Showing papers in "Ultrasound International Open in 2018"

How to perform Contrast-Enhanced Ultrasound (CEUS).

Abstract: “How to perform contrast-enhanced ultrasound (CEUS)” provides general advice on the use of ultrasound contrast agents (UCAs) for clinical decision-making and reviews technical parameters for optimal CEUS performance CEUS techniques vary between centers, therefore, experts from EFSUMB, WFUMB and from the CEUS LI-RADS working group created a discussion forum to standardize the CEUS examination technique according to published evidence and best personal experience The goal is to standardise the use and administration of UCAs to facilitate correct diagnoses and ultimately to improve the management and outcomes of patients

Ultrasound and Cystic Echinococcosis.

Abstract: The introduction of imaging techniques in clinical practice 40 years ago changed the clinical management of many diseases, including cystic echinococcosis (CE). For the first time cysts were clearly seen before surgery. Among the available imaging techniques, ultrasound (US) has unique properties that can be used to study and manage cystic echinococcosis. It is harmless, can image almost all organs and systems, can be repeated as often as required, is portable, requires no patient preparation, is relatively inexpensive and guides diagnosis, treatment and follow-up without radiation exposure and harm to the patient. US is the only imaging technique which can be used in field settings to assess CE prevalence because it can be run even on solar power or a small generator in remote field locations. Thanks to US classifications, the concept of stage-specific treatments was introduced and because US is repeatable, the scientific community has gained a clearer understanding of the natural history of the disease. This paper reviews the scope of US in CE, describes its strengths and weaknesses compared to other imaging techniques and its relationship with serodiagnosis and discusses sonographic features that may be helpful in differential diagnosis.

Reference Values for Shear Wave Elastography of Neck and Shoulder Muscles in Healthy Individuals.

Abstract: Purpose to establish reference values for ultrasound shear-wave elastography for pericranial muscles in healthy individuals (m. trapezius, m. splenius capitis, m. semispinalis capitis, m. sternocleidomastoideus and m. masseter). Also to evaluate day-to-day variations in the shear-wave speeds and evaluate the effect of the pennation of the muscle fibers, ie scanning parallel or perpendicularly to the fibers. Materials and Methods 10 healthy individuals (5 males and 5 females) had their pericranial muscles examined with shear-wave elastography in two orthogonal planes on two different days for their dominant and non-dominant side. Mean shear wave speeds from 5 ROI’s in each muscle, for each scan plane for the dominant and non-dominant side for the two days were calculated. The effect of the different parameters – muscle pennation, gender, dominant vs non-dominant side and day was evaluated. Results The effect of scan plane in relation to muscle pennation was statistically significant (p Conclusion The shear wave speed variation depended on the direction of scanning. Shear wave elastography may be a method to evaluate muscle stiffness in patients suffering from chronic neck pain.

Influencing Factors of 2D Shear Wave Elastography of the Muscle - An Ex Vivo Animal Study.

Abstract: To evaluate measurement confounders on 2D shear wave elastography (2D-SWE) elastography of muscle. Ex vivo, porcine muscle was examined with a GE LOGIQ E9 ultrasound machine with a 9 L linear (9 MHz) and C1-6 convex probe (operating at 2.5 or 6 MHz). The influence of different confounders on mean shear wave velocity (SWVmean) was analyzed: probes, pressure applied by probe, muscle orientation, together with the impact of different machine settings such as frequency, placement depth and size of region of interest (ROI). The mean of twelve repeated SWVmean measurements (m/s) and coefficient of variation (CV; standard deviation/mean in %) were assessed for each test configuration. Reproducibility (CV) and maximum possible tissue depth of the linear probe were inferior to the convex probe. With the linear probe, there was a linear decrease of SWVmean with placement depth from 4.56 m/s to 1.81 m/s. A significant increase of SWVmean (p 2D-SWE of muscle is influenced by a wealth of parameters. Therefore, standardization of measurement is advisable before application in clinical research studies and routine patient assessment.

Calcifications in Thyroid Tumors on Ultrasonography: Calcification Types and Relationship with Histopathological Type.

Abstract: The purpose of the study is to clarify the prevalence of calcifications within thyroid tumors on ultrasonography as well as the relationship between the calcification and histopathological types. Calcifications were classified into 6 (or 8) types according to their shape, size, and region. The prevalence of calcifications and types were investigated in new outpatients and patients who underwent thyroid surgery. Among 2,902 nodules in 2,678 new outpatients, 747 nodules (26%) had calcifications. The types showed a wide distribution. Among 941 patients with papillary carcinoma (PC), 725 patients (77%) had calcifications, and the types showed a wide distribution. 18 patients with the diffuse sclerosing variant of PC only showed punctate microcalcifications in the parenchyma (100%), 32 patients with the cyst-forming type of PC mostly fragmentary and massive types (100%), and 161 metastatic lymph nodes from PC mostly punctate microcalcifications and fragmentary types (48%). Among 337 patients with follicular carcinoma, 79 patients (23%) had calcifications, and the types were mostly fragmentary, massive, and egg-shell types. Among 41 patients with undifferentiated carcinoma, 33 patients (80%) presented with calcifications, which were mostly the massive and egg-shell types. Among 137 patients with medullary carcinoma, 99 patients (72%) had calcification, and the types showed a wide distribution. None of 173 patients with primary thyroid lymphoma had calcifications (0%). Calcifications on ultrasonography can be one of the characteristic findings and a full understanding of the prevalence of calcifications and types will markedly contribute to the ultrasonic diagnosis of thyroid tumors.

Sonographic Bedside Quantification of Pleural Effusion Compared to Computed Tomography Volumetry in ICU Patients

Abstract: To date, the reliability of ultrasound for the quantitative assessment of pleural effusion has been limited. In the following study, an easy and cost-effective bedside ultrasound method was developed and investigated for specific use in the intensive care unit (ICU). 22 patients (median age: 58.5 years, range: 37–88 years, 14 men and 8 women) with a total of 31 pleural effusions were examined in the ICU. The inclusion criterion was complete visualization of the effusion on chest computed tomography (CT). The ultrasound (US) examination was performed less than 6 h after the diagnostic CT scan. The pleural effusion volume was calculated volumetrically from the CT scan data. Within 4.58 +/- 2.87 h after the CT scan, all patients were re-examined with US in the ICU. The fluid crescent's thickness was measured between each intercostal space (ICS) with the patient in a supine position and a 30° inclination of the torso. The US measurements were compared to the calculated CT volumes using regression analysis, resulting in the following formula: V=13.330 x ICS6 (V=volume of the effusion [ml]; ICS6=sonographic measurement of the thickness of the liquid crescent [mm] in the sixth ICS). A significant correlation between the sonographically measured and the CT-calculated volumes was best observed for the sixth ICS (R2=0.589; ICC=0.7469 with p The sonographic assessment of pleural effusions in a supine position and a 30° inclination of the torso is feasible for the volumetric estimation of pleural effusion. This is especially true for ICU patients with severe primary diseases and orthopnea who are unable to sit upright or lie flat.

MRI-Ultrasound Fusion Imaging for Diagnosis of Deep Infiltrating Endometriosis - A Critical Appraisal.

Abstract: It was the aim of our study to evaluate this procedure using pelvic anatomical landmarks in order to assess the accuracy of fusion imaging and to critically evaluate the applicability in daily practice. In a prospective, single center study, 10 patients with clinical signs of deep infiltrating endometriosis (DIE) were selected. We measured the distance between the landmark organ and the target shown by the software system (measurement 1). Measurement 2 depicts the distance between the landmark and the nearest calibration point. The calibration inaccuracy was measured as a third type of measurement (measurement 3). Measurement 1: the average distance between the organ landmark to the target was 13.6 mm (range: 0–96 mm). Measurement 2: in 31 of the 40 attempts (77.5 %), we could measure the distance from the landmark organ to the nearest calibration point. The average distance was 34.4 mm (range: 0–69 mm). Measurement 3: A perfect match was seen in 6 of 20 attempts (30.0 %). There was a deviation in 14 of the 20 attempts (70.0 %). The mean distance was 11.1 mm (range: 6–23 mm). Conclusion Although very promising, MRI-ultrasound fusion imaging (MUFI) currently cannot be readily implemented into daily practice as a routine evaluation of DIE.

Ultrasound Evaluation of Testicular Volume in Patients with Testicular Microlithiasis.

Abstract: Purpose Ultrasonography is a useful tool to measure testicular volume. According to the European Society of Urogenital Radiology, the combination of testicular atrophy and testicular microlithiasis (TML) is a risk factor for testicular cancer. Testicular atrophy is defined as a volume of less than 12 ml. The aim of this study was to compare testicular volume in patients with TML to patients with normal testicular tissue. Materials and Methods From 2013 to 2015 we included a total of 91 adult patients with TML, and 91 adult patients with normal testicular tissue as a control group. All patients underwent scrotal B-mode ultrasound investigation including measurement of width, length and height in both testicles. Testicular volume was calculated using the formula π/6×length×height×width. Results The median age for patients with TML was 48 years (range: 19-94 years), and 48 years (range: 20–75 years) in patients with normal tissue. No statistically significant difference was found between total testicular volume (both testes) >30 ml in patients with TML compared to patients without (OR 0.77 (95% CI 0.43-1.38, p=0.37). However, patients with TML tended to have lower testicular volume compared to patients without TML, when investigating testicular volume below 12 ml. Conclusion Overall, no association was found between testicular volume and TML, but there was a trend indicating that severe atrophy is often seen in patients with TML compared to patients without TML. However, a significant difference was only found in testicular volume ≤8 ml.

Spontaneous and Traumatic Splenic Rupture: Retrospective Clinical, B-Mode and CEUS Analysis in 62 Patients.

Abstract: Introduction Both B-mode ultrasound and contrast-enhanced ultrasound (CEUS) are well established procedures when diagnosing traumatic splenic ruptures (TSR). To date, there are no data about CEUS patterns in spontaneous splenic ruptures (SSR). It remains unknown whether TSR and SSR differ with respect to clinical characteristics, B-mode and CEUS characteristics. Patients and Methods Between 12/2003 and 2/2010, n=33 SSRs and n=29 TSRs were diagnosed in a tertiary referral center. All patients were examined with B-mode and CEUS, and clinical data and the outcome were retrospectively analyzed. Results Patients with SSR were significantly older than patients with TSR (62 years vs. 44 years; p=0.01). The 4-week mortality was significantly higher in SSR than in TSR (36% vs. 0%; p=0.001). No differences between the grading of TSR and SSR could be shown in B-mode or in CEUS. Notably, CEUS was significantly superior to B-mode with respect to the grading of splenic ruptures (p=0.01). Therefore, therapeutic management was influenced by CEUS. Conclusion There are differences between SSR and TSR, especially concerning clinical data (age, course of disease and mortality). Regarding the sonographic pattern, SSR and TSR show identical grading. When splenic rupture is suspected, CEUS should always be performed to identify patients at risk who require interventional procedures.

Correlation Between Fetal Weight Gain and Birth Weight with Blood Flow in the Uterine Arteries Calculated with the PixelFlux Technique.

Abstract: Introduction The aim was to investigate correlations between fetal weight gain/day and birthweight with blood flow estimates in the uterine arteries calculated with the PixelFlux technique and with measurements from TAmax. We also aimed to examine the agreement between estimates using the two methods. Material and methods We conducted a prospective observational pilot study in pregnancy week 24–25 in women with risk pregnancies referred to the fetal medical centre at St. Olavs Hospital, Trondheim, Norway from March 2016 to June 2016. Blood flow in the uterine arteries was calculated using time-averaged peak velocity (TAmax) and the PixelFlux technique. PixelFlux is a method based on pixelwise calculation of spatially angle-corrected velocities and areas of all pixels inside a vessel during a heart cycle. Results The mean flow calculated from PixelFlux and TAmax was 811 ml/minute and 787 ml/minute, respectively. The intra-class correlation coefficient was 0.83 (95% CI 0.72-0.90) and limits of agreement were −441 ml/minute (95% CI -558 to −324 ml/minute) to 489 ml/minute (95% CI 372 to 606 ml/minute). We observed a significant correlation between mean flow calculated from PixelFlux and birthweight (r=0.41; p Conclusions We found significant correlations between estimated blood flow in the uterine arteries using the PixelFlux technique with fetal weight-gain/day and with birthweight. Estimates from two methods showed good agreement.

Can Ultrasound Alone Predict Papillary Thyroid Carcinoma with Desmoid-Type Fibromatosis? A Retrospective Analysis of 13 Cases, Focusing on the Stromal Area

Abstract: Papillary thyroid carcinoma with desmoid-type fibromatosis (PTC-DTF) is extremely rare. So far, only 4 cases describing the ultrasound findings of this variant have been reported. Here, we describe the ultrasound findings of 13 cases of PTC-DTF, focusing especially on the DTF area. We retrospectively analyzed the clinical reports, ultrasound reports, and ultrasound photographs obtained from medical records at Kuma Hospital. The patients included 8 women and 5 men with a mean age of 47.9 years. The widest dimension of the nodules ranged from 16 to 79 mm (mean: 37.5 mm). The original ultrasound reports classified the nodules as either intermediate suspicion or high suspicion. A diagnosis of PTC was suspected in 12 nodules, and anaplastic carcinoma was suspected in 1 nodule. PTC-DTF presented with an irregularly shaped nodule (100%), taller-than-wide sign (84.6%), heterogeneous echogenicity (100%), no microcalcification (76.9%), and no or mild flow signal on Doppler (75.0%). The DTF area was identified in the ultrasound photographs of 8 nodules. DTF areas were generally heterogeneous (62.5%) and more hypoechoic (71.4%) than PTC areas. Microcalcification was not observed in the DTF areas. All of the DTF areas revealed no or mild flow signal. On ultrasound elastography, the DTF areas were not stiff, and they were more elastic than the PTC areas. It is difficult to predict PTC-DTF using ultrasound alone, and B-mode ultrasonography is more reliable than ultrasound elastography in the ultrasound diagnosis of malignant thyroid nodules.

Evaluation of Peak Reflux Velocities with Vector Flow Imaging and Spectral Doppler Ultrasound in Varicose Veins

Abstract: Purpose Spectral Doppler ultrasound (SDUS) is used for quantifying reflux in lower extremity varicose veins. The technique is angle-dependent opposed to the new angle-independent Vector Flow Imaging (VFI) method. The aim of this study was to compare peak reflux velocities obtained with VFI and SDUS in patients with chronic venous disease, i. e., pathological retrograde blood flow caused by incompetent venous valves. Materials and Methods 64 patients with chronic venous disease were scanned with VFI and SDUS in the great or the small saphenous vein, and reflux velocities were compared to three assessment tools for chronic venous disease. A flow rig was used to assess the accuracy and precision of the two methods. Results The mean peak reflux velocities differed significantly (VFI: 47.4 cm/s vs. SDUS: 62.0 cm/s, p Conclusion Both VFI and SDUS detected the pathologic retrograde flow in varicose veins but measured different reflux velocities with equal precision. VFI may play a role in evaluating venous disease in the future.

Sonographic Evaluation of Nodules Newly Detected in the Neck After Thyroidectomy: Suture Granuloma Versus Recurrent Carcinoma

Abstract: This study aimed to clarify the sonographic features of suture granuloma and recurrent carcinoma newly detected after thyroidectomy. We retrospectively analyzed ultrasound reports with images of 25 cases of suture granuloma and 18 cases of recurrent carcinoma that newly appeared in the resected area after thyroidectomy in our institution. Both suture granulomas and recurrent carcinomas more frequently exhibited multiple lesions rather than solitary lesions. Suture granulomas tended to appear in the more superficial areas than the carotid artery, while recurrent carcinomas were more common between the trachea and carotid artery. A total of 10 of the 11 suture granulomas that we followed up decreased in size. Recurrent carcinomas showed irregular shape (55.6%), taller-than-wide shape (38.9%), low internal echogenicity (83.3%), and no punctate microcalcifications. By contrast, suture granulomas were fusiform in shape (56.0%) and showed linear internal echo parallel to the tissue plane on the longitudinal scan (64.0%). The vascular flow sign was mild to none in the majority of both lesions. Fusiform shape and linear internal echoes indicate suture granuloma, while irregular shape, taller-than-wide shape, and low echogenicity indicate recurrent carcinoma. Given that the clinical management of suture granuloma differs from that of recurrent carcinoma, it is important to distinguish between these two lesions.

Phantom Nodules Detected by Ultrasound Examination of the Neck: The Possibility of Ectopic Cervical Thymic Tissue in Adults.

Abstract: The aim of this study was to investigate the ultrasound characteristics and clinical significance of slightly hyperechoic lesions, referred to as phantom nodules, in the perithyroidal area in patients. A total of 128 patients who underwent thyroidectomy with central neck lymph node dissection at Kuma Hospital in Hyogo, Japan were included in the study. We detected 16 phantom nodules during preoperative ultrasound examinations, defined as slightly hyperechoic masses located in the perithyroidal areas, in 13 of these 128 patients (10.2%; mean age: 55.6 years, range: 36–75 years). All phantom nodules were located in the caudal region of the thyroid gland, and the mean maximum dimension was 7.2 mm. 12 of the 16 nodules were round or oval, while the remaining 4 were fusiform and molded by the surrounding tissue. All nodules were well-defined, solid, homogeneous, hyperechoic masses. No speckled echo pattern, internal linear echo, or vascular flow signal was observed. All 4 nodules subjected to histological examination were composed of ectopic thymic tissue. In 2 of these 4, the parenchyma was severely involuted and almost entirely replaced by adipose tissue. To the best of our knowledge, this is the first report wherein some of the detected hyperechoic perithyroidal masses were composed of ectopic thymic tissue, and some were primarily composed of adipose tissue that completely replaced involuted ectopic thymic tissue. The results of the study suggest that these so-called phantom nodules are clinically insignificant and do not require fine needle aspiration cytology or further investigation.

Early Antenatal Sonographic Findings of Rubinstein-Taybi Syndrome: Imaging of High-Arched Palate and Bilateral Abducted Thumbs on Surface Rendering Mode at 17 Weeks.

Abstract: Introduction Rubinstein-Taybi Syndrome (RSTS) is a rare genetic disorder (estimated birth prevalence 1 in 100,000 to 125,000). Rubinstein and Taybi originally described seven children with typical dysmorphic facial features, broad thumbs and toes, and varying degrees of mental retardation. The syndrome is associated with multiple systemic anomalies. The literature includes about a thousand reported cases since 1963. This condition is inherited in an autosomal dominant pattern, but the majority of cases are derived by de novo mutation. It may be caused by micro deletion within 16p13.3 or different mutations in the genes encoding the transcriptional coactivator CREB-binding protein and E1A-binding protein p300. The cytogenetic anomalies of RSTS remain unknown in about 37 % of patients. The diagnosis is based on clinical presentation during the early postnatal period (Spena S et al. J Pediatr Genet 2015; 4: 177-186). Only three cases of antenatal ultrasound diagnosis or detection have been reported to date. Here we present the ultrasound features of a new case.

Prenatal Diagnosis and Clinical Course of a Patent Urachus Associated with an Allantoic Cord Cyst and a Giant Umbilical Cord.

Abstract: Umbilical cord cysts are rare and the various differential diagnoses influence both management of delivery and postnatal care. Differential diagnoses of umbilical cord cysts include pseudo-cysts, omphalocele, bladder exstrophy, omphalomesenteric duct cysts and other urachal anomalies. Communication between the cyst and the fetal bladder is a hallmark of patent ductus urachus, which has an estimated incidence of 1-2:100,000 and may be detected prenatally by high-resolution ultrasound (Persutte WH et al. J Ultrasound Med 1988; 7: 399-403; Wildhaber BE et al. Arch Dis Child Fetal Neonatal Ed 2005; 90: F535-536). We present a case of a patent ductus urachus initially presenting as an allantoic cord cyst followed by edematous swelling of the umbilical cord.

The Value of an Automated Ultrasound System in the Detection of Synovitis

Abstract: Background The detection of joint swelling caused by synovitis is important for the diagnosis of inflammatory arthritis Ultrasound (US) and MRI have proven to be more sensitive and reliable than physical examination, but they are time-consuming and expensive The automated breast volume scanner was developed to acquire serial B-mode pictures of the female breast and these can be analyzed in all three dimensions Objectives To analyze the value of automated B-mode ultrasound employing the ABVS system in detecting synovitis of the finger joints compared to manual ultrasound (mUS) and physical examination, using MRI as the gold standard Methods 19 consecutive patients suffering from active rheumatoid (n=15) or psoriatic (n=4) arthritis were included Automated and mUS were conducted with a linear array (ACUSON S2000™, 11 MHz) Multiplanar reconstruction enabled examination of the images for the presence of synovitis Results 90% of the hand joints were assessable by automated ultrasound Automated US detected 120, mUS 142, MRI 134, and clinical examination 41 positive joints – i e joints with synovitis - on average per patient The inter-observer reliability of both assessors for automated and mUS, MRI, and physical examination, was 669%, 727%, 951%, and 889%, respectively 843% of the joints classified as positive on MRI were confirmed by automated ultrasound, 855% on mUS, and 360 on physical examination This translated into a sensitivity of 835%, 855%, and 360% for the three methods, respectively Conclusion: Automated ultrasound is a promising ultrasound method for assessing small joints in patients with inflammatory arthritis

Sonographic Venous Velocity Index Identifies Patients with Chronic Kidney Disease and Severe Diastolic Dysfunction

Abstract: Diagnosing cardiorenal syndrome (CRS) in patients with chronic kidney disease (CKD) continues to remain challenging in outpatient practice. In this study, we investigate whether a newly developed venous velocity ultrasound index (VVI) can differentiate between patients with CRS and patients with CKD of other cause or normal renal function (NRF). Patients with CRS (n=30), CKD (n=30), and NRF (n=30) were included in the study. For each patient, duplex ultrasound scans of intrarenal segmental veins were retrospectively analyzed. The VVI was calculated from the renal venous doppler curve as the ratio of the maximal positive venous velocity to the maximal negative venous velocity. Patients with CRS were compared to age-matched controls with NRF and to GFR-matched controls with CKD. The GFRs of patients with CRS and those with CKD were comparable (26.4±5 and 25.6±7 ml/min/m2), as was the age in patients with CRS and NRF (6 ±12 years and 68±16 years, respectively). There was no significant difference in ejection fraction between patients with CRS and those with CKD (44.2±6.2% vs. 47.4 ±7.2), but there was a significant decrease compared to those with NRF (52.6 ±5.1, p 0.6. The newly developed VVI was useful in successfully predicting severe diastolic dysfunction (CRS) in patients with severe kidney injury in outpatient care.

An Atypical Inguinal Hernia in a 9-Month-Old Girl - Case Report and Ultrasound Findings

Abstract: The incidence of pediatric inguinal hernias has been cited in other studies to be between 0.8 % and 4.4 %, and the male to female ratio in a clinical series containing 6361 pediatric ingiunal hernias in infants and children under the age of 18 was 5:1. In female infants, inguinal hernias contained an ovary in 15 % of cases. The presence of a irreducible ovary increases the risk of hernial strangulation, with strangulation rate estimates of 2 % to 33 % (S. Ein, et.al., Journal of Pediatric Surgery, 41.5; 2006;, 980–86.), presenting a risk of necrosis of the ovary. Differential diagnoses in female infants are numerous and include hydrocele of the canal of Nuck, femoral hernia, epidermal inclusion cysts, cystic lymphangiomas, lymphadenopathy, lymphadenitis, rhabdomyosarcoma, and metastatic tumor (K. Hennelly et.al., The Journal of Emergency Medicine, 40.1; 2011;, 33–36). This suggests the importance of rapid and precise diagnosis, with ultrasound (US) possibly being a helpful noninvasive preoperative diagnostic tool for non-reducible inguinal masses. In this case report, we present a female infant with an inguinal hernia containing a torqued and strangulated ovary diagnosed by US.

Atherosclerotic Lesions in the Superficial Femoral Artery (SFA) Characterized with Velocity Ratios using Vector Velocity Ultrasound.

Abstract: Purpose Atherosclerotic arteries are challenging to evaluate quantitatively using spectral Doppler ultrasound because of the turbulent flow conditions that occur in relation to the atherosclerotic stenoses. Vector velocity ultrasound is angle independent and provides flow information, which could potentially improve the diagnosis of arterial stenoses. The purpose of the study is to distinguish significant stenoses in the superficial femoral artery (> 50% diameter reduction) from non-significant stenoses based on velocity ratios derived from the commercially available vector velocity ultrasound technique Vector Flow Imaging (VFI). Materials and Methods Velocity ratios (intrastenotic blood flow velocity divided by pre- or poststenotic velocity) from a total of 16 atherosclerotic stenoses and plaques in the superficial femoral artery of 11 patients were obtained using VFI. The stenosis degree, expressed as percentage diameter reduction of the artery, was determined from digital subtraction angiography and compared to the velocity ratios. Results A velocity ratio of 2.5 was found to distinguish clinically relevant stenoses with>50% diameter reduction from clinically non-relevant stenoses with Conclusion The study indicates that VFI is a potential future tool for the evaluation of arterial stenoses.

Re-Evaluation of 162 Malignant Thyroid Nodules that were Interpreted as Benign Based on Ultrasound Findings.

Abstract: The goal of this study was to estimate the risk of malignant thyroid nodules being interpreted as benign based on ultrasound findings and to clarify the pathological features of these malignant nodules. We retrospectively re-evaluated ultrasound and pathological findings for 162 malignant thyroid nodules that were initially interpreted as benign based on ultrasound findings at Kuma Hospital between April 2012 and June 2015. The incidences of malignancy among “benign” thyroid nodules were 0.5% overall and 6.2% among resected nodules. In addition, 82.7% of thyroid nodules that were originally judged to have low or very low suspicion patterns were subsequently re-categorized as having high or intermediate suspicion patterns. The incidences of irregular margins (63.6%) and low echogenicity (36.4%) were higher than those of punctate microcalcification (17.9%) and the taller-than-wide shape (20.4%). Among microcarcinomas, the incidences were 65.7% for irregular margins and 51.4% for low echogenicity. Rim calcification with small extrusive soft tissue components and extrathyroidal extensions were not observed. After re-evaluation, 40.0% of papillary thyroid carcinomas remained benign based on their variants, such as the encapsulated, follicular, macrofollicular, and oxyphilic cell variants. We conclude that more careful observation, especially for lesions with irregular margins and low echogenicity, can help improve the diagnostic accuracy of thyroid ultrasonography. Furthermore, greater care may decrease the incidence of malignancy among thyroid nodules with low or very low suspicion patterns. Some variants of papillary thyroid carcinoma can have benign ultrasound findings.