Vol 52, No 7 (2024)

Rationale: Due to rising prevalence of metabolic syndrome, obesity and type 2 diabetes mellitus, the prevalence of metabolic-associated hepatic steatosis has amounted to 38–42% worldwide. The burden of its dangerous complications, such as steatohepatitis, liver fibrosis and cirrhosis, hepatocellular carcinoma, make the search for effective diagnostic methods of liver steatosis a priority. However, lack standardization of assessments reduces the accuracy and reproducibility of their results and requires elaboration of unified protocols for such assessments.

Aim: To develop a unified algorithm for quantitative ultrasound steatometry of the liver and to evaluate its diagnostic accuracy (sensitivity, specificity, and reproducibility).

Methods: This was a three step study, with its 1st part including 34 specialists on echography diagnostics aged 28 to 64 years with varying levels of experience (1 to 3 years, n = 5, 15.6%; 4 to 10 years, n = 18, 50%; 11 to 20 years, n = 8, 25%; ≥ 21 years: n = 3, 9.4%). The accuracy of quantitative ultrasound steatometry procedure evaluated with a test questionnaire, by analysis of archived echograms (340 clinical cases), and real-time ultrasound steatometry performed in 102 patients under the direct or remote supervision of the authors. In the 2nd part of the study we examined 173 patients with liver steatosis confirmed by multiparametric echography, comprehensive clinical and biochemical SteatoTest, magnetic resonance spectroscopy, multiaxial computed tomography with color mapping, dual-energy X-ray absorptiometry in the "whole body" mode, and histological examination of liver biopsy samples.

In the 3rd part of the study we assessed the reproducibility of the quantitative ultrasound steatometry algorithm proposed by the authors, 12 ultrasound diagnostic physicians with varying levels of experience were involved (1 to 3 years: n = 3; 4 to 10 years: n = 3; 11 to 20 years: n = 3; more than 21 years: n = 3). Each physician examined 20 patients (5 patients in groups with no steatosis and with histologically confirmed steatosis of grades 1 to 3).

Results: In the 1st part of the study, we identified the main patterns of quantitative ultrasound steatometry of the liver by specialists in the ultrasound diagnostics. Based on the international and Russian guidelines, as well as our own research, we proposed standardized operational procedure for quantitative ultrasound steatometry. The comparative analysis in the 2nd part of the study showed that the implementation of the operational procedure proposed by the author was associated with more narrow intervals for the ultrasound wave attenuation coefficient and better reproducibility, compared to the most common “rules” used by specialists in the ultrasound diagnostics. There were significant differences in the diagnosis of moderate and maximal steatosis with these two approaches (p < 0.05). The sensitivity and specificity of the operational procedure proposed by the authors were 89% and 94%, respectively, compared to 75% and 79% for the commonly used approach. In the 3rd part of the study, there were no significant differences in the ultrasound wave attenuation coefficient measured by specialists with various levels of experience according to the authors’ algorithm. The inter-rater correlation coefficient was 0.948 (95% confidence interval [0.914; 0.973], p < 0.001), confirming the authors method's high reproducibility and consistency.

Conclusion: We have proposed an operational procedure for ultrasound quantitative steatometry of the liver, based on determination of the attenuation coefficient of the ultrasound wave in tissues. The implementation of this algorithm by medical specialists irrespective of their working experience provides high reproducibility of the method, with maximal sensitivity (89%) and specificity (94%).

Background: Breast malignancies take a leading position among incident cancers in women. Mammography has been recognized as the main method for early detection of breast cancer. However, mammogram assessments are based on a subjective opinion of the radiologist, which could lead to diagnostic disagreement. According to the literature, inter-radiologist agreement on mammograms varies from 0.450 to 0.888.

Aim: To assess the inter-reader agreement in mammogram interpretation with BI-RADS (Breast Imaging Reporting and Data System) by radiologists of the Moscow city (Russia).

Methods: The study included 741 mammography images done from January 15, 2020, to June 25, 2023. All mammograms were downloaded from the Unified Radiology Information Service of the Unified Medical Information and Analytical System (EMIAS) of the Moscow city and included radiologist reports with a BI-RADS score (the initial assessment). Each mammogram was further analyzed by two radiologists (with their job experience from 2 to 5 years) (this was the first revision) and thereafter by two more radiologists (with their job experience above 5 years and scientific degree) as a part of the expert review. The inter-reader agreement was assessed using an intra-class correlation coefficient.

Results: The inter-reader agreement for the full BI-RADS score between radiologists who performed the initial assessment and those performing the first revision ranged from 0.836 [95% confidence interval (CI) 0.801–0.865] to 0.875 [95% CI 0.848–0.897]. Similar agreement was observed between radiologists who performed the initial assessment and the experts: 0.838 [95% CI 0.804–0.866] to 0.879 [95% CI 0.854–0.901]. The agreement on the full BI-RADS scale between radiologists who performed the first revision and the experts was significantly higher (p < 0.001) than with those performing the initial assessment and ranged from 0.890 [95% CI 0.866–0.910] to 0.963 [95% CI 0.954–0.970].

Conclusion: The inter-reader agreement between radiologists of the Moscow city in the assessment of mammography study results on the full BI-RADS scale is high. The agreement between the radiologists who performed the revision is higher than their agreement with the radiologists who performed the initial assessment, which may indicate better and more stable results obtained during the revision.

Bezold’s abscess is a rare intra-temporal complication of mastoiditis; it is a deep cervical abscess with the spread of infection from the mastoid to medial to the attachment of the sternocleidomastoid muscle. There are less than 100 cases of Bezold’s abscess described in the literature. Computed tomography (CT) of the temporal bone and neck has been accepted as a tool for the primary and precise diagnostics. The most common radiological signs include destructive abnormalities of the temporal mastoid (53 to 67% of the cases) and an abscess in the neck soft tissues (60% of the cases). There have been isolated reports on the presence of a substrate in the mastoid without any visible destruction.

We present a rare clinical case of primary posttraumatic mastoiditis complicated by Bezold’s abscess and phlegmon of the neck. Patient S., 39 years old, was admitted with complaints of discharge from the right ear, decreased hearing on the right side, tenderness in the right retroauricular region, erythema and swelling on the lateral neck surface, and increased body temperature to 38.3 °C. A week before hospitalization, he had been hit in his right ear. CT of the temporal bones showed no mastoid destruction. The contrast-enhanced neck CT in the conventional mode was unremarkable for any liquid-containing masses and thickening or lumping. Virtual mono-energetic images 40 keV generated from spectral CT scans were able to identify liquid-containing delimited masses representing the accumulation of pus. The patient underwent right antromastoidectomy, with opening and drainage of the neck phlegmon. In the postoperative period, his condition improved with a decrease in clinical signs and symptoms and serum inflammatory markers. The patient was discharged home on the 10^th day to be followed up by an ENT specialist.

This clinical observation of a rare atypical mastoiditis in an adult patient demonstrates the important role of CT in the diagnosis and assessment of the disease zone to determine the surgical strategy. The potential of spectral CT allows to visualize neck abscesses before the planning of a surgical intervention and to confirm the clinically based anticipated diagnosis.