OBJECTIVES:This study aims to investigate the utility of real-time ultrasound in the length measurement and strain calculation of the vocal folds among young professional singers with diverse vocal classifications. METHODS:A total of 102 young singers, including 31 sopranos, 23 mezzo-sopranos, 27 tenors, and 21 baritones, were enrolled in this study. The glottis of each subject was scanned using real-time ultrasound imaging during breath-holding tests and while singing "e" at a low pitch, medium pitch, and high pitch. The image quality of the vocal folds was graded, and the vocal folds length (VFL) of each singer was measured. Multiple photos of each measurement were taken, using both "excellent" and "good" quality images. Strain, the ratio of elongated or shortened vocal folds during singing to their initial length during breath holding was calculated for all pitches. The parameters were compared among groups to explore potential associations with different vocal classifications. RESULTS:The image quality exhibited a declining trend from breath-holding to singing the high pitch, with two cases (2%) being classified as poor. As the pitch increased, both male and female singers had an elevation in the VFL and strain. Female, mezzo-sopranos demonstrated significantly longer vocal folds than sopranos in each state, while the strain was comparable between the two groups. Male, baritones consistently exhibited longer vocal folds in every state; however, no statistically significant differences were observed during breath-holding and singing high tones. Baritones also exhibited higher strains, with significant differences observed for both low and medium pitches, whereas no significant difference was found for high pitches. CONCLUSIONS:Real-time ultrasound can be used as a noninvasive tool for length measurement of vocal folds among singers with different singing voices.

This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). This article has been retracted at the request of the Authors and the Editor-in-Chief. After a thorough investigation, the Editor-in-Chief has concluded that details in the origin of data and permissions integral to the article's acceptance in the journal necessitate a retraction. A single hospital was mentioned in the article but this was not where the data was collected. Reviewers would have assumed that informed consent was received and properly reviewed by this institution, as it was not otherwise specified. Several oversights within the article that were brought forward by the Authors make it clear that the article that was accepted had misrepresentation of key data. While the Authors presented some differences of opinion about how these concerns about the key data originated, it is clear that when the manuscript was accepted that Reviewers and Editors would not have had knowledge of these difficulties, and this may have created a different review process and outcome for this manuscript. One of the Authors has requested an ability to provide additional information to address the concerns. However, the Editor-in-Chief has decided that this would not follow the process for accepted manuscripts or address some of the concerns presented and, therefore, has settled on the retraction of the manuscript as the final decision regarding this paper.

目的 通过北京市多家超声专业基地"强强联合",摸索、试行一种新的培训模式,为今后超声住院医师规范化培训(简称住培)的政策制定和质量改进提供基础.方法 利用北京市各培训基地特色学科的优质教学资源,在现有住培体系内,采用自愿参加原则,组成联合培训体,对入组住院医师和带教老师进行反馈调查,发现该模式在试运行中所遇到的问题,寻找可能的解决方案.结果 联合培训模式能够相互补充各专业基地不足的病种及病例数,增加了住培知识体系的宽度和深度,有益于提升住培质量,但尚需进一步完善、优化培训模式.结论 北京市超声专业基地试行联合培训,住院医师有机会在不同基地的特色亚专业学习,是对目前住培体系的有益补充,有望培养出全面型、高质量的青年超声医学人才.

OBJECTIVE:To investigate the value of computer-aided diagnosis (CAD) system in assessing thyroid nodules concurrent with Hashimoto's thyroiditis (HT).METHODS:Totally 148 patients with 193 thyroid nodules were enrolled. A radiologist assessed the nodules using a thyroid ultrasound CAD system. Additionally, the nodules were evaluated by one experienced radiologist alone, and one training radiologist without and with CAD assistance. The diagnostic performance was compared between the CAD system and the experienced radiologist, and the training radiologist without and with CAD assistance.RESULTS:The CAD system demonstrated a similar sensitivity to that of the experienced radiologist in diagnosing thyroid cancers (89.8% versus 92.4%, P > .05). The specificity and accuracy of the CAD system were lower than that of the experienced radiologist in assessing the nodules with diffusedly altered glands (specificity, 60.0% versus 81.7%, P = .007; accuracy, 77.5% versus 88.1%, P = .011). With CAD assistance, the training radiologist had improved sensitivity and accuracy that increased to 87.9% and 86.8% in classifying nodules with sonographically evident HT (both P = .012).CONCLUSION:The CAD system has comparable sensitivity, but lower specificity compared with the experienced radiologist in diagnosing thyroid malignancies concurrent with HT. For a radiologist with less experience, the CAD system can help improve the diagnostic performance by increasing sensitivity and accuracy in assessing thyroid nodules with diffusely altered parenchyma.

This study aims to confirm the prevalence of incidental cervical extension of normal thymus in children and adolescents undergoing neck ultrasound and describe the ultrasound appearance to minimize future misdiagnosis.

目的 探讨计算机辅助诊断(computer-aided diagnosis,CAD)系统诊断桥本氏甲状腺炎(Hashimoto's thyroiditis,HT)背景 下结节的效能.方法 CAD系统、高年资主治医师回顾性分析151枚经手术病理证实为合并H T的甲状腺结节的超声图像,比较两者的诊断效能.结果 CAD系统诊断敏感性为91.2％,特异性为65.0％,阳性预测值为79.8％,阴性预测值为83.0％,准确性为80.8％.高年资主治医师诊断敏感性为92.3％,特异性为81.7％,阳性预测值为88.4％,阴性预测值为87.5％,准确性为88.1％.两者敏感性相仿(P>0.05),但CAD系统的特异性低于高年资主治医师(P=0.041).CAD系统诊断不同大小结节的效能无显著差异(P>0.05).结论 CAD系统诊断HT背景 下结节的敏感性较高,能有效检出恶性肿瘤;但特异性偏低,单独应用时可能存在过度诊断.

ObjectivesTo document the changing trends of abnormal cervical lymph nodes (LNs) in patients with papillary thyroid carcinoma (PTC) who had serial follow‐up ultrasound (US) scans after surgery and to determine how these node abnormalities progress in real time.MethodsUltrasound findings from 568 consecutive patients with PTC who were monitored postoperatively were reviewed. Abnormal LNs were classified as either suspicious or indeterminate according to the European Thyroid Association guidelines. Outcomes from US monitoring of the LNs were recorded and analyzed.ResultsSeventy‐six (13.4%) of 568 patients were identified with abnormal LNs. Among them, 55 (72.4%) were initially found to have suspicious LNs, and the other 21 (27.6%) had indeterminate lesions. Of the 55 suspicious LNs, final scans showed that 38 (69.1%) lesions were still suspicious, whereas the remaining 17 (30.9%) nodes were shown to have resolved after a median follow‐up of 36 months. Of the 21 indeterminate node abnormalities, final scans showed that 16 (76.2%) LNs remained indeterminate, whereas the other 5 (23.8%) nodes had developed into suspicious LNs after a median follow‐up of 44 months. Loss of the fatty hilum and peripheral or diffusedly increased vascularity were more likely to be linked to persistent suspicious LNs (P = .02 and .04, respectively). Suspicious LNs with echogenic foci but a lack of other abnormal features were more frequently found to have resolved thereafter (P = .03).ConclusionsAbnormal LNs detected after PTC surgery can often remain indolent during US surveillance, and a small portion of the nodes would have resolved over time.

目的 探讨分化型甲状腺癌患者术后颈部可疑淋巴结转移的超声表现及其在超声随访过程中的演变.方法 收集2006年1月～2013年12月北京同仁医院手术治疗的270例分化型甲状腺癌,患者有至少一次术后3个月或以上的颈部超声检查.具备至少一项恶性征象即淋巴结变圆、点状强回声、囊性变、局灶高回声(同甲状腺腺体回声)、淋巴门结构消失及周边型血流或血流丰富的淋巴结,定义为可疑淋巴结转移.测量并比较淋巴结在超声随访中的短径,增大或缩小3 mm或以上者定义为增大或缩小,记录淋巴结超声征象在随访中的演变.结果 270例分化型甲状腺癌患者,女性221例,男性49例,平均年龄(44.8±12.5)岁.超声随访3～135个月(中位随访时间36个月).其中,44例(16.3％)检出可疑淋巴结转移,检出时距手术时间4～96个月.随访12个月可疑淋巴结转移累计发生率为6.9％,随访24个月累计发生率为13.4％,随访36个月累计发生率为16.0％.首次检出淋巴结短径为3～10 mm,平均(5.5±2.0) mm.淋巴门结构消失最为常见,占84.1％ (37/44);其次为点状强回声,占56.8％ (25/44).34例行继续超声随访(中位随访时间20个月),其中24例(70.6％)未见著变,6例(17.6％)恶性征像消失,3例(8.8％)增大,1例(2.9％)变小;随访无进展者占91.2％ (31/34).结论 大部分DTC患者术后颈部可疑淋巴结转移性病变在超声随访中未表现为病变进展.对于DTC患者术后颈部可疑淋巴结转移短径10 mm或以下者,采用超声随访观察而非即时干预,是安全的而有效的临床处理策略.

OBJECTIVE Attempt to visualize the hypopharyngeal anatomy and related structures in normal adults with ultrasound. METHODS Sonographic features of laryngopharynx were confirmed by comparable tissue sections of 6 corpses at the same level. Then, the laryngopharynx of 30 men and 30 women were examined by ult rasound and thei r sonographic images were evaluated. RESULTS In male or female volunteers, perfect visualization pattern was obtained in all (100％) pyriform sinuses, 60％ or 93.3％ postcricoid areas,66.7％ or 93.3％ posterior pharyngeal walls, 96.7％ or 100％ thyroid cartilages, 63.3％ or 93.3％ arytenoid cartilages, 70％ or 93.3％ vocal cords,and 83.3％ or 96.7％ ventricular bands. CONCLUSION The ultrasonic visualization of laryngopharynx and its related structures are satisfactory in healthy adult women. For adult men, the pyriform sinus and thyroid cartilage can be best identified while the identification of vocal cords and ventricular bands is less satisfactory. However, postcricoid region, pharyngeal posterior wall, and arytenoid cartilage are the most difficult to detect.

This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy).This article has been retracted at the request of the Authors and the Editor-in-Chief.After a thorough investigation, the Editor-in-Chief has concluded that details in the origin of data and permissions integral to the article’s acceptance in the journal necessitate a retraction. A single hospital was mentioned in the article but this was not where the data was collected. Reviewers would have assumed that informed consent was received and properly reviewed by this institution, as it was not otherwise specified. Several oversights within the article that were brought forward by the Authors make it clear that the article that was accepted had misrepresentation of key data. While the Authors presented some differences of opinion about how these concerns about the key data originated, it is clear that when the manuscript was accepted that Reviewers and Editors would not have had knowledge of these difficulties, and this may have created a different review process and outcome for this manuscript.One of the Authors has requested an ability to provide additional information to address the concerns. However, the Editor-in-Chief has decided that this would not follow the process for accepted manuscripts or address some of the concerns presented and, therefore, has settled on the retraction of the manuscript as the final decision regarding this paper.

ObjectivesThis study was designed to confirm the echogenicity of normal parathyroid glands using intraoperative ultrasound (US).MethodsBetween October 2015 and January 2016, normal parathyroid glands were examined with an intraoperative US transducer during thyroidectomy procedures in 13 patients with thyroid disease. According to the findings from intraoperative US, routine percutaneous US of normal parathyroid glands was performed in a group of adults. On the basis of previous information on normal parathyroid echogenicity, a series of parathyroid diseases that were proved by surgery and histopathologic analyses were retrospectively reviewed. The presence of residual normal parathyroid in the lesion on US imaging, which was defined as the residual parathyroid sign in this study, was reviewed and correlated with histopathologic results.ResultsIn the intraoperative US group, 23 parathyroid glands were scanned intraoperatively, and 21 (91.3%) were hyperechoic, homogeneous in texture, and oval. In the routine percutaneous US group, 106 parathyroid glands were found in total, and 96 (90.5%) of the glands had hyperechoic and homogeneous echogenicity, with 75 (70.8%) being oval. In the review of parathyroid diseases, 33 parathyroid glands in 30 cases were reviewed, with a positive residual parathyroid sign in 7 (21.2%) parathyroid glands, presenting with a hyperechoic rim in the margin, and 4 of them (12.1%) were confirmed by histopathologic results.ConclusionsThe normal parathyroid had hyperechoic echogenicity on both intraoperative and percutaneous US imaging. Residual tissue of parathyroid glands can also be observed in some parathyroid abnormalities with an echogenic appearance on US imaging and confirmed by histopathologic results.

Rationale: Infantile desmoid fibromatosis of the postcricoid area is a rare disease and is characterized by a proliferation of fibrous tissue with non-metastasis, local infiltration, and a high rate of recurrence after surgical resection. Currently, ultrasound is scarcely used in the hypopharynx and larynx area. Patient concerns: A 4-year-old boy presented with hoarseness, deep voice and snoring for 2∼4 years without any surgical history. On sonography, the lesion was found in the postcricoid area, and the left larynx showed impaired mobility in real time observation. Complete excision with a negative margin in this pivotal anatomic area is impossible, and necessitates a long-time surveillance. Diagnoses: Infantile desmoid fibromatosis of the postcricoid area was diagnosed according to surgery and histopathology. Interventions: Local excision was carried out to relieve the upper airway narrowing. Outcomes: Relieved hoarseness and snoring were reported on the latest follow-up. A residual lesion was seen in the surgical bed and maintained a stable extent on ultrasound and MR imaging after a year. Lessons: Considering the non-radiation merit and diagnostic ability, ultrasonography is advocated as a valuable supplementary imaging method to CT, MR and laryngoscopy in the juvenile larynx and hypopharynx.

Objective To investigate the visualization capability of high-frequency ultrasound in adult paraglottic space (PGS) and measure the depth of PGS at the planes of ventricular band and vocal cord.Methods Two hundreds and forty adults were enrolled in this study,including 120 men and 120 women,and divided into 18～44 years old group(n=105),45～59 years old group(n=87),and ≥ 60 years old group(n=48).The visualization capability of the PGS was evaluated at the planes of ventricular band and vocal cord,by grading criteria of "excellent","good",and "poor" according to the degree of thyroid cartilage calcifications.The depth of PGS was measured in adults with visualization capability categorized as "excellent" and "good".Results The visualization capability of the PGS was better in the plane of ventricular band than that of vocal cord.The visualization capability of the PGS was degraded with age increased.PGS was thicker in the planes of ventricular band than that of vocal cord [(male adults:(2.24±0.25)mm vs.(1.69±0.21)mm,female adults:(2.10±0.31)mm vs.(1.61 ±0.26)mm,all P＜0.01)].The thickness of PGS was increased with age increased.Conclusion The PGS could be well visualized in most normal adults by high-frequency ultrasound.At the plane of ventricular band,the young and middle-aged female had better visualization quality of PGS.

[ABSTRACT]OBJECTIVETo investigate the <br> sonographic appearance of larynx in adult cadavers and compare it with their histoanatomy.METHODS Fourteen adult cadavers were scanned using sonography focusing on the region of larynx. The ultrasound features of each region were compared with those of the corresponding histoanatomy.RESULTS1.Laryngeal cartilages, including thyroid, epiglottic, arytenoid and cricoid cartilages, were hypoechoic structures. These cartilages were delimited bilaterally by hyperechoic lines, corresponding to the perichondria. The elastic epiglottic cartilages rarely undergo calcification, whereas all of the other three cartilages sometimes had calcification areas which were hyperechoic. 2. Vocal folds, corresponding to the internal layers of thyroarytenoid muscles, were hypoechoic with a symmetrical and triangular structure. The thin mucous membrane appeared to be hyperechoic lines on the surface. False vocal folds manifested as the paired hyperechoic and triangular structures. Their echogenicity was related to the glandular and fat contents. 3. Fat-containing spaces like the pre-epiglottic and paraglottic spaces were hyperechoic.CONCLUSlONBy means of comparative study between the sonographic and the histoanatomic appearances, the ultrasound features of normal larynx structures are identified, which could be used as a reference system for the future clinical application.

The objective of the study was to compare the efficacy of three bowel preparation regimens for transabdominal colon ultrasonography. A total of 192 consecutive patients were given one of three regimens (senna, magnesium sulfate or polyethylene glycol electrolyte powder) before ultrasonographic examinations. The cleaning grade (I = emptying; II = filled or filled + empty; III = I or II with some retention; and IV = retention [grades I and II were termed "qualified"]) and cleaning range (A = all seven colon sections were qualified; B = four to six sections were qualified; C = three or less sections were qualified) were evaluated retrospectively. Senna was found more effective than polyethylene glycol in terms of cleaning grade (p < 0.001), qualified rate (p < 0.001) and cleaning range (p = 0.003). Senna was better than magnesium sulfate in cleaning grade (p < 0.001). Our results suggest that senna seems to be the preferred regimen for bowel preparation before transabdominal colonic ultrasonography.

Objective To evaluate quantitative parameters of contrast-enhanced transrectal ultrasonography for differential diagnosis of prostate nodules in peripheral zone.Methods Forty-seven patients suspected of prostate cancer for peripheral zone nodules on ultrasonographic imaging were enrolled in this study.Time intensity curves of contrast-enhanced ultrasound were analyzed in all patients.Results The full-width at half maximum (FWHM) of malignant lesions in peripheral zone was shorter than that of adjacent peripheral zone (47.1 s±21.1 s vs 74.2 s±29.7 s, P=0.01).The peak intensity (PI) of benign nodules in peripheral zone was lower than that of adjacent peripheral zone 11.9 dB±7.7 dB vs 17.5 dB±4.5 dB, P=0.02).Conclusions It is helpful for differentiation diagnosis of peripheral zone nodule through analyzing FWHM and PI on contrast-enhanced transrectal ultmsonography imaging.