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Objective To analyze correlation between ultrasound features and clinical lab indexes of refractory secondary hyperparathyroidism (SHPT).Methods Two-dimensional ultrasound and CEUS were performed in 30 patients with refractory SHPT before operation.The sum volume of hyperplastic parathyroid glands and sum volume of enhanced area of parathyroid glands in each patient were measured and calculated.Clinical lab indexes,including serum intact parathyroid hormone (iPTH),serum calcium,serum phosphorus,serum alkaline phosphatase (ALP) were recorded,and corrected serum calcium and corrected serum calcium-phosphorus product were calculated 2 days before operation.The correlation between sum volume of parathyroid glands and lab indexes was analyzed.Results There were positive correlations (r=0.48,0.50,both P=0.01) between sum volume of parathyroid glands,sum volume of enhanced area of parathyroid glands and iPTH level.No correlation was found between the volume of hyperplastic parathyroid glands and serum calcium,serum phosphorus,ALP,corrected serum calcium,nor calcium-phosphorus product (all P＞0.05).Conclusion The sum volume of parathyroid can reflect active state of parathyroid glands,which is helpful to diagnosis and monitoring refractory SHPT.
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Objective To investigate the value of continuous renal replacement therapy (CRRT) coupled with minimally invasive ultrasound-guided percutaneous transhepatic gallbladder drainage (PTGD) for the treatment of severe acute biliary pancreatitis.Methods Hospitalized patients with severe acute biliary pancreatitis were recruited from the intensive care unit (ICU) of the Mfiliated Hospital of Qingdao University from June 2010 to June 2015,and divided into conventional CRRT alone group (n =30) and CRRT + PTGD group (n =30).Comparisons of postoperatively symptoms (time required for abdominal pain relief,time consumed for,gastrointestinal decompression),laboratory findings (WBC,PLT,PCT,CRP,AMS,TBIL,ALT,ALB,Lac) and acute physiology and chronic health evaluation score (APACHE Ⅱ,Balthazar CT,MODS) were carried out between two groups.The occurrence of complications (ARDS,abdominal infection,bile leakage,abdominal hemorrhage,intestinal injury,catheter translocation,catheter dislocation) was observed.The differences in duration of ventilator support,the length of stay in ICU,and fatality rate were compared between the two groups.Results Compared with the conventional CRRT alone group,the postoperative symptoms were significantly relieved,and time required for abdominal pain relief and time consumed for gastrointestinal decompression were evidently shortened in the CRRT + PTGD group (P ＜ 0.05).There were statistically significant differences in laboratory findings (WBC,PLT,PCT,CRP,AMS,TBIL,ALT) between two groups (P ＜ 0.05).The differences in APACHE Ⅱ,Balthazar CT and MODS score between the two groups also presented statistical significance (P ＜ 0.05).The comparisons of the duration of ventilator support [(6.1 ± 1.3) d vs.(9.5 ± 1.4) d] andthe length of stay [(15.7 ± 1.1) dvs.(21.1 ± 2.5) d] between thetwo groups revealed statistical significance (P ＜ 0.05).Conclusions CRRT coupled with PTGD for the treatment of severe acute biliary pancreatitis can effectively eliminate the inflammatory mediators and toxins from patients.On this basis,the coupled therapy with gallbladder puncture and drainage is capable of decompressing the biliary tract,improving liver function,effectively relieving clinical symptoms,minimizing the changes of laboratory findings an,d APACHE Ⅱ score,and thereby optimizing the prognosis of patients.
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Objective To provide valuable references for ultrasonic diagnosis of pelvic organ prolapsed (POP) by finding an eas ily detecting referential line based on MRI.Methods Data of 107 patients who underwent pelvic MRI were retrospectively analyzed.All the patients were divided into 6 groups according to age:Group 1 (20 29 years old),group 2 (30-39 years old),group 3 (40-49 years old),group 4 (50-59 years old),group 5 (60-69 years old) and group 6 (≥70 years old group).Four reference lines were set basing on the median sagittal view of T2WI:PS-PS line (the line connecting the two endpoint of the pubic symphysis),PIAS line (the line connecting the inferior margin of pubic symphysis and the bottom of sphincter internal anal sphincter),PPC line (the line connecting of the inferior margin of pubic symphysis and the point of the pubococcygeous attached on the rectum) and PM line (the line connecting of the inferior margin of pubic symphysis and the M point [the midpoint of the line from the crosspoint of PPC line and the front wall of the rectum mucosa to the bottom of sphincter internal anal sphincter]).The angles between the horizontal line and PS-PS line,PIAS line,PM line,PPC line (angle 1,angle 2,angle 3,angle 4) were measured,respectively.The differences of the angle among various age-groups were compared.The consistency between the two observes were evaluated.Results PM line was the closest line to the horizontal line.There was no statistical differences of angle 1,angle 2 and angle 3 among the 6 groups (all P＞0.05).The difference of angle 4 among the 6 groups were significant (F=3.42,P=0.01).Intergroup pairwise comparisons showed that significant differences were found between group 1 and group 4,group 5,group 6,between group 2 and group 4,group 5,group 6,between group 3 and group 4,group 5,group 6,respectively (all P＜0.05).And no significant difference was found in the other comparisons.The consistency of the two observers in meaning angle 1,angle 3 and angle 4 were good,but the consistency of angle 2 was poor.Conclusion Of all the referential lines,PM is the closest to the horizontal line and is less influenced by the patient's age.However,the feasibility of using PM lines as the ultrasound referential line is still unclear.
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Purpose To evaluate the diagnostic value of contrast-enhanced ultrasound (CEUS) in papillary thyroid carcinomas (PTC) by exploring the relationship between quantitative parameters of time-intensity curve (TIC) of CEUS for PTC and tumor size and metastasis of cervical lymph nodes.Materials and Methods 124 patients with PTC confirmed by surgery and pathology in the Affiliated Hospital of Qingdao University were retrospectively analyzed.According to maximum diameter of lesions (D),the lesions were divided into three groups with D＜1.0 cm,1.0 cm ≤ D ≤ 2.0 cm and D＞2.0 cm.The lesions were also divided into LN(+) group with lymph node metastasis and LN(-) group without lymph node metastasis based on pathology of cervical lymph nodes.The features of CEUS and quantitative parameters of TIC of the above groups were analyzed.Results ① The CEUS showed that the PTC nodules were mainly concentric and heterogeneous enhancement.Thyroid carcinoma with D＜1.0 cm and 1.0 cm≤D≤2.0 cm showed low enhancement (45/57,31/42),while thyroid carcinomas with D＞2.0 cm exhibited high enhancement (14/25),and the difference was significant (P＜0.05).① With the increase of the diameter of PTC,the peak intensity [(12.75 ± 3.77)％,(15.53 ± 3.62)％,(18.11 ± 4.28)％],the area under the curve [(820.52±289.19)％.s,(873.84± 156.19)％· s,(1118.8± 152.48)％ ·s] and the ratio of the perfusion defects (24.56％,52.38％,72.00％) were increased,and the differences were statistically significant (P＜0.05).③ The cervical lymph node metastasis rate of PTCs with isoenhancement or hyperenhancement patterns showed by CEUS was significantly higher than that with hypoenhancement (P＜0.05).The peak intensity and the area under the curve of LN (+) group were higher than that of LN (-) group,and the differences were statistically significant (P＜0.05).Conclusion There were significant differences in imaging features of CEUS between the PTC nodules with different size and lymph node metastasis,which can provide valuable information for clinical diagnosis.
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Objective To compare the clinical and sonographic characteristics of aggressive and nonaggressive papillary thyroid microcarcinomas(PTMC)in order to improve the preoperative predictive value of aggressive PTMC.Methods A total of 309 patients with PTMC from January 2014 to December 2016 were included in this study.Patients with lymphatic metastasis,extrathyroidal invasion,reccurence, distant metastasis and death were classified into aggressive PTMC group,and patients without above characteristics were classified into nonaggressive group.Clinical and sonographic features were reviewed and compared between the two groups.Results Among the 309 patients,76 cases(24.6%)were aggressive PTMC,and 233 cases(75.4%)were nonaggressive.Patients were younger and larger cancerous nodules, microcalcification,capsular inconnection and multifocality were seen more frequently in aggressive PTMC group compared with nonaggressive group.The best cut-off value of age and diameter were 44.5 years and 0.66 cm respectively.Advanced age was the protective factor and larger tumor size and multifocality were independent risk factors for PTMC aggressiveness.The capsular invasion was related with the lateral cervical lymph node metastasis while other features were not.Conclusions Extra attention should be paid to patients with age<44.5 years,tumor size>0.66 cm and multifocal cancerous nodules because their PTMCs are more likely to be aggressive.Thyroid capsule adjacent to the cancerous nodule should be observed carefully.If there is interruption in the capsule,lateral cervical lymph nodes should be carefully examed.
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Objective To explore the correlation between quantitative parameters of blood perfusion with contrast-enhanced ultrasound (CEUS) and microvessel density (MVD),microvessel area (MVA) in papillary thyroid carcinoma (PTC).And to investigate the value of CEUS in evaluating the angiogenesis in PTC before operation.Methods Totally 69 cases of patients with papillary thyroid carcinoma were selected from April 2014 to October 2016 in the Affiliated Hospital of Qingdao University.The CEUS characteristics of 69 patients with papillary thyroid carcinoma confirmed by pathology were retrospectively analyzed.The patients were divided into three groups according to maximum diameter of lesions (＜ 1 cm group,1-2 cm group and ＞ 2.0 cm group),and two groups according to pathologic reports (neck lymph node metastatic and nonmetastatic groups).The blood perfusion parameters between or among different groups were evaluated by ttest or one-way ANOVA.Immunohistochemical staining were performed to evaluate the MVD,MVA in the surgical specimens,and the correlation of quantitative parameters with MVD,MVA were assessed by Spearman.Results (1) Peak Intensity (Peak),area under the curve (AUC),MVD and MVA of thyroid carcinoma were lower than the surrounding normal thyroid tissue (14.95 ± 4.96 vs 22.67±6.11,970.01±263.20 vs 1798.35±563.67,118.91±31.32 vs 206.27±39.58,8.58±-2.68 vs 18.47±3.13),and the differences were statistically significant (t=-8.700,-11.061,-14.377 and-20.532,all P ＜ 0.05).(2)With the increase of the lesion's maximum diameter,Peak,AUC,MVD and MVA increased,and the differences were statistically significant (t=0.000,0.000,0.000,0.000;t=0.027,0.044,0.033,0.000;t=0.027,0.044,0.033,0.000,all P ＜ 0.05).(3) Papillary thyroid carcinoma with lymphatic involvement had significantly higher values of Peak,AUC,MVD and MVA than those without lymphatic involvement (16.86±4.36 vs 13.80±3.55,1128.16±290.85 vs 874.39±192.27,114.12±30.69 vs 103.67±22.19,10.30 ± 2.44 vs 7.54 ± 2.29),and the differences were statistically significant (t=3.177,4.366,6.336 and 4.742,all P ＜ 0.05).(4) A positive correlation existed between the Peak,AUC and MVD,and the differences were statistically significant (r=0.506,0.478,all P ＜0.05).Peak,AUC and MVA showed positive correlation,and the differences were statistically significant (r=0.648,0.653,all P ＜ 0.05).TP,MTT and MVD,MVA showed no correlations (all P ＞ 0.05).Conclusions The values of Peak and AUC calculated from CEUS were correlated to MVD and MVA.CEUS may be used to evaluated the angiogenesis of PTC before operation.And CEUS is helpful for prediction of prognosis of PTC.
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[Summary] Elastographic and contrast-enhanced ultrasonographic features were reviewed in 160 thyroid nodules co-existed with Hashimoto's thyroiditis. Significant differences in the elastography scores and enhancement pattern were found between malignant and benign thyroid nodules. For the differential diagnosis of benign and malignant thyroid nodules co-existed with Hashimoto's thyroiditis, the combined scores of elastography scores and contrast-enhanced ultrasound features may offer greater values.
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ObjectiveTo explore the relationship between serum markers and liver fat content predicted by hepatorenal ratio in type 2 diabetic mellitus (T2DM) patients.Methods A total of 120 T2DM patients were recruited from January 2011 to September 2012 in the Affi liated Hospital of Qingdao University. The sagittal liver-right kidney diagrams of the patients were obtained by two-dimensional ultrasonic examination, and the hepatorenal ratio were analyzed by NIHimage. Then, the related serum markers were tested 24 hours later. The relationship between hepatorenal ratio and serum markers was analyzed by Spearman rank correlation on the patients of T2DM. Then, the affective factors on the hepatorenal ratio were analysed by multivariate linear regression analysis, with hepatorenal ratio as dependent variable, and the concentration of triglyceride (TG,X1) , total cholesterol (TC,X2), high density lipoprotein cholesterol (HDL-C,X3), low density lipoprotein cholesterol (LDL-C,X4), alanine aminotransferase (ALT,X5), aspartateaminotransferase (AST,X6), glutamyltransferase (γ-GT,X7) , and alkaline phosphatase (ALP,X8) as independent variables. The receiver operating characteristic curve (ROC) was drawn to diagnose the point of the hepatorenal ratio when the TG began to increase (>1.92 mmol/L).Results There was positive correlation between hepatorenal ratio and TG, AST, ALT,γ-GT (r=0.420,P=0.000;r=0.383,P=0.000;r=0.309,P=0.001;r=0.253,P=0.005), while no correlation between hepatorenal ratio and glycosylated hemoglobin, TC, HDL-C, LDL-C, ALP or blood uric acid (BUA) (r=0.0.067,P=0.368;r=0.145,P=0.115;r=?-0.148,P=0.106;r=0.002,P=0.986;r=0.160,P=0.081;r=0.064,P=0.489) were found; the linear regression analysis showed that TG level (X1) was the only markers which had correlation with hepatorenal ratio in the T2MD patients with the regression equation ofY=1.245+0.062X. The ROC curve analysis showed that the optimal cutoff value for hepatorenal ratio to in diagnosinge increased TG (>1.92 mmol/L) was 1.236 in T2DM patients, and the area under the curve was 0.677. The sensitivity and specifi city were 86.7% and 45.3% respectively. Conclusions Hepatorenal ratio can be a reliable indicator to predict liver fat content, which has correlation with TG, ALT, AST andγ-GT. The increased TG level can refl ect the increasing fat content in the liver, and TG begin to increase when the hepatorenal ratio reach 1.236.
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Objective To evaluate the pelvic floor function in post-hysterectomy patients. Methods Transperineal pelvic ultrasound was used to observe the pelvic organs in post- hysterectomy patients, and parameters of pelvic floor were measured. Taking the inferior margin of public symphysis as the reference plane,the shape and motion of the proximal urethra and bladder neck were observed at rest and on maximum Valsalva maneuver. Bladder neck-symphyseal distance(BSD) and retrovesical angle were measured. And the bladder neck descent(BND),urethral rotation angle and the rotation angle of the bladder neck were also calculated. Interclass correlation coefficients were calculated to evaluate the consistency of data. Results At rest,the BSD and retrovesical angle were (-2.73±0.37)cm and (119.00±22.40)°, while on maximum Valsalva maneuver was (-0.25±0.67)cm and (114.74±21.50)°,respectively. BND was (2.46±0.59)cm,the urethral rotation angle and the rotation angle of the bladder neck was (70.68±19.91)° and (60.81±17.34) °,respectively. Combined with pelvic ultrasound and clinical manifestations,29 cases of pelvic floor dysfunction after hysterectomy were diagnosed (58.00%, 5 cases of stress urinary incontinence, 8 cases of proctoptoma and 16 cases of bladder prolapse). The consistency was very high in measuring BNS, retrovesical angle at rest and on maximum Valsalva maneuver and BND by different observers. The interclass coefficient was 0.90,0.89,0.91,0.88,0.92,respectively. And the interclass coefficient of urethral rotation angle and the rotation angle of the bladder neck was 0.79, 0.88,respectively. These results showed a good interobserver agreement. Conclusion Transperineal pelvic ultrasound is a simple,reproducible and noninvasive imaging method, which can reveal the position and function of female pelvic organ dynamically and evaluate postoperative pelvic floor function.