Methods: PubMed, Scopus, Embase, Web of Science and ProQuest databases were searched for clinical studies published until June 2020 that evaluated the use of ultrasound (US) imaging for differential diagnosis of periapical lesions and used histopathology as the reference standard. Animal studies, laboratory-based studies, reviews and clinical studies not using a reference standard were excluded. Risk of bias (RoB) assessment was performed using a modified Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. The random effects model was used for quantitative analysis of the data, and the Deeks test was used for calculating publication bias. Quality of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE).
Conclusion: Although the sensitivity and specificity for differentiating periapical cysts and periapical granulomas using US were high, taking the quality of evidence into consideration, it can serve as an additional tool in differential diagnosis of periapical lesions.
The sure way to accurate ultrasound diagnosis: With more than 2,000 illustrations, this one-of-a-kind book offers an entirely new system for using ultrasound imaging to achieve the correct diagnosis quickly and reliably.
The development of equipment and contrast agents for ultrasound imaging has contributed to major breakthroughs in the diagnosis of pancreatic tumors. We aimed to determine the diagnostic effectiveness of contrast ultrasound with Levovist, using the Agent Detection Imaging (ADI) technique, in 50 patients with pancreatic tumors.
We studied 50 cases of histologically proven pancreatic disease; 39 carcinomas, 2 endocrine tumors, 4 intraductal papillary mucinous carcinomas (IPMCs), and 5 cases of tumor-forming pancreatitis (TFP). Vascular and perfusion images of contrast-enhanced ultrasound (CE-US) were used for the evaluation of tumor vascularity and parenchymal perfusion of the tumor, respectively. The hemodynamics of the tumor, and the diagnostic capacity of CE-US were compared with those shown by computed tomography (CT). The histological diagnosis in all cases was made from either biopsy or surgical specimens.
Objective: Ultrasound imaging has been widely used in breast cancer screening. Recently, ultrasound super-resolution imaging (SRI) has shown the capability to break the diffraction limit to display microvasculature. However, the application of SRI on differential diagnosis of breast masses remains unknown. Therefore, this study aims to evaluate the feasibility and clinical value of SRI for visualizing microvasculature and differential diagnosis of breast masses.
Methods: B mode, color-Doppler flow imaging (CDFI) and contrast-enhanced ultrasound (CEUS) images of 46 patients were collected respectively. SRI were generated by localizations of each possible contrast signals. Micro-vessel density (MVD) and microvascular flow rate (MFR) were calculated from SRI and time to peak (TTP), peak intensity (PI) and area under the curve (AUC) were obtained by quantitative analysis of CEUS images respectively. Pathological results were considered as the gold standard. Independent chi-square test and multivariate logistic regression analysis were performed using these parameters to examine the correlation.
Conclusions: SRI is able to successfully display the microvasculature of breast masses. Compared with CDFI and CEUS, SRI can provide additional morphological and functional information for breast masses. MVD has a great potential in assisting the differential diagnosis of breast masses as an important imaging marker.
Citation: Zhang G, Lei Y-M, Li N, Yu J, Jiang X-Y, Yu M-H, Hu H-M, Zeng S-E, Cui X-W and Ye H-R (2022) Ultrasound super-resolution imaging for differential diagnosis of breast masses. Front. Oncol. 12:1049991. doi: 10.3389/fonc.2022.1049991
Categories of data extracted included: 1) Patient presentation; 2) Setting; 3) Clinical indications; 4) Who performed USI; 5) Anatomical region; 6) Methods of USI; 7) Additional imaging; 8) Final diagnosis; and 9) Case outcome.
Of the 172 papers reviewed for inclusion, 42 were evaluated. Most common anatomical regions scanned were the foot and lower leg (23%), thigh and knee (19%), shoulder and shoulder girdle (16%), lumbopelvic region (14%), and elbow/wrist and hand (12%). Fifty-eight percent of the cases were deemed static, while 14% reported using dynamic imaging. The most common indication for USI was a differential diagnosis list that included serious pathologies. Case studies often had more than one indication. Thirty-three cases (77%) resulted in confirmation of a diagnosis, while 29 case reports (67%) documented significant changes in physical therapy intervention strategies due to the USI, and 25 case reports (63%) resulted in referral.
Outcome categories were limited to patient referral, arriving at a diagnosis, or a change in physical therapy intervention strategies. The imaging case reports focused on diagnostic strategies and often did not include patient-specific clinical outcomes.
The initial search strategy resulted in 172 papers being reviewed by title and abstract for inclusion/exclusion criteria. Most of the excluded papers at this stage used USI for the medical diagnosis and the patient was referred for physical therapy. Since the initial search strategy was not specific, these papers were identified but did not meet the inclusion criteria. Forty-five complete published case reports were obtained for reading and data tabulation. One paper included two cases. Following a complete review, two cases were ultimately excluded because USI was used solely for ultrasound-guided percutaneous electrical nerve stimulation. One paper was excluded because USI was used for drug delivery. One paper was excluded because the relationship of USI to physical therapy practice was indeterminable. Thus, 42 cases were assessed by the researchers.
Case reports either documented a single type of USI (static, dynamic, or Doppler) or more than one type. Eighteen case reports did not specify whether the patient was static or dynamic during USI. These cases were inferred to be static tests from the published images and were added to the seven case reports that specified the patient was static, resulting in a total of 25 cases (58%). The authors assumed that dynamic and Doppler tests would be preceeded by static imaging. Six case reports reported dynamic testing (14%). Eight case reports specified that Doppler imaging was used (19%). See the listing of all case reports, presenting complaints, anatomical regions assessed, and final patient diagnosis in Table 1.
Case reports often had more than one indication for USI (32, 74%). The most common reason for USI during examinations was when the differential diagnosis list included serious pathologies (26, 60%). For example, Hoglund, Silbernagel, and Taweel31 reported that moderately severe lower leg pain with full weight-bearing that originated from running includes stress fracture as a differential. Rosenthal, Hawkes, and Garbrecht45 reported that unilateral calf pain and cramping, with negative spine examination and negative compartment syndrome tests, could include popliteal artery entrapment as a differential.
The purpose of this review was to summarize published case reports that describe the use of USI in PTs practice for the diagnosis and management of patient conditions. Case reports can be used to examine how PTs utilize USI for diagnostic purposes and develop clinical skills.55 This review of case reports corroborates the previous work of Boissonnault and Ross.9 Physical therapists in orthopaedic and sports medicine environments recognized indications for imaging, resulting in improved diagnostic validity for the patient. This diagnostic validity is essential for appropriate care and reduces the potential delay of diagnosis, which causes unnecessary patient hardship. This seems critical as PTs primarily rely on their clinical suspicion when screening for serious pathology, while at the same time are uncertain about their differential diagnostic abilities.56 USI was used as an extension of the physical examination and added valuable data in justifying referrals or monitoring patient change over time. In many instances, PTs were the provider performing the USI examination or were the person referring patients to have USI conducted.
Physical therapists are uniquely positioned to optimize USI as a powerful examination and treatment tool. Ultrasound allows a clinician to view not only static but dynamic anatomical images. Of all healthcare professionals, PTs are movement experts. Due to PTs knowledge and education in anatomy, kinesiology and biomechanics, and physical examination, they are equipped to acquire and interpret static and dynamic images and can relate these images to pathology. A physical therapist can move back and forth between physical examination, history taking, and imaging without losing sight of the primary objectives of the clinical examination. Physical therapists are trained to examine the entire kinetic chain and thus can quickly identify how a region distant to the actual site of symptoms may contribute or be the cause of dysfunction. This ability to perform a more complete assessment of a given condition, including medical screening, may flag a different or more serious differential diagnosis not even suspected by another provider. The ability of physical therapists to discern more serious pathology was seen in the present study which found that 11 cases (26%) reported red flag conditions associated with the patient presentation. For example, Mechelli et al.36 described a case in which a 38-year-old male was initially referred to therapy for chronic lower back pain. The patient also had red flag symptoms of insidious onset unrelenting, deep, boring pain that was constant, irrespective of movements of posture changes or time of day. The resulting USI demonstrated an abdominal aortic aneurysm. Garbrecht et al.25 reported that a patient had exercise-induced unilateral upper extremity arm swelling with negative cervical and shoulder musculoskeletal examinations. Doppler ultrasound discovered a thrombosis of the subclavian and axillary veins. Both of these cases demonstrate the physical therapists ability to differentiate between appropriate and inappropriate conditions ameanable for physical therapy treatment. 59ce067264