Background: Precise preoperative imaging localization of parathyroid tumors is critical in primary hyperparathyroidism (PHPT) for choosing proper surgical methods and ensuring successful surgery, but may be challenging due to the variable size, number, and location of parathyroid tumors. This study aimed to investigate the association between biochemical indices and intraoperative parathyroid tumor size, number, location, and imaging results in a cohort of PHPT patients, and to explore whether these indices can assist in preoperative localization of PHPT. Methods: A total of 462 patients with surgically confirmed PHPT were enrolled in this study retrospectively. Preoperative biochemical indices, including serum parathyroid hormone (PTH), plasma ionized calcium (iCa), and serum calcium (Ca), as well as the intraoperative size, number, location, and imaging results of the parathyroid tumor, were reviewed and analyzed. The correlation between preoperative biochemical indices and intraoperative parathyroid tumor size was investigated using Spearman's rank correlation. The comparison of preoperative biochemical indices between single-gland disease (SGD) and multi-gland disease (MGD), orthotopic and ectopic hyperparathyroidism, as well as imaging true positive (TP) and false negative (FN) groups, was performed using the Mann-Whitney U test. Results: The Spearman's rank correlation coefficient (r(s)) of serum PTH, plasma iCa, and serum Ca with intraoperative parathyroid tumor maximum diameter were 0.352, 0.342, and 0.224, respectively. The r(s) of serum PTH, plasma iCa, and serum Ca with intraoperative parathyroid tumor volume were 0.394, 0.355, and 0.256, respectively. Serum PTH and plasma iCa levels were weakly correlated with intraoperative parathyroid tumor size (P<0.001), while no correlation was found between serum Ca levels and intraoperative parathyroid tumor size (P<0.001). Serum PTH levels were significantly higher in ectopic hyperparathyroidism than in orthotopic hyperparathyroidism (204.8 vs. 139.7 pg/mL, P<0.001). However, plasma iCa (1.38 vs. 1.36 mmol/L, P=0.76) and serum Ca levels (2.74 vs. 2.71 mmol/L, P=0.82) were not significantly different between them. No significant differences were found in these indices between SGD and MGD (P=0.10-0.84), as well as imaging TP and FN groups (P=0.10-0.88). Conclusions: Serum PTH and plasma iCa levels were weakly correlated with intraoperative parathyroid tumor size. Higher serum PTH levels tend to be associated with ectopic hyperparathyroidism. The ability of biochemical indices to reliably predict parathyroid tumor anatomical features (size, number, or location of glands) appears to be limited.

Competency-based training in clinical ultrasonography requires a clear understanding of skill acquisition trajectories. However, objective data on how residents actually learn in real-time clinical environments remain scarce. This study aims to map the learning pathway of ultrasound residents by analyzing real-time consultation patterns and introducing a novel metric—the skill acquisition half-life—to quantify the rate of skill mastery. We conducted a single-center retrospective observational study in a high-volume outpatient ultrasound department. Over an eight-week period, real-time consultation requests initiated by 45 residents across three postgraduate years (PGY-1 to PGY-3) were logged. Consultations were categorized by examination type (Standard vs. Advanced assignments). Adjusted consultation rates were calculated per clinical session. A negative exponential learning curve model was fitted to derive the skill acquisition half-life (T₁/₂), defined as the time required for the consultation rate to decrease by half. A total of 529 consultations were recorded, with PGY-1 residents accounting for 88.5

We report a rare case of Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome accompanied by simultaneous adenomyosis and leiomyoma in rudimentary uterine remnants. A 35-year-old woman presented with progressive lower abdominal pain and underwent diagnostic imaging. The initial ultrasound erroneously suggested an adnexal mass, but subsequent imaging revealed bilateral uterine remnants-one with adenomyotic changes and the other harboring a leiomyoma. Laparoscopic excision confirmed these pathological findings. This case suggests the importance of regular gynecological imaging examinations for MRKH patients and challenges the conventional belief in the non-functional nature of Müllerian remnants. Furthermore, our findings underscore the diagnostic utility of transabdominal ultrasound in accurately identifying complex uterine anomalies.

Transient perivascular inflammation of the carotid artery (TIPIC) syndrome is a relatively rare disease, and ultrasound is the first screening method for initial diagnosis of the disease. Contrast-enhanced ultrasound (CEUS) has unique advantages in the follow-up of patients with TIPIC syndrome. This paper reports a patient with TIPIC syndrome who was treated with acute left neck pain. The inflammation was significantly relieved and subsided after treatment with non-steroidal anti-inflammatory drugs. The ultrasound changes of carotid artery lesions in this patient during follow-up were analyzed, and the application value of CEUS in the follow-up diagnosis of this disease was summarized, in the hope of providing clinical reference.

PURPOSE:To study the value of ultrasound in the diagnosis of juxtaglomerular cell tumor (JGCT). METHODS:From January 2005 to July 2020, fifteen patients diagnosed as JGCT by surgical pathology in Peking Union Medical College Hospital were collected. All patients underwent preoperative ultrasound examination. The clinical, laboratory, ultrasound, computed tomography (CT), surgical, and pathological features of the patients were analyzed retrospectively. RESULTS:The 15 patients were 5 males and 10 females with a median age of 29 years (10∼72 years). 14 of them had hypertension and one had normal blood pressure. The tumors were all solitary, with a median diameter of 1.5 cm (0.9-5.9 cm). Among the fifteen patients, eleven were correctly detected by preoperative ultrasound, and four were missed. There was a significant difference in tumor size (2.64 ± 1.48 cm vs. 1.23 ± 0.21 cm) and whether the tumor protruded outward (9/11 vs. 0/4) between the ultrasound-detected group and the ultrasound-missed group (p = 0.010, p = 0.011). Of the 11 tumors detected by ultrasound, four were extremely hypoechoic, two were hypoechoic, three were isoechoic, and two were hyperechoic. Color Doppler showed no blood flow in five tumors with the size range from 0.9 to 2.0 cm, and mild blood flow in six tumors with the size range from 2.8 to 5.9 cm. CONCLUSIONS:JGCT is rare, and has characteristic clinical manifestations. Diagnosis should be suspected in case of secondary hypertension, particularly in young women, if no renal vascular cause was found. Ultrasound, combined with clinical manifestations, was helpful for the diagnosis.

Background: Diffuse sclerosing variant of papillary thyroid carcinoma (DSVPTC) is a rare but high invasive subtype of papillary thyroid carcinoma, which mandates an aggressive clinical strategy. Few studies have focused on the sonographic characteristics of DSVPTC and the role of ultrasound in diagnosis and treatment of this variant remains unknown. This study aimed to identify and understand DSVPTC more accurately under ultrasound in correlation with pathology. Methods: The ultrasound characteristics and histopathologic sections of 10 lesions in 10 DSVPTC patients who underwent thyroid surgery at our center between 2014 and 2020 were reviewed and compared with 184 lesions in 168 classic variant of papillary thyroid carcinoma (cPTC) patients. Results: 6 DSVPTC cases (60%) showed the “snowstorm” pattern on sonogram and 4 cases (40%) presented hypoechoic solid nodules only. Vague borders (100.0% vs. 18.5%, P =0.019) and abundant microcalcifications (66.7% vs. 10.9%, P =0.037) were more common in DSVPTC nodules than in cPTC nodules, corresponding to the infiltrating boundaries and numerous psammoma bodies under the microscope respectively. Most of the DSVPTC cases had a heterogeneous background (80%) and suspicious metastatic cervical lymph nodes (80%) on sonograms. All DSVPTC cases had histopathological metastatic cervical lymph nodes. Conclusion: The sonographic “snowstorm” pattern indicated DSVPTC with whole-lobe occupation. Hypoechoic solid nodules with vague borders and abundant microcalcifications on sonogram suggested DSVPTC lesion with an ongoing invasion. Regardless of which of the two sonograms was shown, the corresponding DSVPTC lesions were aggressive and required the same attention from the surgeons.

AIM: To introduce a novel computer-aided classification (CAC) system and investigate the feasibility of characterising and diagnosing breast masses on ultrasound (US).MATERIALS AND METHODS: A total of 246 breast masses were included. US features and the final assessment categories of the breast masses were analysed by a radiologist and the CAC system according to the Breast Imaging Reporting and Data System (BI-RADS) lexicon. The CAC system evaluated the BI-RADS assessment from the fusion of multi-view and colour Doppler US images without (SmartBreast) or with combining clinical variables (m-CAC system). The diagnostic performance and agreement of US characteristics between the radiologist and the CAC system were compared. RESULTS: The agreement between the radiologist and the CAC system was substantial for mass shape (K = 0.673), orientation (K = 0.682), margin (K = 0.622), posterior features (K = 0.629), calcifications in a mass (K = 0.709) and vascularity (K = 0.745), fair for echo pattern (K = 0.379), and moderate for BI-RADS assessment (K = 0.575). With BI-RADS 4a as the cut-off value, the specificity (52.5% versus 25%, p<0.0001) and accuracy (73.98% versus 62.6%, p=0.00 02) of the m-CAC system were improved without significant loss of sensitivity (94.44% versus 98.41%, p=0.1250) compared with the SmartBreast. The m-CAC system showed similar specificity (52.5% versus 45.83%, p=0.2430) and accuracy (73.98% versus 73.58%, p=1.0000) as the radiologist, but a lower sensitivity (94.44% versus 100%, p=0.0156). CONCLUSION: The CAC system showed an acceptable agreement with the radiologist for characterisation of breast lesions. It has the potential to mimic the decision-making behaviour of radiologists for the classification of breast lesions.

Background A virilizing ovarian tumor (VOT) is a rare cause of hyperandrogenism in pre- and postmenopausal women. Although transvaginal ultrasound is considered as the first-line imaging method for ovarian tumors, it is examiner-dependent. We aimed to summarize the clinical and ultrasound manifestations of VOTs to help establish the diagnosis with emphasis on those causing diagnostic difficulty. Method We retrospectively identified 31 patients with VOTs who underwent surgery at Peking Union Medical College Hospital. Results Patients with VOTs were predominantly premenopausal. All patients showed androgenic manifestations with serum testosterone levels elevated to varying degrees. The tumor size of VOTs was significantly correlated with age ( P < 0.001). The VOTs in the postmenopausal group were significantly smaller than those in the premenopausal group (median 1.8 cm [range, 1.3–4.8 cm] vs 4.5 cm [range, 0.7–11.9 cm]; P = 0.018). Twenty-seven out of 31 VOTs were successfully identified by ultrasound. On ultrasound, VOTs are mostly solid and hypoechoic masses with enhanced vascularity. Four VOTs (0.7–1.5 cm) were radiologically negative, and they were the smallest among all patients. Conclusion Patients with VOTs showed androgenic manifestations with varying degrees of hyperandrogenemia. Older patients tend to have smaller VOTs. Ultrasound is an effective method for the detection of VOTs. Some VOTs can be very small and difficult to visualize radiologically, especially in postmenopausal patients. Examiners must remain vigilant about very small VOTs on the basis of endocrine symptoms.

Objective To evaluate clinical and sonographic features predictive of lymph nodes posterior to the right recurrent laryngeal nerve (LN-prRLN) metastasis in patients diagnosed with papillary thyroid carcinoma (PTC). Methods We retrospectively reviewed the clinical records and ultrasound (US) images of 479 consecutive PTC patients who received total thyroidectomy or right lobectomy with central neck dissection (CND) between October 2017 and October 2019. Univariate and multivariate analyses were performed to identify clinical and sonographic features associated with LN-prRLN metastasis. Receiver operating characteristic (ROC) analysis was applied to evaluate the efficacy of clinical and sonographic features in the preoperative prediction of LN-prRLN metastasis. Results Overall, 127 (26.5%) patients had LN-prRLN metastasis. Multivariate logistic regression analysis showed that age < 45 years (p = 0.005; OR 2.155; 95% CI 1.262-3.683), male sex (p = 0.043; OR 1.657; 95% CI 1.016-2.704), tumor diameter > 1 cm (p = 0.042; OR 1.702; 95% CI 1.019-2.842), microcalcifications (p = 0.022; OR 1.980; 95% CI 1.104-3.551), and US-detected lateral compartment lymph node (LLN) metastasis (p = 0.001; OR 2.578; 95% CI 1.500-4.430) were independent risk factors for LN-prRLN metastasis. ROC analysis revealed that the multivariate logistic regression model had good accuracy in predicting LN-prRLN metastasis, with an area under the ROC curve of 0.758. Conclusions Age less than 45 years, male sex, tumor diameter larger than 1 cm, microcalcifications, and US-detected LLN metastasis may preoperatively predict LN-prRLN metastasis.

Ultrasonography, the preferred imaging modality for breast diseases, has merits such as absence of radiation, high diagnostic accuracy, and convenience for follow-up, thus playing an important role in clinical diagnosis and management. The American College of Radiology (ACR) proposed Breast Imaging-Reporting and Data System (BI-RADS ) and has updated for several times. Gradually, the BI-RADS has been accepted and adopted by ultrasound physicians at all levels of hospitals in China, and it has played a certain role in improving the diagnostic level of breast ultrasound in China. In order to standardize breast ultrasound application and raise the status of ultrasound in clinical decision-making of breast diseases, based on the latest edition of ACR BI-RADS Atlas 2013, the committee has reached the "Expert Consensus on Clinical Frequently Asked Questions in Breast Ultrasonography"on a number of controversial Frequently Asked Questions (FAQs) in clinical practice (hereafter referred to as "Consensus"), and will be dedicated to updating the contents of the "Consensus", through further experience in clinical practice and the advent of new information from further studies. This consensus is only for reference purposes for medical personnel, and the processes outlined are not mandatory by law.