To achieve efficient ultrasonography-guided photodynamic therapy (PDT), two major obstacles need to be overcome. On the one hand, O2-dependent PDT produces limited effects on hypoxic solid tumors. On ...the other hand, small particles facilitate tumor accumulation whereas large ones strengthen ultrasound (US) imaging, which makes the development of an ultrasonographic probe showing effective tumor accumulation and high US sensitivity an intractable challenge. Therefore, an intelligent perfluorohexane (PFH)-based nanodroplet, PFH@Ce6@O2, was fabricated in order to simultaneously solve the above problems. The nanoscale PFH@Ce6@O2 particles were firstly delivered to elevate the local O2 level of tumors, which is critical for achieving excellent PDT effect under laser irradiation. Then, a spontaneous “small-to-large” growth of droplet at tumor acidic microenvironment resulted in an echo-contrast enhancement for high-performance US imaging of tumor. The in vitro and in vivo results manifested the advantage of PFH@Ce6@O2 in alleviating hypoxic status to inhibit tumor growth. Overall, PFH@Ce6@O2 integrating US/FL bimodal imaging and PDT effect appears to be a promising nanoplatform for ultrasonography-guided PDT of solid tumors.
Computer-aided diagnosis (CAD) systems hold potential to improve the diagnostic accuracy of thyroid ultrasound (US). We aimed to develop a deep learning-based US CAD system (dCAD) for the diagnosis ...of thyroid nodules and compare its performance with those of a support vector machine (SVM)-based US CAD system (sCAD) and radiologists. dCAD was developed by using US images of 4919 thyroid nodules from three institutions. Its diagnostic performance was prospectively evaluated between June 2016 and February 2017 in 286 nodules, and was compared with those of sCAD and radiologists, using logistic regression with the generalized estimating equation. Subgroup analyses were performed according to experience level and separately for small thyroid nodules 1-2 cm. There was no difference in overall sensitivity, specificity, positive predictive value (PPV), negative predictive value and accuracy (all p > 0.05) between radiologists and dCAD. Radiologists and dCAD showed higher specificity, PPV, and accuracy than sCAD (all p < 0.001). In small nodules, experienced radiologists showed higher specificity, PPV and accuracy than sCAD (all p < 0.05). In conclusion, dCAD showed overall comparable diagnostic performance with radiologists and assessed thyroid nodules more effectively than sCAD, without loss of sensitivity.
Pathology of the mammary gland is a common health issue in dogs and includes neoplasia, cysts, inflammation and infection. The use of the B-mode (US) and contrast-enhanced (CEUS) ultrasonography may ...aid in the diagnosis. Previous studies are currently lacking of the ultrasonic images of the mammary gland of healthy bitches in different stages of the estrous cycle and associated normal blood perfusion patterns. The purpose, therefore, was to describe the normal B-mode US and CEUS images of the mammary gland and inguinal lymph node, in six intact female beagles during five different stages of the estrous cycle (proestrus, estrus, early and late diestrus and anestrus). Within the same stage of the estrous cycle, the size (thickness) of the caudal mammary glands increased. During early and late diestrus, all mammary glands increased in thickness and had an increased heterogeneous B-mode ultrasonic appearance. The mammary glands had a heterogeneous, disorganized perfusion pattern when assessed using CEUS. For the cranial abdominal mammary gland, the area under the curve and the mean transit time increased between estrus and late diestrus and decreased between late diestrus and anestrus. For the inguinal mammary gland, only the time to peak was longer during the periods of anestrus compared to estrus whereas all the other contrast parameters did not change during the estrous cycle. In conclusion, hormonal influences cause major changes in the size, appearance and blood perfusion of mammary glands during the estrous cycle and should be considered when evaluating pathological changes of mammary glands.
We conducted a systematic review and meta-analysis to assess the effectiveness of real-time dynamic ultrasound-guided subclavian vein cannulation as compared to landmark technique in adult patients.
...PubMed and EMBASE until June 1, 2022, with the EMBASE search restricted to the last 5 years.
We included randomized controlled trials (RCTs) comparing the two techniques (real-time ultrasound-guided vs landmark) for subclavian vein cannulation. The primary outcomes were overall success rate and complication rate, whereas secondary outcomes included success at first attempt, number of attempts, and access time.
Independent extraction by two authors according to prespecified criteria.
After screening, six RCTs were included. Two further RCTs using a static ultrasound-guided approach and one prospective study were included in the sensitivity analyses. The results are presented in the form of risk ratio (RR) or mean difference (MD) with 95% CI. Real-time ultrasound guidance increased the overall success rate for subclavian vein cannulation as compared to landmark technique (RR = 1.14; 95% CI 1.06-1.23; p = 0.0007; I2 = 55%; low certainty) and complication rates (RR = 0.32; 95% CI 0.22-0.47; p < 0.00001; I2 = 0%; low certainty). Furthermore, ultrasound guidance increased the success rate at first attempt (RR = 1.32; 95% CI 1.14-1.54; p = 0.0003; I2 = 0%; low certainty), reduced the total number of attempts (MD = -0.45 95% CI -0.57 to -0.34; p < 0.00001; I2 = 0%; low certainty), and access time (MD = -10.14 s; 95% CI -17.34 to -2.94; p = 0.006; I2 = 77%; low certainty). The Trial Sequential Analyses on the investigated outcomes showed that the results were robust. The evidence for all outcomes was considered to be of low certainty.
Real-time ultrasound-guided subclavian vein cannulation is safer and more efficient than a landmark approach. The findings seem robust although the evidence of low certainty.
The sensitivity of lymph node core-needle biopsy under imaging guidance requires validation. We employed power Doppler ultrasonography (PDUS) to select the lymph node most suspected of malignancy and ...to histologically characterize it through the use of large cutting needle. Institutional review board approval and informed consent were obtained for this randomized clinical trial. In a single center between 1 January 2009 and 31 December 2015, patients with lymph node enlargement suspected for lymphoma were randomly assigned (1:1) to biopsy with either standard surgery or PDUS-guided 16-gauge modified Menghini needle. The primary endpoint was the superiority of sensitivity for the diagnosis of malignancy for core-needle cutting biopsy (CNCB). Secondary endpoints were times to biopsy, complications, and costs. A total of 376 patients were randomized into the two arms and received allocated biopsy. However, four patients undergoing CNCB were excluded for inadequate samples; thus, 372 patients were analyzed. Sensitivity for the detection of malignancy was significantly better for PDUS-guided CNCB 98.8%; 95% confidence interval (CI), 95.9–99.9 than standard biopsy (88.7%; 95% CI, 82.9–93;
P
< 0.001). For all secondary endpoints, the comparison was significantly disadvantageous for conventional approach. In particular, estimated cost per biopsy performed with standard surgery was 24-fold higher compared with that performed with CNCB. The presence of satellite enlarged reactive and/or necrotic lymph nodes may impair the success of an open surgical biopsy (OSB). PDUS and CNCB with adequate gauge are diagnostic tools that enable effective, safe, fast, and low-cost routine biopsy for patients with suspected lymphoma, avoiding psychological and physical pain of an unnecessary surgical intervention.
The detection of lymph node metastasis affects the management of patients with primary breast cancer significantly in terms of staging, treatment, and prognosis. The main goal for the radiologist is ...to determine and detect the presence of metastatic disease in nonpalpable axillary lymph nodes with a positive predictive value that is high enough to initially select patients for upfront axillary lymph node dissection. Features that are suggestive of axillary adenopathy may be seen with different imaging modalities, but ultrasound is the method of choice for evaluating axillary lymph nodes and for performing image‐guided lymph node interventions. This review aims to provide a comprehensive overview of the available imaging modalities for lymph node assessment in patients diagnosed with primary breast cancer.
Implications for Practice
The detection of lymph node metastasis affects the management of patients with primary breast cancer. The main goal for the radiologist is to detect lymph node metastasis in patients to allow for the selection of patients who should undergo upfront axillary lymph node dissection. Features that are suggestive of axillary adenopathy may be seen with mammography, computed tomography, and magnetic resonance imaging, but ultrasonography is the imaging modality of choice for evaluating axillary lymph nodes. A normal axillary lymph node is characterized by a reniform shape, a maximal cortical thickness of 3 mm without focal bulging, smooth margins, and, depending on size, a discernable central fatty hilum.
This review provides a comprehensive overview of the available imaging modalities for lymph node assessment in patients diagnosed with primary breast cancer.
Ischemic stroke is a foremost cause for disability and death worldwide. This study is conducted in order to compare the diagnostic values between transcranial Doppler ultrasound (ultrasonography), ...computed tomography (CT), and magnetic resonance imaging (MRI) in patients suffering from ischemic stroke by performing a network meta-analysis.
We made use of Cochrane Library, PubMed, and Embase in order to obtain literature and papers. The combination analysis of both direct and indirect evidence in terms of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy was conducted so as to assess the odds ratios (ORs) and surface under the cumulative ranking curve (SUCRA) values of the seven different imaging methods. These imaging techniques include ultrasonography, computed tomography (traditional CT, computed tomography angiography CTA, computed tomography perfusion CTP), and MRI (traditional MRI, diffusion-weighted imaging DWI, magnetic resonance angiography), in order to properly diagnose ischemic stroke patients.
Thirteen eligible diagnostic trials were enrolled into this network meta-analysis. The results of the traditional meta-analysis showed that among CT methods, CTP showed higher sensitivity, NPV, and accuracy; among MRI methods, DWI had relatively higher sensitivity, NPV, and accuracy. The results of network meta-analysis showed that DWI had relatively higher sensitivity, NPV, and accuracy when compared with traditional CT, CTA, magnetic resonance angiography and traditional MRI. CTP showed higher SUCRA among CT methods while DWI showed higher SUCRA among MRI methods. A cluster analysis revealed that DWI had the highest diagnostic value in terms of sensitivity, PPV, NPV, and accuracy amongst the aforementioned seven imaging techniques.
This network meta-analysis provides supporting evidence to the idea that DWI has a higher diagnostic value regarding ischemic stroke among MRI methods, and CTP has a poor diagnostic value among CT methods, which provide therapeutic considerations for Ischemic stroke intervention.
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