OBJECTIVE:To investigate the value of ultrasound viscosity imaging in preoperative differential diagnosis between malignant and benign breast lesions. METHODS:This prospective study was approved by our institutional review board and informed consents were signed by all patients. Patients diagnosed with focal solid breast lesions who plan to undergo surgical or ultrasound guided core needle biopsy were included. A Mindray Resona R9 Elite diagnostic ultrasound system equipped with a linear array transducer (L15-3 MHz) was used. First BMUS was used to identify the lesions, afterwards, ultrasound viscosity imaging and shear wave elastography measurements were performed for each lesion. Viscosity (Pa*s) coefficient and shear-wave speed (m/s) of each breast lesion were measured. Taking the final histopathological results as the gold standard, the optimal cut-off value of viscosity and elastography values in differential diagnosis between malignant and benign breast lesions were evaluated. Diagnostic performance was assessed by using the area under the receiver operating characteristic curve (ROC). RESULTS:From July 2023 to March 2024, 159 consecutive patients with a total of 184 solid breast lesions were included. Among which 74 (40.2%) malignant lesions and 110 (59.8%) benign ones were diagnosed according to the final histopathological results. The mean maximal viscosity coefficient (7.56±3.63 Pa*s) of malignant lesions was significantly higher than that of benign ones (4.52±2.33 Pa*s), whereas the mean maximal SWE value (6.53±1.87 m/s) of malignant lesions was also obviously higher than that of benign ones (4.80±1.62 m/s) (P < 0.05). The cut-off value for diagnosis of malignant breast tumors was 5.39 Pa*s for viscosity, with 75.68% sensitivity, 68.18% specificity and 0.763 AUROC (P < 0.05). When combined viscosity with SWE values, the sensitivity and specificity was 75.68% and 75.45%, with an-area under the receiver operating characteristic curve (AUC) 0.787. CONCLUSIONS:The value of viscosity measurement may provide additional value for preoperative non-invasive differential diagnosis between malignant and benign breast lesions.

Objectives: To assess multimodality ultrasound features of renal cell carcinomas (RCCs) with different tumor sizes, especially in RCCs ≤ 3 cm in diameter. Patients & Methods: Patients with surgery resection and histopathologically confirmed RCCs were included. All patients underwent multimodality ultrasound examinations one week before surgery. Results: From July 2023 to January 2024, a total of 81 RCCs were finally enrolled, including Group 1 (≤ 3 cm, n = 41) and Group 2 (> 3 cm, n = 40). Hypervascular blood supply could be observed more commonly in RCCs > 3 cm than in RCCs ≤ 3 cm (P = 0.039) by MVI. The median SWV values of RCCs > 3 cm were higher than those in the RCCs ≤ 3 cm (P = 0.038). During arterial phase of CEUS, hyper-enhancement could be observed more often in RCCs > 3 cm (P = 0.246). However, 58.5% (24 / 41) of small RCCs ≤ 3 cm showed relatively late wash out after 60 s (P = 0.005). Conclusions: While comparing to bigger ones, RCCs ≤ 3 cm showed relatively less blood supply in the CDFI and MVI techniques, softer texture, hyperperfusion and later wash out after 60 s on CEUS.

Objective: To evaluate the value of dynamic contrast-enhanced ultrasound (DCE-US) analysis in early prediction of tumor response to systemic treatment in patients with intrahepatic cholangiocarcinoma (ICC). Patients & Methods: In this retrospective study, patients diagnosed with ICC by core needle biopsy and histopathological results were included. All patients were diagnosed as advanced stages (stage III/IV) by the 8th edition of the American Joint Committee on Cancer (AJCC)/International Union Against Cancer (UICC) TNM staging system. Liver contrast-enhanced ultrasound (CEUS) examination, DCE-US analysis, CT/MRI, and blood tests were performed in all patients before and 2 months after systemic treatment. CEUS procedure was performed using an ultrasound system (ACUSON Sequoia; Siemens Medical Solutions, Germany) equipped with a 5C1 MHz convex array transducer. Time-intensity curves (TIC) and quantitative parameters were created with VueBox software. According to one-year results of the modified Response Evaluation Criteria in Solid Tumors (m-RECIST) based on CT/MRI, patients were divided into the responder group (RG) and the non-responder group (NRG). Before and 2 months after systemic therapy, the DCE-US perfusion parameters was compared using the paired-sample t test and the Wilcoxon test. Results: From September 2020 to December 2021, a total of 24 patients diagnosed with advanced ICC were included (11 males, 13 females, mean age 59.4 +/- 1.8 years). According to the one year of m-RECIST results, 17 cases (70.8 %) were classified as non-responders by the final m-RECIST criteria, while 7 cases (19.2 %) were responders. Comparing before and 2 months after therapy, the RG took longer time to reach peak intensity, and the peak intensity of TIC was lower. While the TICs of NRG revealed faster enhancement after therapy. Among all DCE-US quantitative parameters, PE (peak enhancement), WiR (wash-in rate), WiPI (wash-in perfusion index) and WoR (wash-out rate) reduced significantly following 2 months of systemic therapy in RG (P < 0.05). Comparing to RG, PE and WiPI decreased slightly 2 months after therapy in NRG (P < 0.05). Conclusions: The DCE-US analysis with quantitative parameters has the potential value to make early and quantitative evaluation of treatment response to systemic therapy in ICC patients.

OBJECTIVE:To study the ultrasonographic manifestations and clinical features of common pediatric testicular germ cell tumors (TGCT) in children.METHODS:We retrospectively analyzed the laboratory, ultrasonographic and clinical data on 92 children with TGCT diagnosed in Shanghai Children's Hospital from March 2013 to January 2019, and investigated the values of the serum alpha-fetoprotein (AFP) level and maximum diameter of tumors in the diagnosis of benign and malignant tumors using the ROC curve.RESULTS:Of the 92 cases of pediatric TGCT, 64 (69.6%) were pathologically confirmed as benign tumors, including 40 cases of teratoma (62.5%), 18 cases of epidermoid cyst (28.1%) and 6 cases of dermoid cyst (9.4%), and the other 28 (30.4%) as malignant neoplasms, including 26 cases of yolk sac tumor (YST, 92.9%) and 2 cases of mixed germ cell tumor (MGCT, 7.1%). Ultrasonography showed that 62.5% of the teratomas were cystic-solid mixed (25/40) and 32.5% solid masses (12/40), that 33.3% of the epidermoid cysts exhibited a typical sign of "onion ring" (6/18) and 22.2% that of capsular calcification (4/18), and that 42.3% of the YSTs displayed isoechoic (11/26), 30.9% hypoechoic (8/26) solid masses without calcium and 26.9% cystic anechoic lesions (7/26). Color Doppler blood flow imaging manifested abundant blood flow signals in most of the YSTs (25/26, 96.2%) but none in either the epidermoid or the dermoid cysts. The area under the ROC curve (AUC) of the serum AFP value was 0.985, with an optimal cutoff value of 124.2 ng/ml, and the sensitivity and specificity of AFP in the diagnosis of benign and malignant tumors were 92.9% and 93.7%, respectively. The AUC of the maximum diameter of the tumors was 0.796, with an optimal cutoff value of 2.7 cm, and the sensitivity and specificity of the maximum diameter of the tumors in the diagnosis of benign and malignant neoplasms were 57.1% and 93.7%, respectively.CONCLUSIONS:Ultrasonographic images have different characteristic manifestations for different pathological types of pediatric TGCT. Pediatric TGCT has a good prognosis and radical orchiectomy should be considered for the treatment of the tumors with serum AFP ≥ 124.2 ng/ml and a diameter ≥ 2.7 cm.

Objective To retrospectively investigate the value of contrast enhanced ultrasound ( CEUS) in breast cancer biopsy . Methods A total of 49 consecutive patients with biopsy confirmed breast cancer were retrospectively analyzed . All patients underwent CEUS and biopsies were thus performed targeting both the high perfusion and low/non‐perfusion regions on CEUS . T he diagnostic performance and core cancer involvement of the biopsy cores taken from the high perfusion regions were compared with those from the low/non‐perfusion . Results A total of 53 breast cancer lesions were biopsy confirmed in 49 patients .CEUS revealed homogeneous enhancement in 8 lesions ( 15 .1% ) ,and heterogeneous enhancement in 45 lesions ( 84 .9% ) . T he diagnostic accuracy rate for biopsy cores taken from the high perfusion regions was significantly higher than that from the low/non‐perfusion regions ( 98 .5% vs 72 .9% , P ＜0 .01) . T he core cancer involvement was also higher in high perfusion lesions ( 55% vs 30% , P ＜0 .01) . Conclusions CEUS can differentiate the active area and necrotic fibrosis area of breast tumors by displaying the microvessels ,thus contributing to the selection of biopsy sites .

Objective To investigate prostate cancer detection rate of different biopsy protocols in different PSA value groups in rural China. Methods A total of 186 patients underwent contrast-enhanced ultrasound (CEUS) in order to determine the puncture target prior to biopsy were enrolled in this retrospective study. All patients underwent 12-core SB combined with CEUS-TB. The biopsy results of different biopsy protocols were compared in patients with stratification by PSA value. Results In 186 patients underwent prostate biopsy, the histopathologic results revealed prostate cancer in 117 cases (62.9%) and benign lesions in 69 cases (37.1%). The PSA 4-10ng/ml group, the prostate cancer detection rate of 8-core and 12-core method was no statistical significance. But the 12-core method was significantly higher than CEUS-TB (44.9% versus 32.7%, P = 0.01). The PSA 10-20ng/ml group, there was no statistical significance in prostate cancer detection rate between SB and CEUS-TB (50.0% versus 45.7%, P = 0.15). The PSA greater than 20ng/ml group, the prostate cancer detection rate by SB was higher than CEUS targeted biopsy, but there was no statistical significance (79.1% versus 76.9%, P = 0.15). In the overall patients, the biopsy core positive rate of CEUS-TB was significantly higher than SB (97% versus 55.5% and 28.5%, P = 0.0001). Conclusion The flexible use of SB combined with CEUS-TB can reduce the number of biopsy cores in higher PSA groups. It has clinical importance in the detection of prostate cancer in different PSA value groups in rural china.

To assess contrast-enhanced ultrasound (CEUS) targeted biopsy (TB) for clinically significant prostate cancer (PCa) detection compared with systematic biopsy (SB).

Objective To investigate the value of ultrasound in assessing leuprorelin treatment response of girls with central precocious puberty. Methods Forty girls with central precocious puberty scheduled for leuprorelin treatment were enrolled. Ultrasound examination as well as the serum hormone level test of luteinizing hormone (LH) and follicle stimulating hormone (FSH) were performed prior to the treatment, after 3 and 9 months of treatment. The correlation between uterine volume, ovarian volume and hormone levels were analyzed. Results After 3 and 9 months of leuprorelin treatment, both the volumes of uterus and ovary and the levels of LH and FSH were significant reduced (all P<0.05). After 3 months of leuprorelin treatment, the reduction rate in ovarian volume was positively correlated with the reduction rate of LH and FSH (r=0.335, P=0.034; r=0.334, P=0.035). No correlation was found between the reduction rate of uterine volume and hormone level changes (r=0.110, P=0.501; r=0.257, P=0.109). After 9 months of treatment, the ovarian volume reduction rate was positively correlated with the reduction rate of LH and FSH (r=0.327, P=0.039; r=0.356, P=0.024), and the uterine volume reduction rate was positively correlated with the reduction rate of LH and FSH (r=0.439, P=0.005; r=0.433, P=0.005). Conclusions Leuprorelin could effectively inhibit hormone release and gonadal development in girls with central precocious puberty. Ultrasound examination, as a noninvasive and convenient method, could dynamically monitor the volume changes of uterus and ovary, thus reflect the development of gonadal development directly and the changes of hormone level indirectly. It could be used as a routine outpatient follow-up method after central precocious medicine treatment. Key words: Ultrasonography; Central precocity; Girls; Drug treatment

Background: Human prostate cancer LNCaP cells can develop an androgen-sensitive prostate cancer animal model that closely mimic clinical disease. However, implantation of LNCaP cells yields a low take rate when subcutaneously xenografted in immunodeficient mice. Given that LNCaP cells are sensitive to hypoxia, we hypothesized that LNCaP cells might undergo substantial apoptosis in response to acute hypoxia under conditions of serum deprivation. Methods: Serum-deprived LNCaP cells were cultured and exposed to either normoxic (21.0% O 2 ) or hypoxic (1.0% O 2 ) conditions. Morphological changes in nuclei were evaluated with Hoechst 33258 staining under fluorescence microscopy. Cell viability and migration were assayed by Cell Counting Kit-8 (CCK-8) and wound healing assay, respectively. The production of intracellular reactive oxygen species (ROS) was measured by a fluorescent probe assay. Apoptosis, mitochondrial membrane potential (ΔΨm), and the cell cycle of LNCaP cells were analyzed by flow cytometry. Results: Serum-deprived LNCaP cells tended to form multicellular aggregates, and the viability and migration of LNCaP cells were markedly suppressed under acute hypoxia. Acute hypoxia exposure for 24 hours induced significant ROS production, which was distributed heterogeneously among cells. LNCaP cells exhibited a time-dependent increase in apoptosis under acute hypoxia by flow cytometric analysis. Furthermore, acute hypoxia induced the collapse of the ΔΨm of LNCaP cells, and it also increased cell cycle arrest at the G0/G1 phases in a time-dependent manner. Conclusions: Acute hypoxia induces substantial apoptosis in LNCaP cells under conditions of serum deprivation. The findings may provide valuable information for improving the tumor-formation method of LNCaP subcutaneous xenografts in nude mice.

The prostate specific membrane antigen (PSMA) is broadly overexpressed on prostate cancer (PCa) cell surfaces. In this study, we report the synthesis, characterization, in vitro binding assay, and in vivo magnetic resonance imaging (MRI) evaluation of PSMA targeting superparamagnetic iron oxide nanoparticles (SPIONs). PSMA-targeting polypeptide CQKHHNYLC was conjugated to SPIONs to form PSMA-targeting molecular MRI contrast agents. In vitro studies demonstrated specific uptake of polypeptide-SPIONs by PSMA expressing cells. In vivo MRI studies found that MRI signals in PSMA-expressing tumors could be specifically enhanced with polypeptide-SPION, and further Prussian blue staining showed heterogeneous deposition of SPIONs in the tumor tissues. Taken altogether, we have developed PSMA-targeting polypeptide-SPIONs that could specifically enhance MRI signal in tumor-bearing mice, which might provide a new strategy for the molecular imaging of PCa.

To investigate the correlation of three-dimensional (3D) ultrasound features with prognostic factors in invasive ductal carcinoma.

PURPOSE:To evaluate elastography using a bi-plane transducer for localizing prostate cancer (PCa) in patients scheduled for radical prostatectomy (RP), in comparison with step section pathological analysis.METHODS:Fifty-six consecutive PCa patients underwent real-time elastography examination with a bi-plane transducer before RP. Transverse elastographic images were obtained from the apex to the base by slightly compressing and releasing the prostate tissue using the probe. The diagnostic performance of elastography was evaluated in correlation with step section RP histopathology.RESULTS:In 56 PCa patients, gray-scale ultrasonography detected at least one lesion in 36 patients, whereas elastography detected at least one lesion in 53 patients (P = 0.001). The overall sensitivity, specificity and accuracy of elastography in depicting tumor lesions were 67.6, 89.5 and 82.7 %, respectively. The detection rate of a PCa lesion with elastography was best in the left posterior region, followed by the right posterior region. Elastography was more sensitive in detecting PCa lesions with higher Gleason scores, diameter >5 mm and extracapsular extension.CONCLUSIONS:The additional use of elastography with the bi-plane transducer can improve PCa detection rate by providing more information about tissue stiffness within the prostate gland.

OBJECTIVE To evaluate the ability of contrast-enhanced transrectal ultrasonography (CETRUS) to detect and localize prostate index tumor. METHODS Eighty-three patients with biopsy-proven prostate cancer (PCa), who were scheduled to undergo radical prostatectomy, were enrolled in this prospective study. Each patient underwent baseline grayscale and CETRUS imaging of the prostate according to a standardized protocol before the operation. Ultrasonography findings (CETRUS and grayscale imaging) were correlated with step-section histopathology. RESULTS Overall, 53 and 68 tumor foci were detected by grayscale imaging and CETRUS, respectively. The combination of grayscale imaging and CETRUS allowed identification of 89 of the 232 cancer foci (38.4%). The sensitivity of combined imaging was significantly superior to that of grayscale imaging (P < .01) and CETRUS (P < .05). Additionally, the prostate index tumor detection rate by the use of grayscale imaging, CETRUS, and their combination was 42 of 83 (50.6%),53 of 83 (63.9%), and 67 of 83 (80.7%), respectively. The combined approach performed significantly better than grayscale and CETRUS imaging (P <.001 and P <.05, respectively). The index tumor detection rate of CETRUS was higher than that of grayscale imaging, but no significant difference was found (P >.05). CONCLUSION Our study has demonstrated significantly improved detection of both PCa and index tumor with a combined approach of CETRUS and grayscale imaging compared with baseline grayscale technique only, and this technique may be applicable to focal therapy of PCa. (C) 2014 Elsevier Inc.

Objective To assess transrectal contrast enhanced ultrasound (CEUS ) targeted biopsy (TB) for detection prostate cancer (PCa) by comparing with systematic biopsy (SB) .Methods 151 consecutive patients scheduled for prostate biopsy were enrolled in this prospective study with a mean age of 68 8.± 8 0. (47-86) and prostate specific antigen (11 5.± 6 9.)μg/L (0 3.-39 8.μg/L) .CEUS was performed by a single experienced radiologist who was blinded to all clinical data with the Sequoia 512 ultrasonography system equipped with EV8C4 endfire probe .Hypoperfusion lesions ,hyperperfusion lesions and lesions with rapid wash‐in or wash‐out were suspicious for malignant ,and these lesions were sampled with 2-4 cores in addition with 10‐core SB .Results The overall PCa detection rate was 40 4.% (61/151) .Of 61 PCa patients , 11 (18 0.% ) had positive cores in TB ,18 (23 0.% ) had positive cores in SB and 36 (59 0.% ) had positive cores in both biopsy protocols .The PCa detection rate of TB and SB was 33 1.% and 31 1.% respectively (P=0 7.12) .A total of 1 755 cores were sampled including 1 510 SB cores and 245 TB cores .The positive rate for TB was significantly higher than SB (52 2.% vs 11 5.% ,P =0.000) .Of 61 PCa patients ,18 had low‐grade cancer (Gleason score<7) and 43 had high‐grade cancer (Gleason score≥7) .The sensitivity for high‐grade PCa was 86 0.% with TB ,which was significantly higher than low‐grade cancer (55 6.% ,P =0.018) . Conclusions The PCa detection rate of CEUS‐TB was equal with SB ,whereas the positive rate by core of CEUS‐TB was significant higher than SB .Furthermore ,CEUS‐TB was more sensitive in detection of high grade prostate cancer .

Objective: To explore clinical value of retraction phenomenon in coronal plane of three-dimensional ultrasonography (3DUS) in diagnosis of breast cancer. Methods: Totally 128 patients with 132 breast tumors underwent conventional US and 3DUS. The presence of retraction phenomenon on 3DUS and the spiculation pattern on conventional US were compared with pathological results. Results: There were 132 breast tumors, including 76 breast cancers and 56 benign neoplasms. The diagnostic sensitivity, specificity, accuracy, positive predictive value and negative predictive value of retraction and spiculation for breast cancer was 63.16% (48/76), 92.86% (52/56), 75.76% (100/132), 92.31% (48/52), 65.00% (52/80) and 44.74% (34/76), 91.07% (51/56), 64.39% (85/132), 87.18% (34/39), 54.84% (51/93), respectively. The diagnostic sensitivity of retraction phenomenon on 3DUS was significantly higher than that of spiculation pattern on conventional US (P<0.05). On 3DUS, the frequency of retraction phenomenon of breast cancer decreased significantly with increase of tumor diameter (P<0.01). Conclusion: The diagnostic value of retraction phenomenon on 3DUS is higher than that of spiculation sign on conventional US for breast cancer. The retraction phenomenon has high specificity for diagnosing breast cancer and high sensitivity for diagnosing breast cancer with small diameter, playing an important role in differential diagnosis of early breast cancer. Copyright © 2013 by the Press of Chinese Journal of Medical Imaging Technology.

Objective To determine whether cadence contrast pulse sequencing (CPS) harmonic ultrasonography can be used to predict aggressiveness of peripheral zone prostate cancer.Methods CPS harmonic ultrasonography was performed in 62 biopsy-proved prostate cancer patients.Time intensity curves were reconstructed for biopsy-proved or radical prostatectomy histopathology proved prostate cancer lesions.The characteristics of the curves were described using hemodynamic parameters including arrival time (AT),time-to peak (TTP) and peak intensity (PI).The differences of hemodynamic parameters between different Gleason score and pathologic stage were analyzed.Results Prostate biopsy revealed 156 peripheral zone prostate cancer lesions among 62 patients,including 40 low grade lesions and 116 high grade lesions.In comparison with low-grade lesions,the contrast agents arrived and distributed earlier in highgrade lesions (P =0.005,0.023).In addition to lower AT and TTP,high-grade tumors had higher PI than low-grade tumors (P =0.008).Among 21 patients underwent radical prostatectomy,histopathology documented 14 low grade tumors and 17 high grade tumors,significant differences of hemodynamic parameters were found between these two groups (P ＜0.05).Furthermore,prostate cancer lesions with extra capsular extension also had high PI than those confined in the gland (P =0.000).Conclusions Contrast-enhanced ultrasound and hemodynamic parameters might be helpful in predicting aggressiveness of prostate cancer.

Objectives-The goals of this study were to investigate the difference in carotid arterial stiffness in obese children compared to healthy children and to study the correlation between carotid arterial stiffness parameters and obesity using ultrasound (US) radiofrequency (RP) data technology.Methods-Carotid artery stiffness parameters, including the compliance coefficient, stiffness index, and pulse wave velocity, were evaluated in 71 obese patients and 47 healthy controls with US RF data technology. In addition, all participants were evaluated for fat thickness in the paraumbilical abdominal wall and fatty liver using abdominal US.Results-Compared to the control group, the blood pressure (BP), body mass index (BMI), fat thickness in the paraumbilical abdominal wall, presence of fatty liver, and carotid stiffness parameters (stiffness index and pulse wave velocity) were significantly higher in the obese group, whereas the compliance coefficient was significantly lower in the obese group. Furthermore, the pulse wave velocity was weakly positively correlated with the BMI, systolic BP, diastolic BP, and paraumbilical abdominal wall fat thickness, whereas the compliance coefficient was weakly negatively correlated with the systolic BP, BMI, and paraumbilical abdominal wall fat thickness. The presence of a fatty liver was moderately positively correlated with the BMI and weakly positively correlated with the pulse wave velocity.Conclusions-Ultrasound RF data technology may be a sensitive noninvasive method that can be used to accurately and quantitatively detect the difference in carotid artery stiffness in obese children compared to healthy children. The detection of carotid functional abnormalities and nonalcoholic fatty liver disease in obese children should allow early therapeutic intervention, which may prevent or delay the development of atherosclerosis in adulthood.

ObjectivesTo determine the accuracy of contrast-enhanced transrectal ultrasonography for tumor size measurements of hypoechoic prostate cancer foci located in the peripheral zone. MethodsA total of 55 men scheduled for radical prostatectomy, with biopsy-proven cancer in hypoechoic foci located in the peripheral zone, were consecutively enrolled in the present prospective study. Each patient underwent grayscale ultrasound and contrast-enhanced transrectal ultrasonography of the prostate according to a standardized protocol. The maximum tumor diameter on grayscale imaging and contrast-enhanced transrectal ultrasonography was compared with that determined using histopathology. ResultsA mean underestimation was documented to be approximately 3.9mm and 0.6mm for grayscale and contrast-enhanced transrectal ultrasonography imaging, respectively. Grayscale and contrast-enhanced transrectal ultrasonography imaging underestimated measurements by 76.67% (46 of 60) and 48.33% (29 of 60), whereas overestimated measurements were 20% (12 of 60) and 26.67% (16 of 60), respectively. A strong correlation was observed between contrast-enhanced transrectal ultrasonography and histopathological measurements (r=0.91, P<0.0001). A weak linear correlation was found between grayscale and histopathological measurements (r=0.59, P<0.0001). Bland-Altman analysis results were in complete accordance with correlation analysis results. For cases with maximum histopathological tumor diameters 10mm and >10mm, 40% (6 of 15) and 86.67% (39 of 45) were index tumors, respectively (P<0.0001). ConclusionsContrast-enhanced transrectal ultrasonography is significantly more accurate than conventional grayscale imaging for measuring prostate tumor size, especially for tumors with a diameter >10mm, and it might have a role in preoperative assessment of prostatic index tumor sizes.