Li Ma

Cronkhite–Canada syndrome is a rare, non-hereditary polyposis syndrome characterized by non-specific gastrointestinal symptoms accompanied by alopecia, cutaneous hyperpigmentation, and nail dystrophy. Characteristic endoscopic findings are diffuse sessile polypoid lesions with edematous mucosa. We report a case of a 44-year-old woman in whom intestinal ultrasound and CT revealed diffuse mucosal thickening and an ileocecal intussusception—findings that may not be pathognomonic but are highly unusual in adults. These imaging features served as critical red flags that directed the clinical suspicion toward Cronkhite–Canada syndrome and prompted timely endoscopic confirmation.

Background: The value of intestinal ultrasound (IUS) in predicting treatment outcomes in ulcerative colitis (UC) remains underexplored. Objectives: To compare the predictive accuracy of representative IUS scores for long-term endoscopic outcomes in UC. Design: A retrospective observational study. Methods: Consecutive UC patients initiating biologics/small-molecule drugs were enrolled. IUS examinations were performed at baseline, 4–6 months, and at the first colonoscopy reassessment (12–30 months). IUS images were reviewed, and bowel wall thickness (BWT), Milan ultrasound criteria (MUC), and International Bowel Ultrasound Segmental Activity Score (IBUS-SAS) were recorded. Endoscopic response was assessed using the Mayo Endoscopic Score (MES), with remission defined as MES = 0 and improvement as MES ⩽1. Results: Forty-nine patients were included. All three IUS scores showed significant correlations with concurrent MES, with IBUS-SAS demonstrating the strongest association (BWT, ρ = 0.54; MUC, ρ = 0.55; IBUS-SAS, ρ = 0.69). IBUS-SAS at 4–6 months was the most accurate predictor of long-term endoscopic remission (area under the curve (AUC) 0.767) and endoscopic improvement (AUC 0.770). On multivariable analysis, an IBUS-SAS score p = 0.005), while an IBUS-SAS score p = 0.006). Conclusion: The IBUS-SAS score at early follow-up may serve as a valuable predictor of long-term endoscopic outcomes in UC.

Background: There are only a limited number of countries systematically tracking the quality of ultrasound at the national and institutional levels. Our study presents an example of a national, data-driven approach to ultrasound medicine quality measurement and improvement through indicators. Aim: This study aims to establish a nationwide, indicator-based framework for measuring and improving the quality of ultrasound medicine in China. By developing and applying quality indicators, we seek to systematically evaluate performance, identify areas for improvement and guide data-driven quality enhancement efforts across institutions. Methods: To enhance ultrasound quality and improve quality management, a leadership team was established. Pertinent quality indicators were developed as evaluation metrics. Quality improvement programmes were designed following the identification of key causes of suboptimal performance. A Plan-Do-Study-Act method was applied. Nationwide sample surveys were conducted annually to collect and document the relevant quality data. 10 ultrasound quality indicators were selected and comparisons of data from 2020 to 2023 were made. χ² tests were used to evaluate statistical differences. Results: The ultrasound instruments quality inspection rate, the completion rate of notification of ultrasound critical findings within 10 min, the qualification rate of ultrasound reports remained and the completion rate of inpatient ultrasound examinations within 48 hours remained consistently high. The Breast Imaging Reporting and Data System utilisation rate of breast lesions in ultrasound reports, the concordance rate of ultrasound diagnoses, the accuracy rate of ultrasound diagnosis of breast lesions and the concordance rate of ultrasound diagnosis of ≥50% carotid stenosis all improved and showed an upward trend. Conclusions: Indicator-based data can drive nationwide measurement, improvement and monitoring of ultrasound medicine quality. The use of indicators supports sustained efforts to improve quality and safety in ultrasound services.

INTRODUCTION: Gastrointestinal ultrasound (GIUS) is recommended for monitoring Crohn's disease (CD). GIUS scores are used to quantify CD activity. Among them, International Bowel Ultrasound Segmental Activity Score (IBUS-SAS), Bowel Ultrasound Score (BUSS), Simple Ultrasound Score, and Simple Ultrasound Score for Crohn's Disease are most commonly used. The aim of this study was to compare and correlate the performance of such indicators with endoscopic activity and to calculate interobserver agreement. METHODS: Consecutive patients with CD at our hospital between June 2015 and July 2021 were retrospectively enrolled. All patients underwent ileocolonoscopy after medical treatment. GIUS was performed within 2 weeks, and 4 GIUS scores were independently calculated. Receiver operating characteristic curve analyses were used to determine a cutoff value. Cohen kappa (κ) coefficient was calculated to estimate the agreement between GIUS findings. RESULTS: A total of 106 patients with CD were enrolled. 80.2% (85/106) were endoscopic active (Simple Endoscopic Score for Crohn's disease ≥3), and 8.49% (9/106) were severe cases (Simple Endoscopic Score for Crohn's disease ≥9). All GIUS features (bowel wall thickness, color Doppler signs, bowel wall stratification, inflammatory signals at the mesentery) were statistically significant in assessing CD activity (P < 0.05). IBUS-SAS showed the highest area under the curve (0.98; 95% CI: 0.96–1.00) and specificity (95.2%) for a cutoff value of 46.50. However, IBUS-SAS had only moderate agreement (Cohen κ = 0.427; P < 0.001). BUSS had substantial interobserver agreement (Cohen κ = 0.947; P < 0.001), with a similar diagnostic value (sensitivity, 100.0%; accuracy, 95.3%; area under the curve of 0.96 [95% CI: 0.91–1.00] for a cutoff value of 4.58). DISCUSSION: GIUS score is an efficient and reliable method to assess CD activity. BUSS achieved a high accuracy and excellent interobserver agreement, which is more suitable for treatment assessment.

Purpose The role of cross-sectional imaging in the management of acute appendicitis (AA) is contentious. This study aimed to investigate the current usage and diagnostic performance of ultrasound (US) and computed tomography (CT). Methods A national survey was conducted by a core group from The National Ultrasound Quality and Control Center of China among radiologists practicing in medical institutions equipped with emergency departments and regularly performing appendectomies. Radiologists participated by completing the survey online from August 2022 to August 2023 after reviewing medical records of at least 40 patients with suspected AA. Sensitivity, specificity, positive predictive value, and negative predictive value and likelihood ratios were calculated for US and CT, respectively. Diagnostic performance of US between hospital subgroups were also compared. Results A total of 141 questionnaires were submitted and 118 were eligible, each representing a distinct hospital. A total of 1844 children and 4165 adults were included. There were 76.4% patients underwent US studies, while 23.9% underwent CT studies. Higher percentage of children underwent US studies than adults (82.2% vs. 73.9%, P = 0.000). In children, the sensitivity and specificity of US were 89% and 90%, and of CT were 90% and 48%. In adults, the sensitivity and specificity of US were 92% and 84%, and of CT were 94% and 79%. The Likelihood ratios of US were higher in specialized hospitals (children’s or children’s and women’s hospitals) than general hospitals (34.1 vs. 6.43). Conclusion US is more commonly used than CT for diagnosing AA in both adults and children. The diagnostic performance of US is comparable to CT. These findings underscore the recognition of US in clinical practice as a low-cost, non-radiative tool.

INTRODUCTION: Stricture is a common complication in Crohn's disease (CD). Accurate identification of strictures that poorly respond to biologic therapy is essential for making optimal therapeutic decisions. The aim of this study was to determine the association between ultrasound characteristics of strictures and their therapeutic outcomes. METHODS: Consecutive CD patients with symptomatic strictures scheduled for biologic therapy were retrospectively recruited at a tertiary hospital. Baseline intestinal ultrasound was conducted to assess stricture characteristics, including bowel wall thickness, length, stratification, vascularity, and creeping fat wrapping angle. Patients were followed up for a minimum of 1 year, during which long-term outcomes including surgery, steroid-free clinical remission, and mucosal healing were recorded. Statistical analyses were performed. RESULTS: A total of 43 patients were enrolled. Strictures were located in the ileocecal region (39.5%), colon (37.2%), anastomosis (20.9%), and small intestine (2.3%). The median follow-up time was 17 months (interquartile range 7–25), with 27 patients (62.8%) undergoing surgery. On multivariant analysis, creeping fat wrapping angle > 180° (odds ratio: 6.2, 95% confidence interval [CI]: 1.1–41.1) and a high Limberg score (odds ratio: 2.3, 95% CI: 1.4–6.0) were independent predictors of surgery, with an area under the curve of 0.771 (95% CI: 0.602–0.940), accuracy of 83.7%, sensitivity of 96.3%, and specificity of 62.5%. On Cox survival analysis, creeping fat >180° was significantly associated with surgery (hazard ratio, 5.2; 95% CI: 1.2–21.8; P = 0.03). In addition, creeping fat was significantly associated with steroid-free clinical remission (P = 0.015) and mucosal healing (P = 0.06). DISCUSSION: Intestinal ultrasound characteristics can predict outcomes in patients with stricturing CD who undertook biologic therapy.

This study aims to establish precise quality indicators for evaluating and enhancing ultrasound performance, employing a methodology based on a comprehensive review of the literature, expert insights, and practical application experiences. We conducted a thorough review of both the domestic and international literature on ultrasound quality control to identify potential indicators. A dedicated team was formed to oversee the complete indicator development process. Utilizing a three-round modified Delphi method, we sought expert opinions through personalized email correspondence. Subsequently, data from diverse hospital indicators were collected to validate and assess feasibility. A novel set of seven indicators was compiled initially, followed by the convening of a 36-member nationally representative expert panel. After three rounds of meticulous revisions, consensus was reached on 13 indicators across three domains. These finalized indicators underwent application in various hospital settings, demonstrating their initial validity and feasibility. The development of thirteen ultrasound quality indicators represents a significant milestone in evaluating ultrasound performance. These indicators empower hospitals to monitor changes in quality effectively, fostering efficient quality management practices.

Purpose To assess the consistency of Ovarian-Adnexal Reporting and Data System (O-RADS) lexicon interpretation between senior and junior sonologists and to investigate its impact on O-RADS classification and diagnostic performance. Methods We prospectively studied 620 patients with adnexal lesions, all of whom underwent transvaginal or transrectal ultrasound performed by a senior sonologist (R1) who selected the O-RADS lexicon description and O-RADS category for the lesion after the examination. Meanwhile, the junior sonologist (R2) analyzed the images retained by R1 and divided the lesion in the same way. Pathological findings were used as a reference standard. kappa (к) statistics were used to assess the interobserver agreement. Results Of the 620 adnexal lesions, 532 were benign and 88 were malignant. When using the O-RADS lexicon, R1 and R2 had almost perfect agreement regarding lesion category, external contour of solid lesions, presence of papillary inside cystic lesions, and fluid echogenicity (к: 0.81–1.00). Substantial agreement in solid components, acoustic shadow, vascularity and O-RADS categories (к: 0.61–0.80). Consistency in classifying classic benign lesions in the O-RADS category was only moderate (к = 0.535). No significant difference in diagnostic performance between them using O-RADS (P = 0.1211). Conclusion There was good agreement between senior and junior sonologists in the interpretation of the O-RADS lexicon and in the classification of O-RADS, except for a moderate agreement in the interpretation and classification of classic benign lesions. Differences in O-RADS category delineation between sonologists had no significant effect on the diagnostic performance of O-RADS.

Background: Intestinal Behçet’s disease (BD) and Crohn’s disease (CD) are two diseases that commonly involve the ileocecal region and are difficult to differentiate. We aimed to investigate the value of intestinal ultrasound (IUS) in differentiating between these diseases. Methods: In this case-control study, patients diagnosed with intestinal BD or CD in the ileocecal region involved were recruited. The IUS characteristics of the two disease groups in terms of disease location, ileocecal region characteristics, and complications were compared. The differences were analyzed using univariate and multivariate analyses. Results: We consecutively enrolled 22 intestinal BD and 44 age- and sex-matched CD patients. On univariate analysis, focal lesion, ileocecal region involvement only, presence of ulcers on ultrasound (US), large ulcers (>2 cm) on US, and fistulas were significantly more common in intestinal BD than in CD, whereas small intestine involvement was significantly more common in CD. On multivariate analysis, focal lesion [odds ratio (OR) 0.156, 95% confidence interval (CI): 0.043–0.564], and large ulcers (OR 0.056, 95% CI: 0.006–0.550) were independent predictors of intestinal BD over CD. The area under the curve for the receiver-operating characteristic was 0.808 (95% CI: 0.706–0.929), and the sensitivity and specificity with a cutoff value of 0.7 were 75.0% and 77.3%, respectively. Conclusions: IUS can provide useful information for the differential diagnosis of intestinal BD and CD.