As one of the advanced technologies, artificial intelligence (AI) makes a profound progress in a wide range of disciplines and industries. With the development of computer hardware and data storage device, as well as the emergence of big data and new algorithms, the application of AI technique makes a big breakthrough in many aspects. In medical imaging field, AI technique has been early and widely applied. Recently, AI products used in breast imaging diagnosis are rapidly transitioning from experiment to application, showing a promising value and trend. This article reviewed the development, application and future direction of AI technique in breast imaging, hoping to provide a reference for further AI research.

Radiomics refers to the extraction and analysis of a large amounts of advanced quantitative imaging features from medical images, for diagnosis and treatment of diseases. The concept was born less than five years, but has become a research hotspot in global clinical medicine and biomedical engineering. The research of radiomics involves the screening, diagnosis, treatment, and evaluation of several types of tumors, and has achieved considerably optimistic results. Radiomics, which will obtain more standard, stable features and complete validation based on multicenter research, may be applied in precision oncology from evidence-based medicine hereafter. In this paper, a systematic and comprehensive exposition of radiomics in the past, present and future is given.

Prostate specific membrane antigen (PSMA) is expressed in normal prostate epithelial cells and strongly up regulated in initial and advanced prostate carcinoma. Therefore, PSMA is an attractive molecular target for the detection of primary and metastatic lesions. It plays an important role in the diagnosis, staging, prognostic evaluation and targeted treatment in prostate carcinoma patients. This review will summarize the progress of small molecular radionuclide probes, which targeted PSMA, for visualizing prostate cancer.

Lung cancer has high incidence in China. Faced with the lack of imaging physicians and the growing medical needs of large patient populations, the application of artificial intelligence technology in pulmonary nodules imaging can effectively balance current medical resources. This paper expounds the current situation of the development of artificial intelligence technology in pulmonary nodule imaging, discusses how to correctly treat this techonology the core elements and the faced challenges. It is pointed out that the artificial intelligence technology in lung nodule imaging has achieved initial success. The standardized image data training set and the multi-task model suitable for clinical scenes are the core elements of future product landing.

   Objective: To evaluate estrogen receptor (ER) expression level in human breast cancer model using ¹⁸F-fluoroestradiol (¹⁸F-FES) microPET/CT. Methods: ER⁺ human breast cancer cell lines (ZR-75-1 and MCF-7) and ER- control (MDA-MB-231) were used to construct BALB/c nude mouse model. There were ten mice in each ER⁺ group. The estrogen pellets were implanted 3 d prior to tumor cell inoculation and removed 3 d before administration of ¹⁸F-FES. The mice were implanted with ZR-75-1 and MCF-7. There were 5 mice in ER- group. MDA-MB-231 cells were inoculated into thoracic mammary fat pad. ¹⁸F-FES PET/CT was performed until the tumor length reached 5 mm. %ID/g_max was used to quantitate ER expression. ER expression was also detected by immunohistochemistry. Results: The tumor formation rates for ZR-75-1, MCF-7 and MDAMB- 231 were 100% (10/10), 70% (7/10) and 100% (5/5), respectively. There was no statistical difference in the volume among three groups (P>0.05). %ID/g_max values were 6.6±1.0, 3.3±0.5 and 1.1±0.1, respectively. Significant differences were observed when ZR-75-1 was compared to MCF-7 (P<0.05) and MDA-MB-231 (P<0.001). There was significant difference between MCF- 7 and MDA-MB-231 (P<0.05). The ratios of tumor to muscle (T/M) were 4.2±0.3, 2.6±0.2 and 1.1±0.1, respectively. There were significant differences among three groups (P<0.001). A significantly positive correlation was found between the results of 18F-FES imaging and immunohistochemistry (%ID/g_max: r²=0.65, P<0.001; T/M: r²=0.87, P<0.001). Conclusion: %ID/g_max from ¹⁸F-FES PET/CT imaging is able to evaluate ER expression reliably. ¹8F-FES PET/CT can be used as a noninvasive and dynamic method in vivo.

The Prostate Imaging Reporting and Data System Version 2 (PI-RADS V2) is a system aimed at the diagnosis of clinically significant cancer in prostate by using multiparametric magnetic resonance imaging (mpMRI). PI-RADS V2 is a standard guideline that prescribes the technical parameters for an acceptable prostate mpMRI, standardizes the content of radiology reports and establishes the assessment categories for risk of clinically significant cancer. Based on PI-RADS V2, a structured report of clinically significant cancer in prostate was built. This review aims to introduce and interpret the structured report of prostate mpMRI based on PI-RADS V2.

Objective: To investigate the prenatal ultrasonographic characteristics and their clinical significance of the fetal hemivertebra. Methods: The prenatal ultrasonographic characteristics of 14 cases of fetal hemivertebrae, which were confirmed by X-ray in Chashan Hospital of Dongguan and Shijie Hospital of Dongguan between May 2011 and May 2016 were retrospectively analyzed. Results: Among the 14 cases of fetal hemivertebra, 6 cases had single vertebral deformity (4 cases in the thoracic spine, 4 cases in the lumbar spine), 8 cases had multiple vertebral deformity (5 cases in the thoracic spine, 2 cases both in the thoracic and lumbar spine, 1 case in the lumbar spine). There were a total of 19 hemivertebras, in which 17 were found by prenatal ultrasound but 19 were found by postpartum X-ray). Besides the vertebral defect, 9 fetuses had additional anomalies, of which 7 fetuses had cardiac malformations (2 cases of complete endocardial cushion defects and double outlet right ventricle, 1 case of complete transposition of the great arteries, 1 case of double outlet right ventricle, 1 case of pulmonary atresia and ventricular septal defect, 2 cases of tetralogy of Fallot), 4 fetuses had urinary tract abnormalities (3 cases of polycystic kidney disease, 1 case of left renal agenesis), 2 fetuses had central nervous system malformation (1 case of holoprosencephaly, 1 case of absence of the cerebellum ), and 12 fetuses had other abnormalities (10 cases of missing ribs, 2 cases of polydactyly). Conclusion: Hemivertebra has characteristic ultrasonic performance and the prenatal ultrasound of hemivertebra has important clinical significance in eugenics.

Objective: To evaluate the diagnostic value of American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) in thyroid carcinoma. Methods: The sonographic features of 123 thyroid carcinoma nodules of confirmed by surgical pathology were retrospectively analyzed using ACR TI-RADS. Results: All thyroid carcinoma nodules were solid or almost completely solid (100%), hypoechoic or extremely hypoechoic (100%), and the other sonographic features were vertical growth (72.36%), punctuate echogenic foci (54.47%), lobulated/irregular shape (37.40%) and extra-thyroidal extension (17.89%). In 113 TR5 nodules, 31 had cervical lymph node metastasis. The correlation between lymph node metastasis rate and thyroid nodule size was not statistically significant. Conclusion: The 2017 ACR TI-RADS employs quantitative score in the assessment of thyroid nodules, with high sensitivity in the detection of thyroid carcinoma, and it is easy to handle. However, it is probably conservative and simple to distinguish nodules by size in TR4 and TR5 nodules.

   Objective: To review and analyze the clinical and ultrasonic features of lipoblastoma. Methods: A total of 46 cases with pathologically proved lipoblastoma in our hospital were selected. The data including clinical characteristics, ultrasonic images and pathologic results were retrospectively analyzed. Results: Age: 35 cases were less than or equal to 3 years old (76%). Physical examination: All lesions were single and painless soft tissue masses, among which 39 (85%) were soft or moderate, and 41 (89%) had good or preferable mobility. Location and size: 26 lesions were located in subcutaneous soft tissue (57%), 14 in muscle (30%), 2 (4%) in both subcutaneous soft tissue and muscle, and 4 (4%) in retroperitoneum or mesenterium. The tumor size in most cases (89%) were greater than or equal to 3 cm. Pattern of echogenicity: 33 lesions were hyperechoic (72%), 11 (24%) were hypoechoic and 2 were heterogeneous. Linear or cord-like separations with strong echo were found in 36 lesions (78%). 1 case had calcification in the mass and 1 case had slit-shaped weak echo. Boundary and shape: 35 cases (75%) had clear boundary and regular shape. Blood supply: According to Adler semi-quantitative classification standards, 20 lesions (43%) were grouped into grade 0, 23 (50%) into grade Ⅰ and 3 (7%) into grade Ⅱ. All lesions could be grouped into diffuse type (36 cases) and localization type (10 cases). The hardness, mobility, location, size, shape and inner hyperechoic separation of lesions between the two types were significantly different (P<0.05). Conclusion: The typical clinical characteristics of lipoblastoma are as follows: Most patients are infants. All lesions are single soft tissue masses. Most lesions are soft or moderate, and have good or preferable mobility. The typical ultrasonic characteristics of lipoblastoma are large hyperechoic subcutaneous mass with strong echoic seperations, regular shape and clear boundary. More than half of them have grade Ⅰ or grade Ⅱ blood supply according to Adler semi-quantitative classification standards. If the mass is hard, larger than 6 cm, and irregular in the muscle without hyperechoic separations, lipoblastomatosis should
be taken into account.

Objective: To explore the sonographic features of borderline ovarian tumors, and to evaluate the value of ultrasound in the diagnosis of borderline ovarian tumors. Methods: The data of 114 patients who underwent surgical treatment and were diagnosed with borderline ovarian tumors were retrospectively analyzed. The patients’ sonographic features and clinical characteristics were reviewed. Results: The 114 patients with borderline ovarian tumors were mainly at childbearing age. 98 patients had unilateral lesions and 16 patients had bilateral lesions. Bilateral involvement was more common in serous borderline tumors (22.6%, P=0.022). Compared with mucinous borderline tumors, serous borderline tumors were likely to emerge papillary structure (73.8%, P=0.005). The mucinous borderline tumors were bigger (tumors more than 10 cm occupied 55.6%, P=2.27×10^-8). The mainly sonographic features of mucinous borderline tumors were multiple separations (70.4%, P=1.2×10^-5). Five patients with intraperitoneal implantation were diagnosed with serous borderline tumors. They had high levels of serum carbohydrate antigen 125 (CA125) and exophytic papillary on ultrasound. Conclusion: The diagnosis of ovarian borderline tumors by preoperative ultrasound examination is difficult, while ultrasound is helpful in preoperative tumor staging and surgical approach selecting.

Breast cancer is the most common malignancies in women. Axillary lymph node status is critical for the treatment and prognosis of breast cancer patients. Conventional ultrasound, as one of the important methods for the evaluation of axillary lymph node metastasis of breast cancer, has the advantages of high efficiency, simplicity and economy, but only from the morphology and blood flow of lymph nodes. It has high specificity and low sensitivity. Intravenous contrast-enhanced ultrasound can observe microcirculation perfusion in lymph nodes and was gradually used in preoperative examination. Percutaneous contrast-enhanced ultrasound has important clinical value in localization of sentinec lymph nodes. In this paper, the application of conventional ultrasound and contrast-enhanced ultrasound in assessment of axillary lymph node status in breast cancer is reviewed

Objective: To investigate the clinical significance of maximum standardized uptake value (SUV_max) of ¹⁸F-FDG PET/CT imaging in esophageal cancer. Methods: The PET/CT imaging data of 60 esophageal cancer patients were analyzed retrospectively. The relationship between SUV_max and the size of tumor (maximum diameter and length), the difference in SUV_max between length, and the relationship between SUV_max of the primary esophageal carcinoma lesions and metastasis were analyzed. Results: The correlation of SUV_max with both maximum diameter and length was statistically significant (r=0.495, P=0.000; r=0.420, P=0.001). The differences in SUV_max between groups ＜3.0 cm and 3.0-5.0 cm and between groups ＜3.0 cm and ＞5.0 cm were statistically significant (t=-2.860, P=0.007; t=-3.036, P=0.005), the difference between groups 3.0-5.0 cm and ＞5.0 cm was not statistical significant (t=-3.036，P=0.005). SUV_max of the primary lesions was not correlated with metastasis (F=1.256，P=0.293). Conclusion: SUV_max of ¹⁸F-FDG PET/CT imaging has an important value in evaluating the size of esophageal carcinoma, but SUV_max is not related to lymph node metastasis or distant metastasis.

   The liver is the largest gland in the body. Focal liver lesions are the clinical common liver diseases with complex pathological types. Their treatment and prognosis are significantly different. So the differential diagnosis of focal liver lesions becomes urgent in clinic. In recent years, the second generation contrast agents and the low mechanical index realtime scanning technology have developed rapidly. As a noninvasive technique, contrast-enhanced ultrasound can clearly display the intrahepatic vessels, intrahepatic tissues and intrahepatic lesions, then evaluate the period of vascular perfusion in the liver to improve the diagnostic accuracy. The contrast-enhanced ultrasonographic features of different focal liver lesions are reviewed in the present paper.

Objective: To investigate the value of contrast-enhanced ultrasound (CEUS) combined with acoustic elastography in differential diagnosis of Thyroid Imaging Reporting and Data System (TI-RADS) 4 lesions. Methods: The routine ultrasound, acoustic elastography and CEUS data of 120 patients with a total 144 TI-RADS 4 lesions were retrospectively analyzed. The pathological findings were set as the gold standard to build the receiver operating characteristic (ROC) curve. Then the values of CEUS, acoustic elastography and CEUS combined with acoustic elastography in differential diagnosis of TI-RADS 4 lesions were compared. Results: The sensitivity, specificity and accuracy were 89.96%, 86.67%, 88.19% for CEUS; 81.16%, 81.33%, 81.25% for acoustic elastography; and 94.20%, 92.00%, 93.06% for CEUS combined with acoustic elastography. The combination of two methods had the highest diagnostic efficacy, with significant difference (P<0.05). Conclusion: CEUS combined with acoustic TIelastography is helpful in differentiating benign and malignant TI-RADS 4 lesions.

Hepatic fibrosis is a reversible intermediate link of chronic liver diseases to cirrhosis during the early stage, resulting from an imbalance between fibrolytic and fibrogenic processes. The clinical management and prognosis of hepatic fibrosis are highly dependent on the diagnosis and staging. Therefore, it is urgent to find accurate and non-invasive diagnostic methodology to assess the progress of hepatic fibrosis. With the rapid development of ultrasonic diagnostic technique, many ultrasound technologies such as conventional ultrasound, contrast enhanced ultrasound, real-time tissue elastography, transient elastography, point shear wave speed measurement elastography, shear wave speed imaging and so on have been wildly used in the diagnosis of hepatic fibrosis with their significant advantages. Ultrasonic elastography especially shows great clinical value in the non-invasive diagnosis and staging of hepatic fibrosis. The purpose of this paper is to investigate and summarize the current status and progress on ultrasonic diagnosis of hepatic fibrosis, based on consulting abundant domestic and foreign literatures and reports.

   Objective: To investigate the application value and the key technique of ultrasound-guided percutaneous biopsy of neck lymphadenopathy by freehand. Methods: Forty-two patients with neck lymphadenopathy of unknown cause from March 2011 to March 2013 underwent ultrasound-guided percutaneous biopsy using 18 G or 16 G tissue biopsy needle by freehand, The size of 1ymph nodes was 1.0 cm×0.6 cm-8.6 cm×5.0 cm. Each patient was punctured 2 to 5 times, A biopsy was considered technically successful if a targeted tissue was obtained and it could meet the requirement of qualitatively pathologic diagnosis. Results: The rate of technically successful biopsy which could meet the requirement of qualitatively pathologic diagnosis was 92.9%, The pathological results showed that lymph nodes in 12 patients (28.6%) were malignant, including metastatic carcinoma in 7 patients and malignant lymphoma in 5 patients, while lymph nodes in 26 patients (61.9%) were benign, including tuberculous lymphadenitis in 14 patients, reactive hyperplasia in 5 patients, chronic granulomatous inflammation in 4 patients and histiocytic necrotizingly lymphadenitis in 3 patients. There was one case with uncertainty (2.4%). Conclusion: Ultrasound-guided percutaneous biopsy by freehand is real-time, accurate, flexible and minimally invasive. It has high value in diagnosis of cervical lymphadenopathy.

Objective: To investigate the advantage of DR automatic splicing technology in the radiography of adolescent whole spine and double lower limb length. Methods: The data of children’s spine and double lower limbs length during Jul. 2015 to Feb. 2017 were randomly chosen. There were 50 cases included by manual (25 cases) or automatic splicing technology (25 cases). The image quality, image joint error and image contrast were compared. Results: By automatic splicing technology had better image quality, no image joint error, and good image contrast. The first class rate of image was 100% (25/25). By manually splicing technology, the first class rate of image wass 48% (12/25), the second class rate of image was 44% (11/25), the third class rate of image was 8% (2/25). It had worse image quality and worse image contrast exposured to neighboring area with image joint error and dislocation. Conclusion: DR automatic splicing technology is a new era of digital splicing technology. It is more accurate than traditional manual splicing technology, and can provide more valuable reference for treatment.

Objective: To evaluate the preliminary clinical application value of MAMMI dedicated breast PET. Methods: A total of 76 patients with positive breast lesions on whole-body ¹⁸F-fluorodeoxyglucose (18F-FDG) PET/CT or suspicious occult breast cancer voluntarily underwent MAMMI PET in prone position after whole-body ¹⁸F-FDG PET/CT. The maximal standardized uptake values (SUVmax) were compared according to lesion size, ultrasound grading and molecular subtype of breast cancer. Results: MAMMI PET visualized 63 lesions in 48 patients with specific pathologic diagnosis. The smallest lesion was 0.3 cm in diameter. Malignant lesions were classified into 3 groups based on diameter as follows: grade 1, 1 cm or smaller; grade 2, 1 to 2 cm; and grad 3, larger than 2 cm. The mean values of SUVmax of them were 4.58 ±2.01, 7.51 ±3.10 and 11.27±5.29, respectively, and there were significant differences in SUVmax through pairwise comparison (P<0.01 or P<0.05). Difference in SUVmax was also observed between Breast Imaging Reporting and Data System (BI-RADS) grade 4 and grade 5 (P<0.05). But there were no significant differences among different molecular subtypes. Conclusion: MAMMI PET has a promising clinical value in detecting small, multicenter and multiple primary breast lesions.

Objective：To evaluate the value of maximum standardized uptake value (SUVmax) in the diagnosis of rib metastasis. Methods: From May 2016 to November 2016, SPECT/CT fusion imaging and follow-up diagnosis of rib metastasis were performed in 21 patients with 42 rib metastasis lesions and 12 patients with 22 rib injury lesions. The contralateral normal ribs were used as controls, and SUVmax values were measured. t-test and receiver operating characteristic (ROC) curve analyses were performed. Results: The mean SUVmax was 24.05 (SD=11.84) in the metastasis group, 13.71 (SD=5.61) in the injury group, and 5.25 (SD=1.63) in the control group. There were significant differences among three groups (P<0.001). The area under the ROC curve was 0.990 and the cutoff value was 7.96 when SUVmax was used to diagnose rib lesions. But the area under the ROC curve was 0.808 and the cutoff value was 20.45 when SUVmax was used to diagnose rib metastasis. Conclusion: SUVmax is more valuable in SPECT/CT fusion imaging for the diagnosis of rib metastasis.

   Objective: To evaluate the value of the lateral ventricle and cerebellum plane scanning in the diagnosis of fetal central nerve system (CNS) midline structure abnormalities. Methods: Ultrasound imaging features of 97 fetuses with fetal CNS midline structure abnormalities from 3 921 abnormal fetuses were analyzed retrospectively. Results: Among the 97 fetuses, there were 9 cases of encephalocele, 7 cases of anencephaly, 4 cases of meningocele, 11 cases of transparent septum widened, 16 cases of complete agenesis of the corpus callosum (ACC), 15 cases of partial ACC, 15 cases of holoprosencephaly, 4 cases of arachnoid cyst, 10 cases of Dandy-Walker malformation, 4 cases of malformation Arnold-Chiari type Ⅱ, and 2 cases of vein of Galen aneurysm malformation. Conclusion: The lateral ventricle and cerebellum plane scanning is a safe, liable, practical and quick method to diagnose the fetal CNS midline structure abnormalities.

The mutual integration and application of artificial intelligence (AI) system and ultrasonic medical big data analysis and processing technology has developed into a new hot spot in the integration of medical industry. One of the most important algorithms at the heart of AI technology is deep machine learning, which can intelligently recognize and classify ultrasonic images. In recent years, more and more technical experts engaged in the field of ultrasound medical engineering and computer science at home and abroad have begun to devote themselves to how to promote the highly integrated development of intelligent ultrasound and big data technology, aiming at assisting clinical physicians screening, diagnosis, prognosis risk assessment, etc. It is helpful to reduce the workload of front-line medical staff, increase the accuracy of ultrasonography in assisting disease diagnosis and reduce the misdiagnosis rate of patients’ conditions, so as to improve the diagnosis and treatment efficiency and meet the rapid growth of various clinical service demands. This paper focused on the application of AI and big data technology in the clinical and practical work of hospital ultrasound, and summarized the technical necessity, development status and existing problems of AI and big data in the development of “medical and industrial integration” one by one. It aimed to promote the sustainable development of the integration of medicine and industry and improve the level of clinical practice of ultrasound medicine.

Clinically, space-occupying lesions aroud the wrist and hand are very popular. High-frequency ultrasound probe has a good soft tissue resolution. Some details of soft tissue masses such as shape, border, size and relationship with surrounding tissues can be shown clearly with high-resolution probe. We can draw a proper judgement of soft tissue masses around the wrist and hand when combining sonographic findings with clinical data. In this paper, we describe the clinical appearance and ultrasound findings of common soft tissue masses around the wrist and hand.

Objective: To explore the value of radiomics in thyroid carcinoma. Methods: Seventy-seven cases with unifocal papillary thyroid carcinoma in Fudan University Shanghai Cancer Center were chosen. The ultrasound examines were performed before surgery. The ultrasound images were analyzed and predicted lymph nodes metastasis by radiomics. The radiomics results were compared with pathological results. Results: There were 27 cases with lymph node metastasis. Among them, 4 cases were diagnosed by ultrasound before surgery. There were 50 cases without lymph node metastasis. Among them, 47 cases were diagnosed by ultrasound before surgery. Compared with pathological results, the accuracy, sensitivity and specificity of lymph node metastasis prediction by radiomics were 73.1%, 71.4% and 74.0%, respectively. Conclusion: There are certain value and great potential to determine the lymph node metastasis of papillary thyroid carcinoma by radiomics.

   Objective: To investigate the CT and MRI findings of primary hepatic neuroendocrine carcinoma (PHNEC) and its differential diagnosis. Methods: The data of CT and MR images of 2 cases with pathologically proved PHNECwere retrospectively analyzed. Results: One case with a single mass in the right hepatic lobe showed heterogeneous hypodense with intratumoral cystic degeneration on CT. The solid component was enhanced moderately in arterial phase and declined in portal venous phase. The mass with hypointensity on T1-weighed imaging (T1WI) and hyperintensity on T2-weighed imaging (T2WI) was shown on MRI. The other case had a dominant mass surrounded by satellite nodules and showed hypodense on non-enhanced CT. The masses were enhanced slightly in arterial phase and declined in portal venous phase. Conclusion: Slight to moderate enhancement in arterial phase and decline in portal venous phase was observed in PHNEC. Intratumoral cystic degeneration and dominant mass with satellite nodules might be the features.

  Objective: To explore a simple and accurate approach of assessing subacromial bursa (SAB) by comparing the ultrasound findings between patients with subacromial impingement syndrome (SIS) and healthy volunteers. Methods: Fifty-eight patients with totally 65 shoulders diagnosed with SIS and 50 healthy volunteers were recruited. Ultrasound of the shoulders was performed in all participants using four standard static views (both short-axis view and long-axis view of the supraspinatus tendon and the subscapularis tendon) to evaluate bursal effusion and bursal thickness. Results: The incidences of increased bursal thickness and bursal effusion were statistically higher in SIS patients than that in the controls (χ²=71.265, P＜0.001; χ²=15.345, P＜0.001). On static views, bursal thickness measured on the short axis view of the supraspinatus was greater than that measured on the other three views (all P＜0.05). Conclusion: Increased thickness and effusion of SAB in SIS patients can be accurately detected by ultrasound, and bursal thickness can be measured on the short axis view of the can supraspinatus simplely and accurately.

  Tumors and tumor-like lesions arising from tendons are infrequent. Here we reviewed the anatomy of tendons and the common types of tumors and tumor-like lesions of tendons and their sonographic features. Primary malignant or metastatic tumors of tendons are very rare, while primary benign tumors and tumor-like lesions are relatively more common. Benign tumors of tendons occur as soft tissue masses which are usually painless or just slightly tender. The common types of benign tumors of tendons are giant-cell tumor, chondroma, osteochondroma, osteoma, neurinoma, cavernous lymphangioma, cavernous hemangioma, leiomyoma and fibrolipoma. About half of these tumors are giant-cell tumors. Primary malignant tumors of tendons usually occur during 40-60 years old and often arise in the lower extremity. They are mainly various sarcomas, including clear-cell sarcoma, synovial and epithelioid sarcoma. Metastatic tumors of tendons, which are common in the hand, usually occur by direct extension from tumorous skin, joint, or tendon sheath, and hematogenic metastases are extremely rare. Tumor-like lesions of tendons tend to occur in the hand. The most common types are tendon ganglia, epithelial cyst and xanthoma.

Objective: To investigate the application value of fine-needle aspiration cytology (FNAC) combined with BRAF mutation detection in the diagnosis of thyroid nodules. Methods: A total of 87 patients who were diagnosed as suspicious malignant thyroid nodules by ultrasonic examination from June 2014 to June 2015 were selected. All the patients underwent FNAC and BRAF mutation detection by fluorescence polymerase chain reaction (PCR). Results: Among 64 malignant cases, 48 cases were positive and 16 cases were negative for FNAC, and 40 cases had BRAF^V600E mutation. Among 23 benign cases, 5 cases were positive and 18 cases were negative for FNAC, and no case had BRAF^V600E mutation. Compared with the postoperative pathological results, the sensitivity was 75.0%, the specificity was 78.3%, and the accuracy was 75.9% for FNAC. The sensitivity of BRAF mutation detection was 62.5%, the specificity was 100.0%, and the accuracy was 72.4%. The sensitivity was 89.1%, the specificity was 78.3%, and the accuracy was 86.2% for FNAC combined with BRAF^V600E mutation detection. Conclusion: FNAC combined with BRAF^V600E mutation detection can improve the sensitivity of diagnosis of malignant thyroid nodules.

Objective: To evaluate the ultrasonographic and mammographic characteristics of sclerosing adenosis (SA), and compare the diagnostic accuracy of the two radiological methods. Methods: Imaging characteristics of 151 lesions pathologically confirmed as SA were reviewed. All the lesions were graded by Breast Imaging Reporting and Data System (BI-RADS). Results: A total of 151 lesions were found in 145 patients. All the patients underwent ultrasonography, and imaging findings were as follows: heterogeneously echogenic areas in 9.3% (14/151), mass lesions in 65.6% (99/151), focal acoustic shadowing in 4.0%(6/151), and negative in 21.2% (32/151). A total of 136 patients underwent mammography, and imaging findings were as follows: microcalcifications in 31.6% (43/136), masses in 23.5% (32/136), asymmetric focal density in 14.7% (20/136), focal architectural distortion in 22.8% (31/136), and negative in 7.4% (10/136). Comparing BI-RADS category with histopathology, the accuracy of ultrasonography was higher than mammography (53.6% vs. 40.4%). Conclusion: There are no specific imaging characteristics of SA, and further studies about this disease are needed.

High-frequency ultrasound devices are able to provide high-resolution images of the skin successfully. Therefore, the high-frequency ultrasound with the frequency of 20~75 MHz may provide valuable and non-invasive diagnostic information for various benign and malignant skin tumors, inflammatory diseases, wounds and infections. But, due to the characteristics of skin structure including thinness and stratification, special attention should be paid to the clinical application of high-frequency ultrasound in dermatology, meanwhile, some challenges may be encountered. Herein, this article reviewed the principle, situation and prospect of the application of high-frequency ultrasound in dermatology.

Objective: To explore the application value of magnetic resonance imaging (MRI) in the diagnosis of complex anal fistula. Methods: A total of 32 cases with complex anal fistula underwent endoanal ultrasound (EAUS) and MRI. The diagnostic accuracies of EAUS and MRI were compared with surgical results. Their sensitivities of displaying the internal openings, primary tracts and secondary extensions or abscesses of complex anal fistula were compared too. Results: Compared with the surgical results, the accuracy of MRI was 90.6%. There were significant differences in the sensitivities of displaying internal openings and secondary extensions or abscesses between MRI and EAUS (P<0.05), but there was no significant difference in the sensitivity of displaying primary tracts between MRI and EAUS. Conclusion: The accuracy of diagnosing complex anal fistula by MRI was 90.6%. Compared with EAUS, MRI could more accurately display the internal openings, primary tracts, secondary extensions or abscesses of complex anal fistula, with important value in clinical application.

Objective: To evaluate the clinical value of technetium-^99m labelled small molecule against prostate specific membrane antigen (PSMA) (HYNIC-Glu-Urea-A, ^99mTc-PSMA) in the detection of primary and metastatic prostate cancers. Methods: A total of 69 consecutive prostate cancer patients who received ^99mTc-PSMA SPECT/CT were retrospectively analyzed. The sensitivity of ^99mTc-PSMA for the detection of the primary and metastatic lesions was evaluated. The relationships between positive ^99mTc-PSMA and prostate specific antigen (PSA) level and Gleason score were analyzed. Results: Of all patients, 6 cases with PSA<0.2 ng/mL after radical prostatectomy remained biochemically disease-free. Based on per patient, in 77.8% (49/63) of the patients at least one lesion indicative of prostate cancer was detected by ^99mTc-PSMA SPECT/CT. The level of PSA in the patients with positive ^99mTc-PSMA imaging was significantly higher than that in the patients with negative ^99mTc-PSMA imaging (PSA median 25.52 ng/mL, range: 0.85-3 239 ng/mL) vs. (PSA median 0.35 ng/mL, range: 0.003-9.28 ng/mL)(P<0.001). Among newly diagnosed patients and recurrent patients with PSA>1.0 ng/mL, ^99mTc-PSMA imaging was able to detect lesions with improved sensitivity of 97.4% (37/38); furthermore, among recurrent patients with PSA>10.0 ng/mL, the number and extent of lesions detected by ^99mTc- PSMA SPECT/CT increased significantly. Gleason score in the patients with positive ^99mTc-PSMA imaging was significantly higher than that in the patients with negative ^99mTc-PSMA imaging (P<0.001). Conclusion: Among newly diagnosed prostate cancer patients and recurrent patients with PSA>1.0 ng/mL, ^99mTc-PSMA SPECT/CT can detect prostate cancer and metastases in a high number of patients and can provide important information for clinical treatment decision.

Objective: To study the quality control of ¹⁸F-fluoroestradiol (18F-FES), and to establish the standard operation procedure (SOP) and quality criteria. Methods: ¹⁸F-FES was synthesized by SIEMENS Eclipse ST cyclotron and Explora GN/LC synthetic system. The contents and methods of quality control for ¹⁸F-FES were investigated, and the quality parameters were determined with standard procedure. Results: The SOP of 18F-FES synthesis was established, the corrected radiochemical yield was about 38%. The quality control methods and quality criteria were established according to Chinese Pharmacopoeia based on practice, and all quality parameters met the requirements. Conclusion: The methods and results of quality control of ¹⁸F-FES could ensure the drug safety for clinical PET imaging.

Ultrasound is critical to the diagnosis and treatment of colorectal cancer liver metastases. New ultrasound techniques, such as contrast-enhanced ultrasound, fusion imaging, acoustic elastography and intraoperative ultrasound, make ultrasound an indispensable tool for the diagnosis and treatment of colorectal cancer liver metastases. The present article emphasizes the clinical progress on new ultrasound techniques in the diagnosis and treatment of colorectal cancer liver metastases.

    Objective: To analyze the imagings of two-dimensional ultrasound and color Doppler flow imaging (CDFI) of chondrosarcoma, and to investigate the ultrasonic features of chondrosarcoma. Methods: A retrospective analysis of ultrasonography was performed in 19 cases pathologically diagnosed with chondrosarcoma. Results: 17 lesions (89.5%) were located in the deep muscle and close to the bone cortex surface, and two lesions (10.5%) were located in the breast. The lesion diameters in 18 cases (94.7%) were greater than or equal to 5 cm. 15 lesions (78.9%) had weak echo . Clear boundary was shown in 12 cases (63.2%) and irregular morphology was shown in 15 cases (78.9%). Heterogeneous internal echo appeared in 19 cases (100%). 17 cases (89.5%) had bone destruction, and 17 cases (89.5%) had calcification. The blood flow grades in 12 cases (63.2%) were 0 and I. There were 9 cases with low-grade chondrosarcoma and 10 cases with high-grade chondrosarcoma. There were significant differences in blood flow grade and calcification type between low-grade chondrosarcoma and high-grade chondrosarcoma (P<0.05). However, the size, boundary, shape, internal echo, calcification, bone destruction were not significantly different (P>0.05). Conclusion: Chondrosarcoma is a kind of weak echo mass localized in the deep muscle and close to the bone cortex, with diameter greater than or equal to 5 cm, clear boundary, irregular shape, uneven internal echo. Bone destruction, calcification and less blood supply are the common ultrasonographic appearances. The most common ultrasonic difference between low-grade chondrosarcoma and high-grade chondrosarcoma is that the former has less blood supply and patchy calcification.

Objective: To investigate the automatic radiomics approach in predicting the association between quantitative ultrasound features and hormone receptor status in invasive breast carcinoma. Methods: A total of 204 patients who accepted breast cancer surgery were retrospectively reviewed for pre-operative ultrasound images and post-operative pathological reports. Based on the expressions of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER-2), all patients were divided into hormone receptor positive (ER⁺, PR⁺, HER-2^-) group and hormone receptor negative (ER^-, PR^-, HER-2^-) group. Two dimensional features of shape, margin, echo pattern, posterior acoustic feature and calcification were assessed by two experienced radiologists and correlated with hormone receptor status. The same ultrasound images were then segmented for using a phase-based active contour model. The high-throughput radiomics features were extracted based on the two dimensional sonographic features. Target features were selected using Students’ t-test. The support vector machine classifier with radial basis function and leave-oneout-cross-validation were used to correlate quantitative sonographic features with the status of hormone receptor. Results: The two groups had significant differences in the objective sonographic characteristics of shape, angular/spiculated margin, echo pattern and posterior acoustic feature (P<0.05). In the quantitative radiomics analysis, 54 features were selected with high accuracy in predicting the status of hormone receptor (accuracy 67.7%, area under the curve 73.2%). In addition, in the quantitative analysis, the two groups showed significant difference in margin, echo pattern, posterior acoustic pattern and calcification (P<0.05).Conclusion: The quantitative features of ultrasound radiomics were well correlated with hormone receptor status of invasive breast carcinoma. Further study is warranted to validate its value in the precise diagnosis and biological behavior prediction of breast carcinoma.