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To establish a practical and simplified Chinese thyroid imaging reporting and data system (C-TIRADS) based on the Chinese patient database. A total of 2141 thyroid nodules that were neither cystic nor spongy were used in the current study. These specimens were derived from 2141 patients in 131 alliance hospitals of the Chinese Artificial Intelligence Alliance for Thyroid and Breast Ultrasound. The ultrasound features, including location, orientation, margin, halo, composition, echogenicity, echotexture, echogenic foci and posterior features were assessed. Univariate and multivariate analyses were performed to investigate the association between ultrasound features and malignancy. The regression equation, the weighting, and the counting methods were used to determine the malignant risk of the thyroid nodules. The areas under the receiver operating characteristic curve (Az values) were calculated. Of the 2141 thyroid nodules, 1572 were benign, 565 were malignant, and 4 were borderline. Vertical orientation, ill-defined, or irregular margin (including extrathyroidal extension), microcalcifications, solid, and markedly hypoechoic were positively associated with malignancy, while comet-tail artifacts were negatively associated with malignancy. The logistic regression equation yielded the highest Az value of 0.913, which was significantly higher than that obtained using the weighting method (0.893) and the counting method (0.890); however, no significant difference was found between the latter two. The C-TIRADS, based on the counting method, was designed following the principle of balancing the diagnostic performance and sensitivity of the risk stratification with the ease of use. A relatively simple C-TIRADS was established using the counting value of positive and negative ultrasound features.

Thyroid nodules are very common all over the world, and China is no exception. Ultrasound plays an important role in determining the risk stratification of thyroid nodules, which is critical for clinical management of thyroid nodules. For the past few years, many versions of TIRADS (Thyroid Imaging Reporting and Data System) have been put forward by several institutions with the aim to identify whether nodules require fine-needle biopsy or ultrasound follow-up. However, no version of TIRADS has been widely adopted worldwide till date. In China, as many as ten versions of TIRADS have been used in different hospitals nationwide, causing a lot of confusion. With the support of the Superficial Organ and Vascular Ultrasound Group of the Society of Ultrasound in Medicine of the Chinese Medical Association, the Chinese-TIRADS that is in line with China's national conditions and medical status was established based on literature review, expert consensus, and multicenter data provided by the Chinese Artificial Intelligence Alliance for Thyroid and Breast Ultrasound.

Objective To test the value of qualitative virtual touch imaging quantification (VTIQ) features in differentiating benign from malignant breast lesions. Methods From November 2016 to August 2017, 230 lesions were subjected to conventional US and virtual touch imaging quantification before biopsy. The maximum shear wave velocity (SWVmax) was measured using a standardized method. Qualitative VTIQ features, including the "stiff rim" sign and color pattern classification, were assessed according to a binary classification. The sensitivity, specificity and area under the receiver operating curve (AUC) of Breast Imaging Reporting and Data System (BI-RADS), SWVmax, qualitative VTIQ features, and combined data were compared. Results Among the 230 breast lesions, 150 were benign and 80 were malignant. Compared to the benign lesions, the malignant ones had higher SWVmax values and were more likely to show the "stiff rim" sign and VTIQ pattern 2 (P

AIM To identify the differences between ultrasound (US) features of parathyroid carcinoma (PC) and benign parathyroid (BP) lesions in patients with primary hyperparathyroidism (PHPT). MATERIAL AND METHODS Twenty-one patients with PC and 64 consecutive patients with BP, whose diagnoses were confirmed at surgery, were enrolled from January 2013 to December 2018. The US features, demographic, clinical, and biochemical characteristics of the two groups were compared retrospectively. RESULTS There are no significant differences between the patients with PC and BP regarding mean age or mean ionized calcium levels but differences were seen in sex distribution and mean parathyroid hormone (PTH) levels. On US imaging, PC significantly exhibited higher incidences of larger size and higher depth/width (D/W) ratio, heterogeneous echotexture, irregular shape, non-circumscribed margin, intra-nodular calcifications, indistinct border, cystic change, and the presence of suspicious lymph nodes compared to BP lesions. CONCLUSION Preoperative ultrasonography is helpful to differentiate PC and BP. Patients with PC are differentiated from BP by their sex distribution, mean PTH levels, and major US characteristics: larger size, higher D/W ratio, heterogeneous echotexture, irregular shape, non-circumscribed margin, indistinct border, intra-nodular calcifications, cystic change, and the presence of suspicious lymph nodes.

Background Lung ultrasound (LUS) can be an important imaging tool for the diagnosis and assessment of lung involvement. Ultrasound sonograms have been confirmed to illustrate damage to a person’s lungs, which means that the correct classification and scoring of a patient’s sonogram can be used to assess lung involvement. Methods The purpose of this study was to establish a lung involvement assessment model based on deep learning. A novel multimodal channel and receptive field attention network combined with ResNeXt (MCRFNet) was proposed to classify sonograms, and the network can automatically fuse shallow features and determine the importance of different channels and respective fields. Finally, sonogram classes were transformed into scores to evaluate lung involvement from the initial diagnosis to rehabilitation. Results and conclusion Using multicenter and multimodal ultrasound data from 104 patients, the diagnostic model achieved 94.39% accuracy, 82.28% precision, 76.27% sensitivity, and 96.44% specificity. The lung involvement severity and the trend of COVID-19 pneumonia were evaluated quantitatively.

Objective: Cervical lymph node metastasis (LNM) was found to be clinically significant prognostic factors of patients with papillary thyroid carcinomas (PTC). Ultrasound (US) characteristics of thyroid nodules and thyroid parenchyma may be used to predict LNM. To investigate the value of nodular US features as well as thyroid parenchymal microcalcifications on US in predicting LNM in patients with PTC.Methods: This prospective study was approved by the Institutional Review Board. From January 2018 to June 2019, 971 consecutive patients with solitary PTC who underwent preoperative neck US evaluation were included from six hospitals in China. The US features of thyroid nodules as well as thyroid parenchyma microcalcifications were carefully evaluated based on the static images and dynamic clips. Univariate and multivariate analyses were performed to determine independent predictors of LNM.Results: Of the 971 patients, 760 were female, 211 were male. According to the pathological examination, 241(24.82%) patients were found with cervical LNM (LNM positive group), while 730 (75.18%) patients were not (LNM negative group). Multiple logistic regression analysis showed that young age (P = 0.047), large size (>10 mm) (OR = 1.814, P < 0.001), intratumoral microcalcifications (OR = 1.782, P = 0.002) and thyroid parenchyma microcalcifications (OR = 1.635, P = 0.046) were independent risk factors for LNM of PTC.Conclusions: Young age, large nodule size, intratumoral microcalcifications, as well as thyroid parenchyma microcalcifications on US are independent predictors of cervical LNM for patients with PTC.

The handheld ultrasound demonstrates clinical and economic value in combating COVID-19 based on interviews with frontline ultrasound physician and cardiologist as well as a national expert in medical ultrasound.

Breast cancer is the most common invasive cancer in women. Besides the primary B-mode ultrasound screening, sonographers have explored the inclusion of Doppler, strain and shear-wave elasticity imaging to advance the diagnosis. However, recognizing useful patterns in all types of images and weighing up the significance of each modality can elude less-experienced clinicians. In this paper, we explore, for the first time, an automatic way to combine the four types of ultrasonography to discriminate between benign and malignant breast nodules. A novel multimodal network is proposed, along with promising learnability and simplicity to improve classification accuracy. The key is using a weight-sharing strategy to encourage interactions between modalities and adopting an additional cross-modalities objective to integrate global information. In contrast to hardcoding the weights of each modality in the model, we embed it in a Reinforcement Learning framework to learn this weighting in an end-to-end manner. Thus the model is trained to seek the optimal multimodal combination without handcrafted heuristics. The proposed framework is evaluated on a dataset contains 1616 sets of multimodal images. Results showed that the model scored a high classification accuracy of 95.4%, which indicates the efficiency of the proposed method.

Evaluation of liver fibrosis is important to assess prognosis and guide the treatment for chronic hepatitis B. To analyze and compare transient, point, and two-dimensional (2D) shear wave elastography techniques in grading the liver fibrosis. Based on the severity of liver inflammation and fibrosis (Scheuer criteria), 158 patients with chronic hepatitis B were assigned into group 1 (either G or S classification

Objectives Our goal was to assess the diagnostic efficacy of ultrasound (US)-guided fine-needle aspiration (FNA) of thyroid nodules according to size and US features. Methods A retrospective correlation was made with 1745 whole thyroidectomy and hemithyroidectomy specimens with preoperative US-guided FNA results. All cases were divided into 5 groups according to nodule size (≤5, 5.1–10, 10.1–15, 15.1–20, and >20 mm). For target nodules, static images and cine clips of conventional US and color Doppler were obtained. Ultrasound images were reviewed and evaluated by two radiologists with at least 5 years US working experience without knowing the results of pathology, and then agreement was achieved. Results The Bethesda category I rate was higher in nodules larger than 15 mm (P 20 mm) with several US features tended to yield false-negative FNA results.

To evaluate the efficacy and safety of percutaneous laser ablation (PLA) for unifocal T1N0M0 papillary thyroid microcarcinoma(PTMC).A retrospective study was conducted in 30 patients with single PTMC which was diagnosed by fine-needle aspiration biopsy (FNAB). PLA was performed for proper time to achieve adequate ablation zones. The extent of ablation was assessed by contrast-enhanced ultrasound (CEUS) immediately and 7 days after PLA. Complications were recorded. The size and volume of the ablation area and thyroid hormones were measured, and clinical evaluations were performed at 1, 3, 6 and12 months, and every half year thereafter.The procedure was well tolerated without serious complications. Of the 30 patients, 29 were treated successfully under local anaesthesia in a single session. Only one incomplete ablation was detected by immediate CEUS after PLA, and a second ablation was performed. At the last follow-up, ten (33.3 %) ablation zones had disappeared, and 20 (66.67 %) ablation zones remained as scar-like lesions. No regrowth of treated tumours, local recurrence or distant metastases were detected.During the short-term follow-up period, ultrasound-guided PLA appears to be effective and safe for treating solitary T1N0M0 PTMC in selected patients who are ineligible for surgery.• Ultrasound is a useful tool in percutaneous laser ablation (PLA). • PLA is safe for treating papillary thyroid microcarcinoma. • PLA is effective for single papillary thyroid microcarcinoma.

Background The evaluation of thyroid nodules with ultrasonography has created a large burden for radiologists. Artificial intelligence technology has been rapidly developed in recent years to reduce the cost of labor and improve the differentiation of thyroid malignancies. This study aimed to investigate the diagnostic performance of a novel computer-aided diagnosing system (CADs: S-detect) for the ultrasound (US) interpretation of thyroid nodule subtypes in a specialized thyroid center. Methods Our study prospectively included 180 thyroid nodules that underwent ultrasound interpretation. The CADs and radiologist assessed all nodules. The ultrasonographic features of different subtypes were analyzed, and the diagnostic performances of the CADs and radiologist were compared. Results There were seven subtypes of thyroid nodules, among which papillary thyroid cancer (PTC) accounted for 50.6% and follicular thyroid carcinoma (FTC) accounted for 2.2%. Among all thyroid nodules, the CADs presented a higher sensitivity and lower specificity than the radiologist (90.5% vs 81.1%; 41.2% vs 83.5%); the radiologist had a higher accuracy than the CADs (82.2% vs 67.2%) for diagnosing malignant thyroid nodules. The accuracy of the CADs was not as good as that of the radiologist in diagnosing PTCs (70.9% vs 82.1%). The CADs and radiologist presented accuracies of 43.8% and 60.9% in identifying FTCs, respectively. Conclusions The ultrasound CADs presented a higher sensitivity for identifying malignant thyroid nodules than experienced radiologists. The CADs was not as good as experienced radiologists in a specialized thyroid center in identifying PTCs. Radiologists maintained a higher specificity than the CADs for FTC detection.

The objective of this study was to evaluate the inter-operator reproducibility of strain elastography (SE) and shear wave elastography (SWE) in three groups: all lesions, benign lesions and malignant lesions. Ninety-one lesions from ninety-one women were examined by SE and SWE from January 2017 to December 2017 by two radiologists. The reproducibility of elastic score, SE strain ratio and SWE Young's modulus between operators was prospectively evaluated. There was good agreement on elasticity score, with κ values of 0.711, 0.640 and 0.766. The intra-class correlation coefficients of the strain ratio, mean elastic modulus (Emean), maximum elastic modulus (Emax) and elastic modulus standard deviation (Esd) ranged from 0.723-0.876, which indicated good and excellent agreement. We concluded that both SE and SWE had good reproducibility among different operators using the same probe in the same ultrasound instrument. Strain elasticity score was more consistent among operators in malignant breast tumors. There was better agreement on strain elastic ratio and shear wave elasticity among operators in benign breast lesions.

The goal of our study was to investigate the anisotropy of normal breast glandular and fatty tissue with acoustic radiation force impulse (ARFI) quantification. A total of 137 breasts in 137 women were enrolled. These breasts were divided into the duct-apparent group and the duct-inapparent group, divided into the ligament-apparent group and the ligament-inapparent group. Shear wave velocity (SWV) in the radial (SWV(r)) and anti-radial (SWV(a-r)) directions was measured. The elastic anisotropy of glandular tissue and fatty tissue was evaluated as the ratio between SWV(r) and SWV(a-r). The SWV ratio was 1.30 ± 0.45 for glandular tissue and 1.27 ± 0.53 for fatty tissue in the total group. In glandular tissue, the SWV ratio of the duct-apparent group was higher than that of the duct-inapparent group (p = 0.011). In both glandular and fatty tissue, the SWV ratio was higher in the ligament-apparent group than in the ligament-inapparent group (p 0.05 for both). SWV(r) was higher than SWV(a-r) in both glandular tissue and fatty tissue in all groups (p 0.05 for all) except in breast fatty tissue in the ligament-inapparent group (p = 0.913). It is concluded that both breast glandular tissue and fatty tissue exhibited anisotropy of elastic behavior. To improve the diagnostic power of elastography in breast lesions, the elastic anisotropy of glandular tissue and fatty tissue should be taken into account in calculating strain ratio or elasticity ratio.

The goal of this study was to verify the ultrasound features of hyper-echoic rims in thyroid nodules and to evaluate their diagnostic value in predicting thyroid malignancies. We retrospectively analyzed 228 pathologically proven thyroid nodules (137 malignant and 91 benign nodules). Forty-eight thyroid nodules had a hyper echogenic rim. All malignant nodules (137) were papillary carcinomas, which were studied to identify the correlation between the hyper-echoic rim (detected by ultrasound) and other histologic features. Presence of a hyper-echoic rim had high specificity (94.51%), but low sensitivity (31.39%) in predicting malignancy (p < 0.05). Thirty-seven of 43 malignant nodules had boundary zones of mixed structure (apparent fibrous stroma bands or dense collagenous border with a mixed population of cancerous cells) under microscopic examination. In conclusion, the hyper-echogenic rim could be one additional ultrasound parameter in the diagnosis of thyroid lesions.

The goal of our study was to investigate the value of color-coded Virtual Touch tissue imaging (VTI) using acoustic radiation force impulse (ARFI) technology in the characterization of breast lesions and to compare it with conventional ultrasound (US). Conventional US and color-coded VTI were performed in 196 solid breast lesions in 196 consecutive women (age range 17-91 y; mean 48.17 ± 14.46 y). A four-point scale VTI score was assigned for each lesion according to the color pattern both in the lesion and in the surrounding breast tissue. The mean VTI score was significantly higher for malignant lesions (3.80 ± 0.66, range 1-4) than for benign ones (2.02 ± 1.20, range 1-4) (p

Ultrasound shear wave elastography (USWE) enables us to quantitatively characterize the mechanical properties of solid tumors and is of clinical importance in differentiating malignant tumors from benign ones. However, limited by the resolution of USWE, it remains challenging in evaluating the elastic properties of tumors with small dimensions. Here we study the size effect in USWE of tumors via phantom experiments. Gelatin phantoms consisted of spherical inclusions and softer matrix were fabricated to model the tumors embedded in surrounding soft tissues. Our results show that elastic moduli E of the phantom tumors measured with conventional USWE are highly related to their diameters d (r > 0.96, P

Purpose The purpose of this study was to sonographically evaluate the diagnosis of localized Castleman disease in the abdomen and pelvis. Methods This was a retrospective analysis of 18 cases of Castleman disease localized in the abdomen and pelvis. The following features of the lesions were assessed on sonography (US): location, size, margin, echogenicity, echotexture, intralesional cystic necrosis, intralesional calcification, posterior acoustic enhancement, and blood supply. Results Of the 18 tumors, 16 were located in the abdomen and 2 were located in the pelvis close to iliac vessels. The most frequent appearance of localized Castleman disease in the abdomen and pelvis on US was of a single, well-defined, hypoechoic solid mass with no intralesional cystic necrosis. The internal echotexture was homogeneous in 4 cases and heterogeneous in 14 cases, with thin hyperechoic septa (n = 14) or calcifications (n = 3). Posterior acoustic enhancement was seen in 17 of the 18 cases (94%). Ninety-four percent of the lesions (17/18) had marked vascularity on color Doppler US. Conclusions Localized Castleman disease in the abdomen and pelvis usually appears on US as a heterogeneously hypoechoic lesion containing thin septa, and more commonly than not, demonstrates posterior acoustic enhancement and marked vascularity. © 2014 Wiley Periodicals, Inc. J Clin Ultrasound 43:401–405, 2015

To compare the diagnostic performance of the fat-to-lesion strain ratio (FLR) and gland-to-lesion strain ratio (GLR) in the diagnosis of breast lesions. This was an institutional ethics committee approved prospective study. One hundred and ninety-three breast lesions in 193 women (mean age, 46.03 ± 13.60 years, range 18–82 years) were examined with conventional and elastographic US. Both the FLR and GLR of the lesions were calculated. The elasticity scores of the lesions were also evaluated using the five-point elasticity scoring system. For diagnostic performance, the sensitivity, specificity and receiver operating characteristic (ROC) analysis were obtained. Seventy lesions were malignant and 123 were benign. Both the FLR and GLR of the lesions were significantly higher in malignant cases than in benign ones (P

To evaluate the stiffness of the surrounding tissue of breast lesions using the strain ratio assessment method by ultrasound (US) elastography. This was an institutional ethics committee approved prospective study. A total of 127 breast lesions in 118 women (mean age 48.23 ± 14.32, range 20–90) were examined with conventional and elastographic US. The strain ratio assessment method was utilized to semi-quantitatively evaluate the stiffness of the breast lesions and the surrounding tissue. Fifty-five lesions were malignant and 72 were benign. The strain ratio of the surrounding tissue was significantly higher in malignant cases (1.49 ± 0.67) than in benign ones (1.17 ± 0.44) (P = 0.001), and yielded an Az value of 0.669 in the diagnosis of breast lesions. There was a significant high positive correlation between the strain ratio of the lesion and the strain ratio of the surrounding tissue in the malignant group (r = 0.740, P

Ultrasonography, the preferred imaging modality for breast diseases, has merits such as absence of radiation, high diagnostic accuracy, and convenience for follow-up, thus playing an important role in clinical diagnosis and management. The American College of Radiology (ACR) proposed Breast Imaging-Reporting and Data System (BI-RADS ) and has updated for several times. Gradually, the BI-RADS has been accepted and adopted by ultrasound physicians at all levels of hospitals in China, and it has played a certain role in improving the diagnostic level of breast ultrasound in China. In order to standardize breast ultrasound application and raise the status of ultrasound in clinical decision-making of breast diseases, based on the latest edition of ACR BI-RADS Atlas 2013, the committee has reached the “Expert Consensus on Clinical Frequently Asked Questions in Breast Ultrasonography”on a number of controversial Frequently Asked Questions (FAQs) in clinical practice (hereafter referred to as “Consensus”), and will be dedicated to updating the contents of the “Consensus”, through further experience in clinical practice and the advent of new information from further studies. This consensus is only for reference purposes for medical personnel, and the processes outlined are not mandatory by law.