The Earliest Timing Ultrasound can be Performed in the Screening for Developmental Dysplasia of the Hips (DDH)

Si Heng Sharon Tan, Keng Lin Wong, Andrew Kean Seng Lim and James HoiPo Hui Department of Orthopaedic Surgery, University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Health System (NUHS), Singapore (Full postal address: 1E Kent Ridge Road, NUHS Tower Block, Level 11, Department of Orthopaedic Surgery, Singapore 119074)

 Abstract

  Purpose

 The current study aims to evaluate the results of ultrasound screening done at various weeks of life, to determine the earliest timing ultrasound screening can be performed reliably.

 Methods

 In the 17-year cohort study, all neonates who underwent ultrasound screening prior to the twelfth week of life  with subsequent follow-up radiograph done at one year of life were included. The ultrasound images were  evaluated according to Graf classification, Harcke's dynamic ultrasound screening and Terjesen's femoral head  coverage. The radiographic images were evaluated according to acetabular index and femoral head position. The  accuracy and correlation between the ultrasound findings performed at the various weeks of life with the  radiographic findings performed at one year of life were evaluated.

Results

 A total of 348 neonates were included. When the ultrasound findings were correlated with the radiographic  findings at one year of life, significant differences were identified for ultrasound screening performed prior to the fourth week of life (day 21 and before) (p < 0.05). In contrast, there were no significant differences  identified when the ultrasound was performed between the fourth and twelfth week of life (day 22 and beyond)  (p > 0.05). The accuracy of ultrasound screening was 79.2% and above when performed during or after the  fourth week of life (day 22 and beyond).

Conclusion

The earliest timing that ultrasound screening for DDH can be performed reliably is during the fourth week of life (day 22 and beyond).

COMBINATION of ADVANCED ULTRASOUND TECHNIQUES, DIAGNOSING for THYROID NODULES BETTER

By Kate Madden Yee, AuntMinnie.com staff writer

March 5, 2019 -- Using a combination of advanced ultrasound techniques improves the accuracy of the modality for diagnosing suspicious thyroid nodules compared with conventional ultrasound alone, according to a study published online March 1 in the International Journal of Clinical Oncology

Chinese researchers used a combination of superb microvascular imaging (SMI), real-time elastography (RTE), and conventional ultrasound to analyze the characteristics of thyroid nodules that could indicate malignancy, wrote a team led by Dr. Shufang Pei of Southern Medical University, Guangzhou, Guangdong.

"The ultrasonographic features of these thyroid nodules are complex, and the characteristics of conventional ultrasound images often overlap," the group wrote. "The conventional ultrasound features of some nodules were shown to be benign, and the pathology of the surgery was confirmed to be malignant; while the conventional ultrasound features of some nodules showed malignancy, and the pathology confirmed by surgery was benign. ... Therefore, it is particularly important to accurately diagnose benign and malignant nodules.

Pei and colleagues conducted a study that included 196 thyroid nodules classified as category 4 using the Thyroid Imaging Reporting and Data System (TI-RADS 4) -- first imaged on ultrasound alone, then with a combination of ultrasound, SMI, and RTE. The group compared the sensitivity, specificity, accuracy, false-negative rate, and false-positive rate of each ultrasound method; the gold standard was surgical pathology results.

Of the nodules imaged, 78 were benign and 118 were malignant. The researchers found that their combination technique improved the diagnostic accuracy of TI-RADS 4 nodules and also helped differentiate malignant from benign nodules.

Advanced ultrasound techniques vs. conventional ultrasound for thyroid nodules
Performance measure	Ultrasound alone	Superb microvascular imaging (SMI)	Real-time elastography (RTE)	Ultrasound + SMI and RTE
Sensitivity	65.3%	78%	80.5%	94%
Specificity	69.2%	93.6%	84.6%	87.2%
Accuracy	66.8%	84.2%	82.1%	91.3%
False-negative rate	34.8%	22%	19.5%	6.9%
False-positive rate	30.8%	6.4%	15.4%	12.8%

All results were statistically significant.

The sensitivity, specificity, and accuracy rates of SMI and RTE were higher than those for ultrasound alone. Additionally, the group found that RTE had a higher sensitivity than SMI but also a higher false-positive rate.

It was the combination of the three that was the winning ticket.

"The results of this study suggest that the application of RTE and SMI may help compensate in areas in which conventional ultrasound may be deficient in assessing the TI-RADS category 4 nodules," the group concluded. "Thus, multimodal ultrasound imaging -- using the three methods -- may provide more comprehensive information regarding the nodules, facilitating more accurate diagnoses."