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Objectives To assess the respective diagnostic value of Sonazoid™ and SonoVue® for characterizing FLLs as benign or malignant and the corresponding safety. Methods This prospective Phase 3 study was conducted at 17 centres in China and... more
Objectives To assess the respective diagnostic value of Sonazoid™ and SonoVue® for characterizing FLLs as benign or malignant and the corresponding safety. Methods This prospective Phase 3 study was conducted at 17 centres in China and Korea (May 2014 to April 2015); 424 patients (20 to 80 years) with at least 1 untreated focal liver lesion (FLL) (< 10 cm in diameter) underwent a contrast-enhanced ultrasound (CEUS) examination (218 received Sonazoid of 0.12 μL microbubbles/kg; 206 received SonoVue of 2.4 mL). Three independent blinded readers evaluated pre- and post-contrast images characterising the FLLs as benign or malignant. Results Sonazoid-enhanced and SonoVue-enhanced ultrasound provided a statistically significant improvement in specificity for all 3 readers comparing to unenhanced ultrasound (for Sonazoid: p = 0.0093, < 0.0001, 0.0011; for SonoVue: p = 0.002, 0.03, 0.12, respectively). Difference in accuracy improvement between the 2 groups was within the pre-specifie...
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Research Interests: Gastroenterology, Medicine, Biopsy, Humans, Internal Medicine, and 15 moreLiver, Doppler Ultrasound, Animals, Male, Hepatocellular Carcinoma, Fibrosis, Aged, Cirrhosis, Hepatic Fibrosis, Flow Rate, Blood Flow Velocity, Laser Doppler Flowmetry, Esophageal varices, Medical and Health Sciences, and Hepatitis B surface antigen
The purpose of this study was to determine clinical and ultrasonographic characteristics of male breast tumors. The medical records of male patients with breast lesions were retrieved from an electronic medical record database and a... more
The purpose of this study was to determine clinical and ultrasonographic characteristics of male breast tumors. The medical records of male patients with breast lesions were retrieved from an electronic medical record database and a pathology database and retrospectively reviewed. A total of 112 men (125 breast masses) with preoperative breast ultrasonography (US) were included (median age, 59.50 years; age range, 15-96 years). Data extracted included patient age, if the lesions were bilateral, palpable, and tender, and the presence of nipple discharge. Breast lesion features on static US images were reviewed by three experienced radiologists without knowledge of physical examination or pathology results, original breast US image interpretations, or surgical outcomes. The US features were documented according to the BI-RADS (Breast Imaging-Reporting and Data System) US lexicons. A forth radiologist compiled the data for analysis. Of the 125 breast masses, palpable tender lumps and b...
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This paper performs a comprehensive study on the deep-learning-based computer-aided diagnosis (CADx) for the differential diagnosis of benign and malignant nodules/lesions by avoiding the potential errors caused by inaccurate image... more
This paper performs a comprehensive study on the deep-learning-based computer-aided diagnosis (CADx) for the differential diagnosis of benign and malignant nodules/lesions by avoiding the potential errors caused by inaccurate image processing results (e.g., boundary segmentation), as well as the classification bias resulting from a less robust feature set, as involved in most conventional CADx algorithms. Specifically, the stacked denoising auto-encoder (SDAE) is exploited on the two CADx applications for the differentiation of breast ultrasound lesions and lung CT nodules. The SDAE architecture is well equipped with the automatic feature exploration mechanism and noise tolerance advantage, and hence may be suitable to deal with the intrinsically noisy property of medical image data from various imaging modalities. To show the outperformance of SDAE-based CADx over the conventional scheme, two latest conventional CADx algorithms are implemented for comparison. 10 times of 10-fold cr...
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Ultrasound (US) elastography can provide information about the hardness of calcification and might help decide treatment strategy. The purpose of this study was to evaluate the hardness of the calcific area within rotator cuffs by US... more
Ultrasound (US) elastography can provide information about the hardness of calcification and might help decide treatment strategy. The purpose of this study was to evaluate the hardness of the calcific area within rotator cuffs by US elastography as an aid for the selection of aspiration or fine-needle repeated puncture for the treatment of rotator cuff calcific tendinosis. This prospective study included 39 patients (32 males, 7 females; mean age, 52.9 years) who received US elastography and gray-scale ultrasonography before US-guided treatment for rotator cuff calcific tendinosis. The morphology of the calcifications was classified as arc, fragmented, nodular, and cystic types. US elastography using virtual touch imaging (acoustic radiation force impulse) technique was performed to examine the calcified region to obtain an elastogram that was graded dark, intermediate, or bright. The hardness of the calcifications were recorded, and graded as hard, sand-like, or fluid-like tactile...
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A previously healthy man suffered from watery diarrhea, right lower quadrant pain, leucocytosis, increased erythrocyte sedimentation rate and C- reactive protein level but without fever. Sonography of the right lower abdomen revealed a... more
A previously healthy man suffered from watery diarrhea, right lower quadrant pain, leucocytosis, increased erythrocyte sedimentation rate and C- reactive protein level but without fever. Sonography of the right lower abdomen revealed a noncompress- ible thick-walled tubular structure with an atypical target pattern on short axis scan, attaching to the medial wall of the cecum. The outer diameter of this
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Research Interests: Mathematics, Algorithms, Ultrasound Imaging, Ultrasound, Medicine, and 14 moreAlgorithm, Humans, Female, EM algorithm, Robustness (evolution), Maximum a Posteriori, Clinical Sciences, Carcinoma, Performance Indicator, Level Set Method, Region of Interest, Fibroadenoma, Breast Neoplasms, and Ultrasonography mammary
We report a case of a 54-year-old male patient with a hard, painful nodule within his right breast which was misdiagnosed preoperatively as breast cancer. Preoperative work-up included physical examination, non-contrast chest computed... more
We report a case of a 54-year-old male patient with a hard, painful nodule within his right breast which was misdiagnosed preoperatively as breast cancer. Preoperative work-up included physical examination, non-contrast chest computed tomography (CT), sonography, and sono-guided breast biopsy. Isolated breast panniculitis with vasculitis (BPWV), a rare disease, was diagnosed by histopathologic examination of tissue obtained from excisional biopsy. Subcutaneous panniculitis with or without vasculitis, a condition of nonsuppurative inflammatory process involving the subcutaneous fat layer of skin, is related to different causes. A palpable benign male breast lesion resembling a malignancy includes gynecomastia, panniculitis with or without vasculitis, fat necrosis, ruptured epidermal cyst, pseudoangiomatous stromal hyperplasia, subareolar abscess, intraductal papilloma, hematoma, and atypical fibroadenoma. To make an accurate preoperative diagnosis of a male breast mass, a physician h...
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Research Interests: Medicine, Primary, Humans, Male, Sarcoma, and 4 moreClinical Sciences, Middle Aged, Ultrasound In Medicine, and Macho
Doppler angle (i.e., beam-to-flow angle) is an important parameter for quantitative flow measurements. With known Doppler angles, volumetric flows can be obtained by the mean flow velocity times the cross-section area of the vessel. The... more
Doppler angle (i.e., beam-to-flow angle) is an important parameter for quantitative flow measurements. With known Doppler angles, volumetric flows can be obtained by the mean flow velocity times the cross-section area of the vessel. The differences or changes between prestenotic and poststenotic volumetric flows have been quantified as an indicator for assessing the clinical severity of the stenosis. Therefore, several research groups have dedicated themselves to developing user-independent methods to determine automatically the Doppler angle. Nevertheless, most of these methods were developed for narrow ultrasound beam measurements. For small vessels, where the beam width is a significant fraction of the diameter of the vessel, the effect of velocity gradients plays an important role and should not be ignored in the Doppler angle estimations. Accordingly, this paper is concerned with a method for improving the estimation of Doppler angles from spectral width Doppler (SWD) method, b...
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The breast section of these Guidelines and Recommendations for Elastography produced under the auspices of the World Federation of Ultrasound in Medicine and Biology (WFUMB) assesses the clinically used applications of all forms of... more
The breast section of these Guidelines and Recommendations for Elastography produced under the auspices of the World Federation of Ultrasound in Medicine and Biology (WFUMB) assesses the clinically used applications of all forms of elastography used in breast imaging. The literature on various breast elastography techniques is reviewed, and recommendations are made on evidence-based results. Practical advice is given on how to perform and interpret breast elastography for optimal results, with emphasis placed on avoiding pitfalls. Artifacts are reviewed, and the clinical utility of some artifacts is discussed. Both strain and shear wave techniques have been shown to be highly accurate in characterizing breast lesions as benign or malignant. The relationship between the various techniques is discussed, and recommended interpretation based on a BI-RADS-like malignancy probability scale is provided. This document is intended to be used as a reference and to guide clinical users in a pr...
Research Interests: Radiology, Medical Physics, Ultrasound, Medicine, Humans, and 15 moreLiver Cirrhosis, Liver, Female, Breast Imaging, Mammography, Clinical Sciences, Mechanical Stress, Internationality, Shear Strength, Elastic Modulus, Tensile Strength, Elastography, Breast Neoplasms, breast ultrasound, and Elasticity Imaging Techniques
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To the Editor: Breast cancer has the highest cancer incidence rate and the fourth highest mortality rate for women in Taiwan (1). Between 1995 and 2006, breast cancer incidence and breast cancer deaths in Taiwan’s women increased by 82%... more
To the Editor: Breast cancer has the highest cancer incidence rate and the fourth highest mortality rate for women in Taiwan (1). Between 1995 and 2006, breast cancer incidence and breast cancer deaths in Taiwan’s women increased by 82% and 14.4%, respectively (1). The U.S. Preventive Services Task Force explicitly recommended biennial mammography screening for women aged 50–74 years in their updated breast cancer screening recommendations published in July 2008 (2). Taiwan implemented the universal National Health Insurance Legislation, and more than 98% of the population was covered (3). To reduce breast cancer mortality and morbidity, Taiwan’s Bureau of Health Promotion and the Radiological Society Republic of China (RSROC) collaborated to implement a mammogram-based nationwide screening for breast cancer. Since July 2004, Taiwan’s women between the ages of 50 and 69 years can receive free mammogram service every 2 years. This program included 184,580 consecutive screening mammograms between July 2004 and December 2006. About 8% of approximately all 2,220,000 women aged 50–69 in Taiwan were enrolled during the first 3-year period. The participating screening centers were 102 hospitals in 2004 and increased to 123 hospitals in 2006. We report the results of the first 3 years (2004– 2006) of the Taiwan Mammography Screening Program. Table 1 shows a summary of the important data of mammography screening. The common breast density categories of screenees were of category 2 (scattered fibroglandular) and 3 (heterogeneously dense), which accounted for 80% of screenees. The mammography screening percentage among the total eligible women aged 50–69 increased from 0.85% in 2004 to 4.75% in 2006. We estimated that about 8% of women aged 50–69 years had a screening mammogram during the first 3-year period. The annual national incidence of breast cancer increased by 13% in 2004 compared with the previous year and showed a slowly progressive increase in 2005 and 2006. The dramatic rise in breast cancer prevalence in 2004 could be related to the direct (mammography screening) or indirect effect (public awareness) of national cancer screening (Fig. 1) (4). The total breast cancer rate among screenees was found to be the highest (6.3 ⁄ 1,000 screenees) in 2004. The results of the following 2 years (2005 and 2006) suggested that the total breast cancer rate in screenees is about 4.8 per 1,000 screenees in Taiwan. The average screen-detectable breast cancer rate in 2004–2006 was about 4.5 per 1,000 screenees (range, 4.0–5.4). In the first 3-year period, a total of 918 women were found in the registrations of both the Taiwan Mammography Screening Program and Taiwan Cancer Registry. Of the 918 women, 767 (88%) cases of breast cancer were interpreted from abnormal mammograms, and 151 (12%) cases of breast cancer were interpreted from negative mammograms. The false-negative rate was 1.0 per 1,000 screenees in the first 2 years and then dropped to 0.9 per 1,000 screenees in the third year. The accuracy of the mammography screening is affected by the experiences of the radiologists in recognizing subtle mammography findings suggesting possible cancer. The sensitivity of mammography screening for detecting breast cancer has increased from 81.9% in 2005 to 84.0% in 2006. These data suggest continuing improvements in the quality of screening. Women in Taiwan have smaller breasts and a higher percentage of dense breasts (5), which can make breast cancer detection difficult. We found some radiologists miscategorized dense breasts as BI-RADS category 0 and recommended the screenees to focus breast ultrasound for diagnostic images. The RSROC Address correspondence and reprint requests to: Huay-Ben Pan, MD, Department of Radiology, Kaohsiung Veterans General Hospital, 386 Da-Chung first Rd., Kaohsiung 813, Taiwan, or e-mail: r2207759@ms19. hinet.net.
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*Department of Radiology, Taipei Veterans General Hospital, Taiwan; Department of Radiology, School of Medicine, National Yang-Ming University, Taiwan; Department of Diagnostic Radiology, Lo-Hsu Foundation, Inc., Lotung Poh-Ai Hospital,... more
*Department of Radiology, Taipei Veterans General Hospital, Taiwan; Department of Radiology, School of Medicine, National Yang-Ming University, Taiwan; Department of Diagnostic Radiology, Lo-Hsu Foundation, Inc., Lotung Poh-Ai Hospital, Taiwan; Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taiwan; and Department of Surgery, School of Medicine, National Yang-Ming University, Taiwan
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Real-time ultrasonography (US), computed tomography (CT), and biochemical tests were prospectively performed to detect gallstones in 88 consecutive patients immediately after the onset of an attack of acute pancreatitis. The sensitivity... more
Real-time ultrasonography (US), computed tomography (CT), and biochemical tests were prospectively performed to detect gallstones in 88 consecutive patients immediately after the onset of an attack of acute pancreatitis. The sensitivity of biochemical tests was 84.6% when the patients had three or more positives of five parameters [including serum bilirubin, alkaline phosphatase (AP), gamma-glutamyl transpeptidase (GGT), alanine transaminase (ALT), and alanine transaminase-aspartate transaminase (ALT-AST) ratio]. The sensitivity, specificity, and accuracy were 71.8, 98.0, and 86.4% for US, and 52.9%, 100%, and 79.5% for CT. The sensitivity, specificity, and accuracy were improved to 82.1, 100, and 93.2% by the combination of US and CT, and 94.9, 100, and 97.7% by the combination of US and biochemical tests. Adding CT to the combination of US and biochemical tests resulted in only a slight improvement in sensitivity and accuracy. In conclusion, a combination of US and biochemical tests can provide the best noninvasive method in rapidly detecting gallstones as an etiological factor in acute pancreatitis. Computed tomography is not cost-effective. A positive result of biochemical tests despite a negative finding in US calls for an intensive search for gallstones by further investigation with endoscopic retrograde cholangiography or repeated US examinations.