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Objective:To explore the feasibility of artificial intelligence ultrasound to diagnose of biliary atresia (BA) based on deep learning.Methods:A total of 531 gallbladder ultrasound images in 177 cases of BA patients (BA group) and 585 gallbladder ultrasound images in 195 cases of Non-BA patients (Non-BA group) were collected in Hunan Children′s Hospital from September 2018 to October 2020. For the BA and Non-BA groups, all images were divided into training set and test set according to the ratio of 2∶1. The Mask R-CNN model was trained by training samples, and then the model was tested, according to patient and image as a unit respectively, to evaluate the gallbladder organ detection rate and the diagnostic accuracy of BA. In addition, the images of the test set were randomly numbered.Four sonographers were invited to interpret the images to calculate the diagnostic accuracy individually. Last, the diagnostic accuracy of the Mask R-CNN model was compared with that of sonographers.Results:In terms of the automatic detection of gallbladder organs, the detection rate in both BA and Non-BA group reached 100%, but there were 17 false alarms in 372 test images, with a false alarm rate of 4.57%. In terms of the diagnostic rate of gallbladders, when taking patient as a unit, the total diagnostic accuracy of the model in the test set was 95.97%, which was higher than that of the sonographers in other hospitals and the sonographer with intermediate professional title in our hospital, and the difference was statistically significant ( P<0.005). It was slightly higher than that of sonographer with senior professional title in our hospital (91.94%), but the difference was not statistically significant ( P=0.183). When taking picture as a unit, the total diagnostic accuracy of the model was 97.04%, which was higher than that of the sonographers in other hospitals and the sonographer with intermediate professional title in our hospital, and the difference was statistically significant ( P<0.001). It was slightly higher than that of sonographer with senior professional title in our hospital (94.09%), but the difference was not statistically significant ( P=0.05). Conclusions:The artificial intelligence technology based on Mask R-CNN can automatically and accurately detect gallbladder organs and diagnose BA, which is worthy of further study.
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Objective:To investigate the application value of shear wave elastography(SWE) in assessing the degree of hepatics fibrosis in children with biliary atresia before Kasai portoenterostomy.Methods:From January 2017 to January 2018, 49 cases of children in Hunan Children′s Hospital with highly suspected biliary atresia in clinical were collected. The stiffness of the lower segment of right anterior lobe of the liver in all cases was assessed using SWE in 3 days before Kasai portoenterostomy. Pathological results of liver tissue specimens from the lower edge of the right liver during the surgery was taken as the gold standard. The correlation between the liver stiffness and the hepatics fibrosis was analyzed using Spearman correlation analysis. The receiver operating characteristic (ROC) curves were created to assess the area under curve (AUC), the best cutoff value, sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the liver stiffness in diagnosing hepatocirrhosis.Results:All of the 49 cases were confirmed by surgery and pathology. According to the stages of hepatics fibrosis, 5 cases were in stage S2, 23 cases in stage S3, 21 cases in stage S4, and no cases of stage S0 and S1. Spearman correlation analysis showed that the correlation coefficient between the liver stiffness and the stages of hepatics fibrosis was 0.779( P<0.001). The area under the curve of the liver stiffness in diagnosing cirrhosis was 0.914. When the cutoff value was 14.45 kPa, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 85.7%, 89.3%, 85.7%, 89.3%, 87.8%, respectively. Conclusions:The liver stiffness measured by SWE is positively correlated with the stages of hepatic fibrosis, and the performance of SWE in the diagnosis of cirrhosis is remarkable. SWE can be used to evaluate the stages of hepatics fibrosis in children with biliary atresia before Kasai portoenterostomy.
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Objective To investigate the value of the shear wave elastography ( SWE) in the diagnosis of biliary atresia ( BA ) in infants by ultrasonography . Methods SWE was used to measure the liver stiffness measurement( LSM ) of 138 infants . Following surgical or pathological diagnosis ,the infants were subclassified into BA and non-biliary atresia ( non-BA ) groups . ROC analysis was used to determine the sensitivity and specificity of LSM ,the ultrasonic findings in the differential diagnosis of suspected BA ,and the cut-off value to diagnose BA . Results Of the 138 infants with cholestatic hepatitis ,51 were diagnosed as BA group and 87 cases were assigned to the non-BA group . The ROC analysis showed the cut-off value of LSM for diagnosis of biliary atresia in children with jaundice was 12 .35 kPa ,the AUC was 0 .936 ,and the sensitivity and specificity were 84 .3% and 89 .7% ,respectively .In the parallel test ,the triangular cord ( TC) sign combined with abnormal gallbladder ( AbGB) had the best diagnostic performance in all patients . However ,in patients older than 30 days ,the LSM combined with TC had the best AUC ( 0 .987 ) and diagnostic performance( 98 .6% ) like with TC combined with AbGB . Conclusions Both SWE and gray scale ultrasound have higher diagnostic performance for BA . LSM can be used as a valuable index for diagnosing BA by ultrasound .
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Objective To investigate the value of shear wave elastography (SWE) in the differential diagnosis of biliary atresia (BA) in infants within 60 days.Methods SWE was used to detect the hepatic Young's modulus of 85 infants within 60 days who were suspected with cholestatic hepatitis.All the patients were classified into BA group and non biliary atresia (Non-BA) group according to surgical or pathological results.At the same time,45 normal infants within 60 days were selected as the control group.The hepatic Young's modulus were compared among the 3 groups.The sensitivity and specificity of hepatic Young's modulus in suspected BA patients were calculated by ROC.Results In the 85 cases,42 cases were diagnosed as BA,and 43 cases were classified as Non-BA group.The Young's modulus values of the 3 groups were as follows:BA group (15.86 ± 5.89) kPa,Non-BA group (10.89 ± 2.38) kPa,and control group (6.64 ± 0.53)kPa,with a significant difference among the 3 groups(P ＜0.01).The ROC analysis showed a cut off value of 12.9 kPa for differentiation between BA group and Non-BA group.The area under ROC curve (AUROC) was 0.787,with a sensitivity of 59.5％ and a specificity of 88.4％.Conclusions The young's modulus in BA patients can be increased at early time,and the SWE technique can be used to reflect the change of hepatic Young's modulus accurately,which will be helpful in the early differential diagnosis of BA.
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Objective To observe the abdominal ultrasonic manifestations of children with Langerhans cells histiocytosis (LCH).Methods Imaging features of histopathologically proved LCH in 28 children were retrospectively analyzed.Results Among 28 eases,multi system involvement was found in 25 cases,while only liver and bile duct involvement were detected in 3 cases.Different degrees of enlarged liver,inhomogeneous echo of liver parenchyma,scattered or diffuse hypoechoic regions were found in all 28 cases.Uneven thickening and echo enhancement of the bile duct wall,as well as local expansion or stricture of bile duct cavity were found in 13 cases.Splenomegaly was found in 17 cases,swelling of the pancreas was found in 5 cases,varying degrees of ascites were found in 13 cases,and hepatic hilar lymphadenectasis were found in 14 cases.Conclusion There are specific ultrasonographic manifestations of LCH in children,which may be helpful to improving diagnostic accuracy of LCH.
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The children with dilated cardiomyopathy (DCM) are in the different stages of growth and development,so the measurements of the cardiac size and the function in the echocardiography can change with those growth and development.But the influence factors of growth and development had been ignored by the previous standards,which was not conducive to evaluate the efficacy of drugs and the prognosis of patients.The disadvantages above can be overcome by converting the echocardiographic measurements into the Z score after correction of the body surface area.With the development of the ultrasonic technology,there have been some studies of the Z score combined with the ultrasound to assess the left/right ventricular heart function and prognosis in children with dilated cardiomyopathy.The progresses of Z score in children with dilated cardiomyopathy were reviewed in this article.
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Objective To explore the clinical value of real-time shear wave elastography (SWE) in liver tissue stiffness of normal children.Methods Totally 243 normal children were examined by SWE.The data of liver stiffness measurement (LSM) were recorded and analyzed.The differences of LSM between different genders and hepatic segments were compared.According to the age,243 normal children were divided into pre-school group,school age group and adolescent group;and the differences of LSM between 3 groups were compared.The consistency was analyzed in different operators.Results The mean value of LSM in normal children was (4.21±0.70)kPa,and the 95％ confidence interval was (4.11,4.31)kPa.The success rate of segment S5 was higher than that of segment S4 (100％ [243/ 243] vs 79.83％ [194/243]),and the mean value of LSM in segment S5 was lower than that in segment S4 (P＜0.05).The mean value of LSM increased with age,and the boys' was a slightly higher than the girls',but there were no statistical differences between them (all P＞ 0.05).LSM had good consistency in different operators,the intraclass correlation coefficient was 0.92.Conclusion SWE could be an objective and quantitative assessment in liver stiffness of children.
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Objective To investigate the diagnostic value of high frequency ultrasound combined with esophageal filling in neonates with congenital esophageal atresia.Methods Fifty-eight newborns who were suspected with congenital esophageal atresia underwent ultrasound,the surgical results considered as the gold standard,then the ultrasound features of the congenital esophageal atresia were summarized.ResultsSeven cases were the type Ⅰ of the congenital esophageal atresia,1 case belongs to type Ⅱ,40 cases were considered as type Ⅲ,4 cases were classified type Ⅳ and 6 cases were type Ⅴ,the diagnostic accuracy of ultrasound in congenital esophageal atresia was 96.55% and the classification accuracy was 89.65%.Conclusions High frequency ultrasound combined with esophageal filling has a high accuracy and can be used as a new diagnostic method in diagnosing neonates with congenital esophageal atresia,and it′s worthy of further research and promotion.
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Objective To investigate the diagnostic value of high frequency color Doppler ultrasound combined with gastrointestinal filling in infants with duodenal obstruction . Methods One hundred infants who were suspected with duodenal obstruction underwent both gastrointestinal ultrasound and upper gastrointestinal tract ,put the surgical results as the ?gold standard ,the values of ultrasonic and upper gastrointestinal tract in the diagnosis of pediatric congenital duodenal obstruction were compared . Results The diagnostic accuracy of ultrasound and upper gastrointestinal tract in duodenal obstruction was 100%and 94% respectively ,the difference was statistically significant ( P = 0 .041) . The accuracy rate of obstruction location was 98 .04% and 84 .31% respectively , also was considered to denote statistical significance ( P = 0 .023 ) . The total diagnostic accuracy of congenital disorders caused by duodenal obstruction was 89% and 49% respectively ,and P = 0 .001 implies statistically significant difference . Conclusions There is a high diagnostic accuracy in high frequency ultrasound combined with gastrointestinal filling in children with congenital duodenal obstruction ,and the diagnosis of some diseases is better than that of the upper gastroenterography .
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<p><b>OBJECTIVE</b>To investigate the effect of polyethylene oxide (PEO) on renal blood flow and its renoprotective effect in rabbits with endotoxin sepsis.</p><p><b>METHODS</b>Twenty normal New Zealand white rabbits were randomly divided into normal saline (NS) group and PEO group (n=10), and endotoxin shock was induced by an intravenous injection of 0.6 mg/kg lipopolysaccharide. Resuscitation was performed when the blood pressure of the rabbits showed a 30% decline, using NS (in NS group) or the mixture of equal volumes of NS and 20 ng/g PEO (in PEO group) perfused at the rate of 5 ml/kg per hour. Before and during shock and at 1 h after resuscitation, the renal hemodynamics was monitored by ultrasound and the venous blood was extracted to examine the renal functions. The heart rate and arterial blood pressure were monitored throughout the experiment.</p><p><b>RESULTS</b>The rabbits in both groups showed a significantly lower renal artery blood flow velocity during the shock (P<0.05) with significantly increased pulsatility index (PI) and resistance index (RI) compared with those before the shock. One hour after resuscitation, the blood flow velocity in the renal arteries at all levels and the tertiary veins were reduced in NS group without obvious reduction of the PI and RI; in PEO group, the blood flow velocities in the renal arteries increased significantly compared to those before shock (P<0.05), and the PI and RI of the tertiary arteries were significantly lower than those in NS group (P<0.05). In both groups, BUN and Cr increased during endotoxin shock stage, and 1 h after resuscitation, PEO group showed significantly lower BUN and Cr levels than NS group (P<0.05).</p><p><b>CONCLUSION</b>A small dose of PEO can significantly promote renal perfusion in rabbits with septic shock, thus offering renoprotective effect against early damage in septicopyemia and septic shock.</p>
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Animals , Rabbits , Hemodynamics , Polyethylene Glycols , Pharmacology , Therapeutic Uses , Renal Circulation , Shock, Septic , Drug TherapyABSTRACT
OBJECTIVE@#To evaluate intraventricular systolic dyssynchrony in rats with post-infarction heart failure by quantitative tissue velocity imaging combining synchronous electrocardiograph.@*METHODS@#A total of 60 male SD rats were randomly assigned to 3 groups: a 4 week post-operative group and an 8 week post-operation group (each n=25, with anterior descending branch of the left coronary artery ligated), and a sham operation group (n=10, with thoracotomy and open pericardium, but no ligation of the artery). The time to peak systolic velocity of regional myocardial in the rats was measured and the index of the left intraventricular dyssynchrony was calculated.@*RESULTS@#All indexes of the heart function became lower as the heart failure worsened except the left ventricle index in the post-operative groups. All indexes of the dyssynchrony got longer in the post-operative groups (P0.05).@*CONCLUSION@#Quantitative tissue velocity imaging combining synchronous electrocardiograph can analyse the intraventricular systolic dyssynchrony accurately.
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Animals , Male , Rats , Echocardiography, Doppler, Color , Heart Failure , Diagnostic Imaging , Myocardial Infarction , Diagnostic Imaging , Random Allocation , Rats, Sprague-Dawley , Systole , Ventricular Dysfunction, Left , Diagnostic ImagingABSTRACT
OBJECTIVE@#To quantitatively detect variation in regional myocardial systolic function in heart failure rat model induced by myocardial infarction by strain and strain rate imaging.@*METHODS@#Seventy 2-month-old adult male SD rats were randomly assigned to 4 groups: a 4-week and a 8-week group after the operation (each n = 25) had thoracotomy, the pericardium opened and the anterior descending branch of left coronary artery ligated; a sham operation group (n = 10) had thoracotomy and the arcula cordis opened, but did not ligate the artery; a control group (n = 10) had no treatment. The changes of general state of health of the rats were observed and recorded every day. To assess the change of heart function, echocardiography was used at the end of the 4th week and 8th week after the surgery. To evaluate the change of heart function in heart failure rats, we quantitatively analyzed the regional myocardial systolic function in all rats by strain and strain rate imaging and myocardium to detect the level of MMP-9 at the end of the 4th week and 8th week. The repeatability and discrepancies of the results were all analyzed.@*RESULTS@#Obviously objective signs of heart failure manifested themselves in the survived mice 10 to 14 days after the surgery. Compared with the control group and the sham operation group, the fraction shortening (FS) and ejection fraction (EF) of the 4-week group after the operation were lower (P < 0.05), the left ventricle index (LV index) of the 8-week group after the operation was higher, left ventricle posterior wall index (LVPW index), interventricular septum index (IVS index), FS, and EF of the 8-week group after the operation were lower (P < 0.05), EF and FS of the 8-week group after the operation were lower than those of the 4-week group. Except the mid-inferior wall and base-inferior wall, the systolic peak strain, systolic peak strain rate, the strain of end-systole in all segments of the operation group were lower than those of the other 2 groups (P < 0.05). The post-systolic strain index of the operation group was higher than that of the other 2 groups (P < 0.05).@*CONCLUSION@#Strain and strain rate imaging of echocardiography can quantitatively evaluate the changing of regional myocardial systolic function in the heart failure rat model induced by myocardial infarction, with good repeatability.