Epiq 5

Ultrasound check was conducted using ultrasonographic scanners (Accuvix A30/ Samsung Medison, Aixplorer/SuperSonic Imagine and EPIQ5/Philips) equipped with a linear transducer (10–12 MHz) for morphological studies and a 4.7 MHz transducer for color-Doppler evaluation. All patients received scanning in supine position with hyperextended neck, in transverse and longitudinal planes. Real time imaging of thyroid lesions is visualized using both gray-scale and color Doppler techniques. The imaging characteristics of a mass, including shape, locations, size, margin (well defined or blurred), vascular pattern, contents (presence/absence of calcification) and echogenicity (isoechoic, hyper-or hypo-echoic) were checked and recorded.
Referring to the AJCC TNM-8 staging standard [8 (link)], we established the following ultrasonic T/N staging criteria (Tables 1 and 2). Thyroid ultrasound T-stage is based on the size, location of thyroid nodules and their relationship with surrounding tissues and organs.
One ultrasound doctor and one surgeon in our hospital performed T/N staging of ultrasound and pathological results of DTC patients by a double-blind method. The inconsistency was solved by discussion.

This study was approved by the Ethics Committee of Tongji Medical College of Huazhong University of Science and Technology. Informed consent from the patients was exempted (2019S1233). All ultrasound images included were consecutively acquired from 11 operators with more than 5 years of experience from Tongji hospital, Wuhan, China (internal cohort), and Xiangya Hospital of Central South University, Changsha, China (external cohort) from June 2017 to April 2019. Ultrasound equipment manufactured by GE Healthcare (LOGIQ E9, LOGIQ S7), Samsung (RS80A), and Philips (EPIQ5, EPIQ7 and IU22), was used to generate the thyroid ultrasound images. Ultrasound images were derived from the picture archiving and communication system (PACS) workstations.

TTE was performed routinely, on average 1–4 weeks before TAVR using either an iE33 or Epiq 5 (Philips Healthcare, Hamburg, Germany) ultrasound device. Examinations were conducted by experienced clinicians with more than 4 years of training in echocardiography. Severe AS was classified according to current guidelines of the European Society for Cardiology (ESC). Left ventricular ejection fraction (LVEF) was calculated using Simpson’s method. To graduate mitral, aortic and tricuspid valve regurgitation in minimal, mild (I), moderate (II) and severe (III) spectral and color-Doppler images were used. TRVmax was obtained by continuous wave Doppler over the tricuspid valve. Pulmonary artery pressure (PAP), right atrial pressure (RAP) and at least sPAP was calculated as described previously [6 (link)]. As part of an extensive literature search and a self-authored review on the topic of non-invasive ways of determining PH in severe AS, the most commonly used sPAP cut-off values of 40 and 50 mmHg were used [1 (link), 7 (link), 8 (link)]. To also assess the severity of echocardiographically determined PH, patients were further subdivided into no PH by sPAP < 35 mmHg, mild PH by sPAP 35–50 mmHg, moderate PH by sPAP 51–70 mmHg and severe PH by sPAP > 70 mmHg [9 (link)]. This classification is based on the recommendations of the American Society for Echocardiography [10 (link), 11 (link)].