Diagnostic Accuracy of Ultrasound in Differentiation Uterine Leiomyosarcoma from Uterine Leiomyoma: A Systematic Review

Background: Uterine leiomyosarcoma is a rare malignant pathology of smooth muscle of uterus which is mostly asymptomatic with a wide range of late onset of symptoms such as post-menopausal bleeding and severe abdominal pelvic pain and abnormal vaginal discharge. Uterine leiomyosarcoma characteristically has structural and clinical similarities with giant uterine leiomyoma because both originate from the smooth muscle cells of the uterus. The diagnosis of uterine leiomyosarcoma through ultrasound is very different difficult due to indistinguishable sonographic features of uterine leiomyoma and leiomyosarcoma but there are certain sonological features which can prove the reliability of ultrasound as the diagnostic tool for differentiating uterine leiomyosarcoma from uterine leiomyoma. Aim: To access the accuracy of ultrasound in differentiating uterine leiomyosarcoma from uterine leiomyoma. Methods: An electronic database search was performed (PubMed, Science direct, Google Scholar) with the data range from 2000 to 2021. All studies included in the research was in English language. Articles which had descriptive studies related to sonographic features of uterine leiomyosarcoma and uterine leiomyoma. Results: Total 15 articles were found regarding the prevalence, clinical manifestation and sonographic findings of uterine leiomyosarcoma and uterine leiomyoma ,10 articles were included in the introduction and technique where as 6 articles were selected for systemic review with the sample size ranging from 20-200 in all different articles and age criteria of the participant in the selected articles was above 40 years with most candidates were investigated in the post menopause period. Conclusion: We identified certain sonographic patterns that can accurately differentiate uterine leiomyoma sarcoma from uterine leiomyoma with moderate sensitivity and specificity. Keywords: Transvaginal ultrasonography, leiomyoma, leiomyosarcoma

Clinical and Sonographic Classification of Neurofibromas in Children with Neurofibromatosis Type 1 – A Cluster Analysis

Purpose High-frequency ultrasound allows the accurate identification of neurofibromas in neurofibromatosis type 1 (NF1). This study aimed to analyze the ultrasound features of neurofibromas in children with NF1, to establish a classification based on the clinical and sonographic patterns of the different types of neurofibromas, and to evaluate the interobserver correlation coefficient (κ) of this classification. Materials and Methods In this prospective, single referral center observational study, clinical and ultrasound findings of neurofibromas in children diagnosed with NF 1 were analyzed. To identify the ultrasound patterns, a cluster analysis allowing the inclusion of both clinical and ultrasound data was designed. The κ coefficient was calculated using 9 external evaluators. Results 265 ultrasound scans were performed on a total of 242 neurofibromas from 108 children diagnosed with NF1. Cluster analysis allowed the identification of 9 patterns (Snedecorʼs F, P < 0.001) classified as “classic” cutaneous neurofibroma, blue-red neurofibroma, pseudoatrophic neurofibroma, nodular subcutaneous neurofibroma, diffuse subcutaneous neurofibroma, congenital cutaneous neurofibroma, congenital plexiform neurofibroma, congenital diffuse and plexiform neurofibroma, and subfascial neurofibroma. The κ coefficient of the interobserver ratings was 0.82. Conclusion Patterns identified in the cluster analysis allow neurofibromas to be classified with a very high interobserver correlation.

Limited scleroderma: sonographic pattern in the stage of erythema/edema

Objective. To describe the sonopattern of limited scleroderma (LS) in the early stages after the onset of erythema.Materials and methods. The work describes a clinical case of limited plaque scleroderma. The sonographic examination was carried out on an ultrasound scanner using a transducer with operating frequencies of 10–16–18 MHz. Material sampling for the histologic examination of the skin was performed from the area with the most pronounced inflammatory changes under sonographic control.Results. It has been found that increased echogenicity of the dermis, “blurring” of the dermis/hypodermis boundary, increased echogenicity and the “stalactite-like” pattern of subcutaneous fat occur in the frst week of the disease; normalization or a signifcant improvement of the sonopattern is noted by the end of the second week or by the beginning of the third week after the onset of erythema.Conclusion. There is a certain parallelism between the histologic and sonographic patterns, which makes it possible to adequately assess both the activity and the stage of the LS process.

Uterine Myoma: an Ultrasonographic Study of Patterns at the Central Hospital in Warri, Delta State, Nigeria

This analysis considered the sonographic patterns of uterine myoma seen at the Central Hospital in Warri, Delta State, Nigeria. Ultrasonographic records of the uteri of 312 women seen from December 2017 to January 2021 were retrieved from the Central Hospital in Warri, Nigeria. Information on the leiomyoma size, weight, occurrence site, types and number of nodules were fetched from available ultrasonographic reports. Ethical approval was obtained from the Research/ Ethical Committee of Human Anatomy Department at the Delta State University, Abraka, and the Warri Central Hospital. Data was entered into Statistical Package for the Social Sciences (version 23). Results were presented in mean and simple percentage of occurrences of sampled parameters. The chi-square test was used to obtain association between categorical variables, while setting p-value < 0.05 as statistically significant. A total of 312 cases of women with leiomyoma were detailed. The 45-50 years age group had the highest frequency of 52 (16.7%). Regarding the location of the leiomyoma in the different parts of the uterus, the anterior corpus was the commonest site of occurrence of the leiyomyoma accounting for a frequency of 80 (25.6 %) while the fundus had the least frequency of 53 (17%). Based on volume and number of observed nodules, about 160 (51.3%) of assessed leiomyoma lesions were > 200cm3, whereas 152 (48.7%) were < 200cm3. Also, 1-5 nodules were observed in 117 cases, accounting for about 37.5% of the leiomyoma lesions. Conclusively, this study has shown that an insignificant association exists between patient age and the weight, size, type and number of nodules of leiyomyoma Keywords: Leiomyoma, uterine, myoma, ultrasonography.

Common Sonographic Patterns of Kidney Diseases in Nnewi North, Anambra State, Nigeria

Introduction: Despite the increasing prevalence of kidney diseases in Nigeria, and the value of ultrasonography in the diagnosis of these diseases, there is a paucity of data on the sonographic patterns of kidney diseases peculiar to people in Nnewi North Anambra state, Nigeria.Objective: The objective of this study was to document the common sonographic patterns of kidney diseases in Nnewi-North, Anambra state, Nigeria and to correlate certain Ultrasound detectable kidney diseases of patients with age and sex.Methods: This study adopted a cross-sectional retrospective design. Secondary records from files, folders were retrieved from patient’s records from the Radiography departments of Waves diagnostic center and Nnamdi Azikiwe University teaching hospital both in Anambra State, Nigeria. A total of 400 patients were reviewed from the health institutions between April 2020 and April 2021. The data were analyzed using descriptive and inferential statistics.Results: Common kidney diseases were: hydronephrosis [74(17.8%)], nephrolithiasis [69 (17.3%)], renal cyst [39(9.8)], urolithiasis [9(75%)], renal parenchyma disease grade I [27(6.8%)], renal parenchyma disease grade II [12(3.0%)], renal parenchyma disease grade III [12(3.0%)],renal parenchyma disease grade I-II [6(1.5%)], renal parenchyma disease grade II-III [1(0.3)], nephritis [6(1.5%)], ectopic kidney [3(0.8)], polycystic kidney disease[ 9(2.3%)], pyelonephritis [14(3.5%)], nephrocalcinosis [29(7.2%)]. It was found out that normal patients had the highest occurrence [81 (21.3%)], the most prevalent kidney disease was hydronephrosis [74(17.8%)] and the least prevalent was renal parenchyma disease grade II-III [1(0.3%)]. The prevalence of hydronephrosis was seen more in male patients [42 (59.2%)] than their female counterparts [29 (40.8%)]. The subjects between the ages of 37-52 years were more likely to develop hydronephrosis than other age groups and also there was no significant relationship between kidney diseases and age. It is therefore recommended that Ultrasound should be used as the first line of diagnosis in kidney pathologies and suspected flank pain, because of its availability, cheapness, improved safety profile, and level of diagnostic accuracy.Conclusion: Common sonographic patterns of kidney diseases were those of hydronephrosis, nephrolithiasis, and renal parenchyma diseases grade I-III predominantly among male subjects. Age and sex had no significant effect on sonographic patterns of kidney diseases.

Comparative Efficacy of Ultrasonography and Acoustic Radiation Force Impulse (ARFI) Elastography in Prediction of Malignancy in Thyroid Nodules

Objective: The incidence of malignancy in thyroid nodules is infrequent, but this trend may be reversing. The present study was conducted to emphasize the diagnostic accuracy of acoustic radiation force impulse (ARFI) imaging, in addition to conventional gray-scale ultrasonography (US), for differentiating benign and malignant thyroid nodules. Methods: A total of 141 patients with thyroid nodules (≥10 mm) were included in the study and were evaluated with US, Doppler, and ARFI elastography using Siemens S2000 Acuson ultrasound equipment. Results: The sonographic patterns most predictive and indicative of malignancy included irregular margins and presence of microcalcifications. The Doppler findings in isolation were not extremely sensitive in the detection of malignancy. The shear wave velocity cutoff value on ARFI imaging using receiver operating characteristic curves for differentiation of benign and malignant nodules were noted at 2.87 m/s. ARFI imaging performed better than US and Doppler with sensitivity of 75%, specificity of 96%, and accuracy of 94%. Conclusion: ARFI elastography could be utilized as a reliable initial screening test for detection of malignancy in thyroid nodules.

MON-505 Quantitative Characteristics and Sonographic Patterns Before and After Thyroid Radiofrequency Ablation

Although most thyroid nodules (TNs) are benign and require only serial observation, some may need treatment for symptoms. Radiofrequency ablation (RFA) has been used and shown to be a promising and well-tolerated new approach. The efficacy of RFA is evaluated by using parameters such as volume reduction ratio (VRR), and cosmetic or symptomatic improvement. However, no index is now available to predict the therapeutic success before RFA. And apart from size reduction, little is known about their ultrasonography (US) appearances after RFA. The purpose of this study was to 1) assess the effectiveness of single session RFA treatment on volume reduction 2) determine if quantitative US characteristics are correlated to the VRR 3) demonstrate the US characteristics from the baseline and during the follow-up. Quantification of characteristics was performed using commercial software. The CAD software classified nodules into the 2015 ATA sonographic patterns and TIRADS categories. All patients underwent a single treatment session and with significant improvement in cosmetic and pressure symptoms. It shows that there is a direct correlation between the initial tumor size/cyst component percentage and VRR. The US characteristics are significant different after RFA, and the tumors were categorized to more suspicious ATA patterns and had higher TIRAD scores. In conclusion, RFA is effective on volume reduction and US characteristics correlated with therapeutic success. Post RFA US features may potentially mislead and clinicians should always keep in mind.

Overview of foreign clinical guidelines for the use of fine-needle aspiration biopsy of thyroid nodules

Fine-needle aspiration biopsy (FNA) is the most accurate and cost-effective method for evaluating thyroid nodules. FNA results are useful for stratifying the risk of malignant neoplasms and provide key information to determine the appropriateness of an operation. However, we should keep in mind that FNA is an invasive diagnostic method, sothere is a possibility of complications. There is a likelihood of nondiagnostic, false positive and false negative results that can lead to a late or unnecessary operation. We see a growing incidence of thyroid nodules, associated mainly with the increased availability of ultrasound diagnostic of this organ. So the leading organizations involved in the development of clinical guidelines for diagnostics and treatment of thyroid pathologies suggest limiting the conduct of FNA. The use of this method in some cases is not necessary and at times can be even dangerous to apatient. When making clinical decisions, sonographic patterns of thyroid nodules and individual anamnestic and clinical factors ofthe patient should be considered. For small thyroid nodules, the FNA in most cases is not necessary. It is more rational to make a decision based on sonographic patterns rather than be guided by a threshold node size of 1 cm. The specific sonographic patterns of malignancy are: presence of calcifications, irregular margins, hypoechoic nodule, taller-than-wide shape, metastases to the cervical lymph nodes, and extrathyroidal extension. The totality of these signs is useful for stratifying the risk of malignancy of the thyroid nodules and deciding on the need for FNA.