Faculty Bibliography

Though consistently shown to detect mammographically occult cancers, breast ultrasound has been noted to have high false-positive rates. In this work, we present an AI system that achieves radiologist-level accuracy in identifying breast cancer in ultrasound images. Developed on 288,767 exams, consisting of 5,442,907 B-mode and Color Doppler images, the AI achieves an area under the receiver operating characteristic curve (AUROC) of 0.976 on a test set consisting of 44,755 exams. In a retrospective reader study, the AI achieves a higher AUROC than the average of ten board-certified breast radiologists (AUROC: 0.962 AI, 0.924 ± 0.02 radiologists). With the help of the AI, radiologists decrease their false positive rates by 37.3% and reduce requested biopsies by 27.8%, while maintaining the same level of sensitivity. This highlights the potential of AI in improving the accuracy, consistency, and efficiency of breast ultrasound diagnosis.

Scrotal ultrasound examinations of 23 male adults and children with the diagnosis of lymphoproliferative disease (LPD) were performed. Diagnoses included acute lymphoblastic leukemia (ALL) (six patients); acute myelogenous leukemia (AML) (one patient); chronic lymphocytic leukemia (CLL) (nine patients); non-Hodgkin's lymphoma (four patients); Hodgkin's lymphoma (three patients). Sonography-biopsy correlation was 100% in identifying testicular infiltrates. Nine of ten patients with testicular involvement had bilateral disease. Six patients had nonpalpable disease correctly identified by sonography. Ultrasound has great potential value as a screening modality for testicular biopsy in ALL and for detecting subclinical or nonpalpable disease in adults with LPD.

Adult cystic fibrosis (CF) patients are increasingly diagnosed with hepatic cirrhosis, cholecystitis, and cholelithiasis. A continuing diagnostic problem is the early detection of cirrhosis prior to diffuse liver involvement. Sonography has been used in evaluating the pancreas, gallbladder, liver, and spleen in cystic fibrosis patients. We used a real-time mechanical sector scanner to study the portal veins in adult CF patients randomly selected from our CF population and correlated the portal vein diameters with liver function studies. A measurement greater than 12 mm was interpreted as a probable sign of portal hypertension. Of 21 patients studied, 14 had portal veins that measured greater than 12 mm, and 12 patients had (although not necessarily at the time of the exam) elevated serum alkaline phosphatase levels. Three patients had associated splenomegaly and thrombocytopenia, and 10 patients also exhibited cholelithiasis and abnormal gallbladders on sonography. Initial results indicate that portal vein measurement may be a sensitive indicator of early portal hypertension. Sonography may, thus, isolate patients at high risk for possible future complications. Serial sonograms can be performed easily in evaluating the progress of liver disease.

One hundred and twenty-six patients had fine needle aspiration of the pancreas under ultrasonic guidance. The aspirates of 66 patients contained malignant cells. Two of 38 patients who had negative cytology subsequently were diagnosed at laparotomy as having carcinoma of the pancreas. The results of this study show that the sensitivity of the cytologic method was 97%, and the specificity and predictive value were 100%.

The ultrasonic findings in 10 patients with diffuse leukemic infiltration of the kidneys are described. The findings are analogous to those seen pathologically and include enlargement of the kidneys, diffuse leukemic infiltration of the renal cortex with sparing of the adjacent medullae, loss of definition and distortion of the renal sinus echo complex and a focal mass. The ultrasound findings correlated well with those seen with intravenous urography making it the preferable screening modality for the initial detection of renal involvement, subsequent follow-up and response to therapy in leukemic patients.

Computed tomography (CT) was performed in 9 consecutive cases of primary gastric neoplasm. Lesions were surgically or endoscopically proved; cross-sectional images are correlated to specific histopathology in each case. The CT images of leiomyoma and leiomyoblastoma are characterized as models of pure bulging intramural growth resulting in a lunate contrast distribution when imaged in the cross-sectional plane. In 5 cases of lymphoma, distortion of the contrast-filled hollow viscus is relatively consistent. Nodular growth is reflected on the CT image as a series of digitations encroaching on the opacified portion of the gastric lumen. Image pattern recognition, relative to histopathology, is of more than academic interest since endoscopy is frequently unreliable in cases of submucosal and exophytic pathology. Further, biopsy of such lesions is commonly nondiagnostic as a result of random choice of biopsy site or inadequate depth of tissue sample. Additionally, this report includes images of lesions that simulate the primary gastric pathology and may be a source of erroneous interpretation. These include: pseudocyst of the pancreas (2 cases) and enlargement of the left lobe of the liver with encroachment on the gastric lumen (1 case). Image specificity on CT examination is increasingly essential to diagnosis and surgical planning.

Percutaneous ultrasound-guided puncture of the gallbladder (PUPG) is a new method for antegrade study of the gallbladder and the common bile duct. All procedures were scheduled immediately prior to planned surgery. Under ultrasound guidance, a 22-gauge sheathed needle was placed into the gallbladder lumen, and dilute (25% to 30%) diatrizoate meglumine (Hypaque) was injected. Indications in five patients included: evaluation of the common bile duct for calculi and/or obstruction, specifically in one patient who had hypersensitivity to intravenous contrast material; aspiration of bile for gram stain, crystal analysis, and cytology; evaluation of the gallbladder lumen for intraluminal masses; and to establish the anatomic site of an occult abscess. A small bile leak occurred in one patient who had no obstruction, and a more significant leak occurred in a patient who had obstructive jaundice and ampullary carcinoma. PUPG obviated the need for surgical intervention in three patients. Although the method has limited indications, we feel that it has great diagnostic potential in conditions related to the gallbladder and biliary ducts.

Eleven cases of sonographically detected metastatic disease to the gallbladder are reported. This paper represents the first comprehensive review of the ultrasonographic findings in this not infrequently encountered disease process. Four distinctive sonographic diagnostic patterns have evolved and are described. The suspicion of metastatic tumors in the gallbladder should be raised, particularly in the presence of focal gallbladder wall thickening in association with nonshadowing intraluminal soft tissue masses. In contrast to primary carcinomas of the gallbladder, cholelithiasis usually is absent. The differential diagnosis, which includes various benign conditions of the gallbladder, is discussed.