Ultrasonographic Detection of Vascularity of Focal Breast Lesions: Microvascular Imaging Versus Conventional Color and Power Doppler Imaging

To compare microvascular flow imaging (MVFI) to conventional Color-Doppler (CDI) and Power-Doppler (PDI) imaging in the detection of vascularity of Focal Breast Lesions (FBLs). A total of 180 solid FBLs (size: 3.5–45.2 mm) detected in 180 women (age: 21–87 years) were evaluated by means of CDI, PDI, and MVFI. Two blinded reviewers categorized lesion vascularity in absent or present, and vascularity pattern as (a) internal; (b) vessels in rim; (c) combined. The presence of a “penetrating vessel” was assessed separately. Differences in vascularization patterns (chi2 test) and intra- and inter-observer agreement (Fleiss method) were calculated. ROC analysis was performed to assess performance of each technique in differentiating benign from malignant lesions. About 103/180 (57.2%) FBLs were benign and 77/180 (42.8%) were malignant. A statistically significant ( p < .001) increase in blood flow detection was observed for both readers with MVFI in comparison to either CDI or PDI. Benign FBLs showed mainly absence of vascularity ( p = .02 and p = .01 for each reader, respectively), rim pattern ( p < .001 for both readers) or combined pattern ( p = .01 and p = .04). Malignant lesions showed a statistically significant higher prevalence of internal flow pattern ( p < .001 for both readers). The prevalence of penetrating vessels was significantly higher with MVFI in comparison to either CDI or PDI ( p < .001 for both readers) and in the malignant FBLs ( p < .001). ROC analysis showed MVFI (AUC = 0.70, 95%CI = [0.64–0.77]) more accurate than CDI (AUC = 0.67, 95%CI = [0.60–0.74]) and PDI (AUC = 0.67, 95%CI = [0.60–0.74]) though not significantly ( p = .5436). Sensitivity/Specificity values for MVFI, PDI, and CDI were 76.6%/64.1%, 59.7%/73.8% and 58.4%/74.8%, respectively. Inter-reader agreement with MVFI was always very good ( k-score 0.85–0.96), whereas with CDI and PDI evaluation ranged from good to very good. No differences in intra-observer agreement were noted. MVFI showed a statistically significant increase in the detection of the vascularization of FBLs in comparison to Color and Power-Doppler.

New strategy of color and power doppler sonography combined with DMSA in the assessment of acute pyelonephritis in infants

Background The purpose of this study was to evaluate the clinical value of color and power doppler sonography (CPDS) when combined it with 99mTc-dimercaptosuccinic acid scintigraphy (DMSA) in assessment of acute pyelonephritis (APN) in infants. Methods A total of 79 children with APN admitted to our hospital from June 2016 to Jan 2019 were enrolled, including 52 boys and 27 girls, age range 1 month to 3 years old. All cases followed the diagnostic criteria for acute pyelonephritis and excluded anatomical abnormalities of urinary system. All 79 patients were examined by urinary ultrasonography (US), CPDS, and DMSA within 48 h of fever and analyzed the clinical value of combining the two methods in the assessment of APN in infants. Results Among 79 children, urinary ultrasonography revealed 2 cases of renal cortical echo changes, both located in the upper pole of the kidney, 24 cases of kidney enlargement, and 1 case of left kidney shrinkage. Ninety-five kidneys were shown to be diseased with DMSA, while 105 kidneys abnormal by CPDS. The sensitivity of CPDS was 69.4%, and the specificity was 38.1%. In children younger than 6 months, the sensitivity of CPDS was 56.9%, which was 84.2% in childeren between 6 months to 1 year, and 94.4% from 1 to 3 years old, respectively. The corresponding specificity of CPDS was 44.1, 26.7, and 35.7%. There was no significant correlation between CPDS levels and DMSA positive results. The abnormal rate of intermediate part in the kidneys was significantly lower than that in the upper and lower poles. Children with abnormal CPDS have a greater risk of renal scarring(p < 0.05). Conclusion Abnormalities detected by CPDS in a cohort of infants with APN poorly correlated with DMSA findings. But the sensitivity of CPDS is highly age-related, it can be used as a non-invasive helpful tool for early diagnosis of acute pyelonephritis in infants older than 6 months old.

New strategy of color and power doppler sonography combined with DMSA in the assessment of acute pyelonephritis in infants

Background: The purpose of this study was to evaluate the clinical value of color and power doppler sonography (CPDS) when combined it with 99mTc-dimercaptosuccinic acid scintigraphy (DMSA) in assessment of acute pyelonephritis (APN) in infants. Methods: A total of 79 children with APN admitted to our hospital from June 2016 to Jan 2019 were enrolled, including 52 boys and 27 girls, age range 1 month to 3 years old. All cases followed the diagnostic criteria for acute pyelonephritis and excluded anatomical abnormalities of urinary system. All 79 patients were examined by urinary ultrasonography (US), CPDS, and DMSA within 48 hours of fever and analyzed the clinical value of combining the two methods in the assessment of APN in infants. Results: Among 79 children, urinary ultrasonography revealed 2 cases of renal cortical echo changes, both located in the upper pole of the kidney, 24 cases of kidney enlargement, and 1 case of left kidney shrinkage. 95 kidneys were shown to be diseased with DMSA, while 105 kidneys abnormal by CPDS. The sensitivity of CPDS was 69.4%, and the specificity was 38.1%. In children younger than 6 months, the sensitivity of CPDS was 56.9%, which was 84.2% in childeren between 6 months to 1 year, and 94.4% from 1 to 3 years old, respectively. The corresponding specificity of CPDS was 44.1%, 26.7%, and 35.7%. There was no significant correlation between CPDS levels and DMSA positive results. The abnormal rate of intermediate part in the kidneys was significantly lower than that in the upper and lower poles. Children with abnormal CPDS have a greater risk of renal scarring(p<0.05). Conclusion: The clinical application value of CPDS is not as good as that of DMSA. But the sensitivity of CPDS is highly age-related, it can be used as a non-invasive helpful tool for early diagnosis of acute pyelonephritis in infants older than 6 months old.

New strategy of color and power doppler sonography combined with DMSA in the assessment of acute pyelonephritis in infants

Objectives The purpose of this study was to evaluate the clinical value of color and power doppler sonography (CPDS) when combined it with 99mTc-dimercaptosuccinic acid scintigraphy (DMSA) in assessment of acute pyelonephritis (APN) in infants. Methods A total of 79 children with APN , including 52 males and 27 females, age range 1 month to 3 years old. All patients underwent laboratory inspection including urinary routine test, clean medium urine culture, urinary β2 microglobulin (β2-MG), urinary N-acetylglucosaminidase (NAG), blood routine test, C-reactive protein(CRP), renal function, serum electrolyte and urinary ultrasound. All 79 patients underwent CPDS and DMSA within 48 hours of fever. Results All 79 patients with fever. The peripheral blood routine showed elevated white blood cells in 75 cases, normal in 4 cases, CRP increased in 77 cases, normal in 2 cases. Urine β2-MG increased in 40 cases and normal in 39 cases. Urinary ultrasonography revealed 2 cases of renal cortical echo changes, 24 cases of kidney enlargement, and 1 left kidney shrinkage. Among 79 children, DMSA showed abnormal findings in 95 kidneys and CPDS, in 105 kidneys. The total sensitivity of CPDS was 69.4%, and the total positive predictive value was 62.8%. The sensitivity of CPDS under 6 months was 56.9%, which was 84.2% between 6 months to 1 year, and 94.4% from 1 to 3 years old, respectively. There was no significant correlation between CPDS levels and DMSA positive results. The abnormal rate of intermediate part in the kidneys was significantly lower than that in the upper and lower poles. Children with abnormal CPDS have a greater risk of renal scarring(p<0.05). Conclusion The sensitive of CPDS is highly age-related, it can as a non-invasive tool for assessment of acute pyelonephritis in infants, especially for infants more than 6 months old. CPDS is useful to be combined with DMSA to assess the APN of infants, for infants more than 6 months with febrile urinary tract infections, CPDS is the first recommendation, and followed by DMSA six months later to assess renal scar formation. For those less than 6 months, the DMSA assessment is still the preferred choice.

Superb Microvascular Imaging: Added Value and Novel Applications

Determining the presence and characteristics of vascular flow is an essential part of sonography interrogation. However, small vessels and low velocities are not always possible to depict with conventional color and power Doppler ultrasound. This can be frustrating, especially when the diagnosis depends mainly on the existence of vascular flow, the sonographic examination will be inconclusive, further imaging examinations will be required and diagnosis delayed. Superb microvascular imaging (SMI) is a novel vascular imaging mode, which provides visualization of low velocity and microvascular flow. SMI uses a clutter suppression algorithm to extract flow signals and depicts this information as a color overlay image or as a monochrome or color map of flow. By using SMI, high frame rates and high-resolution images remain maintained. With SMI, it is possible to visualize small vessels including their branches that, until now, it is possible to demonstrate only using contrast-enhanced ultrasound. Availability of this additional technology on all ultrasound machines may make some of the computed tomography scans unnecessary. In our paper, we describe six patients, aged 16–73 years, in which final diagnosis was achieved only with SMI and where conventional color and power Doppler failed. All these examinations were performed using Aplio 500 Platinum ultrasound unit (Toshiba Medical Systems, Tokyo, Japan).