findings were compared to pathologic scoring. Receiver operating characteristic (ROC) curve was used for analysis.
Results: Area under the curve (AUC) values were calculated for each SWE metric below:
| Dispersion slope | Attenuation coefficient | Shear-wave speed | |||
| Inflammation grade | AUC | Steatosis grade | AUC | Fibrosis grade | AUC |
| A1 (mild) | 0.95 | S1 (mild) | 0.88 | F1 (portal fibrosis) | 0.79 |
| A2 (moderate) | 0.81 | S2 (moderate) | 0.86 | F2 (periportal fibrosis) | 0.88 |
| A3 (marked) | 0.85 | S3 (severe) | 0.79 | F3 (septal fibrosis) | 0.90 |
| Combined AUC using all three to diagnosis NASH: 0.81 | F4 (cirrhosis) | 0.95 | |||
Conclusions and remarks: SWE can be helpful in monitoring and assessing NAFLD using dispersion slope, attenuation coefficient, and shear-wave speed.
Primary Research
The role of real-time shear wave elastography in the diagnosis of idiopathic nephrotic syndrome and evaluation of the curative effect
Yang, Xue, et al. “The role of real-time shear wave elastography in the diagnosis of idiopathic nephrotic syndrome and evaluation of the curative effect.” Abdominal Radiology (2020): 1-10.
https://doi.org/10.1007/s00261-020-02460-3
Background: Idiopathic nephrotic syndrome (INS) is a group of glomerulopathies including minimal change disease and focal segmental glomerulosclerosis. Glomerulosclerosis and tubulointerstitial fibrosis of the kidneys result in decreased elasticity on SWE.
Question: Can shear-wave elastography (SWE) aid in the diagnosis of INS and how does it fair in assessment of treatment response?
Location: The Affiliated Hospital of Qingdao University, Shandong, China
Participants and inclusion criteria: 120 patients with INS and renal biopsy and 30 health subjects as controls
Design: Prospective design; SWE was used measuring Young’s modulus (YM) of the renal parenchyma in both the INS and healthy subjects groups. YM was compared to glomerular sclerosis index (GI) and renal interstitial fibrosis (RIF) on pathology. Patients were separated into steroid-sensitive and steroid-resistant groups. ROC curve was used for analysis.
Results: The YM was significantly higher in the INS group than the control (p<0.05). Additionally, a difference was seen between the steroid-sensitive and steroid-resistant group with the YM values highest in the steroid-resistant group (P<0.05). The YM values were compared between the groups (below). YM in the INS patients positively correlated with the GI (r=0.631) and RIF (R=0.606), which were both significant (p<0.05).
| Comparison groups | AUC on ROC analysis | Optimal cut-off for AUC | Sensitivity | Specificity |
| INS vs. Control | 0.871 | 7.96 m/s | 81.7% | 93.3% |
| Steroid sensitive vs. Steroid resistant | 0.836 | 10.73 m/s | 86.0% | 77.9% |
Conclusions and remarks: SWE may be able to evaluate INS and monitor steroid treatment response.
Primary Research
Differential diagnosis of <3 cm renal tumors by ultrasonography: a rapid, quantitative, elastography self-corrected contrast-enhanced ultrasound imaging mode beyond screening
Sun, Di, et al. “Differential diagnosis of< 3 cm renal tumors by ultrasonography: A rapid, Quantitative, Elastography Self-corrected Contrast-enhanced Ultrasound Imaging Mode beyond Screening.” The British Journal of Radiology 93 (2020): 20190974.
https://doi.org/10.1259/bjr.20190974
Background: Small renal tumors, <3 cm in size, are often difficult to characterize given their small size. Previously, contrast enhanced US (CEUS) and shear-wave elastography have been used to characterize and diagnosis malignancy in other organs with success.
Question: Can the combination of CEUS and SWE help differentiate clear cell renal cell carcinoma (ccRCC), urothelial carcinoma of the renal pelvis (UCRP), and other small tumors?
Location: Shanghai Jiao Tong University Affiliated Sixth People’s Hospital & Shanghai Institute of Ultrasound in Medicine, Shanghai, China
Participants and inclusion criteria: 35 patients with 37 renal tumors and a renal biopsy
Design: Prospective design; an elastography self-corrected CEUS (ESC) US mode was created to allow for quantification of tumors. ESC and shear-wave elastography values were recorded for each tumor and compared to the pathologic diagnosis.
Results: There was variability in the elastography properties of tumors with ccRCC showing high elasticity values, and UCRP low elasticity. ESC was able to differentiate ccRCC, UCRP, and other small renal tumors with a 94.6% accuracy.
Conclusions and remarks: Using the in-house designed elastography self-corrected CEUS (ESC) ccRCC, UCRP, and other small renal tumors were able to be differentiated from one another with a high accuracy of 94.6%.
Vascular and Interventional US
Primary Research
Contrast-enhanced ultrasound–guided celiac plexus neurolysis in patients with upper abdominal cancer pain: initial experience
Wang, Lu, et al. “Contrast-enhanced ultrasound–guided celiac plexus neurolysis in patients with upper abdominal cancer pain: initial experience.” European Radiology (2020): 1-10.
https://doi.org/10.1007/s00330-020-06705-z
Background: Celiac plexus neurolysis is a technique of injecting alcohol into the celiac plexus to relieve pain.
Question: Is celiac plexus neurolysis using CEUS safe and effective?
Location: University of Electronic Science and Technology of China, Chengdu, China
Participants and inclusion criteria: 35 patients with abdominal cancers and uncontrollable pain ≥7/10
Design: Prospective design; post-procedural pain and opioid use was monitored after celiac plexus neurolysis was performed. 3D-CEUS was used to assist and monitor dispersion of the alcohol lysis agent around the aorta.
Results: Pain relief at different time points was observed for each patient. 28 (80%) of patients had immediate relief, 27 (77.1%) still had relief at one month, and 10 (29.4%) at three months. The median duration was 2.7 months of relief. All patients who had relief had 90° of dispersion around the aorta.
Conclusions and remarks: Celiac plexus neurolysis using CEUS is an effective way to treat upper abdominal malignancy-associated pain.
Musculoskeletal US
Primary Research
Ultrasound of Musculoskeletal Hematomas: Relationship of Sonographic Appearance to Age and Ease of Aspiration
Yoon, Edward, Bin Lin, and Theodore T. Miller. “Ultrasound of Musculoskeletal Hematomas: Relationship of Sonographic Appearance to Age and Ease of Aspiration.” American Journal of Roentgenology (2020).
https://doi.org/10.2214/AJR.19.22752
Background: Musculoskeletal hematomas can be a source of pain and aspiration has been shown to decrease pain and complications.
Question: Is ultrasound-guided aspiration safe and effective for intramuscular hematomas?
Location: Hospital for Special Surgery, New York, NY
Participants and inclusion criteria: 165 aspirations in 148 patients
Design: Retrospective design; US characteristics of hematomas were monitored including echotexture, age, location, and needle gauge used and those were compared to ease of aspiration. Echotexture was categorized as hypoechoic, complex, heterogenous, or echogenic. US-guidance was used to aspirate the intramuscular hematomas.
Results: 100 patients returned for follow up and all had symptomatic relief without complication after aspiration. There was an odds ratio of 3.64 comparing ease of aspiration in hypoechoic hematomas vs. all other echotextures combined (P=0.01). Other findings were not significantly associated with ease of aspiration, including hematoma age, location, and needle gauge.
Conclusions and remarks: US-guided intramuscular hematoma aspiration is safe and effective in alleviating symptoms. Hypoechoic hematomas are also easier to aspirate than complex, heterogenous, and/or echogenic hematomas.
Primary Research
The effect of injection volume on long-term outcomes of US-guided subacromial bursa injections
Klontzas, Michail E., et al. “The effect of injection volume on long-term outcomes of US-guided subacromial bursa injections.” European Journal of Radiology (2020): 109113.
https://doi.org/10.1016/j.ejrad.2020.109113
Background: US-guided corticosteroid injection in the subacromial-subdeltoid (SA-SD) bursa is an effective method to alleviate bursal pain.
Question: Is high-volume steroid injection in the SA-SD bursa more effective in the immediate and long term, compared to low-volume?
Location: Crete, Greece
Participants and inclusion criteria: 136 patients undergoing a SA-SD bursa US-guided steroid injection
Design: Prospective design; Patients were either assigned to the low-volume or high-volume steroid groups. The low-volume group received 1 mL triamcinolone acetonide/40mg, while the high-volume got 1 mL triamcinolone acetonide/40mg + 9 mL of anesthetic. Pain was recorded at multiple time points up to one year.
Results: Injection volume predicted early pain with high-volume having a higher chance of early relief (p<0.001). There was a statistically significant difference between pain in the high-dose and low-dose groups (p<0.001). Pain was 2.2/10 in the high-volume and 4.7/10 in the low-volume at 3 weeks, 1.6/10 and 2.5/10 at 6 months, and 1.6/10 and 1.8/10 at 1 year, respectively. Cadaveric volume measurements of the SA-SD bursa were 6.9 mL.
Conclusions and remarks: High-volume (steroid + 9mL anesthetic) US-guided injection in the subacromial-subdeltoid bursa was superior to low-volume (steroid only) in achieving early pain relief.
Review
Advanced Musculoskeletal Ultrasound Techniques: What are the applications?
Van Holsbeeck, Marnix T., et al. “Advanced Musculoskeletal Ultrasound Techniques: What are the applications?.” American Journal of Roentgenology.
https://doi.org/10.2214/AJR.20.22840
Overview: A very comprehensive review of newer techniques and advancements in musculoskeletal ultrasound. They also discuss traditional uses such as evaluation of carpel tunnel syndrome. Newer applications include uses of ultra-high frequency transducers, microvascular imaging in inflammatory and neoplastic disease, and elastography to help identify and potentially treat pathology.
Head and Neck US
Meta-analysis
Variability in the interpretation of grey-scale ultrasound features in assessing thyroid nodules: A systematic review and meta-analysis
Liu, Huan, et al. “Variability in the interpretation of grey-scale ultrasound features in assessing thyroid nodules: A systematic review and meta-analysis.” European Journal of Radiology (2020): 109050.
https://doi.org/10.1016/j.ejrad.2020.109050
Background: The Thyroid Imaging Reporting and Data System (TI-RADS) is a tool to stratify thyroid nodules by risk of malignancy based on US features.
Question: What is the interobserver agreement between radiologists when assessing thyroid nodules on US using TI-RADS?
Design: A literature review was performed between October 1972 and December 2018 in which interobserver agreement was determined. Seven studies with 927 patients were extracted.
Results: Variability among radiologists using TI-RADS was 0.54 in the studies. Based on feature, calcification had the least variability between observers (0.71), while nodule margin had the most (0.40). Other features examined were composition, echogenicity, shape, and echogenic foci with variabilities of 0.61, 0.58, 0.53, and 0.43, respectively.
Conclusions and remarks: Overall interobserver agreement was moderate and feature variability ranged from highly variable (nodule margin) to some variability (calcification).
Common abbreviations:
*US: Ultrasound
*CEUS: Contrast Enhanced Ultrasound
*SWE: Shear-Wave Elastography
