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ABSTRACT: We explored the efficacy of thin-slice volumetric 3-D ultrasound (3-DUS) in distinguishing between benign and malignant thyroid nodules. A total of 103 thyroid nodules were evaluated prospectively using 3-D gray-scale ultrasonography. The shape, margin, halo and potential capsular invasion of the nodules were compared with the findings of conventional 2-D ultrasound (2-DUS). Of the 103 thyroid nodules, there were 50 pathologically confirmed benign lesions and 53 malignant lesions (51.5%). Shape irregularity, ill-defined margins and capsular invasion provided sensitivities of 90.0%, 47.2% and 39.6% and specificities of 88.0%, 84.0% and 100%, respectively, for the malignant lesions. The diagnosis of thyroid cancer was improved in 3-DUS compared with 2-DUS, with a sensitivity of 88.7%, specificity of 90.0%, positive predictive value of 90.4%, negative predictive value of 88.2% and accuracy of 89.3%. The sensitivity of detection for lesions with capsular invasion increased to 39.6% with 3-DUS, more than twice that of 2-DUS. Three-dimensional US is highly accurate in diagnosing thyroid nodules, particularly those with capsular invasion.
Ultrasound in medicine & biology 09/2015; DOI:10.1016/j.ultrasmedbio.2015.06.022 · 2.21 Impact Factor
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ABSTRACT: The purpose of this study was to evaluate the utility of contrast-enhanced sonography as an adjunct to conventional transvaginal sonography for detecting endometrial carcinoma and defining the depth of myometrial invasion.
A total of 35 patients with endometrial carcinoma diagnosed by endometrial sampling were examined with transvaginal sonography followed by contrast-enhanced sonography before treatment. The contrast enhancement phases (ie, early wash-in/out and late wash-in/out) were visually observed before comparison of tumors grouped by average diameter and histopathologic grade. We evaluated the effectiveness of contrast-enhanced sonography as an adjunct to transvaginal sonography in tumor imaging. We calculated the accuracy of contrast-enhanced sonography for diagnosing the depth of tumor invasion into the myometrium by using arcuate vascular plexus involvement as the sonographic standard for diagnosis of deep myometrial infiltration.
Of the 34 tumors identified by contrast-enhanced sonography, 28 (82.4%) showed early wash-in, and 6 (17.6%) showed late wash-in. Similar numbers of cases showed early and late wash-out. The enhancement phases did not differ significantly across groups with different average tumor diameters or histologic grades (P > .05). Contrast-enhanced sonography contributed the most to tumor imaging in patients with a thin endometrium after endometrial biopsy because it enhanced the contrast between the tumor and tissue. The diagnostic accuracy of contrast-enhanced sonography for determining the myometrium infiltration depth was 85.3%.
This study revealed diagnostically useful characteristics of the enhancement phase of endometrial carcinoma. The ability to enhance tumor-to-tissue contrast makes contrast-enhanced sonography a valuable adjunct to conventional sonography of endometrial carcinoma, especially for the thin endometrium found after endometrial biopsy. Contrast-enhanced sonography performed well in the diagnosis of the myometrial infiltration depth when using arcuate vascular plexus involvement as a marker of deep myometrial infiltration.
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 11/2011; 30(11):1519-27. · 1.54 Impact Factor
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ABSTRACT: No conventional imaging method reliably distinguishes between benign and malignant thyroid nodules. Our objectives were to characterize the enhancement patterns of thyroid nodules on gray-scale contrast-enhanced ultrasound (US) and to evaluate whether these patterns were useful in the differential diagnosis of thyroid nodules.
Ninety-five patients, scheduled for surgery for thyroid nodules detected by gray-scale sonography, were enrolled in this prospective study. In all, there were 104 nodules (47 papillary carcinomas, 3 medullary carcinomas, 1 metastatic carcinoma, 44 hyperplasia nodule, 7 follicular adenomas, 1 suture granulomas, and 1 Hashimoto's disease). After intraveneous (i.v.) injection of a 1.2 mL bolus of SonoVue, lesions were scanned with real-time gray-scale pulse inversion harmonic imaging US for at least 3 minutes at low mechanical index (MI) (0.05 to 0.08). The enhancement patterns were classified into one of four patterns by two experienced readers.
After administration of SonoVue, four enhancement patterns (homogeneous, heterogeneous, ring-enhancing, and no enhancement) were observed. Four benign and 3 malignant nodules had homogeneous enhancement pattern, 4 benign and 45 malignant nodules had heterogeneous enhancement, 44 benign and 3 malignant nodules had ring enhancement, and 1 benign nodule had no enhancement. There was a significant difference between benign and malignant nodules (p < 0.001). The benign thyroid nodules showed four enhancement patterns: ring enhancement 44/53 (83.0%), homogeneous enhancement 4/53 (7.5%), heterogeneous enhancement 4/53 (7.5%), and no enhancement 1/44 (1.9%). The malignant thyroid nodules showed three enhancement patterns: heterogeneous enhancement 45/51 (88.2%), ring enhancement 3/51 (5.9%), and homogeneous enhancement 3/51 (5.9%). Ring enhancement correlated highly with a benign diagnosis (sensitivity 83.0%, specificity 94.1%, positive predictive value 93.6%, negative predictive value 84.2%, and accuracy 88.5%). Heterogeneous enhancement correlated highly with a malignant diagnosis (sensitivity 88.2%, specificity, 92.5% positive predictive value 91.8%, negative predictive value 89.1%, and accuracy 90.4%). In both mixed and solid nodules, ring enhancement was highly predictive of a benign finding, whereas heterogeneous enhancement was highly predictive of a malignant finding.
Contrast-enhanced US enhancement patterns were different in benign and malignant lesions. Ring enhancement was predictive of benign lesions, whereas heterogeneous enhancement was helpful for detecting malignant lesions.
Thyroid: official journal of the American Thyroid Association 01/2010; 20(1):51-7. DOI:10.1089/thy.2009.0045 · 4.49 Impact Factor