Objectives
The main aim was to assess the performance and cutoff value for the detection of liver steatosis (grade S > 0) with the Attenuation Imaging–Penetration (ATI‐Pen) algorithm available on the ...Aplio i‐series ultrasound systems (Canon Medical Systems, Otawara, Japan). The magnetic resonance imaging–derived proton density fat fraction (MRI‐PDFF) was used as the reference standard. Secondary aims were to compare the results to those obtained with the previous ATI algorithm (Attenuation Imaging–General ATI‐Gen) and with the controlled attenuation parameter (CAP) and to generate a regression equation between ATI‐Pen and ATI‐Gen values.
Methods
Consecutive adult patients potentially at risk of liver steatosis were prospectively enrolled. Each patient underwent ultrasound quantification of liver steatosis with ATI‐Pen and ATI‐Gen and a CAP assessment with the FibroScan system (Echosens, Paris, France). The MRI‐PDFF evaluation was performed within a week. The correlations between ATI‐Pen, ATI‐Gen, the CAP, and the MRI‐PDFF were analyzed with the Pearson rank correlation coefficient. The diagnostic performance of ATI‐Pen, ATI‐Gen, and the CAP was assessed with receiver operating characteristic curves and an area under the receiver operating characteristic curve (AUROC) analysis.
Results
Seventy‐two individuals (31 male and 41 female) were enrolled. Correlation coefficients of ATI‐Pen, ATI‐Gen, and the CAP with the MRI‐PDFF were 0.78, 0.83, and 0.58, respectively. The AUROCs of ATI‐Pen, ATI‐Gen, and the CAP for detecting steatosis (S > 0) were 0.90 (95% confidence interval, 0.81–0.96), 0.92 (0.82–0.98), and 0.85 (0.74–0.92), and the cutoffs were greater than 0.69 dB/cm/MHz, greater than 0.62 dB/cm/MHz, and greater than 273 dB/m. The regression equation between ATI‐Pen and ATI‐Gen was ATI‐Pen = 0.88 ATI‐Gen + 0.13.
Conclusions
Attenuation Imaging is a reliable tool for detecting liver steatosis, showing an excellent correlation with the MRI‐PDFF and high performance with AUROCs of 0.90 or higher.
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Abstract
The updated version of the EFSUMB guidelines on the application of non-hepatic contrast-enhanced ultrasound (CEUS) deals with the use of microbubble ultrasound contrast outside the liver in ...the many established and emerging applications.
Summary
Objective ShearWave™ Elastography (SWE) is real‐time, quantitative and user‐independent technique, recently introduced in the diagnostic work‐up of thyroid nodules. Hashimoto’s thyroiditis ...(HT), characterized by variable degrees of lymphocytic infiltration and fibrosis, might affect shear wave propagation. The aim of this study was to assess the feasibility of SWE in cytologically benign thyroid nodules within both Hashimoto’s and nonautoimmune thyroid glands. The effect of autoimmunity on the gland stiffness was also evaluated.
Design longitudinal study in a single centre.
Patients SWE was performed in 75 patients with a benign thyroid nodule at cytology: 33 with Hashimoto’s thyroiditis (HT group) and 42 with uni‐ or multi‐nodular goitre, negative for thyroid autoimmunity (non‐HT group).
Results The elasticity index (EI) of the extra‐nodular tissue was greater, though not statistically significant, in the HT than in the non‐HT group (24·0 ± 10·5 kPa vs 20·8 ± 10·4 kPa; P = 0·206). However, the EI of extra‐nodular tissue was related to the TPOAb titre in the HT group (P = 0·02) and was significantly higher in patients with HT receiving L‐thyroxine than in the euthyroid subjects (P = 0·02). The EI of thyroid nodules was similar in HT and non‐HT groups. In both groups, the stiffness of nodules was significantly higher than that of the embedding tissue.
Conclusions Our data indicate that SWE correctly defines the elasticity of thyroid nodules independently from the coexistence of autoimmune thyroiditis, always being able to differentiate nodular tissue from the surrounding parenchyma. In HT, the stiffness of extra‐nodular tissue increases in relation to both the thyroid antibody titre and the degree of impairment of thyroid function.
The development of ultrasound contrast agents with excellent tolerance and safety profiles has notably improved liver evaluation with ultrasound(US)for several applications,especially for the ...detection of metastases.In particular,contrast enhanced ultrasonography(CEUS)allows the display of the parenchymal microvasculature,enabling the study and visualization of the enhancement patterns of liver lesions in real time and in a continuous manner in all vascular phases,which is similar to contrast-enhanced computed tomography(CT)and contrast-enhanced magnetic resonance imaging.Clinical studies have reported that the use of a contrast agent enables the visualization of more metastases with significantly improved sensitivity and specificity compared to baseline-US.Furthermore,studies have shown that CEUS yields sensitivities comparable to CT.In this review,we describe the state of the art of CEUS for detecting colorectal liver metastases,the imaging features,the literature reports of metastases in CEUS as well as its technique,its clinical role and its potential applications.Additionally,the updated international consensus panel guidelines are reported in this review with the inherent limitations of this technique and best practice experiences.
Wall shear stress (WSS) is considered as a key factor for atherosclerosis development. Previous WSS research based on pulsed wave Doppler (PWD) showed limitations in complex flows. To improve ...accuracy for nonlaminar flow, a commercial ultrasound vector flow imaging (UVFI)‐based WSS calculation is proposed. Errors for PWD are presented theoretically when flow is not laminar. Based on this, simulations of WSS calculations between PWD and UVFI were set up for different turbulent flows. Our simulations show that UVFI has obviously better performance than PWD in WSS calculations. Wall shear stress results in different flow conditions at carotid bifurcations are described.
Carotid artery atherosclerotic disease is still a significant cause of cerebrovascular morbidity and mortality. A new angle-independent technique, measuring and visualizing blood flow velocities in ...all directions, called vector flow imaging (VFI) is becoming available from several vendors. VFI can provide more intuitive and quantitative imaging of vortex formation, which is not clearly distinguishable in the color Doppler image. VFI, as quantitative method assessing disturbed flow patterns of the carotid bifurcation, has the potential to allow better understanding of the diagnostic value of complex flow and to enhance risk stratification. This pictorial review article will show which new information VFI adds for the knowledge of hemodynamics in comparison to the conventional ultrasound techniques.
Teaching points
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VFI is an angle-independent technique measuring flow velocities in all directions.
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This kind of VFI is based on a plane wave multidirectional excitation technique.
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VFI allows quantitative assessment of carotid streamlines progression and visualizes vorticity.
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VFI does not allow a precise comprehension of streamlines’ 3D shape.
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VFI allows a better understanding of carotid artery complex flows.
Abstract
Primary bone lymphoma is a rare entity and it usually occurs in long bones. Primary mandibular involvement is very rare, and it usually shows unspecific features, mimicking odontogenic ...inflammatory lesions. We present the unusual case of a diffuse large B-cell lymphoma (DLBCL) of the right mandibular body in a 91-year-old woman, who presented with acute pain in the mandibular region initially suspicious for odontogenic abscess. No significant findings were seen on orthopantomography (OPG) and her almost complete edentulism made the diagnosis of abscess unlikely. Computed tomography and magnetic resonance images showed an expansive mass around the right mandibular body with erosion of cortical bone and involving the right mandibular canal and nerve. Final diagnosis of DLBCL was pathologically proven. The presence of odontogenic-like pain in nearly complete edentulism should be suspicious for malignancy, and it needs further diagnostic workup despite the absence of signs on OPG.
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