Advances in mesenchymal stem cells therapy for tendinopathies / 中华创伤杂志(英文版)

Tendinopathies are chronic diseases of an unknown etiology and associated with inflammation. Mesenchymal stem cells (MSCs) have emerged as a viable therapeutic option to combat the pathological progression of tendinopathies, not only because of their potential for multidirectional differentiation and self-renewal, but also their excellent immunomodulatory properties. The immunomodulatory effects of MSCs are increasingly being recognized as playing a crucial role in the treatment of tendinopathies, with MSCs being pivotal in regulating the inflammatory microenvironment by modulating the immune response, ultimately contributing to improved tissue repair. This review will discuss the current knowledge regarding the application of MSCs in tendinopathy treatments through the modulation of the immune response.

Diagnostic value of contrast-enhanced ultrasound in hepatic epithelioid hemangioendothelioma / 中华肝脏病杂志

Objective: To investigate the features of contrast-enhanced ultrasound (CEUS) in hepatic epithelioid hemangioendothelioma (HEHE) in order to improve the preoperative diagnosis rate. Methods: CEUS images of 32 pathologically-proven cases of hepatic epithelioid hemangioendothelioma from January 2004 to August 2021 were collected. Lesions were analyzed to observe the features of enhancement mode, enhancement intensity, and distinct enhancement phases. Results: Among the 32 cases, one had a solitary lesion, 29 had multiple lesions, and two had diffuse-type lesions. Contrast-enhanced ultrasound revealed a total of 42 lesions in 32 cases. In terms of arterial phase enhancement, 18 lesions had overall enhancement, six lesions had uneven dendritic enhancement, 16 lesions had rim-like enhancement, and two lesions had just slight peripheral spot enhancement around the lesions. Among the three cases, there were multiple lesions that had overall enhancement and ring enhancement. In terms of the enhancement phase, 20 lesions showed "fast progression", 20 lesions showed "same progression", and two lesions showed "slow progression". During the late arterial or early portal venous phases with rapid washout, all lesions manifested as hypoechoic. With peaked enhanced intensity, 11 lesions had a lower enhancement intensity than the surrounding normal liver parenchyma; 11 lesions had the same enhancement degree as the surrounding normal liver parenchyma; and 20 lesions had a higher enhancement degree than the surrounding normal liver parenchyma. All 16 ring-enhancing lesions had marked hyperenhancement. In the typical enhancing lesions, four showed hyperenhancement, five showed low enhancement, and nine showed isoenhancement. In the dendrite-enhancing lesions, there were two isoenhancing and four hypoenhancing. Contrast-enhanced ultrasound delineated the boundaries of all lesions more clearly than two-dimensional ultrasound. Conclusion: Contrast-enhanced ultrasound has certain value in the diagnosis of hepatic epithelioid hemangioendothelioma.

Pathological Change of Chronic Hepatitis B Patients with Different Tongue Coatings by Circular Multi-Omics Integrated Analysis / 中国结合医学杂志

OBJECTIVE@#To compare the circular pathological changes of chronic hepatitis B (CHB) patients according to the tongue diagnosis.@*METHODS@#Totally 41 CHB patients with typical white tongue coating (WTC) or yellow tongue coating (YTC) were enrolled and 14 healthy volunteers with normal tongue manifestation served as controls. The mRNA expression of peripheral leukocytes was detected by GeneChips, and 9 genes were randomly selected for expression validation. Circular metabolites were detected by gas chromatographymass spectrometry. Biological information was analyzed based on ingenuity pathways analysis or metabolomics database and the integrated networks were constructed by ClueGO.@*RESULTS@#A total of 945 and 716 differentially expressed genes were found in patients with WTC and YTC relative to healthy volunteers respectively. The biological information analysis indicated that CHB patients had obviously increased functions in cell death, apoptosis and necrosis (Z-score ⩾2, P<0.05) and decreased activation in T lymphocytes (Z-score ⩽-2, P<0.05), regardless of the tongue manifestation. Compared to patients with WTC, the YTC patients were predicted to be more active in functions related to virus replication (Z-score ⩾2, P<0.05), and the content of circular fatty acids, such as oleic acid (P=0.098) and lauric acid (P=0.035), and citric acid cycle-related metabolites were higher in the YTC patients (P<0.1). The integrated analysis based on differential genes and metabolites indicated that the most difference in the biological function network between the WTC and YTC patients was tumor necrosis factor receptor associated factor 6 mediated-nuclear factor kappa-B activation process.@*CONCLUSIONS@#CHB patients with YTC had more severe inflammation and fatty acids metabolism aberrant than patients with WTC. The results facilitate the modern pathological annotation of Chinese medicine tongue diagnosis theory and provide a reference for the interpretation of pharmacological mechanisms of Chinese medicine treatment.

LU Shan-zhong's academic contribution to the recent and modern acupuncture and moxibustion / 中国针灸

By arranging Mr. LU Shan-zhong's papers and works, his academic contributions to acupuncture and moxibustion were summarized. It mainly includes standardizing the clinical diagnosis and treatment of acupuncture and moxibustion, and finding the fusion point of the western and traditional medicine; building the acupuncture and moxibustion education system, innovating acupuncture and moxibustion talent training programs; exploring the academic connotation of acupuncture and moxibustion, and promoting acupuncture and moxibustion therapy.

Exploration of practice of acupuncture-moxibustion scientization by HUANG Xue-long, the successor of Chengjiang school / 中国针灸

HUANG Xue-long is a direct disciple of CHENG Dan-an. He is the second-generation representative heir of Chengjiang school. Through research on his practice and achievements of acupuncture and moxibustion scientization, we found that his main contributions were as follows. He has carried out beneficial explorations along with the scientific thinking of Chengjiang school, elucidated the theory of acupoints, clarified acupuncture and moxibustion manipulations, and explained the mechanism of acupuncture and moxibustion. His explorations promote the scientific process of acupuncture and moxibustion and enrich the academic system of acupuncture and moxibustion.

Clinical application of contrast-enhanced ultrasound in inflammatory hepatocellular adenoma / 中华超声影像学杂志

Objective:To investigate the contrast-enhanced ultrasound (CEUS) features of inflammatory hepatocellular adenoma (I-HCA).Methods:The contrast-enhanced ultrasound features I-HCA of 28 cases from April 2009 to November 2019 in Zhongshan Hospital, Fudan University were retrospectively analyzed, including arterial phase enhancement pattern, the homogeneity of enhancement, subcapsular enhancement, and the internal perfusion defect. All I-HCA lesions were divided into >5 cm group( n=9) and ≤5 cm group( n=19), the CEUS features between the two groups were compared. Results:All I-HCA lesions were hyper-enhanced in the arterial phase, among which 39.3% (11/28) showed diffuse filling, 39.3%(11/28) showed centripetal filling, and 21.4%(6/28) showed centrifugal filling pattern. Twenty-five percent (7/28) of I-HCAs showed heterogeneous enhancement, 10.7% (3/28) revealed unenhanced areas within the lesions. Subcapsular vessels were observed in 67.7 (21/31) of I-HCA lesions. Heterogeneous enhancement and unenhanced areas were more frequently detected in lesions >5 cm ( P=0.020, 0.026, respectively), while there was no difference in the enhancement pattern and subcapsular vessels between the two groups ( P>0.05). Inportal venous phase, 42.9%(12/28) of I-HCAs showed hypo-enhancement, and 57.1%(16/28) of lesions showed washout in late phase. According to "hyper-enhancement in arterial phase, sustained hyper- or iso-enhancement in portal venous and late phase" by CEUS, the diagnostic accuracy of benign lesion was 42.9%(12/28). According to any of hyper-enhancement pattern in arterial phase, subcapsular vascular enhancement, and sustained hyper- or iso-enhancement in portal venous and late phase, the diagnostic accuracy of I-HCA was 71.4% (20/28). Conclusions:CEUS is valuable in the diagnosis of inflammatory hepatocellular adenoma.

Prevalence of gene mutations in a Chinese 46,XY disorders of sex development cohort detected by targeted next-generation sequencing / 亚洲男科学杂志(英文版)

46,XY disorders of sex development (DSD) is characterized by incomplete masculinization genitalia, with gonadal dysplasia and with/without the presence of Müllerian structures. At least 30 genes related to 46,XY DSD have been found. However, the clinical phenotypes of patients with different gene mutations overlap, and accurate diagnosis relies on gene sequencing technology. Therefore, this study aims to determine the prevalence of pathogenic mutations in a Chinese cohort with 46,XY DSD by the targeted next-generation sequencing (NGS) technology. Eighty-seven 46,XY DSD patients were enrolled from the Peking Union Medical College Hospital (Beijing, China). A total of fifty-four rare variants were identified in 60 patients with 46,XY DSD. The incidence of these rare variants was approximately 69.0% (60/87). Twenty-five novel variants and 29 reported variants were identified. Based on the American College of Medical Genetics and Genomics (ACMG) guidelines, thirty-three variants were classified as pathogenic or likely pathogenic variants and 21 variants were assessed as variants of uncertain significance. The overall diagnostic rate was about 42.5% based on the pathogenic and likely pathogenic variants. Androgen receptor (AR), steroid 5-alpha-reductase 2 (SRD5A2) and nuclear receptor subfamily 5 Group A member 1 (NR5A1) gene variants were identified in 21, 13 and 13 patients, respectively. The incidence of these three gene variants was about 78.3% (47/60) in patients with rare variants. It is concluded that targeted NGS is an effective method to detect pathogenic mutations in 46,XY DSD patients and AR, SRD5A2, and NR5A1 genes were the most common pathogenic genes in our cohort.

Cumulative Risk Assessment of Exposure to Heavy Metals through Aquatic Products in China / 生物医学与环境科学（英文）

Objective@#This study aimed to assess the risk of cumulative exposure to Pb, Cd, Hg, and iAs through aquatic products consumed by Chinese people.@*Methods@#Heavy metal concentration data were obtained from the national food contamination monitoring program during 2013-2017. Consumption data were derived from the China National Food Consumption Survey in 2014 and the relative potency factor (RPF) method was used to estimate cumulative exposure for neurotoxicity and nephrotoxicity.@*Results@#The results demonstrated that the cumulative exposure based on neurotoxicity was below the lower confidence limit on benchmark doses of lead (BMDL @*Conclusion@#The cumulative exposures of the 2-6 year-old group to the four heavy metals did not reach (but came close to) the corresponding safety threshold for both neurotoxicity and nephrotoxicity. Given that there are still other food sources of these four heavy metals, it is necessary to more closely study their cumulative health effects.

Analysis and Enlightenment of Foreign Open Breast Image Datasets / 中国医学科学院学报

With the upsurge of medical artificial intelligence,the use of computer vision technology to study medical images,which can effectively help doctors to identify and screen diseases,has become a focus of researchers.This paper summarizes the basic situation,specific information,related research,and data sharing and utilizing ways of foreign breast image datasets.This review provides inspirations for the opening of Chinese medical and health data.

Clinical value of contrast- enhanced ultrasound in the diagnosis of subcapsular small liver cancer / 中国肿瘤临床

Objective: To evaluate the value of contrast-enhanced ultrasound (CEUS) in the diagnosis of subcapsular small liver cancer. Methods: Fifty-one patients diagnosed with subcapsular liver cancer by ultrasound or other imaging between January 2017 and July 2019 were enrolled. The manifestations of conventional ultrasound and contrast-enhanced ultrasonography were analyzed, and the characteristics, summarized. Results: There were a total of 53 lesions, all of which were confirmed on the basis of surgical findings, clinical manifestations, or imaging findings. All lesions were located under the liver capsule. Forty-five lesions were located close to the liver capsule, whereas 8 lesions were located within 10 mm from the liver capsule. Of the subcapsular lesions, 90.6% (48/53) were isoechoic and slightly higher or lower echoic, and 94.3% (50/53) had unclear boundaries. CEUS revealed rapid arterial enhancement in 48 of 53 lesions and synchronous enhancement in 5 lesions. In the portal phase, 38 lesions (71.7%) presented hypoechoic changes, and 15 lesions presented isoechoic changes. In the delayed phase, 50 lesions (94.3%) presented hypoechoic changes, and 3 lesions presented isoechoic changes. Among the 53 lesions, the "fast in and fast out" type was found in 38 cases (71.7%) and the "fast in and slow out" type, in 12 cases (22.6%). There were also 3 cases (5.7%) of "fast in and no out" type. Conventional ultrasound revealed 15 lesions, with a detection rate of 28.3% (15/53), and contrast-enhanced ultrasound revealed 53 lesions, with a detection rate of 100% (53/53). The difference between the two methods was statistically significant (P<0.01). Conclusions: Contrast-enhanced ultrasound has a high detection rate for subcapsular small liver cancer and has a significant clinical value.

The fifth metacarpal neck fracture treated by closed reduction and intramedullary fixation with antegrade Kirschner wire plus rod rotation technique / 中华创伤骨科杂志

Objective:To assess the clinical effects of closed reduction and intramedullary fixation with antegrade Kirschner wire plus rod rotation technique in the treatment of the fifth metacarpal neck fracture.Methods:In this retrospective study, 26 patients with the fifth metacarpal neck fracture were treated by closed reduction and intramedullary fixation with antegrade Kirschner wire plus rod rotation technique at Department of Orthopaedics, Central Hospital of Karamay from August 2015 to October 2017. They were 23 males and 3 females, aged from 12 to 53 years with an average age of 25.2 years. In the intramedullary nailing, a Kirschner wire pre-bent by 10° to 15° was inserted from the base of the fifth metacarpal into the medullary canal before closed reduction. After satisfactory reduction was achieved, the Kirschner wire was inserted across the fracture site into the metacarpal head for further reduction and fixation using rod rotation technique. After operation, a plaster was applied to protect the fixation for 2 weeks. Functional exercise was started after removal of the plaster. The Kirschner wire was not removed under local anaesthesia at the outpatient department until about 10 to 16 weeks postoperation when X-ray showed fracture healing. Records of their operation time, head/shaft angle of the fifth affected metacarpal, active range of motion of the metacarpophalangeal joints and Total Active Movement (TAM) of hand function at the last follow-up were collected.Results:Their operation time averaged 21 minutes (from 12 to 35 minutes). Anatomical reduction was achieved in 23 cases but not in 3 ones whose metacarpal head/shaft angle and alignment were obviously improved. Follow-ups for 6 to 29 months (average, 15.8 months) showed all the patients obtained solid fracture healing with no infection or delayed fracture healing. The head/shaft angle was improved significantly from preoperative 61.2°±11.2° to postoperative 14.7°±3.5° ( P<0.05) which was not significantly different from that of the healthy side (14.6°±1.7°)( P>0.05). The active range of motion of the metacarpophalangeal joint was 89.3°±4.2° after fixation removal, not significantly different from that of the healthy side (90.7°±1.5°) ( P>0.05). According to TAM scores at the last follow-up, 22 cases were rated as excellent, 3 as good and one as fair. Conclusion:In the treatment of the fifth metacarpal neck fracture, closed reduction and intramedullary fixation with antegrade Kirschner wire plus rod rotation technique is effective, because it is simple and limitedly invasive, and leads to limited complications, low costs and secondary reduction.

Definition of lost acupuncture technique: based on / 中国针灸

OBJECTIVE@#By defining the inclusion criteria of the lost acupuncture technique and sorting out the content of lost acupuncture technique (possibly lost acupuncture technique), this article aimed to provide ideas and methods of the inheritance of acupuncture technique.@*METHODS@#The whole entries of @*RESULTS@#A total of 364 items of acupuncture technique were retrieved, including 17 items of lost acupuncture technique and 12 items of possibly lost acupuncture technique.@*CONCLUSION@#The lost acupuncture technique is defined as the acupuncture technique recorded in ancient classics but can not be retrieved in modern literature of clinical application or expert's experience. The change of government or alternation of dynasty, the evolution of acupuncture-moxibustion theories and education are the related causes of lost acupuncture technique.

Discussion on the needling technique with filiform needle in acupuncture-moxibustion teaching materials in the Republic of China / 中国针灸

Through collecting the literature data of the needling technique with filiform needle in 20 acupuncture-moxibustion teaching materials in the Republic of China， the manipulation techniques with filiform needle were analyzed, such as the technique of needle insertion, the technique of reinforcing and reducing, and the management of acupuncture abnormal conditions, as well as manual techniques and analgesics methods. It is found that the era of the Republic of China was the transition period of traditional acupuncture techniques to the modern ones in acupuncture-moxibustion teaching materials, in which, the twirling technique was predominated in the technique of needle insertion. In that period, the insertion technique of tube needle had been introduced and simplified, the theory and method of the new-style technique of reinforcing and reducing were emerged and the types of acupuncture abnormal conditions recorded in the teaching materials were different from those at present. Additionally, the applicable manipulation had not been specified nationally. There were the highly influential teaching materials, i.e. , and . The acupuncture-moxibustion teaching materials in the Republic of China has been influenced by the transition of acupuncture-moxibustion education modes, the introduction of Chinese-translation version of Japanese acupuncture-moxibustion books, the academic thoughts of acupuncture masters and the manufacturing process of needle devices.

Prognosis analysis and 21-gene recurrence score according to TAILORx standard in hormone receptor positive early-stage breast cancer / 中华普通外科杂志

Objective@#To explore the association of 21 gene recurrence score(RS)according to TAILORx standard and prognosis of hormone receptor(HR) positive, axillary lymph node negative breast cancer.@*Methods@#The clinicopathologic data of 558 early breast cancer patients who underwent 21 gene RS testing from May 2012 to Jan 2017 were retrospectively analyzed. RS was subgrouped according to TAILORx standard.Estimates of relapse free survival(RFS) were made from the Kaplan-Meier curves.@*Results@#In 558 patients, RS≤10, RS 11-25 and RS≥26 groups accounted for 23.1%, 63.6% and 13.3%.After a median follow-up of 38 months, the recurrence ratesin RS≤10, RS 11-25 and RS≥26 groups were 3.3%, 4.5% and 5.4%, respectively. Kaplan-Meier RFS curve showed no significant difference between the 3 groups(P=0.788). The recurrence ratesin RS≤15 group(3.0%) was significantly lower than that in RS≥16 group(5.9%)(P=0.041).@*Conclusions@#A significant association exists between RS and breast cancer prognosis.It is rational not to give chemotherapy to RS<18 low risk patients according to classical standard.

Discordance of Estrogen Receptor,Progesterone Receptor,Cerb-B2,Ki-67 Index and P53 Expressions between Primary and Recurrent or Metastatic Sites in Breast Cancer Patients / 中国医学科学院学报

Objective To approach the discordance of estrogen receptor(ER),progesterone receptor(PR),Cerb-B2,Ki-67 index and P53 expressions between primary and regional or distant recurrent lesions in recurrent or metastatic breast cancer patients.Methods Clinical and pathological data of 56 recurrent or metastatic breast cancer patients who were treated in Peking Union Medical College Hospital from January 2001 to February 2015 were retrospectively analyzed.The changes in the expressions of ER,PR,Cerb-B2,Ki-67 index,and P53 status were analyzed.Results The hormone receptor positive rate between primary tumor and recurrent or metastatic sites decreased from 60.7% to 57.1% for ER and from 55.4% to 44.6% for PR,respectively.Changes in hormone receptor status were seen at the rate of 12.5%(7/56)and 16.1%(9/56)for ER and PR,respectively.Cerb-B2 receptor positive rate increased from 19.1% to 29.5% and the discordance rate was 9.1%(4/44).The discordance rate of Ki-67 index was 24.5%(12/49).The P53 receptor positive rate increased from 37.5% to 55.6% and the discordance rate was 13.3%(6/45).Conclusion Although the relevant rules of above changes are still controversial,these findings still have great clinical significance for making effective treatment decisions of recurrent or metastatic breast cancer.

Prognosis analysis and 21-gene recurrence score according to TAILORx standard in hormone receptor positive early-stage breast cancer / 中华普通外科杂志

Objective To explore the association of 21 gene recurrence score (RS)according to TAILORx standard and prognosis of hormone receptor (HR) positive,axillary lymph node negative breast cancer.Methods The clinicopathologic data of 558 early breast cancer patients who underwent 21 gene RS testing from May 2012 to Jan 2017 were retrospectively analyzed.RS was subgrouped according to TAILORx standard.Estimates of relapse free survival(RFS) were made from the Kaplan-Meier curves.Results In 558 patients,RS≤10,RS 11-25 and RS≥26 groups accounted for 23.1％,63.6％ and 13.3％.After a median follow-up of 38 months,the recurrence ratesin RS ≤ 10,RS 11-25 and RS ≥ 26 groups were 3.3 ％,4.5％ and 5.4％,respectively.Kaplan-Meier RFS curve showed no significant difference between the 3 groups(P =0.788).The recurrence ratesin RS ≤ 15 group(3.0％) was significantly lower than that in RS≥ 16 group(5.9％)(P =0.041).Conclusions A significant association exists between RS and breast cancer prognosis.It is rational not to give chemotherapy to RS ＜ 18 low risk patients according to classical standard.

Combined application of contrast enhanced ultrasound and dynamic contrast enhanced magnetic resonance imaging in hepatic epithelioid hemangioendothelioma / 中华超声影像学杂志

Objective To analyze the imaging characteristics of contrast-enhanced ultrasound(CEUS) and dynamic contrast enhanced magnetic resonance imaging ( CEMRI) for diagnosis of hepatic epithelioid hemangioendothelioma ,and to increase the accuracy of diagnostic imaging . Methods The imaging characteristics of CEUS and dynamic CEMRI in 11 patients with hepatic epithelioid hemangioendothelioma confirmed by surgical pathology or fine needle aspiration biopsy were retrospectively analyzed . Results On conventional ultrasound ,14 lesions in 11 patients showed hypoechoic . The peripheral blood flow was detected in most patients by color Doppler flow imaging and the average resistant index was 0 .62 ± 0 .05 . During the arterial phase ,6 lesions showed diffuse enhancement ,6 lesions showed annular enhancement and 2 lesions showed branch enhancement .As to time of peak enhancement ,compared to the normal hepatic parenchyma ,hypoenhancement ,isoenhancement and hyperenhancement were observed in 1 lesion ,7 lesions and 6 lesions respectively . Synchronous enhancement was observed in 8 lesions on contrast-enhanced ultrasound ,rapid enhancement was observed in 5 lesions and slow enhancement was observed in 1 lesion and all lesions decreased quickly in portal phase and delayed phase . On CEMRI ,all lesions showed low signal on TIWI ,high signal on T2WI and DWI . There were 5 lesions showed obvious annular constant enhancement and 1 lesion showed obvious annular progressive enhancement . Progressive peripheral enhancement and fully filling in delayed phase were found in 4 lesions .While progressive peripheral enhancement and incompletely filling in delayed phase were found in 3 lesions . One lesion displayed constant enhancement and incompletely filling in delayed phase . Halo sign" , lollipopsign" , capsular retraction sign" and vessel sign" were appeared in 6 ,7 ,8 and 8 patients respectively . Conclusions Both contrast-enhanced ultrasound and CEMRI have characteristic manifestations for the diagnosis of hepatic epithelioid hemangioendothelioma and cominbing them would be great significance to improve the preoperative diagnostic accuracy .

Imaging features of hepatic epithelioid angiomyolipomas on real-time contrast-enhanced ultrasound / 中华超声影像学杂志

Objective To evaluate the imaging features of hepatic epithelioid angiomyolipoma (EAML) on contrast-enhanced ultrasound (CEUS). Methods The imaging features of pathologically proved hepatic EAML lesions in 17 patients who had undergone baseline ultrasound and CEUS examinations were evaluated retrospectively. Results All of the cases were single lesion.70.6% (12/17) of the lesions were hypoechoic on ultrasound and 82.4% (14/17) of the lesions were heterogeneous.Flow signals were detected in 88.2% (15/17) of the lesions and 82.4% (14/17) of the lesions showed ringlike or arc arterials peripherally on color Doppler flow imaging (CDFI).The value of RI was 0.38-0.56.On CEUS,all lesions exhibited remarkable hyperenhancement in the arterial phase. 29.4% (5/17) of the lesions showed branched enhancement,70.6% (12/17) of the lesions showed diffusely entire enhancement.Strong ring-like enhancement peripherally was detected in 29.4% (5/17) of the lesions.88.2% (15/17) of the lesions were detected homogeneously enhancement during the peak period on CEUS. Washout of contrast agent and hypoechogenicity to surrounding liver tissue during portal or late phase were observed in 41.2% (7/17) and 64.7% (11/17) of the cases retrospectively.Conclusions The combination of real-time CEUS and baseline US can improve the correct diagnosis of hepatic EAML.

Clinical application of contrast-enhanced ultrasonography for malignant hepatic lesions undetected on conventional ultrasound / 中华超声影像学杂志

Objective To explore the value of contrast-enhanced ultrasound(CEUS) on the diagnosis of undetected liver cancer.Methods The study was focused on 85 consecutive patients from Jan 2015 to Sep 2016.The patients suspected liver cancer by clinical symptoms and other imaging studies were examined for regular gray-scale ultrasound and CEUS.Results Ninety-two lesions in 85 patients were confirmed by surgery,clinic manifestation and other imaging.All lesions including invisible or poorly invisible with greyscale ultrasound were examined by CEUS with the guideline of MRI imaging.Twenty lesions were detected by grey-scale ultrasound,89 lesions were detected by CEUS.The maximum diameter of those hepatic lesions was 20 mm × 18 mm,the minimum lesions was 8 mm × 6 mm.All the lesions were isoechoic,slightly hyperechoic or hypoechoic on grey-scale sonogram with mostly indistinctive margins.After SonoVue administration,82 lesions (92.1 ％) displayed as hyper-enhanced in arterial phase and 7 lesions (7.9 ％) as iso-enhanced.Sixty-one lesions(68.5 ％) showed hypo-enhanced and 28 lesions (31.5 ％) showed iso-enhanced in portal-vein phase.Seventy-four lesions(83.1 ％) showed hypo-enhancement and 15 lesions (16.9 ％) also showed iso-enhanced in late phase.The average enhancement time began at (15.3 ±6.1)s,reached to peak at (25.2 ± 8.8)s and decreased from (95.7 ± 57.8)s.Among 89 lesions,61 lesions (68.5％) were accordanced with fast in fast out and 28 lesions (31.5％) were no fast in fast out.The percentage of no fast in fast out on CEUS in undetected liver tumor was higher than in common liver tumor,the comparative difference was statistically significant (P ＜ 0.01).Conclusions Contrast-enhanced ultrasound has a more characteristic performance in undetected liver cancer and the higher detection rate than grey scale ultrasound.