Search Results (10)

Background/Objectives: Thyroid cancer encompasses distinct histological subtypes with varying biological behavior and treatment implications. Accurate preoperative subtype differentiation remains challenging. Although ultrasound (US) is widely used for thyroid nodule evaluation, qualitative assessment alone is often insufficient to distinguish between papillary (PTC), follicular (FTC), and medullary thyroid carcinoma (MTC). Methods: A retrospective analysis was performed on patients with histologically confirmed PTC, FTC, or MTC. A total of 224 standardized B-mode ultrasound images were analyzed. A set of fully quantitative features was extracted, including morphological characteristics (aspect ratio and perimeter-to-area ratio), internal echotexture (echogenicity and local entropy), boundary sharpness (gradient measures and KL divergence), and structural components (calcifications and cystic areas). Feature extraction was conducted using semi-automatic algorithms implemented in MATLAB. Statistical differences were assessed using the Kruskal–Wallis and Dunn–Šidák tests. A Random Forest classifier was trained and evaluated to determine the discriminatory performance of individual and combined features. Results: Significant differences (p < 0.05) were found among subtypes for key features such as perimeter-to-area ratio, normalized echogenicity, and calcification pattern. The full-feature Random Forest model achieved an overall classification accuracy of 89.3%, with F1-scores of 93.4% for PTC, 85.7% for MTC, and 69.1% for FTC. A reduced model using the top 10 features yielded an even higher accuracy of 91.8%, confirming the robustness and clinical relevance of the selected parameters. Conclusions: Subtype classification of thyroid cancer was effectively performed using quantitative ultrasound features and machine learning. The results suggest that biologically interpretable image-derived metrics may assist in preoperative decision-making and potentially reduce the reliance on invasive diagnostic procedures. Full article

Background: Parathyroid neoplasia is a heterogeneous group of tumors, including parathyroid adenoma (PA), atypical parathyroid tumors (aPTs), and parathyroid carcinoma (PC). Differential diagnosis, especially preoperatively, between parathyroid carcinoma and the other two entities is challenging. The purposes of this study were to highlight the main differences between different parathyroid tumors and to evaluate how combined PC suspicion and intraoperative adjuncts can influence surgical decision-making and outcome-related issues. Methods: We performed a retrospective study of a database of patients diagnosed with parathyroid tumors who underwent surgical treatment at our endocrine surgery referral center between June 2019 and July 2024. Demographic, clinical, biochemical, imaging, intraoperative, immunohistochemical, and follow-up data were analyzed. Results: A total of 83 cases were included in our study, divided for analysis into PA (n = 67), aPT (n = 9) and PC (n = 7) subgroups. The clinical profile of the cohort showed a significant difference (p < 0.05) between the PA, aPT, and PC subgroups regarding the presence of palpable tumors (0% vs. 11.11% vs. 14.29%), both bone and kidney involvement (14.93% vs. 44.44% vs. 85.71%), and extensive disease beyond bone and kidney involvement (4.48% vs. 44.44% vs. 71.43%). PTH levels over five times the normal value were present at significantly different rates (p < 0.001), with higher rates in the aPT and PC subgroups (55.56% and 85.71%, respectively) compared with the PA subgroup (7.46%). Also, a significant difference (p < 0.001) was observed when analyzing extreme albumin-corrected serum calcium elevations over 14 mg/dL, with much higher rates in the PC subgroup (71.43%) compared to PA (1.49%) and aPT (33.33%). On preoperative ultrasonography, a significantly higher number of PCs presented diameters ≥ 3 cm (p < 0.001), depth-to-width ratios (D/W) ≥ 1 (p = 0.003), suspicious delineation (p < 0.001), and suspicious echotexture features (p < 0.001), compared to PAs. On preoperative US performed by the surgeon, suspicious features for thyroid cancer were identified in five more patients compared to the four identified by the initial US evaluation, and all (10.84% of all patients) were confirmed on final histopathology as papillary thyroid cancers. Intraoperatively, a significant difference (p < 0.001) regarding parathyroid macroscopic suspicious features, including adhesions to the thyroid gland, was seen between subgroups. When analyzing only cases with en bloc resection, we found that, in all PC cases, a combined preoperative suspicion was present, and in five cases an intraoperative suspicion was raised. Immunohistochemical data showed significantly different median Ki-67 indices between subgroups (1, 2, and 5; p = 0.008) and a different parafibromin staining profile between PC and aPT. Regarding intraoperative neuromonitoring use, a significantly lower incidence of voice changes related to the external branch of the superior laryngeal nerve was observed in the monitoring vs. non-monitoring group (57.14% vs. 12.5%, p = 0.019). Conclusions: Our findings confirm that, in a multimodal and combined diagnostic approach, early pre- and intraoperative PC suspicion can be raised in order to optimize surgical treatment and, thus, favorably influence the outcome. Utilizing all resources available, including intraoperative parathormone determination, laryngeal nerve neuromonitoring, and immunohistochemistry staining, can bring extra benefit to the management of these challenging cases. Full article

Background/Objectives: Ultrasound (US) imaging and echotexture analysis are emerging techniques for assessing muscle tissue quality in the post-stroke population. Clinical studies suggest that echovariation (EV) and echointensity (EI) serve as objective indicators of muscle impairment, although methodological limitations hinder their clinical translation. This secondary analysis aimed to refine the assessment of echotexture by using robust statistical techniques. Methods: A total of 130 regions of interest (ROIs) extracted from the gastrocnemius medialis of 22 post-stroke individuals were analyzed. First, inter-examiner reliability between two physiotherapists was assessed by using Cohen’s kappa for muscle impairment classification (low/high) for each echotexture feature. For each examiner, the correlation between the classification of the degree of impairment and the modified Heckmatt scale for each feature was analyzed. The dataset was then reduced to 44 ROIs (one image per leg per patient) and assessed by three physiotherapists to analyze inter-examiner reliability by using Light´s kappa and correlation between both assessment methods globally. Statistical differences in 21 echotexture features were evaluated according to the degree of muscle impairment. A binary logistic regression model was developed by using features with a Cohen’s kappa value greater than 0.9 as predictors. Results: A strong and significant degree of agreement was observed among the three examiners regarding the degree of muscle impairment (Kappa_light = 0.85, p < 0.001), with nine of the 21 features showing excellent inter-examiner reliability. The correlation between muscle impairment classification with the modified Heckmatt scale was very high and significant both globally and for each echotexture feature. Significant differences (<0.05) were found for EV, EI, dissimilarity, energy, contrast, maximum likelihood, skewness, and the modified Heckmatt scale. Logistic regression highlighted dissimilarity, entropy, EV, Gray-Level Uniformity (GLU), and EI as the main predictors of muscle tissue impairment. The EV and EI models showed high explanatory power (Nagelkerke’s pseudo-R² = 0.74 and 0.76) and robust classification performance (AUC = 94.20% and 95.45%). Conclusions: This secondary analysis confirms echotexture analysis as a reliable tool for post-stroke muscle assessment, validating EV and EI as key indicators while identifying dissimilarity, entropy, and GLU as additional relevant features. Full article

Background/Objectives: Strokes remain a major global health concern, contributing significantly to disability and healthcare costs. Currently, there are no established indicators to accurately assess the degree of muscle tissue impairment in stroke-affected individuals. However, ultrasound imaging with an echotexture analysis shows potential as a quantitative tool to assess muscle tissue quality. This study aimed to identify specific echotexture features in the gastrocnemius medialis that effectively characterize muscle impairment in post-stroke individuals. Methods: An observational study was conducted with 22 post-stroke individuals. A total of 21 echotexture features were extracted and analyzed, including first-order metrics, a grey-level co-occurrence matrix, and a grey-level run length matrix. The modified Heckmatt scale was also applied to correlate with the most informative echotexture features. Results: Among the features analyzed, echovariation (EV), echointensity, and kurtosis emerged as the most informative indicators of muscle tissue quality. The EV was highlighted as the primary feature due to its strong and significant correlation with the modified Heckmatt scale (r = −0.81, p < 0.001) and its clinical and technical robustness. Lower EV values were associated with poorer muscle tissue quality, while higher values indicated better quality. Conclusions: The EV may be used as a quantitative indicator for characterizing the gastrocnemius medialis muscle tissue quality in post-stroke individuals, offering a more nuanced assessment than traditional qualitative scales. Future studies should investigate the correlation between the EV and other clinical outcomes and explore its potential to monitor the treatment efficacy, enhancing its applicability in clinical practice. Full article

Objectives: Pregnancies in women with Fontan circulation are on the rise, and they are known to imply high maternal and fetal complication rates. The altered hemodynamic profile of univentricular circulation affects placental development and function. This study describes placental sonomorphologic appearance and Doppler examinations and correlates these to histopathologic findings and pregnancy outcomes in women with Fontan circulation. Methods: A single-center retrospective analysis of pregnancies in women with Fontan circulation was conducted between 2018 and 2023. Maternal characteristics and obstetric and neonatal outcomes were recorded. Serial ultrasound examinations including placental sonomorphologic appearance and Doppler studies were assessed. Macroscopic and histopathologic findings of the placentas were reviewed. Results: Six live births from six women with Fontan physiology were available for analysis. Prematurity occurred in 83% (5/6 cases) and fetal growth restriction and bleeding events in 66% (4/6 cases) each. All but one placenta showed similar sonomorphologic abnormalities starting during the late second trimester, such as thickened globular shape, inhomogeneous echotexture, and hypoechoic lakes, resulting in a jelly-like appearance. Uteroplacental blood flow indices were within normal range in all women. The corresponding histopathologic findings were non-specific and consisted of intervillous and subchorionic fibrin deposition, villous atrophy, hypoplasia, or fibrosis. Conclusions: Obstetric and perinatal complication rates in pregnancies of women with Fontan circulation are high. Thus, predictors are urgently needed. Our results suggest that serial ultrasound examinations with increased awareness of the placental appearance and its development, linked to the Doppler sonographic results of the uteroplacental and fetomaternal circulation, may be suitable for the early identification of cases prone to complications. Full article

Testicular ultrasound is a non-invasive technique that could be very useful for predicting ram seminal quality. Recent software developments allow macroscopic and microscopic evaluation of testicular parenchyma. Thus, the aim of this study was to evaluate the testicular echotexture using ultrasound-video analysis and investigate its possible correlation with semen quality. Nine rams were evaluated for one year using a portable ultrasound scanner and the echotexture was analyzed with ECOTEXT^® software. The number of black (Ec1), white (Ec2), and grey pixels (Ec3), tubular density (TD), lumen area (LA), and lumen diameter (LD) were analyzed. Semen was collected by an artificial vagina the same day and the sperm concentration, morphology, motility, viability, phosphatidylserine (PS) translocation, reactive-oxygen-species (ROS) levels, DNA damage and capacitation state were evaluated. Ec2 and Ec3 correlated positively with “bad quality” sperm parameters (the percentage of spermatozoa with high ROS levels, with PS translocation and proximal cytoplasmic droplets), and negatively with motility. In contrast, TD and LA showed a positive correlation with “good quality” parameters (motility or normal morphology) and a negative correlation with spermatozoa with high ROS levels, with DNA fragmentation, and proximal or distal cytoplasmic droplets. Thus, echotexture analysis by ultrasound-video analysis could be a valuable tool for assessing ram fertility. Full article

This study set out to examine associations among echotextural, physicochemical and sensory attributes of the pectoralis major muscles in 17-week-old organic turkeys (B.U.T. Big-6) varying in the amount of wheat and oat grain in daily feed rations (Group C: complete feed only; Group Exp1: 5–30% of wheat and 0–20% of oat; and Group Exp2: 5–50% of wheat and 0–50% of oat; n = 15 turkeys/group). Digital ultrasonograms of the left pectoral muscle in four different planes (longitudinal-L, transverse-T, and two oblique planes-O1 and O2) were obtained with a 5.0-MHz linear-array transducer just before slaughter. Mean numerical pixel intensity (MPI) and pixel heterogeneity (MPH) of the muscle parenchyma were computed using the ImageProPlus^® analytical software. Ten significant correlations between echotextural attributes and various meat characteristics were recorded in Group C, one in Group Exp1, and eight in Group Exp2. When data were pooled for all birds studied, there were twelve significant correlations (p < 0.05); all but one correlation (between MPH and moisture) were for physical and sensory characteristics of meat samples. Computer-assisted analysis is a potential method to determine moisture as well as physical (e.g., coloration) and sensory (e.g., aroma) characteristics of pectoralis major muscles in organic turkeys. Full article

Different types of scaffolds are used to reconstruct muscle volume loss injuries. In this experimental study, we correlated ultrasound observations with histological findings in a muscle volume loss injury reconstructed with autologous adipose tissue. The outcome is compared with decellularized and porous matrix implants. Autologous adipose tissue, decellularized matrix, and a porous collagen matrix were implanted in volumetric muscle loss (VML) injuries generated on the anterior tibial muscles of Wistar rats. Sixty days after implantation, ultrasound findings were compared with histological and histomorphometric analysis. The muscles with an autologous adipose tissue implant exhibited an ultrasound pattern that was quite similar to that of the regenerative control muscles. From a histological point of view, the defects had been occupied by newly formed muscle tissue with certain structural abnormalities that would explain the differences between the ultrasound patterns of the normal control muscles and the regenerated ones. While the decellularized muscle matrix implant resulted in fibrosis and an inflammatory response, the porous collagen matrix implant was replaced by regenerative muscle fibers with neurogenic atrophy and fibrosis. In both cases, the ultrasound images reflected echogenic, echotextural, and vascular changes compatible with the histological findings of failed muscle regeneration. The ultrasound analysis confirmed the histological findings observed in the VML injuries reconstructed by autologous adipose tissue implantation. Ultrasound can be a useful tool for evaluating the structure of muscles reconstructed through tissue engineering. Full article

Background: the aim of this study was to compare the echotexture of patients with soleus muscle injury and age matched controls. Methods: a sample of 62 athletes was recruited at the private clinic and was divided in two group: a healthy group (n = 31) and a soleus pathology group whose athletes had soleus muscle injury, located in the central tendon (n = 31). The muscle thickness (MTh), echointensity (EI) and echovariation (EV) were analyzed. An intra-rater reliability test (Intraclass Correlation Coefficient-ICC) was performed in order to analyze the reliability of the values of the measurements. Results: Sociodemographic variables did not show statistically significant differences (p > 0.05). Ultrasound imaging measurements who reported statistically significant differences were EI (p = 0.001) and standard deviation (SD) (p = 0.001). MTh and EV variables did not show statistically significant differences (p = 0.381 and p = 0.364, respectively). Moreover, reliability values for the MTh (ICC = 0.911), EI (ICC = 0.982), SD (ICC = 0.955) and EV (ICC = 0.963). Based on these results the intra-rater reliability was considered excellent. Conclusion: Athletes with a central tendon injury of soleus muscle showed a lower EI when they were compared to healthy athletes. The echogenicity showed by the quantitative ultrasound imaging measurement may be a more objective parameter for the diagnosis and follow-up the soleus muscle injuries. Full article

Thirty clinically healthy Holstein-Friesian cows underwent twice daily machine milking and ultrasonographic examinations of the udder just prior to and after milking. Digital ultrasonographic images of each udder quarter were subjected to computer-assisted echotextural analyses to obtain mean numerical pixel values (NPVs) and pixel heterogeneity (PSD) of the mammary gland parenchyma. The average milk yield and pH were higher (p < 0.05) in the morning, whereas crude fat, total solids, solids non-fat and citric acid content were higher (p < 0.05) during the evening milking period. Mean NPVs and PSDs of the mammary gland parenchyma were greater (p < 0.05) after than before milking. There were significant correlations among echotextural characteristics of the udder and protein percentage, lactose content and freezing point depression determined in the milk samples collected in the morning and crude protein, casein, lactose and solids non-fat in the evening. Our results can be interpreted to suggest that computerized analysis of the mammary gland ultrasonograms has the makings of a technique for estimating non-fat milk constituents in cows. However, future validating studies are necessary before this method can be employed in commercial settings and research. Moreover, significant inter-quarter differences in udder echogenicity may necessitate further echotextural studies of separate quarters. Full article