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American Institute of Ultrasound in Medicine <strong>Proceedings</strong> J Ultrasound Med 32(suppl):S1–S134, 2013nant lesions, SVI had no V s in 10 (18.1%); 25 (44.6%) were benign; and21 (37.5%) were malignant. The QM was low in all cases where no SVIsignal was obtained: in 19 of 25 (76.0%) soft malignant lesions, 2 of 5(40%) hard benign lesions, and 6 of 89 (6.7%) soft benign lesions. TheQM was high in 3 of 25 (12.0%) soft malignant lesions, which were lymphoma.Three false-negatives on EI were lymphomas. In cases were thereis a low QM, if the lesion is solid, it is most likely a cancer.Conclusions—Strain imaging had the highest sensitivity, whileSVI had the highest specificity (without or with the QM). There was a significantimprovement in the sensitivity of SVI with the addition of theQM; however, an additional 16.9% of cases could not be evaluated.Table 1. Comparison of TechniquesNo. Sensitivity, Specificity,Technique Evaluable % % AUROCStrain (EI) 163 95 88 0.9595SVI – QM 166 41 95 0.6756SVI + QM 138 78 94 0.7988SVI + low QM and 166 93 87 0.9006solid lesion = malignantAUROC indicates area under the ROC curve.1536920 Differentiation of Benign and Malignant Breast Lesions:A Comparison Between Automatically Generated BreastVolume Scans and Handheld Ultrasound ExaminationsHongyan Wang, 1 * Yuxin Jiang, 1 Qingli Zhu, 1 Jing Zhang, 1Qing Dai, 1 He Liu, 1 Xingjian Lai, 1 Qiang Sun 2 1 DiagnosticUltrasound, 2 Breast Surgery, Peking Union Medical CollegeHospital, Beijing, ChinaObjectives—To assess the diagnostic value of automated breastvolume scanning (ABVS) and conventional handheld ultrasonography(HHUS) for the differentiation of benign and malignant breast lesions.Methods—The study prospectively evaluated 239 lesions in213 women who were scheduledfor open biopsy. The patients underwent ABVS and conventionalHHUS. The sensitivity, specificity, accuracy, false-positive rate,false-negative rate, and positive and negative predictive values for HHUSand ABVS images were calculated using histopathologic examination asthe gold standard. Additionally, diagnostic accuracy was further evaluatedaccording to the size of the masses.Results—Among the 239 breast lesions studied, pathology revealed85 (35.6%) malignant lesions and 154 (64.4%) benign lesions.ABVS was similar to HHUS in terms of sensitivity (95.3% vs 90.6%),specificity (80.5% vs 82.5%), accuracy (85.8% vs 85.3%), positive predictivevalue (73.0% vs 74.0%), and negative predictive value (93.3% vs94.1%). The area under the receiver operating characteristic curve, whichis used to estimate the accuracy of the methods, demonstrated only minordifferences between HHUS and ABVS (0.928 and 0.948, respectively).Conclusions—The diagnostic accuracy of HHUS and ABVS indifferentiating benign from malignant breast lesions is almost identical.However, ABVS can offer new diagnostic information. ABVS may helpdistinguish between real lesions and inhomogeneous areas, find smalllesions, and demonstrate the presence of intraductal lesions. This techniqueis feasible for clinical applications and is a promising new techniquein breast imaging.1540513 Functional Images of Hemoglobin and Blood OxygenSaturation Coregistered With Ultrasound Provide AccurateDifferentiation of Breast TumorsPamela Otto, 1 * Kenneth Kist, 1 N. Carol Dornbluth, 1 ThomasStavros, 2 Donald Herzog, 2 Thomas Miller, 2 Bryan Clingman, 2Jason Zalev, 2 Michael Ulissey, 3 Philip Lavin, 4 SergeyErmilov, 5 Alexander Oraevsky 2,5 1 Radiology, University ofTexas Health Science Center, San Antonio, Texas USA; 2 SenoMedical Instruments, San Antonio, Texas USA; 3 Radiology,University of Texas Southwestern Medical Center, Dallas, TexasUSA; 4 Aptiv Solutions, Southborough, Massachusetts USA;5TomoWave Laboratories, Inc, Houston, Texas USAObjectives—A novel system called Imagio combines ultrasound(US) and opto-acoustics (OA) to more accurately distinguish malignantfrom benign tumors. We analyzed the ability of blind readers toassess the probability of malignancy (POM) using coregistered functionaland anatomic images vs conventional diagnostic ultrasound (DUS) alone.Methods—Seventy-three patients with breast masses were assessedwith OA and DUS. All the masses were biopsied, and histologywas the gold standard. OA employs near-infrared laser pulses at 2 differentwavelengths (to provide contrast between oxygenated hemoglobin inbenign lesions and deoxygenated hemoglobin in malignant lesions) to illuminatetissues through a fiber-optic bundle incorporated into a prototypehandheld OA US probe. It detects the laser pulse–induced acousticpressure waves that are then used for reconstruction of 2D functional andanatomic images. OA maps of total hemoglobin and blood oxygen saturationprovide functional information that is coregistered with the morphologicalinformation from B-mode grayscale US images.Results—Five blinded readers independently assessed POMfor OA and DUS. OA provided a >40% higher mean POM for all malignantlesions, a >30% higher mean POM for malignant Breast ImagingReporting and Data System (BI-RADS) 4B lesions, and a >10% highermean POM for malignant BI-RADS 5 lesions than did DUS. OA could potentiallyspare 23.7% more negative biopsies than DUS at the critical 2%POM level.Conclusions—The fused functional OA and grayscaleanatomic information significantly improved distinction of benign frommalignant breast masses compared with DUS alone, especially within theBI-RADS 4B category, where OA better distinguishes benign from malignantlesions and thereby prevents unnecessary biopsies.1522001 Granulomatous Mastitis: Clinical and Sonographic FeaturesWith Image-Guided Biopsy CorrelationPriyanka Handa, 1 * Derek Sun, 1 Jill Leibman, 1,2 Aryeh Goldberg,1 Maria Abadi 1,2 1 Jacobi Medical Center, Bronx, NewYork USA; 2 Albert Einstein College of Medicine, Bronx, NewYork USAObjectives—Granulomatous mastitis (GM) is an unusual inflammatorylesion that can mimic breast cancer on clinical exam andimaging studies. The purpose of this study was to review the clinical presentationand imaging findings (including sonography) associated with GMand determine the adequacy of image-guided biopsy for diagnosis.Methods—A retrospective study was performed to identify patientswith breast imaging studies and a pathologic diagnosis of GM. Theclinical presentation, imaging findings, biopsy method, and pathology reportswere reviewed.Results—Twenty-seven patients were included; average agewas 35.3 years (range, 21–66 years). Twenty-four patients presented withpain, a palpable mass, and/or discharge. Three asymptomatic patients presentedfor screening mammograms. All patients were imaged with ultrasound(US), demonstrating a mass in 19 (70%), tubular lucencies withouta mass in 6 (22%), and no findings in 2 (8%). In the 25 patients with positivesonographic findings, the mass was anechoic in 3 (12%), hypoechoicS13
American Institute of Ultrasound in Medicine <strong>Proceedings</strong> J Ultrasound Med 32(suppl):S1–S134, 2013in 12 (48%), hyperechoic in 1 (4%), and mixed echogenicity in 9 (36%).Four of the 25 masses demonstrated posterior acoustic enhancement(16%), and 21 of the 25 masses did not demonstrate posterior acoustic enhancement(84%). Doppler vascularity was present in 11 patients (44%).A mass was demonstrated in 19 patients; 5 masses were well defined(26%), and 15 masses had irregular margins (74%). Twenty-six of the 27patients had correlative mammographic findings. Pathologic diagnosiswas made by US-guided biopsy in 11 of 27 (40%), US-guided fine- needleaspiration in 1 of 27 (4%), and mammotome biopsy in 1 of 27 (4%).Palpation-guided tissue sampling was performed in 12 of 27 (44%). Surgicalexcision was performed in 7 of 27 (26%).Conclusions—The sonographic features of GM are infrequentlydescribed. Our study demonstrated that the sonographic findingsare indeterminate and may mimic malignancy. Although previously reportedexclusively in young women with palpable findings, our studydemonstrates that it can occur in postmenopausal as well as asymptomaticpatients. The diagnosis of GM is optimally made by US-guided corebiopsy.1538026 Using a New Ultrasound Image-Processing Technique forIdentification of Microcalcifications in Patients Prior toBiopsyPriscilla Machado,* John Eisenbrey, Barbara Cavanaugh,Flemming Forsberg Radiology, Thomas Jefferson University,Philadelphia, Pennsylvania USAObjectives—To evaluate a new commercial image-processingtechnique (MicroPure; Toshiba America Medical Systems, Tustin, CA)for the identification of breast microcalcifications in patients undergoingstereotactic or ultrasound (US)-guided biopsies and to compare results tox-ray imaging of the tissue retrieved.Methods—Twelve women, scheduled for stereotactic biopsyor US-guided biopsy of an area with breast calcifications (identified on aprior mammogram), were enrolled in the study. The patients underwent aUS examination consisting of real-time dual imaging of grayscale US andMicroPure using an Aplio XG scanner (Toshiba America Medical Systems)with a broad-bandwidth linear array. MicroPure combines nonlinearimaging and speckle suppression to mark suspected calcifications aswhite spots in a blue overlay image. Still images and digital clips of thetarget area were acquired. Independent and blinded readers (2 radiologistsand 2 physicists) analyzed 26 digital clips to determine the number of calcificationsseen with MicroPure and also to give a subjective view on thelevel of suspicion (LOS) of the findings. X-ray imaging of the specimenwas analyzed by a radiologist who counted the exact number of microcalcifications.The number of microcalcifications was compared using themean number from the 4 readers with the mean number on the x-rayimage. The LOS was compared with the pathologic findings using receiveroperating characteristic (ROC) analysis.Results—The mean number of microcalcifications seen onMicroPure was 6.96 (3.33–13.37). These values show excellent agreementwith the mean number of microcalcifications seem on the x-rayimage of the tissue retrieved (7.42; P = .39). ROC analysis of the readers’LOS scores compared to the pathologic findings produced areas under thecurve of 0.74–0.99.Conclusions—MicroPure imaging was able to identify microcalcificationsat the target area as confirmed by x-ray imaging of the tissuespecimen. These findings indicate that MicroPure may be used toguide breast biopsy procedures, but more studies are needed.1540975 The Natural History of Thyroid Nodules With PeripheralCalcificationArash Anvari,* Anthony Samir Radiology, AbdominalImaging and Intervention, Massachusetts General Hospital,Boston, Massachusetts USAObjectives—Peripheral dystrophic calcification is a known patternin thyroid nodules seen on ultrasound (US) and can be found in bothbenign and malignant nodules. The American Thyroid Association (ATA)guidelines for recommending biopsy in the setting of nodule follow-upare predicated on a change in nodule size exceeding 50%. It is unknownwhether rim calcification in a thyroid nodule may prevent nodule enlargement,potentially rendering the ATA biopsy criteria ineffective. Theobjective of this study was to determine whether rim calcified nodules undergoingUS follow-up are able to enlarge to an extent meeting ATA criteriafor fine-needle aspiration biopsy (FNAB).Methods—We searched our institute’s radiology report databasefor thyroid nodules with rim calcification between 2002 and 2011. Wethen reviewed each subject to determine parameters like demographicdata, nodule size, timing and number of follow-up sonograms, and FNABand/or surgical pathologic results. We calculated nodule volumes usingthe formula for a rotational ellipsoid (volume = depth × width × length ×π/6) to evaluate the growth rate between the first and last US reports.Results—We found 197 thyroid nodules with peripheral rimcalcification in 192 subjects; 164 subjects (85.4%) were female (age range,30–90 years; 60.35 ± 13.77 years; maximal dimension range, 3–36 mm;11.95 ± 7.12 mm). We evaluated volume changes in 59 nodules that hada US follow-up interval of at least 1 year (range, 1–9.5 years; 3.58 ± 2.14years). Thyroid nodule volumes ranged from 0.02 to 14.19 mL (1.04 ±2.29 mL) at the initial follow-up and ranged from 0.02 to 10.75 mL (11 ±2.06 mL) at the last follow-up. Over the period of follow-up, 17 of 59 rimcalcified nodules (28.9%; 95% confidence interval, 17.3%–40.4%)changed in volume by >50%. The proportion of nodules with volumechanges exceeding 50% increased with longer follow-up and when themaximal diameter was
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