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Objective:To analyze the gray-scale ultrasound and contrast-enhanced ultrasound features in secondary hyperparathyroidism (SHPT) to construct a clinical and ultrasound-based model, and to investigate the relationship between this model and serum intact parathyroid hormone(iPTH) level in order to find proper indicators for evaluation of the severity of SHPT.Methods:From February 2016 to March 2021, a total of 59 SHPT patients with 181 parathyroid glands (PTGs) admitted to the First Affiliated Hospital of Sun Yat-Sen University were enrolled. Gray-scale ultrasound and contrast-enhanced ultrasound were performed in every participant. Patients were divided into low-iPTH group ( iPTH<800 ng/L) and high-iPTH group (iPTH≥800 ng/L) according to the serum iPTH level. The characteristics of gray-scale ultrasonic imaging and contrast-enhanced ultrasonic imaging were analyzed by 2 sonographers.Biochemical parameters were collected and combined with ultrasonic characteristics to construct the clinical and ultrasound-based model. The relationship between the model and serum iPTH level was analyzed by multivariate linear regression (stepwise). Independent influencing factors on serum iPTH level was investigated in SHPT patients without iPTH-reducing drugs using history.Results:There were 19 patients in low-iPTH group and 40 patients in high-iPTH group.Serum calcium, serum phosphorus, serum creatinine, PTG number, total PTG volume, blood scores, calcification and cysts scores, CEUS scores (washing-in phase and washing-out phase) were significantly different between two groups(all P<0.05). The multivariate linear regression (stepwise) showed that serum phosphorus, total PTG volume and blood scores were independently related with serum iPTH level (standardized β coefficient were 0.387, 0.254 and 0.242 respectively; all P<0.05). Conclusions:Serum phosphorus, total PTG volume and blood scores are independent influencing factors on serum iPTH level. Ultrasonography combined with clinical parameters can help evaluate the severity of SHPT more accurately.
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Objective:To explore the value of shear wave elastography imaging(SWE) in the diagnosis of renal allograft fibrosis and analyze its advantages and limitations.Methods:The renal allograft of 61 patients who underwent renal allograft biopsy from June 2019 to April 2020 in the First Affiliated Hospital of Sun Yat-sen University were included in this study. According to the Banff classification, there were 51 patients with mild-degree fibration(interstitial fibrosis/tubular atrophy, IFTA 0-Ⅰ), and 29 patients with moderate or severe-degree fibration(IFTA Ⅱ-Ⅲ). Two-dimensional ultrasound, color Doppler flow imaging, SWE and kidney function test performed. All the results were compared between the two groups. Diagnostic performance was evaluated by receiver operating characteristic (ROC) curve using pathology as gold standard. The sensitivity, specificity, positive predictive value and negative predictive value were calculated for the diagnosis of moderate or severe-degree fibration.Results:Compared to mild-degree fibration group, creatinine( P<0.001), glomerular filtration rate( P<0.001), RI of arcuate arteries( P=0.022) and SWE value( P<0.001) significantly increased in the moderate or severe-degree fibration group. There were significant correlations between IFTA and creatinine ( r s=0.488, P<0.001), glomerular filtration rate ( r s=-0.452, P<0.001), RI of arcuate arteries( r s=0.228, P=0.042), SWE value( r s=0.584, P<0.001). Taking the cutoff value of SWE value deduced by ROC curve as 21.7 kPa, the area under ROC curve was 0.827. The sensitivity, specificity, positive predictive value and negative predictive value were 86.2%, 74.5%, 61.0% and 89.7%, respectively. Conclusions:There is a good correlation between the SWE value and the degree of fibrosis in the transplanted kidney. SWE can be used to distinguish mild from moderate or severe fibrosis of renal allograft, providing a potential noninvasive method for the assessment of kidney allograft fibration.
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Objective:To establish a model based on two-dimensional shear wave elastography (2D-SWE) for predicting post-hepatectomy liver failure (PHLF) among patients with hepatocellular carcinoma (HCC).Methods:One hundred and one consecutive patients with HCC undergoing hepatectomy from August 2018 to July 2019 were enrolled prospectively in the First Affiliated Hospital of Sun Yat-Sen University. Laboratory tests, shear wave elastography in liver parenchyma, and abdominal contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI) were performed preoperatively. Liver functional reserve, liver stiffness (LS), and tumor-related imaging parameters were assessed. PHLF was defined according to the definition of International Study Group of Liver Surgery Recommendations (ISGLS). A predictive model was developed by logistic regression analysis and the performance thereof was evaluated by receiver operating characteristic (ROC) curve analysis and Hosmer-Lemeshow test.Results:PHLF occurred in 39 patients (38.9%). Logistic regression analysis identified that international normalized ratio ( OR=1.09, P=0.026), LS( OR=1.297, P=0.004) and the largest nodule diameter( OR=1.191, P=0.015) were independent risk factors of PHLF.The area under curve (AUC) of the model was 0.842(95% CI =0.763-0.921), which was significantly higher than those of ALBI score, MELD score and Child-Pugh score (AUC 0.626-0.688, P<0.05). The model also showed good calibration in Hosmer-Lemeshow test ( P=0.498). Conclusions:A model based on 2D-SWE provides good preoperative prediction of PHLF among patients with HCC, which might have the potential in better customizing treatment strategy in those patients.
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Objective To compare three-dimensional contrast-enhanced ultrasound ( 3DCEUS) fusion imaging and computed tomography ( CT ) fusion imaging in evaluating ablation margin ( AM ) after radiofrequency ablation ( RFA) for hepatocellular carcinoma ( HCC) . Methods The 3DCEUS images of 60 patients before and after RFA were collected . The AM was evaluated by the self-developed 3DCEUS fusion imaging technique . The consistency of AM evaluation was compared between 3DCEUS and CT fusion imaging . The risk factors of local tumor progression ( LTP) including AM were analyzed . Results The registration success rate of 3DCEUS fusion imaging was 96 .7％ ( 58/60) . Thirty-one cases were in the AM<5 mm group ,and 27 cases were in the AM ≥5 mm group . The consistency of AM evaluation between 3DCEUS and CT fusion imaging was good ( Kappa coefficient = 0 .895 , P < 0 .001) . During a follow-up period ranging 4 .2 to 18 months ,LTP was identified in 5 tumors (8 .6％ ,5/58) .The incidence of LTP with the AM<5 mm was higher than that with the AM ≥5 mm ( P =0 .033) . Conclusions 3DCEUS fusion imaging is feasible for AM evaluation immediately after RFA with high consistency with CT fusion imaging . AM<5 mm evaluated on 3DCEUS fusion immediately after RFA is a risk factor for LTP .
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Objective To evaluate the safety and effective of ultrasound-guide percutaneous radio frequency ablation (RFA).Methods Retrospectively analyze the incident,management and influence factors of complication of ultrasound-guide percutaneous RFA.Results From 2001 to 2011,536 patients with 762 lesions underwent RFA were enrolled in this study.Incident of RFA complication was 2.03％ (11/536),including 5 (0.92％) major complication.The complication covered fever (1 case),massive hydrothorax (2 cases),hydrothorax accompany with ascites (1 case),massive ascites (1 case),liver abscess (1 case),liver capsule hemorrhage (1 case) and hemothrorax (1 case).No RFA relate mortality was observed.According to logistics regression analysis,the liver function Child-Pugh grading was associated with the RFA complication (P =0.005).Conclusions Ultrasound-guide percutaneous RFA is a safe and effective local treatment approach for hepatocellular carcinoma.It's necessary to comprehensively think over the basic condition of patients and the characters of tumor such as tumor location,size and abutting organs.Nevertheless,an appropriate treatment plan and closely monitor during and after RFA are crucial.
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Objective To retrospectively compare the safety and local efficacy of multiple-electrode switching based radiofrequency ablation (RFA) and the conventional RFA in treating single early-stage hepatocellular carcinoma (HCC).Methods A total of 82 patients with single early-stage HCC received either RFA with a multiple-electrode switching system (n =43) or conventional RFA (n =39) as the first-line treatment.The rate of initial local complete response,major complications and local tumor progression (LTP) were compared between two groups.Results The total ablation time was significantly shorter in the switching-RFA group [(16.7 ± 3.4) mins] than in the conventional RFA group [(29.8 ± 10.4) mins] (P ＜ 0.05).The rate of initial local complete response was 100％ (43/43) in the switching-RFA group and 94.9％ (37/39) in the conventional RFA group (P ＞0.05).After a mean follow-up period of (26.4 ± 21.8)months (ranging 3.0-91.6 months),the rates of LTP in the switching-RFA group and conventional RFA group were 16.3％ (7/43) and 17.9％ (7/39),respectively.The LTP rates in two groups were 16.1％ versus 11.2％ atyear1,and20.5％ versus 20.6％ at year2 (P=0.666).Conclusions The multiple-electrode switching based RFA is safe and effective with shorter ablation time in treating single early-stage hepatocellular carcinoma.
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Objective To summarize the first experience with ultrasound-guided percutaneous ab lation treatment (PAT) for recurrent hepatoblastoma (HB) after liver resection in children.Methods From August 2013 to April 2015,PAT was used to treat 6 children with a total of 9 recurrent HB,including 5 patients with 8 tumors in the liver and 1 patient with 1 tumor in the lung.The mean size of ablated tumors was (1.5 ± 0.8) cm,and the tumor size range was 0.7 cm to 3.1 cm.Results Four patients were performed percutaneous radiofrequency ablation (RFA) for recurrent HB;and 2 patients were performed percutaneous ethanol injection (PEI).Ablation success was achieved in all patients (6/6,100％).The complete ablation rate after the first ablation session was 88.9％ (8/9) on a tumor-by-tumor basis.Only 1 patient developed a fever with temperature ＞ 39 ℃;it was resolved by conservative therapy.During the follow-up period of 5-30 months,3 patients died to tumor progression.The 1-and 2-year overall survival rates after ablation were 83.3％ and 41.7％,respectively.Conclusions PAT is a safe and promising therapy for children with recurrent HB after liver resection,and further investigation in large-scale randomized clinical trials is required to determine its role in the treatment of this disease.
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Objective To investigate the utility of virtual endoscopy ultrasound Fly-Thru in the diagnosis of obstructive bile duct diseases.Methods One-hundred patients with obstructed bile duct diseases underwent Fly-Thru examination.All Fly-Thru images were reviewed by two radiologists with different experience.The capabilities of Fly-Thru for bile duct obstructive degree evaluation and distinguishing malignant lesion from benign one were assessed respectively.Results The accuracy and sensitivity of Fly-Thru image in obstruction degree evaluation were 70.59％ and 89.2％ (95％CI 74.6％-96.9％).The diagnosis accuracy of 2DUS for lesion characteristics increased from 80％ to 84％,accompany with Fly-Thru images,especially for lesions in common bile duct from 77.2％ to 86.0％ (x2 =14.399,P =0.001).Conclusions The virtual endoscopy ultrasound Fly-Thru is only partly capable to display the obstructed degree of some bile ducts,but it can improve the diagnostic accuracy of common bile duct diseases.
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Objective To comparatively analyze CEUS features of hepatitis B virus (HBV)-related combined hepatocellular-cholangiocarcinoma (CHC) and hepatocellular carcinoma (HCC).Methods Thirty-one patients with HBV-related CHC and 31 patients with HBV-related HCC confirmed by pathology were enrolled and CEUS features were compared.Results On CEUS,HBV-related CHC and HBV-related HCC mainly manifested as hyper-enhanced in arterial phase and hypo-enhanced in portal phase and delayed phase.No significant differences of enhancement level on CEUS were found between HBV-related CHC and HBV-related HCC.When the maximum diameter of tumor ≤3.0 cm,both HBV-related CHC and HBV-related HCC were mainly homogeneous enhancement (P=1.000).When the maximum diameter of tumor more than 3.0 cm,diffuse heterogeneous enhancement and peripheral irregular rim-like enhancement were more commonly observed in HBV-related CHC,while diffuse heterogeneous enhancement was more commonly noted in HBV-related HCC (P=0.001).Conclusion The enhancement pattern of HBV-related CHC ＞3.0 cm has relative specific performance.
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Objective To evaluate the clinical significance of personalized biomechanical modeling of prostate deformation based on ultrasound elastography for magnetic resonance imaging(MRI)-transrectal ultrasound(TRUS)image registration.Methods A total number of 5 patients and 1 commercial prostate phantom were imaged via transrectal ultrasound elastography,3D-TRUS and MRI from June 2016 to December 2016.A personalized biomechanical model via the patient-specific ultrasound elastography was made for the deformable registration of prostate MRI and 3D-TRUS images.The registration accuracy was evaluated by the target registration error(TRE)and also the t-test was conducted to validate the statistical significance of our results.Results All the 5 sets of patient data as well as the phantom data were successfully registered.The TRE value of the phantom data was 1.65 mm.The mean TRE value of 5 patients was 1.31 mm,compared with the 2.52 mm TRE value of the registration method without patient-specific biomechanical properties via elastography,was approximately 48% lower(P <0.05).Conclusions Personalized biomechanical modeling of prostate deformation based on ultrasound elastography for MRI-TRUS image registration possesses important clinical significance and is a promising way to provide more quality guidance and improve the accuracy of prostate biopsy.
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Objective To investigate the feasibility of our new found 3-dimensional contrast-enhanced ultrasound 3D-CEUS registration system as an early assessment of the therapeutic response to radio frequency ablation for liver cancer Methods Twenty-seven patients with 28 lesions accepted 3D-CEUS before and after radio frequency ablation RFA the therapeutic respond to which would be assessed with 3D-CEUS registration system recording the rate of successful registration The CT was considered as the reference standard Results Ten cases 35 7% were successful matched with auto-registration and 24 cases 85 7% were succesful matched with interactive-registration relatively All cases were considered as complete ablated which were confirmed by CECT with 100% accuracy There were two cases achieving ablation margins ≥5 mm without local tumor progression LTP and nineteen cases achieving 0 -4 mm ablation margin with 3 LTP 3-month 6-month and 1-year later Conclusions The 3D-CEUS interactive-registration system can easily assess the therapeutic response of RFA in liver cancer immediately with high accuracy.
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Objective To compare the features of different heating modes cauterization mode and standard ablation mode of Cool-tip on coagulation zone and thermal field distribution in order to provide references for focused and accurate vascular occlusion and explore the primary efficacy of Cool-tip applied to intrahepatic vascular occlusion in living dogs Methods Ex-vivo porcine livers were ablated for 2 4 6 8 minites with cauterization mode and standard ablation mode respectively and the long- and short-axis diameters in the greatest dimension were compared The tissue temperature around the tip midpoint and end of the exposed part of radiofrequency electrode were measured under the circumstance of 4 min ablation by the two modes respectively Animal experiment the intrahepatic vessels of 2 Beagles were ablated with cauterization mode one procedure for each animal and contrast-enhanced ultrasound was used to evaluate the perfusion change of liver tissue Gross anatomy and pathological examination of the liver was performed after 1 week Results In the 2 min 4 min 6 min and 8 min ablation the coagulation volume of cauterization mode and standard ablation mode were 1 01 ± 0 41 cm 3 vs 2 95 ± 0 74 cm 3 1 47 ± 0 33 cm 3 vs 5 03±1 06 cm 3 2 29±0 49 cm 3 vs 9 23±2 53 cm 3 2 70±0 24 cm 3 vs 1 5 89±0 77 cm 3 The coagulation volume was significant smaller in cauterization mode than in standard ablation mode P <0 05 for all The peak temperature of cauterization mode presented on the tip of electrode which averaged 94 4℃ in maximum and maintain around 70 ℃ in the equilibrium phase The peak temperature of standard mode presented on the midpoint of the electrode which periodically variated between 70 ℃- 100 ℃ The result of the animal experiment showed that cauterization mode could be used to occlude the intrahepatic vessel in vivo which induced the ischemia and necrosis in the corresponding area Conclusions Cauterization mode and standard alation mode of Cool-tip have different characteristic in terms of coagulation zone and thermal distribution and carterization mode may have a promising application in intrahepatic vascular occlusion.
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Objective To investigate the factors affecting Fly-Thru (FT) and the best reconstruction conditions in a bile duct model.Methods The bile duct model was made with corn powder and rubber pipes.FT data of bile duct in vitro were acquired with a 3-dimensional probe of Toshiba Aplio 500,and the data were reconstructed offline in Fly-Thru workstation.Two US doctors assessed the FT images in three degrees.Results The images were divided into good,moderate and poor groups with corresponding score 3,2,1.Of 162 images,72 were rated as grade 1,57 as grade 2 and 33 as grade 3.According to x2 analysis,the diameter,scanning way,and Filter were brought into multinomial regression,then the scanning way was found to be correlated to FT images quality as well as filter (likelihood ratio =87.598,294.290,x2 =9.492,313.722,respectively,P ＜0.01).Best images of FT can be acquired by transverse scanning,reconstructing in Filter =3,gain =5(0,dynamic range (DR) =50 and threshold ranging 40-90.Conclusions Best FT images in the model could be achieved by scanning in short-axis,and reconstructing the data in Filter =3,gain =50,DR =5(0 and threshold ranging 40-90,which would be basic information for advanced clinic study.