OBJECTIVES:Uterine polypoid adenomyoma (PA) tends to persist, recur, and carry a high risk of malignancy. However, preoperative distinction between PA and endometrial polyp (EP) remains challenging in clinical practice, often leading to suboptimal therapeutic decisions. This study aimed to compare the clinical and ultrasonographic characteristics of PA and EP and to develop a nomogram for accurate preoperative diagnosis. METHODS:We retrospectively identified women with pathologically confirmed PA diagnosed at Peking Union Medical College Hospital between January 2017 and April 2024. Patients with EP hospitalized during the same period and diagnosed postoperatively were randomly selected as the control group. Demographic, clinicopathological, ultrasound, and surgical data were extracted from medical records. Nomogram predictors were identified through univariate and multivariable logistic regression analyses. Model performance was assessed using the area under the receiver operating characteristic curve (AUC), with internal validation via bootstrap resampling (1000 iterations). RESULTS:A total of 52 patients with PA and 52 with EP were included. In the PA group, 32 cases (61.5%) were preoperatively diagnosed as benign by ultrasound, 15 (28.8%) unclassified, and 5 (9.6%) suspected of malignancy. Compared with the EP group, the PA group was significantly older (p < .05) and had higher proportions of postmenopausal status (32.7% versus 7.7%, p < .05) and postmenopausal bleeding (17.3% versus 0%, p < .05). Significant ultrasonographic differences were observed in lesion multiplicity, maximum diameter, morphology, echogenicity, intralesional cysts, blood flow signals, and moderate vascularity (all p < .05). The nomogram incorporated 4 ultrasound parameters: lesion multiplicity, maximum diameter, irregular morphology, and cystic components. The model achieved an AUC of 0.930 (95% CI: 0.884-0.975), outperforming individual parameters (AUC range: 0.606-0.798), with satisfactory calibration (Hosmer-Lemeshow p = .848). CONCLUSION:PA and EP exhibit distinct clinical and ultrasound features. The ultrasound-based nomogram demonstrates discriminative capacity for distinguishing PA from EP, providing a valuable tool for guiding clinical management. However, given the single-center design and limited sample size, further external validation in larger, multi-center prospective studies is warranted to confirm its generalizability and clinical utility.

OBJECTIVES:Cesarean scar pregnancy (CSP) refers to a special type of pregnancy with a variable prognosis. We aimed to establish a prognostic classification system using ultrasound and clinical features to provide a reference for management strategies. METHODS:Exactly 230 patients with CSP were included and categorized into three groups based on treatment and prognosis: Group A (favorable prognosis), Group B (moderate prognosis), and Group C (poor prognosis). A total of 26 ultrasound features and 8 clinical features were collected for further analysis. Machine learning and traditional scoring models were then constructed for Group A and Group C and integrated to predict CSP prognosis using the significant features. RESULTS:In the univariate analysis, 26 variables were significantly correlated with Group C, while 21 variables were significantly correlated with Group A. For Group C, a linear scoring model was established using three key features: the criteria length of the implantation portion (IMPL) ≥2.43 cm, the height of the gestational sac or mass protruding above the uterine cavity line (GSUCL) ≥1.4 cm, and absent residual myometrial thickness (RMT), achieving an area under the curve (AUC) of 0.939 (0.872, 1.000), which demonstrated comparable performance to the machine learning model (P = .814). For Group A, 13 significant univariate variables were utilized to construct the machine learning model with an AUC of 0.917 (0.842, 0.993). CONCLUSION:Multiple features were associated with CSP prognosis, such as GSUCL, IMPL, RMT, and the anterior-posterior diameter of the gestational sac at the level of the niche (GSSH). The CSP prognostic prediction can be achieved by integrating machine learning and linear scoring models to balance performance and interpretability, which can assist clinicians in treatment decisions.

This study aims to propose a novel ultrasound classification for tubal ectopic pregnancy (TEP) and explore relationships between sonographic features and serum markers. A retrospective single-center cohort study was conducted involving TEP patients, who were classified into two groups (simple gestational sac (GS)-like and complicated masses) based on ultrasound characteristics indicating a clear trophoblastic ring, hematosalpinx, or clear salpinx structure. Statistical comparisons and Spearman’s rank correlation analyses were performed. In this study, 320 women with TEP were classified into a simple GS-like mass group (n = 128) and a complicated mass group (n = 192). Compared with complicated masses, simple GS-like masses were smaller, had higher β-human chorionic gonadotropin (β-hCG) levels, and higher color Doppler flow imaging grades (all p < 0.05). β-hCG was strongly correlated with mass size in simple GS-like mass cases (r = 0.720, p < 0.01), but weakly correlated in complicated mass cases (r = 0.211, p < 0.01). Hemoglobin levels were inversely correlated with pelvic free fluid depth in complicated masses (r = −0.344, p < 0.01). The proposed ultrasound classification differentiates TEPs into subtypes with unique clinical and pathophysiological profiles. The variation in the correlation among sonographic indices and serum markers across TEP subtypes underscores the necessity for tailored clinical strategies. In simple GS-like masses, β-hCG and mass size are positively correlated, thus, clinical decisions could be made based on these two factors as recommended by guidelines. However, in complicated masses, β-hCG and mass size were poorly correlated, thus, the mass size should be deemphasized. Decisions should be made through comprehensive assessments under such circumstances. The novel ultrasound-based classification proposed in this study differentiates tubal ectopic pregnancies into simple gestational-sac-like and complicated subtypes presenting with different correlations between sonographic indices and serum markers, which require tailored strategies in clinical settings.

OBJECTIVES:We aimed to investigate the value of deep learning (DL) models based on multimodal ultrasonographic (US) images to quantify RA activity.METHODS:Static greyscale (SGS), dynamic greyscale (DGS), static power Doppler (SPD) and dynamic power Doppler (DPD) US images were collected and evaluated by two expert radiologists according to the EULAR-OMERACT Synovitis Scoring system. Four DL models were developed based on the ResNet-type structure, evaluated on two separate test cohorts, and finally compared with the performance of 12 radiologists with different levels of experience.RESULTS:In total, 1244 images were used for the model training, and 152 and 354 for testing (cohort 1 and 2, respectively). The best-performing models for the scores of 0/1/2/3 were the DPD, SGS, DGS and SPD models, respectively (Area Under the receiver operating characteristic Curve [AUC] = 0.87/0.95/0.74/0.95; no significant differences). All the DL models provided results comparable to the experienced radiologists on a per-image basis (intraclass correlation coefficient: 0.239-0.756, P < 0.05). The SPD model performed better than the SGS one on test cohort 1 (score of 0/2/3: AUC = 0.82/0.67/0.95 vs 0.66/0.66/0.75, respectively) and test cohort 2 (score of 0: AUC = 0.89 vs 0.81). The dynamic DL models performed better than the static ones in most of the scoring processes and were more accurate than the most of senior radiologists, especially the DPD model.CONCLUSION:DL models based on multimodal US images allow a quantitative and objective assessment of RA activity. Dynamic DL models in particular have potential value in assisting radiologists to improve the accuracy of RA US-based grading.

ObjectiveTo explore the ultrasound characteristics of accessory cavitated uterine malformation (ACUM) and the causes of misdiagnosis, in order to better understand the disease and improve the diagnostic ability of radiologists.MethodsWe retrospectively collected clinical, pathological and imaging data of ACUM patients who were diagnosed after surgery at Peking Union Medical College Hospital from December2013 to December 2023. Besides, we analyzed ultrasound features of ACUM and the cause of misdiagnosis.ResultsA total of 11 patients were included, with a mean age of diagnosis of (27.1±7.4)years. There was a mean interval of (6.1±5.5)years between menarche and onset of dysmenorrhea. Preoperative ultrasound showed that ACUM appeared as solitary lesions located under the insertion of the round ligament, with a mean maximum diameter of (3.0±1.0)cm. Lesions were round or oval (90.9%, 10/11) and not connected to the uterine cavity (100%, 11/11) with clear boundaries (72.7%, 8/11), presenting as regular thick-walled cystic-solid structures. Cystic areas were observed within the mass (100%, 11/11) with a ground-glass-like appearance (90.9%, 10/11) and hyperechoic endometrial lining (90.9%, 10/11). The surrounding of the mass showed hypoechoic or isoechoic areas resembling the muscular layer and circular or semi-circular vascularity was detected around the mass. No adenomyosis or other uterine lesions were found. Analysis of misdiagnosis: Among the 11 ACUM cases, 6 were correctly diagnosed by the initial ultrasound examination, and 5 cases by MRI. Two patients were misdiagnosed as residual horn uterus by MRI, despite ultrasound suggesting ACUM with visible bilateral uterine horns.ConclusionsACUM exhibits distinct ultrasound characteristics. When young women present with progressive dysmenorrhea and ultrasound reveals a regular cystic-solid mass with thick wall located under the round ligament insertion, ACUM should be considered.

BACKGROUND:Schwannomas are benign usually encapsulated nerve sheath tumors derived from the Schwann cells, and affecting single or multiple nerves. The tumors commonly arise from the cranial nerves as acoustic neurinomas but they are extremely rare in the pelvis and the retroperitoneal area. Retroperitoneal pelvic schwannomas often present with non-specific symptoms leading to misdiagnosis and prolonged morbidity. CASE PRESENTATION:We report the case of a 59-year-old woman presenting with a feeling of heaviness in the lower abdomen who was found to have a retroperitoneal pelvic schwannoma originating from the right femoral nerve. She had a history of two resections of peripheral schwannomas at four different sites of limbs. After conducting magnetic resonance imaging, this pelvic schwannoma was misdiagnosed as a gynecological malignancy. The tumor was successfully removed by laparoscopic surgery. Pathological analysis of the mass revealed a benign schwannoma of the femoral nerve sheath with demonstrating strong, diffuse positivity for S-100 protein. CONCLUSIONS:Although retroperitoneal pelvic schwannoma is rare, it should be considered in the differential diagnosis of pelvic masses, especially in patients with a history of neurogenic mass or the presence of neurogenic mass elsewhere.

Objective:To evaluate the quality of ultrasonic diagnosis of retroperitoneal schwannomas and its influencing factors to find the measures to improve the diagnosis quality.Methods:From January 2015 to April 2022, patients with retroperitoneal schwannomas who underwent surgery at Peking Union Medical College Hospital were studied. All of the cases were confirmed by pathology. The results of preoperative ultrasound reports were summarized, and the quality of ultrasound diagnosis was evaluated by localization diagnosis and qualitative diagnosis.Results:There were 21 cases of retroperitoneal schwannomas with preoperative ultrasound report, all of them were single, and one case (4.8%) was missed by preoperative ultrasound. The maximal diameter of the 20 schwannomas diagnosed by preoperative ultrasound was (6.7±3.6) cm, of which 16 (80.0%) were located in the abdominal retroperitoneum and 4 (20.0%) were located in the pelvic retroperitoneum; 14 (70.0%) manifested as a heterogeneous solid and cystic mass, and 6 (30.0%) presented as a hypoechoic solid mass. Among the 20 cases, 17 (85.0%) were in accordance with the localization diagnosis and 3 (15.0%) were not; 2 (10.0%) were qualified for qualitative diagnosis and 18 (90.0%) were not.Conclusion:Ultrasound has a high accuracy for the localization diagnosis of retroperitoneal schwannomas. Retroperitoneal schwannomas lack typical sonogram characteristics, and sonographers should be familiar with the anatomy and pay attention to the medical history collection to further improve the accuracy of its qualitative diagnosis.

Objective:To assess the clinical application value of ultramicroangiography (UMA) in the evaluation of proliferative blood vessels in rheumatoid arthritis (RA) patients and the clinical significance of penetrating blood flow signals in bone erosion defects on UMA.Methods:Power Doppler ultrasound (PDUS) and UMA were performed on the wrist joint, 2-3 metacarpophalangeal joints, and 2-3 proximal interphalangeal joints in 29 patients with RA at Peking Union Medical College from May 2020 to April 2021, and synovial blood flow signals and semi-quantitative score were recorded. Wilcoxon's sign rank test was used to compare the differences of PDUS-sum and UMA-sum in the above joints. Spearman's correlation was used to analyze their correlation with C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), DAS28(ESR), DAS28(CRP), simplified disease activity index (SDAI), clinical disease activity index (CDAI), swollen joint count, tender joint count, visual analog scale (VAS), patient's global assessment, and evaluator's global assessment. The patients were divided into either a UMA-sign (+) group or a UMA-sign (-) group according to whether UMA-sign appeared, and the differences in the above disease activity-related indicators between the two groups were analyzed by the Mann-Whitney U test.Results:In the 29 RA patients included, the display rates of synovial blood flow signals were 21.38% and 27.59% in PDUS and UMA mode, respectively. There was a statistical difference between PDUS-sum and UMA-sum (Z=3.472, P=0.001). The degree of correlation between UMA-sum and disease activity-related indicators was higher than that between PDUS-sum and disease activity-related indicators; the correlation between PDUS-sum and CRP was the highest (r=0.536, P=0.003), while the correlation between UMA-sum and the swollen joint count was the highest (r=0.664, P=0.000). The disease activity-related indicators CRP, ESR, DAS28(ESR), DAS28(CRP), SDAI, CDAI, swollen joint count, tender joint count, VAS, patient's global assessment, evaluator's global assessment, PDUS-sum, and UMA-sum were significantly higher in the UMA-sign (+) group than in the UMA-sign (-) group (P＜0.05).Conclusion:UMA is more sensitive in detecting synovial proliferative blood vessels when compared with PDUS, and UMA-sum has potential clinical significance in evaluating disease activity in RA patients. The appearance of UMA-sign in RA patients may indicate higher disease activity.

Background Synovial hypoxia is a hallmark of rheumatoid arthritis (RA). Photoacoustic (PA) imaging, based on the use of laser-generated US, can detect the oxygenation status of tissue in individuals with RA. However, large studies are lacking, with few investigating the correlation between oxygenation status and disease activity. Purpose To measure synovial oxygenation status in participants with RA by using a multimodal PA US imaging system and to determine the correlation between PA imaging-measured oxygen saturation (SO2) and disease activity. Materials and Methods In this prospective observational cohort study, multimodal PA US imaging examinations were performed on small joints of consecutive participants with RA, who were treated at two outpatient rheumatology clinics from 2019 to 2021, and healthy controls. The SO2 values of the synovium were measured with dual-wavelength PA imaging and classified into three categories-hyperoxia, intermediate oxygenation status, or hypoxia-based on the signal coloration and clustering analysis of the SO2 values. The correlations of oxygenation status with power Doppler US (PDUS) scoring and clinical disease activity index were evaluated with one-way analysis of variance and the Kruskal-Wallis test with Bonferroni correction. Results A total of 118 participants with RA (median age, 55 years [IQR, 41-62 years]; 92 women) and 15 healthy control participants (median age, 37 years [IQR, 33-41 years]; 11 women) were included. The wrist synovium was categorized as hyperoxic in 36 participants with RA, of intermediate oxygenation status in 48 participants, and hypoxic in 34 participants. All control participants had hyperoxic synovial tissues. For participants with RA, hyperoxic synovium had more affluent Doppler US-depicted vasculature than those with hypoxia and intermediate oxygenation status (mean PDUS grade: hyperoxia, 2.7 ± 0.6 [SD]; intermediate, 1.3 ± 0.7; hypoxia, 1.1 ± 0.8; P < .001). Participants with intermediate status synovium had a lower clinical disease activity index than those with hypoxia (intermediate, 11.0 [IQR, 5.0-21.5] vs hypoxia, 26.0 [IQR, 18.0-39.0]; P = .001). Conclusion Photoacoustic imaging-detected hypoxia in thickened synovium correlated with less vascularization and higher disease activity in participants with rheumatoid arthritis. Clinical trial registration no. NCT04297475 © RSNA, 2022 Online supplemental material is available for this article.

During routine evaluation of a 31-year-old woman (gravida 1 para 0), disordered blood vessels in the liver of the fetus were detected on 2-dimensional ultrasound imaging performed in the 37th week of gestation. An aberrant vessel with pulsatile flow between the middle hepatic vein and the intrahepatic umbilical vein was noted on a Doppler ultrasound examination (Figure 1). The vessel's dimensions remained constant and heart failure was not suggested. Routine obstetric ultrasound showed echogenic bowel and intrauterine growth restriction in the second trimester, but both normalized by the 39th week. Chromosomal abnormal was excluded by amniocentesis. Resistance index of the fetal middle cerebral artery Doppler measurements were low during the last 9 weeks of pregnancy. The uterine artery Doppler ultrasound examination measurements were normal throughout the pregnancy. Considering the suspected intrauterine growth restriction and streptococcal infection, the mother gave birth to a male baby weighing 2590 g naturally in the 39th week of pregnancy. The Apgar score was 10 at 1, 3, and 10 minutes, and the baby was sent to neonatal unit because of anatomical abnormalities in hepatic vascular and scattered cutaneous bleeding. The hepatic vascular anatomy was then confirmed by postnatal ultrasound examination, which showed several branches connecting the left portal vein and the main portal vein (Figure 2; Video available at www.jpeds.com). This satisfied the diagnosis of congenital portosystemic shunt type 2 described by Park et al.1Park J.H. Cha S.H. Han J.K. Han M.C. Intrahepatic portosystemic venous shunt.AJR Am J Roentgenol. 1990; 155: 527-528Crossref PubMed Scopus (204) Google Scholar Laboratory results showed an elevated serum total bilirubin level of 4.2 mg/dL (reference range, 0.3-1.3 mg/dL), and other hematological measurements were normal. The results of platelet count and coagulation test were in the normal range at day 4 after birth and the skin bleeding gradually subsided. Considering the good prognostic characteristics of intrahepatic portosystemic venous shunts based on the existing published evidence, conservative treatment was recommended and the patient was discharged on day 5 with no further symptoms. Ultrasound examination showed that a proportion of the shunts spontaneously closed after about 6 weeks. Congenital portosystemic venous shunts are rare vascular anomalies, with an incidence of approximately 1:30 000 at birth and 1:50 000 for adults.2Papamichail M. Pizanias M. Heaton N. Congenital portosystemic venous shunt.Eur J Pediatr. 2018; 177: 285-294Crossref PubMed Scopus (67) Google Scholar Postnatal classifications mainly include (1) extrahepatic portosystemic shunts (called Abernethy malformation) that often require interventional radiology or surgical closure for high shunt ratio (>30%) and complications and (2) intrahepatic portosystemic shunts; these patients may benefit from a wait-and-see approach because they tend to have no symptoms and a higher rate of spontaneous closure within 2 years, especially for those with a distal or multiple intrahepatic shunts.3Franchi-Abella S. Gonzales E. Ackermann O. Branchereau S. Pariente D. Guerin F. Congenital portosystemic shunts: diagnosis and treatment.Abdom Radiol (NY). 2018; 43: 2023-2036Crossref PubMed Scopus (38) Google Scholar,4Paganelli M. Lipsich J.E. Sciveres M. Alvarez F. Predisposing factors for spontaneous closure of congenital portosystemic shunts.J Pediatr. 2015; 167: 931-5 e12Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar A fetal classification, termed the umbilical portal systemic venous shunt, was proposed based on the embryological-anatomical origin of the shunt: type I, umbilical-systemic shunt; type II, ductus venosus-systemic shunt; type IIIa, intrahepatic portosystemic venous shunt; and type IIIb, EHPSS (Figure 3).5Achiron R. Kivilevitch Z. Fetal umbilical-portal-systemic venous shunt: in-utero classification and clinical significance.Ultrasound Obstet Gynecol. 2016; 47: 739-747Crossref PubMed Scopus (36) Google Scholar Thanks to advances in ultrasound technology, some intrahepatic vascular dysplasias can now be diagnosed accurately.6Shay R.L. Goldberg A. Sundaram S.S. Browne L.P. Wright C.J. Annam A. Neonatal presentation of congenital portosystemic shunt.J Pediatr. 2022; 241: 261-262Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar Additionally, ultrasound examination allows for noninvasive monitoring throughout the prenatal and postnatal periods, protecting children from radiation damage and early overintervention. eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiI1NzE4Mzk2MDdjMWU2NWIxNmU0OTNiNzZkZTVmY2ZmNiIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjcxMDA1NzUwfQ.Zc6mRjegMTM_ZvcguGHnU8H04QduiELuuIqOS2wFZAoWBLv4iT0q41Qf3kBqMDeZaeWKaVSyCnypKC9jaJdOkkERmVmm9RjJaD80Ahw1BXnjsEobCLEkbfmNkjVAv5LF9-3OcXYvGi2bbKekA8WUDaeockSsJ9VkhXxsyZEij6QiCjsss2Bt3fkeYxqm5mHWGsQpUVOZ5raE16qtOgt2HURZZ6K9zj8lmTSu2YNucf5wq-05o8Hl1ROGz72ogBtlfS8EM76pvaDqA6YLjpqSVBGLug5fLfEVtXHXvM9P7uj0DsiHCTdE9phGZfifDAG_NlBQ5n9d9T1zu_NnMluhdA Download .mp4 (0.68 MB) Help with .mp4 files VideoMuitiple shunts detected by postnatal ultrasound examination.

病例1，女，19岁，既往月经规律，量中略偏多，近20个月出现月经期盆腔疼痛并呈进行性加重，VAS 9~10分，药物治疗后症状无缓解。CA19-9 16.1 U/ml，CA125 14.3 U/ml。查体于盆腔左侧扪及触痛包块，直径约3 cm。患者月经前行经直肠妇科超声检查显示子宫左宫角部范围约2.8 cm×2.1 cm的混合回声，其中心区域见1.3 cm×1.1 cm边界清楚的无回声，内充满细小点状回声，内壁可见薄环状中高回声，周边为较厚的肌性低回声包绕，彩色多普勒血流显像(color Doppler flow imaging，CDFI)显示包块周边见部分环绕血流信号(图1A，B)。超声提示子宫左宫角部囊实性包块，子宫附腔畸形不除外。患者于月经后行经腹超声复查，左宫角部混合回声大小为2.3 cm×2.1 cm，中心区域无回声范围1.4 cm×1.3 cm，其内可见絮状低回声，CDFI显示包块周边见条状血流信号(图1C)。盆腔磁共振成像(MRI)显示子宫左侧肌层内见圆形腔性病灶，内呈T1、T2高信号，不与宫腔相通(图1D，E)。盆腔其他部位无子宫内膜异位症的迹象。

Objective:To explore the application value of APP-based self-learning and teaching mode in small joint ultrasound training.Methods:Thirteen sonographers were included in this study. First, they were allowed to learn "the joint ultrasound scoring system" independently through the electronic course set in the APP. Following the course, they were admitted to enter "the APP ultrasonographic image assessment platform" to perform ultrasound scoring for 140 small joints with inflammatory rheumatic diseases in the form of multiple choices. The ultrasound score included the second and third metacarpophalangeal joints (MCP2/3), wrist joints, and the second and third proximal interphalangeal joints (PIP2/3), which were evaluated for synovitis, tenosynovitis/paratenonitis, and erosions from the dorsal side by gray-scale ultrasound (GSUS) and power Doppler ultrasound (PDUS). The overall agreement rate (%) and intraclass correlation coefficient (ICC) values were calculated to analyze the ultrasound training effect.Results:A moderate to good interobserver agreement was observed for the detection of synovitis, tenosynovitis, and erosions (ICC=0.49-0.97, overall agreement 76.4%~90.4%). In detail, the ICC value for GSUS in evaluating synovitis was only 0.65 (overall agreement 45.2%), and for PDUS it was 0.88 (overall agreement 75.7%). The best training results were found for the detection of synovitis and erosions by PDUS in the MCP2 joint (80.8%/0.77; 88.5%/0.95). Good ICC values were observed for GSUS in the detection of synovitis in the MCP2/3 joints; however, the overall agreement rates were lower (0.63, 0.75; 44.4%, 46.2%). Poor agreement values were observed for GSUS in detecting erosions in both the wrist region and synovitis in PIP2/3 joints (27.4%-53.8%; 0.14-0.37). Good overall agreement rates were observed for GSUS in the detection of synovitis in the wrist, and erosions in PIP2/3 and MCP3 joints, while the ICC values were lower (74.40%-81.2%; 0.24-0.38). The overall ultrasound training effect was similar between MCP2 and MCP3 joints (71.8%/0.83 vs 64.7%/0.83), as well as between PIP2 and PIP3 joints (58.1%/0.60 vs 59.3%/0.45).Conclusion:APP-based self-learning and testing mode has the potential to be an effective tool in joint ultrasound training. More training and standardization of image acquisition, and adequate interpretation for multiple joints with poor agreement values will help to further optimize the teaching effect and improve the clinical diagnostic ability.

Objective:To explore the clinical and ultrasound image characteristics and differential diagnosis of female urethral diverticulum(UD) and vaginal wall cysts.Methods:A retrospective analysis of the clinical and ultrasound image features of 12 female patients with UD were collected as UD group and 30 patients with vaginal wall cysts confirmed by surgical pathology and clinical follow-up were collected as vaginal wall cysts group in Peking Union Medical College Hospital from January 2017 to May 2021. Ultrasound image characteristics, and the main points of the differential diagnosis of the two were analyzed and summarized.Results:There were no significant differences in the age of the patients and the maximum diameter of the lesions between UD group and vaginal wall cysts group(all P>0.05). Eight cases (66.7%) of female patients with UD had urinary system symptoms, 5 cases (16.7%) of vaginal wall cysts had urinary system symptoms, the difference was statistically significant ( P<0.05); In 10 cases (83.3%) the UD lesions were located in the upper middle and upper pelvic floor, and vaginal wall cyst lesions in 23 cases (76.7%) were located in the lower middle and lower pelvic floor, the difference was statistically significant ( P<0.05). In terms of ultrasound image characteristics, UD lesions were often irregular in shape, surrounding the urethra, with unclear borders, cyst wall thickness >0.1 cm, internal wall not smooth along with calcification, internal visible separation, partly visible to the urethra, and peripheral blood flow signals were abundant. Vaginal wall cysts were mostly round-shaped, not surrounding the urethra, clear borders, thin and smooth walls, less internal partitions, not communication with the urethra, and the peripheral blood flow signals were not abundant. The differences between the two group were statistically significant (all P<0.05). Whether the sound transmission inside the lesion was not statistically significant ( P>0.05). Conclusions:Combined with urinary system symptoms, lesion location, ultrasound characteristics (morphology, whether surrounding the urethra, boundary, cyst wall thickness, inner wall calcification, internal separation, whether it is connected to the urethra, blood flow distribution) can be used to distinguish between UD and vaginal wall cysts, whether the sound transmission inside the lesion cannot be used as the basis for the differential diagnosis of the two.

Multimodal ultrasound has demonstrated its power in the clinical assessment of rheumatoid arthritis (RA). However, for radiologists, it requires strong experience. In this paper, we propose a rheumatoid arthritis knowledge guided (RATING) system that automatically scores the RA activity and generates interpretable features to assist radiologists' decision-making based on deep learning. RATING leverages the complementary advantages of multimodal ultrasound images and solves the limited training data problem with self-supervised pretraining. RATING outperforms all of the existing methods, achieving an accuracy of 86.1% on a prospective test dataset and 85.0% on an external test dataset. A reader study demonstrates that the RATING system improves the average accuracy of 10 radiologists from 41.4% to 64.0%. As an assistive tool, not only can RATING indicate the possible lesions and enhance the diagnostic performance with multimodal ultrasound but it can also enlighten the road to human-machine collaboration in healthcare.

This study aimed to identify features of breast intraductal lesions in photoacoustic/ultrasound (PA/US) imaging and compare PA/US with color Doppler flow/ultrasound (CDFI/US) in the evaluation of breast intraductal lesions. In the nine patients with 10 breast intraductal lesions and 8 patients with 8 benign lesions, total vessel scores evaluated from PA/US are significantly greater than those from CDFI/US (p=0.005). PA internal vessel scores and oxygen saturation (SO2) score are significantly increased in breast intraductal lesions than in benign lesions (p=0.016, p=0.006). With a cutoff PA score (sum of PA internal vessel score and SO2 score) of 2.5, we obtained a sensitivity of 90% and a specificity of 87.5% in differentiation of two groups. PA/US upgraded 40% of breast intraductal lesions, and downgraded 50% of benign lesions from the Breast Imaging Reporting and Data System grading results based on CDFI/US. PA/US functional imaging has the potential in differentiating breast intraductal lesions.

OBJECTIVE:Ultra-microangiography (UMA) is a novel Doppler technique that has high sensitivity for low-velocity blood flows. In this study, a distinctive imaging feature, penetrating blood vessels on the surface of eroded bones within the inflamed joints, was observed on UMA. We aimed to investigate the feasibility of UMA in assessing disease activity and identify the clinical value of the UMA feature for evaluating rheumatoid arthritis (RA).METHODS AND MATERIALS:Power-Doppler ultrasound (PDUS) and UMA were performed on small joints of RA patients. The semiquantitative scores of PDUS and UMA of the joints were assessed and compared. The UMA imaging feature of penetrating vessels on the surface of eroded bones was evaluated, and the patients were divided into three groups based on imaging features. (Group 1: no inflammatory signs; Group 2: inflammatory US features but no UMA features; and Group 3: detected UMA features). The correlations between the groups and clinical parameters were assessed.RESULTS:A total of 52 patients with RA were recruited, with 364 joints (MCP, PIP, MTP and wrist) scanned. Synovial blood vessel signals were detected for 68 by PDUS and for 93 by UMA (display rate of blood vessel signals: 18.68 % VS 25.55 %). UMA presented better display capability of blood vessels within the inflamed regions than that of PDUS in overall. Significant differences were detected in clinical scores (P < 0.0001 for DAS28 [ESR], DAS28 [CRP], SDAI, CDAI, CRP P = 0.0303, SJC P = 0.0059, and TJC P = 0.0423) between Group 2 and 3. Significant correlations between the groups and clinical parameters were also observed (DAS28 [ESR] ρ=0.750; DAS28 [CRP] ρ=0.762; SDAI ρ=0.778; CDAI ρ=0.773; CRP ρ= 0.524; SJC ρ=0.742; TJC ρ=0.693, P < 0.0001), indicating that the UMA feature was related to high disease activity.CONCLUSIONS:UMA can help enhance the detection rate of micro-vascularization. The UMA feature of the penetrating vessels on the surface of eroded bones is likely to be associated with severe disease activity.

目的 观察静脉内平滑肌瘤病(IVL)的临床、超声与CT特征表现.方法 回顾性分析55例经术后病理证实的IVL患者的临床及影像学特征,对比超声、CT诊断IVL的准确率.结果 Ⅰ期IVL超声多表现为子宫肿物呈“蠕虫”或条索串珠样向宫旁延伸,血流信号丰富;CT多表现为子宫或盆腔低密度肿物,伴子宫静脉或卵巢静脉内肿物.Ⅱ～Ⅳ期IVL超声表现为生殖静脉、髂静脉、下腔静脉、右心甚至肺动脉内条索状肿物沿静脉走行,内见血流信号;增强CT肿物呈“丝瓜络”样不均匀强化.超声与CT诊断IVL的准确率分别为49.09％和58.18％,CT诊断准确率高于超声(P＜0.05);超声和CT诊断Ⅱ～Ⅳ期IVL的准确率均高于Ⅰ期(P均＜0.05).超声与CT联合诊断IVL准确率达74.55％.结论 IVL影像学表现具有一定特征性,联合超声与CT可显著提高诊断IVL的准确率.

关节炎性疾病发病率逐年升高,给社会经济造成了巨大负担,其早期诊治具有重要意义.光声成像是一种新型光学影像技术,结合了光显像和超声波接收转换的优点,可对关节开展形态学、微血管及功能成像,并可通过外源性造影剂实现分子成像.近10年来,研究人员开发了一系列光声成像仪器,包括独立光声断层成像系统、多模态影像系统等,针对关节炎性疾病开展了动物实验和人体试验,证实其在关节炎性疾病诊断中的价值,其中配备手持光声探头的一体化双模态光声/超声成像系统易于临床转化,有较好的发展前景.