To explore the characteristics of high-frame-rate contrast-enhanced ultrasound (H-CEUS) in Chinese thyroid imaging reporting and data system (C-TIRADS) 4-5 thyroid nodules.

One hundred and two patients with C-TIRADS 4-5 thyroid nodules (n=109) diagnosed at the First Affiliated Hospital of the Air Force Military Medical University from September 2022 to May 2023 were prospectively collected. H-CEUS and conventional contrast-enhanced ultrasound (C-CEUS) were performed. The characteristics of H-CEUS imaging were analyzed with regard to whether there was tortuous blood vessels in the nodules, enhancement direction, enhancement uniformity, enhancement intensity, whether the boundary was clear, and the time-intensity curve (TIC) parameters [arrival time (AT), time to peak (TTP), peak intensity (PI), maximum slope of rise curve (AS), and maximum slope of decline curve (DS)]. These features were then compared with the C-CEUS imaging features. Based on fine-needle aspiration or surgical pathology, the nodules were divided into either a benign group or a malignant group. The χ² test or Fisher exact probability method was used to compare the differences in imaging features between H-CEUS and C-CEUS in the two groups. Nonparametric Mann-Whitney test was used to compare the differences between C-CEUS and H-CEUS TIC parameters in the two groups.

Of the 109 nodules included, there were 48 benign nodules and 61 malignant nodules. In malignant nodules, H-CEUS showed that 78.7% (48/61) of the nodules had tortuous blood vessels after enhancement (C-CEUS showed 31.1%, χ²=27.843, P<0.001). In benign nodules, H-CEUS showed that 91.7% (44/48) of the nodules had a clear boundary after enhancement (C-CEUS showed 38.9%, χ²=36.984, P<0.001). H-CEUS and C-CEUS showed that there was no significant difference in enhancement direction, enhancement uniformity, or enhancement intensity between thyroid benign and malignant nodules after enhancement (P>0.05). In H-CEUS, the PI of benign nodules and malignant nodules was 24.18 (19.09, 31.20) and 18.20 (16.66, 23.91), respectively, significantly lower than that of C-CEUS [35.42 (25.83, 39.77) and 27.79 (25.88, 29.98), respectively; Z=-3.467 and -3.922; P=0.001 and <0.001, respectively]. In H-CEUS, DS [-0.11 (-0.15, -0.09)] was signifciantly higher than that of C-CEUS [-0.15 (-0.18, -0.12); Z=-2.578, P=0.010]. There was no significant difference in AT, TTP, or AS between H-CEUS and C-CEUS in both benign and malignant nodules (P>0.05).

H-CEUS can reflect the different enhancement characteristics of C-TIRADS 4-5 thyroid nodules, and has appreciated advantages in showing tortuous blood vessels and nodule boundary.

To summarize the problems and improvements in the quantitative assessment of mitral regurgitation (MR) by echocardiography.

We retrospectively analyzed the image sequences of 196 patients who underwent MR evaluation by echocardiography from August 2021 to April 2023 at the Renmin Hospital of Wuhan University. The patients were divided into a pre-quality control group and a post-quality control group. The control group consisted of 107 patients who underwent MR evaluation between August 2021 and August 2022, while the observation group consisted of 89 patients who underwent MR between September 2022 and April 2023. According to the 2017 American Society of Echocardiography guidelines and standards, the degree of MR was divided into four grades (mild, moderate, moderate-severe, and severe). The inconsistency between the grade to which four quantitative parameters, namely, vena contracta width (VCW), effective regurgitant orifice area (EROA), regurgitant volume (RVol), and regurgitant fraction (RF), belonged and the degree of regurgitation within each grade group was counted and classified as complete consistency (all 4 parameters were consistent), low inconsistency (1 parameter inconsistent), medium inconsistency (2 parameters inconsistent), and high inconsistency (3 parameters inconsistent). The χ² test was used to compare the differences in inconsistency between various grade groups and before and after quality control. The intraclass correlation coefficient (ICC) was utilized for the repeatability test.

Among the 196 MR patients, there were 31, 35, 51 and 79 cases in the mild group, moderate group, moderate-severe group, and severe group, respectively. In the mild, moderate, moderate-severe, and severe groups, the percentages of complete consistency, low inconsistency, moderate inconsistency, and high inconsistency were 16.13%, 51.61%, 29.03%, and 3.23%, 14.29%, 62.86%, 17.14%, and 5.71%, 0%, 41.18%, 45.10%, and 13.73%, and 68.35%, 18.99%, 10.13%, and 2.53%, respectively. Patients with severe MR had the highest percentage of complete consistency (mild vs moderate vs moderate-severe vs severe: 16.13% vs 14.29% vs 0% vs 68.35%, χ²=79.734, P＜0.001), while the highest percentage of low inconsistency was seen in patients with moderate MR (mild vs moderate vs moderate-severe vs severe: 51.61% vs 62.86% vs 41.18% vs 18.99%, χ²=24.012, P＜0.001). Moderate-severe MR patients had the highest percentage of medium inconsistency (mild vs moderate vs moderate-severe vs severe: 29.03% vs 17.14% vs 45.10% vs 10.13%, χ²=22.427, P＜0.001). The highest percentage of high inconsistency was observed in moderate-severe MR patients, but the difference between groups was not statistically significant (P＞0.05). The percentage of incomplete consistency was significantly lower in the post-quality control group compared to the pre-quality control group (58.43% vs 74.77%, χ²=5.899, P=0.015). All the inter-observer and intra-observer ICCs were higher than 0.9.

When performing the quantitative assessment of MR, patients with severe MR have a higher degree of consistency than the other groups, and quality control is successful in decreasing the inconsistency. Therefore, quality control for quantitative MR assessment needs to be highlighted and popularized.

To evaluate the clinical value of high-frame-rate contrast-enhanced ultrasound (H-CEUS) in grading and staging bladder cancer.

The H-CEUS features of 23 patients with bladder cancer treated at the First Medical Center, Chinese PLA General Hospital from January to March 2023 were retrospectively analyzed and compared with pathological examination results. According to pathological grades, the patients were divided into a low grade urothelium carcinoma (LGUC) group and a high grade urothelium carcinoma (HGUC) group. According to pathological stages, the patients were divided into a non-muscular invasive bladder cancer (NMIBC) group and a muscular invasive bladder cancer (MIBC) group. The t test was used to compare the difference in age and tumor diameter between patients with different grades and different stages. The Fisher exact test was used to analyze the differences in the number of vascular branches, vascular morphology, the source bladder wall layer from which microbubbles directly entering the lesion, and the integrity of the intrinsic muscle layer of the bladder wall at the base of the lesion observed by H-CEUS between patients with different grades and different stages.

The number of visible blood vessels within the lesion in the LGUC group (n=12) was mostly 1-2 (66.7%, 8/12), while it was ≥ 3 (54.5%, 6/11) in the HGUC group (n=11), with a statistically significant difference between the two groups (P=0.01). The percentage of patients with an intact mucosal layer was 83.3% (10/12) in the LGUC group, while it was 27.3% (3/11) in the HGUC group, with a statistically significant difference between the two groups (P=0.012). There was no significant difference between the LGUC group and HGUC group in patient’s age, lesion size, vascular morphology, and the source bladder wall layer from which microbubbles directly entering the lesion (P>0.05). The number of vessels in the NMIBC group (n=16) was 1-2 (68.7%, 11/16), while it was ≥ 3 (57.1%, 4/7) in the MIBC group (n=7), with a statistically significant difference between the two groups (P=0.003). Compared to MIBC, NMIBC had more microbubbles that entered into the lesion directly from the mucosal layer (75.0% vs 14.3%, P=0.019). Compared to NMIBC, MIBC mostly had an incomplete intrinsic muscle layer (100% vs 18.7%, P<0.001). There was no statistically significant difference between the NMIBC group and MIBC group in terms of lesion diameter, basal width, and vascular morphology.

H-CEUS greatly improves the contrast frame frequency, presents the perfusion details of the tumor to a large extent, and brings new diagnostic value to the staging and grading of bladder cancer.

To evaluate the value of ultrasound-guided attenuation parameter (UGAP) for evaluating the degree of metabolic dysfunction-associated fatty liver disease (MAFLD) in children.

One hundred and thirty-one children in which obesity was confirmed at Shenzhen Children's Hospital between May 2022 and February 2023 were retrospectively selected. According to the ultrasound findings, the patients were divided into two groups: MAFLD group (n=76) and simple obesity group (n=55). Fifty-eight sex- and age-matched healthy children were selected as a control group. The attenuation coefficient (AC) was compared among all groups and different hepatic steatosis grades. Correlation ratio (Eta²) and Spearman's correlation coefficient were used to assess the correlation between AC and the grade of hepatic steatosis, body mass index (BMI), fibrosis-4 (FIB-4) index, and laboratory indices. Multivariate logistic regression analysis was used to construct an MAFLD predictive model. The diagnostic performance of the predictive model was evaluated by receiver operating characteristic (ROC) curve analysis.

AC values in the MAFLD, simple obesity, and normal control groups were (0.758±0.076), (0.637±0.039), and 0.575 (0.560, 0.590) dB/cm/MHz, respectively. AC values in the patients with mild, moderate, and severe fatty liver were (0.728±0.067), (0.789±0.070), and (0.858±0.041) dB/cm/MHz, respectively. There were significant differences in AC values among different groups and hepatic steatosis grades ( P<0.05 for all). There was a highly significant correlation between AC values and hepatic steatosis grades (Eta²=0.586); a moderate correlation between AC values and BMI (r_s=0.422, P<0.001); but no correlation between AC values and FIB-4 index (r_s=-0.080, P=0.58). The equation of the MAFLD predictive model was: Logistic (P) = -22.081+0.242X (100AC)+0.233X (BMI). The area under the curve of the predictive model was 0.869. The cut-off values were AC ≥ 0.675 dB/cm/MHz and BMI ≥ 22.05 kg/m².

AC values in the liver increase in children with simple obesity and those with MAFLD, which could reflect the grade of hepatic steatosis. AC values quantified using UGAP and BMI are predictors of MAFLD in children with obesity. UGAP might be an effective tool for clinical screening, diagnosis, and evaluation of hepatic steatosis severity and monitoring its progression.

To explore the clinical value of a nomogram based on preoperative thyroid ultrasonic and clinical characteristics for predicting central and lateral cervical neck lymph node metastases of thyroid papillary carcinoma (PTC).

A total of 1071 patients, including 560 patients without lymph node metastasis, 415 with central cervical lymph node metastasis, and 96 with lateral cervical lymph node metastasis, who were admitted to Jinling Hospital, School of Medicine Nanjing University (Eastern Theater Command General Hospital) from January 2014 to June 2021 were analyzed retrospectively. All lymph node metastases were pathologically confirmed after surgery. Preoperative clinical and thyroid ultrasonography data were retrospectively analyzed and compared among the three groups using univariate analysis. Binary multivariate logistic regression analysis was performed to identify significant independent risk factors for metastasis. Then, a nomogram was generated for visualizing the risk factors for predicting lymph node metastasis.

Univariate analysis showed that there were statistically significant differences in patient age, transverse diameter, longitudinal diameter, and longitudinal/transverse ratio of nodules measured by thyroid ultrasound, edge, lateral acoustic shadow, acoustic corona, calcification, color Doppler imaging blood grade, and TSH level between patients without and patients with cervical lymph node metastasis (P＜0.05 for all). Logistic regression analysis showed that patient age ≤ 45 years, anteroposterior diameter ≥ 20 mm, transverse diameter ≥ 10 mm, and CDFI grade 3 were risk predictors of central cervical lymph node metastasis, and the three former factors were risk predictors of lateral cervical lymph node metastasis. The ROC curve of the nomogram combining the above factors showed relative good prediction performance for central cervical lymph node metastasis with an AUC of 0.735, sensitivity of 29.47%, and specificity of 89.09%, while for lateral cervical lymph node metastasis, the AUC, sensitivity, and specificity were 0.866, 19.96%, and 100%, respectively.

The nomogram based on thyroid ultrasonography (anteroposterior diameter ≥ 20 mm, transverse diameter ≥ 10 mm, and CDFI grade 3) and clinical features (patient age ≤ 45 years) can be applied as a noninvasive quantitative tool to predict cervical lymph node metastasis in PTC patients. Especially, the nomogram exhibits a high diagnostic specificity for lateral cervical lymph node metastasis. The nomogram may facilitate decision-making for prophylactic lymphoid dissection in such patients.

To assess the diagnostic value of the Chinese thyroid imaging reporting and data system (C-TIRADS) in thyroid nodules with different sizes.

A total of 1 146 patients with 1 247 thyroid nodules confirmed by surgical pathology were prospectively selected from December 2020 to December 2022. According to the maximum diameter of thyroid nodules measured by ultrasound, all the thyroid nodules were divided into A₁ group (＜10 mm), A₂ group (10-20 mm), and A₃ group (＞20 mm). According to the C-TIRADS, the ultrasonic characteristics of thyroid nodules in each group were evaluated and scored. The Mann-Whitney U-test was used to compare the C-TIRADS scores of benign and malignant nodules among the groups. Receiver oeprating characteristic (ROC) analysis was performed to obtain the optimal cut-off values for scoring and classification. The diagnostic efficacy of C-TIRADS scoring and classification for thyroid nodules of different sizes was then analyzed.

The scores of benign and malignant nodules were 2 (1, 3) and 3 (2, 3) in group A₁, 1 (0, 2) and 3 (3, 4) in group A₂, and 0 (0, 1) and 3 (2, 3) in group A₃, respectively. The scores of thyroid malignant nodules in each group were significantly higher than those of benign nodules (Z=3.501, 15.273, and 10.012, respectively, P＜0.001 for all). The area under the curve (AUC) of C-TIRADS scoring in groups A₁, A₂, and A₃ was 0.580, 0.893, and 0.918, respectively, and the cut-off value was >2, >1, and >1, respectively. The AUC of C-TIRADS classification was 0.625, 0.877, and 0.918, respectively, and the cut-off value was >4B, >4A, and >4A, respectively. The corresponding sensitivity and specificity were consistent among the three groups, and as the diameter of the nodule increased, the sensitivity gradually decreased (96.43%, 93.86%, and 77.17%, respectively) and the specificity gradually increased (30.64%, 69.90%, and 94.12%, respectively).

C-TIRADS has different diagnostic value for thyroid nodules with different sizes. As the diameter of thyroid nodules increases, the diagnostic value of C-TIRADS for thyroid nodules increases as well.

To evaluate the quality of ultrasonic diagnosis of retroperitoneal schwannomas and its influencing factors to find the measures to improve the diagnosis quality.

From January 2015 to April 2022, patients with retroperitoneal schwannomas who underwent surgery at Peking Union Medical College Hospital were studied. All of the cases were confirmed by pathology. The results of preoperative ultrasound reports were summarized, and the quality of ultrasound diagnosis was evaluated by localization diagnosis and qualitative diagnosis.

There were 21 cases of retroperitoneal schwannomas with preoperative ultrasound report, all of them were single, and one case (4.8%) was missed by preoperative ultrasound. The maximal diameter of the 20 schwannomas diagnosed by preoperative ultrasound was (6.7±3.6) cm, of which 16 (80.0%) were located in the abdominal retroperitoneum and 4 (20.0%) were located in the pelvic retroperitoneum; 14 (70.0%) manifested as a heterogeneous solid and cystic mass, and 6 (30.0%) presented as a hypoechoic solid mass. Among the 20 cases, 17 (85.0%) were in accordance with the localization diagnosis and 3 (15.0%) were not; 2 (10.0%) were qualified for qualitative diagnosis and 18 (90.0%) were not.

Ultrasound has a high accuracy for the localization diagnosis of retroperitoneal schwannomas. Retroperitoneal schwannomas lack typical sonogram characteristics, and sonographers should be familiar with the anatomy and pay attention to the medical history collection to further improve the accuracy of its qualitative diagnosis.