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Echocardiography is the primary method for noninvasive evaluation of cardiovascular system in children. However, conventional echocardiography cannot observe and analyze transient cardiac events and transient phases due to its low temporal resolution, nor can it evaluate the mechanical properties of myocardium. In recent years, ultrasonic imaging technology, and the improvement of computing capacity greatly promoted the development of the ultrafast cardiac shear wave imaging, allowing the speed of 5 000 frames/s via chest cardiac imaging, has fast dynamic movement of heart tissue, real-time observation for myocardial properties, function and blood flow to the heart pattern advantages, can better diagnose cardiovascular disease in children. In this paper, the principle of ultrafast cardiac shear wave imaging and its recent application in pediatric cardiac imaging are reviewed.
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Objective To analyze the characteristics of left ventricular systolic function in Kawasaki disease (KD) patients with intravenous immunoglobulin (IVIG) resistant during acute phase by two-dimensional speckle tracking imaging (2D STI).Methods IVIG resistant patients (n=40) as well as age and gender matched IVIG responder patients (n=40) were selected from KD patients in acute phase.Patients in IVIG resistant group were further divided into coronary artery dilation (CAD) subgroup and no coronary artery dilation (NCAD) subgroup.Then conventional echocardiography,2D STI and laboratory indexes were acquired and compared between IVIG resistant group and IVIG responder group,as well as between CAD and NCAD subgroup.ROC curve analysis was used to determine threshold values of 2D STI measurements associated with IVIG resistance.Results Compared with IVIG responder group,coronary artery dilation,left ventricular mass and left ventricular mass index increased,systolic global longitudinal strain (GLS) and systolic global circumferential strain (GCS) decreased,albumin,erythrocyte sedimentation rate,C-reactive protein and platelet increased in IVIG resistant group (all P＜0.05).Taking absolute GLS 16.8％ as a threshold,the area under curve (AUC) was 0.769 (P=0.021),sensitivity,specificity in diagnosis of IVIG resistant was 79.27％,68.36％.Taking absolute GCS 15.9％ as a threshold,AUC was 0.749 (P=0.038),sensitivity,specificity in diagnosis of IVIG resistant was 71.43％,57.28％.Conclusion IVIG resistant KD patients present significantly greater systolic dysfunction compared with responders in patients with KD,which may be the results of myocardium infection other than coronary artery lesions.2D STI may predict myocardial injury in IVIG resistant KD patients.
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Objective To assess the value of shear-wave elastic modulus for differential diagnosis of benign and malignant breast lesions using Meta-analysis.Methods Relevant Chinese and foreign articles about shear-wave elastography for differentiating benign and malignant breast lesions were collected from the literatures published before Apr.2016.Meta-analysis was conducted to assess the overall ability of the shear wave elastic modulus including Emax,Emea,Eratio and Esd.Results Totally 31 studies were brought into the Meta-analysis.The summarized sensitivity (SSEN) and summarized specificity (SSPE) of Emax were 0.87(95％CI [0.83,0.91]) and 0.91 (95％CI [0.87,0.93]).The SSEN and SSPE of Emea were 0.84 (95％CI [0.77,0.89]) and 0.88 (95％CI [0.84,0.91]),The SSEN and SSPE of Eratio were 0.88(95％CI [0.83,0.91]) and 0.87 (95％CI [0.80,0.91],the SSEN and SSPE of gsd were 0.85 (95％CI [0.80,0.89]) and 0.90 (95％CI [0.85,0.94]).The summarized receiver operator characteristic analysis showed that the area under the curve of E E Eratio and Esd were 0.95,0.93,0.93 and 0.93.Conclusion The shear wave elastic modulus contribute to differentiate benign and malignant breast lesions.Among these indices,Emax is the best one.
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Objective To systematically analyze and assess the overall value of transrectal shear wave elastograpy in diagnosis of prostate cancer (PCa) using Meta-analysis.Methods Relevant Chinese and foreign papers diagnosing PCa with transrectal shear wave elastograpy published before December 2016 were searched.The references were evaluated and screened according to the criteria of diagnostic research.The selected references were analyzed by Meta-Disc 1.4 and Stata 12.0 statistical software.Results Eight articles were included in the present Meta-analysis.Five of these literatures were about transrectal shear wave elastograpy in diagnosis of PCa,the summarized sensitivity (SEN) and summarized specificity (SPE) in diagnosis of PCa were 0.80 (95％CI [0.75,0.84]) and 0.75 (95％CI [0.71,0.79]),respectively;the positive likelihood ratios (PLR) and negative likelihood ratios (NLR) were 3.60 (95 ％ CI [2.57,5.05]) and 0.17 (95 ％ CI[0.08,0.37]),respectively;the area under SROC curves was 0.895.Five of these literatures were about transrectal shear wave elastograpy supplemental prostatic biopsy in diagnosis of PCa,the summarized SEN and SPE were 0.86 (95％ CI [0.83,0.88]) and 0.84 (95％CI [0.82,0.85]) respectively;the PLR and NLR were 5.81 (95％CI [3.07,10.99]) and 0.14 (95％CI [0.04,0.49]) respectively;the area under SROC curves were 0.924.Conclusion Transrectal shear wave elastograpy has better clinical value in detection of PCa and can be used to supplemental prostatic biopsy.
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Objective: To analyze the long-term prognosis of re-operation in patients with functional tricuspid regurgitation (FTR) after left sided valve replacement (LSVR) and hence evaluate the optimal timing of mentioned re-operation. Methods: A total of 59 FTR patients who had re-operation after their prior LSVR in our hospital from 1999-01 to 2013-01 were analyzed. The clinical information and post-operative follow-up results were recorded in all patients. Results: There were 5/59 (8.5%) patients died in peri-operative period and the overall post-operative mortality was 11.9% (7/59). The follow-up data of 54 survivors were available for the mean time of 51.1 (21-188) months. There were 19/54 (35.2%) patients suffered from MACE and 30 (55.6%) were beneifted by improved cardiac function. Uni-variable analysis indicated that pre-operative NYHA class IV (P=0.008), pre-operative right ventricular (RV) dysfunction (P=0.037), concomitant left-sided redo-operation (P=0.017) and TVR operation (P=0.002) were associated with all cause mortality of tricuspid re-operation. Multi-variable Cox regression analysis showed that pre-operative RV dysfunction was the only independent risk factor of long term MACE-free accumulating survival rate (HR=3.0, 95% CI 1.11-8.2,P=0.031); while TVR operation (HR=12.8, 95% CI 1.53-107.02,P=0.019) and pre-operative NYHA class IV (HR=5.3, 95% CI 1.20-24.51,P=0.032) were the independent risk factors for long-term mortality in patients after tricuspid re-operation. Conclusion: Patients with compensatory RV function showed better long term prognosis after secondary tricuspid operation. Aggressive re-operation before the occurrence of right ventricular dysfunction could be beneficial for relevant patients.
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Objective To discuss the diagnostic value of high frequency ultrasound on lesions of knee traumas.Methods Ninty-eight cases with post-traumatic knee injuries were examined by high frequency ultrasound,and the characteristics of changing ultrasonogram were observed and comparing with surgical results and MR.Results Of the 98 cases with post-traumatic knee injuries,there were 57 cases with effusion and hematocele in knee joint,among which there were 41 cases with collateral ligaments and meniscus injuries,the diagnostic coincidence rate was 93.3% in tendon tear and complete tendon fracture(compared with MR),91.7% in partial and complete muscle tear(compared with MR),67.7% and 71.4% in collateral ligaments and meniscus injuries(compared with surgical results).Conclusions High frequency ultrasound can be used as a conventional imaging examination method for post-traumatic knee injuries.
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Objective To explore the value of color Doppler ultrasound detection renal interlobar arterial hemodynamic parameters for early diagnosis in patients with chronic kidney disease(CKD).MethodsSeventy-eight patients with CKD were undergone interlobar arterial hemodynamic parameters detection and 65 normal persons served as the control.The peak systolic velocity (PSV),end-diastolic velocity (EDV),pulsatility index(PI),resistive index (RI) of interlobar arterial and serum cystatin C (SCysC) were measured.The variation of RI and the correlation of renal interlobar arterial RI and pathological findings in early CKD was analyzed.Results In 40 CKD cases with normal SCysC(group A),the PSV,EDV,PI,RI of renal interlobar arterial were not statistically significant (P＞0.05).In 38 CKD cases with increased SCysC(group B),the RI of renal interlobar arterial were higher than those of group A and control group (P＜0.05),and the PSV and EDV were lower than those of group A and control group (P＜0.05).In cases of CKD with normal RI,the disease limited to the glomeruli;while the RI increased,the disease locate in the tubulointerstitial compartment.Conclusions Interlobar arterial RI united SCysC is a sensitive indicator in assessing early injury of chronic kidney disease.