Abstract Background and Aims Urinary stone disease (USD) has been associated with increased risk for chronic kidney disease (CKD) and end-stage renal disease (ESRD) in Western populations. However, the comparison of metabolic disorders between unilateral and bilateral renal stones and their association with CKD have not been fully examined. It is also unclear whether there is an increased risk for kidney tubular injury makers such as N-acetyl-ß-D-glucosaminidase (NAG) and alpha-1-microglobulin (α1-MG) in different stone formers. Method We performed a cross-sectional study of 10,281 participants in rural China in 2014. All subjects underwent a renal ultrasound to detect USD; stone formers were grouped into one or two sides of USD by ultrasound exams. CKD was defined as a decreased estimated glomerular filtration rate (eGFR, <60mL/min/1.73m2) and/or albuminuria (ACR≥30mg/g). Increased urine NAG and α1-MG were defined as the values of NAG and α1-MG above the 75th percentile of the sample distribution. Results The mean age of the study population was 55.4±10.0 years; 47.1% were males. Among all participants, 4.9% (n=507) had unilateral renal stone, and 0.7% had bilateral renal stones. The proportion of CKD in non-stone formers, unilateral and bilateral renal stones were 11.0%, 19.2%, and 29.7%, respectively (p for trend<0.001). Bilateral renal stone formers tend to have a higher proportion of hypertension and diabetes. In multivariate analyses after adjustment for multiple confounders, bilateral renal stones were significantly associated with an increased risk of decreased eGFR (OR 3.38; 95% CI 1.05-10.90), albuminuria (OR 3.01; 95% CI 1.76-5.13), CKD (OR 3.18; 95% CI 1.88-5.36), increased NAG (OR 1.95; 95% CI 1.21-3.16) and α1-MG (OR 2.54; 95% CI 1.56-4.12) compared with non-stone formers. Conclusion In the present study, bilateral renal stone formers tend to have a higher proportion of metabolic disorders and are also associated with a higher risk of CKD and kidney tubular injury. Further studies are needed to confirm the increased risk for ESRD.

Chronic kidney disease (CKD) is a progressive and irreversible pathological syndrome that starts silently, continues through renal dysfunction and ends up in renal failure. Currently there is a critical need to develop non-invasive imaging biomarkers for the identification of early renal damage and the assessment of renal pathological alterations. Anisotropy is the intrinsic property of the architecture of renal parenchyma, which is responsible for the variation of measurement between different orientations on ultrasonic elastography (USE). Based on this correlation, we hypothesize that USE may quantify the degree of parenchymal anisotropy of kidney with the orientation-derived variation of measurement. In order to standardize the variation, a novel USE biomarker is proposed, the anisotropic ratio (AR), which is the ratio of elasticity of renal parenchyma achieved with the transducer aligned along versus across the nephrons. If this hypothesis could be proved, AR may enable the detection of pathological changes in the parenchymal structure of kidney. Then, AR would be used in the management of disease in CKD patients, and serve as a diagnostic and monitoring biomarker.

Objective To investigate the association between body fat composition and urinary stone disease(USD) in different community-based sex populations.Methods The study was based on the cross-sectional survey performed in Pinggu District,Beijing in 2014.One thousand eight hundred and thirty-five participants in the survey were included in this study.All the subjects received interview for a questionnaire and somatological index measurement,and volunteered to take a 24-hour urine sample for determination of serum creatinine,blood urea,electrolytes and so on.Diagnosis of USD was identified by renal ultrasonic examination.The body composition analysis was performed with bioelectrical impedance measurement and a body composition analyzer(InBody720).Based on tertiles of the body fat percentage(BFP),the female and male subjects were divided into the low,medium and high body fat groups,respectively.Result In the present study,1730 participants were included in the final analysis.The mean age was 54.9±8.8 years,and 46.3% were males.The USD prevalence which ultrasonography proved was 7.0%.In all subjects and males,the prevalence of USD increased in parallel with BFP(P trend <0.05).The male had a odds ratio(OR) 2.63 times that of the females( 95%CI 1.77～3.92).In the male subjects,increase of BFP was significantly correlated with increase of the USD prevalence.In the multivariate logistic regression,the OR in the high BFP group was 1.98 times that in the low BFP group(95%CI 1.07～3.69),although there was no significant association between higher BFP and risk of USD in the female subjects. Conclusion In the male population in a common community,increase of BFP is associated with USD risk.Obesity measures,especially higher BFP,may help reduce USD risk,positively associated with a high risk of USD in males,but further studies are required to prove it.

Abstract Introduction: Accessory liver lobe (ALL), an autonomous island of normal liver parenchyma, is a rare congenital anomaly that is difficult for preoperative diagnosis and often identified incidentally. It can also be accompanied with benign or malignant diseases, which is extremely rare. There are only 3 cases of focal nodular hyperplasia (FNH) detected on ALL reported by previous literature. Patient concerns: A 33-year-old woman was incidentally diagnosed with a mass in left upper quadrant abdomen by a routine ultrasound examination. Doppler ultrasound revealed that the mass was attached to left liver lobe with a vascular pedicle. A spoke-wheel artery with diffuse enhancement during hepatic arterial phase was visualized on contrast-enhanced ultrasound, and the mass was continuously hyper-enhanced with a hypo-enhanced intralesional scar during the portal and delayed phase. And contrast-enhanced computed tomography showed a similar enhancement mode of the mass. Diagnosis: The mass was resected and postoperative histopathologic result of the lesion revealed a nodular hyperplastic parenchyma with a central fibrous scar, without tumor cells. And a final diagnosis of FNH on ALL was determined accordingly. Interventions: Mass resection was conducted according to patient's demand. Outcome: After general postoperative administration, the patient was discharged. Then, she had been undergoing regular serological tests and imaging examinations in our hospital for 24 months. Conclusion: The finding of a mass connecting with liver by a stalk should alert the clinician of the possibility of ALL, as well as benign or malignancies on an ALL. This is the first case of FNH on ALL preoperatively confirmed by contrast-enhanced ultrasound. We suggest that an integrated radiologic approach is crucial to evaluate an incidentally detected, asymptomatic abdominal focal mass.

Introduction: Accessory liver lobe (ALL), an autonomous island of normal liver parenchyma, is a rare congenital anomaly that is difficult for preoperative diagnosis and often identified incidentally. It can also be accompanied with benign or malignant diseases, which is extremely rare. There are only 3 cases of focal nodular hyperplasia (FNH) detected on ALL reported by previous literature. Patient concerns: A 33-year-old woman was incidentally diagnosed with a mass in left upper quadrant abdomen by a routine ultrasound examination. Doppler ultrasound revealed that the mass was attached to left liver lobe with a vascular pedicle. A spoke-wheel artery with diffuse enhancement during hepatic arterial phase was visualized on contrast-enhanced ultrasound, and the mass was continuously hyper-enhanced with a hypo-enhanced intralesional scar during the portal and delayed phase. And contrast-enhanced computed tomography showed a similar enhancement mode of the mass. Diagnosis: The mass was resected and postoperative histopathologic result of the lesion revealed a nodular hyperplastic parenchyma with a central fibrous scar, without tumor cells. And a final diagnosis of FNH on ALL was determined accordingly. Interventions: Mass resection was conducted according to patient's demand. Outcome: After general postoperative administration, the patient was discharged. Then, she had been undergoing regular serological tests and imaging examinations in our hospital for 24 months. Conclusion: The finding of a mass connecting with liver by a stalk should alert the clinician of the possibility of ALL, as well as benign or malignancies on an ALL. This is the first case of FNH on ALL preoperatively confirmed by contrast-enhanced ultrasound. We suggest that an integrated radiologic approach is crucial to evaluate an incidentally detected, asymptomatic abdominal focal mass.

该回顾性研究旨在探究超声(US)、钼靶(MG)、MRI及其联合技术对乳腺疾病诊断的效果.选取2018年10月～2019年10月期间收集的456例乳腺疾病患者作为研究对象,以病理学检查为参照,分析US、MG、MRI及其联合检测对乳腺良恶性病变的鉴别效果.病理检查结果显示,乳腺恶性肿瘤主要为乳腺浸润性癌、浸润性导管癌和乳腺导管原位癌,良性肿瘤主要为纤维腺瘤.US、MG与MRI鉴别乳腺恶性肿瘤的敏感度方面,MRI优于MG和US;特异度方面,MG优于MRI和US;三种影像技术联合后的检查敏感度为97％,特异度为98％.本文证实超声、钼靶、MRI三种技术对乳腺疾病诊断具有良好的鉴别效果,且三者联合的效果更好.

Rationale: The most common cardiac involvement of Fabry disease (FD) is left ventricular hypertrophy (LVH), which usually occurs in male patients over the age of 30. In rare cases, it can progress to ventricular dilation in the late stage of the disease. Patient concerns: A 16-year-old boy presenting with recurrent extremity pain and chest distress was admitted to our hospital. Imaging examinations revealed ventricular dilation. Diagnosis: alpha-Galactosidase A enzyme assay andGLAgene sequencing confirmed the diagnosis of FD and revealed a novel mutation c.76_77insT. Interventions: The patient was treated using metoprolol (23.75 mg qd) and angiotensin-converting enzyme inhibitor (fosinopril sodium 5 mg qd). He refused enzyme replacement therapy for financial reasons. Outcomes: The echocardiography, electrocardiography, renal function, and routine blood and urine tests performed 20 months after the patients discharge from hospital showed no significant changes. The patient reported a slow and gradual decrease in the frequency and degree of pain and chest distress, starting approximately 24 months after discharge. Lessons: Cardiac involvement of FD can progress rapidly in some cases. Screening for FD should be considered in patients with unexplained ventricular dilation, especially in those with a history of typical FD manifestations.

Background: Pediatric community acquired pneumonia (pCAP) is a major public health and economic problem with a considerable impact on morbidity and mortality in children. Recently many studies and meta-analyses have shown promising results on the accuracy of lung ultrasonography (LU) in diagnosing pneumonia and potentially replacing chest radiography (CR) in pediatric population. However, previous studies establishing the accuracy of LU often used CR as reference standard and took into account different clinical settings all together. To make a more objective and specific analysis, we performed a systematic review and meta-analysis to compare the diagnostic accuracy of LU and CR for pCAP in the emergency department (ED) setting. Methods: A literature search of PubMed and Embase databases up to December 2018 was conducted. Pooled sensitivity, specificity, positive and negative likelihood ratio, and diagnostic odds ratio of LU and CR were calculated, and summary receiver operating characteristic (SROC) curves were drawn. Results: A total of six studies, which included 575 pCAPs from 701 patients, were finally analyzed. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratios of LU were 96.7%, 87.3%, 8.10, 0.05, 256.68, while they were 89.7%, 93.7%, 9.97, 0.12, 175.07 for CR, respectively. The area under the SROC curves in diagnosing pCAP in the ED setting were 0.99 [95% confidence interval (CI), 0.98-1.00] and 0.97 (95% CI, 0.95-1.00) for LU and CR, respectively. Conclusions: Our meta-analysis suggests that LU is an accurate tool in the diagnosis of pCAP in the ED setting with a superior sensitivity over CR.

The goal of the study described here was to compare the automatic breast volume scanner (ABVS) and handheld ultrasound (HHUS) with respect to diagnostic performance in the differential diagnosis of benign and malignant breast lesions. A literature search of the PubMed, EMBASE and Cochrane Library databases through 30 June 2018 was conducted. Pooled sensitivity, specificity, positive and negative likelihood ratios and diagnostic odds ratios of the ABVS and HHUS were calculated, and summary receiver operating characteristic (SROC) curves were drawn. A total of nine studies, including 1985 lesions (628 malignant and 1357 benign) from 1774 patients, were analyzed. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio for ABVS were 90.8% (95% confidence interval: 88.3%-93.0%), 82.2% (80.0%-84.2%), 5.39 (4.26-6.80), 0.10 (0.06-0.15) and 61.68 (32.31-117.76); those for HHUS were 90.6% (88.1%-92.8%), 81.0% (78.8%-83.0%), 5.22 (3.14-8.67), 0.11 (0.08-0.17) and 52.60 (32.06-86.35), respectively. The areas under the SROC curves in the differentiation of benign and malignant breast lesions were 0.93 and 0.94 for ABVS and HHUS, respectively, which were not significantly different (p = 0.853). In conclusion, based on available evidence in the literature, ABVS the diagnostic performance of the ABVS is similar to that of HHUS in the differentiation of benign and malignant breast lesions.

Serial cervical length (CL) measurement in mid-trimester is recommended in post-conization pregnancy to estimate the risk of spontaneous preterm birth (SPTB). A short mid-trimester cervix (CL < 25 mm) has been considered as a strong predictor for SPTB. However, the low incidence of short cervix limits the utility of mid-trimester CL measurement in prediction of SPTB. A great proportion of women who develop SPTB don’t have a short mid-trimester cervix. Therefore, this study was aimed to investigate the additional value of serial CL measurement in predicting SPTB in addition to detecting short cervix alone. A total of 613 post-conization pregnant women who did not have short mid-trimester cervix between January 2004 and January 2014 were included in this study. Serial CL measurements were taken by transvaginal ultrasound at three timepoints (A: 13 + 0–15 + 6 weeks, B: 16 + 0–18 + 6 weeks, and C: 20 + 0–22 + 6 weeks). Eight parameters were analyzed for predicting SPTB, including CL measurements at different timepoints (CLA, CLB, CLC), the maximum and minimum CL measurements (CLMAX, CLMIN), and the percentage change in CL measurement between different timepoints (%ΔCLAB, %ΔCLBC, %ΔCLAC). After univariate and multivariate analysis, CLMAX and %ΔCLAC were independent variables in predicting SPTB. Lower CLMAX (OR [95%CI]: 0.92 [0.90–0.93]) and higher %ΔCLAC (OR [95%CI]: 1.05 [1.01–1.09]) were related to an increasing risk of SPTB. In conclusion, our study for the first time in literature reported the value of serial CL measurement in prediction of SPTB in post-conization pregnancy without short mid-trimester cervix. In the subpopulation of pregnant women who did not have short mid-trimester cervix, CLMAX and %ΔCLAC were of value in predicting SPTB, which warranted further investigations.

Rationale and Objectives: This study was aimed to evaluate the independent value of ultrasound-diagnosed nonalcoholic fatty liver disease (us-NAFLD), as a surrogate imaging marker of the pathologic entity of NAFLD, in predicting incident diabetes mellitus (DM) in nonoverweight individuals. Materials and Methods: A total of 10,064 participants who had a body mass index <23 kg/m(2) were included in this retrospective cohort study. us-NAFLD was diagnosed using abdominal ultrasound. All participants were divided into subgroups according to the presence or absence of us-NAFLD and metabolic syndrome (MS). Results: Over a mean follow-up of 6.0 years, 125 participants (1.2%) developed DM. The incidence rates of DM were 1.0% in participants without us-NAFLD, 6.2% in participants with us-NAFLD, 1.1% in participants without MS, and 13.2% in participants with MS. The adjusted hazard ratios for incident DM were 2.52 (95% confidence interval:1.58-4.03) for us-NAFLD and 2.64 (95% confidence interval:1.54-4.54) for MS. Conclusion: This study demonstrates that us-NAFLD has an independent value in predicting incident DM in non-overweight individuals.

Objective: To study the correlations between the sonographic features of papillary thyroid microcarcinoma (PTMC) and the presence of high-volume lymph node metastasis. Method: Medical records of 2363 PTMC patients were reviewed form October 2013 to December 2015. All the patients with lymph node metastasis identified by histopathology were included. Preoperative sonographic features, such as multifocality, tumour size, echogenicity, calcification, vascularity of papillary microcarcinoma, and capsule invasion, were recorded. Univariate and multivariate analyses were performed to investigate the relationships between sonographic features and high-volume lymph node metastasis (number of metastatic lymph nodes >5). Results: In total, 152 patients had high-volume central lymph node metastasis (6.4%,152/2363). Multiple logistic regression analysis showed that the preoperative ultrasonic features of microcalcifications (OR = 3.33, p = 0.022), larger tumour size (>7 mm) (OR = 2.802, p <0.001), and capsule invasion (OR = 2.141, p = 0.006) were independent risk factors for high-volume lymph node metastasis in the central compartment of PTMC. Conclusion: The sonographic features of primary papillary microcarcinoma of the thyroid are correlated with high-volume central lymph node metastasis. (C) 2018 Elsevier Ltd. All rights reserved.

The aim of this article is to explore the value of ultrasonic diagnosis and localization of intrathyroid parathyroid diseases. The medical records of 15 patients with surgically confirmed intrathyroid parathyroid diseases were reviewed. We analyzed the diagnosis process and recorded sonographic features of these intrathyroid parathyroid lesions. The patients included 11 females (73%, 11/15) and 4 males (27%, 4/15) with a mean age of 46.2 +/- 10.2 years and a mean lesion size of 2.1 +/- 1.1cm. A total of 11 intrathyroid parathyroid lesions in this study presented as hypoechoic (73.3%, 11/15). Nine lesions were located in the right lobe of the thyroid (60%, 9/15), and most of the lesions were located in the middle and inferior thyroid (80%, 12/15). All of the 15 intrathyroid parathyroid lesions were variable in shape and well defined. Only 1 lesion showed microcalcification, which was confirmed as parathyroid adenocarcinoma by the postoperative pathological diagnosis. The blood supply of 13 lesions was plentiful (86.7%, 13/15). A hyperechoic line on the parathyroid lesion was detected in 13 lesions (86.7%, 13/15). Based on the degree to which the parathyroid gland was embedded in the thyroid gland, 12 cases were classified as the complete type (80%, 12/15), and 3 cases were classified as the incomplete type (20%, 3/15). Ultrasound was used to diagnose 10 cases, and sestamibi-SPECT was used to diagnose 11 cases preoperatively; the 2 imaging methods were complementary. Ultrasonic preoperative localization could be helpful in the diagnosis and management of intrathyroid parathyroid diseases.

To evaluate the contrast enhanced perfusion pattern of PTC micro-vascular imaging (MVI) quantitatively, and investigate the correlation between MVI features, CD34 micro-vascular density (MVD), and whole genoe DNA copy number abrrevation(CNA) of the PTCs. Thirty-nine pathological and clinical confirmed sporadic PTCs were evaluated with real-time gray-scale contrast-enhanced micro-vascular imaging under a low mechanical index. The micro-bubble agent was SoneVue. Of the 39 PTCs, 33 were classical PTCs, 6 were PTC with follicular variant (FVPTC). The △ROI ,which is the subtraction of peak echo intensity between the lesion region of interest (ROI) and normal thyroid parenchyma ROI, was used to evaluate the perfusion characteristics of PTC MVI quantitatively. The paraffined specimens were selected for immunohistochemical (IHC) staining for CD34. The correlation between △ROI, CD34 expression level and the whole genome DNA copy number abbrevation(CNA) grouping of the PTCs were evaluated. △ROI was strongly correlated with the CD34 expression(p=0.000), significant differences were detected in the distribution pattern of △ROI value among different CD34 expression levels, no overlapping of the mean △ROI values and the 95% confidence intervals was found among the different CD34 expression levels. The PTC MVI perfusion was therefore classified into 3 patterns, low perfusion, focal perfusion and high perfusion, on the basis of combining △ROI values with the peak ehco pattern in time-intensity curve. The high DNA CNA PTCs presented mainly with high and focal perfusion pattern, the low DNA-CNA PTCs showed a combination of focal and low perfusion, the normal DNA-CNA PTCs mostly demonstrated low perfusion patterns. The mean △ROI values rose with the extent of DNA-CNAs accordingly. Based on the strong correlation of △ROI and CD34 expression, △ROI can be take as an objective indicator for the quantitative evaluation of PTC MVI pattern and intensity. The MVI perfusion intensity of PTC showed a positive correlation with the extent of CNAs, which proves that the PTC angiogenesis is related to the gene level pathogensis.

Objective To evaluate the usefulness of skin ultrasound and acoustic radiation force impulse (ARFI) quantification in diffuse cutaneous systemic sclerosis (dcSSc). Patients and methods 28 patients with dcSSc, and 15 age gender matched normal controls were recruited. Skin echogenicity, thickness, and ARFI quantification were measured by ultrasound at 17 sites corresponding to the modified Rodnan skin score (mRSS) in each participant. Compared with controls, skin echogenicity of dcSSc patients was classified into isoechoic, hypoechoic, and hyperechoic. The skin thickness, ARFI quantification and mRSS were compared between isoechoic, hypoechoic, hyperechoic and controls. Results In patients with dcSSc, the skin thickness increased as the echogenicity changed on the order of isoechoic, hypoechoic and hyperechoic. ARFI quantification was significantly higher in hyperechoic than isoechoic (p<0.001). The mRSS were significantly higher in hyperechoic and/or hypoechoic than isoechoic. For isoechoic patients and healthy controls, the skin echogenicity or thickness was no significant different, however, the ARFI quantification was significantly higher in isoechoic than controls. Conclusion Skin ultrasound is feasible for assessing the skin involvement in dcSSc. Skin echogenicity correlates with skin thickness, stiffness, and mRSS. ARFI quantification may be more sensitive to detect skin changes, compared with skin echogenicity and thickness.

Introduction: Urinary stone disease (USD) is associated with cardiovascular disease (CVD) in Western populations. However, the prevalence and relationship between USD and CVD risk have not been fully examined in the Chinese population. Methods: We performed a cross-sectional study of 10,281 participants in rural China. All subjects underwent renal ultrasound to detect USD, brachial-ankle pulsewave velocity (baPWV) measurement to estimate arterial stiffness, and ankle-brachial index (ABI) examination to detect peripheral arterial disease (PAD) (defined as ABI <0.9 on at least 1 side of the body). Results: Mean age of the study population was 55.4 +/- 10.0 years; 47.1% were men. Among all participants, 5.7% (n = 582) had USD, mean baPWV was 15.6 +/- 3.2 m/s, and 4.0% had PAD. The prevalence of USD increased in parallel with mean arterial pressure, albuminuria, Framingham risk score, and baPWV. In multivariate analyses after adjustment for demographic characteristics, USD was significantly associated with an increased risk of hypertension (odds ratio [OR]: 1.32; 95% confidence interval [CI]: 1.08-1.62), albuminuria (OR: 2.17; 95% CI: 1.74-2.69), chronic kidney disease (OR: 2.11; 95% CI: 1.70-2.62), increased arterial stiffness (OR: 1.24; 95% CI: 1.01-1.52), and PAD (OR: 1.50; 95% CI: 1.04-2.16). Discussion: In rural China, USD was associated with a high prevalence of traditional CVD risk factors, increased arterial stiffness, and PAD. The presence of USD should increase physician awareness of the concomitant presence of CVD risk factors.

Objective To evaluate the contrast enhanced perfusion pattern of PTC micro-vascular imaging (MVI) quantitatively.Investigate the correlation between PTC MVI features and CD34 micro-vascular density (MVD).Methods Thirty-nine pathological and clinical confirmed sporadic PTCs were evaluated with real-time gray-scale contrast-ernhanced micro-vascular imaging under a low mechanical index.The micro-bubble agent was SoneVue.Of the 39 PTCs,33 were classical PTCs,6 were PTC with follicular variant (FVPTC).The △ ROI,which is the subtraction of peak echo intensity between the lesion region of interest (ROI) and normal thyroid parenchyma ROI,was used to evaluate the perfusion characteristics of PTC MVI quantitatively.The paraffined specimens were selected for immunohistochemical (IHC) staining for CD3,and the correlation between △ ROI and the CD34 were evaluated.Results △ ROI was strongly correlated with the CD34 expression (P=0.000),significant differences were detected in the distribution pattern of △ ROI value among different CD34 expression levels,no overlapping of the mean △ ROI values and the 95％ confidence intervals was found among the 3 CD34 expression levels.The PTC MVI perfusion was classified into 3 patterns,low perfusion,focal perfiusion and high perfusion,on the basis of combining△ ROI values with the peak ehco pattem in time-intensity curve.Conclusions The △ ROI is strongly correlated with the CD34 expression in papillary thyroid cancer.It can be used for the quantitative evaluation ofPTC MVI pattem and intensity as an objective indicator.