scholarly journals Value of Contrast-Enhanced Ultrasound in Adjusting the Classification of Chinese-TIRADS 4 Nodules

2022 ◽  
Vol 2022 ◽  
pp. 1-6
Author(s):  
Hong Cheng ◽  
Shuang-Shuang Zhuo ◽  
Xin Rong ◽  
Ting-Yue Qi ◽  
Hong-Guang Sun ◽  
...  
Keyword(s):  
Thyroid Nodules ◽  
Maximum Diameter ◽  
Diagnostic Efficiency ◽  
Contrast Enhanced Ultrasound ◽  
Predictive Values ◽  
Group I ◽  
Contrast Enhanced ◽  
Significant Difference ◽  
Group Ii

Objectives. To explore the value of applying contrast-enhanced ultrasound (CEUS) in adjusting the classification of category 4 nodules in the Chinese-Thyroid Imaging Report and Data System (C-TIRADS). Methods. The data of preoperative conventional ultrasound and CEUS examinations of 125 C-TIRADS 4 nodules in 109 patients were retrospectively analyzed. We divided the thyroid nodules into two groups based on whether recommend by the guide fine-needle aspiration (FNA). Group I included C-TIRADS 4A nodules with a maximum diameter ≤15 mm and C-TIRADS 4B and 4C nodules with a maximum diameter ≤10 mm, and Group II included C-TIRADS 4A nodules with a maximum diameter >15 mm and C-TIRADS 4B and 4C nodules with a maximum diameter >10 mm. In CEUS, thyroid nodules showing suspicious malignant features such as hypoenhancement or early washout were adjusted to a level higher in the C-TIRADS classification; thyroid nodules showing possible benign features such as iso- or hyperenhancement were adjusted to a level lower; and thyroid nodules showing no enhancement were adjusted to C-TIRADS 3. Taking the pathological results as the gold standard, the receiver operating characteristic (ROC) curves of the C-TIRADS classification before and after the adjustment based on CEUS were plotted, and the diagnostic efficiency was compared. Results. The sensitivity, specificity, accuracy, and positive and negative predictive values of the C-TIRADS classification for the diagnosis of thyroid nodule malignancy before the adjustment based on the CEUS results were 83.6%, 63.8%, 74.4%, 72.7%, and 77.1%, respectively, and these values were 91.0%, 82.8%, 87.2%, 85.9%, and 88.9%, respectively, after the adjustment. The area under the ROC curve (AUC) was 0.737 and 0.869, respectively, showing a significant difference (Z = 3.288, P = 0.001 ). The diagnostic efficiency of C-TIRADS classification after the adjustment based on the CEUS results in both groups was improved compared with the result before the adjustment, and the difference in Group II was significant (Z = 2.931, P = 0.003 ). Conclusions. CEUS significantly improved the diagnostic performance in the adjustment of C-TIRADS 4 nodule classification, especially for the nodules which needs FNA recommended by the C-TIRADS.

scholarly journals Does contrast-enhanced ultrasound (CEUS) play a better role in diagnosis of breast lesions with calcification? A comparison with MRI

2020 ◽  
Vol 93 (1112) ◽  
pp. 20200195
Author(s):  
Jiamin Pan ◽  
Wenjuan Tong ◽  
Jia Luo ◽  
Jinyu Liang ◽  
Fushun Pan ◽  
...  
Keyword(s):  
Breast Imaging ◽  
Breast Lesions ◽  
Diagnostic Efficiency ◽  
Contrast Enhanced Ultrasound ◽  
Roc Curve Analysis ◽  
Diagnostic Efficacy ◽  
Score System ◽  
Contrast Enhanced ◽  
Significant Difference

Objective: To compare the efficacy of contrast-enhanced ultrasound enabled reclassification of Breast Imaging Reporting and Data System (CEUS-BI-RADS) with MRI in the diagnosis of breast lesions with calcification. Methods: A total of 52 breast lesions with calcification from 51 patients were detected by ultrasound as hyperechoic foci and categorized as BI-RADS 3–5. The 51 patients further underwent CEUS scan and MRI. The ultrasound-BI-RADS combined with CEUS 5-point score system redefined the classification of BI-RADS which was called CEUS-BI-RADS. The diagnostic efficacy of three methods was assessed by receiver operating characteristic (ROC) curve analysis. Histopathological assessment used as the gold-standard. Results: The sensitivities of Ultrasound-BI-RADS, MRI classification of BI-RADS (MRI-BI-RADS) and CEUS-BI-RADS were 85%, 90% and 95% without significant difference among the three modalities (p > 0.05). The diagnostic specificities of ultrasound-BI-RADS, MRI-BI-RADS and CEUS-BI-RADS were 78.1%, 78.1% and 96.8%, respectively (p < 0.05); and the accuracy were 80.7%, 82.6% and 96.1% for ultrasound-BI-RADS, MRI-BI-RADS and CEUS-BI-RADS, respectively (p < 0.05). The area under ROC (AUROC) in differentiation of breast lesions with calcification was 0.945 for CEUS-BI-RADS, 0.907 for MRI-BI-RADS and 0.853 for ultrasound-BI-RADS, with no significant difference among the three modalities (p > 0.05). Conclusion: The CEUS-BI-RADS has a better diagnostic efficiency than MRI-BI-RADS in the differentiation of the breast lesions with calcification. Advances in knowledge: •CEUS is a better method in differentiation of breast lesions with calcification. •CEUS-BI-RADS increases the efficiency of diagnosis compared to MRI.

scholarly journals Exploring the Value of Radiomics Features Based on B-Mode and Contrast-Enhanced Ultrasound in Discriminating the Nature of Thyroid Nodules

2021 ◽  
Vol 11 ◽  
Author(s):  
Shi Yan Guo ◽  
Ping Zhou ◽  
Yan Zhang ◽  
Li Qing Jiang ◽  
Yong Feng Zhao
Keyword(s):  
Diagnostic Performance ◽  
Thyroid Nodules ◽  
New Technologies ◽  
Statistical Significance ◽  
Characteristic Curve ◽  
Logistic Models ◽  
Contrast Enhanced Ultrasound ◽  
Clinical Value ◽  
Contrast Enhanced ◽  
Significant Difference

BackgroundWith the improvement of ultrasound imaging resolution and the application of various new technologies, the detection rate of thyroid nodules has increased greatly in recent years. However, there are still challenges in accurately diagnosing the nature of thyroid nodules. This study aimed to evaluate the clinical application value of the radiomics features extracted from B-mode ultrasound (B-US) images combined with contrast-enhanced ultrasound (CEUS) images in the differentiation of benign and malignant thyroid nodules by comparing the diagnostic performance of four logistic models.MethodsWe retrospectively collected and ultimately included B-US images and CEUS images of 123 nodules from 123 patients, and then extracted the corresponding radiomics features from these images respectively. Meanwhile, a senior radiologist combined the thyroid imaging reporting and data system (TI-RADS) and the enhancement pattern of the ultrasonography to make a graded diagnosis of the malignancy of these nodules. Next, based on these radiomics features and grades, logistic regression was used to help build the models (B-US radiomics model, CEUS radiomics model, B-US+CEUS radiomics model, and TI-RADS+CEUS model). Finally, the study assessed the diagnostic performance of these radiomics features with a comparison of the area under the curve (AUC) of the receiver operating characteristic curve of four logistic models for predicting the benignity or malignancy of thyroid nodules.ResultsThe AUC in the differential diagnosis of the nature of thyroid nodules was 0.791 for the B-US radiomics model, 0.766 for the CEUS radiomics model, 0.861 for the B-US+CEUS radiomics model, and 0.785 for the TI-RADS+CEUS model. Compared to the TI-RADS+CEUS model, there was no statistical significance observed in AUC between the B-US radiomics model, CEUS radiomics model, B-US+CEUS radiomics model, and TI-RADS+CEUS model (P&gt;0.05). However, a significant difference was observed between the single B-US radiomics model or CEUS radiomics model and B-US+CEUS radiomics model (P&lt;0.05).ConclusionIn our study, the B-US radiomics model, CEUS radiomics model, and B-US+CEUS radiomics model demonstrated similar performance with the TI-RADS+CEUS model of senior radiologists in diagnosing the benignity or malignancy of thyroid nodules, while the B-US+CEUS radiomics model showed better diagnostic performance than single B-US radiomics model or CEUS radiomics model. It was proved that B-US radiomics features and CEUS radiomics features are of high clinical value as the combination of the two had better diagnostic performance.

scholarly journals Efficacy of contrast-enhanced ultrasonography and shear-wave elastography in conjunction with BI-RADS classification for diagnosis of small breast nodules

2020 ◽  
Author(s):  
Yan Shen ◽  
Jie He ◽  
Miao Liu ◽  
Jiaojiao Hu ◽  
Yonglin Wan ◽  
...  
Keyword(s):  
Shear Wave ◽  
Shear Wave Elastography ◽  
Receiver Operating Curve ◽  
Maximum Diameter ◽  
Diagnostic Efficacy ◽  
Predictive Values ◽  
Small Breast ◽  
Contrast Enhanced ◽  
Receiver Operating

Abstract Background: Identification of malignancy in small breast nodules can be difficult using conventional methods, especially in patients with dense breast tissue. Advanced imaging techniques, including contrast-enhanced ultrasound (CEUS) and shear-wave elastography (SWE), could be used in conjunction with Breast Imaging Reporting and Data System (BI-RADS) classification to characterize these nodules more effectively. This study aimed to evaluate the use of CEUS and SWE for the differentiation of benign and malignant small breast nodules (maximum diameter ≤ 2 cm).Methods: This retrospective study reviewed the imaging data of 302 patients who underwent evaluation for 305 small breast nodules from November 2015 to December 2019. BI-RADS classification of nodules and the results of CEUS and SWE were retrospectively analyzed; the diagnostic efficacy of these techniques was evaluated by comparison with pathology results. Receiver operating characteristic curves were analyzed based on the CEUS patterns and shear-wave velocity values of nodules. The sensitivities, specificities, positive and negative predictive values, and accuracies of BI-RADS, CEUS, SWE, and a combination of all three methods for identifying benign versus malignant small breast nodules were investigated.Results: CEUS was effective in diagnosing malignant nodules when at least two of the nine suspicious features were present. Receiver operating curve analysis revealed that the best cut-off value for SWE was 3.7 m/s. For the diagnosis of benign breast nodules, the BI-RADS classification was reduced by one level when both CEUS and SWE data were used, and was unchanged when CEUS or SWE alone was used; the highest and lowest levels were category 5 and 3, respectively. Furthermore, when using the combined method, 75.8% (91/120) of small breast nodules with a BI-RADS category 4A did not need coarse needle biopsies.Conclusion: Both CEUS and SWE can be used as auxiliary methods for clarifying BI-RADS classification of breast nodules, and a combination of these techniques may provide improved diagnostic efficacy for identifying malignancy in small breast nodules.

Contrast-Enhanced Ultrasound Improves the Accuracy of the ACR TI-RADS in the Diagnosis of Thyroid Nodules Located in the Isthmus

2021 ◽  
Author(s):  
Yunlin Huang ◽  
Yurong Hong ◽  
Wen Xu ◽  
Kai Song ◽  
Pintong Huang
Keyword(s):  
Diagnostic Performance ◽  
Thyroid Nodules ◽  
Characteristic Curve ◽  
Diagnostic Value ◽  
Contrast Enhanced Ultrasound ◽  
Institutional Review ◽  
Contrast Enhanced ◽  
Significant Difference ◽  
Image Reporting ◽  
Benign Nodules

Abstract Objectives To evaluate the diagnostic performance of the American College of Radiology (ACR) Thyroid Image Reporting and Data System (TI-RADS), contrast-enhanced ultrasound (CEUS), and a modified TI-RADS in differentiating benign and malignant nodules located in the isthmus. Methods This retrospective study was approved by the institutional review board. Informed consent was obtained. Grayscale ultrasound (US) and CEUS images were obtained for 203 isthmic thyroid nodules (46 benign and 157 malignant) in 198 consecutive patients (156 women, mean age: 44.7 years ± 11.3 [standard deviation]; 47 men, mean age: 40.9 years ± 11.0). The area under the receiver operating characteristic curve (AUC) of the diagnostic performance of the ACR TI-RADS, CEUS, and the modified TI-RADS were evaluated. Results Lobulated or irregular margins (P = 0.001; odds ratio [OR] = 9.250) and punctate echogenic foci (P = 0.007; OR = 4.718) on US and hypoenhancement (P < 0.001; OR = 20.888) on CEUS displayed a significant association with malignancy located in the isthmus. The most valuable method to distinguish benign nodules from malignant nodules was the modified TI-RADS (AUC: 0.863 with modified TR5), which was significantly better than the ACR TI-RADS (AUC: 0.738 with ACR TR5) (P < 0.001) but showed no significant difference with respect to CEUS (AUC: 0.835 with hypoenhancement) (P = 0.205). The diagnostic value was significantly different between CEUS and the ACR TI-RADS (P = 0.028). Conclusion The modified TI-RADS could significantly improve the accuracy of the diagnosis of thyroid nodules located in the isthmus.

Diagnostic Efficiency of Quantitative Contrast-Enhanced Ultrasound Indicators for Discriminating Benign From Malignant Solid Thyroid Nodules

2017 ◽  
Vol 37 (2) ◽  
pp. 425-437 ◽  
Author(s):  
Xiaohui Zhou ◽  
Ping Zhou ◽  
Zheyu Hu ◽  
Shuang Ming Tian ◽  
Yongfeng Zhao ◽  
...  
Keyword(s):  
Thyroid Nodules ◽  
Diagnostic Efficiency ◽  
Contrast Enhanced Ultrasound ◽  
Contrast Enhanced

scholarly journals Evaluation of characteristics of thyroid nodules on contrast-enhanced ultrasonography: a retrospective analysis of 252 cases

2020 ◽  
Vol 22 (2) ◽  
pp. 164
Author(s):  
Wen Luo ◽  
Xiao Yang ◽  
Jiani Yuan ◽  
Lina Pang ◽  
Peidi Zhang ◽  
...  
Keyword(s):  
Retrospective Review ◽  
Thyroid Nodules ◽  
Contrast Enhanced Ultrasound ◽  
Diagnostic Specificity ◽  
Benign Lesions ◽  
Predictive Values ◽  
Contrast Enhanced ◽  
Contrast Enhanced Ultrasonography ◽  
Benign Nodules ◽  
Sensitivity Specificity

Aim: This study investigated the enhancement patterns observed on contrast-enhanced ultrasound (CEUS) images for differentiating thyroid nodules.Material and methods: A retrospective review was conducted of CEUS cine loops of 252 nodules by two independent readers. Seven categories of enhancement patterns were identified: concentric hypoenhancement; heterogeneous hypoenhancement; hypoenhancement with sharp margin; homogeneous hyper/isoenhancement; hyper/isoenhancement with ring-like vascularity; island-like enhancement; and no perfusion. Associations between these patterns and the confirmed pathological/cytological outcomes (178 malignant, 74 benign) were analyzed and the sensitivity, specificity and positive predictive values (PPVs) determined. The agreement of the readers’ assessments was evaluated by Kappa value.Results: For malignant nodules, the predominant 3 patterns were: concentric hypoenhancement, heterogeneous hypoenhancement and homogeneous hyper/isoenhancement. For each of these, the diagnostic specificity was above 87% and the PPV more than 85%. Combining these patterns for malignancy the rates of sensitivity, specificity and PPV for reader 1 (reader 2) were 96.1% (98.9%), 71.6% (71.6%), and 89.1% (89.3%), respectively. For benign nodules, the predominant 4 patterns were: hypoenhancement with sharp margin; hyper/isoenhancement with ring-like vascularity; island-like enhancement; and no perfusion. The specificity for each was above 98% and the PPV more than 70%. Combining these patterns for benignity, the rates of sensitivity, specificity and PPV for reader 1 (reader 2) were 71.6% (71.6%), 96.1% (98.9%) and 88.3% (96.3%), respectively. The inter-reviewers agreement for classifying enhancement patterns was excellent (κ = 0.84, 95% CI: 0.79-0.89).Conclusions: Enhancement patterns of thyroid nodules on CEUS investigation, enable differentiation between malignant and benign lesions with good diagnostic sensitivity, specificity and PPV.

Comparison of lymphatic contrast-enhanced ultrasound and intravenous contrast-enhanced ultrasound in the preoperative diagnosis of axillary sentinel lymph node metastasis in patients with breast cancer

2021 ◽  
Author(s):  
Lingling Zhuang ◽  
Xu Ming ◽  
Jun Liu ◽  
Chao Jia ◽  
Yubiao Jin ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Accurate Method ◽  
Diagnostic Efficiency ◽  
Contrast Enhanced Ultrasound ◽  
Intravenous Contrast ◽  
Contrast Enhanced ◽  
Significant Difference ◽  
Histopathological Result

Objectives: This study aimed to compare diagnostic efficiency for axillary sentinel lymph node (SLN) metastasis between lymphatic contrast-enhanced ultrasound (LCEUS) and intravenous contrast-enhanced ultrasound (ICEUS) in patients with breast cancer. We also examined whether adding ICEUS to LCEUS could improve the diagnostic accuracy of LCEUS. Methods: Sixty-nine patients with breast cancer were recruited preoperatively. All patients underwent LCEUS followed by ICEUS, and the enhancement pattern of one SLN was analysed for each patient. The targeted SLN was marked with wire and excised during surgery. The imaging diagnosis was compared with the histopathological result. Diagnostic efficiency was compared among LCEUS, ICEUS, and the combination of LCEUS and ICEUS. Results: The sensitivity values for LCEUS, ICEUS, and the combination of LCEUS and ICEUS were 86.2%, 82.6%, and 93.1%, respectively. Specificity values for the three methods were 95.0%, 92.5%, and 87.5%, respectively. Accuracy values for the three methods were 91.3%, 88.4%, and 89.9%, respectively. The area under the receiver operating characteristic (ROC) curve for LCEUS was 0.906, and there was no significant difference among LCEUS, ICEUS, and the combination of LCEUS and ICEUS (p = 0.752). Conclusions: LCEUS may represent an accurate method for predicting SLN metastasis preoperatively. Our findings suggest that adding ICEUS to LCEUS for SLN evaluation in patients with breast cancer is unnecessary. Advances in knowledge: This is the first study in which both LCEUS and ICEUS were performed for the same lymph node and the first to compare the diagnostic efficiency of LCEUS, ICEUS, and the combination of LCEUS + ICEUS.

Diagnostic performance of intravascular perfusion based contrast-enhanced ultrasound LI-RADS in the evaluation of hepatocellular carcinoma

2021 ◽  
pp. 1-9
Author(s):  
Dongsheng Zuo ◽  
Kefeng Yang ◽  
Size Wu
Keyword(s):  
Hepatocellular Carcinoma ◽  
Diagnostic Performance ◽  
Focal Liver Lesions ◽  
Liver Imaging ◽  
Diagnostic Efficiency ◽  
Liver Lesions ◽  
Contrast Enhanced Ultrasound ◽  
Predictive Values ◽  
Contrast Enhanced ◽  
Sensitivity Specificity

BACKGROUND: The contrast-enhanced ultrasound (CEUS) liver imaging reporting and data system (LI-RADS) is a relative new algorithm for hepatocellular carcinoma (HCC) assessment. OBJECTIVE: To validate the diagnostic efficiency of the intravascular perfusion based CEUS LI-RADS for HCC. METHODS: Archives of 873 patients with focal liver lesions (FLLs) undergoing CEUS were reviewed, and target images were read by two sonologists independently according to the CEUS LI-RADS. The diagnostic performance was calculated and compared. RESULTS: Assessment with reference to CEUS LI-RADS, 87 of 218 FLLs (39.9%) were categorized as LR-5, 131 of 218 FLLs (60.1%) were categorized as non-LR-5, 19 of 99 HCCs were categorized as non-LR-5, and 7 of 119 non-HCCs were categorized as LR-5. The sensitivity, specificity, AUROC, positive and negative predictive values of CEUS LI-RADS for diagnosing HCC were 80.81%(95%CI: 71.7%–88.0%), 94.1%(95%CI: 88.3%–97.6%), 0.87 (95%CI: 0.82–0.92), 91.9%(95%CI: 84.1%–96.7%), and 85.5%(95%CI: 78.3%–91.0%), respectively. CONCLUSIONS: The diagnostic efficiency of the intravascular perfusion based CEUS LI-RADS for the evaluation of HCCs is very good.

scholarly journals Usefulness of Contrast-Enhanced Ultrasound in the Evaluation of Chronic Kidney Disease

2021 ◽  
Vol 17 ◽  
Author(s):  
Byoung Hee Han ◽  
Sung Bin Park
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Microvascular Perfusion ◽  
Contrast Enhanced Ultrasound ◽  
Control Groups ◽  
Group Iii ◽  
Group I ◽  
Contrast Enhanced ◽  
Group Ii ◽  
And Control

Background: Contrast-enhanced ultrasound (CEUS) can provide more improved images of renal blood flow and much more information of both macro- and microcirculation of the kidney as comparing to Doppler US. Objective: To investigate the usefulness of CEUS by analyzing differences in perfusion-related parameters among the three chronic kidney disease (CKD) subgroups and the control group. Methods: Thirty-eight patients with CKD and 21 controls who were age matched (20−49 years) and included. Included CKD patients were stratified into three groups according to their eGFR: group I, eGFR ≥ 60 ml/min/1.73 m2 (GFR category I and II); group II, 30 ml/min/1.73 m2 ≤ eGFR < 60 ml/min/1.73 m2 (GFR category III); and group III, eGFR < 30 ml/min/1.73 m2 (GFR category IV and V). Comparisons with the controls (eGFR > 90 ml/min/1.73 m2 ) were performed. Real-time and dynamic renal cortex imaging was performed using CEUS. Time-intensity curves and several bolus model quantitative perfusion parameters were created using the VueBox® quantification software. We compared the parameters among the CKD subgroups and between the CKD and control groups. Results: Eight patients were included in group I, 12 patients in group II, and 18 patients in group III. Significant differences were noted in the wash-in and wash-out rates between the CKD and control groups (p = 0.027 and p = 0.018, respectively), but not between those of the CKD subgroups. There were no significant differences of other perfusion parameters among the CKD subgroups and between the CKD and control groups. Conclusion: A few perfusion related CEUS parameters (WiR and WoR) can be used as markers of renal microvascular perfusion relating renal function. CEUS can effectively and quantitatively exhibit the renal microvascular perfusion in patients with CKD as well as normal control participants.

Discriminating Malignancy in Thyroid Nodules: The Nomogram Versus the Kwak and ACR TI-RADS

2020 ◽  
Vol 163 (6) ◽  
pp. 1156-1165
Author(s):  
Juan Xiao ◽  
Qiang Xiao ◽  
Wei Cong ◽  
Ting Li ◽  
Shouluan Ding ◽  
...  
Keyword(s):  
Thyroid Nodules ◽  
Characteristic Curve ◽  
Area Under The Curve ◽  
Diagnostic Study ◽  
Diagnostic Efficiency ◽  
Training Set ◽  
Multivariable Logistic Regression Model ◽  
Predictive Values ◽  
Validation Set ◽  
Sensitivity Specificity

Objective To develop an easy-to-use nomogram for discrimination of malignant thyroid nodules and to compare diagnostic efficiency with the Kwak and American College of Radiology (ACR) Thyroid Imaging, Reporting and Data System (TI-RADS). Study Design Retrospective diagnostic study. Setting The Second Hospital of Shandong University. Subjects and Methods From March 2017 to April 2019, 792 patients with 1940 thyroid nodules were included into the training set; from May 2019 to December 2019, 174 patients with 389 nodules were included into the validation set. Multivariable logistic regression model was used to develop a nomogram for discriminating malignant nodules. To compare the diagnostic performance of the nomogram with the Kwak and ACR TI-RADS, the area under the receiver operating characteristic curve, sensitivity, specificity, and positive and negative predictive values were calculated. Results The nomogram consisted of 7 factors: composition, orientation, echogenicity, border, margin, extrathyroidal extension, and calcification. In the training set, for all nodules, the area under the curve (AUC) for the nomogram was 0.844, which was higher than the Kwak TI-RADS (0.826, P = .008) and the ACR TI-RADS (0.810, P < .001). For the 822 nodules >1 cm, the AUC of the nomogram was 0.891, which was higher than the Kwak TI-RADS (0.852, P < .001) and the ACR TI-RADS (0.853, P < .001). In the validation set, the AUC of the nomogram was also higher than the Kwak and ACR TI-RADS ( P < .05), each in the whole series and separately for nodules >1 or ≤1 cm. Conclusions When compared with the Kwak and ACR TI-RADS, the nomogram had a better performance in discriminating malignant thyroid nodules.

Sign in / Sign up

Export Citation Format

Share Document